1. Dietetics
Reflective
practice
Orna O’Brien
March 2012

2. Description
Action plan Feelings
Gibb’s
Reflective
Cycle
Conclusion Evaluation
Analysis
Gibbs et al. (1988)

3. Framework
for
reflective
practice
Rolfe et al. (2001)

4. Description (summary of patient case)
PC: 36yo , referred to Community dietetics dept. by GP, for weight loss
advice
Dx: Wt: 138kg (rising) Ht: 1.76m Obesity III (BMI 44kg/m2)
PMHx: Sleep apnoea x 1y (untreated)
Dyslipidaemia (total cholesterol↑, LDL↑., HDL↓, Trigs↑)
SOBOE, attended PLAN in past, ? mild learning difficulty
Social Hx: Lives alone, unemployed non-smoker, non-drinker, poor mobility 2 to
weight
Nutritional Why did pt. feel he was here; previous wt loss attempts; acceptability
Ax: of weight/being weighed. Little confidence in weight loss ability.
Explained benefits of 5-10% wt loss.
Diet Ax: Poor meal pattern, portion size+++, treats+, good F&V, PA 3/7
(cycling/walking 45mins), night eating.
Goals set: Breakfast (porridge measurements, toppings, fruit, water)
Biscuits (buy ½ packet, have after evening snack)
Plate model
Sleep clinic discussion
(potato portions)

5. Feelings
On
Initially
Reflection

6. Evaluation
Positive
• Sensitive, non-judgemental attitude and
approach1
• Expanded knowledge
• Insight into human behaviour
Negative
•Bad judgement – put my own assumptions
ahead of the patient’s capabilities
•Readiness to change
1 DOM, UK (2008, 2011)

7. Analysis
Significant
learning
Flexible Practical
experience
Input
Research1,2,3 from
others
What
Did my What did I
was I
advice base my
trying to
help? actions on?
achieve?
1 Dept. of Health, UK (2006); 2 INDI (2007); 3 DOM, UK (2008)

8. Conclusion
How does this learning experience
integrate into my dietetic practice?
• Lessened the gap between theory I learned in
college and practice I learned in placement
• Improved quality of care for patients through
patient-tailored assessment and goals

9. Action plan
• Assess readiness to change: • Understanding patients
thoughts on referral
o Is your weight affecting your life in any
• Expectations of treatment
way at the moment? (UK DH, 2006) • Motivation to change
lifestyle
• Weight history
• Referral to relevant health services • Dieting history
• Patient understanding of
obesity
• If patient not ready to change: • Potential barriers to
o Reassure that I am available to talk change
about it when he/she is ready • Eating patterns
o Briefly advise on the risk of overweight • Current lifestyle: dietary
intake and physical
& benefits of weight loss
activity
o Offer an appointment in, e.g. 6 • Support networks
months.

10. References
UK Department of Health (2006) Care pathway for the management of
overweight and obesity. London: DH.
Weigh Management Interest Group, INDI (2007) Position of the Irish
Nutrition and Dietetics Institute: weigh management. Available at:
http://www.indi.ie/docs/979_94_wmig.pdf [accessed March 16th 2012]
Grace C, Pearson D et al. (2008) DOM, UK: The Dietetic Weight
Management Intervention for Adults in the One to One Setting: is it time
for a radical rethink? Available at: www.domuk.org/docs/dietetic-
interventionfinalversion301007.doc [accessed March 18th, 2012]
Grace, C. (2011), A review of one-to-one dietetic obesity management
in adults. Journal of Human Nutrition and Dietetics, 24: 13–22.
doi: 10.1111/j.1365-277X.2010.01137.x

11. References
Rolfe et al. (2001) Framework for reflective practice, as cited by Students
Learning with Communities: information for students: resources. Available
at: http://www.communitylinks.ie/students-learning-with-
communities/information-for-students/resources/
[accessed March 23rd, 2012]
Gibbs et al. (1988) Gibb’s Reflective Cycle, as cited by Students Learning
with Communities: information for students: resources. Available at:
http://www.communitylinks.ie/students-learning-with-
communities/information-for-students/resources/
[accessed March 23rd, 2012]

12. Thank you!
Any questions?