What are Dietitians Doing During the COVID-19 Pandemic?
By Lindsay Chan, MPH (c)
During this unusual time, Canadians are constantly on the internet or watching the television to get the latest news on COVID-19. We see and hear about the hard work and dedication from doctors and nurses. But what about other healthcare providers, like dietitians, who are just as essential and continue to work in the frontline throughout the pandemic?
Dietitians are one of the many healthcare heroes that play a critical role in the healthcare system, day in and day out. They collaborate and work alongside a team of healthcare providers to create individualized care plans for patients, residents, and clients. Robyn Turner, a dietitian from British Colombia, would like Canadians to know that, “while dietitians are not the first profession that come to mind when thinking about healthcare right now, we are working just as hard and facing the same risks.”
Dietitians are present and ready – from acute care and long-term care to community programs and home care. We’ve gathered some personal stories from dietitians across Canada on how they are adapting to the ever-changing environment by upskilling, redeploying, and providing support to manage the surge of new cases and relieve the stress of worried Canadians. Many are also solving challenges related to patient care and foodservice to ensure infected and at-risk individuals are receiving optimal nutrition under the special circumstances.
Dietitians are Problem Solving!
Dietitians are using their leadership skills and expertise in the science of food and nutrition to strategize action steps for solving a host of challenges during the pandemic.
Many dietitians currently working in hospitals are responsible for assessing the nutritional needs of COVID-19 patients who may also be intubated and unable to eat or drink by mouth. Timothy Lau, who works at a hospital with COVID-19 patients requiring tube feeding, explained about his clinical role.
“I gather nutrition history/anthropometrics as best I can; determine estimated energy, protein, and fluid requirements; choose a formula; and then monitor tolerance. Often, the ICU dietitians go straight to a more concentrated formula, as the doctors are trying to remove fluid as it can build up in the lungs. One thing we have to especially monitor for is if a patient needs to be proned, which is when a patient is placed flat on their stomach to improve oxygenation. Because they are flat on their stomach, they are at greater risk for aspiration. If the patient requires proning for a couple of days or longer, we would need a post-pyloric feeding tube (nasoduodenal tube) to reduce aspiration risk while still providing adequate nutrition.” Lau also pointed out, “the ICU dietitians work very closely everyday with doctors, nurses, pharmacists, and respiratory therapists. It’s a very critical relationship that help ensures the best possible patient care. Still, unfortunately, many patients who spend time in the ICU come out with weight loss and reconditioning, a rather unavoidable scenario especially for patients who see extended length of stays.”
Dietitians are Adapting!
Dietitians are showcasing their ability to adapt to a wide range of work environments and tasks. Some are also choosing to volunteer and step up to the frontline at locations seeking extra support.
Dietitians are committed to staying on top of new research, skills, and techniques, but COVID-19 pushed many who work in different areas to upskill further through training and self-studying. Audra Donison told us about her transition from home care and outpatient care to a new position at a hospital’s ICU with the support of a colleague, Lisa Wourms, the sole dietitian at the hospital.
“The next day I started at the hospital. Despite 25+ years of nutrition experience, it had been years since I had worked in acute care, and there were some learning curves I needed to climb, especially in Pediatrics and ICU!” said Donison. “I received excellent training… there were fewer patients and visitors in the hospital while waiting for the first wave to hit, which allowed us time for thorough training. I have absolutely enjoyed the new learning challenges! Gaining new skills and seeing a different view of our health care system has also made me a better dietitian in my regular role. I am currently enrolled in the DC course Nutrition in Critical Care, which will help me become more confident in the ICU. Dietitian services in the NWT are now better prepared for any future COVID impact.”
Deborah Wildish and Andrea Miller told us how they have redeployed to other crucial positions within and outside of the hospital to manage the pandemic.
“The first phase of my redeployment involved juggling two new roles as a: Coronavirus Screener at Toronto General Hospital entrances and as a Respite Centre support worker to help health care and services staff restore their overall sense of well-being during the COVID-19 pandemic,” revealed Wildish. “I mastered the art of smiling with my eyes (I’m wearing a surgical mask). And often, to my delight, I am rewarded with a smile in return – during this very heart-wrenching time.” More recently, she was redeployed as a PPE coach at another hospital, “to assist with ‘in the moment’ safety coaching while staff don and doff personal protective equipment. The goal was to help keep everyone safe (e.g. nursing, allied health, housekeeping, transport workers, security, external paramedic staff, etc.) as well as to identify potential environmental issues that may pose risk of infection or cross contamination.”
Miller, who has been reassigned to long term care highlighted, “the staff in the home are amazing, dedicated, hard working people who are deeply committed to the residents. I am pleased to be able to help in any way I can.”
Apart from working at facilities, dietitians continue to support Canadians by providing evidence-based nutrition information, counselling, and education sessions through the internet. Zeina Khawam and Clara Birnie explained how they are promoting health and wellness to their clients and community members.
“Having been working in private practice in physical offices for the past six years, social distancing measures in place forced me to adjust my ways,” stated Khawam. “I had to counsel clients and host planned presentations virtually, all while continuing to keep posting on my social media channels for those now had more time to spend there. I also had to come to realize that many clients lost their jobs or insurance coverage. For this reason, I opened up certain time slots for pay-what-you-can sessions to be able to reach those who needed it most. So, no matter the situation, dietitians can continue to support our clients through virtual channels available!”
Birnie, who works in a team of dietitians that provides nutrition and program management support to deliver healthy meal and snack programs for almost 300 schools said, “when in-class instruction was suspended, schools adapted their programs to be able to continue to support students… by providing food packages/hampers to their homes. Some offered food items that could be picked up. Some schools would partner with local stores, or community organizations.” She added, “part of the support we offered initially was gathering examples of delivery models that programs were doing to help us determine how we could best support schools in their efforts to provide nutritious food to students... We consulted with partners to create resources that provided programs with ideas of how they could offer meals and snacks, what foods they could purchase and food safety and storage information. We also looked at the monitoring and evaluation of these initiatives to support schools as they move into the next phase of offering adapted programs in the 2020-2021 school year.”
Let’s Continue to Support One Another!
As you can imagine, healthcare providers are working extensive hours around the clock and this is having a huge toll on their mental health due to physical isolation from family members, compassion fatigue from high volumes of patient care, and grieving for patients who have passed. This has led dietitians from coast to coast to coast to form support groups, both big and small, to help one another through this difficult time.
Dietitians of Canada has created a temporary COVID-19 Response Group on Facebook
for dietitians and nutrition students as a real-time support group to seek advice, offer resources, discuss practice issues, and share experiences.
Nutrition students are also receiving support to fulfill their practicum needs for program requirements and timely graduation. For example, some Ontario universities are reaching out to hospitals for additional placement opportunities and dietitians are actively seeking to take on practicum students during the pandemic. Chelsea Cross, told us why she loves mentoring and how she adapted her student’s practicum in the midst of COVID-19. She urges other dietitians to become preceptors, too, to help students feel confident and gain the opportunities necessary to succeed in the field!
“I find there is a real lack of counselling in the programs, sadly, and I can see this when students graduate and are still terrified of counselling and that is why I began having shadow students (even as early as 2nd/3rd year undergraduates) because I want them to gain confidence in the room and be able to see how that works earlier on,” she said. Cross continued to describe one of the modifications to her student’s placement. “I came up with the idea that I would find her videos of influencers' "What I Eat in a Day” on Youtube and those were acting as our clients. She would watch the video and tell me things like: what their goals were, how to help them better reach their goals, problematic statements/claims they made, and how to correct them gently as a counsellor. Although it's not in-person, she has told me this has been really good for her and her learning because she is seeing clients and challenges she hasn't had in class yet and having to apply her knowledge in a more practical way. I hope this gets her ready for in-person when they start in a few weeks.”
Share Your Story!
If you are a dietitian, we want to hear from you!
Share your experiences with us by email or on social media platforms using the hashtags #DietitiansAreKey
. Tag us @DietitiansCAN
and your local government representatives to let Canadians know that dietitians play a key role in the healthcare system.
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