Jessilyn Cauble

NUTR 409
Critical Care- Sharp Memorial
Journal #1
Brenda ODay is an advanced practitioner on the critical care unit at Sharp Memorial and
has been a registered dietician (RD) for 25 years. As an RD she specializes in nutrition support,
the largest credentialed A.S.P.E.N. practitioner group within the Academy of Nutrition and
Dietetics1, and has earned the certified nutrition support clinician (CNSC). RDs in this specialty
are classified as competent, proficient, and expert with each level representing a different depth
of knowledge and a specified set of responsibilities within their scope of practice. The CNSC is
representative of the proficient level but compounded with her experience Brendas classification
as an expert enables her to oversee and direct clinical care, assume leading roles in scholarly
work, guide collaborative, interdisciplinary teams, and lead the advancement of evidence-based
nutrition support practice.1 The majority of her patients are on enteral nutrition (95%), illustrative
of her motto If the gut works, use it! and the remaining 5% receive parenteral feedings. During
a usual work day, Brenda checks her electron charting and does rounds for various units (cardiac,
skin, nutrition support team, etc.) by assessing the patient and collaborating with the trauma
surgeon, nurse practitioner, and/or any other professionals required to assure optimal care for that
specific individual. This type of interdisciplinary approach has been proven to improve outcomes
and enhance quality of care.2 Brenda revealed that the comradery and trust amongst her team was
a reason she loved her job. She has strong relations with the physicians on-site and they accept
her as an essential asset to patient care. Sharp Memorial Hospital can care for up to 4 trauma
patients at a time and has 52 private patient care rooms.3 The imperative differing factor amongst
those on the floor and those within the intensive care unit (ICU) is necessity of being on a

ventilator. The patients in the ICU receive oxygen by tube, are on nutrition support, and are
hooked up to various monitoring equipment paramount to their survival. The hospital has
evolved dramatically from having one RD to four with Brenda personally seeing about 80% of
the patients. The assessment of the patient is critical and from that acquiring what their specific
needs are. Metabolism, hormone response, utilization, and how the body responds to intervention
are entirely different when dealing with a patient in ICU.
During the hospital visit it was impressive to see how renovated and nice the interior of
the building was. It was clean and professional without a hint of the overwhelming intensity you
would expect from a critical care hospital. It was reassuring to observe pleasant, helpful staff and
an environment in which everyone appeared to be enjoying their job. I learned that when
working in the critical care unit your work day is busy, fast paced, and changing every day. It is a
challenging career in which you are constantly learning and evolving. This field illustrates the
importance of not only understanding various concepts (i.e. molecular mechanisms and
nutritional pathways) but knowing how to apply them correctly to benefit your patient. The ICU
illustrates how all the courses and material we learn in school can be combined and put to use to
make a positive impact and truly save lives. I would have never imagined myself in this area of
dietetics but after this field trip my mind has changed and I am now intrigued by every aspect.
The critical thinking is what draws me in most. The fact that every patient is in essence a new
puzzle to be solved, with different issues and conditions coming into play attracts me. Having the
ability and opportunity to take new information, piece it together, and make decisions each day
to bring your patient one step closer to optimal health is awarding and the components of a
fulfilling career. The take home message for me was to use every resource within grasp from
your personal knowledge to assistance of other professionals to create the best plan possible for

your patient. Take accountability for your decisions, monitor and make subtle changes as needed,
and never stop learning.

References
1. Brantley S. L., Russell M. K., Mogensen K. M., et al. American Society for Parenteral and
Enteral Nutrition and Academy of Nutrition and Dietetics: Revised 2014 Standards of
Practice and Standards of Professional Performance for Registered Dietitian Nutritionists
(Competent, Proficient, and Expert) in Nutrition Support. Journal of the Academy of
Nutrition and Dietetics. 2014; 114(12): 20012008.e37.
2. DeLegge, M. and Kelley, A. State of nutrition support teams. Nutrition Clinical Practice.
2013; 28:691697.
3. Sharp Memorial Hospital San Diego http://www.sharp.com/hospitals/memorial/ Accessed on
10/11/2015