1. Name: Alexandra Dagenais
2. Date of placement: 3/3/15
3. Placement site/description (urban, suburban, demographics, i.e. gender, age, race/ethnicity, etc)
 Charter Oak Health Center
o Urban
o Low socioeconomic
o Primarily Hispanic and black
o ~50% males 50% females
4. Site mentor: Lorie Reardon, Diane Bussolini
5. Language barriers
 During the Nutrition class there was no language barrier as everyone spoke English. When
tabling in Internal Medicine waiting room there was a language barrier. The majority of the
cliental spoke Spanish. We used a volunteer translator to help us communicate with the clients. I
think it’s important to be bilingual because it would be a richer interaction without a translator.
6. Describe the supervised prax placement/activity here. Please weave into your response the following:
A. Connections to the Nutrition Care Process
i. Assessment--- “food for thought”: what “issues” might your participants
have that make nutrition education (again, direct OR indirect) important; how
would nutr ed “fit” in well at the site, etc. Please LIST learning models and
stages of change models you are learning about in class and you decide
would apply to the demographic/group you are discussing in your reflection.
1. The cliental are overweight, have type 2 diabetes, and a knowledge
deficit. The participants of the nutrition lesson voluntarily sign up to
attend the class and 80% have previously met with the dietitians for
individualized diabetes consultation. Nutrition education is important
because they don’t have prior knowledge but have shown they are
open to change (contemplation stage) by attending consults with the
RD. Group classes can provide a support network while in the action
stage to prevent relapse. The classes can be part of social learning
theory and increase self-efficacy and learn from peers. I would apply
the IMB theory to the clients and nutrition education. The
information provided by the class along with motivation from
instructors and peers can impact their behavioral skills and spur
change.
2. Since the cliental were diabetic, overweight, had limited food access,
and a lack of nutrition knowledge, providing basic nutrition
knowledge can help them be more aware of their choices.
Additionally diabetes requires a regulated diet and awareness of
macronutrient content in food to help manage blood sugar. Since the
clients were visibly overweight, education on a balanced diet can be
a starting point to make them think about change moving into the
contemplation and preparation stages. (transtheoretical model)
ii. Diagnosis
1. Food and nutrition related knowledge deficit related to lack of prior
education as evidenced by skewed views on food and visually
overweight.
iii. Plan—
1. Direct nutrition education in both group and individual settings
would work best.
2. Individualized consultant on weight and diabetes
3. Supplemental group nutrition education on food groups,
carbohydrate counting, and meal preparation.
4. Provide handouts for at home guidance.
iv. Implementation
The day began with a tour of the facility with HR and discussing with the RD
and diabetes educator Diane. In the meeting with Diane I was able to gather
information on her education and prior experience. This was beneficial to
learn what professions are out there and to get advice and perspective from a
working RD.
Next I observed a diabetes education class. The class was led by an
outsourced CHES. He led the lesson (2nd in a series of classes) focused on
MyPlate to give the participants a basic understanding of the food groups and
daily recommendations. In addition to the lesson a chef made a trail mix for
the participants to try and had the participants briefly watch her prepare a
quiche. The program did not have proper time management. It ran over and
the food tasting was not properly weaved into the class. Additionally I felt
the instructor rushed when reviewing how to read nutrition labels and left
some participants overwhelmed and slightly confused.
We were told to just observe he class however I wish I spoke up quicker and
more often. I added my input when the instructor asked if we had something
to add but I think it would have been more enjoyable and a better learning
experience if we had been more involved. I do understand the problem with
this as he instructor was outsourced and not the RD we were working with.
After the class ended we ate lunch. After lunch we went to the Internal
Medicine waiting room and set up a table on sugar sweetened beverages and
flyers for the classes offered. During this hour and a half we talked with
Carlos the translator, some patients in the waiting room, and a health
promotion graduate student conducting research. The student provided
insight into the field. Lorie came down to talk with us about what we were
doing and her experience. After speaking with Lorie we packed up and left.
v. Evaluation/Modification
1. It was not our lesson to lead so we personally did not evaluate the
program. At the end of the lesson the participants filled out and
evaluation form. There were questions rating the experience 1-4 and
knowledge questions based on the lesson. This will provide feedback
as to what the participants liked and what to change. It will also
provide information in regards to whether the participants
understood the lesson.
2. Based on this lesson, if I were to lead the next lesson I would make a
few changes. I would change recipes to use less expensive
ingredients and ingredients the participants had at home and had
access to. An example of this would be not using Kashi cereal. I
would also give a more thorough presentation of food prep.
Additionally, I would try to better manage class time.
vi. Lessons learned
1. If I were leading the lesson I would try to acknowledge the
participants questions yet stay on task better. The instructor lost
some control in the middle of the lesson due to participant questions
and comments. It strayed off task and therefore changed the timeline
and flow of the lesson. I think my nutrition background and
experience would be a benefit to the program. The instructor was
knowledgeable however I believe stronger nutrition knowledge
would assist in the answering of participant questions. To improve
the lesson I would tie the snack and tasting into the lesson more
fluidly. To do this I would talk about why the trail mix contained the
ingredients it did (food groups, blood sugar, carbohydrate count).
Due to the low education level I would also show more preparation
of the quiche so that the recipe could be replicated at home and not
be seen as a daunting task. Additionally the participants were either
looking through handouts or writing a lot. In the future I would
handout the papers as we go so they are not distracted and put
important information on the handouts to minimize the writing and
possible incorrect information.
B. Competencies you addressed/met. Please list by the number and statement listed
in your syllabus. Also, please add what you did at this placement that would
qualify for having met the competency. (To format for my reading , it’s helpful
if you cut and paste the competency from your syllabus and then bullet below it
your activities that justify your having met the competency. The reflection
example will demonstrate this. Thanks much!)
CRD 2.5: Demonstrate active participation, teamwork and contributions in group
settings
CRD 2.10: Establish collaborative relationships with other health professionals and
support personnel to deliver effective nutrition services
I spoke up during the class and assisted the CHES instructor in answer questions
during the lesson.
C. Connections to class lecture notes
In Health Education and Behavior Interventions we talked about current health topics
and interventions. The motivational interviewing from class could be used in the
private consults to help the client make behavior change.
D. Last brief notes:
a. Acceptance of your presence at the site
I felt accepted at the site. Both dietitians were inviting, willing to talk, and wanting
the best experience for us. The instructor of the class asked for our input. The
participants appreciated our presence; they wanted to talk about their experiences and
recipes as well as asked questions. The volunteer translator was very appreciative of
us and enjoyed talking to us and helping us help the community during tabling.
b. Your perceived value and worth of the activities/lesson
I think the classes are of great importance. The people need to obtain basic nutrition
knowledge and information specifically related to their diabetes so they can make
educated choices. It is good supplemental knowledge to the one on one meetings with
the RD. An idea for a follow up class would be how to use the ingredients from
SNAP/foodshare/food pantry to make a few meals. The knowledge isn’t enough.
They need to have the ability to apply it and have confidence in their ability. You
can talk about MyPlate and balanced diet but if they don’t know how to create a meal
it’s of no use.in addition they have limited access therefore using foods they have
access to, to create the meal would be beneficial.
The tabling seemed less valuable. Not many people were interested in talking in the
waiting room. A simple message can get across but it would be better if we were
more similar to the target population- there would be less language barrier and the
clients would be more likely to talk and willing to listen to those they can relate to.
As the worth to me, as a student, I think it would have been more valuable if we
could sit in on an RD counseling session and see how they coordinate the programs
rather than observing a non-RD and tabling to advertise the events.
c. Site mentor perceived value and worth of the lesson /share any of their comments
I think both Lorie and Diane are valuable contacts. In talking to them I learned about
their journey, including education and prior experience to get the job. Both were
willing to answer questions for us.
d. Your comfort level at site
I felt comfortable in the nutrition education portion of CHOC. I felt like I could lead
the class if asked. I felt less comfortable tabling in the waiting room. The cliental
primarily spoke Spanish, thus needing a translator. I also felt out of place and that
people were less interesting in learning and more interesting in expressing their
opinion.
7. KEY POINT TO END:
After this experience I felt more competent working with minority populations. The experience helped to
be understanding with different populations. It required patience to slowly explain the nutrition
information and not judge participants for not knowing or thinking certain things. They live very different
lives and have different education levels which require modifications. We had to use handouts in Spanish
and English to accommodate the different languages. The RDs spoke about them not being able to speak
Spanish and asking for help. This taught me that it’s okay to not know something and just ask for help. As
an RD you don’t have to know everything. For example, Lorie didn’t have time to create and lead the
lesson so she outsourced.