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Dietetics
Reflective
practiceOrna O’Brien
March 2012
Description
Feelings
Evaluation
Analysis
Conclusion
Action plan
Gibb’s
Reflective
Cycle
Gibbs et al. (1988)
Rolfe et al. (2001)
Framework
for
reflective
practice
Description (summary of patient case)
PC: 36yo , referred to Community dietetics dept. by GP, for weight loss
advice
Dx: Wt: 138kg (rising) Ht: 1.76m Obesity III (BMI 44kg/m2)
PMHx: Sleep apnoea x 1y (untreated)
Dyslipidaemia (total cholesterol↑, LDL↑., HDL↓, Trigs↑)
SOBOE, attended PLAN in past, ? mild learning difficulty
Social Hx: Lives alone, unemployed non-smoker, non-drinker, poor mobility 2 to
weight
Nutritional
Ax:
Why did pt. feel he was here; previous wt loss attempts; acceptability
of weight/being weighed. Little confidence in weight loss ability.
Explained benefits of 5-10% wt loss.
Diet Ax: Poor meal pattern, portion size+++, treats+, good F&V, PA 3/7
(cycling/walking 45mins), night eating.
Goals set: Breakfast (porridge measurements, toppings, fruit, water)
Biscuits (buy ½ packet, have after evening snack)
Plate model
Sleep clinic discussion
(potato portions)
Feelings
InitiallyOn
Reflection
Evaluation
• Sensitive, non-judgemental attitude and approach1
• Expanded knowledge
• Insight into human behaviour
Positive
•Bad judgement – put my own assumptions ahead of the patient’s capabilities•Readiness to change
Negative
1 DOM, UK (2008, 2011)
Analysis
What
was I
trying to
achieve?
Did my
advice
help?
What did I
base my
actions on?
Research1,2,3
Input
from
others
Flexible Practical
Significant
learning
experience
1 Dept. of Health, UK (2006); 2 INDI (2007); 3 DOM, UK (2008)
Conclusion
• Lessened the gap between theory I learned in college and practice I learned in placement
• Improved quality of care for patients through patient-tailored assessment and goals
How does this learning experience integrate into my dietetic practice?
Action plan
• Assess readiness to change:o Is your weight affecting your life in any
way at the moment? (UK DH, 2006)
• Referral to relevant health services
• If patient not ready to change:o Reassure that I am available to talk
about it when he/she is ready
o Briefly advise on the risk of overweight
& benefits of weight loss
o Offer an appointment in, e.g. 6
months.
• Understanding patients thoughts on referral
• Expectations of treatment• Motivation to change
lifestyle• Weight history• Dieting history• Patient understanding of
obesity• Potential barriers to
change• Eating patterns• Current lifestyle: dietary
intake and physical activity
• Support networks
ReferencesUK Department of Health (2006) Care pathway for the management of
overweight and obesity. London: DH.
Weigh Management Interest Group, INDI (2007) Position of the Irish
Nutrition and Dietetics Institute: weigh management. Available at:
http://www.indi.ie/docs/979_94_wmig.pdf [accessed March 16th 2012]
Grace C, Pearson D et al. (2008) DOM, UK: The Dietetic Weight
Management Intervention for Adults in the One to One Setting: is it time
for a radical rethink? Available at: www.domuk.org/docs/dietetic-
interventionfinalversion301007.doc [accessed March 18th, 2012]
Grace, C. (2011), A review of one-to-one dietetic obesity management
in adults. Journal of Human Nutrition and Dietetics, 24: 13–22.
doi: 10.1111/j.1365-277X.2010.01137.x
ReferencesRolfe et al. (2001) Framework for reflective practice, as cited by Students
Learning with Communities: information for students: resources. Available
at: http://www.communitylinks.ie/students-learning-with-
communities/information-for-students/resources/
[accessed March 23rd, 2012]
Gibbs et al. (1988) Gibb’s Reflective Cycle, as cited by Students Learning
with Communities: information for students: resources. Available at:
http://www.communitylinks.ie/students-learning-with-
communities/information-for-students/resources/
[accessed March 23rd, 2012]
Thank you!
Any questions?