a placement workbook - plymouth.ac.uk14 bsc (hons) dietetics – plymouth university a placement...

A Placement Workbook

Student Name........................................ Module Code DIET 406

2 BSc (Hons) Dietetics – Plymouth University A Placement Workbook

INTRODUCTION TO PLACEMENT A Placement A Placement A is designed to introduce the student to the work of a dietitian by observing working practices and undertaking practical exercises. It consists of: -

1 week of scheduled activities outside of the University 2 weeks on placement in the South West

SPECIFIC AIMS (LEARNING OUTCOMES) for A Placement: At the conclusion of the placement, the student should: Knowledge K1 Be familiar with the range of food products available to the general public

including major nutrient-modified foods and ready-prepared meals. K2 Be aware of how the use of nutrient-modified foods can influence the diet both

quantitatively and qualitatively. K3 Be able to demonstrate the ability to record, calculate and analyse individuals’

nutritional intake either by hand or by computer assisted analysis. K4 Appreciate the factors to be considered in all aspects of menu planning. K5 Appreciate the process of meal selection, service and delivery within an

institutional food production unit. K6 Be aware of the major health and safety issues within the working

environment. Communication C7 Have an understanding of the methods by which dietitians communicate with

other health professionals, patients and the general public. C8 Have experience of communicating with patients and healthcare

professionals. C9 Demonstrate an ability to talk with patients and healthcare professionals. Professional Practice P10 Be aware of the need to respect the point of view of patients and why it is

important to avoid discrimination. P11 Demonstrate the ability to maintain confidentiality. P12 Be able to explain the reason and need for the Statement of Conduct.


P13 Demonstrate professional appearance and behaviour. P14 Be able to identify those health professionals who work closely with a dietitian. P15 Be able to identify the key sources of patient information available to plan

dietetic care. P16 Demonstrate an interest in and a commitment to the work of dietitians.

Sections of this workbook have been adapted with permission from the Nottingham University placement

workbook


Assessment: Completion of this workbook will demonstrate that the required learning outcomes have been met. Failure to complete all sections of the workbook to an acceptable standard will result in failure of the placement. The A placement work consists of two sections, section A and Section B. Section A Section A of the workbook consists of learning outcomes K1- K4. Students are provided with 1 week of protected time outside of

scheduled lectures to complete activities relating to these learning outcomes.

The placement team will facilitate a review and reflection session,

following which the workbook will be submitted for review of section A. Workbooks will be returned to students to allow completion of remaining activities (section B) on placement

Section B Discussion and feedback on the evidence collected for the remaining learning outcomes, will occur during the 2 weeks of placement. The final review takes place at the end of the 2 weeks.

The placement educator will meet with the student to check all sections of the workbook have been completed and signed off and identify areas that may require further work on return to university. The placement educator will complete and sign the A placement review form and summary of learning outcomes with the student at the final review meeting.

During the 2-week placement you will be expected to: - 1. Complete Section B of the A placement workbook.

This process will enable you to collect together information and experiences to help inform future placements and to develop some basic dietetic skills.

2. Additional learning experiences

You may be offered the opportunity to visit other areas such as pharmacy to see PN feeds being made up, gastroscopy visits, swallow assessments, feeding clinics and passing of NG tubes etc. You will have the opportunity of speaking to lots of patients. Please make use of these opportunities as well as additional sessions with the dietitians and other health care professionals. These extra opportunities will ensure that you get the most out of your A placement experience.


End of Placement: The workbook will have been completed and the placement educator will have signed the relevant learning outcomes in the workbook and the following sections at the back of the workbook: -

The summary of learning outcomes which is completed and signed at the end of the A placement

The A placement review form which is completed with the placement educator and signed at the end of the placement.

The completed signed workbook along with the summary of learning outcomes and A placement review form are submitted to the university along with the ‘Summative Declaration Slip’ (found on the last page of this workbook), by the deadline given in the module hand book for DIET 406


Nutrition and Dietetic Care Process The following tables illustrate the Nutrition and Dietetic Care Process used by dietitians. You will need to refer to these when completing the following two sections of the workbook: -

Assessments

Communication Observations Nutrition and Dietetic Care Process

Communication

Start of consultation

Information gathering

Information provision

End of consultation

Establish rapport Set agenda

Addresses patients concerns / issues raised Appropriate language used (No jargon) Speaks clearly Offers opportunities for patient to ask questions

Provides information Check patients understanding Explore options Explores barriers to change Goal setting / decisions shared

Closes consultation Summarises decisions/goals Offers a review date if appropriate

Assessment Nutrition / dietetic diagnosis

Intervention Monitoring Evaluation Review

Anthropometry Problem – what are we going to change? Aetiology – what caused it to be a problem? Signs & symptoms – how do I know it’s a problem?

Dietetic management Patient specific goals implementation

Monitoring Evaluation Review

Biochemistry

Clinical /medical information

Dietetic (Nutritional information)

Environmental / Lifestyle / psychosocial


WORKBOOK

Please use the space provided in the text boxes to answer the questions.

Try to limit responses where possible to one or two concise sentences.

Section A

Learning Outcomes K1- K4


Knowledge K1 Be familiar with the range of food products available to the general public including major nutrient-modified foods and ready-prepared meals. Signature of assessor …………………… Date…………

Visit a supermarket and describe the energy content per standard portion (not per 100g) and cost per standard portion of the foods listed in the table?

Food Energy content per standard portion

Cost per standard portion

What is the energy difference between the two foods

Full- fat cheddar/ half fat cheddar

Crisps / low fat crisps

doughnut/ currant bun or teacake

Bread/ Nimble bread

Sausages/ low fat sausages

Ice cream/ frozen yoghurt

Fish in batter/ fish in breadcrumbs

Standard ready meal curry / healthy option ready meal curry

a) Would the ‘healthier options’ be of benefit for people trying to

lose weight?


b) For all foods listed above collect additional information on the following nutrients

Protein / CHO / Fat / Salt / Sugar per standard portion size and complete the table below: -

Food Protein (g)

CHO (g)

Fat (g)

Salt (g)

Sugar (g)

Standard Portion


c) Collect the same nutritional information on 3 other types of ready made meals, plus 3 other food items of your choice e.g. deserts and add to the table below.

Food Energy (Kcals)

Protein (g)

CHO (g)

Fat (g)

Salt (g)

Sugar (g)

Standard Portion size


Knowledge K2 Be aware of how the use of nutrient-modified foods can influence the diet both quantitatively and qualitatively. Signature of assessor………………………………………………. Date…………………………………………

Identify 3 named brands where the nutrients have been modified in each of the listed products.

Brand 1 Brand 2 Brand 3

Yoghurt

How is this modified?

What is the purpose of this modification?


Snack bars (chocolate/ cereal bars etc.)





Fat spreads




Squash drink




Milk




What effect does the modification have on the nutritional profile of the product and the cost? What is a functional food? List at least 3 functional foods you found in the supermarket and state their benefit to health. 1. 2. 3.


Knowledge K3 Be able to demonstrate the ability to record, calculate and analyse individuals’ nutritional intake either by hand or by computer assisted analysis

1. Using a food record chart or dietary recall from one of the following; a. Relative or friend b. Resident in a care home c. Student from another programme

Record what the individual eats and drinks over a 24-hour period.

2. Collate the information and analyse using computer-assisted analysis program,

or by hand using relevant food composition tables. For the following nutrients: -

Energy (Kcals)

Protein (g)

Carbohydrate (CHO) g

Fat (g)

(indicate percentage energy contribution from Protein, Fat and Carbohydrate)

Vitamin C (mg)

Iron (mg)

Calcium (mg)

Vitamin B12

3. Compare the nutrient values obtained to the DRV’s

Energy (kcals)

Fat (g)

Protein (g)

CHO (g)

Vitamin C (mg)

Iron (mg)

Calcium (mg)

Vitamin B12 (μg)

Calculated analysis

DRV’s


Signature of assessor ………………. Date ………………

a) Comment on the values obtained from your analysis.

b) Comment on the relevance of using DRV’s for people who are sick in hospital.


Knowledge K4 Appreciate the factors to be considered in all aspects of menu planning. Signature of assessor …………………… Date …………………..

List five factors to be considered when menu planning in an institutional setting such as a hospital or residential setting 1) 2) 3) 4) 5) If you can attend a local residential home, then select an example of a day’s menu including portion sizes for a patient or use the sample menu and associated materials provided on the DIET406 - MOODLE site.

1. Find out the budget allocation for meals and beverages to feed a patient for one week.

2. Compare this with an estimate for your own food and drink expenditure

(excluding alcohol).


Knowledge K4 Appreciate the factors to be considered in all aspects of menu planning. Signature of assessor …………………… Date …………………..

3. Assess the nutritional composition of a typical days intake from the menu using the suppliers nutritional composition data available on line, web link provided on DIET406 - MOODLE site.

Energy (kcals)

Fat (g)

Protein (g)

CHO (g)

Vitamin C (mg)

Iron (mg)

Calcium (mg)

Vitamin B12 (μg)

Calculated analysis

DRV’s For 75 year old female resident

4. Interpret your findings and the potential nutritional implications

5. Consider the challenges of a standard menu offering like this and how it could be individualised for a patient requiring additional nourishment 1. 2. 3. 4. 5.


Section B

Please use the space provided in the text boxes to answer the questions.

Try to limit responses where possible to one or two concise sentences.


Knowledge K5 Appreciate the process of meal selection, service and delivery within an Institutional food production unit.

Follow a patient/resident’s meal: - i) selection, ii) service and iii).delivery. Briefly describe what you see and reflect how this might effect a patient’s/ resident’s nutritional intake

1) Who gives out menus and assists patients in completing them?

2) When are the menus given out in relation to the meal that they are ordering?

3) What times are meals served?

4) Who is involved in the distribution of meals?

5) Who removes the patient’s meal tray?


Signature of assessor ……………….… Date…………..

6) How does the ward/home identify patients who need assistance with eating?

7) Once identified who assists the patient with eating?

8) Consider factors that may reduce patient’s food intake?

9) Give one example of how this might be addressed?

10) What options are available if a patient had missed a meal?

Any comments about your overall observations?


Knowledge K 6 Be aware of the major health and safety issues within the working environment. Signature of assessor ………………… Date…………

From your observations, list 6 health and safety issues that you have come across directly linked to the dietitians’ role. 1) 2) 3) 4) 5) 6)


Communication C8 Have experience of communicating with patients and healthcare professionals. Signature of assessor …………………… Date……………

Reflect on an interaction between yourself and a patient or a colleague Detail the positive aspects and record any difficulties you encountered. Outline how you could overcome these in the future.


Communication C7 Have an understanding of the methods by which dietitians communicate with other health professionals, patients and the general public. Signature of assessor …………………… Date……………

Observe the dietitian and list 3 methods of communication they use with patients and/or the general public. 1) 2) 3) Describe one successful communication between you and another individual. Consider why you think it was successful (it may help you to understand this if you reflect on another communication where you had difficulties) Observe an interaction between a dietitian and a colleague; describe the key points of the interaction. Amongst other issues consider ‘confidentiality’


Professional Practice P10 Be aware of the need to respect the point of view of patients and why it is important to avoid discrimination. Signature of assessor ................................ Date........................

From your experience list between four and six ways in which individuals can be discriminated against. 1) 2) 3) 4) 5) 6)


Professional Practice P12 Be able to explain the reason and need for the BDA Code of Professional Conduct (2008) Signature of assessor …………………. Date……………

List two points from the standards of conduct, performance and ethics and state how you have observed these being applied during your placement? 1) 2)


Professional Practice P13 Demonstrate professional appearance and behaviour Signature of assessor ……………… Date……………

Why are photo identity badges needed? Why is there a need for a Trust dress code, in particular in relation to patient care? List four personal qualities required by the professional dietitian: 1) 2) 3) 4)


Professional Practice P16 Demonstrates an interest and a commitment to the work of dietitians. Signature of assessor ………………….. Date ………………….

a) Describe how you have demonstrated an interest in and commitment to the work of a dietitian whilst on A Placement

b) Demonstrates punctuality on A placement and demonstrates ability to complete given workload (Work book) within the allocated time.


Communication Observations The following observation sheets will help you observe and identify communication skills/behaviours used by dietitians in a consultation and address learning outcomes C7 and P11. You need to complete at least 3 observation sheets Before you start your observations review the communication section of the Nutrition and Dietetic Care Process provided on page 5 of the workbook.


DIETETIC SHADOWING (covers learning outcomes C7, P11, ) Observation sheet 1 Type of patient/diet…………………………………………………………………… Observe the dietitian throughout the interview Try to concentrate on observing the dietitian in consultations. Look for what is said as well as techniques used by the dietitian. Try to comment on the following, ready for discussion later.

1. How did the dietitian start the consultation? What do you think was the reason for this?

2. What did the dietitian do to make the patient feel more at ease?

3. What information did the dietitian try to obtain from the patient?

4. Were there any difficulties in obtaining the information? How did the dietitian overcome these?

5. Did the dietitian manage to build up a rapport with the patient? If so how was this done?

6. How did the dietitian identify whether the patient was ready to make dietary changes?

7. Did the dietitian agree any targets or goals with the patient? How was it done? Record something you have learnt from observing the dietitian


Observation sheet 2 Type of patient / diet ………………………………………..……………………………… Observe the patient throughout the interview Concentrate on watching the patient in the interviews on the wards and in clinics. Watch how they participate in the consultation and how they react. Try to comment on the following ready for discussion later.

1. How was the interview started? Did the dietitian put the patient at ease? If so how was this achieved?

2. How did the patient seem when they were first met by the dietitian?

3. Can you describe any changes that occurred in the patient’s body language as the introduction took place and then as the interview progressed?

4. Do you think the patient understood the reason for being prescribed the diet? a) At the beginning of the interview? b) By end of interview?

5. Were targets or aims agreed with the patient? (were decisions/goals shared

with patient) Describe how this was done?

6. Do you think the patient was ready to make changes, if yes what made you think this?

7. How did the patient react to the follow up arrangements?

Record one thing you have learnt from observing patients


Observation sheet 3 Type of patient/diet………………………………………………………………………… Observe a new patient consultation. This interview may occur in the clinic or on the wards. Try to concentrate on the patient during the interview. Look at the different stages of the interview itself, what is said and done. Try to comment on the following ready for discussion later.

1. How did the interview start? (establish rapport and set agenda) What did the dietitian do and say? Why do you think this was said?

2. What was discussed next?

3. How important was it to take a diet history from the patient, explain why this was important? If a diet history was not taken explain why it was appropriate not to take a diet history for the patient seen.

4. What information was the dietitian trying to get from the diet history? (dietetic/Nutritional information)

5. What did the dietitian do after the diet history?

6. Was any written information given? Why do you think this is important?

7. How did the dietitian end the consultation?

8. How long did the consultation take? What did the dietitian spend the longest time doing?

Record something you have learnt from observing the dietitian


Observation sheet 4 Type of patient / diet …………………………………………………………………….. Observe a follow up consultation Try to concentrate on observing follow up consultations. Look at different stages of the consultation and what is said and done. Try to comment on the following ready for discussion later.

1. How did the interview start? What did the dietitian do and say? How did this differ from a consultation with a new patient?

2. How did the dietitian identify whether changes had been made by the patient?

3. What did the dietitian do next and what do you think were the reasons for this?

4. How did the dietitian end the consultation? Record something that you have learnt from observing the follow up consultation.


ASSESSMENTS For the following learning outcomes, we want you to focus on the data that needs to be collected for the assessment that is used to plan dietetic care. The core data required for assessment is listed in the Nutrition and Dietetic Care Process on page 5 under the heading assessments and below for your reference:- Nutrition and Dietetic Care Process

Assessment

Anthropometry

Biochemistry

Clinical /medical information

Dietetic (Nutritional information)

Environmental / Lifestyle / psychosocial


Professional Practice P15 Be able to identify the key sources of patient information available to plan dietetic care.

1. Collect as much documented information as you can to inform the ‘assessment’ A, B, C, D, E using medical or any other notes apart from dietetic record card for an identified patient. List collected information under the headings A, B, C, D, E

Anthropometry Biochemistry Clinical / medical information


Dietetic (nutritional information) Environmental / Lifestyle / Psychosocial


1) Look at how the medical notes are structured and state where you would get the following information from:

a) The date of admission

b) The patients past medical history

c) What drugs the patient is on

d) The patient’s weight, height and MUST score

e) The consultant’s assessment of the patient

f) The nurse’s assessment of the patient

g) The patient’s temperature

h) The patient’s fluid balance 2) Record any abbreviations that you come across and document what they stand

for


Signature of assessor ………………. Date ……………

3) List up to six pieces of information you need to use to plan dietetic care state how you would use this information and indicate where you might find this information (e.g. admission date; to identify how long the patient has been in hospital; found in admissions booklet)

1. 2. 3. 4. 5. 6.

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BSc (Hons) Dietetics – Plymouth University A Placement Workbook

Communication C9 Demonstrate an ability to talk with patients and healthcare professionals. Signature of assessor ………………. Date ……………

1. Under the supervision of a member of the team, initiate a conversation with a patient and collect additional information about their experiences in of food in hospital compared to their food at home.

Use the adapted communication model from the dietetic care process below to guide you (do not progress to giving advice)

2. Reflect on this conversation held with the patient and write a report on your

reflections 3. Clearly present your reflections of your conversation with the patient to an

appropriate group identified by your supervising dietitian

Start of consultation Information gathering

Establish rapport Set agenda

Appropriate language used (No jargon) Speaks clearly Offers opportunities for patient to ask questions

39


P11 Demonstrate the ability to maintain confidentiality Signature of assessor ………………. Date ………………

1. Demonstrated your ability to maintain confidentiality when presenting

your conversation to an appropriate group.

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Ward Worksheet (P14) Identify the different grades of nursing staff present on the ward and record their uniforms below:

Grade Uniform Role

Remember these uniforms may be different in another Trust

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Identify other personnel on the ward below:

Personnel Uniform Role

Rank these titles for doctors, listing the most senior doctor first. Registrar Consultant F1 F2

1. Who takes part in the ward round?

2. What time do drug rounds occur?

3. When do nursing shifts change over?

4. When are visitors allowed?

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When visiting other members of the inter-professional team try to find out.

1. What is the unique contribution of that profession to care of patients?

2. In which areas does their professional practice overlap with that of a dietitian?

3. Are there opportunities for joint working between other professions and dietetics?

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Appendices:

Summary of learning outcomes

Placement A review form

Safety and professional behaviour form

Summative declaration slip

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Summary of Learning Outcomes Achieved for Placement A (Workbook)

SECTION A

K1 Be familiar with the range of food products available to the general public

including major nutrient-modified foods and ready-prepared meals.

K2 Be aware of how the use of nutrient-modified foods can influence the diet both

quantitatively and qualitatively.

K3 Be able to demonstrate the ability to record, calculate and analyse individuals’

nutritional intake either by hand, or by computer assisted analysis.

K4 Appreciate the factors to be considered in all aspects of menu planning.

SECTION B

K5 Appreciate the process of meal selection, service and delivery within

an Institutional food production unit.

K6 Be aware of the major health and safety issues within the working environment.

C7 Have an understanding of the methods by which dietitians communicate with

other health professionals, patients and the general public.

C8 Have experience of communicating with patients and healthcare professionals.

C9 Demonstrate an ability to talk with patients and healthcare professionals.

P10 Be aware of the need to respect the point of view of patients and why it is

important to avoid discrimination.

P11 Demonstrate the ability to maintain confidentiality.

P12 Be able to explain the reason and need for the Statement of Conduct.

45


P13 Demonstrate professional appearance and behaviour.

P14 Be able to identify those health professionals who work closely with a dietitian.

P15 Be able to identify the key sources of patient information available to plan dietetic

care.

P16 Demonstrate an interest in and a commitment to the work of dietitians.

Name of Dietitian Signed (Dietitian) Date

46


Review of Placement A This review should be undertaken by you at the end of Placement A. You should discuss and agree the outcome of the review with your key worker/supervising dietitian and then compile the learning contract to be addressed on your return to Plymouth University. This completed signed form must be submitted to programme admin at PAHC by the stated hand in date indicated in the DEIT 115 module handbook.

Placement A Review

Name of Student

Signature of Student

Name of Dietitian

Signature of Dietitian

Location of Placement

Date From To

Number of Weeks Completed

Is there evidence to demonstrate that all the Placement A learning outcomes have been met? If not, please identify the omissions below:

Specific Aims Not Met: (refer to learning outcomes for A placement in portfolio)

47


You should identify any strengths or areas for improvement, using the evidence presented by the student to inform your comments, under the general headings of Knowledge, Communication and Professional Practice.

KNOWLEDGE Strengths: Areas for Improvement: Action Points:

COMMUNICATION Strengths: Areas for Improvement: Action Points:

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PROFESSIONAL PRACTICE Strengths: Areas for Improvement: Action Points:

Particular areas which need to be developed and have been agreed with your key worker/supervising dietitian, should be incorporated into a Learning Contract to be considered when you return to University

Learning Contract date

Learning Objectives to be achieved (what do I need to learn) Resources to support learning (how am I going to learn) Action Plan Progress/evaluation – dates Signed and Dated – student/tutor as appropriate

49


Safety and professional behaviour

Unsafe practice and/or violations of the Rules of Professional Conduct will normally cause the student to fail the placement. Records of warnings of unsafe practice or concerns about the professional behaviour of the student must be recorded below. Safety: Fails to apply knowledge of the departmental health and safety policy to specific patient groups /conditions. Is unaware of or disregards contraindications of treatment. Is unreliable in reporting and often fails to tell the educator about adverse findings and/or patient complaints. Persists in unsafe practice despite verbal instructions and/or warnings. Record of warnings given: Entries should be dated and signed by both the student and the educator.

Violation of Rules of Professional Conduct: Practises outside their safe scope of practice. Fails to respect the rights, dignity and individual sensibilities of their patients. Does not respect patient confidentiality. Fails to communicate and co-operate with other staff and/or criticises them in front of patients. Fails to report circumstances which may put patients or others at risk. Inappropriately advertises their services. Sells, supplies, endorses or promotes the sale of services or goods in ways which exploit the professional relationship with their patient. Fails to adhere at all times to personal and professional standards which reflect credit on the profession. Record of warnings given: Entries should be dated and signed by both the student and the ed

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Please use this slip to submit your completed A placement workbook to Program Admin.

Name

Registration No:

Module Code:

Programme:

Module Title

Cohort:

Module teacher/marker:

Submission deadline date:

Submission No:

1 2 3

COURSEWORK DECLARATION: This work was prepared entirely by me in accordance with the University of Plymouth Prevention of Academic Dishonesty Code of Practice. It also complies with guidelines on confidentiality and with the instructions issued by the Module Teacher.

Signed (Student):_____________________________________________ Date:_______________

Peninsula Allied Health Centre, Derriford Road, Plymouth, Devon, PL6 8BH

SUMMATIVE DECLARATION SLIP

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a placement workbook - plymouth.ac.uk14 bsc (hons) dietetics – plymouth university a placement...

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