4. Cultural and Religious Dietary Needs
This topic covers information about: Profile of the Community Diet and Religion Cultural and Religious Menu Planning
Activities in this topic cover the following performance criteria: Identify client group, use correct terminology and observe cultural customs Consider cultural groups and general characteristics of their cuisine Identify dietary regimes and factors associated with cultural and religious groups that may influence food choices Plan and modify meals and menus to meet specific cultural and religious needs of client group in line with organisational guidelines Follow processes defined by dietitian to evaluate meals and menus to ensure they meet cultural and religious needs of the clients
4.1 Profile of the Community Australia is a multicultural society. Cultural groups in our society include but are not limited to: Asian Aboriginal and Torres Strait islander Caucasian/European Indian Mediterranean Middle Eastern South Sea Islanders South American African
There are many factors that may influence food choices of different cultural backgrounds including: Background – where did they come from? Migration pathway – did they come straight here or spend time in another country? Was it a choice to migrate or forced migration?
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How old were they? Did they have children and if so how old are their children? Can they speak the language? What is their level of education? Are they able to work and if so do they work outside of the home? Are there other community members here and if so can they access that community? Are there other family members? Are familiar foods available? Are shopping facilities familiar? Are cooking facilities familiar? What is their income? What are the pressures to conform? Do specific cultural foods have different cultural values? (ASeTTS, 2007)
These factors may vary significantly from country to country and region to region and also within a country. Each cultural group may also have special food traditions; specific ways of preparing, cooking, serving and eating food; special occasions of food celebration (feast); and times of fasting or avoidance of certain foods/drinks (e.g. Lent or Eid). Modern changes to the traditional diet are not always healthier particularly when more processed western food is used, which tends to be higher in saturated fat, salt and sugar. Many people prefer bland or traditional foods (i.e. or food from childhood) when they are unwell (such as steamed or sticky rice in some Asian diets). Education about the positive aspects of the traditional diet alongside suitable modern choices can be provided in hospital and may help improve intake during admission and on discharge. Queensland is considered a culturally and religiously diverse state (Australian Bureau of Statistics, 2011: 26.3 % (1 in 4) Queenslanders were born overseas in more than 230 countries (↑ from 17.9% 2006 survey and 16.7% 1996) 23.2% of Qld population spoke a language other than English at home
Recently Queensland Health published a document on community profiles for health providers for Queensland Health and is a useful introductory reference. http://www.health.qld.gov.au/multicultural/health_workers/profiles-complete.pdf
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Arrivals in Queensland People from New Zealand and the United Kingdom have been constantly arriving since before 1970. Pre 1970 - Dominated by European arrivals 1970’s – PNG (following independence from Aust) and Vietnam (following Vietnam war) 1980’s – Philippines, Fiji and China 1990’s – Asian countries (Philippines, Taiwan, Vietnam, China) and South Africa 2000’s – China, India, Philippines, South Korea, Japan
Religious affiliations in Queensland (Australian Bureau of Statistics, 2011) Christianity (62.0%) Buddhism (1.5%) Islam (0.8%) Hinduism (0.7%) Other (1.2%) No religion (22.3%) Not stated (12.7%) More than 147,313 (3.4%) people in Qld followed a religion other than Christianity Between 2006 - 2011 the fastest growing religions were Islam and Hinduism
Increasing cultural, linguistic, and religious diversity in the Queensland population means that to be safe, health services need to be culturally appropriate and responsive. Research indicates a strong link between:
Poor quality health Cultural outcomes and incompetence significant risks
Figure 9: Link between cultural background and Nutrition (Johnston and Kanitsaki 2005)
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Levels of adherence to a religious or cultural custom are a personal decision. Whilst some clients prefer to be strict and follow their religious beliefs to be 100% compliant, others may be less strict. Islam, Hinduism, Sikhism, and Buddhism are universal religions which are practiced in many countries around the world Each of these religions place responsibility on the individual to practice his/her religion Varying degrees of orthodoxy exist; people who follow particular faiths may follow food related customs fully or in part.
Personal and cultural variations make it difficult to provide definitive rules and regulations that apply to all patients that identify with a particular religion. Therefore it is best to consult a patient on an individual/personal level for religious observances.
For example, a Muslim from West Africa may have a slightly different way of observing Islam when compared to a Muslim from Bosnia, Indonesia, or Iran.
It is important that healthcare providers do not stereotype their clients. Stereotypes assume that all people from certain race, nationality, social group, religion, or culture automatically share the same beliefs and values. Do not assume dietary preferences: . Even if the client appears to comes from a specific group, or is perceived to have certain cultural affiliations . As with all clients, it is best to identify a patient’s individual dietary preferences/customs and religious observances
Appropriate terminology is vital when communicating with clients from different cultures. It is essential to be politically correct and non-discriminatory with all clients to reduce the risk of offending clients and their families. Effective communication occurs when clients and carers have common terms of reference and it is the healthcare providers responsibility (within reason) to learn and use the terminology that will be used and understood by clients, which includes food and food terminology.
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A Nutrition Assistant is unable to assist a client with food preferences if they do not recognise/understand what the client is requesting.
Resources available to assist with communicating with patients from culturally-diverse backgrounds include: Interpreters – Be aware of your healthcare facilities protocol to access interpreters as usually booking in advance is required. – Via phone contact – Face to face – a Nutrition Assistant may be involved directly or indirectly via Dietitian Ward Communication tool Communication tools developed by individual facilities
Queensland Health provides a list of interpretive resources on their website. http://www.health.qld.gov.au/multicultural/public/language.asp http://www.health.qld.gov.au/multicultural/support_tools/WCT.asp
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The following pictures/tools are courtesy of Mater Health Services who developed these tools to help communicate dietary preferences with West African inpatients.
Figure 10a: Dietary preference communication tool (West African) (Mater Health Service, 2008)
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Figure 10b: Dietary preference communication tool (West African) (Mater Health Service, 2008)
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There are several factors that influence food choices and these include: Availability Accessibility Familiarity Beliefs and Values Food advertising Cultural preferences Therapeutic diet requirements
Cultural preferences Special food traditions/customs Different religious needs Specific ways of preparing, cooking, serving and eating food Holy Days/Festivals/Special Occasions which impact on food intake Fasting or avoidance of certain foods/drinks
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Observing Cultural Customs Nutrition Assistants can provide better nutrition care if they are aware of Holy Days/Festivals/Special Occasions that have an impact on food intake. Festive Occasions and Holy Days – Can carry great significance for many people and the need to acknowledge them is important. – The ability to accommodate special customs and customary foods at this time will contribute to quality of life, to what the clients recognise to be a normal lifestyle. – Particularly important in Residential Care. Fasting – Ramadan in the ninth month in Islamic year during which most Muslims fast. It is iImportant to know this when monitoring a patient’s intake.
A religious Calendar is published in the Queensland Health Multicultural Clinical Support Resource folder. http://www.health.qld.gov.au/multicultural/support_tools/mcsr.asp
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Activity 20 – Factors Influencing Food Choices Select a member of your local community (can be a friend, family member, etc.) who has been raised in a county other than Australia. Ask them if they would agree to be interviewed by you regarding their experiences as a child and then as an adult in Australia regarding their food experiences.
1. In what country was this person born? (or has experience with)
2. What types of foods did this person eat in their home country? (Ask them to outline for you a typical day’s menu)
Breakfast
Morning Snack
Lunch
Afternoon Snack
Evening Meal
Supper
3. What new foods has the person introduced into their daily menu as a result of moving to Australia? (Ask them to outline for you a typical day’s menu)
Breakfast
Morning Snack
Lunch
Afternoon Snack
Evening Meal
Supper
4. Ask the person to list three (3) factors that have influenced their food choices. a) b) c)
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Cultural Overview The following overviews of different cultures allow you to gain an understanding of the diverse range of foods and fluids one culture may prefer compared to another culture. It allows you to see any overlap of foods in the cultures that may be available for selection on a hospital menu and those that may not be accessible or readily available.
Some of the cultures you may be working with include: Aboriginal and Torres Strait Islander diet The Aboriginal and Torres Strait Islander diet has changed from a hunter-gather lifestyle to a more westernised diet that is typically a high kilojoule, low nutritional lifestyle. Traditionally, Aboriginal and Torres Strait Islander peoples enjoyed a healthy diet of high in carbohydrates, protein, and nutrients, and low in fat and sugars. With white settlement came flour, sugar and processed meat (NHMRC, 2000).
Characteristics of Hunter-Gatherer and Western Lifestyles
Hunter gatherer lifestyle Western lifestyle
Physical activity level High Low
Principle characteristics of diet
Energy density Low High
Energy intake Usually adequate Excessive
Nutrient density High Low
Nutrient composition of diet
Protein High Low-moderate
Carbohydrate Moderate High
Simple Carbohydrate Usually low High
Dietary fibre High Low
Fat Low high
Sodium: potassium ratio Low High
(NHMRC, 2000)
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When providing nutrition support for indigenous Australians, involve local Aboriginal and Torres Strait Islander Cultural Liaison Officers, local indigenous communities or health organisations wherever possible. They can provide specific information about cultural and spiritual needs and methods of catering for the dietary needs of these people.
Mediterranean Diet The Greek and Italian communities are well-established in Australia. There is a large amount of integration with mainstream communities, with second and third generation migrants growing up and sending their children to Australian schools (ASeTTS, 2007)
Italian (Gallegos & Perry, 1995) Common foods patients prefer may vary slightly depending on the region in Italy the patient is from, and the degree of influence from living in Australia for many years. Preferences may include: Pork, veal, chicken, fish, cold meats e.g. salami, prosciutto, mortadella etc., are popular served with olives, cheeses, pickled vegetables. Vegetables – many people grow their own – E.g. radicchio (bitter lettuce), lettuce, spinach, artichokes, peas, capsicum, tomato, broccoli, broad beans, eggplant, and zucchini. – Pulses - eaten in soups and served with pasta e.g. Lima beans, broad beans, chickpeas and lentils. Bread – usually present at every meal Sweets – served on special occasions. – May be rich liqueur soaked cakes or fritter type pastries. – May contain cream or ricotta cheese. Fruit – the usual ending to a meal. Beverages – Strong black coffee or coffee with milk. – Tea (in Australia). Herbal teas are used for ailments and insomnia.
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Greek (Gallegos & Perry, 1995) Environment and regions determine the type of diet. Common foods often preferred may vary slightly depending on the region the patient may be from and include: . Meats including lamb, chicken, fish, and pork. Beef is used less often. Meat may be baked, braised boiled, fried, or grilled. . Salty seasonings such as anchovies, caviar, cheese, sardines, and salt are very popular. . Vegetables – Many vegetables (e.g. tomato, capsicum, zucchini, and eggplant) are stuffed with a meat and rice filling as a main course. – Leafy greens e.g. chicory and endive with lemon juice and olive oil dressing and salads. Fruit – dried fruit and nuts are popular Bread is popular Sauces – Traditionally tomato, olive oil, garlic, herbs (oregano and parsley) or egg and lemon. – Herbs and flavourings – parsley, oregano, garlic, celery, mint and bay leaves. Sweets – Often covered in honey syrup. E.g. Greek walnut cake, semolina cake, Halva, filo-pastry with custard, baklava, Greek shortbread. Beverages – Coffee (Greek or instant) and cocoa.
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Polish Meat – Meat, pork in particular. – Baked or fried meats usually come with gravy (red meat), sour cream sauce (white meat); boiled meat is cooked with black peppercorns, salt and bay leaves. – Cold meats such as ham, polish salami and jellied meat like pigs trotters. – Chicken, duck, and game are enjoyed in traditional recipes. – Fish, baked or fried in butter, tinned herrings are popular. Vegetables – Boiled in salted water, sautéed in butter, sprinkled with breadcrumbs, and usually cooked with sugar, salt, vinegar and cream. – Popular vegetables include cabbage, beets, onions, mushrooms, tomatoes, carrot, spinach, beans, cauliflower, turnips, peas, parsnips, potatoes, capsicum, celery, cucumber, and eschalots. – Salad with lettuce, tomato, onion, cucumber, and radish eaten with sour cream; may accompany main meal. Sweets – Puddings, Kisiel (opaque jelly containing flour), poppy seed cake, jelly, fruit, ice cream. – Yeast cakes and torts are served at festivals. (Gallegos & Perry, 1995)
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Bosnia-Herzegovina, Republic of Croatia, Republic of Serbia Each of these groups is unique in their culture (Gallegos & Perry, 1995). The following is aimed as a guide to possible eating habits and is not a clear definition. General characteristics of the diet: Crusty white bread is common and usually eaten at most meals. Pickled or preserved foods are common. Vegetables are usually dressed with a sauce or fried with onion and garlic and may have other sauces with them. Commonly eaten vegetables include potato, silver beet, cabbage, capsicum, beans, peas, sauerkraut, tomatoes, squash, eggplant, pumpkin, cauliflower, and corn. Soups, stews, and goulashes are favoured. Moussakas, pastries, and rice dishes are all commonly eaten. Cornmeal dishes similar to polenta and pasta are also enjoyed. Turkish coffee and sweet desserts and cakes such as baklava are frequently eaten. Condiments and herbs such as fresh tomato sauce, olive oil, paprika, dill, parsley, rosemary, basil and bay leaves are common.
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Asian examples
Chinese There are a number of regions in China that all have different ways of preparing food. Rice is the almost always the basis of a meal. Foods are commonly steamed, boiled or stir fried. Meat and chicken are cut up finely. Beef, pork, and chicken are used in traditional cooking. Fish – whole, steamed with fresh ginger, shallots, dry sherry. Fresh green prawns are preferred to the cooked variety. Stir-fry seafood combinations usually contain scallops, squid, prawns with ginger along with shallots and Chinese broccoli. Sauces add flavour, e.g. light or dark soy sauce, soybean paste, black bean sauce, prawn paste, oyster sauce, peanut or sesame oil and salty bean curd are often used in cooking. Soups based on stock with meat and vegetables. Noodles and dumplings are added for substance. Wheat flours (noodles, dumplings) are available in northern China while rice is more available in southern China. Vegetables – many varieties are enjoyed for example; Chinese cabbage, Chinese spinach, Chinese broccoli, English spinach, eggplant, snake beans, French beans, celery, carrot, capsicum, marrows, pumpkins, tomatoes, shallots, chives, onion, bamboo shoots, lotus, water chestnuts, sweet potatoes, yams, soybean, mung bean sprouts, garlic, ginger, chilli, and shallots. Beverages – Chinese tea or plain water. – Soups are sometimes drunk as refreshers during the meal. – May enjoy fruit juice in Australia. Soft drinks rare at home. . Sweets – fruit and sweet snacks, sweet bean soup, sesame seed balls, egg rolls.
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Vietnamese Rice forms the basis to the diet and is often eaten at each meal although noodles are sometimes used as an alternative. Meats – Pork and poultry such as chicken or duck. – Fish and shellfish are popular. Shellfish and fish bones are a source of calcium in the diet. Prawn shells and fish bones are used to make stock. Vegetables – E.g. Spring onions, celery, capsicum, mushrooms, cauliflower, cabbage, onion, Chinese cabbage, Chinese mustard greens, bean sprouts, snow peas. Legumes are frequently used. – Salads are usually sprinkled with fresh herbs like parsley or peppermint leaves. – Popular salads include: cabbage, lettuce, watercress, or bean sprouts. Breads – crusty French bread sticks are preferred. Sauces – soy sauce and fish sauce is used for most dishes for flavour. Sweets – Rice cakes and sticky rice dishes are part of festive occasions. – Fresh fruit especially the tropical varieties such as mango, banana, and water melon. Beverages – Chinese tea or coffee with condensed milk.
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African examples
IMPORTANT: Be aware that some of this information will not be tribe specific, for example, Sudan consists of one geographical country but is populated by more than 200 different language groups. Ethnicities can have very different cultures and practices which will not all be described here (ASeTTS, 2007).
The following is a list of foods that are either not common in an Australian context or are used in different ways in Africa. It is not an exhaustive list. Some people from this part of the world are Muslim and may require access to Halal foods. Bread and cereals – Maize flour can sometimes be called mealie meal and is used to make porridge. – Millet flour. – Flour is used to make the staple porridge eaten alone or as an accompaniment. Sorghum flour is another variety used to make porridge. – Teff is a grain used in Ethiopia to make injera. It is grown in Australia as animal feed but is currently unavailable for human consumption. Quinoa may be an adequate substitute. – Injera is the Ethiopian/Eritrean name given to flat, fermented bread. – Asida is one of the South Sudanese names for the porridge. Pulses – Black-eyed beans are used extensively both in cooking and as a snack. – All other pulses. – Seeds and nuts. – Tahini is used as a spread and as an addition to stews and vegetable dishes. Fruit – Plantain is like a large green banana. It is quite starchy and is always cooked. – Tamarind Available from Asian food markets in fresh, puree or dried form. – Used to flavour porridge, as a drink or to eat. Dairy – Camel’s milk may be consumed by those coming from Ethiopia, Eritrea, Somalia and parts of Kenya. – There is no commercial dairy in Australia.
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Vegetables – Sweet potatoes are eaten extensively as are the leaves. – Amaranth also called Chinese spinach. – Cassava is a starchy woody shrub used as flour or grated in savoury or sweet dishes. – Okra. – Molokhia is a small green leaf which is used to thicken stews. Meat – Dried fish is used in many dishes and is often used to flavour stews. – Goat meat is eaten by a number of different African groups. It can be found in some selected butcher’s shops. Italian butchers sell goat as capreto. – Camel meat may be consumed by those coming from Ethiopia, Eritrea, Somalia and some parts of Kenya. Camel meat may be locally available but this will need to be checked depending on the location of your health service. Fats and Oils – Red Palm Oil is used especially in West Africa and gives food a distinctive taste. It is not readily available but there are some local importers emerging. (ASeTTS, 2007)
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Middle Eastern examples The following foods are either not common in an Australian context or are used in different ways in the Middle East. It is not an exhaustive list. Many people from this part of the world are Muslim and may require access to Halal foods.
Name in English Name in Arabic Availability
Bread Khoboz wa Samoon
Bread Samoon Many different varieties of bread are used. Some Lebanese Bread Khoboz Lubnani are leavened breads and others are flat breads. In Afghanistan there is a variety which is called naan Turkish Bread Samoon turky which is similar to what is called Turkish bread in Australia. Rice and Flour Rooz wa Taheen
Fruit Fakiha
Apricot and Dried Mishmish wa apricot mishmash mojefef
Dates Temor Dried fruit is a common feature in the Middle East. It Prune Injas is usually eaten as a snack
Sultanas Kishmish
Fig and dried Fig Teen wa teen mojefef
Vegetable Khothrewat
White Cabbage Lehana Available fresh from Asian food markets. Also Leek Korath available frozen or canned. Okra is cooked quickly to retain its crispness or for longer to draw on its Turnip Shelgum mucilaginous properties. Okra Bamya
Dairy Alban
Yoghurt Leben Plain yoghurt is used extensively Spreadable yoghurt, is available in some Labneh Leben Mokethef supermarkets Many different varieties of milk are used including Milk Haleeb cow, sheep, goat and camel
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Pulses Bokool
Black-eyed Beans Lobya Yabsa (Beatha)
Broad Beans (dried) Bagilla Yabsa
Broad Beans Bagilla khethra
Fasolya Yabsa Cannellini Beans (Beatha)
Chick Peas Hommos All pulses are used extensively as side dishes, additions to main dishes or as snacks. Haricot Beans Lobya khethra
Lentils Adass
Mung Beans Mash
Yellow split peas Hommos Majroosh
Seeds And Nuts Al Mukeserat
Paste made from sesame seeds used as a spread Tahini Rashi or a flavouring
Walnuts Joz
Meat Lehem
Chicken Dejaj
Often sold as capreto at Italian or speciality Goat Lehem Maez butchers
Lamb Lehem Igel
(ASeTTS, 2007)
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Indian Food in India varies from region to region and is strongly influenced by religion and custom. The wide variety of food that is eaten and the regional variation presented in India is too complex to specify, therefore general differences between northern and southern India are identified (Gallegos & Perry, 1995).
Item Northern India Southern India
Staple Wheat – eaten as chapattis Rice
Usually dry so can be eaten with Usually wet so that the rice can Curry chapattis soak up juices
Raira made from yoghurt to which Sambal a mixture of a relish and a Salad fruit and seasonings are added salad
Fruit and vegetables A wide variety are eaten throughout India
Meat Mutton, Chicken, pork. No Beef Mainly vegetarian
Fish River Fish Ocean Fish
Dairy Ricotta cheese, yoghurt Yoghurt at every meal
Ghee Oil Fat No coconut Coconut
Tea Coffee Drinks Lassi (yoghurt drink) Buttermilk
In addition most meals are served with an array of different dishes including pappadums, pickles, relishes, and raitas. Curries are eaten regularly.
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Activity 21 – Meeting Cultural and Religious Dietary Needs
1. List three places where you could source information on the cuisine of various cultural and religious groups that are found in Australian society.
2. Describe how you could access interpreter services for a client in your health care facility?
3. What other services could help you assist culturally diverse clients?
Activity continues on the next page.
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Activity 21 – Meeting Cultural and Religious Dietary Needs continued
Select a religious group which follows dietary restrictions or protocols and answer the questions below. If possible select a group that you have seen represented in the patients at your hospital.
4. What is the religious group that you have selected? Why?
5. What foods or fluids are restricted or forbidden?
6. Complete the following sentences. a) According to the Islamic faith, Muslims should: . Use ______meat . Avoid all ______products . Avoid drinks and food containing ______. b) ______food is food that conforms to Jewish dietary laws. c) Most Hindus do not eat ______or items containing ______products.
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4.2 Diet and Religion There are a number of religious groups within Australian society who may follow particular dietary restrictions. These include, but are not limited to: • Some Christian denominations e.g. Seven Day Adventists • Jewish • Muslim • Hindu There is often: • Food laws and traditions that are observed. • Variability in the level of restriction within religious groups. • Changes to food and eating behaviour as a result of feast and fasting occasions (these may occur many times over the year). Christianity Practices vary between Christian-religious groups, e.g. Protestant, Catholic, Mormon (Latter Day Saints), and Seventh-Day Adventists. Some groups celebrate Easter and Christmas with feasts whilst others do not. Fasting and abstinence practices differ within the specific religions too, for example, fasting for one hour before communion; avoiding stimulants such as caffeine (Mormon, Seventh-Day Adventists); avoiding meat on a Friday (Catholics) etc.
Seventh Day Latter Day Saints Christian Adventists Jehovah’s Witness (Mormons) (Adventists) Christian dietary habits tend to be Abstain from eating Not usually culturally rather than blood, i.e. blood vegetarians but will religiously determined. sausage, and from Lacto-Ovo Vegetarian eat meat sparingly, However, some animal meat if the avoiding products with African and South blood has not been much blood Asian Christians may properly drained. avoid pork.
Alcohol is forbidden according to some Concern over the Christian groups, effects of stimulants, Apart from this there although drinking wine Avoid coffee, tea, do not drink alcohol, is no restriction on (in moderation) plays alcohol. tea or coffee. Some what is to be eaten a symbolic religious avoid hot drinks. role in Holy Communion.
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Judaism and Kosher food There are both liberal and orthodox traditions with both fasting (24 hours during Yom Kippur -Sept/Oct) and feast days (e.g. Rosh Hashana and Passover). Fruit, vegetables, and unprocessed foods are usually permitted. Some foods are contentious, especially with stricter groups e.g. no gelatine, kosher-only food products, etc. Food Laws – Judaism Kosher approved diet: . Meat must be slaughtered in the religiously appropriate fashion. . Certain foods must not be mixed (i.e. meat and dairy). . Strict use of cooking utensils and machinery (i.e. separate pans for meat and dairy items). . Pork, camel, hare, shellfish, and fish without fins are forbidden. . Food without blood is permitted, i.e. no bloody meat; often meat is salted to draw out excess blood, blood-spots in egg, etc.
Muslim (Islamic) The degree to which some practices are followed within the Muslim religion may vary. Foods are either lawful (halal) or unlawful (haram) and guidance is provided via the Holy book (Quran) (Queensland Health, 2010). Fasting occurs during the month of Ramadan. The date changes slightly every year. Fast takes place from Dawn to Dusk, however there are exemptions for people who are sick, menstruating, pregnancy, breastfeeding, children, travelling, or have diabetes. A feast called Eid ul-Fitr (Eid) occurs for three days at the end of Ramadan. Food Laws – Muslim The only foods explicitly forbidden are: • Any meat that is not slaughtered in the Halal way. • Blood. • The meat of pigs or foods that may contain pork (i.e. some forms of gelatine). • Alcohol. • Foods prepared with unclean utensils or those that have cooked forbidden foods.
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Food groups - Comparing Muslim and Jewish Diets
Muslim Jewish Mono and Polyunsaturated Mono and Polyunsaturated margarine/butter margarine/butter (if it is a meat dish use Fats and Oils Other vegetable oils e.g. Olive, vegetable margarine) peanut, etc. Other vegetable oils e.g. Olive, Avoid lard, dripping, suet Peanut, etc. Avoid lard, dripping and suet All raw, dried, canned or cooked All raw, dried, canned or cooked Fruit and using water, vegetable fats and using water, vegetable fats and Vegetables butter butter All breakfast cereal, bread, All breakfast cereal, bread, cakes, cakes, biscuits, rice, pasta that Breads and biscuits, rice, pasta that do not do not contain any animal fat Cereals contain any animal fat except butter except butter, can use vegetable can use vegetable fats fats Beef, Lamb, Chicken (Must be Beef, Lamb, Chicken (All must be Meats Kosher and NOT cooked with milk Halal) products)
Seafood All seafood Any fish with fins
No blood spots All (boiled or cooked in butter or Eggs Avoid contamination with vegetable oils) ham/bacon Dried Beans, All (avoid dishes that contain bacon All (avoid dishes that contain bacon lentils, baked bones, ham, or stock made from bones, ham, or stock made from beans, tofu avoided foods e.g. pork) avoided foods e.g. prawns, pork)
Hinduism The degree to which practices are followed within the Hindu religion may vary. Feast days have regional variation and fasting; depends on your caste (social standing) and days of religions or personal significance (Queensland Health 2011).
Food Laws – Hinduism . Beef is forbidden – meat from animals is avoided. Also avoid gelatine and eggs. Dairy products are allowed. . Strict Hindus are vegetarian. . Alcohol, onion, and garlic are avoided or restricted. . Prohibited animal products vary from one region to another (e.g. duck or crab). . Foods prepared with cooking utensils that have cooked forbidden foods are not permitted.
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Buddhism Buddhism is more a life philosophy than religious doctrine. Rules depend on the branch of Buddhism and differ between countries. Feast days vary from one place to another. Fasting tends to only apply to monks, who fast in the afternoon.
Food laws – Buddhism . Most Buddhists are vegetarian. . Some Buddhists avoid meat and dairy – others only avoid meat. . Alcohol must be avoided.
Sikhism Dietary practices can vary depending on individual beliefs/customs (Queensland Health, 2011).
• Holy Days – Sikhs observe a number of holy days and festivals – they don’t affect food intake – No specific day of worship. • Fasting – Do not fast for religious reasons Food Laws - Sikhism • Many Sikhs follow strict vegetarian diet – No fish, meat, eggs. – Do eat dairy products. • Non-vegetarians – may choose to avoid pork, beef • ALL Sikhs are prohibited from eating meat that has been ritually slaughtered including Halal/Kosher. • Prohibited from consuming alcohol, or other intoxicants.
Summary of Religious Food Requirements Faith Dietary Practices Islam Halal and must avoid pork
Buddhism +/- vegetarian
Hinduism Vegetarian
Judaism Kosher and avoid pork Vegetarian/meat eating must abstain from Sikhism halal/kosher Christianity (Seventh Day Vegetarian (ovo-lacto) Adventist)
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4.3 Cultural and Religious Menu Planning Planning a Menu around Different Cultures Whilst cultural/religious requirements are considered when menu planning is undertaken, a hospital cannot always provide all the foods preferred or chosen by an individual client. It is the role of the Nutrition Assistant to explain and assist the client as much as possible as to what foods and fluids are available for selection for the individual client.
Muslim Menu Planning The following table summarises some examples of important aspects that need to be considered for planning for a Muslim menu. Please note, this information is not exhaustive.
Food Group Muslim (Halal Approved) Muslim (Haram prohibited) Pork or pork products e.g. Beef, lamb, chicken (all must sausages, salami, ham, Meats be Halal) bacon Non-halal meat Seafood All seafood All (boiled or cooked in butter Eggs or vegetable oils Avoid dishes that contain Dried Beans, lentils, bacon bones, ham or stock All baked beans, tofu made from avoided foods e.g. pork Mono and polyunsaturated Avoid lard, dripping, suet and Fats and Oils margerine/butter other animal fats Other vegetable oils e.g. olive All raw, dried, canned or Fruits and vegetables cooked using water, vegetable fats and butter All breads and cereals that do not contain any animal fat Avoid cakes, biscuits with fats Breads and cereals except butter, can use other than butter vegetable oils Ice-cream if Halal i.e. Halal Avoid any with alcohol, gelatin used Desserts vanilla essence or gelatin, All without alcohol, vanilla lard, dripping or suet essence, gelatin Water, milk, tea, coffee, Drinks juices, softdrinks, cordial, Avoid alcohol (bitters) soda and mineral water Milk, yoghurt, cheese, ice- ice cream made with animal Milk and Milk products cream made without animal fat or vanilla essence or non- fat e.g. Gelati and sorbet halal gelatine
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For more information refer to the Queensland Health multicultural page on the following website www.health.qld.gov.au/multicultural
Jewish Menu Planning
Food Group Jewish approved Prohibited Beef, lamb, chicken (all must be Pork. Beef, lamb, chicken Meats kosher and NOT cooked with milk cooked with milk products products) Shellfish (filter feeders); Seafood Any fish with fins rabbit, camel, birds that seize prey Egg with blood spots; or if Eggs Eggs without blood spots contaminated with ham/bacon avoid dishes that contain Dried Beans, bacon bones, ham, or lentils, baked All stock made from avoided beans, tofu foods e.g. (prawns, pork) Mono and Polyunsaturated margarine/ butter (if it is a meat Avoid lard, dripping and Fats and Oils dish – use vegetable margarine) suet Other vegetable oils e.g. Olive, Peanut, etc. All raw, dried, canned or cooked Fruits and using water, vegetable fats and vegetables butter All breakfast cereals, bread, cakes, biscuits, rice, pasta that do not Breads and cereals contain any animal fat except butter*, can use vegetable fats fruit based, custards, gelati, sorbets, pudding made with vegetable margarine or butter, egg Desserts made with Desserts dishes, and rice dishes. gelatin, (pork) Egg-based dishes (neutral – so can be consumed with either meats or milks), Cold water, milk#, tea, coffee, Drinks juices, soft-drink, cordial Avoid alcohol (bitters) Alcohol is permitted Any dairy products that have come in contact with Milk, yoghurt, cheese, ice-cream Milk and Milk meat/ utensils meat has made without animal fat (e.g. products touched. Gelati, Sorbet) Milk and meat cannot be combined at the one meal
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Assisting Patients from Varying Cultures and Religions to Select Meals • Liaise with Nursing Staff and other Health Professionals to ascertain a client’s religion or cultural preference where possible. • Consider the cultural group and general characteristics of their cuisine during meal and menu planning. • Liaise with the client and family members to identify cultural or religious factors or customs that may influence food choices. • Utilise existing resources, either pictorial or specific to culture or religion, to assist the client in choosing preferred foods from the menu. • Utilise an interpreter or family member if required to assist the client with preferred meal selection. • Review the client and evaluate the client’s food intake and acceptance of foods provided. • Maintain regular contact with the client and or family members to assist with food options and intake for the duration of the client’s hospital admission. • Modify meals and menu selection where possible to accommodate the client’s religious or cultural needs – for example kosher approved foods at all times. • When language is a barrier, make an attempt to speak to the client in a simple language to gather basic food and fluid preferences. • Leave a bulk of blank menus for the family to complete when they visit. • Ask the Dietitian or Nursing Staff to gather some food preferences when using interpreters with the client.
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Activity 22– Cultural and Religious Menu Planning
Select a religious group that follows dietary restrictions or protocols and answer the questions below. If possible select a group that you have seen represented in the patients at your hospital.
1. What is the religious group that you have selected? Why?
2. Review your facility’s menu. Can you plan a one day menu for a person from the religious group you have selected from your facility’s menu? Yes – Outline it below No - Plan a one day menu for this person based on information in this guide
Breakfast
Lunch
Evening Meal
Activity continues on the next page.
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Activity 22 – Cultural and Religious Menu Planning continued
3. What mid-meal snacks would be appropriate for this patient?
4. How would you communicate the hospital’s suitability of menu items with regard to religion to the patient? Who would you speak to about this issue?
5. What tools or resources would you use? (Attach a copy of any sheets you would use to your workbook)
Select a religious group that follows dietary restrictions or protocols and answer the questions below. If possible select a group that you have seen represented in the patients at your hospital.
Activity continues on the next page.
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Activity 22– Cultural and Religious Menu Planning continued
6. What is the religious group that you have selected? Why?
7. Review your facility’s menu. Can you plan a one day menu for a person from the religious group you have selected from your facility’s menu? Yes – Outline it below No - Plan a one day menu for this person based on information in this guide
Breakfast
Lunch
Evening Meal
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Key Points
• Cultural factors may vary significantly from country to country and region to region and also within a country. • Each cultural group may also have special food traditions; specific ways of preparing, cooking, serving and eating food; special occasions of food celebration (feast); and times of fasting or avoidance of certain foods/drinks (e.g. Lent or Eid). • Modern changes to the traditional diet are not always healthier, particularly when more processed western food is used which tends to be higher in saturated fat, salt and sugar. • Education about the positive aspects of the traditional diet alongside suitable modern choices can be provided in hospital and may help improve intake during admission and on discharge. • Personal and cultural variations make it difficult to provide definitive rules and regulations that apply to all patients that identify with a particular religion. Therefore it is best to consult a patient on an individual/personal level for religious observances. • It is important that healthcare providers do not stereotype their clients, even if the client appears to comes from a specific group, or is perceived to have certain cultural affiliations • Consult a patient’s individual dietary preferences/customs and religious observances. • It is essential to be politically correct and non-discriminatory with all clients to reduce the risk of offending clients and their family members. • Effective communication occurs when clients and carers have common terms of reference and it is the healthcare providers responsibility (within reason) to learn and use the terminology that will be used and understood by clients. • There are a number of religious groups within Australian society who may follow particular dietary restrictions. • There is often: – Food laws and traditions which are observed. – Variability in the level of restriction within religious groups. – Changes to food and eating behaviour as a result of feast and fasting occasions (these may occur many times over the year).
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5. Nutrition risk screening and implementation of nutrition support
This topic covers information about: • Malnutrition • Nutrition risk screening tools and how to use them • Providing nutrition support services for at risk clients
Activities in this topic cover the following performance criteria: • Confirm the client group for screening with a dietitian • Monitor the nutrition status of clients using standard and validated tools and nutritional indicators • Report the progress of client nutritional status to the dietitian, and/or other health professional according to organisational protocols and timeframes • Use the organisation’s established screening documentation to gather client information • Consult with other appropriate staff before conducting the screening • Explain the screening purpose and process to the client and seek feedback to determine their understanding • Conduct the screening using language appropriate to the client’s needs • Seek appropriate assistance if client participation issues arise • Use screening results to determine level of risk for clients • Inform dietitian of at risk clients in a timely manner and according to organisation protocols • Complete screening forms and organise screening information • Select appropriate nutrition support item or services • Implement nutrition intervention and communicate with food services • Prepare nutrition support item • Use and clean any equipment according to manufacturer’s requirements • Store materials and equipment according to manufacturer’s requirements and organisation protocols • Report equipment problems or faults to appropriate person • Use appropriate terminology to document client response to screening
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Malnutrition is a state in which a deficiency of nutrients such as protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome/increases vulnerability to disease/recovery from diseases/or illness (National Collaborating Centre for Acute Care, 2006).
Risk Factors for Malnutrition Chewing or swallowing problems: • Poor appetite or nausea • Dementia, Depression and other Mental Health issues • Unable to shop for food and/or unable to afford food • On a special or texture modified diet • Increased nutritional requirements (e.g. burns) • Diarrhoea • Drug interactions • Forgetting to eat • Inability to feed themselves (National Collaborating Centre for Acute Care, 2006).
Physical effects of malnutrition may be: • Progressive weight loss – o especially muscle wasting (i.e. loss of muscle – notably at the temples, shoulders, shoulder blades and collar bone, legs (thigh and calf)) o as well as loss of fat, especially under the eyes, over the ribs and from the arms (triceps) • Weakness and apathy • Loss of temperature regulation • Impaired ability to regulate salt and fluid • Impaired ability to regulate periods • Increased risk of developing pressure ulcers • Reduced immune system - risk of urinary tract infection or pneumonia • Poor wound healing • Oedema (fluid status) (Elia & Smith, 2009; Banks, Ash, Bauer & Gaskill, 2007; Detsky et al, 1987)
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Malnutrition is an independent risk factor for: • Increased complication • Increased length of stay (16.7 +24.5, median 9 days vs 10.1+11.7 days, median 6 days) • Increased mortality • Increased costs – 60% higher for meal daily expenses to 300% with treatment costs (Correia & Waitberg, 2003)
Goals of the management of malnutrition include
• Improved nutrient intake – energy – protein – fluid • Improved nutritional anthropometry – i.e. body weight • Improved nutritional biochemistry • Prevention of pressure ulcers • Improved wound healing • Reduced infections and use of antibiotics • Decreased nausea, vomiting and/or diarrhoea • Improved quality of life • Improved mood • Improved physical function • Improved cognition • Improved life expectancy (Dietitians Association of Australia, 2009)
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Malnutrition Screening Well-nourished people have adequate intake of nutrients to meet optimal body functioning. In contrast, malnutrition is a state in which a deficiency of nutrients such as energy, protein, vitamins, and minerals causes measurable adverse effects on body composition, function, or clinical outcome. It is both a cause and a consequence of ill health (National Collaborating Centre for Acute Care, 2006). Individuals ‘At Risk’ of malnutrition are in a state in which a continued poor intake and/or increased nutritional needs will result in malnutrition. Malnutrition is serious. It was found to be present in approximately 30% of acute (hospital) patients, and 50% of more than aged-care residents, in a number of public facilities in Queensland (Banks, Ash, Bauer & Gaskill, 2007). Studies show that prevalence of malnutrition increases as the hospital length of stay increases, and increases hospital costs (Lazarus & Hamlin, 2005) estimated between 35 – 75%. It also results in poorer patient outcomes, including pressure ulcers/injuries (Queensland Health, 2011). Health professionals have a responsibility to be actively involved in the identification, prevention, and management of malnutrition. There are number of nutrition assessment tools, which explore weight changes/loss, dietary intake changes, symptoms of nutrition impact and physical well-being. Although tools are often used to make a complete nutritional diagnosis, other factors must also be taken into account. These factors include dietary habits, biochemistry, the clinical condition, and other co- morbidities, along with the existence of circumstances that increase nutritional requirements, e.g. pressure areas or ulcers. A Dietitian should be able to review these factors for inclusion into the Nutrition Care Plan of relevant patients.
Review the malnutrition screening tool at this site. https://www.health.qld.gov.au/nutrition/resources/hphe_mst_pstr.pdf
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Activity 23 – Determining risks of malnutrition
Match up the reasons which may increase risk of poor intake during admission with the cause that best explains how a patient’s lifestyle, health or well-being might affect their nutrition/food intake.
Life Factors Risk of Poor Intake
Mouth ulcers Will not eat certain menu items
Recently widowed Bored with the menu
Broken arm Unable to swallow
Stroke with dysphagia Unable to chew hard foods
Muslim/Islam or Jewish Not able to cook for themselves
Long-stay patient in a hospital Unable to feed themselves
Activity continues on the next page
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Activity 23 – Determining risks of malnutrition continued
Please examine the following case study below and answer the following questions
Case Study: Young women, nausea and vomiting Christine is a young woman who has been admitted to hospital due to nausea and vomiting. She has been having trouble keeping down solids for the past 5 days and states that food has no taste or appeal. She has lost 7 kg in the past 3 weeks and now weighs 57 kg. She is 170cm tall. She has recently moved from Melbourne with her partner. She is a lacto/ovo vegetarian and says she has never liked meat very much although says she used to eat fish occasionally. She enjoys the traditional Chinese cuisine her mother used to cook when she was growing up but also includes some Western style foods in her diet.
1. What is the Malnutrition Screening Score for this patient? (Fill out the table below)
Have you lost weight recently without trying? No 0 Unsure 2
If yes, how much weight in kilograms have you lost 1-5 1 6-10 2 11-15 3 >15 4 Unsure 2
Have you been eating poorly because of a decreased appetite? No 0 Yes 1
TOTAL
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Activity continues on the next page 2. At what Malnutrition Screening Score should action be taken?
3. Describe the actions that should be taken based on this screening score and why?
4. Christine has not touched any of the food on her dinner tray. She says that the smell of the Beef Stroganoff she received made her vomit. She said she wouldn’t eat it anyway because she is vegetarian. List two factors may be affecting Christine’s acceptance or tolerance of this meal?
One:
Two:
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Remember, if a client cannot communicate it may be a sign they are at risk of malnutrition:
The assessment of malnutrition requires a thorough evaluation by a Dietitian and is time-consuming. It can also be a difficult process as some of the data that needs to be collected is not readily or immediately available (e.g. weight measure on a bed-bound patient). To improve the ability to manage malnutrition in hospital and other facilities, reliable screening methods must be employed by trained staff on a regular basis. The effectiveness of some Nutrition Screening Tools (NST) may be limited in that their cost-effectiveness has not been proven. In addition, they may not identify all ‘at risk’ patients and the tool may not provide consistent results. Additionally, some of the things being screened for are based on ‘clinical judgement’ and intuition rather than reproducible measures (e.g. weight, height etc.).
Common Nutrition Assessment Tools (NAT) include
Tool Use
. Prognostic Nutritional Index (PNI) . Prognostic Inflammatory and All predict morbidity in peri-operative Nutritional Index (PINI) patients. . Nutritional Risk Index (NRI)
Only clinical method that has been validated Subjective Global Assessment (SGA) as reproducible and that evaluates nutritional status (and severity of illness).
Patient involved in the assessment process and the numerical scoring assists in Patient Generated Subjective Global monitoring improvements in nutritional status Assessment (PGSGA) thereby proving a numerical scoring system for triaging.
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For more information on these methods review the QHEPS document ‘Validated Nutrition Assessment Tools: Comparison Guide’ (2009) developed by QLD Health Dietitians: http://www.health.qld.gov.au/nutrition/resources/hphe_asst_tools.pdf
Some NATs are developed for specific groups of patients and may not be relevant for other groups (e.g. burns versus oncology patients). If they are used without an appropriate system for the management of malnutrition being in place, they may end up becoming complicated, time intensive, and invasive.
Malnutrition Screening in Healthcare facilities Some health care facilities use Nutrition and Dietetic Assistants to conduct ongoing malnutrition screening (using tools such as the Malnutrition Screening Tool) for new patients. Once identified as ‘at risk’, the patient is then usually referred to the Dietitian who assesses the patient and organises Medical Nutrition Therapy as relevant. At other healthcare facilities, nursing staff are required to screen new patients for malnutrition.
Consider the following questions: • What system of Malnutrition Screening exists in your facility? • Who performs this screening process? • How frequently are these patients reviewed for malnutrition during admission? • Is the Dietitian involved with high-risk patients? If so, what process or tool/s do they use for their assessment?
Malnutrition Screening Tool (MST) This screening tool is commonly used in many Queensland Health Care facilities and is advantageous in that it: • can be used in a mixed group of adult patients • uses data that is routinely available • is convenient to use; simple, quick and easy if performed by non-professional staff, patients or family • does not require blood test results and therefore is inexpensive • is valid and reproducible (i.e. the same results can be obtained when a different person uses the tool) It is recommended that screening should be performed within 24 hours of hospital admission using the MST (Ferguson, Capra, Bauer, & Banks, 1999).
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The following is an example of the script that is used to implement the MST at one healthcare facility. Begin by introducing yourself to the patient: ‘Hello, I’m ______from the ______department. I am conducting a simple nutrition screen, do you mind if I ask you a couple of questions about your weight and appetite?’
There are only three questions. Yes 1 Have you been eating poorly because of a decreased appetite? No 0 Yes 1 Have you lost weight recently without trying? No 0 (recently can be defined as the last six months) Unsure 2 1.0 – 5.0 1 6.0 – 10.0 2 If yes, how much weight have you lost? 11.0 – 15.0 3 (in kilograms) 15.0 4 Unsure 2
Total Score:
For weight conversion: 1 kilogram = 2.2 pounds and 1 pound = 0.45 kilograms
Action required depending on the MST score This will be different in different institutions and will be determined by the Dietitian.
MST Score 0 – 1 . Re-screen every 7 days
. Provide either selective mid-meals or Flavoured Milk (e.g. ‘Breaka’) at lunch and tea (or other type of extra) MST Score 2 . Provide high protein menu . Intensive mealtime monitoring
. Provide selective mid-meals . Provide extras at lunch and tea MST Score 3 – 5 . Provide high protein menu . Intensive mealtime monitoring
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An advantage of using the scoring system is that patients can be seen in order of priority e.g., patients with a higher score will require attention that is more urgent. The action taken by the Dietitian may be different for different wards/units. Check what procedure is in place at your institution.
What Dietitians do with the MST: • For all positive screens >/=2 - 3 → A comprehensive nutritional assessment is completed • Aim to see by next working day / <48 hours if over weekend • Priority determined by score of MST – higher scores seen first which shows the importance of all 3 questions being asked.
Patient Generated Subjective Global Assessment (PGSGA) • Identifies patients at nutritional risk • Measures nutritional status • Can track changes in nutritional status over time • Focuses on nutrition impacting symptoms (i.e. nausea, early satiety, etc.) → able to tailor nutrition recommendations
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Common eating problems that patients may experience that may lead to poor food intake and malnutrition include:
Problem Things that can help
Open containers, cut up food, organise finger foods or Unable to self-feed food in a bowl
Speech Pathology assessment and medication Drowsy assessment with the Doctor and Pharmacist
Problems Swallowing Speech Pathology assessment
Difficulty chewing Softer diet
Poorly fitted dentures Softer diet
Smaller meals offered more often Poor Appetite/satiety Offer only nutritionally dense foods versus non-nutritious drinks such as tea or coffee
Softer diet or liquid diet Avoid very hot and very cold foods Sore throat or mouth Avoid acidic or spicy foods that sting avoid rough or course foods
Smaller frequent meals Nausea and vomiting Sip cold clear fluids in between meals
Suggest moist foods like casseroles or soups Provide gravy, sauces or spreads to moisten food Dry or coated mouth Provide drinks to sip through meals dunk bread, toast, biscuits in soup, milk, tea, coffee
Cold protein foods may be better than hot ones Loss or alteration of Sweeter protein foods taste Utilise a straw to bypass taste buds
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Providing a high energy and protein diet assists clients with eating problems to meet nutritional requirements. This can be achieved by: • Providing a special high energy/high protein diet rather than the general/standard diet • Making sure that the patient is selecting a sufficient quantity of food • Encouraging the patient to select energy and protein-rich choices from the menu • Providing extra foods at meals • Providing high-energy/protein mid-meals • Providing tube feeds in addition to meals
Nutrition Assistants may be directed by the Dietitian to discuss these options with patients and implement one or more the strategies.
It is important to understand the nutritional value of the ‘supplemental’ foods and drinks available in the health facility. Patient acceptability and supplement cost should also be taken into account.
Every-day food items commonly used as nutritional supplements include: • Dairy desserts, custards, yoghurts, ice cream • Flavoured or fortified milks or milkshakes such as ‘Breakas’ or ‘Milo’ • Crackers with cheese • Chocolates, chips • Muffins, cakes, biscuits Clients will develop taste-fatigue if provided with the same supplement and flavours all the time. Some tips for assisting the client maintain an intake of high protein/high energy foods may include: • Offer the ‘best’ choice first (e.g. highest protein) – This will contribute most to nutritional status – Exchange to similar or lesser choices if necessary • Ability to select – Best to show the patient the items that are available for selection e.g. Selective mid-meals/displayed on trolley/brochure with options – Limit choice to 3 to 4 items. More can overwhelm.
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• Choices consistent with Nutrition Care Plan (NCP) – Dietitian may prescribe a particular nutrition supplement that is not interchangeable – Nutrition Assistant needs to be aware of the NCP
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Activity 24– Ranking Protein and Energy in Certain Foods
Using the list provided, rank the following mid-meal snacks in order of protein content and then do the same for energy content.
Mid-Meal Snack Protein Ranking Energy Ranking
Sustagen Drink
Breaka drink
Jatz and cheese
Soft drink
1 piece of fresh fruit
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Types of commercial supplements: • Milk based, vitamin and mineral fortified e.g. Sustagen, Nutridrink, Fortisip • Soy based, vitamin and mineral fortified e.g. Resource plus, Ensure • Clear fluid, vitamin and mineral fortified e.g. Enlive plus, Fortijuice • Vitamin and mineral fortified puddings e.g. Forticreme
Patients require a choice of different supplements: • Patients become tired of the same supplements and flavours if they are not provide with some variety • Sometimes a particular supplement item is required to meet the specific therapeutic diet needs of the patient e.g. novasource renal for renal patients for clinical reasons • Offering too many choices can be overwhelming; three (3) to four (4) is sufficient and these can be rotated on a delivery schedule • Offer the best choice (e.g. highest protein) first because this is more likely to be selected • Where possible show the patient the items that are available for selections e.g. Displayed in a basket or on a trolley • Queensland Health Hospitals provide supplements as negotiated on state-wide tender
The Dietitian should be informed: . If the patient is not happy with the supplement ordered by the Dietitian and changes to supplements that have been provided by the Nutrition Assistant. They should also be informed of the reasons for the change . Refusal of the supplemental foods and fluids especially when there is a pattern of refusal or a build-up of supplements at the bedside or wastage of supplements
Documenting your involvement, in a timely manner, of anything from a Malnutrition Screening Tool result, to involvement in education sessions or communication about a patient’s food/fluid intake, or understanding of a nutrition principle protects you as an employee, by providing evidence of what was said/found and when.
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When to provide nutrition education feedback to the Dietitian: . Always - if there are concerns or questions arising from the information presented (e.g. does the patient/carer not seem to understand the significance of the advice presented such as issues of safety in enteral feeding or measuring the correct quantity of thickener) . If the patient seems to be disinterested or unable to take in the education provided . If the education is not completed and follow-up appointments need to be arranged . If other staff requested subsequent assessment of the patient . If the patient or any staff asks for an explanation of the rationale, risks and options of Nutrition and Dietetic Care or Services . If the patient reveals they are unlikely to follow the advice you have explained or it conflicts with something s/he has been told by another member of staff or their religion/cultural or social belief system; and . Before education - feedback if it is obvious that additional information has become available that will require interpretation and may impact the advice given (e.g. new blood test results or diagnoses)
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Activity 25 – Monitoring Nutrition Support Read the Case Study below and answer the questions that follow.
Case Study: Woman, 78 years, NESB, recent stroke. Lucia is a 78 year old woman born in Italy who immigrated to Australia with her husband and five children after World War II. She was admitted to the rehabilitation unit after suffering a stroke. The stroke has left her with right sided paralysis. Lucia says she was eating well before the stroke. She does not think her weight has changed because her clothes fit about the same. She currently weighs 85kg and is 152cm tall. She tells you she loves to cook traditional Italian dishes for herself and her family. She was diagnosed with Type II diabetes about twenty years ago.
1. Please list two factors that may affect Lucia’s acceptance or tolerance of meals:
One:
Two:
2. When you are collecting the patient’s menus, you notice that Lucia’s menu has been left blank. When you talk to Lucia she tells you that she cannot read English so is unable to fill in the menu. What would you do? (List two possible solutions)
One:
Two:
Activity continues on the next page.
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Activity 25 – Monitoring Nutrition Support continued
3. List three issues that might affect Lucia’s ability to meet her nutritional requirements during her hospital admission. Then list how you might address this in your role as Nutrition and Dietetic Assistant.
Issue that may affect intake How this might be addressed
4. On the following pages is a record showing the types and amounts of food and drink consumed by Lucia over the past 48 hours. Study the record carefully and then answer the proceeding questions.
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Food and Fluid Intake Record Day: Wednesday Patient: Lucia Type or Other Items Consumed (please circle) Pro kJ Comments Breakfast Official use only
Juice thickened None ¼ ½ ¾ All
Fruit - None ¼ ½ ¾ All
Cereal porridge None ¼ ½ ¾ All
Yoghurt Fruit yoghurt None ¼ ½ ¾ All
Bread - None ¼ ½ ¾ All
Drink Thickened milk None ¼ ½ ¾ All
Supplement - None ¼ ½ ¾ All
Morning Tea Food - None ¼ ½ ¾ All
Drink - None ¼ ½ ¾ All
Supplement thick shake None ¼ ½ ¾ All
Lunch Soup - None ¼ ½ ¾ All
Meat Vitamised meat None ¼ ½ ¾ All
Vegetables Mashed potato None ¼ ½ ¾ All
Sandwich - None ¼ ½ ¾ All
Bread - None ¼ ½ ¾ All
Fruit - None ¼ ½ ¾ All
Dessert Puree fruit and custard None ¼ ½ ¾ All
Drink thick cordial None ¼ ½ ¾ All
Supplement - None ¼ ½ ¾ All
Afternoon Tea Food None ¼ ½ ¾ All
Drink thick shake None ¼ ½ ¾ All
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Supplement None ¼ ½ ¾ All
Dinner Soup None ¼ ½ ¾ All
Meat Vitamised meat None ¼ ½ ¾ All
Vegetables potato and carrot None ¼ ½ ¾ All
Sandwich None ¼ ½ ¾ All
Bread None ¼ ½ ¾ All
Fruit Puree fruit None ¼ ½ ¾ All
Dessert None ¼ ½ ¾ All
Drink thick juice None ¼ ½ ¾ All
Supplement None ¼ ½ ¾ All
Supper Food None ¼ ½ ¾ All
Drink thick shake None ¼ ½ ¾ All
Supplement None ¼ ½ ¾ All
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Food and Fluid Intake Record Day: Thursday Patient: Lucia
Type or Other Items Consumed (please circle) Pro kJ Comments
Official use only
Breakfast Juice thickened None ¼ ½ ¾ All
Fruit - None ¼ ½ ¾ All
Cereal porridge None ¼ ½ ¾ All
Yoghurt fruit None ¼ ½ ¾ All
Bread - None ¼ ½ ¾ All
Drink - None ¼ ½ ¾ All
Supplement - None ¼ ½ ¾ All
Morning Tea Food - None ¼ ½ ¾ All
Drink - None ¼ ½ ¾ All
Supplement thick shake None ¼ ½ ¾ All
Lunch Soup - None ¼ ½ ¾ All
Meat Vitamised meat None ¼ ½ ¾ All
Vegetables mashed potato None ¼ ½ ¾ All
Sandwich - None ¼ ½ ¾ All
Bread - None ¼ ½ ¾ All
Fruit - None ¼ ½ ¾ All
Dessert custard None ¼ ½ ¾ All
Drink thick cordial None ¼ ½ ¾ All
Supplement - None ¼ ½ ¾ All
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Afternoon Tea Food - None ¼ ½ ¾ All
Drink thick shake None ¼ ½ ¾ All asleep
Supplement - None ¼ ½ ¾ All
Dinner Soup - None ¼ ½ ¾ All
Meat Vitamised meat None ¼ ½ ¾ All
Vegetables potato and carrot None ¼ ½ ¾ All
Sandwich - None ¼ ½ ¾ All
Bread - None ¼ ½ ¾ All
Fruit Puree fruit None ¼ ½ ¾ All
Dessert - None ¼ ½ ¾ All
Drink thick juice None ¼ ½ ¾ All
Supplement - None ¼ ½ ¾ All
Supper Food - None ¼ ½ ¾ All
Drink thick shake None ¼ ½ ¾ All
Supplement - None ¼ ½ ¾ All
Activity continued on the next page
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Activity 25 – Monitoring Nutrition Support continued
Answer the following questions in relation to the above Food and Fluid Intake Records for Lucia 4. Does the intake record indicate that Lucia is: a) eating well and probably meeting her nutritional and fluid requirements b) not eating as well as she could, but nothing to me too concerned about c) not eating or drinking well and could be dehydrated d) none of the above
5. The correct action to take would be to: a) stop monitoring her intake because her intake is satisfactory b) continue to monitor her intake c) tell the Dietitian or other relevant person that Lucia is not eating and drinking well d) none of the above
6. Give two possible reasons why Lucia may not be eating very well: One:
Two:
7. List two suggestions you have that may help Lucia One:
Two:
Activity continued on the next page
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Activity 25 – Monitoring Nutrition Support continued
8. Based on the Food and Fluid Intake Chart are there any foods or fluids that Lucia appears to prefer over other options?
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Activity 26 – Delivery of Nutrition Support
Please answer the following questions about the delivery of nutrition support items
1. List two pieces of information that are required for the preparation and/or delivery of nutrition support items. One:
Two:
2. How do you ensure that only nutrition support items that are within their use-by dates are given to patients?
3. What do you do when you find out-of-date nutrition support items?
Activity continues on the next page.
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Activity 26 – Delivery of Nutrition Support
4. Ron’s nurse suggests you look in the bottom drawer of his bed-side table. When you do so you find a stash of vanilla flavoured unopened nutrition support items and you notice a range of flavoured drinks have been ordered for the patient. You also notice an array of half eaten supplements both food and fluid over his meal tray and side table. What would you do in this situation?
5. .On your nutrition support delivery, a patient tells you that he is going home tomorrow. He says he has been enjoying the protein fruit drinks he has been receiving while in hospital and would like to know where he can get them when he goes back to the hostel. What would you tell Jack?
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Activity 27 – Provision of Nutrition Support
Read the Case Study below and answer the questions that follow.
Case Study: Woman, 79 years, fractured NOF after fall Edna is a 79 year-old lady who was admitted to the ward last week after tripping over her cat and falling heavily. She suffered a fractured neck of femur (#NOF) when she fell. Edna lives in her own home with her 81 year-old husband who has Type II diabetes. Edna is her husband’s carer as he has almost completely lost his sight. Meals on wheels has been organised for him while Edna is in hospital and services will go in daily to shower and dress him. Edna is worried about her husband and anxious about who will feed her cat. None of Edna’s children live close enough to assist them with daily activities. Edna and her husband receive support from members of their local church who assist them with cleaning and shopping. At home Edna usually cooks lunch of meat and 3 vegetables for herself and her husband and has black tea and toast for tea. She has plain sweet biscuits for morning and afternoon tea. Edna weighs 44kg, is 154cm tall and has dentures, but they are loose so she prefers not to wear them.
You perform a malnutrition screening on Edna, which reveals the following:
Have you lost weight recently without trying? No 0 Unsure 2 If yes, how much weight in kilograms have you lost 1-5 1 6-10 2 11-15 3 >15 4 Unsure 2 Have you been eating poorly because of a decreased appetite? No 0 Yes 1 TOTAL 3
Activity continues on the next page.
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Activity 27 – Provision of Nutrition Support Continued
Please answer the following questions 1. Is Edna is at risk of malnutrition? Yes No Why/ Why not? (Provide at least two reasons) One:
Two:
2. List two factors that may affect Edna’s acceptance or tolerance of her meals? One:
Two:
3. The Dietitian has requested that Edna receive a high protein high energy diet during her admission. When collecting the lunch orders you notice that Edna has ordered a salad. a) Is this an appropriate choice? Yes No Why/ Why not?
Activity continues on the next page.
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Activity 27 – Provision of Nutrition Support Continued b) What would you say to Edna?
4. Would you provide feedback to the Dietitian if Edna’s food intake remains low or if her selection of foods at meal times is not in line with a high protein/energy diet? a) Yes No Why/ Why not?
5. During her admission Edna develops an MRSA infection and is in isolation. What visual cues would there be outside Edna’s room to alert you to the fact that she is in isolation?
Activity continues on the next page.
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Activity 27 – Provision of Nutrition Support Continued
6. What contact precautions are necessary? (List at least two)
One:
Two:
7. What special precautions would be necessary before you entered Edna’s room?
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Key Points
Malnutrition • is a state in which a deficiency of nutrients such as protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome/increases vulnerability to disease/recovery from diseases/or illness (National Collaborating Centre for Acute Care, 2006). • Risk factors for malnutrition can include a variety of functional e.g. chewing or swallowing, and physical e.g. weight loss, incapacities that render the person unable to eat or drink sufficiently to meet their energy and nutrient requirements. • Malnutrition is an independent risk factor for increased complications, length of stay, mortality and costs of treatment. Malnutrition Screening • Use of a validated malnutrition screening tool on admission and repeated weekly, identifies clients at risk of malnutrition. • Implementing nutrition support as per organisational protocols as early as possible will help to correct the malnutrition. • Referring at risk clients to a dietitian for malnutrition assessment as per the screening protocol will assist the dietitian to focus on the most at risk clients and to develop a Nutrition Care (Individualised) Plan as and if required. Nutrition Support • Nutrition support can range from ordering the client a high protein high energy diet, arranging higher energy and protein mid-meals, providing specialised supplements to the patient being started on enteral or parenteral support by the dietitian or medical team. • If you are asked to prepare nutrition support items for the client, ensure you follow the correct procedures and protocols. Monitoring Nutrition Support • Regardless of the type of nutrition support, it is important to review the client’s progress and report this to the dietitian according to your organisations protocols. This may involve filling out a food and fluid chart or checking supplement wastage or preferences with the client. Reporting on Client Tolerance of Nutrition Support • Always feedback to the dietitian or other appropriate health professional, the client’s tolerance of or any issues that arise with providing the client with nutrition support. • Document all progress in the client’s progress notes or medical chart according to organisational protocols.
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Self-Completion Checklist
Congratulations, you have completed the topics for:
Assist with planning and evaluating meals and menus to meet HLTAHA018 recommended dietary guidelines.
Assist with monitoring and modification of meals and menus HLTAHA019 according to individualised plans
HLTAHA020 Support food services in menu and meal order processing
Assist with the screening and implementation of therapeutic HLTAHA021 diets.
Please review the following list of knowledge and performance criteria for the units of competency you have just completed. Indicate by ticking the box if you believe that you have covered this information and that you are ready to undertake assessment.
Covered in Essential Knowledge topic
Organisation policy and procedures in relation to infection control as it relates to the AHA role assisting with foodservices and menu and meal planning, food, nutrition and special food guidelines Yes
Specific organisation policies or procedures relating to supervisory and Yes reporting protocols
Feedback processes or systems used within the organisation Yes
Legal and ethical considerations in relation to privacy, confidentiality and disclosure Yes relevant to allied health
Legal and ethical considerations in relation to work health and safety - manual handling including identification and control of manual task risk factors Yes
Safe food handling Yes
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Covered in Essential Knowledge topic
Australian Dietary Guidelines and other relevant organisational food, nutrition and special diet guidelines Yes
Principles of nutrition, diet therapy, nutrition supplements and factors that Yes place clients at risk of malnutrition and inadequate hydration Aspects of physical and mental conditions, which might affect a client’s ability to eat and/or feed oneself, including
• Arthritis • Broken bones • Confusion • Pain Yes • Poor dentition • Pressure injuries • Recovery from stroke • Swallowing problems
Principles of the impact of diet on • health, • fluid intake, Yes • rehabilitation and • an individualised plan
How to recognise malnutrition Yes Workings and protocols of the food service system including: • range of menus and menu items and different types of menu management systems • Food preparation and food service systems • Cooking methods and equipment Yes • Standardised recipes • Costing (portion size, mathematics) procedures
Common fluids and food restrictions Yes
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Covered in Essential Knowledge topic
Oral nutrition support products (supplements), their equivalents and enteral Yes feeds and their use
Inter-relationships between food services and nutrition services/dietary departments concerning menu/meal order processing procedures, food Yes production and delivery
Special diets and their importance to a client’s health including: • Texture modified diets (TMDs) and national standards for TMD • High energy, high protein Yes • Modified salt, protein or potassium • Diets for food intolerances including gluten free, fructose malabsorption (FODMAPS), and lactose free
Various cultural and religious requirements in relation to food, relevant to the profile of the community served by the organisation including halal, types of Yes vegetarianism, kosher
Organisation policies and procedures in relation to screening and assessment Yes
Significance of nutritional risk indicators, including weight loss, weight gain, appetite, bowel function, biochemical indicators, allergies and intolerances, Yes swallowing issues
Covered in Essential Performance Criteria topic
Comply with personal hygiene requirements of food safety program Yes
Wear clothing and footwear appropriate for food handling tasks and according Yes to the food safety plan
Report health conditions and/or illness according to the food safety program Yes
Identify and report processes and practices that are not consistent with the Yes food safety program
Take corrective action according to the food safety program and within level of Yes responsibility
Prepare, supply and deliver nutrition supplements according to organisation Yes
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Covered in Essential Performance Criteria topic procedures and dietitian’s instructions and provide support services according to the food safety program
Discard out of date nutrition support items and information Yes
Report any significant wastage to the appropriate personnel in accordance Yes with role and organisation requirements
Maintain the workplace in a clean and tidy order to meet workplace standards Yes
Provide feedback to the dietitian regarding client progress Yes
Seek assistance when client presents with needs or signs outside limits of Yes own authority or competence
Use accepted protocols to report information in line with organisation Yes requirements
Maintain client records according to organisation requirements Yes
Use organisation’s established screening documentation to gather client Yes information
Categorise foods according to food groups, identifying key nutrients by each Yes food group and individual foods within that group
Identify recommended serves of various food groups for client groups, in Yes consultation with a dietitian
Identify the conditions commonly encountered by the client group requiring an Yes individualised plan or dietary modification
Identify dietary factors associated with common lifestyle diseases and/or diet related chronic diseases and other nutrition-related conditions, food Yes intolerances, allergies
Identify special nutritional and dietary needs encountered by the client group Yes
Report dietary and nutrition issues and needs to the dietitian Yes
Consult with dietitian to address the identified risks and needs of client groups Yes
Report the acceptability, tolerance and consumption of meals by the client to Yes the dietitian or relevant health professional
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Covered in Essential Performance Criteria topic
Identify problems which may affect the client’s ability to eat or dinrk to the dietitian and/or other relevant health professional, according to organisation Yes policies and procedures
Provide feedback on consistently poor client meal choices to the dietitian Yes
Follow systems designed by a dietitian to monitor and document on client Yes nutritional status
Distribute menus to clients, or use meal order systems, according to Yes established routines and procedures
Provide guidance to client, to ensure that meal choices are consistent with the Yes individualised plan
Provide all assistance according to the instruction of dietitian and the Yes individualised plan
Collect menus and/or meal orders and assist clients with placing orders and Yes marking menus as appropriate in line with role
Distribute and collect menus for clients receiving diet or nutrition care Yes according to established routines and procedures
Record and provide feedback regarding food preferences and consistently Yes poor menu and/or meal choices to the appropriate person
Report client difficulties and concerns to the dietitian Yes
Implement variations to the individualised plan under the direction of the Yes dietitian
Collate menus and meal orders, including orders for clients receiving diet Yes therapy or nutrition support
Provide information to support the delivery of menu items chosen by the client, Yes according to established routines and procedures
Check meal orders for accuracy against the individualised plan developed by Yes a dietitian, or other health professional
Tally, collate and report menu items Yes
Maintain knowledge of client admissions, transfers and discharges Yes
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Covered in Essential Performance Criteria topic
Process meal orders for food services Yes
Provide information to support the delivery of chosen menu items to the food Yes service within the required time frame
Provide feedback about changes to, needs, food preferences and Yes individualised plan to food services and to dietitian
Plan menus according to menu planning principles Yes
Select food preparation and cooking methods in consultation with food Yes production personnel to maintain maximum nutritional value of foods
Plan meals and menus to minimise nutrient imbalance, incorporating relevant Yes dietary guidelines
Plan meals and food group serves to meet the nutritional needs of individuals Yes within client groups
Discuss and confirm menu plans with the dietitian Yes
Follow processes defined by dietitian to evaluate meals and menus to ensure Yes they meet nutritional requirements of client groups Follow processes defined by dietitian to evaluate meals and menus to ensure Yes client satisfaction
Evaluate meals and menus to ensure feasibility of production in relation to Yes equipment, time and skills as well as budgetary constraints
Make adjustments to menu according to findings and the dietitian’s directions Yes
Modify meals and menus to meet the nutritional and dietary needs of the client Yes group using relevant guidelines
Assess meals and menus for their suitability for texture modification to meet Yes special nutritional and dietary needs, using relevant guidelines
Incorporate sufficient choices of dishes and drinks in to menus for special Yes needs, using relevant guidelines
Provide information regarding individualised plan to client when appropriate Yes and as directed by dietitian or relevant health professional
Monitor the nutrition status of clients using standard and validated tools and Yes
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Covered in Essential Performance Criteria topic nutritional indicators
Report the progress of client nutritional status to the dietitian, and/or other Yes health professional according to organisational protocols and timeframes
Collect client satisfaction, using standard and validated tools Yes
Regularly monitor overall levels and changes in client satisfaction Yes
Provide feedback regarding overall levels and changes in levels of satisfaction Yes to the appropriate person
Use relevant feedback from clients to revise menus Yes
Identify client group, use correct terminology and observe cultural customs Yes
Consider cultural groups and general characteristics of their cuisine Yes
Identify dietary regimes and factors associated with cultural and religious Yes groups that may influence food choices
Plan and modify meals and menus to meet specific cultural and religious Yes needs of client group in line with organisational guidelines
Follow processes defined by dietitian to evaluate meals and menus to ensure Yes they meet cultural and religious needs of the clients
Confirm the client group for screening with a dietitian Yes
Monitor the nutrition status of clients using standard and validated tools and Yes nutritional indicators
Report the progress of client nutritional status to the dietitian, and/or other Yes health professional according to organisational protocols and timeframes
Use the organisation’s established screening documentation to gather client Yes information
Consult with other appropriate staff before conducting the screening Yes
Explain the screening purpose and process to the client and seek feedback to Yes determine their understanding
Conduct the screening using language appropriate to the client’s needs Yes
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Covered in Essential Performance Criteria topic
Seek appropriate assistance if client participation issues arise Yes
Use screening results to determine level of risk for clients Yes
Inform dietitian of at risk clients in a timely manner and according to Yes organisation protocols
Complete screening forms and organise screening information Yes
Select appropriate nutrition support item or services Yes
Implement nutrition intervention and communicate with food services Yes
Prepare nutrition support item Yes
Use and clean any equipment according to manufacturer’s requirements Yes
Store materials and equipment according to manufacturer’s requirements and Yes organisation protocols
Report equipment problems or faults to appropriate person Yes
Use appropriate terminology to document client response to screening Yes
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Workplace Observation Checklist Workplace Supervisor to date and sign
st nd Essential Skills and Knowledge 1 2 observation observation The learner demonstrates the following date and date and Comments *FER skills and knowledge: initial initial
Appropriate level of knowledge to deliver nutrition support services to client groups (019:1.1)(019:1.2)(019:1.3)(019:1.4)(019:2.2)(019:2.3)(019:2.4)(018:1.1)(018:1.2)(018:2.1)(018:2.2)(0 18:2.3)(018:2.4)(018:3.1)(018:3.2)(018:3.3)(018:3.4)(018:EK)(019:EK)(EK:020)(EK:021)
Has a sound knowledge of food, nutrients, serve sizes appropriate for the clients and can assess and modify meals and menus to meet the nutritional and dietary needs of the client group using appropriate guidelines including for those with common lifestyle related conditions.
Has an understanding of the Australian Dietary Guidelines and other relevant Guidelines used in the organisation and how to apply them appropriately to the conditions commonly encountered by the organisations clients that require a Nutrition (individualised) Care Plan or dietary modification
Has an appropriate level of knowledge of various cultural groups common to the client profile including using correct terminology, observing common customs as appropriate, and understands and applies requirements in relation to food, meals and menus to meet specific cultural and religious needs for the clients.
Has an appropriate level of knowledge of principles of the impact of diet on health including fluid intake, and health on dietary intake including arthritis, broken bones, pain, confusion, poor dentition, pressure sores, recovery from stroke, swallowing problems and rehabilitation.
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st nd Essential Skills and Knowledge 1 2 observation observation The learner demonstrates the following date and date and Comments *FER skills and knowledge: initial initial
Has an appropriate knowledge of therapeutic diets and their importance to a client’s health including but not limited to , texture modified diets and national standardised language for these, high energy and protein, modified salt, protein and potassium, allergy and intolerance diets.
An appropriate knowledge of the food service system including usual cooking and preparation methods and equipment and their influence on nutrition, the range of menus and menu items, the use of standardised and costed recipes and different types of menu management systems.
Has an awareness of the significance of nutritional risk indicators and can report on these as appropriate including: weight loss/gain, appetite, bowel function, biochemical indicators, allergies and intolerances and swallowing issues.
Has an appropriate knowledge of supplements and supplement equivalents used in the organisation.
Can evaluate Meals and Menus to meet client nutritional requirements (018:4.1)(018:4.2)(018:4.3)(018:4.4)(018:4.5)(018:2.5)
Follows dietitian approved processes and protocols to evaluate meal and menus to ensure they meet client’s nutritional, cultural and are feasible according to the organisations resources.
Can make adjustment to meals or menus according to findings and following dietitian’s directions to meet the client requirements to their satisfaction within the organisations resources.
Discusses and confirms meal and menu plans with the dietitian as appropriate.
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st nd Essential Skills and Knowledge 1 2 observation observation The learner demonstrates the following date and date and Comments *FER skills and knowledge: initial initial
Distributing, collecting menus from clients (020:1.1) (020:1.4)(020:1.5) (020:5.1)
Update admissions, transfers, discharges and distributes correct menu to patients, or uses meal order system, according to established routines and procedures.
Collect menus and/or meal orders.
Providing guidance and assistance to clients when they are completing their menu (020:1.2)(020:2.2)(020:1.3)(020:5.2)(018:EK)
Access policies, procedures, work procedures and special dietary resources within the workplace
Provide guidance (if required) to clients to ensure meal choices are consistent with Nutrition (individualised) Care Plan
Provide assistance (if required) to clients with marking menus or placing meal orders
Provide information to support the delivery of menu items chosen by the client, according to established routines and procedures
Recording and checking client food preferences and meal orders for accuracy (020:1.6)(019:3.1)(019:2.4) (020:2.3)
Record and respond to client food preferences according to workplace procedures
Can incorporate sufficient choices into menus for special needs using relevant guidelines
Routinely check meal orders for accuracy to ensure choices are consistent with the Nutrition
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st nd Essential Skills and Knowledge 1 2 observation observation The learner demonstrates the following date and date and Comments *FER skills and knowledge: initial initial (individualise) Care Plan.
Providing feedback to Dietitian or other relevant Health Professional on consistently poor client food choices, and consumption and acceptability of meals (020:1.6) (019:3.2)(019:3.4)
Provide feedback to the Dietitian if consistently poor food choices are made by the client
Provide feedback to the Dietitian on poor acceptance/tolerance of food by the client
Collating, tallying and reporting meal orders and special meals to Food Services (020:2.4)(020:2.1)(020:2.2)(020:5.2)(020:5.3)(019:3.1)
Tally, collate and report menu items to Food Services according to established routines and procedures
Provide Food Services with diet order information, including needs, changes and food preferences within designated time frames
Provide feedback about changes to , needs, food preferences and Nutrition (individualised) plan to dietitian.
Monitors client satisfaction with foodservices according to organisational requirements (0202:6.1)(020:6.2)(020:6.3)(020:6.4)
Collects client satisfaction using standardised and validated tools according to organisational protocols
Regularly monitors ad hoc client satisfaction and reports to the appropriate person/s according to organisational protocols
Preparing and delivering nutrition support/ menu items (020:4.1),(021:3.1) (021:3.2)(020:3.3)(020:3.4)(021:5.1)(021:5.2)(021:5.3)
Select and prepare and deliver appropriate nutrition support item or service according to organisations procedures and dietitian’s instructions
Implement nutrition intervention and communicate with foodservices as
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st nd Essential Skills and Knowledge 1 2 observation observation The learner demonstrates the following date and date and Comments *FER skills and knowledge: initial initial appropriate
Routinely check nutrition support items and discard out-of-date nutrition support items
Report any significant wastage to the appropriate personnel in accordance with role and organisation requirements
Maintain the workplace in a clean and tidy order to meet workplace standards
Use, clean and store materials and equipment according to manufacturer’s requirements and organisation protocols
Report any equipment or material issues to appropriate person
Monitor and report on client status and acceptance of Nutritional (individualised) Care Plan (019:1.5)(019:3.4)(019:3.5)(019:3.7)(019:3.6)(019:2.1)(019:3.3)
Follow systems designed by a dietitian to monitor, document and report on progress of client nutritional status or nutrition and dietary issues to dietitian and/or other HP
Use validated tools and nutrition indicators to monitor the nutrition status of client eg. weight, height, food and fluid intake charts
Consults with dietitian to address the identified risks and needs of client groups and identifies problems which may affect the client’s ability to eat or drink and reports these to the dietitian or other relevant HPs
Assists with nutrition risk screening and providing nutrition support to at risk clients (021:1.1) (021:1.2) (021:1.3)(021:1.4)(021:2.1)(021:2.2)(021:2.3)(021:2.4)(021:3.1)(021:3.2)(021:3.3)(021:4.3)(021:4.6)(0 21:6.2)
Carries out nutrition risk screening including rescreening appropriately according to organisation protocols
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st nd Essential Skills and Knowledge 1 2 observation observation The learner demonstrates the following date and date and Comments *FER skills and knowledge: initial initial
Identify clients at nutrition risk, reports to appropriate staff and/or records these results utilising organisational protocols
Implements appropriate nutrition support for at risk clients according to dietitian or organisation protocol
Seeks client feedback about tolerance of nutrition support intervention and implements variations according to dietitian’s directions or organisational protocols
Communicates effectively to complete allocated tasks (21:1.1)(021:1.3)(021:1.4)(021:1.5)(021:2.2)_(021:3.2)(021:4.1)(021:4.5)(021:6.1)(021:6.3)
Communicates with staff and clients in a helpful and polite manner according to organisation policies and protocols
Uses appropriate oral (clear and concise) and written language for the audience
Provides all assistance to the client according to the dietitians instruction or the Nutrition Care (Individualised) Plan or organisational protocols
Seeks clarification or assistance where required, or where client participation issues arise.
Access information from internal and external sources to solve routine problems
Documents and maintains client records according to organisation
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st nd Essential Skills and Knowledge 1 2 observation observation The learner demonstrates the following date and date and Comments *FER skills and knowledge: initial initial requirements and protocols.
Comply with Organisational Policies and Procedures to Ensure Safety Work Practices(020:4.4)(020:4.2)(020:4.3)(020:4.5)(020:4.6)(021:1.6)(021:4.4)(021:4.5)(019:2.5)(020:EK)
Treat clients and colleagues in accordance with the Qld Health Code of Conduct
Complies with infection control processes and procedures
Complies with personal hygiene standards and food safety program
Identifies and reports processes and practices that are not consistent with the food safety program and takes corrective action as appropriate
Complies with legal and ethical considerations relevant to allied health including but not limited to, privacy, confidentiality and disclosure
Complies with work health and safety requirements
Complies with AHA scope of practice including complying with supervisory requirements such as seeking assistance when is presented with a client or situation outside limits of authority or competence *FER – Further Evidence Required
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Appendices
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Appendix A: HLT43015 Certificate IV in Allied Health Assistance Qualification HLT43015 Certificate IV in Allied Health Assistance This qualification covers workers who provide therapeutic and program related support to Allied Health Professionals. The worker is required to conduct therapeutic and program-related activities under the guidance of an Allied Health Professional. Supervision may be direct, indirect or remote and must occur within organisation requirements. The worker is required to identify client circumstances that need additional input from the Allied Health Professional.
This qualification is suited to Australian Apprenticeship pathways.
Occupational titles for these workers may include:
3) Therapy Assistant 4) Podiatry Assistant
5) Physiotherapy Assistant 6) Speech Pathology Assistant
7) Occupational Therapy Assistant 8) Allied Health Assistant
9) Nutrition Assistant 10) Dietetic Assistant
11) Community Rehabilitation Assistant
The importance of culturally aware and respectful practice All workers undertaking work in health need foundation knowledge to inform their work with Aboriginal and/or Torres Strait Islander clients and co-workers and with clients and co-workers from culturally and linguistically diverse backgrounds. This foundation must be provided and assessed as part of a holistic approach to delivery and assessment of this qualification. Specific guidelines for assessment of this aspect of competency are provided in the Assessment Guidelines for the Health Training Package.
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PACKAGING RULES 16 units of competency are required for award of this qualification, including: • 7 core units • 9 elective units A wide range of electives is available and can be packaged to provide either: – a generic qualification that covers a range of work functions, or – a qualification tailored to address specific workplace requirements Packaging for each specialisation: • All Group A electives must be selected for award of the Certificate IV in Allied Health Assistance (Physiotherapy) • All Group B electives must be selected for award of the Certificate IV in Allied Health Assistance (Podiatry) • All Group C electives must be selected for award of the Certificate IV in Allied Health Assistance (Occupational therapy) • All Group D electives must be selected for award of the Certificate IV in Allied Health Assistance (Speech pathology) • All Group E electives must be selected for award of the Certificate IV in Allied Health Assistance (Community rehabilitation) • All Group F electives must be selected for award of the Certificate IV in Allied Health Assistance (Nutrition and dietetics)
Core units
CHCCOM005 Communicate and work in health or community services
CHCDIV001 Work with diverse people
CHCLEG003 Manage legal and ethical compliance
HLTAAP001 Recognise healthy body systems
HLTAAP002 Confirm physical health status
HLTWHS002 Follow safe work practices for direct client care
BSBMED301 Interpret and apply medical terminology appropriately
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• Where 2 (or more) specialisations are completed, award of the qualification would read, for example, Certificate IV in Allied Health Assistance (Physiotherapy, Occupational Therapy) • All electives chosen must contribute to a valid, industry-supported vocational outcome.
Elective units Group A electives – PHYSIOTHERAPY specialisation
HLTAHA003 Deliver and monitor a client-specific physiotherapy program
HLTAHA005 Support the delivery and monitoring of physiotherapy programs for mobility
Group B electives – PODIATRY specialisation
HLTAHA006 Assist with basic foot hygiene
HLTAHA007 Assist with podiatric procedures
HLTAHA008 Assist with podiatry assessment and exercise
Group C electives – OCCUPATIONAL THERAPY specialisation
HLTAHA010 Assist with the development and maintenance of client functional status
HLTAHA016 Support the fitting of assistive equipment
Group D electives – SPEECH PATHOLOGY specialisation
HLTAHA012 Support the development of speech and communication skills
HLTAHA013 Provide support in dysphagia management
HLTAHA014 Assist and support the use of augmentative and alternative communication systems
Group E electives – COMMUNITY REHABILITATION specialisation
HLTAHA004 Support client independence and community participation
HLTAHA024 Work within a community rehabilitation environment
Group F electives – NUTRITION and DIETETICS specialisation
HLTAHA018 Assist with planning and evaluating meals and menus to meet recommended dietary guidelines
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HLTAHA019 Assist with the monitoring and modification of meals and menus according to individualised plans
HLTAHA020 Support food services in menu and meal order processing
HLTAHA021 Assist with screening and implementation of therapeutic diets
Other electives
CHCAGE001 Facilitate the empowerment of older people
CHCAGE005 Provide support to people living with dementia
CHCAOD001 Work in an alcohol and other drugs context
CHCCCS001 Address the needs of people with chronic disease
CHCCCS002 Assist with movement
CHCCCS004 Assess co-existing needs
CHCCCS006 Facilitate individual service planning and delivery
CHCCCS009 Facilitate responsible behaviour
CHCCCS020 Respond effectively to behaviours of concern
CHCCCS023 Support independence and wellbeing
CHCCCS027 Visit client residence
CHCCOM002 Use communication to build relationships
CHCDIS007 Facilitate the empowerment of people with disability
CHCDIV002 Promote Aboriginal and/or Torres Strait Islander cultural safety
CHCHCS001 Provide home and community support services
CHCLAH001 Work effectively in the leisure and health industries
CHCLAH002 Contribute to leisure and health programming
CHCLAH003 Participate in the planning, implementation and monitoring of individual leisure and health programs
CHCMGT001 Develop, implement and review quality framework
CHCMGT002 Manage partnership agreements with service providers
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CHCMHS001 Work with people with mental health issues
CHCPOL003 Research and apply evidence to practice
CHCPRT002 Support the rights and safety of children and young people
CHCPRT003 Work collaboratively to maintain an environment safe for children and young people
CHCSET001 Work with forced migrants
CHCSOH001 Work with people experiencing or at risk of homelessness
CHCYTH001 Engage respectfully with young people
HLTAHA001 Assist with an allied health program
HLTAHA002 Assist with the application and removal of casts
HLTAHA009 Assist in the rehabilitation of clients
HLTAHA011 Conduct group sessions for individual client outcomes
HLTAHA015 Deliver and monitor a hydrotherapy program
HLTAHA017 Assist with social work
HLTAHA022 Prepare infant formulas
HLTAHA023 Support the provision of basic nutrition advice and education
HLTAHA025 Contribute to client flow and client information management in medical imaging
HLTAHA026 Support the medical imaging professional
HLTAID001 Perform cardiopulmonary resuscitation
HLTAID002 Provide basic emergency life support
HLTAID003 Provide first aid
HLTAID006 Provide advanced first aid
HLTAUD001 Assess hearing
HLTAUD002 Conduct play audiometry
HLTAUD003 Assess and respond to occupational noise risk
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HLTFSE001 Follow basic food safety practices
HLTFSE005 Apply and monitor food safety requirements
HLTFSE008 Conduct internal food safety audits
HLTINF002 Process reusable medical devices and equipment
HLTOHC001 Recognise and respond to oral health issues
HLTOHC002 Inform and support patients and groups about oral health
HLTOHC003 Apply and manage use of basic oral health products
HLTOHC004 Provide or assist with oral hygiene
HLTOHC005 Use basic oral health screening tools
HLTOHC006 Apply fluoride varnish
BSBAUD402 Participate in a quality audit
BSBFIM501 Manage budgets and financial plans
BSBFLM306 Provide workplace information and resourcing plans
BSBINM301 Organise workplace information
BSBINN301 Promote innovation in a team environment
BSBLDR402 Lead effective workplace relationships
BSBMED401 Manage patient recordkeeping system
BSBMGT401 Show leadership in the workplace
BSBMGT406 Plan and monitor continuous improvement
BSBWOR204 Use business technology
BSBWOR502 Lead and manage team effectiveness
SISCAQU008 Instruct water familiarisation, buoyancy and mobility skills
SISFFIT003 Instruct fitness programs
SISFFIT019 Incorporate exercise science principles into fitness programming
SITXFSA401 Develop and implement a food safety program
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TAEDEL301A Provide work skill instruction
TAEDEL402A Plan, organise and facilitate learning in the workplace
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Appendix B: Food and Fluid Intake Record
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Appendix C: Australian Food Safety Essentials - Script
SAFE FOOD HANDLING (8min) The greatest threat to food safety is food poisoning bacteria. Food poisoning bacteria gro This includes raw and cooked meat, poultry and seafood; dairy products, food made from eggs, nuts or beans; small goods, cooked rice, fresh and cooked pasta; processed fruit and vegetables or any other foods with these ingredients. These foods are called potentially hazardous foods - or PHF’s, because they support bacterial growth well. You need to keep these foods cold, at 5oC or less, or keep them hot, at 60oC or more. In this module, we look at safe food handling of potentially hazardous foods and their temperature control during: • Food Receipt • Storage • Preparation • Cooking • Serving, and • Handling of Leftovers
Food Receipt • Food should be delivered in appropriate packages or containers, to protect it from contamination. • The label tells you what the food is and names the supplier, so that in the case of a recall, food can be traced back to its source. • Do random checks on regular deliveries. If you have a new supplier, check the initial deliveries as well. • Reject deliveries where the packaging around the food is damaged. • Look out for unusual smell or discoloration, or signs of vermin. • Make sure frozen food is frozen solid. • Chilled foods should be 5º C or less • It's a good practice for a staff member to be present when food is delivered, so that potentially hazardous food is not left lying at room temperature
Food Storage • Store food off the ground on shelves. • Food should be stored in appropriate containers, covered or sealed. • Put older stock in front of recently received goods to allow for good stock rotation. • Storerooms should be kept clean and tidy to avoid attracting pests.
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Refrigeration: • Keep the fridges or cool room running at 5oC or less. • Store raw or thawing food on the bottom shelf of the fridge or cool room. From here, the row juices cannot drip onto other food and contaminate it.
Freezing: • Food should be frozen hard. • Freeze food to -15oC or less, or follow the recommended storage temperatures on the label.
Food Preparation: • Before handling food, wash and dry your hands thoroughly. • Wash all fruit and vegetables thoroughly to remove dirt and bacteria. • Work only on clean, sanitised and dry surfaces and use only clean, sanitised and dry equipment and utensils. • Don't use the same chopping boards or utensils for raw and then ready-to-eat food. • If you have to use the same utensils, clean, sanitise and let them dry before reuse. • Check food for spoilage before you use it. Look out for discoloration, mould or infestation. • Keep the time that food is out of the refrigerator to a minimum. • Put food back into the fridge as soon as it is ready.
Thawing Food: • Make sure food is thawed entirely before you use it • The safest place to thaw frozen food is in the refrigerator or cool room - on the bottom shelf. • You need to plan ahead, as it takes time for food to thaw completely throughout. • You can also use a microwave oven; however, you must cook the food immediately afterwards.
Cooking • Cook foods thoroughly. • This is usually achieved if the core of the food reaches 75o C or hotter. • You can check the temperature with a probe thermometer. • Remember, the probe must be clean and sanitised before use. • In poultry, minced meats, rolled meats and sausages, bacteria can be found completely throughout. These foods must be thoroughly cooked, so that the juices run clear. • Solid meat cuts are more likely to be contaminated with bacteria only on the cut surfaces. Searing the meat on all surfaces will reduce the number of bacteria to a safe level. • Cool food quickly. Divide food into smaller portions or pour in shallow containers. You can leave it to cool for 20 - 30 minutes before placing into the cool room or freezer. • To speed up cooling, keep space between foods, so that cold air can circulate well. Serving When holding ready-to-eat food, remember the rules: 1. Keep cold foods cold: at 5º C or less. 2. Keep hot foods hot: at 60º C or hotter.
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For potentially hazardous food that is held between 5º C and 60º C you have two choices: 1. If you want to use it at a later stage, you must put it into the fridge within a total of 2 hours of being at a temperature between 5 o C and 60 o C and that includes preparation and delivery time. 2. If it is for immediate consumption, it may stay between 5o C and 600 C for 4 hours - and again that would include preparation and delivery. After 4 hours you must throw it out.
Here is an example: a) It takes one hour to prepare these sandwiches in the morning for a lunchtime function. b) The sandwiches are then refrigerated. c) They are taken out of the cool room at 11.30 am, and held at room temperature over lunch.
Because preparation of the sandwiches took one hour, they can only be held at room temperature for a further 3 hours. By 2.30 pm, all uneaten sandwiches are then thrown out • Use tongs or other barriers when handling ready-to-eat food. • Serve all food with clean utensils. All crockery and cutlery must also be clean. • Covers, packaging or sneeze guards must protect food on display from potential contamination by the consumer. • Don't refill trays, mixing old food with fresh food; replace the tray with freshly prepared food.
Handling Leftovers Refrigerate leftovers within 2 hours of cooking. Use all refrigerated leftovers within three days. • REMEMBER: If in doubt, throw it out. • If you have to re-heat leftovers, it’s a good practice to cook it for at least 2 minutes if possible - steaming hot. • Potentially hazardous food shouldn't be cooled and re-heated more than once.
PERSONAL HYGIENE (4 min) In this module we will talk about hand hygiene, gloves and hygienic conduct. • When you handle food with contaminated hands, you can transfer bacteria. • A simple but very effective way to prevent contamination of food is by washing and drying your hands thoroughly. • You must wash your hands immediately before handling food. Even when you handle food with gloves, tongs or utensils, your hands must be clean.
How Well Do You Wash Your Hands? Here's a simple test: • We're putting a gel on this person's hands. • When dry, this gel is invisible to the naked eye. • However, it will show up under ultra-violet light. • Let's see how much of the gel is still there after a casual hand wash. • As you can see, there is still gel left on the hands. And just like bacteria, unless you wash and dry your hands properly, you still leave it on your hands. • This time the hands were washed properly.
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Hand Washing Use warm water and soap. All surface areas of your hands must be washed: a) The wrists b) Between your fingers c) The palms of your hands d) The fingers and tips, and e) The back of your hands
• Rinse thoroughly with warm water. • It is important that you dry your hands well with a disposable or single use towel. • It is very effective if you use these in combination with a blow dryer. • Don't wipe your hands dry on your clothes, as they can contain bacteria.
When To Wash Your Hands You must wash your hands immediately before handling food. Here are some other reasons to wash your hands: • After touching raw meats, poultry and vegetables • After blowing your nose or touching other parts of your body, like ears, mouth or hair • After eating • After smoking • After going to the toilet • After putting away the rubbish • After any unhygienic practice
You are encouraged to wash your hands frequently during your shift. Don't forget to dry them properly.
Gloves • Use barriers when handling ready-to-eat food. • You may also use gloves, but wash your hands first before putting them on. If your hands are dirty, you will transfer bacteria onto the gloves you put on. • The gloves must be clean, and not ripped or torn. • To prevent cross-contamination, use a new pair of gloves for each new task. You should never use the same gloves for raw meats and then for ready to-eat foods. • Disposable gloves should not be worn for longer than one hour. • Wear disposable gloves over brightly coloured dressings to protect minor cuts or wounds.
Hygienic Conduct • Keep your fingernails short and clean. • Wear only minimal jewellery, such as a plain-banded ring. Bacteria hide easily on jewellery, making it harder for you to wash your hands thoroughly. • Long hair should be tied back. • Wear clean protective clothing. • Take it off when you put out the rubbish, go to the toilet or when on a break. • Don't eat where you prepare food. • Don't cough or sneeze over food.
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• If you suffer from an illness report it to your supervisor.
For example • You must not work with food if you have diarrhoea or gastroenteritis.
CLEANING AND SANITATION (5min) In this module we focus on cleanliness of the premises, fixtures and fittings; cleaning and sanitation; and the maintenance of equipment. • Make sure that the premises, fixtures and fittings are clean. • There should be no build-up of grease or dirt, of food waste or mould. Clean not only the obvious areas, but also behind equipment and in areas less easy to reach.
It is a good practice to clean up spills as soon as possible. For an efficient cleaning program you must have a daily and weekly cleaning routine of. • Wiping and sanitation bench tops • Mopping floors • Cleaning back splashes and stove tops • Clean at least once a day at the end of the shift, or as often as necessary. • Range hoods must also be cleaned regularly. Fluff and grease collect in the fitters, and the build-up is a fire hazard, Small bits could fall into the food underneath. Change or clean filters regularly. • When dishcloths get dirty, they are a good nourishing ground for bacteria. Exchange them for fresh ones frequently. • Remove rubbish at least once a day. Rubbish bins and containers for recyclable material should not overflow. It's best to have a lid on them. • Food scraps and general untidiness attract pests, can cause slips and trips and may even be a fire hazard.
Utensils and Equipment • All eating and drinking utensils must be cleaned and sanitised before being used. • To be clean, a utensil has to look clean, smell clean and feel clean. • Cleaning removes food particles and grease, but does not kill or remove all the bacteria and viruses. • Sanitation is required to reduce the number of micro-organisms present on a surface to a safe level. This is a level that does not allow the spreading of a contagious disease and does not endanger food safety. • You also have to clean and sanitise surfaces that come into contact with food. • Think of chopping boards, storage containers, cooking or processing or other equipment, and things like thermometer probes.
• To sanitise, you can use heat or sanitation chemicals or both. The choice is yours. • Use proper sanitation procedures and follow the manufacturer's instructions on correct use and dosage of cleaning and sanitation chemicals. Always add the active agent to the water last. • Store chemicals separate and away from food. • Many commercial dishwashers will both clean and sanitise.
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• If you wash dishes by hand, complete the following steps: 1. Scrape off any food remains 2. Wash with hot water and detergent 3. Rinse 4. Sanitise according to manufacturer's instructions, and 5. Air dry
• After sanitation, all equipment should be air-dried thoroughly. If you use towels, they must be clean and dry.
Equipment Maintenance Slicers, grinders, mixers and other equipment need to work safely. • Don't operate machinery where the machine guarding has been removed or where protective parts are missing.
To clean machinery, • Scrape off any food remains and wipe surfaces. • Disassemble, wash and sanitise the equipment according to the manufacturer's instructions.
It is important to disassemble the equipment. Food particles can get stuck in corners, folds and creases and become a bacterial breeding ground that contaminates the food you process. The equipment, especially the crockery, • Should not be cracked, chipped or broken. • Broken or chipped parts could end up in the food, or cracks in the eating and drinking utensils could impede efficient cleaning and sanitation • This would endanger food safety.
TEMPERATURE MONITORING (3min) • Potentially hazardous foods need to be kept under temperature control. • For this reason you must have a thermometer in the kitchen and it must be easily available. A thermometer helps you: 1. to check the temperature of foods upon delivery 2. to ensure that foods are cooked, cooled and re-heated at safe temperatures, and 3. to check that potentially hazardous foods are held at correct temperatures use a probe thermometer and insert it into the centre of the food.
Thermometer Use a) Insert the probe right into the core of the food, and wait a moment for the reading to stabilise. b) The probe should be cleaned, sanitised and dried before each and every use. This is important when checking different foods to avoid cross contamination. c) Wipe off food remains and wash the probe with warm water and detergent. d) Sanitise according to the manufacturer's instructions.
When you sanitise the probe with an alcoholic wipe, wait until the alcohol has
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evaporated. • You may also sanitise the probe by leaving it in hot water above 77o C for 30 seconds. • Let the probe air dry or dry thoroughly with a disposable towel. • When checking temperatures of hot and cold food with the same probe, it should reach room temperature between measurements.
Fridges, cooling or holding units can distribute temperatures unevenly. It is a good practice to check the temperature of foods in different areas of the unit. In the case of sealed food or frozen food, • You may place the length of the probe in between the packages. This method will give you a close indication of the temperature at the core of the food.
Thermometer Check • The thermometer must be accurate to +/- 1oC. Here's a simple test to check the accuracy of your thermometer: a) Fill a container with equal amounts of crushed ice and water and wait 5 minutes. b) Place the probe into the mixture and leave it in a few minutes. An accurate thermometer will read 0oC. c) If the display shows a temperature outside the range of – 1oC to + 1oC, the thermometer is not accurately calibrated. You should not use it for temperature control. An incorrect reading could be the result of a flat battery.
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References
ASeTTS 2007, Fact Sheet 10; Factors that affect food choices for migrants, Good Food for New Arrivals, Assisting Torture and Trauma Survivors, Perth Western Australia, viewed 17 November 2011,
ASeTTS 2007, Fact Sheet 7; New and Emerging Communities, Good Food for New Arrivals, Assisting Torture and Trauma Survivors, Perth Western Australia, viewed 17 November 2011,
Australian and New Zealand Food Standards Code 2011, Standard 3.2.2 Food Safety Practices and General Requirements, Food Standards Australia New Zealand, Canberra, ACT, Viewed 26 April 2011,
Australian Bureau of Statistics 2007, 2011 Census of Population and Housing: Media Releases and Fact Sheets, Australian Bureau of Statistics, Canberra, ACT, viewed 17 November 2011,
Australian Government Department of Health and Ageing 2013, Australian Guide to Healthy Eating Chart, The Children’s Health Development Foundation, South Australia and Deakin University, Victoria, viewed, 7 July 2011,
Banks M, Ash S, Bauer J, Gaskill, D 2007, Prevalence of malnutrition in adults in Queensland Public Hospitals and Residential Aged Care Facilities, Nutrition & Dietetics, no. 64, pp. 172-178.
Caboolture Hospital 2010, Plating line example, Nutrition and Foodservices, Caboolture Hospital, Caboolture, Queensland.
Caboolture Hospital 2010, Protein portions/serves, Nutrition and Foodservices, Caboolture Hospital, Caboolture, Queensland.
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Coeliac Australia 2011, What is Coeliac Disease? Coeliac Australia, Wahroonga, NSW, Viewed 12 September 2011,
Correia MAT & Waitberg, DL 2003, ‘The impact of malnutrition on mortality, morbidity, length of hospital stay and costs evaluated through a multivariate model analysis’, Clinical Nutrition, vol. 22, no. 3, pp 235 -239.
Cruickshank, D 2009, Development of nutrition standards for general menus for Queensland Health hospitals and residential aged care facilities, State-wide nutrition standards for meals and menus, Background Document, Queensland Health, State of Queensland, Brisbane, Queensland.
Detsky, A, McLaughlin, J, Baker, J, Johnston, N, Whittaker, S, Mendelson, R & Jeejeebhoy, K 1987, ‘What is Subjective Global Assessment of Nutritional Status?’, Journal of Parenteral and Enteral Nutrition, no. 11, vo. 1, pp 8-13.
Diabetes Australia 2010, Hyperglycaemia, Diabetes Australia, Diabetes Queensland, Brisbane, Queensland, viewed 14 November 2011,
Diabetes Queensland 2009, Information about Sugar, Diabetes Australia, Diabetes Queensland, Brisbane, Queensland, viewed 14 November 2011,
Diabetes Queensland 2010, The Glycaemic Index, Diabetes Australia, Diabetes Queensland, Brisbane, Queensland, viewed 14 November 2011,
Diabetes Queensland 2010, What is Diabetes?, Diabetes Australia, Diabetes Queensland, Brisbane, Queensland, viewed 14 November 2011,
Diabetes Queensland, 2009, Hypoglycaemia and Diabetes, Diabetes Australia, Diabetes Queensland, Brisbane, Queensland, viewed 14 November 2011,
Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for Certificate IV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,
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Dietitians Association of Australia 2009, ‘Evidence Based Practice Guidelines for the Nutritional Management of Malnutrition in Adult Patients across the Continuum of Care’, Nutrition & Dietetics, vol. 66(Suppl.3) no. 51, viewed 29 July, 2011,
Dietitians Association of Australia and Speech Pathology Australia, Australian Standards for Texture modified Foods and Fluids, Dietitians Association of Australia, Deakin, ACT, viewed 26 April 2011,
Elia, M & Smith R, 2009, ‘Improving Nutritional care and treatment. Perspectives and recommendations from population groups, patients and carers’, British Association for Parenteal and Enteral nutrition, viewed, 29, July, 2011,
Ferguson M, Capra S, Bauer J & Banks M 1999, Development of a valid and reliable malnutrition screening tool for adult acute hospital patients, Nutrition, no. 15, pp. 458-464.
Gallegos, D & Perry, E 1995, A World of Food. A manual to assist in the provision of culturally appropriate meals for older people, Commonwealth Department of Human Services and Health.
Gout, BS, Barker, LA & Crowe, TC 2009, ‘Malnutrition identification, diagnosis and dietetic referrals: Are we doing a good enough job?’ Nutrition & Dietetics, vol. 66, no, 4, pp 206– 211.
Hand Hygiene Australia 2010, Five Moments for Hand Hygiene, Australian Commission on Safety and Quality in Healthcare, Heidelberg, Victoria, viewed 2 March 2011,
Heart Foundation, n.d, Heart Foundation of Australia, Deakin, ACT, viewed 21 October 2011,
Jegtvig S 2008, What Is a Nutrient?, About.com, The New York Times Company, New York, New York, viewed 15 February 2011,
Johnston, M & Kanitsaki, O 2005, Cultural Safety and Cultural Competence in Health Care and Nursing: An Australian Study, RMIT University, Melbourne, Victoria.
Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for Certificate IV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,
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Lazarus, C & Hamlyn, J 2005, ‘Prevalence and documentation of malnutrition in hospitals: A case study in a large private hospital setting’, Nutrition & Dietetics, no. 62, pp. 41–47.
Mater Health Services 2008, Education Resource, Nutrition and Dietetics – Mater Misericordiae Health Services, South Brisbane, Queensland.
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Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for Certificate IV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,
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Reid, M 2009, Food Additives: A Guide for People with Food Chemical Sensitivity, Royal Prince Alfred Hospital Allergy Unit, Sydney, NSW.
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Schenker, S 2003, ‘Briefing Paper, Under Nutrition in the UK’, Nutrition Bulletin, vol. 28, no. 1, pp 87-120.
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Vivanti A, Suter M, Aliakbari J, Banks M 2007, The Opportunities & Challenges of providing Nationally Recognised Training & Career Progression For Support Workers in Nutrition, Nutrition & Dietetics Department, Princess Alexandra Hospital, 7th National Allied Health Conference, Hobart, Tasmania.
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Resources
Queensland Health Resources
Nutrition Education Materials Online http://www.health.qld.gov.au/nutrition/ (NEMO)
Validated Nutrition Assessment Tools: http://www.health.qld.gov.au/nutrition/resources/hphe_ Comparison Guide’ (2009) developed asst_tools.pdf by Queensland Health Dietitians:
Queensland Health Foodservices http://qheps.health.qld.gov.au/statewidefoodservice/do Best Practice Guidelines cs/june-2015/food-bp-guide-2015.pdf
Department of Health Strategic Plan https://www.health.qld.gov.au/publications/portal/strate 2016 -2020. gic-plan/strategic-plan-16-20.pdf
National Health and Medical Research Centre Resources
https://www.nhmrc.gov.au/_files_nhmrc/publications/att Dietary Guidelines for all Australians achments/n55_australian_dietary_guidelines_130530. pdf
A New Food Guidance System for www.nhmrc.gov.au/_files_nhmrc/file/guidelines/consult Australia – Foundation and Total /consultations/draft_foundation_total_diets_public_con Diets sult.pdf
Australian Guidelines for the Prevention and Control of Infection in http://www.nhmrc.gov.au/guidelines/publications/cd33 Healthcare (2010)
Miscellaneous
Diabetes Australia http://diabetesaustralia.com.au/
Australian Heart Foundation www.heartfoundation.org.au
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Continuous Improvement Form
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Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for Certificate IV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,
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Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for Certificate IV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019,
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