SITE SUMMARY for: Concord Outpatient - Student Clinic Use for all sites (other than conferences and

d reading). Post to your portfolio within 7 days of completing work at the site. For Community sites, team leaders should submit the updated Site Book and Team Leader Report to their advisor at the same time.

Intern name: Claudia Gumina Date: 10/1/2014 Rotation: Community Preceptor: Laura Long th Rotation dates from: November 7 , 2013 to: December 19th, 2013 Total hours: 50

1. Describe the projects and activities you completed during this experience. During my time at the Concord Hospital Outpatient Clinic, I engaged in different counseling settings and taught some classes for kids and Cardiac Rehab Patients. I did some individual counseling with patients living with different conditions and coming from very different backgrounds, and observed Laura and Maureen (A CDE at the hospital) counsel. Emily and I also worked on updating some of the handouts that Laura used with her patients. During the second half of the day, we would always go work with Jan and call patients who had attended the S.M.A.R.T classes after having a cardiac episode. This was done for research purposes to study if the rate of patient readmission declined when there was a follow-up call and even though we were not at the point where we would see any results, it was very interesting. 2. What new knowledge was gained or new skills practiced? I had learned different counseling methods and techniques during my undergrad and it was great to observe them being applied in practice. I remember watching Laura reflect back to the clients in a way that increased their confidence in what they were doing and I think this was one of the most important things I learned. You may have all the knowledge in the world, but if you do not know how to convey it and transmit it, it is not gonna serve any purpose. Laura taught us to watch for nonverbal cues in a patient to understand their feelings and behavior in order to have a more efficient counseling session. During this rotation, I also learned to become more confident in my skills. I had never done one-on-one counseling before without being observed and because Laura gave us a lot of freedom, I was able to do this. I was nervous at the beginning and I am still nervous about situations in which I simply may not know what to say, but I learned to not overthink things when mistakes happen. 3. Identify the roll of the nutrition professional at this site and discuss your interactions with the professionals and audience members at the site. The role of the nutrition professional at this site was to counsel and provide support to clients when it came to nutrition. That said, it was evident that at this site, the nutrition professional also played the role of family counselor and therapist for many of the clients. Because food and the way people interact with it is often linked to emotion and family backgrounds, such topics would often become the focus of conversations when counseling a client about their diet. I think that as dietitians we are not often trained to counsel people in that area, but it is something that we cannot avoid since it is so closely linked to food. We could all benefit from some training in the field. I really enjoyed working with Laura because, as I mentioned earlier, she gave us freedom, but not so much that she didn't provide ant guidance. The audience member were all very different and it was

hard to know what to expect. They all seemed very receptive of the advice we had to give them and most of them did want to be there. 4. Were there regulations or rules at this site that were related to the Scope of Practice for Nutrition and Dietetics, or the Code of Ethics? Because of the population that we were dealing with, there were many instances in which we encountered patients who participated in some questionable activities and had some very detrimental habits. As health professionals, it was our duty to point them out, but to ultimately respect the patient's decision and consider his or her life situation. This concurs with principle 9 on the code of ethics, which states: "The dietetics professional treat clients and patients with respect and consideration." 5. What did you learn about the audience / population group? What did you learn about yourself? I learned that there are many shades to poverty. I think that before this, I had a more urban concept of poverty and now I know that poverty exists everywhere and in many different forms. I learned that there are many resources that I take for granted that people do no have access to and that I should not make any assumptions in this sense. I learned that stress and emotional circumstances are a big factor that affects the diets of people in this population. About myself, I learned that I tend to be very gullible when it comes to believing what a patient is saying. After many sessions, I would be confused when an overweight patient reported having a more-than-ideal diet and then I would realize how much they were keeping from Laura and me and be able to put the pieces together. I know that I need to learn to "dig beneath the surface" to be able to really understand a case. 6. Describe how you were effective with this topic or with this group. What would you do differently in the future? I think I was effective at counseling this group because I tried to use the counseling techniques I learned in class to make the clients feel as comfortable as possible during our session, but struggled because I let the clients go on tangentials and change the topic. I think that I need to be more asserive in the future and be able to direct the session the way I want it to go. 7. Summarize the ways that you applied wellness concepts and messages in this rotation. Discuss whether there were any opportunities to promote sustainable food choices or address sustainability from a food systems perspective. The best way to apply concepts of wellness in this rotation was by suggesting it to the clients that came to us. We always suggested clients switched from processed food options to more natural ones like going from chips to fruit and encouraged the consumption of whole grains. It was definitely a struggle sometimes because, often, more natural products are more expensive and this population cannot afford them. Because we were simply counseling, in terms of sustainability, we were not able to do much, but encourage clients to control their portions and not waste food.