This week I finished my fourth week of food service/long-term care. Only two weeks of my dietetic internship left! To catch up with my previous experience in this rotation, check out:
DI: Week 32 – Starting Food Service
DI: Week 33 – Food Service and Long-term Care
DI: Week 34 – Halfway Through Food Service and Long-term Care
Here’s what my week looked like:
Monday:
I completed another quarterly nutrition assessment on a long-term care resident. This assessment was more emotionally challenging to complete since the resident is so young. She’s in her early 50’s and has early-onset dementia. Working in long-term care can be really emotionally taxing since you’re working with people with numerous medical conditions requiring specialized care. Some residents are expected to improve while others are only anticipated to continue to get worse. The resident I saw already had significant memory deficits which were only expected to continue to worsen with time. The only silver-lining of this experience for me was that she’s been eating well and her weight is stable. Physically, she’s very healthy, it’s just her mental health that’s failing her.
In our night class we learned about costing and sustainability in food service. A lot of our discussion was based around how to make changes that are sustainable both environmentally and financially. Each of us has to present an article at some point during the semester and my presentation was tonight. I presented an article on the impacts on plate waste when switching from a tray to a trayless delivery system.
Tuesday:
Today, we learned how to complete initial nutrition assessments for new residents. These assessments are more comprehensive, and require us to look up previous hospital records to get more of our information. Since this is our first nutrition encounter with the resident we also have to come up with initial nutrition recommendations. For the quarterly assessments we already have recommendations established and just update or change them as needed. It was pretty cool to come up with our own interventions based on the resident’s weight, medical, and diet history. The challenging part, however, is how little information we have on them, particularly with their weight history. Depending on the hospital, they may or may not have a detailed weight history in their medical chart. Some residents can also tell you about their weight history, while others can’t. This makes it challenging to know if they’re gaining or losing weight which would require further nutrition intervention. We have to do our best to get as complete of a picture of the resident as we can and then follow-up once they’ve been here for a few months.
Wednesday:
Our preceptor taught us how to use information from our initial assessments to complete the Minimum Data Set (MDS) and create a Care Area Assessment (CAA). Essentially, what happens is that we have to complete a nutrition assessment on a resident following our facility’s guidelines. After the assessment is completed we have to complete the MDS since our site is Medicaid/Medicare certified. If a resident triggers for a possible nutrition risk in the MDS we have to complete a CAA for them that further explains their possible nutrition risk factor. Sometimes a resident triggers for something that could be a problem, but isn’t. For example, the resident I completed an assessment on today has chewing issues that require him to be on a mechanically soft diet. His chewing difficulty could be a nutrition related problem, however, he is able to meet his needs just fine with a mechanically soft diet. If his chewing ability gets worse, however, this may become an actual problem in the future.
Thursday:
We each completed another nutrition assessment on a long-term care resident. There’s an average of 2-3 assessments that need to be completed per weekday. I have no idea how our preceptor manages to get everything done when she doesn’t have interns to help out! Not only is she a dietitian and thus in charge of resident nutrition assessments, but she’s also the food service manager. She has another dietitian come in to help with the residents most at nutrition risk like those on tube feedings or with severe malnutrition, but otherwise she’s on her own. Just the sheer number of things she’s responsible for is overwhelming!
Friday:
We closed off our week working on some planning for the special 4th of July meal. Today was also one of the days where we saw our preceptor for less than 5 minutes the whole day. She has so many other obligations that most of the time we have to self-direct. It works out fine since she’s always willing to help us if needed, it’s just different from what I’m used to.
Weekend:
My weekend was a little crazy trying to finish up as many assignments as possible. I’ll be driving to Minnesota for a wedding next weekend, so this is my last weekend to really get stuff finished! It’s never fun to spend the whole weekend in front of my computer, but it was very necessary this weekend.
Next week will be week 5 out of 6 of food service/long-term care. Friday after supervised practice I’ll be driving to Minnesota for a wedding on Saturday. Needless to say, the week is going to be pretty crazy! Until then!