Kendal at Ithaca Senior Living Community

Long Term Care Rotation

Preceptors: Natalie Nicholas, MS, RDN, CDN, Director of Dining and Nutritional Services, and Cecilia Hagen-Revelins, MS, RDN, CDN, Clinical Dietitian

I invite you to explore the modules on this page to gain a comprehensive understanding of my experience as a Clinical Dietetic Intern with Kendal at Ithaca Senior Living Community.

Guthrie Cortland Medical Center

Acute Care Rotation

Preceptor: Siena Senn, MS, RDN, CBS, Registered Dietitian Nutritionist, and Leah Pawluck, MS, RDN, CDN, Registered Dietitian Nutritionist

I invite you to explore the modules on this page to gain a comprehensive understanding of my experience as a Clinical Dietetic Intern with Cortland Medical Center.

Module 1: Site Overviews

Module 2: Ethics

Module 3: Nutritional Assessment

Module 4: Case Studies

Module 5: Education & Counseling

Module 6: LTC & Pediatrics

Module 7: Advocacy for Profession

Module 1 - Introduction

I completed my long-term care clinical rotation with Natalie Nicholas, Director of Dining and Nutritional Services, and Cecilia Hagen-Revelins, Clinical Dietitian, at Kendal at Ithaca Senior Living Community in Ithaca, NY.

Kendal at Ithaca's mission statement is as follows, "Our mission is to provide a mutually supportive environment for residents and staff, and to contribute to the greater Ithaca community." The renowned “Kendal spirit” is attributable to Kendal residents, who design and direct the recreational, intellectual, social, and spiritual life of their community. Kendal’s approach is based on the philosophy that growing older can bring new opportunities for growth and development. Kendal at Ithaca offers all-inclusive wellness and healthcare choices to enhance the resident's sense of freedom and security in retirement.

Please visit Module 6 on this page to see the entries I uploaded throughout my clinical rotation with the assisted living and skilled nursing residents at Kendal at Ithaca. These items include the NYS inspection results, familiarity with the Minimum Data Set (MDS), therapeutic diet modifications, adaptive eating devices, meal rounds, wound rounds, nutrition assessment charting and quarterly MDS assessments, nutrition care plans, interdisciplinary (IDT) team meetings, an imaginative nutrition support case study, and a Modified Barium Swallow (MBS) report.

I completed my acute care clinical rotation with Siena Senn, Clinical Dietitian, and Leah Pawluck, Clinical Dietitian, at Guthrie Cortland Medical Center in Cortland, NY.

Guthrie Cortland Medical Center's mission statement is as follows, "Guthrie works with the communities we serve to help each person attain optimal, life-long health and well-being. We will do so by providing integrated, clinically-advanced services that prevent, diagnose, and treat disease, within an environment of compassion, learning, and discovery." As a non-profit healthcare organization, Guthrie, its physicians and caregivers are focused on improving the health and well-being of the communities it serves. Guthrie’s mission, vision, and values statements articulate the principles on which the organization was founded and exists today.

Please visit the modules on this page to see the entries I uploaded throughout my clinical rotation with the medical-surgical, ICU, oncology, cardiac, gastroenterology, respiratory, and wound patients at Guthrie Cortland Medical Center. These items include a Health Promotion Program, caseload documentation including a clinical case log, encounter forms, and monitoring activities, IDT meetings, observation of a swallowing evaluation, a review of Guthrie's policy and coding/billing procedures, an individual patient case study project, outpatient counseling, group nutrition education, pediatric case studies, and advocacy for the nutrition profession materials.

Module 2 - Ethics and Professional Development

MODULE 2 CHECKLIST

Professional Development Plan

I prepared a plan for professional development according to the Commission on Dietetic Registration guidelines using the Student Competency Plan Builder. My plan hits three different spheres with corresponding competencies and performance indicators.

PDP

PDP Activity Log

Throughout the course of my dietetic internship, I will be keeping track of my progress using an Activity Log. I have listed competencies and performance indicators on my professional development plan that I wish to achieve over time.

Activity Log

Academy Code of Ethics

During my clinical rotations, I adhered to the Academy Code of Ethics by maintaining professionalism, respecting confidentiality, and providing evidence-based care. Below are completed Ethical Case Studies from the Code of Ethics Alternate Practice Experiences.

Ethical Case Studies

Academy Membership

I am a student member of the Academy of Nutrition and Dietetics (AND) and a state affiliate of the Pennsylvania Academy of Nutrition and Dietetics (PAND). I am also part of the Sports and Human Performance Nutrition (SHPN) Dietetic Practice Group.

Academy Certificate

Professional Organization Participation

I participated and lead nutrition undergraduates in creating content for Cornell University's Sports Nutrition Instagram page @BigRedFueling throughout the entire year. See below for content I created this Spring.

Cornell Social Media

Health Promotion Project

My HPP revolves around the National Nutrition Month theme of "Food Connects Us." I created multiple nutrition education materials for Guthrie Cortland Medical Center. See below for the bulletin board, infographics, and photos from food demos I held in the cafeteria.

HPP Materials

PAND Membership Meeting and Academy Volunteering

Already completed in community rotation (PAND MNT Act Legislator Meetings).

PAND Meeting

Board Meeting

Already completed in food service rotation (Kendal at Ithaca Board Meeting).

Board Meeting

Module 3 - Nutritional Screening and Assessment

MODULE 3 CHECKLIST

Caseload Summary

I coordinated my caseload based on priority of need (high-risk, moderate-risk, low-risk) for the patients assessed at Guthrie Cortland Medical Center and ensured that appropriate follow-up was achieved. I then completed assigned documentation on nutrition related problems. Please see the below encounter forms and the rest of this module to see evidence of myself utilizing the Nutrition Care Process (NCP), writing PES statements, and referring to other professional disciplines as needed.

Screening Criteria

Screening Example

Clinical Case Log

Below is my clinical case log for both uncomplicated medical conditions and complicated medical conditions. The date of the note addressing the required medical condition can be found on this log.

Clinical Case Log

Encounter Forms

Please see below to view my uncomplicated and complicated cases encounter forms.

Monitoring Activities

See below for an example of an initial and follow-up note that I wrote for a patient, displaying how I conducted routine monitoring activities for patients who resided at the hospital long enough to be seen by nutrition a second time.

Monitoring Activities

Interdisciplinary Team Meetings

I attended IDT meetings daily in the ICU and Medical-Surgical floors of the hospital. This was an opportunity to discuss the admitted patients with multiple disciplines and physicians. You can see my notes from one of the meetings and how they show up on our screening sheets for our nutrition department to use.

IDT Meetings Notes

Swallowing Evaluation

I observed a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) by the SLP on January 23rd. She showed me the instruments and materials she used prior to meeting with the patient. Unfortunately, I could not watch the full procedure be conducted, but the workup of the evaluation was really nice to see.

Swallowing Evaluation

Acute Care Policy and Procedures

I completed documentation on my patients per Guthrie Cortland Medical Center's policy and procedures. Please see below for the dietary department's official policies and procedures.

Guthrie Diet Manual

Coding and Billing Procedures

The dietitians at Guthrie Cortland Medical Center see patients for additional outpatient services. However, these services are billed through the hospital system and not the dietary office itself. I reviewed which diagnoses (T2DM w/o insulin w/ hyperglycemia E11.65, T2DM w/o complication or insulin E11.9, g tube feedings Z93.1, stage 4 CKD N18.4, and gestational diabetes O24.410) are covered by insurance with the clinical dietitians.

Module 4 - Case Study

Case Study Paper

See below for my case study paper on working through the nutrition care process for a 58-year-old female patient with T2DM, Stage 3 CKD + other comorbidities.

Case Study Paper

Case Study Presentation

Attached is the PowerPoint presentation I created to go alongside my case study on a 58-year-old female patient with T2DM, Stage 3 CKD + other comorbidities.

Case Study PWPT

Case Study Evaluation Form

My preceptor's evaluation form is below with exceptional scores and comments describing the case study's informative explanations, appropriate MNT recommendations, and counseling.

Evaluation Form

Module 5 - Education and Counseling

MODULE 5 CHECKLIST

Group Education Lesson Plan

My group education was with the adult day healthcare program on March 4th. I spoke about nutrient-dense foods including their benefits, how to make them balanced snacks, and some examples. We also held a food demonstration of a sample healthy snack.

Lesson Plan

Group Education Evaluation Form

My preceptor, Siena Senn, attended my group lesson with Guthrie Cortland's Adult Day Care Program on March 4th and filled out the group education evaluation form below throughout the talk. Siena marked my lesson as satisfactory for the target population.

Evaluation Form

Motivational Interviewing

My preceptor also completed a motivational interviewing evaluation on my nutrition counseling techniques. At Guthrie Cortland Medical Center, we have both outpatient and in-patient nutrition visits. I was able to take part in both during my time there.

MI Evaluation Form

Module 6 - Long Term Care and Pediatrics

MODULE 6 LTC CHECKLIST

Review of State Inspection

During my food service rotation, I reviewed the New York State Department of Health and Human Services and Centers for Medicare and Medicaid Services inspection of Kendal at Ithaca with my preceptor Natalie.

NYS Inspection Results

MDS, CATs, & CAAs

The Dietitian has a sheet that summarizes how/when to complete the Minimum Data Set (MDS), Care Area Triggers (CATs), and Care Area Assessments (CAAs). I became familiar with these processes as I conducted quarterly assessments.

Protocol Familiarity

Therapeutic Diet Modification

The therapeutic diets Kendal at Ithaca offers include small portions, mechanical soft, pureed, low sodium, and low fat. See below for the outline of each diet and the corresponding menu printout for residents.

Therapeutic Diets

Adaptive Eating Devices

I reviewed the adaptive eating devices the Occupational Therapist, Noah, uses at Kendal at Ithaca and observed proper usage of the devices during my meal rounds with Natalie. See below for descriptions and photos.

Assistive Dining Aids

Meal Rounds

I rounded during mealtimes in the assisted living and skilled nursing dining rooms, observing intakes and resident satisfaction. Dining staff typically record the caloric intake of residents after each meal and input this information into a binder.

Meal Rounds

Medical Rounds

I attended wound rounds alongside Cecilia (RDN) and Jeanne (Nurse Educator) on 10/28, 11/4, 11/6, 11/13 checking in on residents with pressure injuries and open wounds. Below are my notes on the measurements, characteristics, and treatment.

Wound Rounds

Adaptive Eating Devices

Assistive Dining Aids

Follow-up/Reassessment Documentation

Utilizing Matrixcare, I was able to conduct nutrition follow-ups and write assessment documentation for several residents. Below you can see my notes, which became cleaner with routine practice.

Follow-up Documentation

Therapeutic Diet Modification

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MDS Quarterly Assessments

I assisted the Clinical Dietitian in completing MDS quarterly assessments. Using the EHR, I was able to fill out my Encounter Summary Forms based on resident encounters, daily charts, and IDT notes.

MDS Assessments

Interdisciplinary Meetings

I attended interdisciplinary meetings twice a week with a range of professional disciplines, including physicians, nurses, physical therapists, occupational therapists, speech pathologists, and dietitians.

Nutrition Care Plans

In Matrixcare, care plans for a resident can be updated and nutrition specifically falls under section 12. Throughout my clinical rotation, I made sure the nutrition care plans were up-to-date when new developments occured.

Nutrition Care Plans

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Interdisciplinary Meetings

IDT Meetings

Enteral & Parenteral Nutrition

Kendal at Ithaca does not have any residents on nutrition support or with feeding tubes. My preceptor created a case study where I pretended a resident needed enteral nutrition to practice calculating out an order.

Nutrition Support

MBS, FEES or VFSS

I reviewed a Modified Barium Swallow (MBS) report on one of the residents who received this study on 09/19. I tracked the communication between the different professional disciplines, including the physician, SLP, and RDN.

MBS Report

Pediatrics

MODULE 6 PEDS CHECKLIST

I attended the 2025 Dietetic Intern Virtual Pediatric Nutrition Class Day hosted by the Children's Hospital of Philadelphia on Friday, February 21st, 2025. This virtual class day counted towards my pediatrics competency as there was no opportunity to work with children at my acute care rotation.

Case Study #1

Case Study #2

CHOP Class Day

Module 7 - Advocacy for Self and the Profession

MODULE 7 CHECKLIST

LinkedIn Profile

I have updated and maintained a LinkedIn profile since my undergraduate studies at Marywood University. Please see below for a direct link to my homepage.

LinkedIn Profile

Resume

I continually update my resume to reflect the professional experiences and accomplishments I have throughout my undergraduate and graduate studies. Please see below for a copy of my resume, also under the "RESUME" tab at the top of this ePortfolio.

Resume

Cover Letter

Below are cover letters I wrote for a Sports Dietitian position at Penn State University and a Seasonal Performance Nutrition Associate position with the Philadelphia Eagles. As I continue to apply to roles in my desired field, I will individualize the cover letters per the specific job description provided.

PSU Cover Letter

Eagles Cover Letter

Elevator Speech

Attached is a 90-second elevator pitch that is similar to introductions I have used during my interview processes.

Salary Negotiation Practice

Please see below for my completed salary negotiation case study answers.

Salary Case Studies

Mentoring Experiences

During each of my rotations, I was able to be a mentor for both undergraduate and high school students. Throughout my community rotation at Cornell University, I helped lead a social media team of undergraduate nutrition major students in creating sports nutrition infographics for the Instagram page @BigRedFueling, and managing a social media calendar for everyone to follow. At my food service and long-term care rotation at Kendal at Ithaca, I was a mentor for an undergraduate Cornell student working on her DICAS application and getting experience in both food service and clinical. I also created and taught an older employee a new digital inventory system and participated in a career fair at a local high school for students interested in working as cooks in a kitchen. Lastly, at my acute care rotation at Guthrie Cortland Medical Center, we spent mornings once a week with high school students interested in working in healthcare. I would work through my patient screening and charting with these students and bring them to the IDT meetings. I enjoyed all of these mentoring experiences because they allowed me to teach valuable insights and show how much I have learned throughout my schooling and internship alone. I loved being the encouraging leader in each of these cases.

Value of Precepting Others

I think it is extremely important that dietitians provide the opportunity for young students and dietetic interns to learn from their experiences and specific workplaces. I am extremely grateful to all of the Dietitians (many Marywood alumni!) who so graciously took me under their wing and allowed me to learn and grow as a young nutrition professional. Their insights were invaluable and I would not have been able to take as much from my rotations for my future practice without them. I will definitely be partaking in precepting both undergraduate and graduate students in the coming years, as a way to give back to our close-knit community of Dietitians. I am hoping to land a job as a Sports Dietitian out of school and as this is a field that many undergraduates at Marywood are interested in, I would welcome these students to help with nutrition education infographics for athletes on the university's social media page and have them visit if they want for an on-site day-in-the-life as a Sports Dietitian for a great look into what this field is like.