I love this!
My friends, and people I meet are always intrigued or excited when I tell them I’m a dietitian. I get responses like “Put me on a diet or Tell me what to eat”. I absolutely would not mind answering questions but counseling for friends is strictly prohibited in my book. Sometimes I prefer not to tell people my profession because I don’t want them to think I’ll judge them when we go out to eat. People usually think I eat super healthy (Fruits, Veggies, Whole Grains, etc) and I do most of the time, but I love all types of food. Yes, even food considered to be less healthy like junk food. I like to tell people I eat EVERYTHING, but I watch what I eat!
When I see a patient for the very first time, I always get the “you better not tell me what to eat” look. Patients get admitted to the nursing home most likely (not always) as a result of their poor dietary or lifestyle choices. The last thing they want is for someone in a white lab coat to tell them what they are doing wrong. I try to be as understanding as possible and ask a lot of questions to get to know the patient I’m working with. Building a good rapport is key. If the patient thinks I’m judgmental, then most likely I’ll be getting answers he or she thinks I want to hear (if any). Believe me, most people know what’s good for them. The important question is, why aren’t they doing it? What are the obstacles? Barriers?
Ideally, the first thing I do is to put myself in the patients shoes. Then I assess their willingness to change. So I ask from a scale of 1-10 how willing are you to change your lifestyle? My approach to counseling is determined by the patients answer. Lifestyle changes are not easy. Giving people a menu or diet to follow is only helpful short term. Proper nutrition counseling takes time. In order to help a patient, I need to know the whole story and the reasons behind why each patient does what he or she does. I usually try not to give advice but rather have the patients themselves come up with a plan that works best for them. If I could, I would like to spend around 1 hour with my patients per week privately in a nice office until I decide they don’t need me anymore.
In actuality, working in a short term nursing home, I spend about 15-30 minutes talking to each new patient for a quick nutritional assessment (if I could find them) in shared rooms with many interruptions, making sure patients are receiving the right foods and care during my meal rounds (if I’m lucky enough to have time), discussing patient progress with the team in care plan meetings (or sitting around auditing the same chart for the 3rd time this month), inputting food preferences in the computer, coordinating with food service for special dietary needs, reading nurses notes and finding physicians orders which may be located in 4 different locations on any given day and forever documenting in charts or filling out MDS’s. Oh yes and doing lots of calorie, protein, fluid, tube-feeding needs calculations.