Wednesday, December 21, 2011

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!






Tuesday, December 13, 2011

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!



Sunday, December 11, 2011

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

Sunday, November 13, 2011

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.

Tuesday, November 08, 2011

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.

Thursday, November 03, 2011

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.