Module 1
Introduction
Acute Care Site: Moses Taylor Hospital, Scranton PA
Moses Taylor Hospital is a 214-bed, acute care hospital with more than 400 physicians on staff and a commitment to providing quality health care that is patient- and community-focused. As Lackawanna County's first choice for labor and delivery, Moses Taylor is known for its pediatric and neonatal care and was the first hospital in the nation to earn Perinatal Care Certification by The Joint Commission.
Long Term Care Site: Birchwood Healthcare and Rehabilitation Center, Nanticoke PA
Birchwood is a 120-bed skilled care facility owned by Guardian Healthcare that is committed to round-the-clock skilled nursing and therapy services through coordinated routines, timely communication as well as a focus on the resident's family taking part in their care experience. A variety of services and staff members are available to encourage residents to reach their fullest potential, allowing them to return home sooner and safer. A few specialty services that were offered at Birchwood are physical therapy, speech therapy, occupational therapy, diabetes management, personalized nutrition evaluation and planning, dental care, optometry services, and more.
Module 2
Ethics & health promotion
Ethical Case Studies
Ethical Case Studies were completed during orientation at Marywood University from 6/24/18 - 6/26/18.
Health Promotion Project
My Health Promotion Project was implemented in December 2021 at Moses Taylor Hospital. I was given the task to create informational handouts for a table outside of the employee cafeteria. I chose to do my educational handouts on health around the holidays.
You can check them out below!
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Module 3
nutrition screening & assessment
Grand Round Meetings
Every day, the RDN at Moses Taylor Hospital and myself would attend an interprofessional grand round meeting with the other healthcare team members including, physicians, nursing, therapy, case management, and pharmacy. During the meetings, the care plan of every admitted patient was discussed and evaluated for effectiveness.
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In addition to grand round meetings, I did patient rounds to assess wounds, meal intake, and general nutrition status every day.
Nutrition Care Process Documentation
At Moses Taylor Hospital, all documentation of the Nutrition Care Process was entered into an electronic medical record (EMR) for each patient. The program used at MTH was Cerner.
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Every patient encounter was basis to write a progress note. The notes were usually labeled as initial assessments, malnutrition screening, malnutrition indicators, education, or follow-up notes.
Swallow Evaluation
Accurate identification and management of patients at risk for oropharyngeal dysphagia is important to decrease morbidity and complications related to food texture and viscosity.
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Videofluoroscopy and endoscopic assessment of swallowing generally are considered the two best instrumental tools for examination of individuals at risk for oropharyngeal dysphagia.
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Below are examples of the swallow studies I was able to review with the Speech Language Pathologist (SLP).
Module 4
case study: diabetic ketoacidosis
Grand Round Meetings
I completed my clinical case study on one of critical care patients in the ICU who came to the ER disoriented, nauseous, and with a blood glucose level of 911 mg/dL. She was immediately ventilated, intubated, and admitted to the ICU. The next steps of her care process are explained in my presentation below.
Module 5
education & counseling
Group Education
Group Education for patients was unfortunately not an option for me during my time at Moses Taylor, however I had the opportunity to present my group education presentation to the nurses at Moses Taylor Hospital. I decided to teach them how to build a healthy, balanced, and satiating snack that promotes energy and cognitive function throughout the day. Below are the key points I highlighted to include while building a snack.
1. Slow-digesting Carbohydrates, or whole grain products rich in fiber such as fruits and vegetables, legumes, quinoa, rice or sprouted grain crackers, etc.
2. Healthy Fats such as legumes, seeds and nuts, avocado, high-protein dairy, etc.
3. Protein such as dairy products, eggs, lean meats, legumes, seeds and nuts, seed and nut spreads, etc.
Below you can view my lesson plan and preceptor evaluation of the group education.
Motivational Interviewing
At Moses Taylor Hospital, the RDNs provided inpatient and outpatient nutrition counseling. Many of our outpatient counseling sessions were targeted towards pregnant women who were struggling to meet calorie needs, lacked nutrition-related knowledge, or were recently diagnosed with gestational diabetes (GDM).
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I found my experiences with motivational interviewing to be very helpful in improving my communication skills with patients. It was also rewarding to encourage patients to adopt healthy eating habits and seeing their "light bulb" moments when I'd explain a concept they didn't previously understand.
Below is my preceptor evaluation form for motivational interviewing.
Module 6
Long term care & pediatrics
Pediatrics
I completed my pediatrics rotation at Nemours Children's Hospital in Delaware. ​
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Nemours Children’s is one of the largest integrated pediatric health systems in the country. Everything — medical care, research, education, and prevention and advocacy efforts — is focused on kids.
Nemours goal is to help children, everywhere, grow into healthy adults. Nemours believes that health involves education, food, housing, family stability, emotional well-being, equity, justice and more.
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I thoroughly enjoyed my time at Nemours and fell in love with pediatrics during this rotation. I had the opportunity to shadow multiple dietitians, all with a different specialty, throughout the rotation. Examples of areas of nutrition I experienced at Nemours are:
-bariatrics
-eating disorders
-weight management
-new-onset diabetes
-epilepsy/ketogenic diets
-cystic fibrosis
-autism and developmental disorders
-NICU
Long Term Care
I completed my long term care rotation at Birchwood.
Birchwood is a 120-bed skilled care facility owned by Guardian Healthcare that is committed to round-the-clock skilled nursing and therapy services through coordinated routines, timely communication as well as a focus on the resident's family taking part in their care experience. A variety of services and staff members are available to encourage residents to reach their fullest potential, allowing them to return home sooner and safer. A few specialty services that were offered at Birchwood are physical therapy, speech therapy, occupational therapy, diabetes management, personalized nutrition evaluation and planning, dental care, optometry services, and more. ​
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State Inspection Results
My preceptor allowed me to review the most recent state inspection results during my rotation. The main problem that was related to nutrition was due to a patient that lost his dentures during his stay at Birchwood. This was problematic because he could no longer properly chew his food and required a soft diet until he could be seen by a dentist and fitted for new dentures. The dietitian placed a referral to the dentist, as well as coordinated with the Speech Therapist to prescribe a soft-textured diet for the resident. Additionally, the facility developed a corrective action plan to prevent this from happening in the future.
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Understanding of MDS & CATs
The Long Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status which forms the foundation of the comprehensive assessment for all residents of long-term care facilities certified to participate in Medicare or Medicaid.
Certain single MDS items can trigger a care area. Some care areas are triggered by comparing responses entered on the previous MDS to the present MDS. Care area triggers (CAT) alert the assessors to potential problems/needs/strengths. The triggers also direct the assessor to conduct assessment activities. Triggered CAAs must be completed even if the same CAA triggered on the previous comprehensive MDS. ​​
Meal Rounds
It was a daily requirement at Birchwood to complete meal rounds. During meal rounds, I would go to patient rooms or common dining areas during lunch time to assess the needs of patients and document their intake. This was interesting and productive because this was also the time of the day that the SLP would complete their rounds, so there was a good amount of coordination. Documentation of intake was completed in the patients' EMR and usually quantified by a percentage of intake rather than calories. If a resident had poor appetite and intake, this was always documented. Any preferences were also updated during rounds. For example, if a patient didn't like corn, we would make a note of this in their chart and alert the kitchen. ​
Wound Rounds
I also conducted daily wound rounds where I would go see residents with pressure wounds or surgical wounds and assess how they're healing. Some residents were already taking supplements to promote wound healing, so I would also need to ask how they were tolerating their supplements during wound rounds. I had a younger resident who was diagnosed with Fornier's Gangrene and had extensive necrosis. I followed his care during my entire rotation and was able to see him be discharged to home. His case was extremely eye-opening on the topic of wound care, and it was a complicated case due to him having DMT2. We often provided nutrition education during wound rounds for this resident.
Morning Huddle
Morning huddles took place every day with the entire care team. Each resident was reviewed and their care plans were discussed in full detail to ensure that they were receiving the best care. Examples of these updated care plans can be found in my quarterly assessments. I participated in these meetings every day of my rotation.
Adaptive Eating Devices
I had the opportunity to review adaptive eating equipment with the dietitian and OTR during my time at Birchwood. Above are examples of the types of equipment that was used in their facility. During meal rounds, I observed the patients eating their meals with use of these devices.