A few days back, the Greater New York Dietetic Association (GNYDA) held their annual Health and Wellness Conference at the Cornell Campus of NY Presbyterian Hospital. The event featured updates on advances in critical care nutrition, motivational interviewing techniques and how to develop a nutrition communications business. I had the pleasure to attend this event so that I can share some insightful information I gathered during my time there.
Motivational interviewing requires engaging the client, focusing on a desired behavior change, evoking reasons why habits that need to be altered, and a plan of action. For this portion of the conference, Ms. Shelley Mesznick, MA, RD, CDE, CDN a dietitian in private practice for a number of years now, expanded on her knowledge of this technique she uses to assist her clients with lifestyle changes. Engaging and building rapport with clients is necessary to help win their trust and confidence in the services you are providing for them as they go about the arduous path towards change. OARS is an acronym for an effective counseling skill she reviewed that can be of great assistance to outpatient dietitians for the purpose of promoting dietary changes. OARS stands for the following: Open questions, Affirmations, Reflective Listening, and Summaries. In utilizing this skill you are actively listening to the patients story, reflecting on what is being said thereby clarifying the intended meaning of the speaker, and being empathetic to the clients needs. In discussing affirmations, she described them as words of understanding, appreciation, or even a compliment like, “that was a great suggestion!”. She also reviewed the 6 stages of change (precontemplation, preparation, contemplation, action, maintenance, and termination) noting that humans are at varying levels of change on any given day and that dietitians should capitalize on those days when their client exhibits a higher degree of readiness. She also advises to ask open questions and limiting self disclosure to moments where you feel it can be helpful in assisting patient towards goals. Having a conversation with a client should not be the same as talking to a friend. Creating achievable goals, a plan to reach them and scheduling follow ups to monitor their progress is important throughout the counseling process.
Second up were the cofounders of C & J Nutrition, Ms. Stephanie Clarke, MS, RD and Ms. Willow Jarosh, MS, RD who met at Tuft’s Nutrition Communications graduate program. The focus of their presentation was the business of nutrition communications. They discussed tips on pitching queries and stressed the possibilities of networking in this business. When developing a piece for a magazine, they suggest reading 3 to 4 recent back issues to make sure you do not replicate anything they have recently done. You must pitch the story to the editor 3 to 4 months before it is to be published. When contacting editors, communication should be short, sweet and to the point. Starting a blog and guest blogging is a great way to start. Additionally, defining your skill set, creating a logo and creating business cards for networking purposes are necessary components of developing your brand. You can also consult companies with regards to nutrition marketing, social media, etc. Thinking out of the box is key to success in nutrition communications. The speakers noted that they consulted a fashion brand on how to market nutraceuticals in their products.
Finally, Dr. David Seres of Columbia University Medical Center enlightened us on some myths regarding nutrition in critical care. First off, he disputed the use of albumin as a marker of “malnutrition.” He stated that low albumin levels are related to a redistribution of the protein which gets the signaling molecules to call out to the white blood cells. Hypoalbuminemia is a good indicator of severity of illness. As always, it still stands that enteral nutrition is superior to parenteral nutrition in critical care nutrition, as long as the gut works! He reports that even patients with severe pancreatitis can be fed via NG or NJ routes successfully. Dr. Seres pointed out that gastric feedings have been shown to increase pulmonary immunity in mice. Regarding aspiration, he stated that everyone aspirates and the best ways to avoid pneumonia is to follow proper head out of bed protocol, monitoring for dysphagia, noting abdominal distention and gastric residuals in excess of 500cc. Early enteral feeding promotes better outcomes in critically ill patients but feeding a patient too early could lead to disastrous outcomes like refeeding syndrome. When is it too early to initiate feedings? It is when a patient is not well resuscitated or perfusing well. Some ways to determine whether these criteria are being met are checking lactic acid levels, pulse and urine output. Parenteral nutrition should be used when there is gut failure and the patient is severely malnourished or requires TPN for greater than two weeks. Short term PPN should only be used, “… to resolve refeeding abnormalities when central line is delayed.” There is a greater complication rate and cost with the use of parenteral nutrition versus enteral nutrition. Some other myths regarding nutrition support in critical care that he disputed were as follows: diabetic tube feeding formulas improve blood glucose control, protein restriction in renal failure, and presence of bowel sounds for diarrhea.