Dietetic Internship: Week 17 & A Final Recap

As I’m typing this, I am officially DONE with my clinical rotation portion of my dietetic internship! After spending a total of 15 weeks at the hospital (and other various sites), I completed over 600 hours of supervised practice and came in contact with over 200 patients and clients that presented with a number of different illnesses and conditions.

Aside from my “home base” at the hospital, I also spent a couple days at a weight management clinic, the cancer center, a dialysis clinic, and with the metabolic support team at the main hospital in Asheville. I saw patients with a number of conditions ranging from COPD exacerbation and respiratory failure, stroke, hip fractures, pancreatitis, cholecystitis, small bowel obstruction, various types of cancer, pneumonia, chronic kidney disease, substance abuse, Parkinson’s, dementia, heart failure, diabetes, hypertension, and rhabdomyolysis…just to name a few. I was able to watch multiples swallow studies, a metabolic cart study, a nasogastric tube placement, and both types of dialysis. I performed the Nutrition Care Process in the acute care setting, taught various nutrition education classes, conducted one on one appointments with patients, and designed or updated nutrition education handouts. I also conducted quality outcome measures, assisted in meal order and delivery, and witnessed what it was like to juggle the many different hats a dietitian has to wear when there’s only one dietitian at a facility.

My last week of rotations was November 30-December 4, and I spent the entirety of the week at the hospital that I was placed at for the majority of the 15 weeks. I’ll give a quick overview of what each day of my last week looked like (from what I can remember!), before recapping my clinical rotation as a whole. I still can’t believe it’s over!

Monday, November 30, 2015: Nothing too out of the ordinary….saw some patients in ICU and acute care, as well as followed-up with the few that were in our transitional care unit. I observed the dinner tray line assembly and delivery. We had done a test tray a couple weeks ago to determine areas of improvement (with food temperature, taste, presentation, timing, etc..), so we completed a follow-up test tray today to check for improvements. Other than that, it was a normal Monday! 

Tuesday, December 1, 2015: I gave my final clinical case study presentation to my preceptor and a small handful of the Cardiac Rehab staff!

As our final clinical rotation assignment, we were to follow a patient throughout their hospitalization and monitor their response to our nutrition care and intervention specific to their disease state or condition. We were required to give a 30 minute presentation on our patient, complete with a thorough literature review, overview of the disease state/condition, full discussion of the Nutrition Care Process performed, and rationale for making the decisions that we did.

Overall, I thought my presentation went well, much better than I expected, at least! There were definitely areas that needed some tweaking and improvement, but for the most part I was pleased with how it turned out. The patient that I decided to follow was a sweet little lady that had come in for hip surgery after suffering from a hip fracture. What typically is a relatively short hospital stay turned into over four months of complications – she was at the hospital longer than my whole rotation!!! I ultimately decided to follow her due to her consistently poor appetite and intake, history of Celiac Disease with limited food choices/preferences, and poor healing of her wound. 
Wednesday, December 2, 2015: I remember that this morning seemed crazy busy. Wednesday mornings are when we teach the Cardiac Rehab nutrition class, and since this was my last week at the hospital, I taught one last time! The focus this week was on fiber, and as a way to say “thank you” and show my appreciation to all of the participants, I brought little cuties to pass out at the end as a “source of fiber” 😉 The first class was absolutely PACKED. I think there was a total of 12 people, which was double what the usual attendance was! 

We also have a couple 25-minute one on one appointments with each participant in the program to discuss individual concerns and questions a bit deeper, and I was able to conduct both of those this morning as well. These visits typically focus on looking at lab results, decreasing saturated fat and cholesterol in the diet, managing diabetes, discussing weight loss efforts, and adopting a diet that focuses more on fruits, veggies and whole grains. 

Thursday, December 3, 2015: My second to last day at the hospital, and I was finally able to facilitate an outpatient appointment!!! We had seriously been planning on me taking the reigns in an outpatient appointment since about the beginning of November, but I’m not exaggerating when I say that every single time we had it all lined up, the client either didn’t show up or cancelled last minute! Better late than never though, right? Thankfully I had some prior experience with counseling and motivational interviewing from my time working as a WIC Nutritionist, however those appointments typically ranged from just 15 to 30 minutes compared to a full hour that this outpatient appointment was! 

Other than the outpatient appointment, Thursday went on as usual, following-up with a few patients in acute care, completing a malnutrition tracking log, and beginning to gather all of my final documents before my LAST DAY. 

Friday, December 4, 2015: LAST DAY, LAST  DAY, LAST DAY!!! As relieved as I was to see that I made it all the way through my 15 week clinical rotation, I was equal parts sad to leave at the end of the day. Today included following-up with every patient in the transitional care unit (all like, four of them), doing one last TCU initial assessment on a new patient fresh out of knee surgery, taking meal orders for lunch and dinner (we were short kitchen staff), and conducting a patient satisfaction survey/questionnaire to help determine food preferences for an upcoming revision of the menu. I actually really enjoyed going room to room to conduct the survey. The gist of it was to determine specific foods and meals that patients would and would not want to eat during a stay in the hospital. I’ve found that for many people food can be such a comforting and personal experience, as it can take us back to special events and memories from our past. I feel like I learned a little bit more about each patient that I visited while conducting this survey, as it was an opportunity to sit down and allow the patient to talk about what they enjoy. I mean, who doesn’t love to talk about something they enjoy??

Remember the patient I followed for my case study? Yeah well, she was still in the hospital on this Friday. I’ll admit that I might’ve taken a liiiittle bit more time taking her meal orders this morning, not only to make sure she was ordering foods she’d actually eat, but also to soak in the last little bit of time I had with her. After wishing her a speedy (remainder) of her recovery and dropping the news that it was my last day, she went on to thank me for all of the time and effort I’d spent making sure she was doing well and told me she loved me and would miss me…cue the waterworks. 

She wasn’t the only one that sent me off with such positive words of encouragement. During my 15 weeks there, I had numerous patients that took the time to not only learn more about what I was doing as a dietetic intern, but also willingly offered many words of affirmation, appreciation, and gratitude. 

As the day came to a close, I actually found myself sorta dreading 4:30. After filling out my final evaluation form and swapping little gifts with my awesome preceptor, it was time to go. I was fortunate enough to work with such a patient and understanding preceptor that inspired me to not only be a better (future) dietitian, but also a more fervent Follower of Christ. Between my preceptor, the gracious patients, and the welcoming staff, I had such a positive experience at the little hospital I was stationed at for the majority of my clinical rotations. I started my clinical rotations at the end of August feeling doubtful and insecure, but walked out on my final day of my 15 weeks with a much higher level of confidence in myself and my clinical practice. I’m sad to see this part of my internship come to a close, but am looking forward to even more opportunities to learn and grow as a nutrition professional in January as I begin my community rotation.  

Monday, December 7, 2015: Instead of reporting to the hospital, today was spent in class, with each intern presenting their final clinical case study as well as a quick “highlight reel” of their clinical rotation experiences. Our director made a really great white bean and kale soup with cornbread for lunch, but it was a loooong day – we were listening to presentations from 9 until 5:30! It was great to catch up with the other interns, as some of them don’t live as close by as others. After listening to the final presentation, we were officially DONE for a whole month!