Dietetic Scopes of Practice Across Canada.

PURPOSE: The purpose of this study was to explore the concept of scope of practice in dietetics in Canada. METHODS: Using interpretative description methodology, data were collected through 4 phases. This article reports on phases I and IV. In phase I, 8 provincial dietetic regulatory bodies participated in semi-structured telephone interviews on dietetic scope of practice. Phase IV consisted of a document analysis of Canadian dietetic scope of practice statements. RESULTS: A review of dietetic statements found in legislation across Canada has shown considerable variability in terms of length, wording, and reference to specific practice areas. Phase I participant discussion focused on 3 concepts: creating a scope of practice, using a scope of practice, and perceived or expected outcomes of a scope of practice. CONCLUSION: Dietetic scopes of practice statements are a product of a complex multi-player process. The nature of provincial health care makes it unrealistic to expect similar dietetic scope of practice statements across all provinces. However, maintaining relationships between dietetic regulatory bodies can aid in the replication of ideas, best practices, and policies between provinces.

Dietetic Scope of Practice in Saskatchewan: Dietitian Perceptions.

PURPOSE: The purpose of this study was to explore the concept of scope of practice for dietetics in Saskatchewan. METHODS: Using interpretative description methodology, data were collected through 4 phases. This article reports on phases II and III. In phase II, 92 Saskatchewan Registered Dietitians (RDs) participated in an online survey on scope of practice. In phase III, 8 Saskatchewan RDs participated in a 3-week online focus group. RESULTS: Results from phases II and III indicate that participants saw numerous opportunities in defining, understanding, and working with a scope of practice. Without a scope of practice, participants were interpreting their role from a combination of documents (e.g., ethics, research) and stakeholders (e.g., employers and colleagues). Current confusion amongst employers, other health professions, and RDs themselves regarding the role of dietitians was identified. CONCLUSION: Most participants believed a scope of practice would provide guidance to employers, other health professions, the public, regulatory bodies, and RDs themselves about the role of a dietitian. Dietetic regulators should continue to provide clear guidelines to their members and employers on safe dietetic practice. Dietitians need to be certain they are safely practicing within provincial policies and their own professional knowledge and skill at all times.

Dietitians' perceptions of precepting: knowledge, skills, attitudes, barriers, and training.

PURPOSE: The extent to which dietitians agreed or disagreed with key informants' perceptions of precepting knowledge, skills, and attitudes (KSA), training needs, and barriers was determined. METHODS: A 98-item survey was developed and distributed electronically to Dietitians of Canada members (n=5376). RESULTS: Of the 750 respondents who completed the survey (14% response rate), more than 95% agreed that preceptors should have knowledge of promoting learning and skills acquisition, and of learner assessment and evaluation. More than 90% of respondents agreed that preceptors should have skills in planning, teaching, coaching, research, facilitation, and evaluation. Differences in respondents' perceptions of preceptor participation in practice-based research differed with years of experience. Respondents with fewer than five years of experience had a higher level of agreement that preceptors should participate in practice-based research than did those with more experience (P<0.05). Respondents indicated that barriers to precepting training were insufficient time (93%) and work environments not supportive of precepting (64%). CONCLUSIONS: The findings articulate the KSA, training needs, and barriers to precepting considered significant for dietitian preceptors. The results are important for the advocacy for resources to support the training and development of preceptors, upon whom sustainability of the profession depends.

Dietitian preceptor knowledge, skills, attitudes, and training: key informant perceptions.

PURPOSE: Through consultation with Canadian dietitian informants, we aimed to identify the desired knowledge, skills, and attitudes (KSA) for preceptors, training opportunities, and the barriers that prevent preceptor training. METHODS: In this qualitative study, an open-ended survey was sent electronically to 100 key informants across Canada. Informants had experience as preceptors or with dietitian preceptors. Informants were asked to reflect upon the desired KSA, training needs, and barriers to training for dietitian preceptors. Categories of responses under each of these headings were developed on the basis of informants' responses. RESULTS: Forty-nine key informants completed the survey, for a 49% response rate. Of the respondents, 41% (20/49) were in clinical practice and 35% (17/49) worked in community/public health areas. The knowledge and skills domains consisted of themes related to teaching and learning, including assessing, planning, and evaluating. Attitudes expressed included considering learners as colleagues and the training of learners as a professional responsibility. Perceived barriers to training preceptors included workload demands and a lack of recognition from peers and employers for this work. Dietitian preceptor training opportunities ranged from no training to formal programs. CONCLUSIONS: These findings are integral to the basic understanding of the desired KSA and training needs of Canadian dietitian preceptors.

Student perceptions of an experiential education clinic within a pharmacy school.

BACKGROUND AND PURPOSE: Pharmacy schools would benefit from new models of experiential education. The University of Saskatchewan (Canada) recently opened a patient care clinic called the Medication Assessment Centre (MAC) as new experiential education model. The purpose of this paper is to describe the structure and function of the MAC and to report program evaluation data. EDUCATIONAL ACTIVITY AND SETTING: The MAC is a unique application of an existing experiential education model in that it is an pharmacist-run ambulatory clinic (which is common) that is physically located on campus amongst the classrooms and supervised by pharmacy faculty (which is unique). Students are all required to participate in the clinic on a regular basis, in between lectures, throughout the four years of the pharmacy program. FINDINGS: Students were invited to participate in one of five focus groups to assess the value of the experience. Transcripts were analyzed using thematic analysis, and the results identified strong satisfaction amongst students. The overall themes fell into three categories: (1) aspects that students liked, (2) aspects that students found challenging, and (3) positive impact on student learning. Previously published studies have found strong support for the MAC amongst patients and physicians. SUMMARY: Students felt that a faculty supervised experiential education clinic that is physically located within their pharmacy school was a valuable learning experience. This paper provides a description of how the MAC has been integrated into an existing pharmacy curriculum, which may be valuable to schools contemplating a similar addition to existing experiential learning.

Canadian dietitians' understanding of the client-centered approach to nutrition counseling.

Many dietetic researchers have recommended the use of a client-centered approach to counseling, but little has been written about what that means from the perspective of the practicing dietitian. The purpose of this study was to explore dietitians' understanding of the client-centered approach to nutrition counseling. In-depth qualitative interviews were conducted with 25 Canadian dietitians from a variety of practice areas. Interview transcripts were analyzed using a form of inductive, thematic analysis. Results suggest that although participants believe that practicing in a client-centered manner is important, they were struggling in their attempt to balance their practice values and beliefs with the realities of their work environments. Meeting clients' needs and wants was seen as critical to the client-centered approach, but there was some indecision around who determines these needs and what the difference is between needs and wants. Recognizing the expertise that clients can bring to the counseling relationship was also an issue for participants. Additional research to explore the way that dietitians learn how to counsel can lead to a better understanding of how to develop effective therapeutic relationships with our clients within the confines of current workplace environments.

Exploring food security with collective kitchens participants in three Canadian cities.

Collective kitchens are small groups of people who pool their resources to cook large quantities of food. With the help of semi-participant observation and in-depth individual interviews, this study is an exploration of participants' perceptions of changes in food security since becoming involved in a collective kitchen. Several important themes emerged, including Increased Variety, Making Ends Meet, and Comparisons to Food Banks. Participants in groups that cooked large quantities of food (upwards of five meals monthly) reported some increases in their food resources. Participants also reported increased dignity associated with not having to access charitable resources to feed their families. Some participants reported decreased psychological distress associated with food insecurity. Overall, participants reported increases in food security; however, collective kitchens are not a long-term solution to the income-related food insecurity experienced by many Canadian families.

Dietitians' opinions and experiences of client-centred nutrition counselling.

PURPOSE: The concept of "client-centredness" was explored within a nutrition counselling relationship. METHODS: A two-round reactive Delphi survey was used. The first survey was sent to 65 Dietitians of Canada members who indicated in the member database that they had advanced counselling skills. Following analysis of the data, the second-round questionnaire was developed and sent to participants with a report of the first-round results. Analysis of the second-round survey indicated that participants' responses had remained stable, and the Delphi survey was terminated. RESULTS: Participants agreed that most of the issues identified in the Delphi questionnaire should be included in a client-centred approach to practice; however, when participants were asked about their experience in these areas, median responses and/ or the interquartile ranges changed, indicating some difficulty in implementing the client-centred approach. Comments also indicated that the reality of their workplaces did not allow participants to be as client-centred as they thought they should be, and suggested that the concept of "client-centredness" is not universally understood by dietitians. CONCLUSION: If a client-centred approach to practice is truly important, we need to start a dialogue within the profession to gain a deeper understanding of what this means and how it can be implemented.

Food and nutrition-related learning in collective kitchens in three Canadian cities.

PURPOSE: To determine what food and nutrition-related learning takes place in collective kitchens (CKs) in three Canadian cities. METHODS: Semi-participant observation and in-depth interviews were conducted with CK participants and leaders. Major nutrition-related themes that emerged were categorized and integrated to form a picture of how food-related knowledge and behaviours were affected as a result of CK involvement. RESULTS: In general, CKs were perceived as an important source of food-related knowledge and skills. Some behaviour changes that resulted from participation were an increased variety of foods in the diet, increased vegetable consumption, and decreased fat consumption. CONCLUSIONS: Collective kitchens can be important tools for nutrition education. However, the broader social conditions, such as poverty, that influence food-related behaviours should also be taken into account.

Imagination nourishes dietetic practice. 2005 Ryley-Jeffs Memorial Lecture.

Albert Einstein once stated that imagination is more important than knowledge. How important is imagination to the dietetic profession? What have been the imaginations of dietitians over the years? Where would we be today without these imaginations? Can imagination be fostered and developed? What future imaginations will shape the dietetic profession? This article explores the phenomenon of imagination and why it is important to dietetic practice.

Collective kitchens in Canada: a review of the literature.

PURPOSE: Collective kitchens are community-based cooking programs in which small groups of people cook large quantities of food. They have developed over the past 20 years, and hundreds of groups have been formed across the country. However, collective kitchens described in the literature vary considerably in structure, purpose, and format. The purpose of this review is to synthesize research on this topic. METHODS: Articles and theses were collected through searches of major databases, and synthesized to improve understanding of current information, and of continuing gaps in the knowledge of collective kitchens in Canada. RESULTS: The limited published research on collective kitchens suggests that social and learning benefits are associated with participation. Some indication exists that participants also find the food cooked to be high quality, culturally acceptable, and acquired in a manner that maintains personal dignity. Whether collective kitchens have an impact on food resources as a whole is unclear, as research has been limited in scale. CONCLUSIONS: The role of collective kitchens in community building and empowering participants often is noted, and bears further investigation. Dietitians and nutritionists have a unique opportunity to facilitate the health promotion and food security benefits of collective kitchens.

Client-centred nutrition counselling: do we know what this means?

In Canada, professional standards mandate that dietitians should use a client-centred approach to provide nutrition counselling services. Although most dietitians would probably agree that this is an important standard, how this mandate is translated into our daily practice is not always clear. The purpose of this paper is to explore the origins of the "client-centred approach" used in dietetic counselling. A historical review of selected dietetic literature is used to demonstrate the evolution of this term, the multiple meanings associated with it, the remaining ambiguity in dietetic practice today, and the need for further research.

Children with Cerebral Palsy: Caregivers' Nutrition Knowledge, Attitudes and Beliefs.

Knowledge is lacking about the feeding relationship between caregivers and children with cerebral palsy (CP). In this relationship, the child's dependency and the caregiver's influence on the child's nutrition may be magnified. A questionnaire was developed to examine caregivers' nutrition knowledge, attitudes, and beliefs. Reliability and validity were pretested with groups independent of the study. The questionnaire was administered to CP caregivers (n=52, 34% response rate) and a comparison group of non-CP caregivers (n=35). Over half of the children with CP were mildly to moderately affected by physical disability and presented with few oral-motor difficulties. Caregivers' perceptions of children's feeding behaviour did not differ between the two groups (p>0.05). Significant differences were evident in nutrition knowledge, as well as on one of two attitude scales and one of two belief scales measured. Non-CP caregivers scored higher in nutrition knowledge (p<0.001), had a more positive attitude about the importance of nutrition (p<0.05), and had a more positive belief in the relationship between nutrition and health (p<0.05). Results suggest that non-nutritional factors may have a higher priority with those caring for children with CP. Further investigation is warranted to examine the role that nutrition has in the care of children with various degrees of disability from CP. and inflammatory modulation.

Qualitative investigation of barriers to accessing care by people who inject drugs in Saskatoon, Canada: perspectives of service providers.

BACKGROUND: People who inject drugs (PWID) often encounter barriers when attempting to access health care and social services. In our previous study conducted to identify barriers to accessing care from the perspective of PWIDs in Saskatoon, Canada: poverty, lack of personal support, discrimination, and poor knowledge and coordination of service providers among other key barriers were identified. The purpose of the present investigation was to explore what service providers perceive to be the greatest barriers for PWIDs to receive optimal care. This study is an exploratory investigation with a purpose to enrich the literature and to guide community action. METHODS: Data were collected through focus groups with service providers in Saskatoon. Four focus groups were held with a total of 27 service providers. Data were transcribed and qualitative analysis was performed. As a result, concepts were identified and combined into major themes. RESULTS: Four barriers to care were identified by service providers: inefficient use of resources, stigma and discrimination, inadequate education and the unique and demanding nature of PWIDs. Participants also identified many successful services. CONCLUSION: The results from this investigation suggest poor utilization of resources, lack of continuing education of health care providers on addictions and coping skills with such demanding population, and social stigma and disparity. We recommend improvements in resource utilization through, for example, case management. In addition, sensitivity training and more comprehensive service centers designed to meet PWID's complex needs may improve care. However, community-wide commitment to addressing injection drug issues will also be required for lasting solutions.