Final Weeks at Food, Nutrition, and Wellness (DOA)

The last two weeks of my internship were at our Food, Nutrition, and Wellness. There were some projects to finish and presentations we had to give. The other intern and myself worked on an in-service for our division. We then presented the short power point to the whole department.

We spent a lot of time working and completing our research paper which we presented to the supervisors the last week of the internship. We also worked on the Florida School Breakfast week menu.

This internship was wonderful. It provided me with so many opportunities and I really feel well-rounded coming out of this program. I have learned to make the most of everything given to me and I feel as though I really did.

Thank you to Florida Department of Agriculture and Consumer Services, Division of Food, Nutrition, and Wellness as well as all the preceptors throughout the internship who helped me during this internship!

Florida Department of Health- CCFP Rotation

The last rotation was at the Department of Health's Child Care Food Programs. 

The Child Care Food Program and two related programs, the Afterschool Nutrition Program and the Homeless Children Nutrition Program, are administered by the Bureau of Child Care Food Programs. These programs provide nutritious meals and snacks to children through public-private partnerships with organizations committed to caring for children. All three programs are funded by the U.S. Department of Agriculture Food and Nutrition Service. http://www.doh.state.fl.us/ccfp/

We worked with the Nutrition sections while with this department and created a 4 week cycle menu. We also worked on a food safety online training for CCFP centers. We created three modules for the training and presented our work at the end of the rotation. We met with various staff in the department to learn what they did for the program.

It was a good learning experience and nice change of pace to end the internship.

TMH Diabetes Center Rotation

I worked at TMH's Diabetes center for one week. This was an outpatient setting. http://www.tmh.org/diabetes

The first day I came in and met my preceptor then sat in while she saw clients. I also sat in with the RN when she had clients. While with the RN, I sat in with clients who had Gestational Diabetes. That afternoon my preceptor and I saw a few pediatric patients. One pediatric patient was a new Type 1 patient. That evening I sat in on an Optifast class that the diabetes center offered. http://www.optifast.com/Pages/program.aspx

This center offers three diabetes education classes that are offered for adults who get a referral from their doctor. The second day of this rotation I attended the third diabetes education session then sat in with a dietitian all afternoon and saw clients. Tuesday evening I attended the second diabetes education session.

Wednesday I sat in on classes all day. I attended a Gestational Diabetes class in the morning followed by Diabetes Education Session 2 again. I sat in on class 2 again because I was able to teach part of it. It was a great experience to get up in front of the class and teach about food labels. After I taught the class I was able to sit in with a pediatric client with my preceptor.

Thursday I sat in on the center's case review with the endocrinologist, RN's and RD's. The rest of the morning I then sat with a dietitian and saw a few type 2 diabetes clients. That afternoon I sat with and RD who works for the Bariatric Center and saw a client who was focused on weight loss (no surgery). I stayed that night for another Optifast class that evening followed by a Diabetes Prevention Program class.

This rotation was a great experience and offered a lot of variety. It was really neat to work with so many different dietitians and see how they all council clients.  I also learned a lot from attending all the classes that were offered the week I was there.

Wakulla County Cooperative Extension Service, University of Florida

I was at Wakulla Cooperative Extension Office for two weeks.
Check out their website: http://wakulla.ifas.ufl.edu/

The Cooperative Extension Service is nationwide and was established by the Smith-Lever Act of 1914. It is a partnership between state land grant universities, the United States Department of Agriculture (USDA) and the county governments throughout the nation. All of these groups share in the planning, financing, and operation of extension programs. In Florida, the Cooperative Extension Service is administered by the University of Florida.

Wakulla County Commissioners provide support for local faculty, staff and facilities. The Wakulla County Cooperative Extension Service conducts research-based educational programs in Agriculture, Horticulture, Family & Consumer Sciences, marine interest, and 4-H Youth Development. Locally based advisory committees assure that programs are designed to meet community needs. Volunteer training is strongly emphasized in our programs to enable us to reach more of the county’s population.

These two weeks have been jammed packed with different events. The first day I attended a canning class to learn how to pressure can foods.

The next day I went to EFNEP nutrition lesson in a school. Later that day I went to an after school program where there was a guest speaker talking about electricity.

Wednesday I was not in the office as I had a makeup day for my renal rotation.

Thursday was a work from home day because my preceptor was out of the office.

Friday I attended a School Advisory Committee meeting. I found out that the extension services are now going to be promoting the USDA HealthierUS School Challenge program so we discussed this with the principle for a few minutes http://www.fns.usda.gov/tn/healthierus/.

The second week I worked on my article for a local news paper and also worked on my lesson plan that I would be giving later that week. Shelley and I then met with a farm to school coordinator and spoke about what needs to be done to get some schools into the HealthierUS School Challenge. Tuesday I was at the Tallahassee Children's Day at the Capital (separate post).

Wednesday April 10th, I went to see an EFNEP nutrition lesson in a kindergarten classroom. It was really cute how involved and excited the students were for the nutrition lesson. They learned about vegetables.

The rest of the day I prepped the food for my nutrition lesson. My lesson was given later that afternoon. I taught the nutrition lesson to elementary school students about protein and Florida Agriculture. We made salsa- a bean, tomato, and corn salsa, then a mango salsa.

Thursday I was with Shelley helping her in the kitchen. We prepared different foods for an herb workshop that evening.

Friday morning I finished my newspaper article about dehydration. I then attended an EFNEP quarterly discussion.

I really enjoyed this rotation so I managed to go back for a couple extra days. This might have been my favorite rotation.

Tallahassee Children's Day with the Florida Dairy Council

On Tuesday April 9th I worked with the Florida Dairy Council along with the Florida Dairy Farmers at the Tallahassee Children's Day at the Capital as part of Tallahassee's children's week http://www.childrensweek.org/ 

I arrived at 7:30 am to meet all new faces and just jump in and start serving breakfast bags. These breakfast bags were reusable 'breakfast bag' with a yoplait yogurt, a yogurt covered granola bar, a tangerine,  and a chocolate milk. Breakfast was suppose to be 8-10 am, however, most children did not come until after 10 am. We gave out over 1500 bags!!! Most of the bags were pre-made the day before and held in the dairy truck, but there were bags that needed to be made during the event. There was almost nothing left at the end of the event! 

 At 9 am, there were some students who came and sang, then we had a milk toast. The dairy council had been told the toast was going to be 4 people and six cups were brought, but there ended up being a few more without cups. There was the President of the Florida Dairy Farmers as well as some Legislators present for this milk toast.

 After we gave out all of the breakfast bags we gave out pencils. We all received free lunch- a sandwich from Nuke's. I was able to sit down with the Dairy Council employees and talk to them about working for the Dairy Council. There seems to be a lot of opportunities with them.

I worked mostly with Alyssa Greenstein, RD, LD/N, Senior Manager, Nutrition Affairs for DAIRY COUNCIL OF FLORIDA, a division of Florida Dairy Farmers. 

floridamilk.com

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twitter.com/floridamilk 

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Renal Rotation

Renal rotation was at DaVita, a world wide dialysis center (http://www.davita.com/) This rotation was only Monday, Wednesday, and Friday due to those being the days clinic is open.

The Tallahassee center offers dialysis in three shifts, 6 am, 11 am, and 5 pm. They are the only one around that offers 5 pm dialysis which is great for those persons still working and cannot come during the middle of the day. This center has 24 chairs total.

The first day I met with the RD and learned about the dialysis machine and the 'fake kidney'.

The second day of this rotation I was in Perry, Florida (about an hour drive) at another DaVita dialysis location. It was a much smaller clinic with only 12 chairs and two shifts.

The dietitian talked about the effects of cancer and dialysis and she showed me their charting program. We charted on some patients together. They use a point of care note, not nutrition care process so there's no PES (problem, etiology, signs/symptoms) statements. Their charting covers why the patient was seen, what education was given and what was spoken, as well as if goals were set, met, or not met. It's mostly a lot of box clicking with minimal writing. The RD does suggest putting in comments that will make you remember the patient at a later point in time if needed.

At dialysis, the lab values of concern are Albumin, PO4, K, Ca.

The first Friday was very interesting. I was back at the Tallahassee DaVita clinic, and saw some of the same patients from Monday. I was able to sit down with two of the patients and hear their story about dialysis and how they live with it and what it's like to be in kidney failure. These patients shared their stories and experiences.

It was interesting to know that if any DaVita patients travel, DaVita's are world wide- they can set up appointments while traveling and DaVita sets the appointments. DaVita can even schedule dialysis appointments around the world even if it's not a DaVita clinic.

The following Monday I was back in Perry, FL . It was kind of a crazy morning, the doctor was there for rounds on the patients. The interaction between the patients and the doctor was pretty neat. He checked almost every patient for fluid retention in their legs/abdomen. After rounds we met with the doctor to discuss bone mineral disease and see if the medications are enough or too much for the patients related to their calcium levels.

In Perry I made this lovely bulletin board (below)

Wednesday I was not at the rotation, I was at RD Legislature Day. (I have a separate post about this)

Friday I was back in Tallahassee and gave the patients reminders that 'big labs' were on Monday. Big Labs are when monthly labs are taken. I had to remind them to watch what they ate on Easter and to take extra binders if needed.

I went back to DaVita for my final day on Wednesday April 3rd as a make up day because I missed a day due to the Legislature Day. I went around to the patients and gave them their 'report card' for their monthly labs. Many people had high phosphorus lab values so I had to educate them on proper foods and to take binders.

RD Legislative Workshop Day

March 27th, 2013  was Florida Dietetic Association's  2013 Legislative Workshop held at the Leon County Extension Office, 615 Paul Russell Road, Tallahassee, FL 32301

Lauri Wright, PhD, RD, LD/N, Florida Dietetic Association (FDA) President, started off the legislative workshop by speaking about the legislative process and why it is important for Registered Dietitians to be involved in the process. Public policy is important for the protection of the health of the public as well as for insurance reimbursement and future legislation. FDA has their own Public Policy team consisting of 5 members: Julie Spiker- state policy representative, Jennifer Boutin- public policy coordinator, Sue Stemke- state regulatory specialist, Nadine Pazder- licensure liaison, and Dianne Van Treeck- reimbursement representative. There is no paid lobbyist for Florida Registered Dietitians.

Lauri Wright stressed the importance of dietitian advocacy by identifying and spreading the word about being a Licensed, Registered Dietitian. Lauri also went through specific tips for gaining influence in the legislature. She suggested getting to know your legislators, write, email, and visit them. Planting the seed is the beginning of the process for bills. The most important tip Lauri gave today was to be brief, clear, accurate, persuasive, timely, persistent, grateful, and polite when presenting your position and communicating with your legislators.  

In order to understand legislature, one must understand the basics as to how a bill becomes a law. First there is an idea formed by a citizen, group or legislator. A Representative must then decide that the idea should be a bill. A House Bill is then drafted and referred to a committee or subcommittee meeting and is reviewed for inclusion on an agenda. All bills must be read three times before being voted on.  A bill can ‘die’ in a council or committee, never being heard. It is the Chair of the committee or subcommittee who decided which bills should be heard. Next the bill is placed on a Special Order Calendar and is voted on prior to the house considering those bills on a specific legislative day. Once the bill has been introduced and read on the Special Order Calendar, it is explained, questions are answered about the bill and amendments are considered. This is the bill’s second reading. This process is then repeated for the bill, it is put on the Special Order Calendar and read for a third time, at which point, the bill is then voted on by the members of the House. Any bill not receiving a favorable vote ‘dies’ on the floor. If the bill is passed by the House, it is sent to Senate with a ‘message’. The Senate can vote to pass the bill without amendments and return the bill to the House, refer the bill to a committee for consideration, or defeat the bill on the Senate floor. The Senate may decide to further amend the bill and pass it. If this happens, the bill is returned to the House. At this point, the bill is in an ‘enrolled’ version and is sent to the Governor for consideration. The Governor has a specific time period to respond to the bill and may take one of three actions: Sign the bill into law, allow the bill to become law without his signature, or veto the bill. If the Governor vetoes the bill, the Legislature may override his/her veto by ⅔ vote of the Legislature during the next session.

Julie Harmon, RDN, LD/N, 2012-2013 FDA’s State Policy Representative showed how to find local representatives. Those interested in becoming part of the legislative process must become familiar with their elected officials, which may be done by visiting myfloridahouse.gov and searching for the representative for his/her geographic area. Julie also spoke about the key messages/current bills and leaders that Registered Dietitians and dietetic students are currently focused on within the legislative process.The following are current bills in the process of becoming approved that Registered Dietitians in the state of Florida have a specific interest in.

The Community Health Workers (HB 241 and SB 894) is aimed at improving the health care services of residents living in medically under served communities, including those in geographic areas with a shortage of health care professionals and those individuals without public or private health insurance and are at or below 185 percent of the federal poverty level.  This bill involves Community Health Workers who will serve as liaisons between health care services, social services and the under served community. Community Health Workers are trusted members of the community with an understanding of the community and the residents he or she serves. Their aim is to promote culturally appropriate education, including nutrition education, regarding preventive care and disease management. They also aim provide information regarding available resources, provide social support, assist residents during communication with health care providers and establish referral services and continuation of care. The Community Health Worker Task Force, established under the Department of Health, would provide administrative support and services to the task force. The task force would be established within a state college or university and will include 1 member of the Senate, 1 member of the House, 1 State official, 6 culturally and regionally diverse community health workers, and 3 representatives of the Florida Community Worker Coalition. The inclusion of a Registered/Licensed Dietitians or Dietetic Technician as part of the task force and in the training of Community Health Workers in topics surrounding nutrition education, disease prevention, and disease management is strongly encouraged. This bill has been approved by the house and is currently awaiting approval in the Senate.

The Physical Education in the Public Schools (HB 877 and SB 1144) aim is to revise the criteria to waiver physical education requirements for students in grades 6-8th. Registered Dietitians are in support of this bill because regular physical activity is an important factor in achieving and maintaining a healthy weight. Instilling healthy habits such as physical activity at a young age will positively affect children's health as they grow and develop. The Physical Education in the Public Schools bill will require school district boards to provide 150 minutes of physical education each week for students in grades K-5. This is equal to 30 minutes of physical activity per day during the school week. The bill also will require that 6-8th grade students be provided physical education for the equivalent of one class period per day for one semester each year. This equals 3 semesters of physical education in 3 school years. Exemptions from this requirement for 6-8th grade students are limited to the following criteria: The student is enrolled in a remedial course, the student’s parent has indicated in writing to the school principal or designee and thus been verified that this student is participating in physical activities outside of school that are greater than or equal to the mandated requirement, or a letter is submitted from a licensed physician specifying the health reason to and why the student should not participate in physical education.

The final topic discussed was the Patient Protection and Affordable Care Act (PPACA). This federal law is implemented through state and federal rule making and state legislation. It is referred to as the Acts. The goals of the Acts is to provide coverage for 32 million uninsured Americans, to improve affordability and stability of insurance for those who already have it, and to slow the growth of health care costs to reduce the federal budget deficit. This will be achieved in the hopes of health care’s shift from a current fee-for-service payment model to a preventive care and wellness model, a patient centered approach, and a reformed delivery system that includes more primary providers, medical homes and community based health centers. Registered Dietitians are identified as potential but not required providers. It is the goal of Registered Dietitians to be the required providers for disease prevention and chronic disease management.

After the legislative workshop, Nadine Pazder, FDA’s Licensure Liaison allowed us to shadow her around the Capitol Building. She showed us where to find our specific legislative officials. We followed her to her Senate Representative, Jack Latvala, though unable to set an appointment up with him today, we spoke with his Legislative Assistant, Jennifer Wilson. Nadine explained very briefly who we were and why we were there. There was a quick bullet point summary given to the assistant and explained why the bills are of importance from our perspective. We then went on to another Senator and repeated the process. Again, the Senator was out of office and we spoke with an assistant. Once we were finished we found the Calendar of the House of Representatives and the Calendar of the Senate and looked at the committee meetings occurring at that time.There was one committee meeting we were interested in, however this meeting was not in session at the designated time so we were unable to attend.

Overall, this was a great learning experience and really showed us how important it is to be involved with public policy.