Dietetics

Reflective

practiceOrna O’Brien

March 2012

Description

Feelings

Evaluation

Analysis

Conclusion

Action plan

Gibb’s

Reflective

Cycle

Gibbs et al. (1988)

Rolfe et al. (2001)

Framework

for

reflective

practice

Description (summary of patient case)

PC: 36yo , referred to Community dietetics dept. by GP, for weight loss

advice

Dx: Wt: 138kg (rising) Ht: 1.76m Obesity III (BMI 44kg/m2)

PMHx: Sleep apnoea x 1y (untreated)

Dyslipidaemia (total cholesterol↑, LDL↑., HDL↓, Trigs↑)

SOBOE, attended PLAN in past, ? mild learning difficulty

Social Hx: Lives alone, unemployed non-smoker, non-drinker, poor mobility 2 to

weight

Nutritional

Ax:

Why did pt. feel he was here; previous wt loss attempts; acceptability

of weight/being weighed. Little confidence in weight loss ability.

Explained benefits of 5-10% wt loss.

Diet Ax: Poor meal pattern, portion size+++, treats+, good F&V, PA 3/7

(cycling/walking 45mins), night eating.

Goals set: Breakfast (porridge measurements, toppings, fruit, water)

Biscuits (buy ½ packet, have after evening snack)

Plate model

Sleep clinic discussion

(potato portions)

Feelings

InitiallyOn

Reflection

Evaluation

• Sensitive, non-judgemental attitude and approach1

• Expanded knowledge

• Insight into human behaviour

Positive

•Bad judgement – put my own assumptions ahead of the patient’s capabilities•Readiness to change

Negative

1 DOM, UK (2008, 2011)

Analysis

What

was I

trying to

achieve?

Did my

advice

help?

What did I

base my

actions on?

Research1,2,3

Input

from

others

Flexible Practical

Significant

learning

experience

1 Dept. of Health, UK (2006); 2 INDI (2007); 3 DOM, UK (2008)

Conclusion

• Lessened the gap between theory I learned in college and practice I learned in placement

• Improved quality of care for patients through patient-tailored assessment and goals

How does this learning experience integrate into my dietetic practice?

Action plan

• Assess readiness to change:o Is your weight affecting your life in any

way at the moment? (UK DH, 2006)

• Referral to relevant health services

• If patient not ready to change:o Reassure that I am available to talk

about it when he/she is ready

o Briefly advise on the risk of overweight

& benefits of weight loss

o Offer an appointment in, e.g. 6

months.

• Understanding patients thoughts on referral

• Expectations of treatment• Motivation to change

lifestyle• Weight history• Dieting history• Patient understanding of

obesity• Potential barriers to

change• Eating patterns• Current lifestyle: dietary

intake and physical activity

• Support networks

ReferencesUK Department of Health (2006) Care pathway for the management of

overweight and obesity. London: DH.

Weigh Management Interest Group, INDI (2007) Position of the Irish

Nutrition and Dietetics Institute: weigh management. Available at:

http://www.indi.ie/docs/979_94_wmig.pdf [accessed March 16th 2012]

Grace C, Pearson D et al. (2008) DOM, UK: The Dietetic Weight

Management Intervention for Adults in the One to One Setting: is it time

for a radical rethink? Available at: www.domuk.org/docs/dietetic-

interventionfinalversion301007.doc [accessed March 18th, 2012]

Grace, C. (2011), A review of one-to-one dietetic obesity management

in adults. Journal of Human Nutrition and Dietetics, 24: 13–22.

doi: 10.1111/j.1365-277X.2010.01137.x

ReferencesRolfe et al. (2001) Framework for reflective practice, as cited by Students

Learning with Communities: information for students: resources. Available

at: http://www.communitylinks.ie/students-learning-with-

communities/information-for-students/resources/

[accessed March 23rd, 2012]

Gibbs et al. (1988) Gibb’s Reflective Cycle, as cited by Students Learning

with Communities: information for students: resources. Available at:

http://www.communitylinks.ie/students-learning-with-

communities/information-for-students/resources/

[accessed March 23rd, 2012]

Thank you!

Any questions?