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Madeline McAndrew

Volunteering at the San Francisco Veterans Affairs Medical Center


April 20 2015-April 10 2016

While volunteering at the San Francisco Veterans Affairs Medical Center I experienced
an inside view of the clinical perspective of dietetics. I performed many volunteer duties which
exposed me to the many positions and responsibilities of diet technicians and dietitians. I
conducted thorough interviews with patients regarding their food preferences, food allergies,
pain levels, symptoms, and daily eating patterns as well as curtailing the tray to their specific
diets with consideration of dysphasia, aphasia and dental or dexterity issues. I made handouts for
patients based on different facets of education, partook in tray audits, produce raffles, clerical
work, and I participated in classes focused on educating veterans on nutrition, different foods,
and cooking. Interacting with veterans made me realize the value in taking care of the human
body, but also how short life is, and to make the most of the time you have. Talking with patients
who are lonely and contributing to bettering their stay at the hospital made me feel valuable.
Interviewing Skills
Interviewing patients helped me gain interpersonal communication skills and confidence.
As a new volunteer I was hesitant to interview patients; I was timid, quiet, and afraid to start
conversations. Performing repeat interviews with patients aided me in overcoming my shyness.
Interviewing became a regular occurrence and led me to become confident in my abilities. I am
grateful for the opportunities I was granted at the VA. I was given hands on experience
discussing pertinent information with patients; I was exposed to the hospitals patient screens and
directed towards the most important information, in addition to being educated on chronic
conditions facing the Elderly American population. I was also informed on preventative care and
management of chronic diseases, hospital conduct, as well as the community atmosphere in
which healthcare becomes a team effort for the benefit of the patients well-being.
Inquiring with patients at the VA expanded my development of many skills which
dietitians need in the field. After many lengthy interviewing sessions I learned to ask
supplemental questions regarding the patients nutritional status to investigate why the patient
was having certain issues which needed to be addressed. I would ask questions about physical
activity level and how often they participated in physical activity, what their activities of choice
were, and if they were familiar with the M.O.V.E. program at the VA. I would also ask questions
regarding their food preferences and if snacks in between meals were more beneficial than the
large meals three times daily. I tried my best to accommodate patients when possible but also let
them know the diet technicians would make the changes they saw fit.
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In addition to interviewing patients admitted to the hospital for diagnostics and


procedures I worked one on one with a patient in the Community Living Center who required a
specialized diet. He is a diabetic and on a renal diet. I would help him select meals for his renal
diet weekly. Throughout my experience I made my observations which were wonderful
regarding care and characteristics which could be changed. With this particular patient I saw his
intake of food decline due to the diet he was on. He complained to me many times about the
three week cyclic menu, how he was bored of it, and how items repeat for him every few days
due to his specific diet. I realized the food was having a negative impact on his quality of life; he
was losing weight, and seemed uninterested in eating. I pondered different solutions to aid him in
developing a better appetite. My first inclination was to bring the situation to the registered
dietitian in the Community Living Center. I suggested adding on to the three week cyclic menu
and that I would take responsibility of designing menu items. My suggestion was not regarded
for a few reasons which I had overlooked. The kitchen staff would have to adapt to a whole new
menu and the VA would need to order new food; basically, the costs would outweigh the benefits.
Still, I wanted to help this resident I would see weekly to eat more as well as enjoy his stay more.
I discussed liberalizing his diet as well, and looked into all the three week cyclic menus which
were printed out systematically to see which meals he could possibly add to his diet in order to
mix it up and provide more options. However the reason these items were not on his diet are
because of the renal diet restrictions. I spoke with his dietitian about liberalizing his diet and she
declined due to his twice a week outings where he ate whatever he wanted and as a result his
phosphorus levels skyrocketed. It seems unfortunate to me that the diet he is on is so restrictive it
makes him uninterested in food and then when given the opportunity to eat something else he
goes overboard. Perhaps if his diet was liberalized he would not feel the need to over eat the
foods his renal diet restricts because he would be satisfied. Another solution is to possibly give
the family members renal friendly recipes for when he goes away to solve the increase in
phosphorus levels when he is away. From my experience with this resident at the VA I have
gained much knowledge regarding the renal diet and negotiating, being creative, and problem
solving with patients, residents, and their family members.
Medical Nutrition Therapy Experience
By interviewing and reading through patient screens I learned about many chronic
diseases and the nutritional therapy which can manage the diseases. I also learned about alternate
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methods such as pharmaceuticals which are used in treatment. Topics which the diet technicians
educated me on were diabetes, congestive heart failure, hypertension, high cholesterol, and
wound healing after surgeries. One of the first pharmaceutical prescriptions I learned about was
Lasix- which prevents the body from absorbing too much salt, allowing the salt to instead be
passed through urine. This drug treats fluid retention in people with congestive heart failure or
high blood pressure. Patients with congestive heart failure or who need to lower their blood
pressure are given Lasix to make it easier for the heart to pump. This diuretic helps alleviate
edema and may be prescribed in addition to a giving a fluid restriction. Another subject I learned
a lot about at the VA is diabetes because it was very prevalent in the patients I interviewed. Many
patients have adult onset diabetes, a disorder of the metabolism, in which cells cannot take in
glucose it which results in it building up in the blood. I was educated on how to recognize a
diabetic through their A1C test, a blood test which shows the average blood sugar levels for the
past 2-3 months. The diagnostic for diabetes is an A1C level of 6.5% or higher. Throughout
volunteering at the VA I have come to learn about some of the treatment methods for diabetes.
Managing diabetes requires keeping close watch over blood sugar levels in addition to a
combination of medications, exercise, and diet. It is really important to minimize or avoid the
rapid changes in blood sugar levels. Diab-MNT and renal diets trays focus on the balancing of
carbohydrate dispersions throughout the day.
Likewise I was educated on medications which conflicted with foods and was given the
responsibility to provide discharging patients with handouts and information regarding the
conflictions. The nutrition intervention for a common medication, Warfarin (Coumadin), a blood
thinner, is to avoid vitamin K. Vitamin K is essential for chemical reactions inside the body
causing the formation of blood clots. Warfarin works by decreasing the activity of vitamin K;
lengthening the time it takes for a clot to form. To help Warfarin (Coumadin) work effectively, it
is important to keep your vitamin K intake as consistent as possible. Increasing intake of vitamin
K can decrease the effect of Warfarin while decreasing intake can increase the effect of Warfarin.
In addition to Warfarin, I was educated on food interactions with statins, cholesterol lowering
drugs, and distributed informative handouts to patients who needed information regarding the
food related interactions with grapefruit. I also produced an Excel spreadsheet which lists
common psychiatric drugs and food interactions while taking certain prescriptions as an
assignment from Marie. I completed a great deal of research regarding the interactions between
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certain pharmaceuticals and foods which helped me to construct a handout focused on


pharmaceutical prescriptions and food interactions.
Clerical Skills
In addition to the conversing with patients I became acclimated with the VAs archaic
computer system after volunteering in the nutrition office for a year. I performed calorie counts
for patients who were not eating enough and faced malnutrition, and conducted Brief Patient
Inquirys, which locate and verify patients room numbers as well as let the staff know if patients
have discharged. I also familiarized myself with the computer system through printing tray
tickets specific to patients diet which I would visit and ask how much of each meal they ate over
the course of their stay. Learning to navigate the VA data base was valuable when searching for
patients room numbers and their status, printing out tray tickets, and completing calorie counts.
Knowing the system which conveys all the information for the department of veteran affairs well
is beneficial because it helps to understand the various tasks a dietetic technician is responsible
for as well as assists in effectively accomplishing the assignments at hand.
After deciphering the VA system I became experienced with conducting calorie counts on
the VA computer system. I was given the task of completing a full week of calorie counts based
off of one weekly menu. For each food item in each meal of each day I searched the database for
the correct item and its caloric value in order to obtain the final caloric value of the meals, days,
and week of a specific diet at the VA. Encountering and completing a calorie count as large as
this one improved my proficiency at calorie counts, and made me more capable of navigating the
food search database at the VA because I had more knowledge surrounding the types of food and
their code names. Completing this series of calorie counts accelerated my performance on other
calorie counts I finalized for VA patients.
Volunteering at the Veterans Affairs Medical Center in San Francisco gave me experience
with many clerical skills needed in any office. Clerical tools I now possess regarding
organization are strategies when sorting through paperwork, filing important records, and
keeping files in the correct places. In addition I participated in many different activities such as
sending informative letters to veterans, folding informative brochures placed on patients trays
during mens health week with healthy food information on them, and putting together
informative packets for patients regarding nutrition information and handouts for discharging
after various procedures. I also have experience making reminder phone calls for nutrition
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classes which teach healthy cooking techniques to veterans, imputing data for calorie counts, and
going through files to remove discharged patients. I also participated in delivering informative
handouts to patients and performed investigative research for food resources in different regions
of the Bay area for patients. I can now implement these skills in other future experiences I have.
Volunteer Duties
Among the many volunteer duties I performed, tray audits and the produce raffles were
weekly responsibilities. I participated in tray audits for the administrative chief of the nutrition
department. In a hospital setting it is very important to ensure patients get the nutrition they need
based on their chronic conditions. As volunteers we conduct tray audits to detect whether or not
trays are making it to the patients with the correct criteria for their dietary needs. We go through
trays both in the kitchen and on the ward and check if the trays have all the essential items for the
specified diet. We then score the audit at the end. Many mistakes were found through auditing
trays due to the pace of the foodservice assembly line. I found more mistakes were discovered
when auditing on the ward rather than in the kitchen because the kitchen staff was aware of our
inspecting trays in the kitchen, whereas on the ward they were not.
The produce raffle is another responsibility of the volunteers. Involvement in
participating in raffling off the produce consists of a series of steps. The produce raffle held at
the VA is done to encourage healthy eating as well as to advertise and raise awareness of Terra
Firma Farms available produce, and to support local farming. We partnered up with different
volunteers and raffled off boxes of produce monthly for The Veteran Affairs employees. At the
lunch period around noon we would go to the cafeteria and ask employees if they wanted to sign
up for the produce raffle while showing off the produce the winner would be collecting. Many
employees were excited about entering the raffle and winning the produce. We had participants
fill out slips with their name and department extension for us to get a hold of the produce winner.
When a winner was selected we called their extension and they came to pick up the produce.
Spreading awareness of local farming in San Francisco and healthy eating habits reinforces the
importance of taking care of ones health as well as being environmentally sustainable when
selecting food. Terra Firma Farm drops of a produce box weekly at the VA for employees. Terra
Firma is a local certified organic farm which grows seasonal fruits and vegetables year round.
Terra Firma Farm focuses on sustainable farming and employment. Their farming practices
protect and build soil, conserve water and energy, and preserve wildlife. By dropping produce off
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at the VA for employees, Terra Firma Farm is providing fresh produce and nutrients as well as
educating the public regarding sustainable farming practices and the importance of organic
foods.
Over the course of the year while volunteering at the VA I was assigned to complete
many handouts pertaining to various nutrition department needs. I analyzed results of employee
surveys, crafted flyers for parties, formulated healthy snack options in a packet for psychiatric
patients, and constructed informative handouts for the veterans when being discharged. One
handout in particular which I fashioned is now given to veterans who are facing homelessness or
have a low income and turn to fast food frequently for their meals. This handout is titled The
Lesser Evils and discusses the least harmful items to buy at many fast food restaurants as well
as techniques to reduce calorie, sugar, sodium and fat intake. It is set up in table format and has
pictures of each fast food restaurant with the description of the menu items.
Another task I accomplished was computing survey results for the Health Promotion
Disease Prevention and Nutrition SF VA Employee Wellness Survey. A series of questions were
asked concerning wellness options for VA employees in a table format which employees ranked
how likely they would be interested in participating in the following options. The purpose of this
survey was to conclude which wellness programs or activities VA employees were most
interested in joining at work, or as a unit. The concept of the survey was to see how many
employees were interested in certain listed wellness topics and which topics could be
implemented for employees on premises. I tallied the results and made a comprehensive report
including all the percentages of each listed option and how likely employees would be to
participate in it.
In addition to computing survey results I conducted a survey on the patients in the
Community Living Center regarding a serving of vegetables on their entre. The collard greens
had been complained about by many patients when the three week cyclic menu presented them at
dinner. I volunteered to stay for the Community Living Centers dinner and asked patients about
their collard greens on both the ground floor and the first floor. Many patients on the first floor
are immobile and cannot self-feed, so it was difficult to obtain their opinions pertaining to the
greens. In addition many are on modified diets including purred and mechanical soft which
eliminated the textural component which was another complaint on its own. The nursing staff
who help feed and assist the patients in the community Living Center gave me essential feedback
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saying the greens never get eaten. They are always left on the plate and it is a shame we are
wasting the food. They also urged me to try it and see if I enjoyed it which I did and I definitely
understood why this menu option was disliked and rarely eaten. The patients on the ground floor
were easier to communicate with about the greens. Collectively many veterans thought the
greens were bland, difficult to consume due to the stringy and slimy texture, and unappealing due
to the appearance when plated. After gathering the information collected I created a table with
the results of the survey including the questions I had asked. After consideration and thought this
item was removed from the three week cyclic menu because it was unappealing and the
complaints from the majority of patients made it evident it was not a desired menu item.
Leadership Skills
After volunteering for a few months I was given the responsibility of training new
volunteers who began in the dietetics department. I began by giving the new volunteers a tour of
the hospital and the places in which we participated in different duties. I explained and
demonstrated how to complete tray audits and score them. I taught basic instructions for the
computer system and helped new volunteers get acclimated to the office routine and procedures
such as going through the daily folders and seeing patients which are due as well as going over
the key information needed by the diet technicians. I instructed new volunteers on how to
navigate the computer system, printing tray tickets, completing Brief Patient Inquiries, and
presented how the produce raffle is done. My biggest responsibility was to demonstrate my
interviewing techniques with patients. I would display my interviewing style to new volunteers
by performing several initial interviews on patients who were recently admitted. Through
demonstrating my interviewing skills I taught many volunteers how to go about approaching
patients in their rooms and what supplemental questions to ask when interviewing. I explained
how I follow the format of the interview sheet we are given and how to complete follow up
interviews as well.
Participating in Classes
I was also given the opportunity to sit in and help teach Maries class on the psychiatric
floor of the hospital. Many patients on this floor struggle with PTSD and mental disorders. The
class would focus on a nutrition topic which we would go over in detail, give handouts of, and
provide a sample of food as an example of the discussion topic. To prepare for the class I found
handouts regarding the topic. For example one day the topic was fiber and food labels. I found
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handouts regarding the importance of fiber in the diet and its benefits as well as how to read food
labels, what to look out for, and the importance of reading food labels to be informed on what
one is eating. Food prep was also included in class preparation. For the fiber and food labels
class I sliced nectarines and placed them in individual containers for the patients to sample. I also
made caprice salad with tomatoes, basil, and balsamic vinaigrette for the patients to try
something new which is very important to Marie, the diet technician who presides over the
psychiatric floor. By assisting Marie teach her class I discovered how fun and exciting it is to
educate others on nutrition and to show patients how to make better choices regarding foods. I
felt beneficial by finding information on a subject and collecting corresponding handouts to give
to patients which reinforced the information learned. I also felt positive about teaching veterans
about nutrition and encouraging healthy lifestyles. I am grateful to have gotten the opportunity to
experience sharing knowledge pertaining to nutrition with others and appreciative of Marie
demonstrating her teaching abilities.
In addition to experiencing and participating in Maries class, I was also able to
participate in Brandis classes. Brandi taught Cooking Matters sessions supported by 18 Reasons,
which educated veterans and their family members about different nutritional topics while
incorporating cooking skills and healthy recipes to reinforce the lesson plan. During Brandis
classes she would first give an informative and interactive lesson regarding different nutrition
topics, such as fiber, reading labels, the importance of protein, how to incorporate more fruits
and vegetables into daily routines, and what an actual serving of fruit and vegetables look like.
Then the cooking lesson would begin and the recipe would reinforce the topic discussed in the
lecture. I participated in the set-up of the classes as well as the initial food preparation including
washing the produce, sanitizing the food preparation tables, setting up place mats for all
participants, setting up the cooking areas with appropriate ingredients and the food preparation
areas with bowls for the prepared ingredients. Observing Brandi instruct the veterans during her
class instilled in me effective teaching methods and communication skills. She demonstrated
how beneficial her interactive questions are in reinforcing the lesson. By asking follow up
questions and for examples from her students as she lectured she exhibited a teaching strategy
which involved her students and encouraged their input. This method helped her students learn
the material while making connections to situations in daily life. I definitely learned to model her
behavior when teaching because involving students in the lecture is very valuable. It emphasizes
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and supports the lesson as well strengthens the students connection to the material. I am very
appreciative to have gotten the opportunity to participate in and observe these classes with the
veterans as well as learn from the instruction methods of Brandi and Marie.

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