Changing Roles and Responsibilities of Dietitians from Diverse Settings During the First Three Waves of the COVID-19 Pandemic in Nova Scotia.

Purpose: To explore the impact of the COVID-19 pandemic on Nova Scotian dietitian's roles, responsibilities, and professional development needs.Methods: We conducted a province-wide, online, exploratory survey with registered dietitians during the initial waves of the COVID-19 pandemic. Differences were explored with descriptive statistics by work sector (hospital/acute care; primary health/community or public health (PH); long-term care [LTC]; other [e.g., private practice, retail]).Results: Dietitians (n = 122) reported being most frequently challenged by stress and anxiety, changing work expectations, and rapidly evolving safety protocols during the pandemic. Those working in PH, primary health, and LTC reported experiencing more work responsibilities, more change, and perceived less employer support than dietitians in other sectors. Despite the identified challenges, most participants (70.7%) felt their education and training were sufficient to take on these new work roles. Primary and PH dietitians, however, more frequently perceived their skill sets to be under-utilized than other sectors. Key learnings from practice identified as being important for dietetic education included qualities such as resilience, problem-solving, flexibility, and self-care.Conclusion: These findings will be of interest to health administrators, professional bodies, and academic institutions to inform strategies for strengthening dietetic practice, building resilience, and preparing for future emergencies.

Identifying and Mapping Canadian Dietetic Students' Interaction(s) with Simulation-Based Education: A Scoping Review.

This scoping review mapped literature available on Canadian dietetics, nutrition, and foods students' and graduates' interaction(s) with simulation-based education (SBE) during undergraduate and/or practicum. One certified Librarian led the preliminary search (Summer, 2021), while three Joanna Briggs Institute-trained reviewers conducted the comprehensive search via MEDLINE (OVID), CINAHL (EBSCO), Academic Search Premier (EBSCO), Embase (Elsevier), Scopus (Elsevier), and Google (February 2022). A data extraction tool designed specifically for the study objectives and research inclusion criteria was used. We recorded 354 results and included 7. Seven types of SBE were recorded: (i) comprehensive care plan (n = 2); (ii) nutritional diagnosis/assessment (n = 2); (iii) body composition assessment (n = 1); (iv) introducing patient to dysphagia care (n = 1); (v) nutrition counselling session (n = 1); (vi) nutrition-focused physical examination (n = 1); and (vii) professional communications via social media (n = 1). Results indicate that Canadian dietitian-led SBE includes the use of simulated patients, nutritional diagnosis/assessment, and the creation of comprehensive care plans, among others. Students have been assessed for performance of trained tasks through exams, self-awareness surveys, and interviews, and SBE activities have been evaluated for effectiveness through questionnaires and interviews with users/students. Canadian literature is limited, and more can be learned by exploring the global context within and outside the profession.

Evaluation of a Media Training Workshop for Nutrition Students and Trainees in Nova Scotia.

Gaps in communication training have been identified in Canadian and international academic and practicum dietetics programs. A workshop was developed to pilot supplementary media training to nutrition students/trainees studying in Nova Scotia. Students, interns, and faculty from two universities participated in the workshop. Data on perceived learning, media knowledge/skill use, and workshop feedback were collected immediately post-workshop using a mixed-form questionnaire. A modified questionnaire was administered eight months post-workshop to obtain information on utility of the perceived acquired knowledge/skills. Closed-ended responses underwent descriptive analysis, while open-ended responses underwent thematic analysis. Twenty-eight participants completed the questionnaire post-workshop, and six completed it at follow-up. All participants rated the workshop positively (7-point Likert scale) and reported learning something new (perceived). Perceived learning emphasized general media knowledge/skills and communication skills. Follow-up data suggested participants had applied perceived media knowledge/skills in message development and media and job interviews. These data suggest that nutrition students/trainees may benefit from supplementary communications and media training and provide a stimulus for ongoing curriculum review and discussion.

Unintended Consequences of "Breast Is Best" Messaging on Mothers: An Autoethnography.

Purpose: To describe the breastfeeding experiences of a dietitian and mother so as to expose dominant discourses reinforcing expert-driven imperatives to breastfeed.Methods: Professional experiences and personal challenges related to breastfeeding promotion are described, analyzed, and interpreted using autoethnography. The social ecological model (SEM) is used as a sensitizing concept to guide the organization, presentation, and analysis of experiences.Results: Data were organized into two discussion themes: breastfeeding promotion practices and "failure" to breastfeed. Dominant discourses reinforcing expert-driven imperatives to breastfeed are revealed, including health as a duty, intensive motherhood, and mother blame. Discourses promoting or reinforcing breastfeeding simultaneously judge and denormalize formula-feeding.Conclusions: Contemporary breastfeeding promotion messages and strategies are quiet coercions used to influence infant-feeding decisions and do not support the principles of evidence-based practice, person-centred care, and informed choice.

University Students Harvesting the Benefits of a Garden Laboratory.

Community gardens (CG) are areas of land where individuals or groups grow food in single or shared plots, typically in an urban setting, providing fresh produce, urban greening, and opportunities to socialize and improve the community. The purpose of this descriptive study was to introduce a CG laboratory (lab) as part of an introductory foods course within a nutrition program and explore how the lab influenced students' learning and overall experiences. Forty-one students, 2 lab instructors, and 3 student volunteers who tended the CG participated in the survey. Survey analysis revealed 4 interrelated themes: (i) connection and exposure, (ii) food preparation, (iii) benefits of using local food, and (iv) explicit learning. Overall, the lab fostered multiple types of individual and relational learning involving the acquisition of course content and food literacy skills. The CG was valued by students as a curriculum component as well as opportunities for personal growth and development. With the growing importance of food systems knowledge to the profession, CG may act as a site for embodied forms of learning in nutrition programs.

"It was Like Magic": Relationships Supporting Compassion, Creativity, and Sense of Coherence in Nutrition Students.

The purpose of this exploratory research was to understand the experiences and learnings of dietetic and nutrition students following a 3-week intensive summer course designed to enhance students' understandings of compassion, creativity, and sense of coherence as they apply to personal growth and socially just professional practice. Seven of 15 students participated in one-on-one, semi-structured interviews. Data analysis was conducted using inductive thematic analysis, resulting in 3 meta-themes: (i) personal meaning and sense making, (ii) relational and power dynamics, and (iii) disruption; participants contextualized these themes via a dynamic interplay within and among the domains of self, pedagogy, and practice. As a result of taking this course, participants developed an enhanced sense of coherence, self-compassion, well-being, and a more equity-focused understanding of health. Student development may have been achieved through attending to student experience and a relational pedagogical epistemology that allowed students to make personal, interpersonal, and systemic connections among their own subjective experiences, the experiences of peers, and broader social impacts on health. Given nutrition classrooms are largely positivist, it is important to consider how these environments as relational contexts may support or undermine compassion, sense of coherence, and ultimately the health and well-being of students.

Student Engagement with Community-Based Participatory Food Security Research: Exploring Reflections through Photovoice.

FoodARC is a research hub for community-based participatory research (CBPR) contributing to healthy, just, and sustainable food systems for all. University students, largely from dietetics programs, are engaged as co-learners and research partners. This study explores the contribution of CBPR to student learning on household food insecurity (HFI) and community food security (CFS) and ways to address these issues through practice. Photovoice, an arts-informed 3-phase participatory research process, was used to take pictures that reflected student experiences and insights regarding CBPR. Through a half-day guided discussion, 5 participants shared and discussed their photos and the meanings behind them with other participants and then collectively analyzed and interpreted common themes. Three overarching themes reflecting student learning and development associated with CBPR experiences were identified: students' expanded understandings of HFI and CFS as well as potential solutions to address these issues, their modeling of participatory ways of working, and applications to future professional practices. Student understandings about HFI and CFS through the integration of a community-engaged learning environment like CBPR results in important learning and personal and professional development. Learning is enriched and students are able to imagine their roles in addressing these issues through practice.

Weight Inclusive Practice: Shifting the Focus from Weight to Social Justice.

Obesity is framed by mainstream media and health care professionals as an "epidemic" contributing to the ill health of the population. This paper reviews literature related to dominant discourses about weight in dietetics, drawing on literature from other health care disciplines, and how these discourses influence patient care. Emerging, competing discourses are also reviewed. Literature highlighted that dietitians and dietetic students are often biased and hold stigmatizing beliefs toward "overweight" and "obese" patients. No research has been conducted in Canada addressing this question, leaving this as an opportunity for future research. Weight stigma and interventions focused on weight have multiple negative implications for individuals, especially those living in larger bodies, including reluctance to seek health care, poor body image, subsequent weight gain, and increased disordered eating. There are alternative discourses emerging, which shift the focus away from weight and toward social justice. The ways in which dietetic students are trained to "manage" weight, and how dominant discourses influence this training, is an important area of future exploration. Dietetic professionals are encouraged to reflect on their weight biases and educate themselves on weight inclusive approaches to health, such as Health at Every Size and Well Now.

Men who are Dietitians: Deconstructing Gender within the Profession to Inform Recruitment.

Purpose: In Canada, few men are dietitians. Literature is sparse regarding why so few men are drawn to dietetics. This study, part of a larger qualitative study, explores the experiences of men who are dietitians throughout their training and careers using a phenomenology framework. The study examines the meanings participants make about dietetics in relation to recruitment. Methods: Semi-structured individual interviews with 6 men who are dietitians were completed, transcribed, and analyzed. Results: An overarching theme, "experiences and outcomes of a gendered profession", was related to the participants' perspectives concerning recruitment into the dietetic profession. Four sub-themes are reported: (i) societal gender division, (ii) gender division within the profession, (iii) isolation from men who are mentors and other men, and (iv) the need to deconstruct and change. The results provide insight into recruitment barriers and potential approaches for increasing the number of men within dietetics, including changing the perceptions of the profession, increasing role models for men, and dismantling gendered practices. Conclusion: Participants believed that increasing men within dietetics would be beneficial and would increase diversity. It is unlikely that recruitment of men will increase if the status quo and gender norms of the profession are not disrupted and challenged.

A Qualitative Study Exploring the Experience of the Male Dietitian from Student to Professional.

PURPOSE: In Canada, dietitians serve a sex-diverse population despite the profession being predominately female (>95%). It is unknown why there are so few male dietitians. The objective of the present study was to explore the experience of the male dietitian, as a minority, in female-dominated dietetics. METHODS: Two semi-structured interviews were conducted, approximately 6 weeks apart, with Nova Scotian male dietitians. The interviews prompted participants to reflect on their experience of being a male dietitian. Interviews were analyzed using Interpretative Phenomenological Analysis. RESULTS: Male dietitians with between 1 and 17 years of experience participated (n = 6). Participant experiences were expressed as 4 themes: (i) feelings of difference and otherness, (ii) adapting to the female-dominated culture, (iii) constructing a professional identity, and (iv) passion as the driver for success. A theoretical framework for understanding the male dietitian's experience was outlined. CONCLUSION: The experience of the male dietitian is unique and is a consequence of training and practicing in a female-dominated space. The effect of adaptation and construction of a professional identity that is a response to female-dominated cultural norms is wide ranging and may be constraining for male practitioners thereby affecting their contributions to the field.

The Nature of Competition in Dietetics Education: A Narrative Review.

The impact on student development associated with being part of a competitive program is an emerging finding in dietetics research. As such, a narrative review of relevant literature was conducted pertaining to competition in post-secondary programs and the educational experience of students with respect to developing a career in dietetics. The review was guided by 2 questions: How is competition experienced by students? What strategies can reduce competition among dietetics students within the educational experience? A refined literature screening process justified including 32 articles in the review. The overall review findings suggested that, across dietetics programs, the outcomes of competition negatively impacted students' personal identity, motivation in the learning process, and involvement behaviours, including collaboration among students, participation in academic opportunities, and student relationships with faculty. The implementation of strategies conducive to addressing the effects of excessive competition and building a supportive academic environment, for example increasing collegiality and engaging students in intrinsic learning, are important for continued growth of the dietetics profession. Educators can reflect on the complex nature of competition and how the effects of excessive competition may be in opposition with the competencies that students are expected to develop as professionals.

Stronger Together: Use of Storytelling at a Dietetics Conference to Promote Professional Collaboration.

During a Dietitians of Canada conference session (2015), 4 facilitators drew upon "Alice's Adventures in Wonderland" (Alice) to engage participants in discussing the future of dietetic education. The aim was to feature Nova Scotia (NS) collaborative experiences as an example of dietetic education planning that could be implemented elsewhere. Three vignettes from the Alice story were chosen as metaphoric representations of dilemmas and assumptions commonly faced by dietetic educators. Story quotations and facilitator questions related to each vignette-guided discussion. The 3-part story-based arts approach of hearing stories, recognizing stories, and telling stories enabled participants to reflect on their own practice, relate to the challenges of others, and question conventional wisdom. Participants heard the Alice stories, recognized their experiences through the NS examples and had an opportunity to tell their own stories during discussions. Participants identified barriers to and strategies for collaborative planning in their own regions. Evaluation suggests most participants were positively engaged by the storytelling approach. Participants recommended that future offerings allow more time for orientation and for completion of planned activities. Bilingual programming should also be considered. Participants valued the unconventional approach to workshop engagement and planned to implement it in their own workplaces.

School Gardens: Cultivating Food Security in Nova Scotia Public Schools?

PURPOSE: A small but growing body of peer-reviewed research suggests that school gardens can play a role in building community food security (CFS); however, to date little research exploring the role of school gardens in supporting CFS is available. This paper begins to address this gap in the literature. METHODS: A qualitative, exploratory, single-case study design was used. The focus of this case study was the school food garden at an elementary school in the River Valley, Nova Scotia, school community. RESULTS: Results provide useful information about potential CFS effects of school gardens in addition to the environmental effects on school gardens important to their effectiveness as CFS tools. Findings suggest children gained food-related knowledge, skills, and values that support long-term CFS. A local social and political landscape at the community, provincial, and school board level were key to strengthening this garden's contributions to CFS. CONCLUSIONS: We support Dietitians of Canada's nomination of school gardens as an indicator of CFS with theoretical and practical evidence, underscore the importance of a supportive environment, and need for further research in this area. Health professionals and community organizations provide critical support, helping to weave gardens into a greater movement towards building CFS.

Males in Dietetics, What Can Be Learned from the Nursing Profession? A Narrative Review of the Literature.

In Canada 95% of dietitians are female despite serving a sex-diverse population. Literature examining why there are so few male dietitians is limited. However, nursing, like dietetics, is female dominated but has a large body of literature examining sex diversity within the profession. Therefore, a narrative literature review was conducted to find articles that examined the following questions: (i) What are the barriers and motivating factors for prospective male nursing students? and (ii) What are the perceived sex-based challenges that male nursing students encounter during their education? A total of 38 articles were included in the final review and the results are presented under the following headings: barriers, motivators, and educational experiences both in the classroom and during clinical rotations. The review outlines the current state of knowledge regarding sex as it relates to nursing and how this information compares with the current dietetics literature. Conclusions and recommendations are drawn about what changes could be made in dietetic education immediately and how further research could provide insight towards reducing the barriers and facilitating easier access to dietetics education for males.

Exploring the Meanings that Dietitians Associate with their Role of Mother and Dietitian and How They Translate into Child-feeding Practices.

PURPOSE: To explore the meanings that dietitians associate with their role of mother and dietitian and how they translate into child-feeding practices. METHODS: The ideological case-study approach of Interpretative Phenomenological Analysis, a qualitative research design, was utilized. A convenience sample of 3 dietitians was recruited from the faculty of a university nutrition department. Dietitians participated in semi-structured interviews that were voice-recorded and transcribed. Data were thematically organized and interpreted using the theory of Symbolic Interactionism. RESULTS: Five themes were developed: the evolution of food-related practices, tensions between the role of dietitian and mother, mealtime interaction, integration of dietetic values in child-feeding practices, and the individuality of the mother. Dietitian mothers used various parenting styles when interacting with their children. Their beliefs about best practice in child-feeding correspond with the recommendations of their dietetic profession. Their perception of what it meant to be a good mother was influenced by their identity as a dietitian. RELEVANCE TO PRACTICE: Dietitian mothers need to be aware of the influence of professional discourse; professional thoughts can influence personal thoughts and actions related to child-feeding practices. Further exploration of the topic including maternal and child-feeding practices from the child's perspective is warranted.

A Review of Eating Disorders and Disordered Eating amongst Nutrition Students and Dietetic Professionals.

The diet industry and media have a powerful influence over women, leading many to believe that they must modify their appearance for societal acceptance. Dietetics, as one of many predominantly female professions, may be particularly vulnerable to these pressures. An integrative review process was used to examine eating disorders and disordered eating within the dietetics profession with the aim to both synthesize existing data and develop questions for future research. Seventeen articles were reviewed using broad search terms and dates because of the dearth of available literature. Given nutrition programs and dietetic practice often involve significant exposure to food, ideas and opinions about food, weight, and its place in health and dietetic practice researchers were compelled to ask "why". Findings were organized under 3 categories including thinness ideology, implications of food and body associated with nutrition or dietetic education, and establishment of a continuum. This review serves as a platform to inspire future research in an understudied but important topic related to dietetic education and practice. Minimally as a profession, baseline data need to be collected to understand the prevalence of disordered eating and eating disorders along the continuum of practice in Canada.

Crafting meaning: arts-informed dietetics education.

PURPOSE: University nutrition students' experiences of participation in an arts module as part of a senior nutrition course were explored to gain an understanding of the relationship of art to dietetics practice. METHODS: The module comprised discussions, readings, and presentations from dietitian artists, along with three assignments: the production of art, an artist statement, and a reflection paper. The art production depicting an aspect of body image was presented to the class and optionally at a body image conference. An exploratory, qualitative methodology informed by Schön's reflective practice framework was employed. Three surveys administered at various times during the arts module were used to collect students' reflections and were thematically analyzed. RESULTS: Three themes emerged: hesitance to acceptance, emotion and connection, and relationship with dietetics. The education process facilitated a transformation among students, noted as changes in knowledge, perceptions, and attitudes over the course of the module. CONCLUSIONS: The arts provide an alternative platform for an exploration of self and others, for improving practice, and for an examination of novel ways for doing so. Reflection as an education component enables students to contemplate relationships, knowledge, emotions, and practice as interrelated and evolving entities.

A sustainable dietetics bridging program: development and implementation in Atlantic Canada.

A provincial focus on immigration and improved foreign credential recognition has led to an investigation of best practices and subsequent recommendations for the development and implementation of a sustainable university-based bridging program for internationally educated dietitians in Atlantic Canada. Data were collected from various sources and used to inform program decisions and direction. An advisory framework was established through a core group representing dietetics education and regulation and internationalization. Subsequently, a key stakeholder group was formed. As a result of this collaboration and research, a dietetics bridging framework was developed and a program pilot tested. Lessons learned may inform similar endeavours and highlight the importance of collaborative leadership and collaboration among multiple stakeholders, and of creatively addressing program sustainability issues while keeping learners (internationally educated dietitians) at the centre.

Enhanced dietetics education through collaboration: a study to identify opportunities.

With the aim of enhancing dietetics education in Nova Scotia, key stakeholders were engaged in identifying current practice issues along with opportunities for collaboration to address them. A survey containing five open-ended questions was distributed by email to a purposive sample of 24 participants affiliated with three universities with dietetics programs. Participants fell into five categories: internship coordinators, dietetics educators, recent internship graduates, current interns, and prospective interns. The response rate was 58%. Data were thematically analyzed through a process of constant comparison. Primary themes emerged, which reflected survey participants' concerns about three current practice issues: province-wide standards, internship placement availability, and the overall educational experience. Additional comments suggested that overall dietetic educational experiences could be improved if relevant clinical experiences were offered and preceptor workloads were accommodated. The creation of province-wide standards for assessing interns' level of competency was perceived to offer multiple benefits, including decreased preceptor workloads. Participants believed that collaborative actions might increase internship placements and improve the overall dietetic internship experience for interns and preceptors.

Picture this: a photovoice study of international students' food experience in Canada.

PURPOSE: International student enrolment in Canadian universities is increasing. As international university students acculturate, they experience a culture shock in which food plays a major role. International university students' Canadian food experiences therefore were explored. METHODS: A Photovoice methodology was used with 15 international undergraduate and graduate university students, who were recruited to take pictures of their food experiences. They also participated in two focus group discussions that included an analysis of their photos. RESULTS: Seven themes related to the significance of food in acculturation were revealed: the paradox of Canadian convenience, the equation of traditional foods with health, traditional food quality and accessibility, support networks, food consumption for comfort, ethnic restaurants, and the exploration of non-traditional foods. Maintaining cultural identity with traditional foods was an overarching theme related to acculturation. CONCLUSIONS: International students acculturating to Canada have emotional and physical needs, which can be met through food. Opportunities exist to improve their acculturation experiences. Canadian universities can incorporate food acculturation strategies into campus events and menus. Nutrition professionals on campus can facilitate a positive food environment and nurture culture identity formation.