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- Lordly, Daphne MA PDt3
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- Buchholz, Andrea C PhD RD2
- Carrier, Natalie PhD RD2
- Duizer, Lisa PhD2
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- Lordly, Daphne DEd PDt FDC2
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- Mager, Diana R PhD RD2
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- Prior learning assessment (PLA) is a process for documenting competence gained through formal and informal opportunities. It has been endorsed by adult educators but is not widely used in dietetic education. Graduate students at a Canadian university, who have prior learning relevant to dietetics, are given the opportunity to develop a portfolio documenting competence in lieu of portions of formal internship experience. An exploratory descriptive methodology is used to describe the experiences of graduate students (n=6) and faculty (n=3) who participated in this innovative program from 2000 to 2005. All students successfully completed portfolios for one-third or more of their internship. After completing the documentation process, students participated in semi-structured interviews consisting of 16 open-ended questions. Faculty completed a five-item survey designed to capture their experiences with the PLA process. Student and faculty data were thematically analyzed and several risks and benefits were documented. Results indicate that, overall, both students and faculty viewed the PLA as a positive experience. Because of the limited placements available for practical internship experiences, PLA can be a useful process for the confirmation of dietetic competence.
- The Media and the Message – Promoting Healthy Eating and Active Living for Diabetes Prevention was a project aimed at raising awareness of diabetes risk factors and enhancing the public's access to credible, up-to-date, healthy eating and active living messages in the media. Cross-country workshops were held to teach media strategies and key diabetes prevention messages to multidisciplinary groups of health professionals. Evaluation was integral to the project; both the process and outcomes were assessed using Health Canada's Population Health Approach. Timeline and budget were tracked. Questionnaires were created to evaluate advisory committee conference calls and to determine participants’ perceptions of the 19 workshops and resources. A pre-workshop/post-workshop and three-month follow-up questionnaire format, along with an online media-tracking tool, was used to collect outcome data and to measure changes in confidence and media behaviour. Sixty-three percent of participants (150 of 238) reported that multidisciplinary workshops were very valuable. Three-month follow-up revealed a significant increase in confidence in all media activities taught at the workshops, although this failed to translate into increased media activity. Sixty-eight percent (78 of 115) of responding participants disseminated workshop learning. Detailed evaluation revealed that multidisciplinary workshops are valued and effective in increasing confidence. However, eliciting behaviour change following a workshop remains a challenge.
- Wendy Gamblen BSc, RD,
- Sherri Schamehorn BASc,
- Anne Marie Crustolo BScN, RN,
- Tracy Hussey MSc, RD,
- Nick Kates MBBS, FRCP(C), and
- Sari Ackerman BEd
The Hamilton Health Service Organization Nutrition Program integrates nine registered dietitians (RDs) into the offices of 80 family physicians (FPs) at 50 sites in Hamilton, Ontario. The program is based on a shared care model, in which FPs and RDs work collaboratively to provide nutrition services aimed at prevention, treatment, and management of nutrition-related problems. In addition to their clinical role, dietitians in the program are involved in health promotion, disease prevention and early intervention strategies, interdisciplinary collaboration, building links with community services, and research. The RDs’ specialized knowledge, skills, and experience allow them to provide a wide range of services that complement and augment those of the FP. This model is consistent with Canadian health care reform recommendations and offers significant benefits for both health care providers and consumers.- Although nutrition risk is prevalent in Canadian older adults, the process of screening must be considered before nationwide programs can be recommended. A process evaluation of the Bringing Nutrition Screening to Seniors in Canada demonstration project was completed. Through the use of the 15-item Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN©) questionnaire, risk was identified in convenience samples of 1,196 community-living older adults recruited from five Canadian communities. All at-risk participants were offered referrals to community resources. Telephone follow-up of at-risk participants occurred after screening. Telephone interviews with screening administrators and older adults revealed screening benefits and challenges. Nutrition risk occurred in 38.9% of the sample. Most participants found screening helpful. Among the at-risk group (n=465), 39% accepted referrals for additional services. Older adults provided several reasons for refusing referrals, including denial of risk. Dietitian services were an identified gap, as were prevention-level resources. Nutrition risk is prevalent and older adults can benefit from screening. Training, ongoing support, and prioritization (policy, time, and money) are needed for sustainable screening programs. Before implementation of a nationwide screening program, sufficient and appropriate community resources are required, as is a national strategy for screening older adults.
- This article outlines the processes undertaken to revise Canada's Food Guide and shares the updated science that underpins the dietary pattern. The Dietary Reference Intakes provide updated nutrient requirement values and better tools for dietary assessment and planning. Alignment with this updated science was an important component of defining and communicating accurate dietary guidance for Canada. Ensuring that stakeholders had access to the updated review of requirements led to the development of the text Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Equally important was ensuring that stakeholders were provided opportunity to influence the approach taken to giving dietary guidance, both content and the elements of the final package. A combination of research, consultation and expert advice guided the process to the release of Eating Well with Canada's Food Guide(2007).
- Purpose: Dietetic internships provide practical experience leading, in most cases, to the attainment of entry-level dietetic competence. Problematic intern performance issues were examined, as were how educators resolve these issues and the supports they require to manage them. Methods: A survey was electronically distributed to all Dietitians of Canada internship/university course directors (n=57). The response rate was 40% (n=23). Results: Annually, 61% of internships involve challenging performance issues related to intern knowledge, skills, attitude, and behaviour. These issues manifest themselves individually or in combination as an intern's inability to apply/demonstrate appropriate knowledge/skill, a view/approach to the profession that is not in keeping with the organizational view, an attitude that is in conflict with program values, a negative response to feedback, an inability to relate to others, work habits that are in conflict with program values, and personal attributes that detract from the ability to meet program expectations. Educators respond to these issues by modifying their communications, the learning environment, and the program. Conclusions: Educators’ strategies could be enhanced through consultation with other educators, mentor training, and the development of formal procedures.
- Parkinson’s Disease (PD) is a chronic, progressive, neurodegenerative disease. People with PD are particularly susceptible to weight loss and malnutrition. Involuntary movements associated with PD result in increased energy expenditure, while both disease symptoms and medication side-effects can limit food intake. In addition, patients with the disease may choose to follow unconventional nutritional therapies that exacerbate malnutrition. Dietitians play a key role in helping patients with PD to optimize their nutritional status and manage various nutritionrelated symptoms and medication side-effects. To assume this role, dietitians need to have current knowledge about PD and its nutritional consequences, as well as strategies for managing a variety of nutrition-related symptoms.
- In Canada, professional standards mandate that dietitians should use a client-centred approach to provide nutrition counselling services. Although most dietitians would probably agree that this is an important standard, how this mandate is translated into our daily practice is not always clear. The purpose of this paper is to explore the origins of the “client-centred approach” used in dietetic counselling. A historical review of selected dietetic literature is used to demonstrate the evolution of this term, the multiple meanings associated with it, the remaining ambiguity in dietetic practice today, and the need for further research.
- For decades, public health promotion campaigns on bone health have emphasized the importance of adequate calcium and vitamin D intakes, as well as weight-bearing physical activity. However, no obvious consensus has emerged on the role of dietary protein. To identify what agreement does exist in the literature, in this article we review the theoretical basis for protein’s role in bone health, assess some recent cross-sectional and prospective studies, and generate recommendations for practice. There is general agreement in the literature that higher protein intake increases urinary calcium loss; the body compensates for this loss by increasing calcium absorption in the gut, providing that calcium intake is sufficient. A possible explanation for calcium loss, the “acid-ash” hypothesis, is discussed, and suggestions are made about food choices that may counter the calciuric effect of protein. A survey of cross-sectional and prospective studies shows equivocal results, with confounding variables complicating the analysis. Both deficient and excessive protein intakes have been shown to affect bone health negatively, although lower and upper thresholds have not been determined. Practical advice on achieving bone health is given, with an emphasis on the use of Canada’s Food Guide to Healthy Eating in setting dietary goals.
- Each year in Atlantic Canada, a dietetic internship forum is held to inform potential dietetic interns of internship opportunities. This paper provides information to those planning similar events, and seeks to enhance knowledge of students’ information-seeking strategies in the internship selection process. The objectives of this study were to 1. profile students who attended the 2000 forum, 2. determine their intentions, 3. determine how – and if – the forum influenced internship selection, and 4. determine overall satisfaction with the forum. A 23-item questionnaire was used to collect data from 52 forum participants (100% completion rate). Results indicated overall satisfaction with the forum. Prospective interns seek, use, and value information about potential training choices, particularly when that information concerns programs outside the Atlantic region. Participants indicated that the forum helped confirm or alter pre-forum perceptions of their first and second internship choices. The results suggest that alternative types of presentations, which would include out-of-region internship opportunities, should be explored to meet students’ needs for information better.
- The implementation of school nutrition policies poses a challenge to dietitians as they work with schools to increase the availability of nutritious foods. An analysis of the implementation of the Food and Nutrition Policy for New Brunswick Schools, proclaimed by the department of education in 1991, revealed four factors that influenced implementation: selling food for profit, student choice, interpretation of the policy, and the approach to implementation. From 1997 to 1999, data were obtained from 50 participants at the provincial, district, and school levels through semi-structured interviews; supporting evidence was obtained through a review of pertinent documents. The policy goal was to develop good eating habits among schoolchildren. The policy objective to have all food services follow national guidelines for healthy eating was so controversial that implementation was inconsistent and had little impact on school foods. Opponents objected when the sale of certain foods was curtailed, felt the policy limited student choice, were unsure how to interpret it, and resented the department's top-down approach. Dietitians, who had minimal involvement with the New Brunswick policy, need to consider carefully how to work with educational agencies to combine support and pressure to foster the capacity and willingness of schools to implement nutrition policies.
- To evaluate the impact of the Calgary Health Region Collective Kitchen Program on various Population Health Promotion Model health determinants, data were collected through mail-in questionnaires that examined the members’ (n=331) and coordinators’ (n=58) perspectives of the program. Seventy-nine members (24%) and 26 coordinators (45%) were included in the study. Three incomplete questionnaires (from prenatal program members) were discarded. Sixty-one percent of members who reported income level and family size (n=61) had incomes below the low-income cut-off. Fifty-eight members (73%) reported improvements in their lives because of the program. Sixty-four members (81%) perceived they learned to feed their families healthier foods. The members reported their fruit and vegetable consumption before and since joining a collective kitchen, and the proportion of those consuming at least five fruit and vegetable servings a day rose from 29% to 47%. The most common reasons for joining this program concerned social interactions and support. Over 90% of the coordinators perceived that they were competent to coordinate a kitchen. The results indicate that the collective kitchens program addresses several health determinants, and may increase members’ capacity to attain food security and to achieve improved nutritional health.
- Paula Brauer PhD, RD,
- Theresa Schneider MPH, RD,
- Christine Preece BA, MHS,
- Deborah Northmore RD,
- Eva West RD, CDE,
- Linda Dietrich MEd, RD,
- Bridget Davidson MHSc, RD, and
- Steering Committee
Purpose: Primary health care reform presents new opportunities for registered dietitians (RDs) to contribute to health promotion and disease prevention in family practices. Since this is an emerging area of RD practice, a health promotion specialist was contracted to conduct a needs assessment and develop a plan for implementing nutrition-focused healthy lifestyle activities. Methods: The needs assessment was conducted as part of an Ontario-based demonstration project in three Family Health Networks (FHNs). Results: The needs assessment revealed a lack of agreement about what types of activities should be undertaken, a lack of information on the population's needs, a lack of coordination with other agencies in the community, and barriers of time and resources. The health promotion specialist recommended that health care team members in each FHN develop a shared understanding of their goals, and undertake the entire planning and evaluation cycle. Specific strategies were suggested to increase awareness, to provide health education, and to improve environmental support. Conclusions: A significant need exists for conceptual development, planning, testing, and evaluation of disease prevention and health promotion in family physician-based primary health care organizations. The findings may be useful to others interested in increasing the focus on health promotion and disease prevention in such practices.- Purpose: Individuals with mental illness are at nutritional risk because of health, social, and economic factors. To address this problem, the Canadian Collaborative Mental Health Initiative (CCMHI) and Dietitians of Canada (DC) commissioned the development of a toolkit that outlines the role of the registered dietitian (RD) and advocates for RDs in primary health care (PHC) mental health programs. Methods: The development of the toolkit followed a fourstage process: a comprehensive literature review, a focus group discussion with a national working group, interviews with consumers about RD services, and evaluation of the toolkit. Results: The costs of mental illness in Canada are at least $6.85 billion per year. Currently, little evidence exists on how RD services can reduce these expenses. The focus group identified accessibility as the predominant issue facing individuals with mental illness. To explain consumer experiences with RD services, a three-tier theory based on in-depth interviews was developed. Consumer experiences with RDs occur in five categories: financial concerns, perception of service, status of mental illness, engagement, and self-esteem (tier 1). These are further influenced by five individual and contextual factors, e.g., social environment, the mental illness (tier 2), which are weighed as benefits and barriers instrumental in determining actions (tier 3). Conclusions: The evaluation of the final draft of the RD toolkit confirmed that it reflected the visions of PHC. The toolkit is intended to act as a blueprint for action. Dietitians are encouraged to use its contents to advocate for positions in mental health PHC settings.
- John J. M. Dwyer PhD,
- Denise Vavaroutsos MHSc, RD,
- Ann Lutterman MEd, RN,
- Michelle Hier BASc, RD,
- May Hughes BScN, RN, and
- Mary-Jo Makarchuk MHSc, RD
This article illustrates how empowerment evaluation was used in Toronto Public Health’s (TPH) nutrition programming redesign to consult with staff about how roles, responsibilities, and organisational structure could be changed to improve how nutrition programs are delivered. One of three moderators facilitated the ten two-hour focus group sessions in TPH. TPH staff, namely 71 front-line staff and 13 managers who were responsible for providing community nutrition services, participated in the study. Focus group participants included Public Health Dietitians, Public Health Nutritionists, Public Health Nurses (PHNs), and paraprofessionals (i.e., community nutrition assistants). Participants’ preferred roles, responsibilities, and organisational structure in TPH, which they believe would improve nutrition service delivery in the community, were examined. A constant comparison approach was used to develop themes inductively. It was found that participants wanted Dietitians and Nutritionists to provide current nutrition-related information to them. They felt that nutrition programs should be promoted better and made more accessible to the public. They suggested that Dietitians and Nutritionists and other staff should share information with each other better. They suggested that Dietitians and Nutritionists should provide nutrition services directly to the public and provide support to other staff, mainly PHNs, who deliver nutrition programs. In conclusion, this empowerment evaluation produced results that were used to assist in decision making about nutrition programming.- Shelley Williams BASc, RD,
- Krista Witherspoon BASc, RD,
- Peter Kavsak PhD,
- Cyndi Patterson MSc, SLP, Reg. CASLPO, and
- Jacqueline McBlain Bsc, OT, Reg. (Ont.)
In 1995, Oshawa General Hospital (now Lakeridge Health Corporation, Oshawa site) developed an interdisciplinary feeding and swallowing clinic to serve children with feeding problems. After four years, a retrospective chart review of 104 subjects was completed to assess the performance of the clinic, which consists of a pediatrician, a speech-language pathologist (S-LP), an occupational therapist (OT), and a registered dietitian (RD). Goals were set at the initial and follow-up visits. These goals were individualized according to client needs and were related to improvements in growth and/or feeding abilities. During this period, 176 of 232, or 75.9% (70-81, 95% confidence interval), of the initial goals were attained by the first follow-up visit. Progress in the clinic, as measured by the number of goals achieved by the first follow-up visit, was further analyzed according to the patient age group/category (i.e., infant, toddler, and child) and by the health care professional (i.e., S-LP, OT, and RD) to ascertain and compare success rates in these groups and professionals. The overall success rates in the patient age groups (p=0.07) and among the different professionals (p=0.92) were not significantly different. In short, the interdisciplinary team approach proved successful in treating feeding problems in patients referred to the clinic.- Although enteral formularies emerged over 30 years ago, their effectiveness remains to be clearly demonstrated. Enteral formulary (EF) development has occurred over 17 years at the Toronto Rehabilitation Institute (Toronto Rehab), and a historical account is available in the literature. At Toronto Rehab, the creative process begins with a review of specific nutrition support requirements for each patient population, which is coupled with a clinical decision-making algorithm to promote standardized clinical nutrition practices and selection of products. The requirements are translated into detailed product specifications for a streamlined array of oral and tube-feeding formulae. Despite outsourced food service systems, the feasibility of simple in-house production should be considered to help curtail overall costs. The promotion of consistent practices requires nutrition support guidelines, including indications and contraindications for each EF product. Competitive bidding practices and policies that scrutinize non-formulary requests and encourage automatic substitution for non-formulary products promote formulary adherence and contain costs. Ongoing evaluation is intended to capture changes in patient populations and product availability to target opportunities for future EF revisions.