The patient as the teacher
I had a pretty great day today. I was exhausted because I was up last last night working on a school assignment and have to wake up very early for my current rotation, but I pushed through it and did my best. I'm so grateful to be training in a profession that invigorates me even when I am feeling so tired (well, most days) and that today was one of those days.
Patient assignments on my current ward of 53 patients are usually broken up between three nurses into groups of 18 or so. That doesn't leave time for much of anything outside of taking vital signs (manual BP cuff and pulse), performing a quick bedside assessment, administering meds, and performing any other necessary interventions like trach suctioning or tube feedings or wound dressings. Fortunately for me today, I only had one patient and had copious amounts of time to spend with him; he was here for a cardiac event and we had oodles of risk factors and behavior modifications to discuss. After taking his vital signs and performing my assessment, I asked if anybody had talked to him about how his diet can affect his condition, and what diet changes he can make to put him in a better position. He said no and I was caught off-guard so there are a lot of things I would have done differently like ask him what he eats in a usual day and explain to him what his dyslipidemia and prediabetes have anything to do with his diet and heart condition (things I will do tomorrow), but we did get to talk about what his ideal diet would look like.
I have been trying to lose weight on and off for some time now, and one of the most helpful things my diet doctor had to share with me was the idea of visualizing what my plate should look like at every meal, or averaged over meals - a quarter protein, a quarter grains, and the rest fruits and vegetables. This is based on the American ChooseMyPlate.gov dietary guidelines. (Fortunately for me, the Idaho Plate Method is also what is used in the Philippine Practice Guidelines on the Diagnosis and Management of Diabetes Mellitus.)
At the time of my conversation with the client, I didn't know what the guidelines were here so I told him about the plate and asked him to list some foods that he liked in each category. I was trying to show him on my hands what the plate might look like and it wasn't really making sense to him, so my instructor asked if they had an extra paper plate. I broke the plate down into the three sections and asked him to draw his favorite foods. We discussed options in each group, what is possible for him and his wife (who was there with him and joined into the discussion with us) and what options are better than others - chicken is better than beef, fish is better than pork, try to limit fried foods as much as possible, etc. He was so into it and I was not expecting that! He was hesitant to talk to me at all because he was not looking forward to having to speak in English with the foreigner, so I don't think he was expecting it either. But at the end of this conversation, he told me to come back later and we would talk more, and also told my preceptor in Tagalog how nice I am. (Cue sigh of relief.)
This experience was also a good reminder for me on why it is important to have recommendations that are tailored to each patient. The vegetable drawn second from the right is moringa (malunggay in Tagalog), immature seeds from the tree of the same name that are rich in nutrients and are prepared by boiling and preparing in sauce. I would have never thought to include this in his recommendations (I believe I have only heard of this a few times in reference to the medicinal properties of the leaves, I had no idea it was regularly eaten here) and he may have left wondering what to do about whether he can still eat malunggay - one of his favorite foods - and could have really disrupted his ability/motivation to make real changes in his diet. I, for one, know I have to be able to eat foods I like in order to keep me interested in a certain way of eating.
Patient assignments on my current ward of 53 patients are usually broken up between three nurses into groups of 18 or so. That doesn't leave time for much of anything outside of taking vital signs (manual BP cuff and pulse), performing a quick bedside assessment, administering meds, and performing any other necessary interventions like trach suctioning or tube feedings or wound dressings. Fortunately for me today, I only had one patient and had copious amounts of time to spend with him; he was here for a cardiac event and we had oodles of risk factors and behavior modifications to discuss. After taking his vital signs and performing my assessment, I asked if anybody had talked to him about how his diet can affect his condition, and what diet changes he can make to put him in a better position. He said no and I was caught off-guard so there are a lot of things I would have done differently like ask him what he eats in a usual day and explain to him what his dyslipidemia and prediabetes have anything to do with his diet and heart condition (things I will do tomorrow), but we did get to talk about what his ideal diet would look like.
I have been trying to lose weight on and off for some time now, and one of the most helpful things my diet doctor had to share with me was the idea of visualizing what my plate should look like at every meal, or averaged over meals - a quarter protein, a quarter grains, and the rest fruits and vegetables. This is based on the American ChooseMyPlate.gov dietary guidelines. (Fortunately for me, the Idaho Plate Method is also what is used in the Philippine Practice Guidelines on the Diagnosis and Management of Diabetes Mellitus.)
At the time of my conversation with the client, I didn't know what the guidelines were here so I told him about the plate and asked him to list some foods that he liked in each category. I was trying to show him on my hands what the plate might look like and it wasn't really making sense to him, so my instructor asked if they had an extra paper plate. I broke the plate down into the three sections and asked him to draw his favorite foods. We discussed options in each group, what is possible for him and his wife (who was there with him and joined into the discussion with us) and what options are better than others - chicken is better than beef, fish is better than pork, try to limit fried foods as much as possible, etc. He was so into it and I was not expecting that! He was hesitant to talk to me at all because he was not looking forward to having to speak in English with the foreigner, so I don't think he was expecting it either. But at the end of this conversation, he told me to come back later and we would talk more, and also told my preceptor in Tagalog how nice I am. (Cue sigh of relief.)
This experience was also a good reminder for me on why it is important to have recommendations that are tailored to each patient. The vegetable drawn second from the right is moringa (malunggay in Tagalog), immature seeds from the tree of the same name that are rich in nutrients and are prepared by boiling and preparing in sauce. I would have never thought to include this in his recommendations (I believe I have only heard of this a few times in reference to the medicinal properties of the leaves, I had no idea it was regularly eaten here) and he may have left wondering what to do about whether he can still eat malunggay - one of his favorite foods - and could have really disrupted his ability/motivation to make real changes in his diet. I, for one, know I have to be able to eat foods I like in order to keep me interested in a certain way of eating.
Lots of lessons learned from this interaction and it just goes to show that I may have an idea of where a conversation or assessment is going to go, but I can never really know until I'm there and the best thing I can do is just be open to what my patient is telling me and see how I can best use that information to support them in the changes they want to make for themselves.
So yes, an invigorating shift after a long night, but I also did go home and sleep for five hours after this shift. And back at it again tomorrow!
Please feel free to share a time when you had a care plan that ended up taking another direction, a time you had to be open to a different way of thinking about health management in order to support your client, or a time you had to get creative to provide patient education. I'd love to hear about your experiences!
So yes, an invigorating shift after a long night, but I also did go home and sleep for five hours after this shift. And back at it again tomorrow!
Please feel free to share a time when you had a care plan that ended up taking another direction, a time you had to be open to a different way of thinking about health management in order to support your client, or a time you had to get creative to provide patient education. I'd love to hear about your experiences!
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