Table of Contents
Module 1 - Introduction
My MNT rotation was completed through both long term care and acute care experiences. This portfolio is a culmination of months work, and I am proud to present it here. In the first module, I introduce you to my sites of supervised practice. Module 2 is a snapshot of my professional progress and health promotion efforts. Module 3 outlines the types of cases I was exposed to and provides a sampling of both complicated and uncomplicated cases. In Module 4, I present a patient case study. Motivational interviewing and educational projects are presented in Module 5. Pediatric and Long term care experiences are addressed in Module 6. Practice hours are posted at the bottom of the page. All text in green is a link to a resource, file, or related site.
Long Term Care site – Asbury Methodist Village, Wilson Healthcare Center, Gaithersburg, MD
The original Asbury was on the grounds of Rolling Acres dairy farm in Gaithersburg, MD. Today, it is a thriving and sophisticated senior living community as well as a major community partner.
For Nearly 100 years, Asbury has been part of the Montgomery County, Maryland community. With residents initially housed in what is now the administration building, the campus has grown to 134 acres in size. It is a large facility providing an array of ammenities for the residents. Asbury offers 24-hour skilled nursing services, speech, occupational, and physical therapy. Additionally, Asbury has 3 excellent on-site dietitians who worked with me for the duration of my virtual rotation. Flora Kessler, my preceptor, has been the Clinical Nutrition Manager at Asbury for nearly 21 years. I thank her and her staff for the rich experiences and continuous involvement afforded me during this rotation.
Acute Care Site – Howard University Hospital, Washington, D.C.
Howard University Hospital is a busy inner-city medical treatment center with a rich history.
Founded in 1862, Freedmen’s Hospital was the first Hospital of its kind to provide medical treatment to former slaves. Just six years later, the facility became a teaching Hospital for Howard University. It was not until 1967 that Freedmen’s Hospital officially merged with Howard University. In 1975, Howard University Hospital was moved to its current location at 2041 Georgia Ave, as pictured above.
Currently, Howard University Hospital is a designated DC Level 1 Trauma Center. A recent merger with Adventist Healthcare has brought with it a renewal effort spearheaded by energizing CEO Anita Adams Jenkins. A new 226-bed hospital construction is slated to open in 2026.
As an intern at HUH, I was exposed to a variety of cases which increased the depth and breadth of my competency in acute care. Dietitans at Howard have a critical role in patient outcomes and are respected by doctors and nursing staff for their expertise. Thank you to my preceptor Jennifer May, MS, RD, LDN, for her excellence in leadership throughout my acute care rotation at Howard. Additional thanks and appreciation to dietitians Bessie Udoumoh, Kimerra Rao, Sayeeda Habib, Patience Owunwanne, Vanessa King, and Shayna Frost for their guidance, feedback, and mentorship.
Module 2 - Ethics and Professional Development
Several ethical case studies were completed as part of my Marywood Internship orientation June 22nd to 26th, 2020. More were completed as part of my Alternative Practice Experiences, October 30th, 2020 to January 15th, 2021.
Professional development goals were set using Goal Wizard. These goals have continued to guide my internship experience choices and activities. Associated experiences are recorded in my updated Activity Log to track progress towards those goals.
On November 17th, I attended a Maryland Academy of Nutrition and Dietetics Board of Directors meeting which was held virtually. In the coming months
, I became part of MAND’s Member Spotlight Committee; I volunteered at the February 23rd, 2021 committee meeting to generate ideas on how to showcase the efforts of local dietitians.
Health promotion is an important part of professional development, and my interests often turn to diabetes education and heart health promotion. Although gatherings were not allowed as part of pandemic safety protocols, I created a simple Carb Clarity promotion designed to increase patient knowledge and empower informed menu selection for improved self-management of hypertension and diabetes. Geared toward newly diagnosed and existing diabetes patients, the packet below includes a simple quiz. This packet was prepared for future use due to the abbreviated length of the rotation. Outcomes may be quantified by the number of handouts used during patient education sessions.
Click the gallery to scroll through or download the packet here.
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- Carb Clarity
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- Hand and Plate Methods
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- Building a Plate
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- Low Sodium Selector
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- Test Your Knowledge
Module 3 - Nutritional Screening & Assessment
Fully vaccinated smiles at Howard University Hospital. From left to right: Lora Klüber, Kimerra Rao, Oganya Udenyi, Myself
The EMR used at Howard University Hospital is Soarian, although the hosptital may be switching EMRs in the near future. RDs have access to patient information, history, procedures, labs, progress, medications, diet orders, and more via this portal. RDs use this portal not only to retrieve and record data, but to communicate referrals to other professionals, document educations given to patients, and coordinate discharge planning.
Nutrition screening and assessment is a daily process after reviewing the census, and patient follow up is carefully managed. Patient load is prioritized according to level of required care and length of stay. Below are links to samples of some of the cases I worked on throughout this rotation. Click to view:
Module 4 - Case Study
I completed a case study while at Howard University Hospital, and I chose a complex case which intrigued me because of the young age of the patient and the severity of her condition. Due to uncontrolled Type 1 diabetes, she eventually developed chronic kidney disease leading to end stage renal disease. I presented to four experienced dietitians, two of whom are certified renal specialists, and I am grateful for their feedback.
Click to view my case study paper, presentation, and evaluations:
The 19-minute video presentation includes discussion of preceptor feedback.
Module 5 - Education and Counseling
Motivational Interviewing was completed during my Community rotation, and I have attached my preceptor feedback here.
I enjoy education of individuals and groups; during my acute rotation, the dietitians observing me noted that delivering education is one of my strengths. At Howard, I provided education to patients for various diagnoses including Type 2 diabetes, hypertension, portion control, acute pancreatitis, GERD, bariatic surgery, COPD, cancer, and others.
Included in this module is a group education provided to administrators at Asbury emphasizing the impact of vitamin supplementation in effort to reduce poor COVID-19 related outcomes in residents. The request from my preceptor was to create informative education she could distribute to administrators on behalf of the dietitians. For this reason, I created something well-researched and concise. The presentation was completed virtually.
Module 6 - Long Term Care & Pediatrics
Long Term Care
In long term care, positive state inspections and effective corrective action is a must. My preceptor provided recent state inspection results for me to view. To learn more about compliance, I also attended a Survey webinar during this rotation. Webinar Slides and participation certificate here.
Although my long term care rotation was virtual, I attended morning clinical meetings and weekly facility-wide COVID-19 meetings. I also attended a QAPI meeting, much of which was focused on obtaining accurate and reliable weights for patients. I was able to virtually review quarterly MDS as well as an annual. Additionally, I called patient rooms to do assessments and give education. In some cases, I made referrals to the social worker. I participated in care plans via phone. In a virtual rotation, I was unable to complete skin care rounds. However, I attended interdisciplinary meetings for wound care during my acute rotation.
While working with the dietitians at Asbury, I reviewed a Modified Barium Swallow report on December 15, 2020, as provided virtually by my preceptor. During the videofluoroscopy, the patient showed evidence of silent aspiration. His oral phase swallowing was slow to initiate, and pharangeal phase was impaired. When the patient coughed to clear his airway, he could not. Testing all thicknesses of liquids and solids, he showed residuals, despite using the chin tuck method to improve swallowing. Therefore, the recommendation was that he remain NPO. I also learned about recommended swallowing exercises such as the Masako Maneuver and Effortful Swallow. A sample swallow exercise card is shown below.
Pediatrics
In-depth interactive experiences in pediatrics were provided by dietitians at Childrens Hospital of Philadelphia. Topics included assessment, breastfeeding, growth chart plotting, nutrition support, review of formulas, weight management, IBD, PKU, malnutrition, and oncology. Pediatric case studies were completed in other topics including burns as part of my Alternative Practice Experiences, October 30th, 2020 to January 15th, 2021.
Hours Reporting
Extras
In addition to my other projects, I was able to have some fun by doing a menu collaboration with the chef at Asbury Methodist Village. He asked me to create Lunar New Year menu everyone could enjoy, would fit nutritional guidelines, and be culturally appropriate. I presented several nutritious and cost-effective recipes to him, and we decided on the following tasty and colorful menu. The menu was finalized in a meeting with the Food Service Director and Clinical Nutrition Manager; I gave input and introduced a flyer I created to promote the Lunar New Year meal. Chef James shared photos of his finished dishes. It was a hit!
