Amanda Cravinho

NUTR 409
Journal Entry #1

SHARP MEMORIAL HOSPITAL

Sharp Memorial Hospital has been open in SD since 1955 and is Sharp
Healthcares largest hospital and only level II trauma center (1).Sharp is recognized
nationally as providing excellent patient-centered care. Some of the hospitals
outstanding programs other than trauma include heart care, cancer treatment,
orthopedics, bariatric surgery and organ transplantation (1). Sharp Memorial is
staffed with five inpatient clinical dietitians (1).
Brenda Oday was the dietitian that spoke about caring for trauma patients in
her 48 bed discipline. Brenda has been a dietitian for 25 years. It is always
enjoyable to watch Brenda speak about her career because she is so excited and
passionate about what she does. As an RD working in critical care, Brendas job
responsibility is to treat malnutrition associated with increased infection, poor
wound healing, increased ventilator time, longer hospital stays and higher mortality
rate (2). The goals of nutrition in the ICU are aimed at restoring deficiencies in
macro/micro nutrients and have evolved into decreasing morbidity and mortality
rates in the ICU (2). It is Brendas job to take aggressive action to feed the patient
the appropriate amount as soon as possible in order for better long term health and
recovery of her patients (3). Her main priority is feeding the gut if she is still able in
order to keep the microflora and digestive properties intact (3). The most common
types of patients seen consists mostly of trauma, cardiac, COPD and GI surgery who
are intubated. Collaborating with a team of professionals including PAs, the trauma
surgeon and nurses is essential to treating patients with the best nutrition care plan
as possible. Due to the intubation of the patients EN tube feeding is most common
followed by PN.
Unfortunately, during this visit we did not get to walk around the hospital and
visit the ICU so there was not a whole lot I got to observe other than a busy parking
lot and a long hallway into an conference room next to a cafeteria. However, Brenda
is so engaging and well versed in what she does I learned a lot. I can see myself in
the future being just as excited and willing to teach as Brenda. What she does in the
hospital seems very fast paced and dynamic. This is the kind of environment I could
see myself working in as I am very interested in the clinical aspect of being a
dietitian. The way Brenda spoke about her role seemed especially challenging but
extremely rewarding. Since I already put myself into situations in which I am
challenged, not only with one task but multiple at a time, I feel I would be a good fit
for the role of a clinical dietitian in intensive care. Brenda mentioned that a lot of
her job consists of patient rounding. I recently have done patient rounding as a
volunteer at Palomar Health. After listening to Brenda I could see myself applying
that experience with the nutrition knowledge I am currently learning and learned
from her during this field trip. One thing Brenda mentioned that really stood out to
me was when she said humans are equipped to do 2 things eat and move. This
was such as simple statement but really stuck out to me. What she meant was that
this are the two most important things to address for the best patient outcomes. If

the gut works feed it and if the patient is mobile let them move, this is what we
were designed to do. In my future career as a clinical dietitian I can really see
myself running with this concept and putting it to use on my own patients.
My overall impression of the visit was filled with enthusiasm and excitement
for the potential that dietitians carry. It was great to hear that Brenda is a respected
team member within the hospital and even though she cannot enforce orders, her
relationship the physicians and surgeons supports her role and knowledge she
brings to the table. After visiting I did not see much room for improvement as I felt
completely motivated to go after my goals as a clinical dietitian. The take home
message for this field trip was to make sure that the students saw the overall
picture of using a nutrition plan of care (POC) in conjunction with other disciplines
and how nutrition can fit into this. Brenda wanted us to realize that as dietitians, we
are there to facilitate implementation of the POC in a collaborative effort by identify
the patient that will benefit the most from nutrition care and making sure to feed
them the right goldilocks amount. Not too much and not too little, this is the key!

References
1. About Sharp Memorial Hospital. Sharp San Diego health care leader. Available at:
http://www.sharp.com/memorial/about-us.cfm. Accessed October 12, 2015.

2. Pichard C. When more is better. Crit. Care. 2014; 18(2): 126.

3. Thibault R, Heidegger PC, Berger MM, Berger CP. Parenteral nutrition in the
intensive care
unit: cautious use improves outcome. Swiss Med. Wkly. 2014; 44w13997: 1-9.