My Scope of Practice: Nourishing Mind, Body, and Soul

  Let food be your medicine and medicine be your food. — Hippocrates

  Young Hee Kim, MS, RD, LDN, CNSD, wanted to pursue a career in healthcare and was drawn to the science of nutrition. She earned her Bachelors and Masters degrees at Indiana State University and interned at St. Vincent’s Hospital in Indianapolis. She also served as a clinical dietitian specializing in renal nutrition at Baystate Medical Center in Springfield, Mass, a tertiary care, level I trauma center affiliated with Tufts Medical School. Currently, she is a Clinical Nutrition Manager at Mercy Medical Center and Providence Behavioral Health Hospital (members of Sisters of Providence Health System) in Springfield, community hospitals that focus on rehabilitation, acute care, and behavioral health.

  Young Hee has been called “top notch” by co-workers and industry representatives. During her 17 years in nutrition, she has developed numerous protocols to improve both the role of the dietitian and the nutritional care of patients. For her exceptional commitment to clinical nutrition and its practical application, Young Hee was one of two 2006 Nutrition Ambassadors named by the Nestlé Nutrition Institute. The award included a scholarship to attend the fifth annual Nestlé Clinical Nutrition Course in Glion, Switzerland in June 2006 where an international team of nutrition experts explored recent scientific advances in the field of nutrition and effective ways to apply them in a clinical setting.

  Young Hee’s care guidelines have application to numerous aspects of nutrition. In addition to creating a Nutrition Clinical Ladder, she developed a protocol for blood sugar management in patients receiving parenteral nutrition. She also has addressed nutrition for patients in renal failure, striving to provide adequate nutrition to promote wound healing and general well being while minimizing metabolic derangements. She works with ostomy nurses, enabling them to respond to patients who ask, “What do I eat?” with diet suggestions that help maintain normal eating habits.

  Young Hee’s protocols relevant to wound care require clinicians to perform a nutrition screen (see “Wound Care Nutrition Screen”). “When patients with wounds are at low to moderate risk, a nurse can suggest nutritional interventions,” she explains (eg, see “Tips on Improving Your Diet”). “High-risk patients with extensive wounds or with complex co-morbidities are referred to a dietitian for more in-depth counseling.”

  Acknowledging the “ceiling” in clinical nutrition career advancement, Young Hee modeled a Career Ladder for dietitians after a similar instrument for nursing. The career ladder recognizes expertise and involvement in patient care with financial reward and the opportunity to participate in ongoing learning. “Nutritionists deserve the professional and financial recognition afforded other medical fields,” Young Hee says.

  As Young Hee’s responsibilities evolve, she looks more at the big picture, helping to provide better and consistent care throughout the continuum of care. “It’s grown increasingly important to make sure staff and facilities meet standards and keep up-to-date and on the cutting edge of improvements to care,” she says. To that end, Young Hee started a journal club and clinical rounds to help ensure her team is current on diet-related information.

  “Initially, dietitians were ‘nice to have around’,” Young Hee says. “Now, physicians turn to us regarding nutrition-related issues, whether for oral diets or nutrition support. We are an indispensable part of the medical team, providing information on nutritional components such as specific amino acids, types of lipids, vitamins, and antioxidants in medical management of disease states and wound healing.”

  Excited by advancements in her field, Young Hee anticipates the day when treatment will be individualized to the patient’s specific genotype — ie, genetic-based nutrition. Although research has not reached the clinical practice level, a recent conference presentation noted that not all “healthy foods” (such as omega-3 fatty acids) have the same effect on everyone. Spurred by the increase of obesity-related diabetes, Young Hee sees a greater emphasis on prevention in terms of not only increasing quality of life, but also containing healthcare costs.

  “For anyone interested in nutrition, there has never been a better time,” Young Hee says. “The area is exploding — clinical dietetics, nutrition counseling, corporate wellness programs, and the food industry in general. There are so many avenues to pursue in my scope of practice."
 

My Scope of Practice is made possible through the support of ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ.This article was not subject to the Ostomy Wound Management peer-review process.