Community Nutrition: Capstone Experience with Montana WIC
2012-2013 Senior Capstone Experience By: Sherry Winchell Letter of Introduction
Dear Ashlyn Jones,
Thank you for giving me the opportunity to complete my Summer 2012 Capstone Experience with you. I am excited to become involved with the Women, Infants and Children program in a hands-on environment that will provide an incredible learning experience for me.
As a part of my Capstone Experience, I have developed 3 measureable objectives that I plan to accomplish during my time observing and working with the WIC program. These objectives are:
1) I will learn 3 crucial aspects that WIC teaches clients about supplementing infant formula in an infant’s diet by August 27, 2012.
2) I will learn how to perform 3 valuable measures that WIC uses to monitor growth and development of toddlers by August 27, 2012.
3) I will learn how to apply the Nutrition Care Process to a WIC client case study by August 27, 2012.
Another aspect of my Capstone Experience is to complete 30 hours of observation. As we have already discussed, 8 hours of my observation will be completed in the Helena WIC program office and the other 22 hours I will complete here with you and the Townsend WIC program. Some of these observations will include clinical practices with clients, client education (applying the Nutrition Care Process to a “case study”) and two clinical settings in Whitehall and White Sulphur Springs.
As the WIC coordinator in Townsend, I appreciate that you are giving me the chance to observe the WIC program in an intimate setting, as well as providing me with a clinical experience that a classroom can’t deliver. I hope this experience will be as pleasurable for you as I know that it will be for me.
By signing this letter, we both agree to the conditions and terms required by the 2012 Summer Capstone Experience. Thanks once again!
Day One: Wednesday, July 18: 11:30AM-12:00PM Initial discussion of Capstone Experience with Ashlyn Jones. 30 minutes, total hours: 30 minutes
Today was my first time meeting Ashlyn Jones, the WIC coordinator for Townsend, Montana. I met her in Townsend and together we discussed the requirements for the Capstone Experience, as well as set up a timeline for completing my observation hours. I plan to have my 3 objectives ready for her to edit and finalize by Monday. Together we discussed some potential ideas that could work for measureable objectives, but she gave me the freedom to develop the ideas on my own, as long as she could review them before signing my Letter of Introduction (which I also plan to have finalized and signed by Monday). Ashlyn was very friendly and helpful, she gave me a tour of the Townsend WIC office as well as the rest of the Broadwater County Health Center. The Townsend office is typically pretty quiet, however Ashlyn explained that she travels to Whitehall and White Sulphur Springs to provide services there as well, since those areas do not have their own WIC program offices. Ashlyn explained to me that there is a lack of funding in Montana for WIC, so the days that she travels out of town are extremely busy and booked steadily since she can’t provide services to these areas every day (obviously). In fact, I am not positive, but it sounds like she only goes to these two towns once or twice a month, which is a shame to know that there is not more available care for low income mothers in Montana. Ashlyn suggested that I do some of my observation hours on one of these travel days, so I plan to go to a “satellite clinic” Monday August 3rd, which will give me a fully packed day of observation hours and provide a great opportunity for me to learn about health services in rural Montana. I might also go to White Sulphur Springs with Ashlyn on August 8th, depending on whether or not I am able to do the 8 hours of observation in the Helena WIC office (which I am hoping for). Melody Anacker suggested that I try to get at least some of my observation hours in Helena so that I can get a full experience of the different types of WIC offices in Montana , which I completely agree. I hope to hear back from Becky Warren from the Helena WIC office soon. My next meeting with Ashlyn will be observing next Monday, July 23rd. I am really curious and excited to start observing with Ashlyn, and I feel that she is going to provide a great experience for me, which I am extremely thankful for.
Day Two: Monday, July 23rd, 8:00AM-4:00PM First full day of observation with Ashlyn Jones at the Townsend WIC office. 8 hours; total hours: 8.5
Today was an extremely exciting and eventful day. I truly had a blast! I started out the day by signing volunteer forms and confidentiality agreements, and we both signed the capstone letter of introduction (which also established the 3 measureable objectives that I had developed before arriving.) Her day was extremely busy with clients of all ages, which gave me a lot to observe and experience. One girl in particular was a first time WIC client just getting started, so Ashlyn decided before “Sarah” arrived that she would be a perfect case study for me to apply the Nutrition Care Process. The girl was 19 years old and only 7 weeks pregnant, but I was able to establish an adequate assessment and diagnosis for her given the information that she gave Ashlyn and myself. Over all, my assessment and diagnosis was that she had lack of education about referral care services. She currently has not made an appointment with an OB doctor and she has not seen a dentist in several years. Since this was Sarah’s first appointment, Ashlyn referred her to a couple of doctors and one dentist that is located in Townsend.
Also, in order for “Sarah” to receive WIC funding, she had to provide Ashlyn with a proof of residence, proof of income, and a photo ID, which is a standard procedure for all WIC clients. There are certain guidelines and requirements that a client must meet to receive WIC, and income level is the main discerning criteria. Ashlyn explained to me that the WIC guidelines for care are higher because it is a supplemental program, not an entitlement program. Food Stamps and Medicaid are government entitlement programs and are associated with lower income levels, so therefor if a client has already met the requirements for Food Stamps or Medicaid, than they meet the requirements for WIC. Ashlyn explained to me the rest of the guidelines for WIC, as well as how long children and their mothers are covered for WIC as well.
Another aspect of WIC that Ashlyn explained to me was job titles and job descriptions. A WIC office usually consists of an office aid, a CPA (competent professional authority), and the registered dietician. The aid position does not require any credentials; this person basically helps out with busy work, emails, phone calls, faxes, scanning, etc. Before becoming a registered dietitian, Ashlyn was the CPA for the Townsend WIC office. The big difference between the CPA and the office aid is that the CPA is trained and qualified to do certifications, but the aids cannot certify anyone legally. Unfortunately, the Townsend office does not currently have a CPA or an office aid due to lack of government funding. Finally, the registered dietician, of course, can do pretty much everything WIC related.
The funnest part of the day was observing the Ashlyn talking to each mother about their child’s current nutrition status, as well as having the opportunity to measure and weigh the infants and toddlers. A couple toddlers needed to have their hemoglobin checked, so I helped Ashlyn draw blood and bandage the children up afterwards as well. Even when the kids cried, I loved being able to work with the kids and write on their growth charts! Each appointment consisted of kids and parents with different levels of nutrition education and nutrition status, which provided a great educational experience for me. I truly feel like I learned a lot in one day. I could also sense from the things I saw and the experiences that Ashlyn shared with me how each day can be extremely different from the next. Sometimes clients cancel or miss appointments, other times clients show up late or stay and talk for a long time, which shows me how important it is to be patient and flexible having a job as a WIC coordinator. Ashlyn explained to me that this is typical in her office; some days are a little quieter and slow, and other days are booked solid with appointments. I found that aspect to be kind-of exciting; it seems that each day is an interesting experience for Ashlyn, and you never really know what to expect!
The last client of the day really gripped me and reminded me why I am so excited to become a health care professional. The client was low SES, low education level, pregnant with her 3rd child and her 2nd child was showing signs of failure to thrive. Ashlyn has tried several times to refer “Becky” to a doctor for further care and immunization shots, however she refuses every time. Ashlyn is constantly put into a situation where she is frustrated, yet doesn’t want to discourage “Becky” from continuing WIC by making her feel like she is being lectured at or judged. I am passionate about helping people and I really was inspired and motivated by the way Ashlyn handled the situation in a professional manner without any judgement whatsoever. Although it was sad to see a case such as this, I’m glad that there is someone like Ashlyn in that position to help young uneducated mothers do the best that they can.
Day Three: Thursday, August 2nd 8:00AM-12:00PM, 1:00PM-4:00PM. First full day of observation with Becky Warren at the Helena WIC office. 8 hours; total hours: 16.5
Today started out extremely busy right from the start. I observed Becky Warren for the first half of the day. Becky is the main RD in the office, but the office has 3 other CPA’s that can do certifications. Becky explained to me that traditionally, she is the main person to do follow-up visits with high risk population groups, but the other CPA’s tend to do the initial introduction visits and certifications. During the first half of the day, a majority of the clients were pregnant or had young babies, which was nice to observe because my first observation day with Ashlyn consisted primarily of toddlers. One interesting case that I was able to see was a mother in her mid-twenties to early thirties who had a baby that was about 2 months old. When I first saw the baby, I thought that there might be something wrong with him- he had a very odd look about his face that I could not quite put my finger on. I thought he might have downs syndrome, but if so, he did not quite look like a downs syndrome baby. After observing the mother’s visit with Becky, I was quite impressed to learn how hard the mother was working to continue breastfeeding with the baby, even though she works full time and her shifts are typically very long and strenuous. I found out that the baby was actually very healthy, gaining weight and length at a normal progression. After the client’s visit, Becky quietly told me that the little boy was what she called a “FLK”- a funny looking kid. This of course was NOT mentioned in front of the mother, but I knew exactly what she meant. The child, although slightly unattractive, had nothing wrong with him after all; he just looks rather strange. I thought that was interesting to note, because appearances can be deceiving; the mother was doing a fantastic job, and it would be unfortunate if the child was treated as though he needed further care when he in fact did not.
The second part of the day I spent with Maria, who is a CPA. The main thing I noticed that she was encouraging with each client was utilizing the extra WIC dollars that clients are allowed to use towards farmer’s market produce. I was very happy to see this, and I was also very glad to see how receptive a majority of the clients were towards using this extra cash. She also did a lot of breastfeeding education and referrals to the La Leche League for young nursing mothers. It was rather strange for me to see how different young mothers acted towards receiving this information. For myself personally, if I were a young mother, I would want all the information I could possibly stand to read about assistance in these areas. However, this was not what I saw with all of the women clients. Some women were very receptive, however other women had already made up their minds about certain theories on breastfeeding or formula and did not really want the extra information. I even noticed that some women had black and white opinions about using certain baby formulas that weren’t necessarily true, but they were not really receptive towards hearing otherwise. For instance, one mother was convinced that her baby would only take Enfamil and that her baby would not take Similac Advance, even though she had never tried Similac products with her baby before and these two products are almost identical-just sold by different formula companies. The Montana WIC program has a contract with Similac and so they can not issue funding towards Enfamil products, so it takes a lot of sensitivity and careful suggestion to mothers when it comes to educating them and letting down their guard with these kind of issues. Maria dealt with this issue very professionally and carefully by recommending Similac Sensitive for the baby, which is usually recommended for babies who will not take Similac Advance, and it typically works very well with most babies.
Another issue that I was able to observe is the correlation between education level of the parents and willingness to hear new information. Unfortunately, Maria explained to me that a majority of parents who have babies with nutritional and developmental problems seem to be the least receptive towards learning nutritional information and ask the least amount of questions regarding their child’s- or their own- health care. I observed this in the last client of the day. She was a very low SES client, she had potential mental health problems, she had previously been living out of her car during the first 3 months of her pregnancy, and she was currently being followed and watched by Child Protective Services. She was missing a lot of teeth, (and it appeared to be due to drug use,) but she was not interested in hearing a referral to a dentist. It was very disturbing for me to see her open her baby’s bottle of formula using her mouth, and she even licked her fingers as a means of wiping her baby’s face clean. It was pretty disheartening to think about what else is going on in that child’s life when the mother leaves the office. However, I was very impressed to see Maria’s level of compassion and how non-judgemental her attitude was towards this woman. It made me think back to what Ashlyn said; sometimes you have to be very careful how you treat certain people, because without WIC that child might not have another means to receive proper nutrition and care. Maria also explained that her goal as a health care professional is to find one main important piece of information, (or even one main referral,) to focus on with the client during each client’s visit. This is important because even though the client might need education on a million different areas of nutrition, they are probably only going to remember one clear take home message. Obviously, the more information she can provide, the better. However, many clients are not going to remember what Maria says if they do not show initial interest, so she just has to try her best.
Day Four: Monday, August 6, 7:30AM-5:30PM Second full day of observation with Ashlyn Jones at a satellite clinic in Whitehall. 10 hours; total hours: 26.5
Today I met with Ashlyn and the Natalie, who is the Broadwater County Health Department nurse. We met at 7:15AM and drove to Whitehall together for the monthly WIC satellite clinic. Since satellite clinic days are typically booked solid, Ashlyn needs Natalie to do weights and measurements while she does the certs, mid-certs, and follow-up care. It would be extremely difficult for Ashlyn to do everything on her own and stay on schedule, so Natalie comes with Ashlyn to satellite clinics to help everything run smoothly. I managed to move back and forth in the small office throughout the day, helping Natalie with weights and measurements and also observing Ashlyn ask the VENA questions and do follow-up care.
One of the most educational parts of the day involved watching Ashlyn respond to clients with careful discretion and delicately applying her nutrition knowledge to each situation. For instance, one mother said that her son was eating very little and seemed to have no appetite whatsoever, so to make up for the child’s nutritional needs she was giving the 16-month-old boy more milk, more frequently throughout the day (she was giving him milk with every meal, at nap times and at bedtime). I realized right away that even though she was doing what she thought was best, it probably was not in the child’s best interest to be drinking so much milk. In fact, I figured that giving her child milk so frequently was the reason why he was not hungry at meal times. Ashlyn approached the situation by congratulating her efforts, yet delicately encouraging the mother to try her best to cut down on the milk (since too much milk can actually block iron absorption, especially when milk is offered during mealtimes.) The mother responded well; she listened attentively and did not become defensive at all. I was really impressed to watch Ashlyn approach similar situations throughout the day. I noticed that many young mothers coming in to the office that day were giving their 1-2 year-old children more milk than was necessary, and it appeared to be because they were lacking education. Ashlyn said that positive feedback is very important, not only for the young mothers, but for every mother. I could sense how easily some mothers become upset or feel attacked when they are being told to make nutritional adjustments for their child. However, even just observing the mothers and their children was exhausting for me (since I have never had children) so I definitely have sympathy for what these mothers go through, and I realized why it is important to be so sensitive to their needs.
Another educational part of the day was being aware of physical cues of each client. One particular client had 4 children; one was a newborn, one was almost 2 years old, and the other two were 4 and 6 years old. After the mother left the office, Ashlyn asked me if I noticed anything unusual with the mother or the newborn. I noticed that the baby had weird red marks around her neck, but I had no idea why. Ashlyn also pointed out that the baby also had a very flat spot on the back of his head. Given that the mother has 4 kids and that she also seemed to have a depressive affect, Ashlyn thinks that the red marks and flat spot are from the mother leaving the baby in the car seat too much, probably as a result of feeling overwhelmed with having 4 kids, thus also explaining why she might be showing signs of post-pardum depression. I was very impressed that Ashlyn made these observations. She did not make any accusations or conclusive statements, but she told me that these are some important things to notice in case any problems arise later on. I realized at that moment how important it is to remember all aspects of performing an assessment, and how crucial it is to observe every client thoroughly.
Day Five: Wednesday, August 8, 7:30AM-5:30PM Third full day of observation with Ashlyn Jones at a satellite clinic in White Sulphur Springs. 10 hours; total hours: 36.
As always, today was very busy! Natalie Horn, the Broadwater County RN, met Ashlyn and me at the Broadwater Health Center at 7:15AM and together, we packed up Ashlyn’s car and drove to White Sulphur Springs. So far, I feel that the Townsend, Whitehall and White Sulphur Springs WIC clients seem pretty comparable. Typical WIC mothers seem to be between mid-teens to mid-thirties; however, there are also grandparents that come in frequently that have custody over their grandchildren too. The most interesting case that I observed with Ashlyn today was a mother that had a 10- month- old boy and a 3- year- old boy that has a severe milk allergy. The mother has had four children so far, and I was very impressed to hear how hard she has worked to learn about her 3-year-old son’s allergy to give her son the best care possible. She even made an appointment with an out-of- state doctor to get her son the proper consultation to meet his nutritional needs without harming him. With all of her experience and knowledge of children, I figured that this woman would be spot on with her 10-month-old babies’ health and development. However, I realized that it is always important to pay attention to the growth charts before assuming that a child’s health is fine. After Ashlyn plugged in her computer the child’s height and weight, I saw that the woman’s youngest son was actually in the “red” for his weight and weight to height. Ashlyn delicately approached the woman about this matter, and after asking the woman about her child’s eating habits and current developmental issues, we were able to identify that the woman was confusing his desire to chew things to soothe his gums (since he was teething) with hunger cues. Ashlyn gave her some suggestions to try with the baby and she listened attentively without being defensive at all. After the woman left, Ashlyn, Natalie and I discussed the issue, and considering that the mother herself was slightly obese herself, it seemed very likely that the mother is over-feeding her child. Since I have never had children, I was impressed how Natalie and Ashlyn both picked up on the teething factor so quickly. I really had fun working with both Ashlyn and Natalie; it was really cool to have the opportunity to hear the perspective of each client through the eyes of an RD as well as an RN. Although most of the day was too busy to discuss each client right after their appointment, the drive back to Townsend gave me the opportunity to ask both of them questions. I really had a blast observing with those two and I hope to see both of them again in the future.
SUMMER 2012 CAPSTONE EXPERIENCE: OBJECTIVES
1) I will learn 3 crucial aspects that WIC teaches clients about supplementing infant formula in an infant’s diet by August 27, 2012.
1. TYPES OF FORMULA WIC USES:
The most basic categories of formula are milk-based, soy, and hydrolyzed. WIC has a contract with Similac, which means that WIC clients can only buy Similac formula with WIC vouchers. The two basic formulas that are initially implemented are Similac Advance and Similac Sensitive, which are milk based. Similac Advance is used if the child does not experience any digestion problems, such as frequently spitting up, massive diarrhea, bloating, or gas. If one of these problems arise, then the baby will be switched to Similac Sensitive, which basically is easier for the child to digest. Most babies are fine when they switch to Similac Sensitive.
However, if the baby is still not responding well to Similac Sensitive, then the child needs a doctor’s prescription for a specific hypoallergenic formula, which must be transferred to the WIC office. WIC typically will stop issuing formula once a child is one unless the child has a doctor prescription. The types of hypoallergenic (hydrolyzed) formulas that WIC can offer are Alimentum, Nutramigen Enflora LGG, Pregestimil LIPIL, Elecare, and Neocate. Alimentum and Nutramigen are the most common formulas that doctors and WIC professionals use after Similac Sensitive is not responding well with the child. These formulas are very expensive, but seem to work very well with extremely sensitive babies. Neocate is suggested for babies with absorption problems. Pregesimil LIPIL and Elecare are also hypoallergenic formulas that require a prescription, but they are not as commonly issued by WIC as Alimentum and Nutramigen. Similac Sensitive Isomil is an alternative formula that is soy based, however it is usually one of the last formulas supplemented to the baby (if other formulas still aren’t working). Finally, Enfacare LIPIL and Neosure are formulas that are implemented with premature babies, which also require a doctor’s prescription.
2. HOW MUCH FORMULA TO USE:
During the first few months, a new baby will typically eat every 2-4 hours, depending on when your baby cries or shows other hunger cues. Between 6 months and 10 months, a baby will typically feed about 5-7 times a day. A basic guideline to follow for formula is 1-2 ounces per feeding in newborns, 3-4 ounces per feeding for 1-2 month olds, 4-6 ounces per feeding in 2-6 month olds, and 6-8 ounces per feeding in 6 month olds. At 6-7 months, a baby will need anywhere from 27-50 ounces of formula per day, at 7-8 months a baby will need 30-45 ounces of formula per day, at 8-10 months a baby will need 24-34 ounces of formula per day, and at 10-12 months a baby will again need 24-34 ounces of formula per day. WIC recommends bottle weaning between 10-14 months and to begin your child with sips of milk from a cup around 11 months. At 6 months is when WIC suggests starting to introduce baby food.
3. WIC PROMOTION OF BREASTFEEDING VS FOMULA FEEDING:
WIC promotes breastfeeding for several different reasons that result in many different benefits for the client as well as the baby. First and foremost, breastfeeding provides more nutritional benefits for the baby. In every WIC office that I have observed, there is a diagram on the desk of stacked blocks that represent breastfeeding versus formula, which shows breastfeeding have a much higher “stack.” For instance, formula provides the baby with DHA ARA, water, protein, carbohydrates, vitamins and minerals. Breast milk provides the baby with all of these items, plus enzymes, anti-parasites, stem cells, growth factors, anti-allergies, antiviruses, antibodies, and hormones. This list of benefits for the baby is substantially higher.
Also, mothers that breastfeed save money for their families. As far as WIC assistance goes, a mother who breastfeeds receives vouchers with a larger food package, since formula is no longer needed and is very expensive. Also, breastfeeding women are offered 30 ounces of tuna or pink salmon in their food package, which is not offered to non-breastfeeding mothers.
Finally, breastfeeding is promoted by WIC because it fulfills the emotional needs of both the mother and the baby. Breastfeeding provides protection against child abuse by allowing bonding between the mother and the baby, as well as creating the opportunity for the baby to be held more. WIC explains to new mothers that breastfeeding is a special time, and although it can be difficult at first, the positive experience that is shared between the mother and baby is immeasurable. However, WIC does not promote sharing negative feelings towards formula feeding whatsoever; breastfeeding is a choice and not a WIC requirement, and if a mother chooses to formula feed, WIC is completely supportive.
2) I will learn how to perform 3 valuable measures that WIC uses to monitor growth and development of toddlers by August 27, 2012.
WIC has client check-ups every 3 months, but if a mother or child is at nutritional risk, the check-up appointments are monthly or until the area of risk has been eliminated. The three main measurements used by WIC to monitor growth and development are:
1. LENGTH/HEIGHT:
WIC measures the length of babies on a length board up until the child is 24 months old. At age 2, the child’s height is measured. When using the length board, the mother holds the babies head to the back of the board while the baby faces straight up, parallel with the board. The RD or RN will then outstretch the child’s legs and adjust the measurement to the point where the child’s legs are straight and together, while the child’s feet are flat. Measuring the height/stature of a child is similar, except the child is measured standing up, with the child facing forward and both heels touching the back of the board. These measurements are always recorded in inches.
2. WEIGHT:
WIC measures young babies in a “boat” scale until age 2, while children older than 2 are measured on a regular scale. In both instances, the child must take his/her shoes off, but babies who are weighed in the “boat” must be weighed in the nude. In cases where the child is extremely scared, crying and upset (and is at least 2 years of age or older) the child can be weighed by having the mother massed while holding the child, then massed again without the child and subtracting the second weight from the first one. Mothers are also weighed during pregnancy to monitor healthy weight gain. BMI is measured using the height and weight of clients, which is done by taking weight (lbs.) multiplied by height (in.) multiplied by height (in.) divided by 703. BMI, height, and weight are watched by plotting a growth chart. Growth charts are the best indicators for monitoring proper growth and development because they clearly show any dramatic changes that have occurred since the child’s last visit. Growth charts are also used to follow and predict proper weight gain throughout the mother’s pregnancy as well.
3. HEMOGLOBIN:
Hemoglobin is checked once a year to monitor iron levels, which is done by performing a finger prick and collecting a blood sample that can be read by a digital Hemocue. If levels are below normal, however, Hgb checks are every month or until levels are normal again. This is done with both pregnant mothers and newborn babies, and it is done again when the baby turns one. Normal levels are <12g/dL for women and <13.5g/dL for men. Anything below 12g/dL in pregnant women is too low and should be monitored carefully. For boys, hemoglobin levels should be 14.7-18.6g/dL in newborns, 10.3-12.4g/dL in 6 month olds to 2 year olds, and 10.5-12.7g/dL for 2-6 year olds. For girls, hemoglobin levels should be 12.7-18.3 g/dL, in newborns, 10.4-12.4g/dL in 6 month olds to 2 year olds, and 10.7-12.7 g/dL in 2-6 year olds.
3) I will learn how to apply the Nutrition Care Process to a WIC client case study by August 27, 2012.
· Moderately active; rides bikes and lifts weights 30-60 minutes 2X a week
· Smokes a pack of cigarettes a day, but has recently cut down to 2 per day
· No children or previous pregnancies
· Concerns about being pregnant? She says she is “concerned about the whole thing”
· Stress level from 1 to 10= 0
· She plans to breastfeed
· She has no pregnancy weight goal/no knowledge of healthy weight range for pregnancy
· No OB appt. made/no doctor or family practitioner established
· She has not seen a dentist in many years
BIOCHEMICAL DATA:
· BP= 120/75 WNL
· Glucose/Hemoglobin A1C= 12.2 WNL
DIAGNOSIS/PES STATEMENT:
Food and nutrition-related knowledge deficit RT lack of prior exposure to accurate nutrition-related information AEB no previous pregnancies, no pregnancy weight goal, no OB appointment made, no dentist appointment in years, and overall concern regarding the pregnancy
INTERVENTION/GOALS:
· Set up appointment with OB and schedule follow-up WIC appointment in 3 months
· Refer patient to dentist and schedule appointment
· Give patient Medicaid information if necessary
· Main intervention is targeting health care referral systems for patient to receive proper pregnancy information and pregnancy care
Self Evaluation and & Summary of Experience
I feel that my Capstone experience with the Montana WIC program was extremely rewarding. I was able to submerge myself in a setting that taught me how to actually apply the Nutrition Care Process, which I had never experienced beyond the classroom. I walked in to this experience with high hopes and high expectations, and having that attitude really helped me to grow as a dietetic student. There are several lessons that I learned throughout my observation experience:
First of all, I feel that all of my objectives were met perfectly. Although I had some education on gestational and infant nutrition, I had very little knowledge or experience with infant formula prior to doing my capstone project. Analyzing the different types of formula that WIC issues to mothers was a very interesting experience for me, especially since almost half of the mothers using formula had to switch from one formula to another at some point in time. Also, being able to take anthropometric measures on clients was great practice for me, since I had not calculated growth charts in a long time prior to that. Children can be very challenging to measure at times, so I feel that I was able to receive much needed practice. Finally, the case study that I analyzed was a great way for me to put the Nutrition Care Process in motion and to really start using the tools that I have learned in the classroom.
The most unexpected aspect of my Capstone Experience was the pace of the community health setting. I was not expecting things to be so fast paced! The women that I observed have mastered the art of multi-tasking, and I was very impressed how well they could manage several people at once. I was not surprised to see that the WIC program is understaffed, but the amount of juggling that was going on exceeded my expectations. Documentation was done quickly, but accurately. I can see now why it is so important to be able to pick up on potential health-risk indicators quickly, because the RD’s don’t have time to really sit and think.
The easiest and most enjoyable aspect of doing my observations was talking with the clients. Although I was not allowed to really discuss much with the clients, I really like the idea of building healthy relationships with clients and being the one to help them and listen to them. I naturally love to be around people and to help others.
On the other hand, I can imagine a potential challenge as a future professional being that I can easily get too personal with people. I really learned from Ashlyn how to use appropriate language as far as how to ask questions and how to administer information (or correct misinformation) in an empathetic and non-judgemental manner. Its not that I have a problem with speaking to people; I just realized that being delicate with new mothers is very important to establish a good relationship and ensure that the mother will feel welcome at WIC and continue with the program.
After doing my summer capstone experience, I feel very excited and motivated to be a dietitian. I like the challenges that come with it, and I love being able to work with people and help people. I feel that I was born to be a dietitian, and it was very reassuring to see that even the challenging aspects of the job were things that did not discourage me, but motivated me. I feel very blessed that I was able to have such a wonderful eye-opening opportunity.