Milestone: Nutrition Education Presentation

I achieved a milestone today: I successfully completed a 45-min nutrition education presentation to a huge group of 70+ kids aged 5-8 years old at Mitcham Primary School. This presentation stressed me out for the longest time ever because I've never done such a long presentation to a huge group, especially with such a young audience. It was a paired presentation with my fellow Masters student Adam, so we could prompt each other and going mind blank wasn't so much of a concern but I was more stressed over how to connect with a young audience since from past experience I haven't had much luck with that. So this was definitely something out of my comfort zone. I spent so much time researching for ideas and then putting together the lesson plan and the countless times of practicing the presentation.


I have been more used to academic and technical presentations that was full of serious stuff, so trying to come up with something that would suit a young audience really isn't my niche. I was really worried about not being able to engage the audience well. And the practicing was so embarrassing for me because I had to act cute and raise the pitch of my voice to sound excited and interesting to the kids. We also incorporated a dance in the presentation so we also had to practice the movements to the dance, and doing those animated movements is really not my thing. The worst part was probably the practices as I really had to get over my struggle with cognitive dissonance.


But after all that effort, in the end it turned out just fine and the kids were all so sweet, enthusiastic, and eager to learn.


So for our nutrition education presentation, we went through the 5 food groups with them, showed them photos of a variety of fruits and vegetables, and taught them the importance of eating fruits and vegetables. As kids have very short attention spans, we incorporated lots of easy activities such as dancing to a food group song, reading out the names/color of fruits/vegetables, drawing fruits/vegetables, and singing to a fruits/vegetables song. The kids really enjoyed all the activities! Especially the dancing!


This was the food group song that we taught the kids to dance to, and danced along with them:

http://www.youtube.com/watch?v=tqs9XWy-FM8


I think the kids had the most fun with dancing to this song hehee... I think it's a great song to let kids learn about the food groups, the dance movements are easy to do too ;)


Overall I was impressed with how much the kids knew! They seemed to know all the food groups and all the various types of fruits and vegetables! Which was really nice :) When we let the kids draw their favorite fruit/vegetable, Adam and I went around to check on the kids and their drawing... then a bunch of kids who had finished their drawing came up to me and volunteered to show me their drawings. That was such a pleasant surprise, and it wasn't only one or two kids who did that... but a lot of them did! I didn't have to walk through the entire group of kids in the end because they just came to me! It was like one after another coming to me, calling my name and eager to show me what they had drew. My heart melted then because they were so sweet ;)


But honestly some of their drawings were very... abstract. I have eaten lots of fruits and vegetables in my life but honestly, I have never seen fruits/vegetables that look anything like the shapes that the kids drew, haha. I could hardly figure out what fruit/vegetable some were drawing, so I had them tell me what they drew... and I actually encouraged them with "Oh that's a wonderful drawing!" Hahaa.. white lies have no harm, right :P It was really cute though, to see all creative shapes of fruits and vegetables that they drew. Their spelling isn't very good at that age too, so they had problem spelling the names of certain fruits and vegetables... and they would also come up to me to ask if they had gotten the spelling right.


After the presentation, some even came up to me to say 'thank you', aww... so sweet! This has been such a great learning experience for me ;)


The only thing that bothered me during the session today was that there was a girl with disabilities at the session. She was in a motorized wheelchair and seemed to not have much control over her muscles hence she couldn't participate in most of the activities such as the dancing and the drawing. I felt really bad that she couldn't do that while everyone else could :( Her friend helped her to draw her favorite fruit/vegetable but when I was going around during the drawing session to check on the kids, she told me that she was feeling bored :( And then later she told Adam that she was sad :( The only thing that she could really do together was singing along to the fruit/vegetable song and some hand movements with the food group song dance. Boohoo... I wonder what other activities we could have done so that she wouldn't have felt so left out :(


So, it was a short 45 minutes at Mitcham Primary School... but I left there with many emotions and thoughts, and feeling enriched and contemplative. I feel as if I learn so much more through these sort of activities. Although there's so much planning and practice that goes into presentations, it's all worth it in the end as long as the audience enjoys the process and walks out of the session with something useful. of course I'll never know if our presentation was useful in getting them to eat more fruits/vegetables unless i do a prospective evaluation research study, haha. I actually completed another presentation this morning about Diabetes Self-Management before heading to Mitcham Primary School for the presentation, so it's a day filled with presentations. But I think all these practice with public speaking/presentations really help to boost confidence and increase competency. I actually rather enjoy doing such things.... sans the stress. Perhaps one fine day I won't feel the stress anymore, if I get enough practice with it? Or maybe stress is hardwired in us and it can't be changed? Celebrities/singers with years of experience say they still get stage fright every time they perform.. so I don't know the answer ;)


Anyway, here's Adam and I... photo taken right after we completed the session with the kids. See our relieved faces? Hehee, now is the time to relax after all that preparation for the past 3 weeks!

observational placement

last week i did a 2-day observational placement at the Royal Adelaide Hospital (RAH). here's the reflection piece i wrote up for the placement:

Over the 2-day observational placement at RAH, I had to opportunity to observe the dietitian attend to new and review cases in inpatient and outpatient settings.

For inpatient cases, I observed the management of a variety of cases under the cardiology, orthopaedics, and general medicine wards. Most of the cases were seen due to a risk of malnutrition due to low energy intake from low appetite or high energy needs from sepsis, wound healing, or surgery. I also observed the management of tube feedings and a patient at risk of refeeding syndrome.

An inpatient referral goes to the dietitian when the patient is scored as High Risk under the Malnutrition Universal Screening Tool (MUST), which is completed by the nurses for all inpatients. Before seeing the patient, the dietitian would look through the patient's casenotes, the nursing observation charts and the biochemistry data. This process was similar for both new and review cases, but the information gathering process was quicker with review cases as the dietitian only needed to go through the casenote entries from the previous date the patient was seen. I was impressed with how quickly the dietitian was able to scan through the patient's case notes, nursing observation charts, medication list, and biochemical data to find the relevant information before interviewing the patient!

During the patient interview, I was surprised how the dietitian collected very brief information for the diet history. Generally, the patient was asked about appetite level and the amount of food consumed at each meal. If protein level was a concern, the dietitian would focus more on the protein foods and ask how much of the protein foods were consumed. However, the dietitian did not probe for much detail and just estimated the portion sizes consumed. The dietitian mentioned that for inpatient cases, a very detailed diet history is usually only conducted with renal patients as their potassium levels need to be tracked with accuracy. Otherwise for all other cases usually the diet history is kept brief and if detailed information is required, the food chart would be used for that purpose. For the nutrition plan, the dietitian would negotiate with the patient. As most patients seen by the dietitian were at risk for malnutrition, the plan was usually to increase the energy and protein intake of the patient. This was done by incorporating high protein snacks during morning and afternoon tea and also the use of nourishing fluids such as Resource and Ensure. The calculations and documentation also focused mainly on overall energy and protein intake.

The documentation part took the longest as the dietitian had to document in the patient case notes and also in a set of progress notes that was to be kept in the dietetics department. I also observed the dietitan filling out an enteral feeding discharge summary for a patient who was transferring to another hospital.

I observed how there has to be a lot of flexibility in seeing inpatient cases as certain times a patient may be out of the ward for procedures, the medical team may be having ward rounds, or the nursing staff may be having their handover with the nursing observation charts. During such situations where it is not possible to refer to necessary information or interview the patient, the dietitian simply changed her plan and went on to another ward to see another patient.

As for the outpatient setting, cases were observed for half a day during the obesity clinic. Patients who have to attend the obesity clinic are on the waitlist for bariatric surgery and had been referred by their surgeon to lose weight before they could undergo surgery. For the typical outpatient case, the dietitian collected diet history briefly to determine usual eating patterns and did not collect detailed information such as method of preparation or exact portion size. The dietitian then did some nutrition education and handed out some resources on portion control or how to reduce emotional eating. Changes to the diet were negotiated with the patient to reach an agreement and there were usually only one or two changes suggested for the session.

For a new outpatient case, I noted how the dietitian spent significant time trying to build rapport with the patient and when the patient was not very forthcoming with dietary patterns, the dietitian did not probe further and only suggested little changes in the diet during the first session.

Another outpatient case was a review case, but the management of the case ended up being unrelated to nutrition as the patient turned emotional and voiced suicidal thoughts during the session hence the dietitian had to attend to patient's emotions and do the necessary referral to a psychologist. I thought the dietitian managed the situation well by encouraging the patient and showing the patient how much progress had been made up to that point in time, while assuring the patient that the current priority was to take care of his emotions and not to think about losing weight until he is ready.

Observing outpatient cases was truly an eye opener for me as all the patients seen that day were very different and the content discussed differed with each patient. The sessions were more on counseling rather than nutrition education. Much flexibility is required and it can be rather unpredictable, as there can be variations in how each session is conducted and appointments may change due to patients not showing up for, or walk-in patients may need to be slotted in.

These 2 days of observational placement at RAH provided me with great insight to clinical dietetics. I feel that I still need to learn so much in this aspect, to increase my competency with doing nutritional assessments and in counseling, and to build up my knowledge with regards to the various medical conditions.

why do thin people not get fat?

today we watched a very interesting documentary in one of the nutrition tutorials, it was about an experiment done on a group of thin people to test how much weight they could gain. the subjects of the experiment are those who always eat whatever they want and can eat a lot but wouldn't gain a single kilo.

one of the subjects at the opening of the documentary said, "i'm on a 'seefood diet'... i see food, and i eat it". lol.

so the purpose of the experiment was to feed them double (and then more) of their usual caloric intake and see if they would put on weight. they had to consume some 10,000 calories/day every day for 4 weeks, and the target was to put on 20kg. theoretically, they should put on that amount of weight if they were consuming that many calories in excess. their weight and body fat percentage was measured every week and photos of them were taken weekly to document the changes. they were also not allowed to do any exercise during that period and had to wear a pedometer to track their activity level.

at the end of the 4 weeks, the "winner" of the group had put up 9.5kg which wasn't even half of the target weight. only 2 people out of the group of perhaps about 10 people or more had gained weight in the higher single digits. everyone else had weight gain of about 5-6kg only. and the "loser" had put on only 4.5kg. interestingly, the "loser" did not have much of an increase in body fat percentage... instead, he had put on muscle mass and his basal metabolic rate had increased 30%! that's like totally going against theory about how excess calories are stored as fat and basal metabolic rate can't be increased.

maybe the guy's a mutant.

anyhow, he's the exception out of the study and everyone else did put on some sort of weight and increased their body fat percentage. although, it's not that much weight to be putting on for that ridiculous amount of calories consumed. i probably just need to consume 1/10 of what they had and i'll put on 10kg -.-

a follow-up was done with the subjects after the experiment concluded, and basically all of the subjects had returned to their usual weight prior to the study without trying to lose weight. it was like their body's natural setpoint that they are supposed to be thin and they returned to that size. daddy and hubby totally belong to this category of people, they eat and eat and eat and don't put on any weight at all! life's so unfair!

and there's this evolution theory about why there are so many overweight and obese people today: throughout history of human civilisation, the lack of food was more common and in times of famine, it was the fatter ones who had more energy stores and could stay alive for longer than the skinny ones. so it's natural selection of the fatter ones who lived on to procreate and pass the fatty genes down to their offspring. it's survival of the fattest instead of the survival of the fittest. the expression of the fatty genes in the outward appearance of people weren't really observed until the past half century when food became more abundant. with the abundance of food, people consume more and those with the fatty genes store more fat and become heavier. (there's also a theory on how those with the fatty genes are predisposed to consume more when food is available due to a survival instinct).

i totally subscribe to this evolution theory. but sadly, the fatty genes aren't really helping with survival in today's modern world with abundance of food... 

assignment machine

spent my weekend doing assignment again, i guess that's pretty much what my student life is going to be like. the assignment was a reflection and comparison of 2 methods of collecting dietary intake data - the weighed food record and diet history. before writing up the reflection i had spent quite some time analysing the information using Foodworks, this nutrition analysis software. sounds like an easy assignment but lots of time went into organizing the data and putting them together.

anyway, after i completed the assignment the word count was 50% more than the word count limit. then i had to go back and skim down on a lot of things, which is a really painful thing. it might have even taken me longer to do that than write up the reflection. i had written sentences using the most concise manner and thrown in lots of abbreviations to shorten phrases but still i exceeded the word limit. after struggling with it for very long, i finally gave up and left it as it was. it still exceeded the word limit but apparently there was a +/- 10% leeway on word count... and my word count fell into that leeway category hehe.

then i've got another assignment due on thursday which also involves using the Foodworks program to do nutrition analysis...

and next week is mid-semester break! but i'm not really getting a break because i've got to do a 2-day observational placement at a hospital in town, do 3 assignments over the break, and prepare for 2 small group facilitations that are coming up right after we get back from break. 

food practical

i've got to do food science along with the cooking labs/food practicals again. it was something i had done for undergrad so i'm rather familiar with the concepts but it's nice to do it again here because i don't really know much about Australian foods. today we had a food practical for slow cooking up at the north side of town. Flinders doesn't have kitchens or the facilities to do the food practicals so we were using a cooking school's facilities. makes me miss the food lab at IU, it was nice and cosy and each group had our own set of cooking utensils/sink/stove/oven. The cooking school's kitchen is huge but it's a commercial style kitchen so the utensils were all stored at a central location which was quite chaotic going up and down the kitchen to find stuff. the ingredients we needed for our recipes were not sorted by group too... imagine 6 groups fighting for one ingredient. and the sinks are all at the sides of the kitchen so stuff has to be taken here and there. not a very efficient layout in my opinion. i think i spent half of the 6 hours there walking about to find stuff or to wash my hands/wash utensils.

the food practical was about 6 hours... which means standing around for that amount of time. it's tiring and i never feel like i enjoy cooking under such conditions. maybe that's why i don't cooking because i associate cooking with standing around for extended amounts of time and having lots of ingredients to prepare and pots and pans to wash after that. 

anthropometric workshop

yesterday we had an anthropometric workshop for the class Nutrition Care Process, where we had the chance to pinch each others' fats. we paired up and got to do some hands on taking anthropometric measures on our partners. those measures include the basic weight and height, and then knee height, demi-span, waist/hip circumference, mid-arm circumference, and the tricep skinfold test.

i was measured 2 cm shorter than my shortest height ever measured so i really doubt the accuracy of these measures... a poor workman blames his tools? maybe? but all the people i spoke with were measured to be about 2 cm shorter than the height they recall... so hmm.

the tricep skinfold test was the most memorable. i should try to upload the photo of how my arm looked like after the tricep skinfold test. the process involves using a pen to mark:
1) the tip/end of the shoulder blade
2) the start of the radius (radial bone)
3) the mid-arm, which would be the midpoint of 1) and 2)
4) a horizontal line at the mid-arm tricep region
5) a vertical line at the mid-arm tricep region pass the tricep muscle

so that's 5 pen marks in total.

the horizontal and and vertical line would form a cross where by the tricep skinfold test could be performed by pinching the fats using the cross as a guide. and using the calipers to measure the fats there.

5 marks is not too bad actually, but the thing is my partner marked up #1 incorrectly... thus everything else was marked up wrong and the measurements were not accurate. so she did it again... then to realize #2 was not marked up properly, which affected the other markings. and so she did it again.... thank goodness the third attempt was a success. by the end i had 5 x3 pen markings on my arm, which is about 15 marks and my tricep region is bruised up from the pinching by fingers and calipers. lol.

so... the tricep skinfold test really left a deep impression on me, no pun intended.

flooded with assignments

have been caught up with doing assignments and preparing for assignments last and this week.

last week i had an assignment due for the class Nutrients Role and Functions. it appeared to be a short answer style set questions that could have been completed in a day. there was only about 10 questions too. but sadly, this was not the case. each question had like part a, b, c, d, e, f, g.... and in the end when it took me about 3 or 4 days to complete it. i had 11 or 12 pages worth of text in the end. so that was basically what i did the whole of last week. and then by the end of the week i was too tired to do anymore typing, heh.

over last weekend i had to prepare for a small group facilitation segment for my communication class. it was a short segment - 10 minutes only, but i spent considerable time preparing for it a what i'm familiar with is presentations but not facilitation. while presentation is all about providing information and delivering that information in a charismatic manner, facilitation is all about engaging participants and getting participants to be actively involved in the session. it was a whole new concept to me... it involves coming up with an activity whereby participants get to interact with one another/with the facilitator.. and it's much about conversing with participants, listening attentively to what they are saying, paraphrasing/clarifying/summarizing, repeat again... and in the process there's also the need to focus on content because it's an informative session after all. feels as if there's so much more to do than good ol' public speaking in that short span of time. when i first started practicing it was quite unnatural... but after practicing few times it was much better and the actual "show time" went quite well. it's really all about practice makes perfect i guess.

that small group facilitation was an "appetizer" this week as it was a non-graded component just to get us warmed up for the "main course" few weeks later where we'll do a small group facilitation again, albeit this time it would be graded. going to get busy again! but i might like it more than the traditional presentations when i do get used to the facilitating style. and it's really nice that the class has all these little hands on activities where we get to use the skills we learned from theories, i think i can grasps those concepts on facilitation much better when you use it. it's like positive/negative feedback. and it's good we get all these practice in before going out to do it in the real world. for this communication class we also need to do a one-hour small group presentation at a primary school. it's getting me nervous. there would be 70+ kids in that group... i have no idea how i'm going to control those kids or even build some rapport with them. school presentation is in less than a month's time and i'm not looking forward to that.