Approaching the Finish Line

During the initial months of my internship, I was challenged to record regular reflections on my internship experience. I did routinely do this, however, due to the intensity of the internship not all reflections were documented on my blog or even on paper. Reflecting allowed me to ascertain the learnings I had experienced in my day/week/rotation and enriched my overall internship experience. It is a practice that I will continue upon successful completion of my internship (graduation day is July 20th, 2012 which is also my final day of internship).

Highlights:

§  Public Health

o   Interacting with people from different communities in the District Health Authority (DHA)

o   Seeing and experiencing rural Nova Scotia! Great people and beautiful scenery.

o   Learning the intricacies of public health policies

o   Not an area of dietetics in which I see myself practicing (although, I will not rule out the possibility), but I have enormous respect for Public Health Nutritionists and the complexity of their roles with public health.

§  LTC

o   Participation in resident special activities: Christmas teas and Christmas concert

o   The comfort I felt in the role and excitement I had going to work daily. I really enjoyed being amongst the Residents, staff, and other health professionals. Definitely an area I would love to work in.

§  Clinical

o   Increasing comfort level with enteral and parental nutrition prescriptions. I am proud to say that it did not take me the better part of an hour to write out a total parental nutrition (TPN) prescription by the end of my 13 weeks. Furthermore, I, most importantly, became trusting of my eduction and knowledge and what I wanted to recommend for patients. Confidence in my skills grew over the course of my 13 weeks in clinical (+ 1 week in the Diabetes Education Centre).

o   Increased comfort interacting with patients and providing diet education.

o   Observing the dietitians during patient and family interactions. Learn tips and tricks in diet education and various ways to interact with patients and their family. I learned methods that I'd like to emulate in my practice, and methods that I will try to avoid.

o   Working with the Speech-Language Pathologist (SLP) for swallow assessments and Modified Barium Swallow tests.

o   Interprofessional Learning Experience (IPL) - which I blogged about previously. I was also given the opportunity to co-facilitate an IPL team. Which I found enormous benefit in - but this I speak more of in my "Most Significant Learning Experiences" section below.

§  Administration/ Food Service

o   Co-facilitating IPL

o   Program planning and implementation

§  Completing projects and assignments relevant to the workplace

§  Collaborating with interns from other DHAs for projects.

·         Admin - Patient satisfaction survey; food service staff information session on NS Healthy Eating Initiative: Salt by Request provincial TeleHealth session.

o   Participating in dietitian and food service supervisor interviews

o   Conducting reference checks for interviewees

 

Most Significant Learning Experiences

§  My most significant learning experience occurred when speaking with the other dietetic interns in the DHA who recently began or returned to complete their internships. I found myself enjoying sharing what I had learned and instructing them on certain topics. I got excited when they got excited about internship and what they too will learn. I hadn’t before experienced the joy that came with sharing my knowledge and it made me excited for when I am a preceptor for an internship program. Additionally, co-facilitating the IPL team in oncology and palliative care was a great experience. This spring there were two IPL sessions running simultaneously. A stroke team and an oncology/palliative care team. Disciplines representing in the entire group included: SLP, dietetics, nursing, occupational therapy, diagnostic cytology, and respiratory therapy. I was eager to plan the team meetings and search for resources for the students. I enjoyed hearing them reflect on the multidisciplinary rounds they attended and of their experiences in the hospital. I believe that I will really enjoy the preceptor and instructor component of being a dietitian.

§  The importance of a supportive environment

o   Research results: my internship research  projects focused on factors that contributed to a supportive environment for the Food and Nutrition Policy for Nova Scotia Public Schools.

o   Experiences in internship with preceptors and other health professionals

§  Majority of my preceptors fostered learning: encouraged me and gave me a push when I needed it. When I wasn’t provided with the supportive environment, I felt initially discouraged, then used it as fuel to try and excel to show me, not the preceptor or other health professional, what I was capable of when I only had myself to depend on.

 

Unexpected Learning Events

 §  DC National Conference

o   Interactions with others

§  How I treat others and how I want to be treated. Respect!

§  Perhaps it is because I am naive and want to think the best of everyone, but I was taken aback when conference delegates didn’t want to interact with me aside from the basic “I’m from ___” (which seemed to usually be just the province, not city or town) and then stopped the conversation with that.

§  Additionally, I was surprised by an encounter with a dietitian whom I had met previously and corresponded with. I'll spare you the story, but the situation definitely took me by surprise and solidified in my mind that I will treat each person with respect and make an effort to remain positive despite how I am feeling that day, even if someone is being rude to me. I’m not certain why I was regarded with such disrespect, but I know that I will take it as a learning experience for the kind of professional and person I want be.

§  With that said, there were many dietitians whom were eager to interact even if just briefly. I went to the Conference with a goal of meeting as many new people as I could – and was delighted when people took an interest in me as well. I believe that professionally, networking is key in an ever-changing profession such as dietetics. I was delighted to discover that the majority shared this belief and practice. The conference itself was so much fun! I really enjoyed seeing Acadia University alums, made some new friends and acquaintances, and learned a lot from the sessions (educational, key note speakers, and research displays). I'm so grateful that I was given the opportunity to attend (I received sponsorship from the Gerontology Network of Dietitians of Canada as a student member - I applied, they granted).

§  Discussing my casual position with a friend, I was explaining how I deescalated an angry principal who thought I had the power, and the intention, of closing down the school’s cafeteria. As I was explaining the situation to this friend, I could hear the difference in my approach to the situation, in comparison to when I initially started my internship. My friend pointed out this change as well. I let the principal express his concern fully and when he was finished calmly responded. I told him that he is not alone with his concerns and that I had heard them from numerous principals in schools I assessed (which is true). I then explained that I have no intention, or capability, of saying or doing anything in regards to whether the cafeteria remains functioning. My job was to ask questions and to observe the food service workers do their jobs so that I can find ways in which the school board and public health may be able to help them comply with the NS Food and Nutrition Policy. I let him know that I was in the school simply to find ways in which we could support the food service workers in their role. So quite the opposite to shutting down the cafeteria. This conversation showed me how far I have progressed in my education during my internship and was a real "ah-ha" moment for me in my internship.

Challenges I Encountered

 §  Trying to keep sane while completing all internship assignments and projects up to my standard of quality.

o   Organization is important! Throughout my career as a student in both culinary school and at Acadia University, I started projects and assignments as soon as they were given to me. I did this in case something came up in the future that would limit my time available to complete the project and do so well. In the past, the quality of my work declined when it was completed close to the due date, so I knew to not leave assignments to the last minute. In my internship, I continued to start and complete assignments as soon as possible, however, the timelines and due dates got shorter and the quantity of work increased immensely. I found that I was able to rise to the challenge and produce high quality work in short periods of time. My stress level was high, but I’m proud to say that I not only got through it, but received positive feedback from my preceptors on my assignments/projects.

Key Message I Learned During My Internship

§  A supportive environment in which to learn and to teach is important and I believe a key to success and satisfaction in one's position – whether it be a professional environment such as the workplace or social environment. I will strive to obtain and maintain a positive and supportive environment in which co-workers (and myself) can work together and where students feel supported to learn, ask questions, and most importantly, feel that it is okay and accepted to make mistakes. 

I only have 4 weeks remaining in my internship and I know that they will fly by. I am grateful for this internship opportunity and even more grateful that I was able to do it in SWNDHA. My preceptors were knowledgeable and supportive, I got to see and experience areas in NS that I wouldn't otherwise have had the chance to, and I feel prepared to enter the workplace as a dietitian. I have started applying for jobs in Calgary, AB and even have had a couple interviews this past week. I am excited to start my career!

Thanks for reading!

So Much to Reflect On...

So... apparently I've fallen behind on my blogging - but have still kept up with my personal reflections, I just haven't documented them here! I have a lengthy list of topics that I will be blogging on in the not-too-distant future once I get on-top of my projects, assignments, and reports.

Until then, here are some smiles that I've found over the past few months whilst searching for much needed giggles. 

Renal Dialysis Unit

This past week marked my first pre and post hemodialysis clinic in the Renal Dialysis Unit (RDU) in the hospital. What a pre and post day includes in that the dietitian (and myself) go to the clinic three times (10:00, 14:00, 19:00) on Wednesday and Thursday to see the hemodialysis (HD) patients. For those of you whom are unfamiliar with dialysis, here's the basics: depending on how often each patient needs to have HD, depends on how many times they need to go to the clinic to have their blood cleaned (remove PO4, K+, fluid, add calcium, etc. depending on the individual - i.e. not everyone will have fluid removed or calcium fortified above the norm). Some people go to the clinic three times a week (M, W, F), some go four times (M, W, F, Sat), or some can go twice (T, Th). It all depends on what the nephrologist determines would be best for each individual patient. There are different start times in the RDU for HD, which is why the dietitian and I went at three different times each day. This allowed for the patient to be set up on dialysis and for their pre-dialysis blood work to be returned from blood services.

What the dietitian and I did while we were in the RDU: we looked at the patient's pre-dialysis blood work (urea, creatinine, phosphorus, potassium, calcium, magnesium, and albumin), wet weight, dry weight from the previous HD day, and ask the patient how they have been doing in regards to eating (compliant with individualized renal diet?), if they have been or are on any phosphate binders such as Tums or Renegel (which help to bind the phosphorus in foods that are eaten to reduce the phosphate load in the body) and when they take them if they are on them. We asked how their bowels are doing, if they had any nausea or vomiting or illnesses over the past month (which could have an affect on their blood work and weight), any supplements taken (Nepro, Ensure, Glucerna, Boost), if medications have changed (we also check in the chart to verify), and provide encouragement or diet education when required. It is quite the busy time going from patient to patient - seeing ~ 4 or 5 patients in each time slot, then charting on each one.

I was able to the various routes of HD, i.e through a central line access or through fistulas made via surgery in the arm (fusing together a vein and an artery to help the vessels handle the increased blood flow when the blood is being pumped out of and into the body). I was able to see a very interesting patient who had a fistula in his left arm, but had multiple aneurysms in his arm that throbbed and pulsated. I asked the nurses if this was common, and apparently it is. Patients can be given a protective sleeve to help protect the aneurysms, but usually the patients just try to be careful.

I found it very interesting to see the HD machines up close, look at the lab values of each patient, and to speak with the patient regarding diet compliance, medication compliance, and chatting with each patient. Because the patients do frequent the RDU numerous times a week, a rapport is able to be established whereas with in-patients in the hospital, this is difficult as they are only in hospital for limited amounts of time.

While in the RDU, I was "tested" on my knowledge of the nutrient content of foods (phosphorus, sodium, potassium) as well as on my knowledge of renal and diabetic diets. I learned a lot about ideal lab values for dialysis patients vs. pre-dialysis patients vs. the average healthy population. Very interesting and educational experience.

Interprofessional Learning Experience

This past week marked the first of 5-weeks that I will be involved in an Interprofessional Learning (IPL) Experience. 

What is IPL?
"...it provides opportunities for learners from two or more disciplines to learn with, from, and about each other to improve collaboration and the quality of care" (CAIPE definition 1997 revised).

The different students that I will be working with over the next 5-weeks are from the following disciplines: nursing (2 students), recreation therapy, pharmacy, and dietetics (me!). We're a group of only 5, but I can see from our first meeting that we'll get along very well and each are driven to get as much out of the experience as possible. We meet twice each week: once on Wednesdays over lunch with just the 5 of us and two instructors (one from nursing and one from dietetics), and then we all attend stroke rounds Thursday afternoons. On February 10th, we are to present to a group of people from various disciplines, including our individual preceptors, regarding our experiences in IPL. I have an idea for the presentation, and I'm eager to bounce it off the other IPL members next Wednesday to get their input and opinions on it.

In our first meeting, January 11th, we had an activity where our disciplines were written on large white paper and stuck on the walls. We were then to go to every discipline but our own and write down the roles and responsibilities of each. Well, I had thought I had a good understanding of what nursing, pharmacy, and rec therapy professionals do, but I clearly only knew the basics. This activity was the first, of what I believe, will be many educational opportunities that I will experience over the next 5-weeks. I have no doubt that this group will provide me with a better understanding, respect, and appreciation for allied health care.

My experiences working with multiple-disciplines has not before been with a group of students, but rather with me being the only student amongst a group of professionals. In the different facilities and hospitals that I've either worked in or volunteered with, this has been the case, so I hadn't before had the chance to ask questions regarding roles and responsibilities of other disciplines (in a comforting and supportive environment). I am excited to see what unfolds over the next 5-weeks and to assess my own personal mental and creative growth that I know will occur during the IPL experience.

New Year, New Rotation

Handy book I was given for Christmas.

After a fantastic Christmas at home, in my new home, I am back in Yarmouth and have finished my first week in my Clinical rotation. I am currently in the area of stroke and renal and I anticipate learning a lot over the next 4-weeks.

Each week there is an assignment to complete. Week one's was focused on dysphagia, aspiration, and the dysphagia diet. Week two's is more in-depth focusing on protocol, what to look for when doing swallow assessments, etc. I have yet to read through week 3, but will let you know in the not-too-distant-future.

So here's a recap of my week:
Tuesday and Wednesday I essentially observed and answered questions the P.Dt. asked me. On Wednesday, however, I got to see my first Modified Barium Swallow which is a video x-ray of a person showing how they swallow (ie. the physiological function of the muscles, how well/easily/safely the food is swallowed or aspirated) to determine if they are safe to have food by mouth (po) or if they should be NPO or nothing by mouth. I had seem YouTube images before and recordings of MBS' in school, but seeing it live was so interesting! Hearing the Rad. Tech and the Speech-Language Pathologist and the Dietitian discussing what they saw on the screen, each inputting their own specialty wealth of information, was really impressive to witness. Thursday I started charting and having a more active role, and by Friday I was charting, calculating tube feeds (rate, formula, and energy, protein, and fluid requirements of the Pt.), and interviewing patients. I know that this week is going to be even busier so I best keep on-top of my studying to keep all the information fresh and "at the ready".

Happy Holidays!

Today is my second last day in my LTC rotation and to say I have enjoyed myself would be an understatement. I met some really interesting and intelligent people (staff, Residents, health care providers, Resident's friends and family, etc.) during my time at the Villa and I feel that my experiences in this internship rotation were enhanced by these interactions and they allowed me to grow in knowledge, experience, skill, and emotionally. Being a LTC Dietitian allows for so much more than providing nutrition and administrative assistance and leadership - it comes with an opportunity to bring joy, comfort, compassion, and a supportive ear or shoulder to the Residents. I would welcome the chance to have a career in LTC.

With the end of my rotation in LTC, comes some much needed time away with my fiance, Kev! I am so very very excited to fly out in the wee hours of Christmas Eve morning to join him for the holidays.

My next rotation, starting January 3rd, 2012 will be in Clinical with a Renal/Stroke Dietitian.

Merry Christmas and Happy Holidays!

Rotation #2: Long Term Care

Villa Saint Joseph-Du-Lac

I have now finished my first 2 of 4 weeks in my LTC rotation and I can honestly say, that I am loving it! Prior to this rotation I did have experience working in LTC facilities (in Lunenburg, NS; and Calgary, AB) so I knew that being in this setting was something that I enjoyed and thrived in - and this continues to be true.

The tasks and assignments that I have been working on include:

• Admission assessments;
• Dysphagia assessements;
• Menu analysis for number of servings daily available to Residents from Canada's Food Guide;
• Implementation of a new food to the menu;
• Staff in-service education sessions on "Celiac Disease and the Gluten-Free Diet"
• Attend multidisciplinary focus meetings
• Prepare for and present at Resident Care Plan meetings
• Assist with food-related events, such as a birthday party and Christmas tea;
• Charting;
• Prepare and present a detailed case study of a Resident;
• Assess Residents on nutritional supplements (Ensure, Boost) for means of continuation or cessation;
• Cost analysis of the nutritional supplements to determine daily, weekly, and yearly cost;
• Assist Residents with meals ("feeding" - but I hate to use that term so I shall refer to it as "assisting with meals" instead);
• Resident and staff interviews;
• SO much more!

I really am enjoying my LTC rotation!

A more descriptive entry complete with my reflections on my experiences in LTC will be completed when I'm at the airport waiting to board - only 10 days remain!

Lobster!

Dumping Day: November 29, 2011

Since I am doing my internship in a location where the main industry is fishing and lobstering, the other interns and I have been taking advantage of this and participating in as much as we can! 

Lobstering boats ready to depart

Our first lobstering event was Dumping Day. What is Dumping Day, you ask? It is the first day of lobster season when all the lobster fishermen head out on their boats at 6:00am and dump their lobster pots for the first time that season. On November 29th, we three got up crazy early for a Tuesday and were at the Cape Forchu lighthouse for 5:00am. There was a breakfast of bread pudding (incredible), muffins, coffee, and hot chocolate available for donation inside the lighthouse. There were gobs of people waiting outside to see the lobster boats approach the lighthouse. Then, at 6:00am, the horn blew and all the boats increased speed and headed out to sea to applause, cheers, and a message illuminating the rocks on the shore: "Have a safe and prosperous season". It was really great to experience such community spirit and camaraderie! Definitely worth getting up so early - and we were back to the residence in enough time to allow an hours nap before heading to work.

Eating lobster that was caught earlier that day

The next lobster inspired event happened just last night. Tina and I were invited over to our friend's parents home (who live in Pubnico, NS - about a 35 minute drive from Yarmouth) for a fresh lobster feast! Our friend's dad is a lobster fisherman and brought in the lobster from sea just hours before! It was by far the freshest and most tasty lobster I have ever tasted! I was even given a lesson on how to shell the lobster like a pro! 

It was an amazing evening filled with good food and great company! It also put me into the Christmas spirit so I am even more excited to fly home to Calgary for Christmas!

Oh Public Health, What Great Things I Learned During My Time in Thee

So this post is a little delayed due to mass amounts of internship-related work, but here is my final reflection of my public health rotation.

My Office in Public Health

 My rotation in Public Health: 

• Forced me to expand and alter the way I think – think about the bigger picture.  
• Increased my familiarity, comfort, and knowledge in Excel, PowerPoint, Word, and Publisher.
• Allowed me to participate in activities outside of meetings and committees and resource building that Public Health Nutritionists are involved with.
• Meet new people and see parts of Nova Scotia I wouldn’t have otherwise had the opportunity to see. 

Food Service Assessment Project

• Increased my knowledge and experience on how to quickly build rapport (and the importance of doing so) in getting genuine responses.
• It helped me to become familiar with the Food and Nutrition policy so I could better recommend required supports for schools to help them with their efforts to follow the FNP.
• Helped to increase my confidence level in myself and in my background in food service. It felt good to have my preceptors ask me questions to clarify food service-related questions they had. 
• This rotation exposed me to presenting on behalf of a department such as Public Health. It is much more different that a University setting – a necessary and interesting learning experience. 
• I learned so much about prenatal and breastfeeding (nutrition and otherwise). This is an area where I had had no exposure outside the classroom and the prenatal nurse was incredible as a teacher. I was able to create documents, do presentations, help out with prenatal classes and Friendly Feeding Line meetings. I enjoyed having an active role in my education.
• I really enjoyed going on a home visit with a Home Visitor. I hadn’t known that this program existed prior to this rotation, so it was a huge learning experience for me.
• Getting to know the staff of Public Health and meeting with most individually to hear about their roles in the department. 
• Learn about and create documents for the Child Care Regulations – worked with PH Nutritionists province wide for edits. These documents are now being circulated throughout the province. 

Everything hinges on education. Without it, you can't advocate for proper health care, for housing, for a civil rights bill that ensures your rights.

~Susan L Taylor

I Can See Clearly Now the Fog is Gone

This morning I was revamping my research proposal, which actually should have been submitted weeks ago but since I was having some issues with it, I refused to do so until I was happy with it. I know understand why I was having such intense issues - I wasn't seeing the bigger picture. 

Prior to this revamping, I had an epiphany whilst chatting with my fiance, Kevin. I asked him to describe to me the current state of the economy so I could better understand what has and is going on economy-wise in Canada and in Nova Scotia (Kev's my finance guru). This discussion was what I needed to understand - and I mean completely understand - the trials and difficulties with getting schools and people to comply with the Food and Nutrition Policy for NS Public Schools. 

An insane 40% of chronic diseases including obesity, cancer, cardiovascular disease, and type II diabetes are largely preventable through diet and physical activity. However, simply recommending healthy eating and physical activity will not benefit the population as there are underlying factors that inhibit healthy eating and PA. Geography, demographics, socioeconomic status, employment status of families, single parent households, etc. all contribute to the ability of families everywhere (not just NS) to be able to provide healthy foods and safe environments for physical activity. This is why the SFNP is so important! It ensures that for one meal a day, children who might otherwise not have the opportunity to eat healthy, nutritious foods, get this chance! This allows them to benefit from these nutrients and hopefully helps contribute to their healthy development and the possible reduction of the development of chronic disease later in life through developing health habits at a young age. 

Prior to my discussion with Kev, I was aware of the above predicament, but it wasn't until I was explaining why I wanted to know about the GDP and economic state of Canada (and the world in general) in regards to my research project, that I actually understood the importance of considering the big picture. 

Such an amazing feeling to finally have the mental fog cloud lifted.

Food Service Assessment Numero Tres

Yesterday was a very early morning which started with a pick-up by my fellow assessor at 6:30am to allow for our long commute towards the western coastal region of the SW Nova District Health Authority. It was an absolutely gorgeous drive and I loved seeing a part of the province I hadn't traveled to before.
Surreal landscape and ocean views.

An Aside:
From a comment I received a la Barb (a professor and the person who challenged me to reflect on a regular basis) who suggested that I clarify the parameters for my declaring how well a FS assessment went in each school - and I completely agree. So before I continue with this post, allow me to specify my parameters for the past and future FS assessments, as yes, if you can't read my mind - and I certainly hope no one can! - then how are you to know?

For a school to be reviewed in a positive light on this blog, it is based simply* on how well the FS assessment (and our presence observing their jobs/routine) was received by the FS worker, principal, and others we come in contact with - positively, negatively, or neutrally. Of course, the FS worker would have the greatest impact on how smoothly or how rough the FS assessment goes as we have the most direct and frequent contact with him or her. A FS worker who is simply nervous, timid, or unsure of how to respond to our presence tends to respond well when rapport is developed (asking about his or her family, how long they've been working in this position, sharing stories with them - I have found that tossing the "I'm getting married" frisbee in casually has loosened 2 out of 4 FS workers up and made them feel more comfortable with me).

*the term "simply" is used to refer to the fact that the parameter of this blog (not in the formal report or outlined in the official assessment results) consists of the attitudes of the person who was involved in the FS assessment at each school and not on other factors - as all the schools being assessed were identified as needing immediately help complying to the policy, so it can be assumed that the menus need some tweaking. "Simply" does not imply ease as building rapport and questioning/observing someone's job is these are neither easy nor simple, but rather complicated undertakings that require a certain delicacy in our approach as assessors.

For a negative (or "it didn't go well") designation, the FS worker may have been hesitant, reluctant, or showed outward irritation that we were there AND that this affected how well we were able to extract information from him or her and effected the flow of the assessment. I found that in schools, so far, where our presence was met with resistance or disdain (which are vastly different from nervousness as observed in a positive/smooth FS assessment), we found that getting thorough and detailed information was very very difficult and could have, in actuality, affected the outcome of the assessment. A FS worker who is already angry, irritated, or offended that we were assessing the school food service that they work in, will not be ass receptive to rapport making the FS assessment a true challenge when it need not be.
End Aside.

So, with the basics outlined above, the FS assessment yesterday was unpleasant and frustrating for me at times. Upon arrival we were overall very well received by the FS worker, admin assistant, and the principal. However, the questions we asked - even though they were neutral in nature and said with an inquisitive tone/phrasing rather than judgemental (which would have gotten us nowhere) - quickly caused an irritation with the FS worker. When I noticed this I waited until the FS worker was out for recess duty then discussed it with my fellow assessor. I was curious to know if a) she noticed it too, b) if it was the way I was phrasing the questions or through non-verbal communication, and c) how she felt we should proceed with the assessment. So, long discussion short, we feel that it was simply that she was being questioned and was taking offense to the questions, perhaps thinking that we were judging her. We decided not to ask her about her resistance, which I support, as she opened up later saying that she was concerned that her job was in jeopardy. However, even after telling us this and us reassuring her that our goal is to keep her in her position to ensure the students received healthy foods, she continued to show annoyance with us. But we were able to finish our assessment and complete the observation of all food services taking place in the school.

What did I discover about this school worth mentioning ?

Unfortunately, it was largely that the FS worker has become demotivated (through years of poor sales and recently reduced hours) and even though she was concerned about her job, she has made no effort to make herself and asset to the school (by means of creativity in food served, following the school food and nutrition policy more strictly, etc.). The menu offered daily is the same one every single day, every month. If I were a student and had the same limited options for lunch, I too would get bored and stop buying. She said that she likes how she can do her job on "auto-pilot" and then later said that there is no one trained to replace her because anyone can make the food on the menu (basic sandwiches, canned soup, chicken or veggie wraps, frozen individual pizzas, frozen potato wedges). Personally, if I were concerned about losing my job, I would make an effort to keep it. Hopefully she takes our recommendations and supports will will offer (which she identified as being interested in - have students taste test new foods and survey students on which foods they would buy if offered) so that she does gain some job security as the Principal mentioned that the cafeteria is losing money and may have to be shut down.

I am delighted to mention, that despite the lack of variety on the daily menu, the items served were overall fitting with the policy. True moderate items were being offered much too frequently, salad dressing and sauce portion sizes were much too large, the mini pizzas offered daily were cook from frozen made a white crust with pepperoni, sauce, reduced-fat cheese, and no vegetables, and the potato wedges which are a major seller were par-cooked in oil first and had far too much sodium to be offered daily, but what I didn't see was chocolate (other than in milk form)! Hooray for no chocolate!

I do think that a lot of positives came out of yesterday in terms of the FS assessment and what we will hopefully be able to offer in supports to the FS worker... I just hope the FS worker eventually believes/agrees that it was a worthwhile endeavor.

Sugar + Sugar + Sprayed on Nutrients = Breakfast?

Today I am determining the recommendations for menus/foods sold at the two schools that have undergone the food service assessment so far. In my quest to find some examples of maximum nutrition cereals for the Breakfast Programs, I stumbled upon the following horrific items that I have not seen before today and would now that I have, hesitate to call food. I would not recommend that these cereals be consumed, especially as the main component of a meal. Although if you're an adult and feel that you want to eat sugar coating wheat coating even more sugar, then may I suggest having protein with it so your blood sugars don't skyrocket nearly as high as without the protein?

(as I'm typing this while on a break at work, I was just offered a massive Tootsie-Roll by a co-worker, good intentioned but ironic that I'm offered it as I'm writing about how I feel these items should not be labelled as food.)

So which cereals get the designation of being so nutritionally-void?

         

             

Yuck.

Fruitopia ≠ Fruit

Yesterday was the 2nd school that underwent a food service (FS) assessment by moi. Unfortunately, this time the assessment wasn't as inspiring as the last.

Despite the claims of the full-time FS worker that she was trying to follow the policy guidelines, the only evidence of which we witnessed was the Maximum Nutrition Foods poster hanging in the kitchen (not at all faded which leads me to believe that it was recently hung), the change on this month's menu to whole-wheat/grain products, and selling baked chips. However, regular white bagels were still being sold at the canteen for purchase at recess, and refined flour muffins are offered as long as they are in the kitchen (which is at least 3x per week according to their menu). Chocolate was everywhere and anywhere (granola bars, pudding, cookies), a large bag of sprinkles was in the kitchen, hard taco shells were on the menu, large portions of donair sauce to be served with garlic fingers as an entree, hash browns served as a vegetable, and Cheez Whiz or jam sandwiches are offered as alternate lunches daily. The FS worker responded to our questioning her menu with the defense that "kids won't eat anything else." But this begs the question, "have they been given the chance?"

I've noticed a trend that FS workers seem to be confused about the 70:30 maximum:moderate nutrition foods served. The policy guidelines are that 70% of the time (each week, for instance) the foods served to students must be of maximum nutrition value, and only 30% of the time moderate foods are available. At no point during the regular week (or to be sold at any time at any function the school puts on) are minimum nutrition foods (like pop, hot dogs, and chocolate - other than chocolate milk... le sigh) able to be sold at the school. Minimum nutrition foods can be given away at special functions (total of twice per month) as long as maximum nutrition foods (like vegetables) are also provided free-of-charge. Back to the 70:30 ratio: FS workers, as it seems, believe that as long as they have some maximum foods for sale, they can sell as many moderate foods as they like, or only offer a certain number of baked chip flavors daily. Not so much the case. The idea behind the guideline is that students only have the option to purchase moderate foods twice per week (30% of a 5-day school week), therefore, if baked chips are offered for purchase daily from the canteen, this guideline is not being followed. This is because, as I observed yesterday so my idea has merit, kids will more often than not choose baked goods such as freshly baked (not necessarily homemade) muffins, granola bars, or chips over fresh fruit. Not providing them with an option to purchase these moderate foods 3 days a week ensures that they get sufficient nutrients on those days. Seems simple enough to me, but I also have a nutrition degree and am training to be a Dietitian. Both times when this concept was explained to the FS workers at the schools, it was met with resistance and the protest that students won't buy the healthier foods. I say: give THEM a chance to decide for themselves! Perhaps they haven't tried these foods before. School is a place to learn, why not also encourage them to learn about new and different foods? 

So where does the title of this blog entry come into play?

Product comparison courtesy of Coca-Cola's website

Yesterday, the FS worker was telling me about the homemade desserts she makes to sell to the students, and one of which that she was particularly proud of was a frozen fruit pop she makes by combining yogurt and Fruitopia. Fruitopia is neither a fruit nor is it even permitted to be sold in schools as it is a minimum nutrition food. Having "fruit" in the name of a product, does not make a healthy food.

This example shows the level and degree of education and resources that we'll need to provide to the FS workers and their schools to help them better follow the School Food and Nutrition Policy.

Unfortunately, my time in my Public Health rotation will be over before I can help administer the supports that were determined to be necessary for the schools. Perhaps a lucky integrated intern will catch the tail end of it in the spring.