Peer nutrition counseling provides valuable experience for dietetics students

Sunday, April 30, 2017

By Deep Singal, Student, B.S. Program in Dietetics

Aside from the academic rigor, dietetic students are occupied with work and volunteer commitments to acquire the necessary experience to become a Registered Dietitian. Students typically fulfill volunteer hours within community, clinical and food service-based organizations to expose themselves to a plethora of potential job opportunities and career routes within the field of dietetics. 

More often than not, students are unable to access direct patient care due to the Health Insurance Portability and Accountability Act (HIPAA). Patient information is sensitive and protected, thus students are not eligible to assist with nutrition consults in a clinical or community nutrition setting. However, students within the Didactic Program in Dietetics at SF State are granted the opportunity to participate in nutrition counseling with other students on campus at the Student Health Center.

Lauren Muckley RD, MPH, operates the nutrition clinic within the health center and allows dietetic students to work with peers who are pre-dietetic majors or are interested in nutrition. The Peer Nutrition Assessment Clinic (PNAC) is a great opportunity for students in training to have a one-on-one experience with hands-on nutrition counseling. The session allows students to practice with collecting anthropometrics (height, weight, BMI), assessing biochemical data (review of certain labs and specimen), dietary assessment and clinical evaluation of patients.

The PNAC is an opportunity for participating students to explore and learn about several nutrition topics. The interaction between the educator and student consists of four phases. Prior to the meeting, educators adjust the room according to their liking and set up all food and beverage models, paper work, and necessary tools in an orderly fashion convenient for both the student and teacher. The goal is to promote a safe and inviting environment.

educator takes student's measurementsUpon meeting the student for the first time, the educator initiates the involving phase. The educator learns about his or her patient and goes over a brief agenda of what the counseling session entails and reviews a privacy agreement to ensure patient confidentiality. The involving phase should remain within a 15-minute time frame.

In the exploration-education phase, the educator will take anthropometric measurements, which consist of blood pressure, calculating body mass index (BMI), assessing waist circumference and identifying a diabetes risk score. Educators then assess dietary habits through a food frequency questionnaire (FFQ) which tracks snack and beverage consumption of various items throughout the course of a usual week. The final piece to this phase is the 24-hour dietary recall using a three-pass method. Educators record everything the patient ate or drank within the previous 24 hours starting from the moment he or she woke up. Pass One is a quick list of items consumed with times of the day. Pass Two is the most important pass and includes minor details of each item. Educators assess amount, cooking methods, location and brands of all products. The final pass is a recall of what was recorded from passes one and two. The educator ends the recall by asking patients if the recordings reflect a usual day. Lastly, educators evaluate readiness for change by showing clients an assessment graphic with numbers 0-10, with 0 being not ready to change and 10 being confident and prepared for change. This portion of the counseling session will determine what phase of the resolving phase is appropriate for the patient. The exploration phase should last about 20 minutes in total.

The resolving phase matches patient response to the assessment graphic. If clients choose 1-3 on the graphic, they are not ready to make a change. In this portion of the resolving phase, the educator is to create awareness and not go into too much detail about the topic of choice the student selected. At this stage, educators and students should work on creating the smallest goal. If the client selects 4-7, the patient is still ambivalent and unsure about change. Educators should promote change talk and ask open-ended questions when going into detail. The educator should try to resolve the ambivalence and facilitate thoughts of change. The SMART goal should illustrate an action plan and educators should examine the social support needed to create change. If the patient responds with 8-10, he or she is absolutely ready to alter habits and ready for change. In this phase, the educators should probe client concerns regarding the plan of action. The educators should also build on past experience and successes with a newly developed SMART goal and action plan. The plan of action should incorporate an investigation of the environment and review cognitive talk to support change. The educator should also develop a tracking method to assess adherence to the plan.

Once the resolving phase is complete, the session concludes with the closing phase and the interaction is complete. If necessary, educators can refer students to Lauren Muckley if questions are beyond the educator’s scope of practice and recommend food assistance programs for students in need. The SHC provides students with access to Lauren’s services, which are included in the tuition fees. Those who meet eligibility requirements, can also participate in CalFresh is a supplemental food program allowing students additional financial support for groceries. As long as students meet at least one eligibility requirement, he or she is entitled to the financial benefits.

The nutrition consult at the student health center is an enriching experience. Students feel better prepared in performing a nutrition assessment with the additional practice. As dietitians in training, the need for real situations is essential in delivering quality patient care. Educators (students) who participate in the PNAC are taking the necessary steps in redefining health care and promoting a more healthful standard in their future careers.