Journal of the Canadian Dietetic Association最新文献

A mail survey of graduates for the previous three years from Montreal area dietetic internships was carried out in 1977-78. One objective of the survey was to collect data on employment status and job turnover. Mailing lists for graduates were obtained from internship program directors. One hundred and ninety-three questionnaires were mailed. Forty-nine percent of the questionnaires were returned. Sixty-one respondents (64%) reported they had left their first position; 73% of these left within one year. The major reason for leaving first positions was 'temporary position' (43%), and 'family reasons' was cited by 10%. Eighty-one percent of respondents were employed at the time of the survey. The major reasons for unemployment were: 'education' (33%); 'family reasons' (22%), and 'no position' (16%). Family reasons for not working were less common in this survey than in a national survey conducted in 1974. Results presented here indicate that recent dietetic graduates who are married and/or have a family are more likely to work today than in 1974, as is the trend for women in other areas of employment. The implications for new graduates are: higher job turnover, fewer permanent positions, and an increase in the number of post graduate degrees.

Rapid Calculation of the nutrient content of foods and diets requires a current, easily accessible data base. The Canadian Nutrient File is a computerized information bank containing average values for nutrients in foods available in Canada. For easy accessibility, it contains subfiles for food names, nutrient names, and nutrient amounts. Users of the data should appreciate the limitations of this multi-use file.

Food intake of 30 women over 80 years of age and residing in a long-term care facility was determined for a five-day period using the weighed intake method. Purposes of the study were to examine the contribution to nutrient intake of foods from eight major food groups; to characterize intake by time of day; and to examine the effect of age on nutrient intake. The results indicated that intakes of calcium, thiamin, vitamin A, zinc, and protein were below recommended levels. Analysis of intake by food group revealed that the grain group was the primary source of energy and many nutrients. Percentage consumption of foods in this group was significantly higher than that of vegetables or meat and alternates. Analysis of intake by time of day indicated that more energy was consumed at breakfast than at dinner. Advanced age was negatively correlated with overall dietary adequacy, although the distribution of energy intake from the eight food groups did not change with age. Implications of the results, for these subjects and similar groups of elderly, are discussed.

A project is described for the interim renovation of a labor intensive existing foodservice facility. The renovated area will provide effective food management during the hospital's redevelopment period, including a new foodservice. Objectives of the interim project were to conserve labor while emphasizing control and centralization, provide economic foodservices with improved quality, and incorporate one tray distribution system throughout the hospital complex. Immediate measures were necessary in order to generate funds to proceed. Renovations had to occur without disrupting food-service to patients. The project was planned over a three year period and included an ingredient control area, two patient tray service centres, a renewed production kitchen and test kitchen facility. Each phase has been financed on the understanding that the costs of construction and equipment will be repaid within one fiscal year of operating the renovated facility. Positive results are being achieved, attributable to the support and encouragement received from staff during the change process.

Burnaby Hospital recently implemented a computerized Food Management System. The system is fully operational in the Extended Care Unit (ECU) and now is being introduced in the Acute Care Unit (ACU). The main goals for the new program were: cost savings, more effective use of foodservice employee time and skills, and better patient care. To date, the total time saved by use of the computerized system has been equivalent to one full time employee. The ECU dietitian's and the dietary technician's duties have been upgraded. The technician has been relieved of clerical tasks and has taken over some responsibilities formerly performed by the dietitian; the dietitian is able to perform more administrative and planning tasks; and the former ECU coordinator is manager of patient services and responsible for coordinating changes in the computer system. Research indicates that this system, designed and developed for Burnaby Hospital by Rick Hepting & Associates and running on an MAI Basic Four min computer, model 210, is unique among North American hospitals. Current applications include manipulation of patient diet information for automatic menu processing, food tallying, and production of nourishment labels. Future enhancements will take care of production reporting, standard recipe printouts, food cost analysis, and nutrient analysis. The system has valuable potential for use in other hospitals.

This is a report on the author's activities and impressions of the dietetic profession in Australia and New Zealand, during a professional visit in May 1983. Activities included presenting the Abbott Lecture to the Third Annual Conference of the Australian Association of Dietitians, speaking at several state dietetic association meetings, and presenting some seminars. Foodservice systems in several hospitals were observed. Impressions related to the diverse educational backgrounds of dietitians, the focus on clinical practice, and the extreme youthfulness of the profession in some states. The author also modified a post-graduate program at the University of New South Wales to assist dietitians to gain more knowledge in foodservice administration.

The need for dietetic performance indicators that more accurately reflect the performance of the department of dietetics has led to the development of an effective tool for directors of dietetics to use in monitoring departmental performance, planning departmental activities, services and programs, and budgeting. To follow-up on the work initiated by a group of directors of dietetics in Metropolitan Toronto, the joint Ontario Dietetic Association-Ontario Hospital Association (ODA-OHA) Steering Committee on Alternative Dietetic Performance Indicators (SCADPI) was established. The work of this Committee has involved identifying relevant dietetic performance indicators based on three areas of departmental activity: patient meal service, non-patient meal service, and clinical nutrition service; developing the methodology of allocating food, sundry, and labor costs to these three areas of departmental activity; and testing the validity and feasibility of the methodology among hospitals of varying sizes and levels of dietary department management personnel.

A study was done to develop staffing guidelines for the inpatient clinical dietitian based on the Victoria General Hospital Dietary Department's philosophy of nutritional care. The objectives were to identify the major activities being performed by the dietitian, estimate the average amount of time spent on each activity, determine the number of dietitian consults, determine the time required per patient consult, and establish indicators for workload, performance and productivity. All activities were coded for easy record keeping and tabulation, and the D-unit (5 minutes of a dietitian's time) was used as the unit of time measurement. The results showed that the dietitians were spending 44% of time on direct patient care, 20% on patient care support activities, 1% intradepartmental activities, 6% teaching (other than patients), 4% community, 3% on research and special projects, and 7% doing other tasks. Using the % of direct patient care time available, the % of patients requiring nutritional support, and the patient turnover rate, it was possible to develop a formula for the number of dietitians required to provide nutritional care based on the department's philosophy.

A nutritional care plan, encompassing all aspects of nutritional assessment, education, and follow-up was designed and implemented at the Victoria General Hospital in Halifax, Nova Scotia. The care plan was developed in response to the results of an audit on nutritional care of diabetic patients. It was designed to assure referral of all diabetic patients to clinical dietitians, set standards for care and its documentation, provide a teaching tool, and enhance communication between inpatient and outpatient nutrition services. The care plan was developed by the authors in committee and approved by the clinical dietitians and the medical staff at the Victoria General Hospital. The care plan format is described in detail. It has been in effect since March, 1982 with positive feedback reported by clinical dietitians. Reevaluation of care, charting, and referrals to outpatient nutrition services are planned. Additional care plans on other nutritional topics are planned for the future.

The structure of and services provided by the Hamilton-Wentworth Home Care Program are described. The goal of the Home Care Program is to provide coordinated multidisciplinary care for the patient in the familiar home setting, to facilitate early discharge from hospital, and/or prevent admission to a health care institution altogether. Nutrition counseling for patients and consultation for the multidisciplinary health care team is provided by the Home Care nutritionist, a registered dietitian. Her duties and activities are further delineated, as they exist in Hamilton-Wentworth. This unique position provides stimulating and rewarding work for the nutritionist who desires the challenge of therapeutic nutrition counseling in a community setting.