SITE SUMMARY for: NHH Use for all sites (other than conferences and reading).

. Post to your portfolio within 7 days of completing work at the site. For Community sites, team leaders should submit the updated Site Book and Team Leader Report to their advisor at the same time.

Intern name: Claudia Gumina Rotation: Specialty Rotation dates from: 2/25/14 to: 3/14/14

Date: 4/1/14 Preceptor: Cindy Knipe Total hours: 80

1. Describe the projects and activities you completed during this experience. At the NHH, I was shadowing both dietetitians, Cathy and Patti. Initially, I got to observe them and inquire about the process while getting familiar with their systems. Later on, I got to perform my own assessments, come up with nutritional diagosis for the patients and design an intervention and a monitoring plan for them. I got to participate in different projects during National Nutrition Month, like Tea at 2, and Burrito Tuesday and observe how the patients interacted with the staff. I also got to develop a presentation on fiber for a group class called "Just for the Health of It," which was really fun and interactive. 2. What new knowledge was gained or new skills practiced? This rotation was my first practical exposure to clinical nutrition so it definitely helped me become more aquainted with the process and taught me how to assess a patient critically. Of more importance, because of the special population residing at NHH, I learned how to approach patients who are not even slightly interested in nutrition and make them consider what I have to say. Most of the patients at NHH had a lot of other things in their mind that they considered more relevant, but with the right approach, one could manage to get them involved in their dietetic care and figure out any nutrients that they were lacking. It was hard because some patients can get very temperamental but I think that mental illness is everywhere you go and as health professionals, it is our job to understand their needs. 3. Identify the roll of the nutrition professional at this site and discuss your interactions with the professionals and audience members at the site. The RD's at this site were in charge of developing a care plan for all patients who were admitted to NHH after they or the dietetic technician screened them. Whenever a patient was admitted, he or she would get screened and depending on their care level, the dietitian would follow -up with them during their stay. After they were screened, the dietitians interviewed the patients for a more complete assessment and then determined what had to be done. The dietitians were also in charge or communicating patients' preferences to the kitchen regarding likes/dislikes and allergies and designing meals for patients with special needs. 4. Were there regulations or rules at this site that were related to the Scope of Practice for Nutrition and Dietetics, or the Code of Ethics? At NHH, everyone had to be very sensitive to mental illness and avoid discrimination based on mental abilities. I had several experiences in which patients were quite offensive and I observed Cathy and Patti manage similar situations. It is hard to separate the patient from the person

currently screaming at you, but in that environment, one has to understand that their behavior id often beyond their control and be sensitive to their experiences. 5. What did you learn about the audience / population group? What did you learn about yourself? I learned that the patients' demeanor will change from one day to another and that the patient screaming at you one day, may be the sweetest one the next. Mental illness is like a roller coaster for these patients. They have ups and downs like everyone else, but more marked and intense.I learned that ultimately, they all want to control their conditions but have a very hard time. I learned that I can be very patient with this population, but more particularly, that I love working with teenagers. I got to work at the children's wing of the hospital often and it was always my favorite because the older kids were so receptive. 6. Describe how you were effective with this topic or with this group. What would you do differently in the future? I was effective because I made sure to understand their needs before going in and giving them advice on anything. In the future, if I were in a rotation like this, I would like to participate in more presentations and have better understanding of how the diet office works. 7. Summarize the ways that you applied wellness concepts and messages in this rotation. Discuss whether there were any opportunities to promote sustainable food choices or address sustainability from a food systems perspective. I applied wellness concepts though my counseling and presentation in this rotation, as well as through the different activities like Burrito Tuesday and Tea for Two. As I mentioned before, it is hard to get the patients here interested in nutrition, but sometimes after you talked to them, it gev them something to focus on. The patients were not at a space were they could make their dietary habits more sustainable, nor was there a time were I could advocate for more a more sustainable food service system.