Tuesday, July 23, 2013

dietetic internship weeks 1-4: LTC

Every time I think I am settling into a routine, the rug is pulled out from under me. That's the funny thing about internship - you have little time to adjust. You are thrown into new situations at new places with new people and new expectations. It definitely keeps things interesting. 
I just find it SO much easier to stick to my goals (whether it be exercise, blogging, healthy eating, etc.) when I have a routine in place. I already know this is something I'm going to struggle with over the next year as I complete my internship. Maybe my routine will have to be adjusting to new routines ;)

Thanks for sticking by me. I really want to document this experience so I need to make the time.

My first rotation of my dietetic internship was at a long term care facility. Going in, I had no idea what to expect. I had prepared as much as I could by reading the Academy's position papers on older adults and reviewing some important topics (wound healing, dysphagia, etc.) But I couldn't shake the nervous feelings on my first day!

Looking back, I had no reason to be nervous. My site was wonderful and I enjoyed my time there so much. I was lucky enough to work with a great dietitian who really helped me find confidence in myself and my abilities as a [future] dietitian.

Most of my time here was spent performing assessments and charting - which I really enjoyed! As new residents were admitted to the facility we would perform initial nutrition assessments. We would also perform MDS assessments [14-day, quarterly, annual, and significant change] on current residents. 

To start, my preceptor introduced me to their computer system and showed me where they keep their paper charts and let me follow along as she performed an assessment. After that, I worked on my own! To perform an assessment we would gather information from the online chart and nursing notes, refer to the residents paper chart, talk to the resident, and ask nursing about their intake or supplement acceptance. We would often observe meal times as well. At first she was right there with me but by the second week, we would each be assessing separate residents. It felt really good to have that freedom while also knowing I could go to her with any questions. I felt very comfortable saying, "I'm not sure, about _____, could you help me?", but I also felt comfortable saying, "I think this intervention could work for ______." I can't believe how much I learned.


Here's what a typical day looked like for me during LTC and [What I Wore]:

Morning commute!
All staff meeting
Rounds with nursing, physical therapy, and social work
Perform MDS assessments, chart on new admissions, or calculate weight changes
Observe lunch or attend other meetings [each week there was a standards of care meeting and then there were care conferences throughout the week with residents families as well]
Continue charting, updating care plans, and MDS.


LTC Highlights:

- Signing my first note!
- Calculating a real life tube feeding and making adjustments based on cost and other factors that go beyond what you learn about TF from a textbook
- Observing a barium swallow study, seriously this was so cool
- Attending wound rounds. Such an eye-opening experience. It's one thing to read about a coccyx wound on a chart, it's something else entirely to see it. Really helps you recognize their need for PROTEIN and ENERGY!
- Seeing medicine really work for someone. One resident that I completed a case study on had an organ transplant and had severe edema. It was amazing to see this resident lose 25% of their weight [intentionally because of the fluid accumulation] with the help of diuretics and nutrition interventions.
- Attended the Older Adults Protein Needs webinar from Today's Dietitian


Other Assignments:

Along with internship, we also have classes to take. This summer we had one class for internship and another on healthcare management. The class for internship met once so that we could all discuss our different experiences. I liked catching up with my classmates and hearing what everyone else was up to. For this class we had two smaller assignments. One was to relate information from the Academy's position papers to interventions we were putting into place during internship. The other was the case study mentioned above. Basically we had to gather all the information we could about that resident and put it into a case study format with all of the pathophysiology of their condition along with recommendations for their future care. 

The healthcare management class is an online course. I don't love online classes - I like to hear a lecture on something and then go home to read and take notes so that I can make sense of the information. With this class, all the information is from reading. I have to really focus and go over things slowly to "get it" but I've truly enjoyed this class. It's taught me a lot about being a leader and managing other people through delegation. 


Phew! I apologize for such a long post but I really got to do and see a lot during those 4 short weeks. I hope this was interesting and helpful to you if you are currently a dietetic intern getting ready for LTC or if you are still completing your coursework before internship. 

If you have any questions for me, please leave a comment!

What was your experience in LTC like?

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