Straddling the Line of Comfort

(01/30-02/12) Community

A Challenge

It was an interesting ride during the third and fourth weeks of this rotation. I was now comfortable at my sites and with my preceptors, but I was pushed outside of my comfort zone as if I was straddling the line of comfort. I am now counseling initial patients. These patients are starting fresh and are coming for the first time to receive nutrition therapy. They’re relying on me to provide adequate education to meet their needs, and this comes with an uncomforting feeling.

My first initial patient was my biggest challenge. It was an older man that knew little to nothing about diabetes. I started from the ground up explaining what starches were and how carbohydrates affect blood glucose levels. He had a difficult time understanding what I was explaining. I had planned for a patient with a bit more knowledge but had to scratch that and begin with the basics. It was a challenge as I had to problem solve and explain the nutrition in the simplest way possible; but it was a great learning experience as my first initial patient.

Feedback

Having practiced with more initial visits there has been many opportunities for feedback. Some of the feedback my preceptors have given include:

· Slow down when giving descriptions.

· Ask the patient what foods they like.

· Interact more with the patient instead of just going through the education and recommendations.

· Do not overwhelm the patient by starting out with detailed information. Start more basic and then report back to the basic information with detailed explanations.

· Use more generalized, elementary level terms instead of higher level, scientific terminology.

I suggest taking notes of these to better improve your practice and performance with future patients.

Teaching

I had the opportunity to teach a section of a diabetes self-management group education class. It was a great moment to practice speaking in front of an audience and use scientific information to educate patients. The topic was on the diabetes disease process and the reactions taking place in the body when an individual has diabetes.

What is happening with diabetes is a progression in the decline of insulin production. Insulin is a hormone produced by the pancreas that allows glucose from carbohydrates to enter our cells and be used for energy. When an individual has diabetes, the cells in our body begin to become insulin resistant and it takes more time and more insulin to move glucose into the cells. The pancreas begins to produce less insulin and therefore, blood glucose begins to rise, causing diabetes or hyperglycemia (Association of Diabetes Care & Education Specialists [ADCES], 2021).

A second hormone, glucagon, is released by the pancreas and tells the liver to release glucose when blood sugar becomes too low. This bolus of glucose that is released is more than enough glucose needed and will spike sugars in the bloodstream, also leading to diabetes (ADCES, 2021). These are the reasons it is important for diabetics to stay on a consistent carbohydrate diet as mentioned in the previous blog in order to control blood sugar levels.

Community Assessment

One of the major assignments for this rotation is a community nutrition investigation. To complete this assignment, I had to assess a community given to me by my preceptors and identify the food availability and nutrition programs of this community. Because my preceptor does outreach in Jessamine County, Kentucky, she had me evaluate the area surrounding Lexington Clinic Nicholasville. I did TONS of research on the different food assistance programs, nutrition therapy, and education classes provided. I also mapped out the fast-food chains and other restaurants within this location. I completed an extensive NEMS assessment of the local Walmart, looking at the variety of nutritious options available and their pricing. Using all of this data, I was able to rate the Jessamine County community. I met CRDN 1.6 by incorporating critical thinking skills to give recommendations on how to better meet the needs of the people and their conditions.

Written by Brianna Starr, UK Dietetic Intern

References

Association of Diabetes Care & Education Specialists. (2021). Diabetes care and education curriculum. Chicago, IL: Author.