Giving nutritional advice is not just telling the patient or client what to eat and not to eat. It is a lot about getting to know the person and meet them where they are at.
Melany Rivera
When I applied to go to Middle Tennessee State University, I did not realize the plethora of experience that I would be receiving. Currently, I am a senior in the Nutrition Food Science Dietetics program. Going to school and studying dietetics taught me many things related not only to food but also medical disease states and counseling skills. Of course, there are many other courses and topics that are interrelated with each other, but those listed previously stuck out to me the most. One assignment in particular put the knowledge I gained from the classes to the test. The objective of the assignment was to provide experience to give, receive, and observe medical nutrition therapy in fifteen minutes.
The class was split into groups of two. Each group was assigned a time to show up to the nursing building to provide a simulated clinical nutrition setting as much as possible. The catch was the roles, registered dietitian (RD) or patient, would not be assigned until right before the simulation started. Since the roles were unknown, my partner and I put together a word document containing all patient information provided by our case study book. The scenario for the simulation was as follows; the patient went for his physical checkup and the physician noted an enlarged liver and elevated liver enzyme and was subsequently diagnosed with nonalcoholic fatty liver disease (NAFLD). The case study book provided all information needed such as doctors’ notes and diagnosis and as well as laboratory results.
Since we were allowed one page of notes and one to two handouts, my partner and I decided to optimize the page with brief information and helpful resources to educate the patient. Although I knew the information, I was very nervous. My partner reassured me that I would be fine and that his gut was telling him that he would be the dietitian. Upon arriving at the building, the professor had two tiny pieces of paper with RD or patient on it within an envelope. Somehow, I was selected to chose the piece of paper. I reached into the envelope and selected the first paper, but my gut told me to switch to the other paper. As I slowly unfolded the paper, my heart was beating rapidly as I read the letters “RD” across the tiny paper. To set the scene, the main room contained two hospital beds and a dummy laying on one of the hospital beds. Next to this room was an area available to control the dummy; however, for the purpose of the simulation, we only needed the voice. A microphone placed in this room allowed the voice to be projected in the other room through the dummy that allowed my partner to simulate the patient. Once my partner was set in that room, that signaled the beginning of the simulation. I had to switch my thinking from dietetic student to future registered dietitian.
Upon knocking and entering the room, I introduced myself to the patient. Although I had my notes with me, I completely blanked on what I had to say next. I calmly took a breath and tried again. I briefly mentioned that the doctor had already explained the diagnosis to him, and that my role as a dietitian was to explain how food lifestyles contained an impact on the development and progression of NAFLD. Next, I went over important lab values that supported his diagnosis such as elevated ALT and AST levels, high cholesterol levels, and high triglycerides levels. Based on his usual dietary intake, there seemed to be a trend with foods that contained fat such as doughnuts, pastries, meats, fries, chips, pie, and cookies. As the patient asked questions, I was able to answer them to the best of my ability. Next on my to-do list was to introduce the possibility of incorporating aspects of the Mediterranean diet into his current diet. I made sure to ask the patient if he has heard of it and what he could tell me about it. While discussing the aspects of the diet, I decided to tell the patient about current dietary choices that are within this diet and how he can incorporate it more into his eating habits. During the session, I forgot to give the patient the handout of the Mediterranean diet, but I did give it to him at the end to take home. Since my time was running out, I quickly addressed how to incorporate exercise into his daily routine. Finally, I provided a recap on NAFLD, how food plays a role, and possible goals and lifestyle modifications that could be made to lessen the signs and symptoms of NAFLD. Compliance is one hundred percent expected.
In the beginning, I would describe myself as nervous and full of anxiety, but by the end I was a confident and knowledgeable dietitian. This simulation has taught me the importance of learning different disease states and how food can impact a person’s quality of life. Giving nutritional advice is not just telling the patient or client what to eat and not to eat. It is a lot about getting to know the person and meet them where they are at. After the simulation was over, I felt like I could do it again! It was nice to get experience on how it would be when I do go out into the crazy and unique world of registered dietitians.
