Before I started my placement this summer, a lot of friends and family were asking me what I would be doing in my day-to-day and, to be honest, I wasn’t really sure myself. Dietetics is such a varied job that until I started I didn’t know which areas of dietetics practice I would be working in. In reality, it has been extremely varied, especially working in the community as I have been working with different specialist dietitians each day and in different areas of the borough. Therefore, I thought I would give you guys an update on what I’ve been getting up to over the last week.
For the past couple of weeks, I have been working with a diabetes education group on a Monday. It is a whole day event that works with groups of about 10 newly diagnosed Type 2 diabetics. The topics covered during the day include explaining what diabetes is, its complications and various medications used to control it as well as dietary and physical activity information. It’s run by a diabetes nurse and dietitian, with a lot of participant interaction throughout the day.
For the last two weeks, I have been delivering the physical activity section of the day. I invite the group to share their experiences of physical activity and exercise as well as giving advice on the government recommendations and how to overcome barriers. (You can read more about physical activity in some of my earlier blog posts here.)
This group session has given me the opportunity to work with people from very different backgrounds, with diabetes of varying severity and a multitude of challenges in their daily life. It’s also taught me that I can give group presentations without getting nervous and that I’m actually sometimes quite good at them.
Recently, I have been accompanying a malnutrition dietitian on home visits. This has potentially been the biggest learning curve for me so far. Many of the patients are receiving nutritional support through a feeding tube (either because they can’t eat anything at all or because they are not managing to eat enough to sustain them). I across plenty of patients in hospital with a feeding tube on my previous placement, but when you see people in their homes, it becomes apparent what the realities, and difficulties, of living long-term with a feeding tube are.
The feed amount must be carefully calculated by the dietitian based on an individual’s energy needs (which can be very different for each person). People may also often need help to attach the bags or bottles of feed to their feeding tubes, and this is where family, friends and carers come in to play. Each person will also be on a very individualised feeding plan. For example, one may be fed through their tube only overnight, giving them the opportunity to eat and carry out more normal daily activities during the day, whereas others may need to be fed for longer periods throughout the day. Another thing that dietitians must consider when working out someone’s feeding regimen is their medications, as some must be taken on an empty stomach, and others are not.
When the dietitian visits patients at home they often check people’s weight, their appetite, current diet (if they are able to eat anything), and how they’re getting on with the tube.
On Wednesdays, I have been sitting in on and taking part in a general dietetic clinic. Here we’ve seen people who have been referred to the dietitian by their GP for a variety of reasons, the majority of which have been weight loss, oral nutritional support and IBS (irritable bowel syndrome). It has been interesting to work with a variety of conditions and has given me the opportunity to work on my consultation skills.
I have been working as part of the adult mental health team on Thursdays, which so far has involved working with patients with dementia. Once dementia gets more progressive people often either forget to eat (so lose weight), or forget that they have already eaten (so gain too much weight). It often takes delicate management to help people with their diets, taking other lifestyle and health factors into account, as well as their dementia diagnosis.
So far, I have been working in paediatrics (with children) on Fridays. I have thoroughly enjoyed this, and learnt a lot about managing the diets of children with allergies or other health conditions. It has also been an eye-opener as I’ve realised that a consultation doesn’t always run smoothly when you are working with children! Being flexible and adapting to the child and their parents is essential. I’ve learnt to remember that you often need to factor in the whole family’s diet and lifestyle as no child ever wants to be singled out as different. However, something that the paediatric dietitians have reiterated is that you often get to work with families for a long time and see these children grow up.
I think that is one of the biggest things that I have enjoyed so far about working in the community – you often work with people for a long time, so are able to build a rapport with them, and really see their progression.
I hope this post has given you a little insight into my experiences so far as a student dietitian. I may update you guys again a bit later on in the summer to let you know how I’m getting on!
Hope you have a good week.