Angelina Caradonna
Clinical:
During my clinical rotation I had exposure to a variety of health conditions throughout a wide age range. This consisted of long term care, in-patient & out-patient treatment, pediatric populations as well as specialized medicine, including eating disorders. Scroll below to read more information about these experiences.
My first clinical rotation was at Heartland of Dublin hospice care, where I was able to experience the role of a dietitian in a long term care facility. I worked alongside my preceptor to determine best treatment for the patients, based on their history and any newly developed complications. Across the board weight gain/stability was prioritized in the elderly population through higher kcal/kg calculations, with the majority meeting this through nutrition supplements. I also was introduced to the importance of the state presence in long term care, making sure to meet the guidelines and staying within the regulations.
An aspect I enjoyed about this environment was the collaborative approach, I got to sit in on meetings with all of the facility's health professional staff, each providing their specific expertise on the best care for each patient. Specifically, we worked with speech therapy on a couple patients. I also liked how
community was valued to support the mental health of the patients. For instance, everyday at lunch my preceptor and I would go around to patients' rooms and lead them to the dining hall. We would get their meals from the kitchens and distribute them, making sure the patients had what they wanted. I appreciated this hands-on approach to encourage the patients to eat, and the viewpoint that the social aspect of eating with other residents was important.
My next clinical rotation was at Nationwide Children's Hospital, where I got to split my time between the pulmonary clinic and the eating disorder clinic. At the pulmonary clinic I was exposed to their inpatient and outpatient pediatric care, where the majority of the patients I saw had genetic conditions. I appreciated the hands on role I was allotted as an intern. When considering a diagnosis, I worked with my preceptor look at the patient as a whole and what complications they present before determining their diagnosis and appropriate right of care. From my first week I was charting patients on my own and frequently met with the other health professionals (residents, RNPs, etc) to discuss nutrition care.
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At the eating disorder clinic, the patients ranged from pre-adolescence to adulthood. This was an out-patient care setting, and depending on the type of treatment the patient was receiving, were there everyday during daytime hours or attending appointments once a month. I participated in sessions where we ate meals with the patients, and educational seminars for the patients and their guardians. Part of this education was addressing the guardians' approach to food with their patient, this included a "caloric exchange" protocol. Click on the butterflies to the left to see recipes cards I made following this protocol.
The most fruitful aspect of this rotation was sitting in on the counseling sessions with the patients. I admired how the RDs were caring yet assertive when counseling. Whether that was dealing with the patient, their parents, or their circumstances surrounding the eating disorder. I think with my time at the eating disorder clinic I got to see the full power of motivational interviewing. I appreciated how their approaches were different depending on the patient, which I could tell was based on rapport that they were able to build with them. For instance I got to observe one RD using MI to help a patient she had been meeting with for 3 years, where they discussed for an hour her anxiety around food and how she would take steps to deal with that.
My final clinical rotation was at The Ohio State University Wexner Medical Center. I was able to work in The James, Ross Heart, and Doan Hospitals, allowing me to be exposed to those with a variety of chronic and acute conditions. This included cancer, transplant, dialysis, heart failure, gastroparesis, feeding tube malfunction, liver failure, pulmonary, gastric bypass, COVID, etc. While the exposure to a variety of patients allowed me learn about specific dietetic interventions, the unfortunate common denominator I saw was malnutrition. I became much more confident in my ability to diagnose malnutrition through the steps of The Adult Malnutrition Criteria, including the nutrition focused physical examination of muscle & fat loss, and fluid accumulation, as well as weight loss and energy intake.
At the start of this rotation I visited patients with my preceptor, she lead the discussion and recommended nutrition intervention, however after the first week I was confident to go see patients on my own and determined their nutritional needs based on my own judgement. As time went on my preceptor "held my hand" less and less, concluding my rotation only requiring her stamp of approval on my charting notes.
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Also during this time I learned how to advocate for my patients and validate my recommendations as a nutrition professional. For example, I spoke up for a patient who was receiving the wrong tube feed and experiencing adverse intolerance effects, even after other RDs had previously recommended a shift in their tube feed. My preceptor and I took the initiative to speak with the patient's nurse directly and was able to successfully change their tube feed to the proper one. I think out of all the rotations I grew the most in this one, as I truly learned the demands of a RD in a hospital position, and gained the confidence to fulfill them myself.
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Click on the icon below to see a nutrition assessment note I charted on a patient, as well as the methods for the nutritional plan of care.