WEBVTT Kind: captions Language: en 00:00:00.890 --> 00:00:05.279 let's talk a little bit about how your cases are formatted and how they're 00:00:05.279 --> 00:00:10.200 organized to kind of help you think about how to approach the case. Most of 00:00:10.200 --> 00:00:15.749 them have the following categories of: welcome, a learning outcome, perspective, 00:00:15.749 --> 00:00:21.960 mind map, resources, the story, diet history, activities for you to complete 00:00:21.960 --> 00:00:26.220 as you go through the case, and then a reference list. However some of our cases 00:00:26.220 --> 00:00:30.240 are more like real practice, where you just have learning objectives for the 00:00:30.240 --> 00:00:34.170 case; you have information from the electronic health record; you have 00:00:34.170 --> 00:00:38.610 information from interviews with the patients; and you have a diet history. 00:00:38.610 --> 00:00:42.989 And you have a second interview and then your activity is simply to write a 00:00:42.989 --> 00:00:48.840 progress note. So we have a variety of resources that are available. In the 00:00:48.840 --> 00:00:53.520 beginning the cases have more in-depth notes and more background versus ones that are 00:00:53.520 --> 00:00:58.500 more parallel to exactly what you would see in real practice. As you begin to think 00:00:58.500 --> 00:01:04.110 about completing a case our suggestion to you is that you download all the 00:01:04.110 --> 00:01:09.570 activities for the case and save those in the location on your computer. And you 00:01:09.570 --> 00:01:13.440 scan through the activities (even if you're not required to submit them for 00:01:13.440 --> 00:01:17.970 grading), and you consider what kind of information you're going to need to 00:01:17.970 --> 00:01:23.700 complete all of those activities. Then you look at the key resources that are 00:01:23.700 --> 00:01:29.220 listed. On each activity there's a series of links on where we've indicated where we 00:01:29.220 --> 00:01:33.390 think the information that's most pertinent to that activity is located. And then 00:01:33.390 --> 00:01:37.920 you systematically review the information. Now looking at the learning 00:01:37.920 --> 00:01:42.000 objectives, you will note specifically what nutrition diagnosis our problems are 00:01:42.000 --> 00:01:45.570 likely to be addressed in the case. The perspective which gives you your 00:01:45.570 --> 00:01:49.260 thumbnail sketch about what you already learned in undergraduate about that 00:01:49.260 --> 00:01:54.390 medical condition, but it's kind of like a refresher for you. The mind map which 00:01:54.390 --> 00:02:00.000 is your explanation of how you use the NCP terms and also the content that's 00:02:00.000 --> 00:02:03.740 coming from evidence-based practice guidelines In the intervention section. 00:02:03.740 --> 00:02:08.640 You look at the resources tab where there are hyperlinks to resources that we think 00:02:08.640 --> 00:02:14.670 are likely to be helpful for you. And then you look at the story itself... 00:02:14.670 --> 00:02:19.739 all the videos, the diet history. If you do that... here are some estimations for 00:02:19.739 --> 00:02:23.550 time that it will take you to do those activities as you get ready. And this is before you 00:02:23.550 --> 00:02:29.040 start actually completing any of the activities. The recommendation is you 00:02:29.040 --> 00:02:33.540 spend about an hour to an hour and a half looking at the material before you 00:02:33.540 --> 00:02:39.780 actually start doing any of the any of the activities. As you work through the 00:02:39.780 --> 00:02:43.019 activity, start going through them. And again even the ones that you're not 00:02:43.019 --> 00:02:47.459 assigned to turn in--- look at what's in the activity so that you can see what 00:02:47.459 --> 00:02:52.170 information you're going to need to provide care. Complete all the activities 00:02:52.170 --> 00:02:56.310 that are required to be turned in. They're either Word or Excel 00:02:56.310 --> 00:03:01.350 files. And then if you're required to turn those in, then save them as PDF so 00:03:01.350 --> 00:03:05.850 they're ready to be uploaded. Then after you've completed your case and you 00:03:05.850 --> 00:03:07.680 think you've got everything the way you'd like it--- 00:03:07.680 --> 00:03:11.910 then upload or turn in the activities that are required for grading to your 00:03:11.910 --> 00:03:16.410 instructor. Now your instructor may choose several of them all of them or 00:03:16.410 --> 00:03:20.970 just a progress note so it depends on how your instructor wants to use the 00:03:20.970 --> 00:03:24.810 information from the cases. The total time that you should think about 00:03:24.810 --> 00:03:32.940 allocating for a case is between five and seven hours. Each of the NCPRO 00:03:32.940 --> 00:03:37.890 activities was specifically selected to help you demonstrate the competence that 00:03:37.890 --> 00:03:42.450 you're going to need in practice. Each activity represents a piece of a 00:03:42.450 --> 00:03:46.470 practicing dietitians thought process as they would have provided care for that 00:03:46.470 --> 00:03:51.239 particular patient. As a student you are required to practice the critical 00:03:51.239 --> 00:03:56.579 thinking process. So for example you will need to understand which information you 00:03:56.579 --> 00:04:00.780 need to have memorized about the medical condition and the recommended nutrition 00:04:00.780 --> 00:04:06.030 care. And you need to have the ability to identify what additional information is 00:04:06.030 --> 00:04:10.769 needed for the case and for you professionally to make sure that you 00:04:10.769 --> 00:04:15.450 have the current evidence-based information and you need, information 00:04:15.450 --> 00:04:19.019 from the patient or the rest of the healthcare teamabout how to 00:04:19.019 --> 00:04:24.539 tailor this care to this very specific patient. You need to be able to explain 00:04:24.539 --> 00:04:29.650 how you selected the "best" approach and how you tailored the nutrition care 00:04:29.650 --> 00:04:34.810 for your patient. In other words you need to be able to explain why you selected 00:04:34.810 --> 00:04:38.789 the approach you used for care for this patient. 00:04:38.789 --> 00:04:43.990 Examples of what might be explained would be which estimation formula you chose and 00:04:43.990 --> 00:04:48.669 why you think it's appropriate for this case. Which comparative standard did you 00:04:48.669 --> 00:04:54.580 use and why? Wwhich nutrition diagnosis/ problem did you select to address in 00:04:54.580 --> 00:04:58.349 today's consultation? And why did you think that was the most important one? 00:04:58.349 --> 00:05:03.490 What was your approach to intervention and why did you select that? Which 00:05:03.490 --> 00:05:08.110 monitoring and evaluating parameters do you think are the most appropriate to 00:05:08.110 --> 00:05:11.650 identify whether or not the nutrition care you provided is going to be 00:05:11.650 --> 00:05:18.490 effective? All of this critical thinking takes time and practice. And as you 00:05:18.490 --> 00:05:22.900 become more proficient you will know this process. It will come automatically 00:05:22.900 --> 00:05:26.800 as you progress through the consultations. What now takes you 00:05:26.800 --> 00:05:31.870 about 20 to 45 minutes to carefully consider the decisions look at the data 00:05:31.870 --> 00:05:36.580 try to decide-- should I do this--- or should I do that --- what's the best thing to do --- 00:05:36.580 --> 00:05:41.740 looking at references to making sure that you're on track --- looking at the 00:05:41.740 --> 00:05:46.750 activities and trying to decide I have I considered all aspects of this care. It 00:05:46.750 --> 00:05:51.610 takes a lot of time, but eventually after you go through it many times and in 00:05:51.610 --> 00:05:55.840 practice it will really be very quick. It will only take you a few minutes 00:05:55.840 --> 00:06:01.479 to accomplish what now takes a long time. So through all of this remember that the 00:06:01.479 --> 00:06:06.039 goal of doing the cases is to demonstrate that you can provide 00:06:06.039 --> 00:06:11.770 appropriate and tailored nutrition care for the patient that's described in that 00:06:11.770 --> 00:06:19.110 particular case. The activities are available online as either Excel 00:06:19.110 --> 00:06:24.099 spreadsheets or Word documents there are some interactive PDFs but we've 00:06:24.099 --> 00:06:32.409 transitioned from most of those. The reason your instructor has selected the 00:06:32.409 --> 00:06:37.389 various activities for you to turn in is that they want to ensure that the 00:06:37.389 --> 00:06:41.300 content included in those activities are things that you 00:06:41.300 --> 00:06:44.979 understand and know thoroughly and that you need to be able to demonstrate 00:06:44.979 --> 00:06:50.120 competency in. Another part of your instructors role is to know that you 00:06:50.120 --> 00:06:54.289 know how to find evidence-based information and you know how to 00:06:54.289 --> 00:06:59.060 synthesize that information into a coherent nutrition care plan that's 00:06:59.060 --> 00:07:03.590 tailored to the individual patient. We know that our knowledge of nutrition is 00:07:03.590 --> 00:07:07.849 continually changing and as a future practitioner you need to know where to 00:07:07.849 --> 00:07:12.710 look to be sure that you're up-to-date with the care you're providing. We are 00:07:12.710 --> 00:07:17.020 demonstrating that process for you by providing you a range of resources-- 00:07:17.020 --> 00:07:21.680 mostly journal articles, national guidelines, evidence-based practice 00:07:21.680 --> 00:07:27.319 guidelines, textbooks. You realize that from the date of publication the textbook 00:07:27.319 --> 00:07:33.080 information is at least three years old. if you look at the newest citation in 00:07:33.080 --> 00:07:37.909 the textbook it's almost always three to five years before the publication date. 00:07:37.909 --> 00:07:41.810 If you're in practice then you need to make sure that you know what was 00:07:41.810 --> 00:07:47.659 published this year or last year. If something has been updated, you need to 00:07:47.659 --> 00:07:52.190 find and use the current and appropriate resources to guide your thinking as you 00:07:52.190 --> 00:07:56.840 provide high quality care. We are demonstrating for you by showing you 00:07:56.840 --> 00:08:00.949 what the resources might be, but in real life you're going to have to go find 00:08:00.949 --> 00:08:04.880 those resources on your own. In some of the cases have a pre-case 00:08:04.880 --> 00:08:08.930 self-assessment quiz-- which would be similar to that process in practice. 00:08:08.930 --> 00:08:13.340 you'd say what do I know about this this this this and this? Am I ready to see 00:08:13.340 --> 00:08:17.389 this patient or is there something I need to really quickly double 00:08:17.389 --> 00:08:24.919 check to make sure that I'm on track? Tthe goal of using the activities is they're 00:08:24.919 --> 00:08:30.650 designed to give you the experience that dietitians in practice already have. So 00:08:30.650 --> 00:08:35.990 for example do you know how the different energy estimation formulas 00:08:35.990 --> 00:08:40.699 work and whether they will apply to your specific patient? Do you know how to pick 00:08:40.699 --> 00:08:45.800 the appropriate one for your patient and when it will or won't apply to a 00:08:45.800 --> 00:08:50.449 different patient? So we have an activity where you go through and you calculate 00:08:50.449 --> 00:08:54.640 the different energy formula so you can see how they 00:08:54.640 --> 00:08:59.440 differ and the end result of all of those comparisons is you pick the one 00:08:59.440 --> 00:09:04.870 that you're going to use for today. Knowing how to judge whether or not the 00:09:04.870 --> 00:09:08.620 patient's diet history is a true reflection of what they're eating and 00:09:08.620 --> 00:09:12.820 can be used as a starting point for making changes. Iin other words by 00:09:12.820 --> 00:09:18.160 comparing whether the the weight change and the amount of energy difference that would be 00:09:18.160 --> 00:09:22.750 reflected by the weight change match what the person tells you they are 00:09:22.750 --> 00:09:27.790 eating? If their current intake estimation is vastly different from what 00:09:27.790 --> 00:09:33.760 their physiological history and weight change would be, then you know that that 00:09:33.760 --> 00:09:37.510 patient's diet history is not going to be a very good starting place because it 00:09:37.510 --> 00:09:41.050 doesn't really reflect what they're eating... there's some disconnect. Then you 00:09:41.050 --> 00:09:46.900 have to explore further. Do you have the ability to look at a 24-hour diet 00:09:46.900 --> 00:09:50.980 history and in a few seconds be able to say oh that's going to be approximately 00:09:50.980 --> 00:09:55.720 X amount of calories X amount of pro grams of protein and X amount of fat? If 00:09:55.720 --> 00:10:00.310 you cannot do those things then we've given you a way to do that--- which is 00:10:00.310 --> 00:10:05.110 using the abbreviated exchange approach dietitians experience may have learned 00:10:05.110 --> 00:10:09.400 that from calculating hundreds of diets and they just have the exchange lists memorized. Tthey 00:10:09.400 --> 00:10:14.830 know how many servings of each exchange is likely to be in a balanced diet of X 00:10:14.830 --> 00:10:18.880 amount of calories. You don't have all of that memorized yet, so we're giving you a 00:10:18.880 --> 00:10:23.770 way to do that by using the abbreviated exchange list approach. And then knowing 00:10:23.770 --> 00:10:28.840 that if you use that approach for estimating their energy intake and Diet 00:10:28.840 --> 00:10:32.890 pattern from the diet history in the beginning of the consultation, when it comes time later to 00:10:32.890 --> 00:10:37.480 make plans and think about where to make changes you have a very good starting 00:10:37.480 --> 00:10:42.310 point for which foods are going to likely be over the recommendation that 00:10:42.310 --> 00:10:46.030 you need to cut back from in that particular category and which ones are 00:10:46.030 --> 00:10:50.500 under, that you need to add more to. So if you've done the analysis in the way 00:10:50.500 --> 00:10:54.490 using the exchange list, then it's very easy for you to come back during the 00:10:54.490 --> 00:10:58.660 intervention and begin thinking about specifically what changes that person 00:10:58.660 --> 00:11:03.490 needs to make in order to be within that nutrition prescription. And do you know 00:11:03.490 --> 00:11:06.820 which food choices will lead to that desired a nutritional intake that you've 00:11:06.820 --> 00:11:09.970 described. So these are things that dietitians know 00:11:09.970 --> 00:11:13.210 because they've done it over and over and over again and they have it 00:11:13.210 --> 00:11:17.590 memorized. You don't have that experience coming into this 00:11:17.590 --> 00:11:22.120 so we're giving you activities that will help you develop that experience. So then 00:11:22.120 --> 00:11:27.070 you can use that experience as you make critical decisions about what kind of 00:11:27.070 --> 00:11:33.040 care should be provided for this particular patient. So as you're going 00:11:33.040 --> 00:11:37.690 through the activities keep in mind that there are key pieces of information and 00:11:37.690 --> 00:11:41.500 decisions that have to be made out of each of those the activities. 00:11:41.500 --> 00:11:46.240 Questions included are designed to help you think about what is the right answer 00:11:46.240 --> 00:11:51.600 and how did you choose that answer for this particular patient