The Strength in Compassion and an Open Mind

For a recent Monday class we were fortunate to have a day all about trauma informed care (TIC) at the Atascadero State Hospital alongside the dietetic interns there. The Trauma Informed Care Project defines trauma informed care as “an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma.” What I took from this powerful presentation is that we must meet our patients and clients where they are at and see them as a whole person, not solely as their diagnosis. Going through each of the different rotations thus far, currently recently completing a 2-week rotation at DaVita dialysis, I feel this applies strongly in the field of nutrition and dietetics. Having started my dietetic internship with the clinical rotation at Cottage Hospital it is easy to review a patient chart and medical history and formulate a story or assumption about how and why this person continues ending up in the hospital.

It can be a challenge to think broadly and remember we don’t know where this person comes from, what they have been through and why they continue to struggle with specific medical issues, chronic or acute. To be compassionate, effective practitioners in this field I believe it is our responsibility to dig deep and keep an open mind. In the clinical rotation, for example, I feel we should go into a patient’s room with no preconceived notions, find out what we need from them to do our best job, and listen to EVERYTHING they are saying, as that will play a part in how to best help and educate them.

I know that having recently spent two weeks at multiple DaVita dialysis centers this is what I observed my preceptor doing with the patients she has been seeing for many years, and with the new patients recently starting dialysis. She would review labs with each patient and discuss certain lab values (phosphorus and potassium specifically) that may be elevated with the patient with no judgment or tone of superiority. She would draw out the patients to talk about what in their diet may have contributed to these elevated lab values and work with them by supporting any changes they stated they wanted to and know they should make to improve their numbers, which ultimately is going to improve their health and reduce potentially dangerous impacts on their body. Sometimes, though, there are patients whose labs are consistently high, and it can be easy to start feeling frustrated or to start to sum them up as “just one of those patients.” This training was such an impactful reminder that we will be better practitioners if we continue to tell ourselves that we don’t know what causes people to struggle or resist change that will ultimately be “healthy” for them. We all have things that trigger us, cause us anxiety and make change hard.

In one of the dialysis clinics my preceptor informed me that many of the patients were impacted by the recent local fires, causing them to have to evacuate their homes and/or potentially lose their homes. Their priority wasn’t keeping a close eye on their diets, but on surviving and making sure their loved ones and pets survived. Many were displaced for weeks to months, subsisting on convenience and fast foods, living in temporary housing or hotels, which will ultimately impact their lab numbers. My preceptor said just the fact that they kept coming to dialysis three times a week during this traumatic, busy time was a win. We have to celebrate and encourage the wins, not just in our patients, but in our families, friends and selves, to be better practitioners and to be present and provide the best care.

I know throughout this week so many moments from the TIC training have been ringing in my ears, causing me to pause, think and keep an open, compassionate mind. I am grateful to bring this knowledge with me further into the remainder of my dietetic internship and into my working life as a future registered dietitian. I know it will make me a stronger, more compassionate practitioner, but also a kinder, more thoughtful person.