I completed my Acute Care rotation for ND 568 at Grand View Hospital (GVH)

in Sellersville, Pennsylvania. At the hospital, there are three inpatient Dietitians

and one outpatient Dietitian who work at this location every day. There is one
additional outpatient Dietitian at a satellite office in Souderton, Pennsylvania and a
third outpatient Dietitian who manages the Healthy Beginnings program that
provides prenatal care to women with low incomes. I was unable to gain experience
working in the outpatient setting but gained a lot of knowledge from working
alongside the inpatient Dietitians. I spent nine weeks working towards completion
of ND 568 requirements and an additional four weeks to fulfill the ND 500
Professional Practice requirements.
During my first couple weeks I primarily spent shadowing the RD’s during
the charting of patients and counseling. Each week I gained a bit more
responsibility and built up to being completely independent throughout the day.
Once I started counseling patients the RD would shadow me and I initially began
providing nutrition education on a low sodium diet for Congestive Heart Failure
(CHF), the most frequent diagnosis at the hospital. Each time a new opportunity
arose for nutrition education on a diet (i.e. low fat diet, carbohydrate controlled diet
or low fiber diets) I would shadow the RD first to see how they would educate the
patient and key points to include, then educate the next patient who required the
same counseling. After about three weeks at GVH I was going to see a majority of
patients on my own. During the last three weeks of my ND 568 rotation I have been
independent in all aspects including counseling and providing education, calculating
tube feedings, initiating supplements or consulting with other professions regarding
patient care. At the end of the day, the Dietitians are required to cosign my notes
and provide feedback or point out any necessary corrections.
ICU rounds and Rehab meetings are both examples of interdisciplinary
meetings the RD’s attend on a daily and weekly basis respectively. ICU rounds start
at 9 am every morning to introduce new patients, review old patients and provide
the other team members with updates specific to your department. Nutrition is
relevant to these meetings because often times patients are intubated or require a
tube feed while in the ICU. It is our responsibility to calculate the patient’s
macronutrient and fluid needs and be able to make a tube feed recommendation.
Rehab meetings are less formal and require less input from the nutrition
department. The main focus on patients admitted to the rehab floor is their
progress with therapy however, on occasion, we have had patients who require a
bolus feed to meet their energy needs. I have found both interdisciplinary meetings
to be helpful to learn more about the patients, their needs and what the plan of care
is moving forward.
Home care visits were the one form of outpatient counseling experience I had
during this rotation. These visits are scheduled per referral from a patients Doctor,
the Clinical Nutrition Manager or per request from the patient themselves. You
never know what to expect before walking in to a home care visit and each one is
unique and different. I enjoyed this aspect of the job as it served as an opportunity
to help individuals who were actually interested in nutrition services and for the
most part were also motivated and ready to make changes. On average, the RD’s
attend 3-6 home care visits each month and I was able to accompany them during
my rotation.
Since the beginning of March, Diabetes Management classes have restarted. I
have been able to assist the RD, who is also a Certified Diabetes Educator, in running
and conducting classes each week. We have had three consistent participants who
are all extremely motivated and ready to make changes. Not only do I enjoy getting
out of the office and talking with these women, I have learned so much from them.
From being diagnosed with diabetes, medications, insulin therapy and diet control
to manage their diabetes there is always something new I am able to takeaway from
participating in these classes.
As previously mentioned, I gradually gained more responsibility and
independence during my ND 568 rotation. I now feel confident moving forward to
complete not only the ND 500 portion of my clinical rotation but also the end of the
internship practicing as an entry level Dietitian.