My name is Alison Hill and I have been a Dietitian for over 20 years. But, for the past year, I have been working as a Home Enteral Feeding Community Dietitian. This means I visit adults in their own home who have a tube for feeding, either as a sole source of nutrition or in addition to their oral diet.
A day in the life of a home enteral feeding Dietitian
Let me take you through one of my day’s from not so long ago.
My day starts at 08:30, the sun is shining (unusual for Plymouth) and I’m on the road to deepest, darkest Cornwall (passport and Tamar tag in hand). I cover East Cornwall, from Bude to Looe and Liskeard to Saltash. My car boot is filled with the tools of my trade – feeding review checklist, spare feeding tubes, extension sets, tube adaptors, and various others.
I head off to my first visit of the day but I have a wee bit of difficulty trying to locate the house. Cornwall is filled with houses with names but no numbers – who knew?!
My patient is an older gentleman who has just spent the first few days at home using a feeding tube for the first time. He has recently been diagnosed with cancer, is unable to have any food or fluids orally and he’s understandably, quite anxious.
We’ve not met before and I ask him how he’s coping with his feed now he’s at home and not under the safe care of the doctors and nurses on the ward he’s just come from. He tells me he’s doing great but his daughter is concerned he’s lost weight. I weigh him and he’s reassured by this as his weight has stayed steady. My visit involves ensuring he is giving himself the correct feed and that he’s tolerating it well, so I’m looking for things like good urine output, bowels opening regularly, tube stoma site is clean and free from infection.
As I go through my checklist I’m bombarded with questions about his feeding. His main concern was he didn’t want to feed overnight but, could he alter the timing of his feed to allow him to get out and about during the day? I suggest I arrange a rucksack to be delivered which is specifically designed to hold the feeding system to enable him to be more mobile and I arrange our enteral feeding nurses to come and teach him how to use it.
Having answered all his questions, I give him my contact details and encourage him to contact me if he has any further queries. I inform him I will phone him on set dates and as I say goodbye, I can physically see the anxious face I had encountered when I arrived, was looking much more relaxed.
I call the office to let them know I haven’t been kidnapped and held hostage (the usual process for each visit), and I am safe and head off to my next destination.
My next visit is about 20 minutes away to a patient who is well known to me having visited her several times recently due to the degenerative nature of her condition. She has Motor Neurone Disease (MND) which is a term used to describe a group of diseases that affect the nerves (motor neurones) in the brain and spinal cord that tell your muscles what to do.
As I arrive, she greets me with a smile despite all she is going through. She has been finding it increasingly difficult to take oral diet and fluids and as a result we have the discussion (via iPad as her speech has become difficult) about increasing her feed via her feeding tube to ensure she is getting adequate nutrition. As I know her well, I tailor a plan to suit her lifestyle and I will send her an updated feeding regimen. Communication is so important in my job and I make a note to self to discuss this patient at the next MND multidisciplinary team meeting I attend.
I have a few more visits in Cornwall before I head back to the big smoke that is Plymouth.
Once back in the office I busy myself updating feeding regimens, liaising with our Dietetic Assistant to request the necessary changes in feed and any equipment required. The assistant in turn notifies the feed company via an online ordering system to ensure my patients have the necessary deliveries.
Our department is privileged enough to have the expertise of Fresenius (other feed companies are available) enteral feeding nurses to call upon if there are problems with a patient’s tube e.g. blocking or stoma site e.g. infection. It’s the end of my working day and I’ve still got plenty of paperwork to do but that will have to wait until tomorrow. I’m a dietitian – not a magician!
As I’m driving home from work I’m thinking I have the privilege of meeting the most amazing, inspirational people. I see a vast range of people with a wide variety of illnesses requiring home enteral feeding.
What am I most proud of in my job?
Everyone wants to know they are doing well in their job and to me it’s the little things that make me proud to be doing what I do. I have received emails from patients thanking me for my help, appreciative of my input and that I am very easy to talk to.
I am prepared to go the extra distance for my patients – there’s no traffic jams along the extra mile!
Alison is writing as part of the #WeCare2 campaign that will be running across our Trust communications. Look out for more from Dietetics, and their AHP and HCS colleagues, on our social media pages, Trust screensavers, Daily Email, Vital Signs and much more.