RE: Pre-op Education

[Guest guest]

We have a preop seminar that all patients attend and the NP gives a talk about the surgery and risks etc and a bit on nutrition and dumping and the fact that the surgery is a "tool" . At the seminar the patients receive a folder with a lot of information and namely my specific nutrition guidelines with my name and telephone number on it. The patient' s obviously need specific dietary guidelines on what to do before and after surgery.

Do you answer medical questions that are nursing related? "Gregoline, L." <jgregoline@...> wrote:

I'm having a dilemna. I've written in before about this problem but has notbeen resolved. We are a fairly new program (started doing surgery 3/04) andconsist of one RD (me), one nurse manager and psychologist plus 2 surgeons.The nurse manager and I both do pre-op education, she goes before me and Igo after her. The problem I'm having is she feels she needs to cover almostevery topic including fluids, carbonation, dumping syndrome, vitamins, alittle on protein and the meal plan. Right now all information is containedin one surgery handbook that pt's receive and since I seem to continuallyupdate my information I give out my own handout which has some duplicateinformation as the handbook. I'm finding that many patients are calling herwith problems with their protein, food, vitamins, etc and instead offorwarding

the pt on to me she proceeds to answer the questions for them. Iproposed to her having just the diet/nutrition information in my handoutthat way pt's would know who to call with problems. She rejected this ideastating "many of these topics are nursing and dietary and we both need to beable to discuss these issues." She thinks I'm sending mixed messages to thept by giving them my own handout. So my question is, how many of you haveyour own handouts that you give or is it an all encompassing handbood forthe pt. I'm literally at my wit's end over this and am tired of having tobargain with her to talk about my nutrition information. I can't be in theroom with her while she's educating because I'm normally tending to my workwith inpatients in the hospital. Any suggestions/thought, I'm meeting withher later today. Gregoline, RD

[Guest guest]

,

I think probably the most important thing is that everyone in your program is "on the same page."

I think it is ok that the nurse discusses the "nutrition" information....patients can really benefit from

having the message repeated and hearing it from multiple people.

We have 3 dietitians and one nurse coordinator. Often patients will call our RN with a medical question

and realize they also have food questions. I have no problem with it because we all work together

regularly and have the same message...and our nurse doesn't hesitate to refer people to us if she doesn't know

the answer to a food question. But it goes the other way, too. Someone will call me for a calcium question, for

example, and then realize they also had a question about crushing pills or lifting restrictions...if I know, I'll answer

the question. If not, I ask them to call our RN.

I think it's easier for the patients and they see you as a team or as a "program"...not disjointed, separate disciplines.

Oh, and as for written information, we have one binder that the patient receives when they meet with the surgeon...it

includes all of our program information...including nutrition.

Just my thoughts...

Good Luck to you!

M. Roy, RD, LD St. 's/Duluth Clinic Health System 400 East Third Street Duluth, MN 55805 (218) 786-3143

-----Original Message-----From: Staci Stone [mailto:spk1076@...]Sent: Tuesday, May 24, 2005 10:29 AM Subject: Re: Pre-op education

We have a preop seminar that all patients attend and the NP gives a talk about the surgery and risks etc and a bit on nutrition and dumping and the fact that the surgery is a "tool" . At the seminar the patients receive a folder with a lot of information and namely my specific nutrition guidelines with my name and telephone number on it. The patient' s obviously need specific dietary guidelines on what to do before and after surgery.

Do you answer medical questions that are nursing related? "Gregoline, L." <jgregoline@...> wrote:

I'm having a dilemna. I've written in before about this problem but has notbeen resolved. We are a fairly new program (started doing surgery 3/04) andconsist of one RD (me), one nurse manager and psychologist plus 2 surgeons.The nurse manager and I both do pre-op education, she goes before me and Igo after her. The problem I'm having is she feels she needs to cover almostevery topic including fluids, carbonation, dumping syndrome, vitamins, alittle on protein and the meal plan. Right now all information is containedin one surgery handbook that pt's receive and since I seem to continuallyupdate my information I give out my own handout which has some duplicateinformation as the handbook. I'm finding that many patients are calling herwith problems with their protein, food, vitamins, etc and instead off! orwarding the pt on to me she proceeds to answer the questions for them. Iproposed to her having just the diet/nutrition information in my handoutthat way pt's would know who to call with problems. She rejected this ideastating "many of these topics are nursing and dietary and we both need to beable to discuss these issues." She thinks I'm sending mixed messages to thept by giving them my own handout. So my question is, how many of you haveyour own handouts that you give or is it an all encompassing handbood forthe pt. I'm literally at my wit's end over this and am tired of having tobargain with her to talk about my nutrition information. I can't be in theroom with her while she's educating because I'm normally tending to my workwith inpatients in the hospital. Any suggestions/thought, I'm meeting withher later today. Gregoline, RD

[Guest guest]

I too go after the nurse and give my own handouts/quiz only because they are

more in depth and more up to date. I provide pts with my name # and e-mail if

they have questions. The nurse here would just have me answer any diet

questions if they asked, or she says the dietitian will be in next to address

your questions....

Pre-op education

I'm having a dilemna. I've written in before about this problem but has not

been resolved. We are a fairly new program (started doing surgery 3/04) and

consist of one RD (me), one nurse manager and psychologist plus 2 surgeons.

The nurse manager and I both do pre-op education, she goes before me and I

go after her. The problem I'm having is she feels she needs to cover almost

every topic including fluids, carbonation, dumping syndrome, vitamins, a

little on protein and the meal plan. Right now all information is contained

in one surgery handbook that pt's receive and since I seem to continually

update my information I give out my own handout which has some duplicate

information as the handbook. I'm finding that many patients are calling her

with problems with their protein, food, vitamins, etc and instead of

forwarding the pt on to me she proceeds to answer the questions for them. I

proposed to her having just the diet/nutrition information in my handout

that way pt's would know who to call with problems. She rejected this idea

stating " many of these topics are nursing and dietary and we both need to be

able to discuss these issues. " She thinks I'm sending mixed messages to the

pt by giving them my own handout. So my question is, how many of you have

your own handouts that you give or is it an all encompassing handbood for

the pt. I'm literally at my wit's end over this and am tired of having to

bargain with her to talk about my nutrition information. I can't be in the

room with her while she's educating because I'm normally tending to my work

with inpatients in the hospital. Any suggestions/thought, I'm meeting with

her later today.

Gregoline, RD

[Guest guest]

We do the same thing in our program as . We have 2 part-time RD's ,

one bariatric coordinator who is an RN. 2 surgical PA (one in the clinic

and one in the hospital) and 2 RN's that work with each of our surgeons.

We have a nutrition handout we update periodically and this is routed to

all of the above staff in case questions come up. If someone cannot answer

a patient's question or requires more detail the patient is referred to the

" expert " . The RD's field questions regarding crushing pills, etc that are

not strictly nutrition related. The only problem we ever have is when a

staff member has not received updated info or when a float RN or temporary

staff (usually at the hospital) have no clue....

Shirley R. , RD, MS, CD

Registered Dietitian

Dean East Clinic, 1821 S. Stoughton Rd

Madison, WI 53716

Ph: (608) 260-6524

fax : (608) 260-6521

shirley.shelley@...

" Roy, M. " <hroy@...>

Sent by:

" ' ' "

@

< >

groups.com cc:

Subject: RE:

Pre-op education

05/24/2005 10:53 AM

Please respond to

,

I think probably the most important thing is that everyone in your program

is " on the same page. "

I think it is ok that the nurse discusses the " nutrition "

information....patients can really benefit from

having the message repeated and hearing it from multiple people.

We have 3 dietitians and one nurse coordinator. Often patients will call

our RN with a medical question

and realize they also have food questions. I have no problem with it

because we all work together

regularly and have the same message...and our nurse doesn't hesitate to

refer people to us if she doesn't know

the answer to a food question. But it goes the other way, too. Someone

will call me for a calcium question, for

example, and then realize they also had a question about crushing pills or

lifting restrictions...if I know, I'll answer

the question. If not, I ask them to call our RN.

I think it's easier for the patients and they see you as a team or as a

" program " ...not disjointed, separate disciplines.

Oh, and as for written information, we have one binder that the patient

receives when they meet with the surgeon...it

includes all of our program information...including nutrition.

Just my thoughts...

Good Luck to you!

M. Roy, RD, LD

St. 's/Duluth Clinic

Health System

400 East Third Street

Duluth, MN 55805

(218) 786-3143

Re: Pre-op education

We have a preop seminar that all patients attend and the NP gives a

talk about the surgery and risks etc and a bit on nutrition and

dumping and the fact that the surgery is a " tool " . At the seminar

the patients receive a folder with a lot of information and namely my

specific nutrition guidelines with my name and telephone number on it.

The patient' s obviously need specific dietary guidelines on what to

do before and after surgery.

Do you answer medical questions that are nursing related?

" Gregoline, L. " <jgregoline@...> wrote:

I'm having a dilemna. I've written in before about this problem but

has not

been resolved. We are a fairly new program (started doing surgery

3/04) and

consist of one RD (me), one nurse manager and psychologist plus 2

surgeons.

The nurse manager and I both do pre-op education, she goes before me

and I

go after her. The problem I'm having is she feels she needs to cover

almost

every topic including fluids, carbonation, dumping syndrome,

vitamins, a

little on protein and the meal plan. Right now all information is

contained

in one surgery handbook that pt's receive and since I seem to

continually

update my information I give out my own handout which has some

duplicate

information as the handbook. I'm finding that many patients are

calling her

with problems with their protein, food, vitamins, etc and instead of

f! orwarding the pt on to me she proceeds to answer the questions for

them. I

proposed to her having just the diet/nutrition information in my

handout

that way pt's would know who to call with problems. She rejected

this idea

stating " many of these topics are nursing and dietary and we both

need to be

able to discuss these issues. " She thinks I'm sending mixed messages

to the

pt by giving them my own handout. So my question is, how many of you

have

your own handouts that you give or is it an all encompassing handbood

for

the pt. I'm literally at my wit's end over this and am tired of

having to

bargain with her to talk about my nutrition information. I can't be

in the

room with her while she's educating because I'm normally tending to

my work

with inpatients in the hospital. Any suggestions/thought, I'm

meeting with

her later today.

Gregoline, RD

[Guest guest]

You could give patients and evaluation after your appointment asking

for feedback on consistency of information, redundancy, etc... Then

compile it and show her what your customers have to say? I feel for

you as I have had similar issues and have a similar set up, but I am

only part time trying to do my thing (along with seeing general

outpatient appts!) with a nurse that is full time and has had the

surgery! It is very frustrating but my thing is I will go right to

her if I hear anything conflicting from pts so we are on the same

page. I think it is nuts that you have to go right after her and

aren't clear on what she should cover vs. you, etc... I have felt

similarly when going right after our nurse. I have given a post test

to the patient right up front to see what they understand on the

basics and then clarify from there. I get more into specifics on

nutrition and find most pts do learn more from me in the end, but

get initial lifestyle changes from her like protein first, no

liquids with meals, eat slowly, etc... I then show serving sizes,

get more into what is protein, carb and healthy carbs, fats, etc..

Call me if you want to discuss more as I think we might have quite a

bit in common on this issue! Theresa (406-455-2841) PS We give out a

program booklet, but I find pts prefer my handouts on the diet due

to larger print, very specific and clear, etc... The whole staff has

access to these handouts and we ensure all pts get them along with

the program booklet. I like being able to modify these handouts when

I want also.

> I too go after the nurse and give my own handouts/quiz only

because they are more in depth and more up to date. I provide pts

with my name # and e-mail if they have questions. The nurse here

would just have me answer any diet questions if they asked, or she

says the dietitian will be in next to address your questions....

>

> Pre-op education

>

>

> I'm having a dilemna. I've written in before about this problem

but has not

> been resolved. We are a fairly new program (started doing surgery

3/04) and

> consist of one RD (me), one nurse manager and psychologist plus 2

surgeons.

> The nurse manager and I both do pre-op education, she goes before

me and I

> go after her. The problem I'm having is she feels she needs to

cover almost

> every topic including fluids, carbonation, dumping syndrome,

vitamins, a

> little on protein and the meal plan. Right now all information is

contained

> in one surgery handbook that pt's receive and since I seem to

continually

> update my information I give out my own handout which has some

duplicate

> information as the handbook. I'm finding that many patients are

calling her

> with problems with their protein, food, vitamins, etc and instead

of

> forwarding the pt on to me she proceeds to answer the questions

for them. I

> proposed to her having just the diet/nutrition information in my

handout

> that way pt's would know who to call with problems. She rejected

this idea

> stating " many of these topics are nursing and dietary and we both

need to be

> able to discuss these issues. " She thinks I'm sending mixed

messages to the

> pt by giving them my own handout. So my question is, how many of

you have

> your own handouts that you give or is it an all encompassing

handbood for

> the pt. I'm literally at my wit's end over this and am tired of

having to

> bargain with her to talk about my nutrition information. I can't

be in the

> room with her while she's educating because I'm normally tending

to my work

> with inpatients in the hospital. Any suggestions/thought, I'm

meeting with

> her later today.

>

> Gregoline, RD

>

>

>

[Guest guest]

,

I see pts at back to back with our program NP. We actually found that it is

easier for me to evaluate pts first. So I start my clinic 1 hour before her.

This way I can figure out what concerns there are and answer questions. Then

when she evaluates the pt she can focus more on nursing/medical hx issues and

just restate my concerns/suggestions.

Our program has just decided to go to a 3 ring binder approach for our pt info.

That way we can edit pages whenever we need to. We will be handing out all the

info together but the RDs are responsible for the content and education of the

nutrition materials.

--- You wrote:

I'm having a dilemna. I've written in before about this problem

but has not

> been resolved. We are a fairly new program (started doing surgery

3/04) and

> consist of one RD (me), one nurse manager and psychologist plus 2

surgeons.

> The nurse manager and I both do pre-op education, she goes before

me and I

> go after her. The problem I'm having is she feels she needs to

cover almost

> every topic including fluids, carbonation, dumping syndrome,

vitamins, a

> little on protein and the meal plan. Right now all information is

contained

> in one surgery handbook that pt's receive and since I seem to

continually

> update my information I give out my own handout which has some

duplicate

> information as the handbook. I'm finding that many patients are

calling her

> with problems with their protein, food, vitamins, etc and instead

of

> forwarding the pt on to me she proceeds to answer the questions

for them. I

> proposed to her having just the diet/nutrition information in my

handout

> that way pt's would know who to call with problems. She rejected

this idea

> stating " many of these topics are nursing and dietary and we both

need to be

> able to discuss these issues. " She thinks I'm sending mixed

messages to the

> pt by giving them my own handout. So my question is, how many of

you have

> your own handouts that you give or is it an all encompassing

handbood for

> the pt. I'm literally at my wit's end over this and am tired of

having to

> bargain with her to talk about my nutrition information. I can't

be in the

> room with her while she's educating because I'm normally tending

to my work

> with inpatients in the hospital. Any suggestions/thought, I'm

meeting with

> her later today.

>

> Gregoline, RD

--- end of quote ---

Letendre, MS,RD,LD

Bariatric Surgery Program

Section of General Surgery

(603)650-8810