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1. A Reflective Account On The Decision Making Process Essay.
A Reflective Account On The Decision Making Process Essay. For this assignment, I have
used Gibbs reflective cycle to reflect on the impact of psychosocial and cultural issues on
decision making in dietetic practice. In this reflective piece, I have focused on how these
factors contribute to malnutrition in the elderly.A Reflective Account On The Decision
Making Process Essay.ORDER A PLAGIARISM-FREE PAPER HEREMy patient was a 79 year
old Caucasian lady, referred for nutrition support. She had experienced an unintentional
weight loss of 10 kilograms ('kg') over two years, since losing her husband. Her weight loss
had become a serious concern for her, which led to her referral by her general practitioner
('GP').A Reflective Account On The Decision Making Process Essay.During the consultation,
she explained that she had lost 3kg in one month, which is when she started worrying as
she noticed her clothes were loose. I examined her food diary and asked further questions
to get an overall picture of how she was managing and if other factors were affecting her.
She seemed to have an adequate diet, although at her last visit to her GP eight months prior,
she was informed that she had impaired fasting glucose ('IFG'). She therefore decreased her
intake of sugary foods for fear of becoming diabetic.A Reflective Account On The Decision
Making Process Essay.When she mentioned she had lost her husband of 55 years, I
immediately thought this was the reason for her weight loss. She admitted having battled
with loneliness and depression for a while and that support from her son and family was
helping her through this difficult time. However, although they visited at weekends, she had
no other social support. She spent her time at home except for when she was out doing her
weekly shopping.A Reflective Account On The Decision Making Process Essay.Several
psychosocial factors emerged from this part of the consultation including bereavement and
the state of depression, which she endured following this traumatic event .A Reflective
Account On The Decision Making Process Essay.A significant attribute of bereavement and
depression is appetite loss. She no longer had anyone to appreciate her cooking efforts and
the deprivation of companionship at mealtimes became a reminder of her loss. A time of
communication, joy and bonding had become a painful experience, leading to lack of
interest in any activity related to food or eating, making it more of a chore .A Reflective
Account On The Decision Making Process Essay.Eating is a social variable and part of our
self and social identity, which also makes it a cultural variable. It is a structured part of one's
everyday life and a valued social activity for most married people. Food habits developed
throughout life are an important component of culture and strongly influence food
decisions. The stress of bereavement can alter the social, psychological and cultural

2. significance of food during this time .A Reflective Account On The Decision Making Process
Essay.Other psychosocial determinants include access to food, and ability to cook and share
meals with others . The patient was shopping for herself and consuming ready meals as she
still struggled cooking just for one. It is common for elderly people to consume ready meals
as it is convenient since they can buy and freeze them, and they are single portions . She
only cooked when her son came to visit.A Reflective Account On The Decision Making
Process Essay.I suggested joining a social club in the area, which could help improve her
morale . Meal ambiance has been shown to improve levels of ingestion and is an important
stimulus modulated to help increase appetite in places such as nursing homes .
Unfortunately, she suffered from urinary incontinence ('UI') and found it embarrassing to
urinate so frequently when around people, so she declined.A Reflective Account On The
Decision Making Process Essay.I decided it was best to encourage her in relation to her diet
so that she felt she was already doing something to help herself and that her coming to see
the dietitian would add to her efforts in trying to gain weight .Relocation and change of
environment can also yield negative outcomes in terms of psychosocial disturbances such
as, anxiety, depression and loneliness, associated with transferring from one place to
another .A Reflective Account On The Decision Making Process Essay.She had recently
moved to a smaller house, which was a stressful time for her. She had settled in but had had
a hard time adjusting. This is an area I should have explored further. For example, had she
made friends in the area; had she changed her eating habits due to limited access to foods
she was used to having and so forth. These issues would have impacted on her intake and
weight if they were causing her anxiety or depression .A Reflective Account On The Decision
Making Process Essay.Financial constraint is another psychosocial factor to consider when
giving dietary advice, as unaffordability affects intake . Cognitive decline is also associated
with reduced intake in the elderly as they may not have the desire to eat or may forget to do
so .A Reflective Account On The Decision Making Process Essay.According to her food diary
and where she mentioned she was shopping from, she was not restricting herself. She was
consuming three meals a day with snacks. However, as research suggests, misreporting of
food diaries is common where patients try to present themselves more favourably .
Alternatively, keeping the food diary may have acted as a reminder for her to eat. However,
this issue was not explored on this occasion.A Reflective Account On The Decision Making
Process Essay.Another psychosocial issue I considered was the food anxiety which had been
created following the IFG test. Her GP had told her she was in the pre-diabetic stage and so
she had eliminated most fruit and all high sugar foods from her diet as she was worried
about becoming diabetic.Food habits are a set of culturally standardised set of behaviours
which have been reared in individuals from childhood. Therefore, every person has a
culture which dictates their eating behaviour . The burden of disease caused her to change
her eating habits . She was anxious about eating foods with sugar, which formerly was a safe
component of her diet. I explained that she did not have to exclude sugar from her diet
completely. This created confusion as my advice was conflicting with that of her GP's. I
clarified that she could still have small amounts of sugar in her but that she was wise to
reduce on pure forms of sugar e.g. sweets. She was relieved to discover this and seemed
happier that she could relax her diet.A Reflective Account On The Decision Making Process

3. Essay.When negotiating her goals, I explored the cultural aspect of her diet as her
compliance would be affected if I did not consider her current dietary habits. I looked at her
meal pattern and food items. When discussing the food fortification process, I was able to
relate this directly to specific foods in her diet. Using the appropriate wording is also
important as for some, dinner may be evening meal, and tea may be a tea break mid-
afternoon .By the end of the consultation, the patient said she felt better following our
conversation as she had a clear idea of what she had to do. I wrote down her plan and she
said she would buy herself some nice treats on her way home. I hoped that giving her tips
on food fortification would give her more of an incentive to eat .A Reflective Account On The
Decision Making Process Essay.Having explored this case in depth, I feel I could have been
more thorough about her social life. I could have found out if she had close friends whom
she could catch up with over cake and tea. Also, I could have suggested she see her GP about
the UI as research shows that behavioural treatment, drugs, exercise or a combination of
these can help better control UI. In turn, solving or reducing this problem could restore her
confidence in leaving the house more often and lead to her increasing her social network . I
could also have asked about her hobbies as this may have helped generate ideas to help
improve her morale aswell .A Reflective Account On The Decision Making Process Essay.If I
were to deal with such a situation again, in addition to what I did in this consultation, I
would explore more of her cognitive function to see if this was having an impact on her
intake. Decline in sensory function can also cause reduced intake as foods no longer taste or
smell the same. Forgetting to eat is also common and may require distinct measures such as
using an alarm clock as a reminder. I assumed that she was eating well from what she
showed me in her food diary but I could have been more flexible in my questioning which
may have helped to determine whether she was forgetting to have her meals .A Reflective
Account On The Decision Making Process Essay.