ICDEP Activity Reference Guide

1. During an assessment the Learner is able to ask the client questions to identify any social factors that may impact their ability to receive services/support. Ie. Do they have access to healthy, affordable food in their neighbourhood.

2. The Learner reviews organizational policies for accessibility and compliance with the provincial Disabilities Act.

3. Learner makes informed decisions with respect to culture and religion when making changes to patient care plans.

1. Learner does not use accusatory language when speaking to patients/clients. They are assertive and give the patient/client lots of opportunities to share. 

2. Learner is punctual, dependable and engaging. Learner is willing to help others when they are able.

3. Learner upholds all organizational policies and procedures.

1. Learner is able to recognize if the workload is too heavy. Learner meets with preceptor to discuss possible options to ensure Learner successfully completes all projects.

2. Learner is able to admit when they have made a mistake and takes appropriate steps to correct their practice.

3. Learner accepts feedback from their preceptor and implements changes to their projects.

1. Learner complies with legislation, regulation and policies by maintaining privacy and confidentiality of employee information.

2. Learner maintains proper boundaries with staff by not oversharing personal information or acting too informal within the work setting.

3. Learner maintains professional boundaries by sending and responding to work-related emails within working hours.

1. Learner demonstrates awareness of the impacts of privilege by being curious and asking questions instead of making assumptions about others.

2. The Learner recognizes the hierarchy that exists in the hospital and is aware of how someone in a higher position of power is perceived. They try to mitigate that by treating everyone equally, with dignity and respect.

3. The Learner recognizes their own privilege when working with clients and seeks out new learning to increase their knowledge of the stigma surrounding accessing food from food banks.

1. Learner visits with residents and learns about their nutritional status, likes and dislikes, special requests, weight, and overall health.

2. Learner uses active listening skills during the initial assessment when asking about dietary intake. Learner asks about food allergies, intolerances and food preferences. Learner includes this information when developing nutrition care plan.

3. Learner reviews patient satisfaction surveys to understand their dietary preferences and makes recommendations for menu changes.

1. Learner does not share patient information with parties not treating the patient directly.

2. Learner does not discuss or identify clients outside of the placement setting.

3. Learner checks patient arm bands when providing Nutrition & Food Services in order to confirm two patient identifiers.

1. Learner complies with all organizational policies and directives including wearing appropriate PPE when entering patients' rooms and completing orientation training.

2. Learner demonstrates an understanding of the organizations policies and procedures. Learner understands the privilege of accessing records and the importance of protecting privacy.

3. Learner adheres to food safety requirements including proper handwashing, tying hair up before cooking, and reinforcing to participants to follow the food safety rules as well as ensure adults are present when using the oven, stovetop, or knives.

1. Learner ensures they are signed out of online programs which include patient information when online charting is complete.

2. Learner disposes of papers with private patient information in the appropriate "to be shredded" bins on site.

3. Learner maintains security and confidentiality by only taking notes in the secure electronic system made for staff, and only accessing client charts that are applicable to own caseload.

1. Learner contributes to an organizational culture of safety by reading signs on patients' doors that indicate possible droplet exposure and then donning the appropriate personal protective equipment (PPE).

2. Learner completes food temperature audit as per food service policy. Explains process of how to report and manage situations if temperatures are outside safe range.

3. Learner complies with organizational policies and regulations and practices with patient safety, confidentiality and harm reduction in mind.

1. Learner manages time effectively so they are able to complete assignments early in order to obtain preceptor feedback prior to submission.

2. Learner creates a workplan to map out all projects and assigns reasonable timelines.

3. Learner completes charting in a timely manner after counselling sessions with patients.

1. Learner asks for feedback from preceptor to ensure work is being completed correctly.

2. Learner debriefs with preceptor to understand their strengths and areas of improvement for assessments, nutrition support regimens, and chart notes.

3. Learner assesses a patient's prior nutrition care plan that another dietitian put in place and decides whether changes are needed.

1. Learner professionally and respectfully declines request to conduct nutritional counselling when knowledge is limited and preceptor is not present.

2. Learner self-evaluates and seeks feedback to reflect on knowledge and skills. Learner requests additional opportunities to gain experience in areas that need further development.

3. Learner completes reflective journal to identify areas for improvement and discusses them at weekly meetings with preceptor.

1. Learner consults with physician/allied health professionals when uncertain of a medication or a condition. E.g. non-intensive care unit (NICU) patient with complex syndromes unfamiliar to the Learner, Learner researches and discusses assessment and intervention with preceptor.

2. In times when Learner identifies a situation to be beyond their personal capacity, they discuss with preceptor and observe preceptor's method of responding.

3. Learner acknowledges when they are uncertain and raises specific questions with preceptor to gain more understanding.

1. Learner is able to identify credible sources of evidence based information when creating client resources.

2. Learner is able to identify relevant sources of information by seeking out and reading the Diabetes Canada clinical practice guidelines as well as completing assigned diabetes pathophysiology and management modules.

3. Learner uses client resources from Dietitians of Canada practice-based evidence in nutrition (PEN) during client counselling.

1. Learner reviews up-to-date information when conducting a literature search on the topics of the effects of cooking programs on children and dichotomous thinking in relation to building a negative relationship with food.

2. Learner attends workshops and webinars on current nutrition issues to identify new and emerging information relevant to practice.

3. Learner researches sustainability business practices and discusses possible changes to increase sustainability within the organization.

1. Learner uses proper medical terminology when documenting in patient charts and speaking with colleagues. Adjusts medical terminology and word choices to ensure the patient understands communication (oral and written).

2. Learner identifies the opportunity to meet with community partners in person vs online to ensure write-ups for them were accurate and relevant. This was identified to avoid barriers from online communication (miscommunication, not being able to interpret non-verbal communication).

3. Learner is aware when a person's first language is not English, Learner ensure they speak at an appropriate pace and clearly. They gently ask if the patient/client understands or has questions.

1. Learner changed from specific dialect to simple language as needed. E.g., depending on the patient/clients previous experience and knowledge, used of plain language to promote better understanding.

2. When the Learner collaborates with food service staff, they adjust word choice by not using medical terminology as seen when speaking with dietitians.

3. Learner creates an infographic on celiac disease that uses plain language, concise messaging, and visual simplicity.

1. Learner writes the waste audit report following a business report format with detailed procedures and results.

2. Learner outlines blog topic prior to writing to ensure that all relevant information will be included in a clear and organized fashion.

3. When writing emails, reflections, and weekly reports, Learner reviews diligently, and checks spelling.

1. Learner demonstrated care with the annunciation of medical terms during lunch and learn session.

2. Learner includes an agenda, internal summaries and signposts during presentation of food market survey results to ensure clarity.

3. Learner speaks clearly and numerates the key tasks when working with new volunteers during meal service. Additionally, the learner asks the volunteers to list key tasks to ensure understanding.

1. When listening to staff concerns, Learner listens attentively and asks questions. They build rapport by communicating it is difficult to navigate certain situations.

2. Learner displays physical cues of active listening. E.g., head nodding, eye contact, etc.

3. Learner does not interrupt client's opening statement of issues. The learner summarizes and checks understanding of key clinical concerns.

1. When listening to concerns from staff, Learner listens and recognizes it may not be the best time to deliver feedback. Learner sympathizes and shares like experiences.

2. Learner demonstrates emotional intelligence when interacting with others.

3. Learner verbally describes a non-verbal cue and checks-in with client on meaning and what client was feeling.

1. Learner recognizes that it is important to allow open space for all parties to speak, offer reassurance, and to suggest a moment to themselves if need be.

2. Learner asks for client's view on next steps/ goals/ treatment plan and adjusts to align with client's lifestyle and treatment burden.

3. Learner demonstrates the principle of rolling with resistance when client rejects an intervention and then asks follow up questions to better understand client's point of view.

1. Learner respectfully provides feedback to preceptor when appropriate.

2. Learner provides written feedback for a peer that aligns with success criteria for project

3. Learner is able to rewrite or restate feedback to align with principles of constructive feedback.

1. Learner is present and engaged in nutrition care meetings, safety huddle meeting, fire drills, etc.

2. Learner shares information from the literature to support direction of treatment plan with health team.

3. Learner askes questions during project planning meeting with community health centre executives

1. Learner consults with site dietitian to gain knowledge and clarification to create education materials.

2. Learner consults with the cook prior to creating a new menu item, e.g., asked them what cut of meat would be best for the new meal.

3. Learner understands when and how to consult an RD for expertise. E.g., Renal RD for feedback on renal menu diet extension.

1. Learner assessed and made recommendations to the food menu of a continuing/long term care facility to align with national/provincial/territorial nutrition menu standards.

2. Learner identified stakeholders (e.g. food distribution companies, clinical dietitians, patients) to engage in the development of the food services department operational plan.

3. Learner conducted a best-practice review of institutional healthy food policies in support of the organizations 'healthy workplace' strategic priority.

1. Learner reviewed operational costs (e.g. food, venue rental, travel, etc.) of a food skills development program (e.g. community teaching kitchen, cooking class) and made recommendations to improve the operating costs while maintaining delivery of a quality program.

2. Learner reviewed processes associated with the provision of oral nutrition supplements (ONS) to patients/residents of a hospital/long term care unit, including costs associated with use of ONS, and recommended areas for improved quality and financial management.

3. Learner reviewed food services department operating budget, determined budget percentage allocations (e.g. labour and food costs), compared to past budgets/norms/benchmarks and made recommendations to improve the operating budget.

1. Learner assessed the content of nutrition education material(s) (e.g. handouts, presentations) for alignment with current best practice (e.g. government standards, clinical practice guidelines, etc.) on the topic.

2. Learner audited food service indicators or processes (e.g. food wastage, food tray accuracy, food temperatures) for alignment with established standards and benchmarks.

3. Learner interviewed clinical dietitians to assess the challenges of integrating best-practice nutrition care processes (e.g. nutrition risk screening, subjective global assessment) into practice.

1. Learner recommended changes to align nutrition education materials (e.g. handouts, presentations) with best practice (e.g. practice standards, clinical practice guidelines) and a knowledge transfer and dissemination plan of updated information.

2. Learner proposed a plan to address concerns identified from their audit of food service indicators or processes (e.g. education of staff, increased temperature checks).

3. Learner developed a project plan to integrate a nutrition care best practice (e.g. nutrition risk screening) including the goals to be achieved, actions to be taken, stakeholders involved and timelines to be met.

1. Learner developed a P(opulation) I(ntervention) C(omparison) and O(utcome) research question to guide a literature review.

2. Learner investigated a topic of nutritional significance to a dietetic practice area and, with preceptor support, framed a question seeking to identify the best practice(s) associated with the chosen topic.

3.  Learner developed clear, concise and analytical questions in support of their own dietetic learning and competency development. 

1. Through discussion with their preceptor, the Learner identified an appropriate research method (e.g. survey, focus group, key informant interviews) to inform their nutrition quality improvement project. 

2. Learner determined survey method and design to assess the nutrition needs of a target population group (e.g. verbal interviews using phone or virtual platform, written electronic surveys, quantitative and/or qualitative questions).

3. Learner identified a specific clinical nutrition screening tool and generated recommendations of applying it to answer their established research question.

1. Learner communicated research results via presentation(s) (oral or poster) to key stakeholders (e.g. research participants, dietitians, healthcare team, decision makers and/or other peers.

2. Learner developed food/nutrition practice resources (e.g. guidelines, procedural form, checklist, etc.) based on research findings and shared the research results, recommendations and resources with key stakeholders.

3. Learner translated research findings into actionable messages for the public which were presented on visually appealing posters.

1. Learner reframed and communicated therapeutic diet information to a patient, their family/caregiver and the healthcare team when the patient was transferred to another care setting.

2. Learner applied knowledge of food and nutrition to create a recipe, prepare speaking notes and deliver a teaching kitchen (e.g. food/recipe demonstration) to a target audience.

3. Learner created a knowledge translation tool (e.g. handout, brochure, poster, presentation) that reframed food and/nutrition information for a target audience (e.g. hospital malnutrition poster for healthcare professionals).

1. Learner identified Nutrition Month, Canadian Malnutrition Awareness Week and/or other health week/months as an opportunity to advocate for a food and/or nutrition topic or change.

2. Learner identified a process to engage culturally and religiously diverse patient populations to understand the changes needed to diversify the hospital food service menu and explored strategies to effectively adopt the menu changes.

3. Learner identified key stakeholders (e.g. volunteer resources, program managers, unit staff, dietitian), data/information (e.g. # patients requiring mealtime assistance) and processes needed to advocate for a volunteer mealtime assistant program.

1. Learner provided constructive feedback to another learner after attending their clinical nutrition case study presentation.

2. Learner identified a need to educate healthcare professional staff on the different therapeutic and texture modified diet orders available and when to order them.

3. Learner recommended adding eye-catching signs and recipes to highlight nutritious meal options available in the hospital cafeteria.

1. Learner established learning outcomes for a group nutrition education session developed for clients of a primary health care clinic.

2. Learner developed learning outcomes for their clinical nutrition case study presentation to their peers (e.g. dietitians, dietetic interns, healthcare professionals)

3. Learner outlined learning objectives for the orientation of new food service staff to the food service department.  

1. Learner developed and administered a survey to assess the effectiveness of educational strategies at meeting the desired learning outcomes (e.g. electronic questionnaire post food safety training)

2. Learner performed practice audit on a peer learner (e.g. dietetic intern) using a clinical documentation audit tool.

3. Learner assessed achievement of Nutrition Month education and advocacy outcomes.  

1. Learner demonstrated how to prepare a recipe and use cooking utensils, engaging the target audience using plain language and avoiding jargon.

2. Learner developed a visual nutrition education tool for clients with low food literacy.

3. Learner revised hospital patient menu using a food literacy lens.  

1. Learner assessed the level of food knowledge and skills among youth attending a cooking class and identified the strategies to best support development of their food knowledge and skills.

2. Learner developed a list of community resources (e.g. virtual teaching kitchens, community gardens) to support clients to develop their food skills.

3. Learner referred client to a lending library for kitchen appliances as a budget friendly option to help support their goal of preparing nutritious meals at home.  

1. Learner compared nutrient content of oral nutrition supplements (ONS) and recommended substitutes in the event of an ONS product shortage or unavailability.

2. Learner facilitated an education session to clients on understanding food labels and how to read a Nutrition Facts Table using sample food packages.

3. Learner assessed various elements of a food label (e.g. nutrition facts, ingredient list, health and nutrient content claims, date labeling on pre-packaged foods) to inform selection of food products for therapeutic menus, cooking demonstrations, etc.  

1. Learner provided onoing support to parents on how to fortify breastmilk and/or infant formula to meet the needs of their newborn child.

2. Learner supported a client during an individual nutrition assessment to establish goals focused on food skill development.

3. Learner provided education to a community group on cost-effective meal planning and preparation.

1. Learner uses the Resident Assessment Instrument Minimum Data Set (RAI-MDS) to identify long term care residents nutrition and hydration risk.

2. Learner uses validated nutrition screening tool (e.g. Canadian Malnutrition Screening Tool) to identify nutritional risk of acute care in-patients.

3. Learner used daily census sheets to prioritize / triage patient caseload based on patients admitting diagnosis, length of stay, therapeutic diet order (e.g. NPO, oral diet, enteral nutrition) and food texture/fluid consistency.

Assess and interpret food- and nutrition-related history. 

1. Learner asked patient/family relevant food/nutrition related history questions typical foods eaten/preferences (e.g. frequency, type, allergies), normal/changes in food/fluid intake, views/attitudes/beliefs towards food, bowel function, chewing/swallowing ability, etc. and uses this information when determining the patients nutrition issues and plan of care for the patient.

2. Learner conducted meal time audit of long term care resident(s) to assess challenges/barriers to food intake. Learner interpreted findings and explored solutions to address challenges/barriers.

3. Learner conducted thorough assessment of acute care inpatients food/nutrition intake during admission by reviewing therapeutic diets/supplementation ordered during admission (e.g. oral diet, enteral feeds), food intake/wastage logs and discussions with the care team, patient and family and applied this information to determine a plan to address identified issues (e.g. meal time assistance, medpass, etc.).

1. Learner gathered demographic, psycho-social (food access) and health behaviour (cooking skills) history from medical rounds and the patient's chart. Confirmed and gathered additional information in conversation with the patient / family. Considered this information when determining the discharge plan.

2. Prior to appointments, learner reviewed the patient chart to obtain available psycho-social (e.g. socioeconomic, cultural, living/housing arrangements, self-efficacy, supports, etc.) and health-behavior (e.g. attitudes, body image, physical activity level, alcohol/tobacco/drug use) related information. Learner asked patient about this when appropriate during appointment and factored in when making nutrition recommendations.

3. Learner conducted an assessment of a patients social history as it relates to nutrition, including: living/housing arrangement, access to food, food preparation and cooking skills (e.g. who prepares/cooks food), who patient eats meals with, other assistance/supports, etc) and factored this in when making nutrition recommendations.

1.Learner observed resident during mealtimes to investigate reasons for their poor oral intake. Learner noticed resident experienced feeding difficulties whereby they ate from one side of the plate. Learner consulted with food services and nursing staff and recommended the residents plate be turned 180 degrees mid meal to increase intake.

2. Learner visited patient in-person/bedside and visually assessed physical signs of malnutrition such as sunken temples, indentation between ribs, fat/muscle wasting, etc. and interpreted how that would impact their nutrition status (e.g. sign of needing to monitor for refeeding).

3. During appointments, learner observed patient’s appearance for signs of malnutrition including weight loss, muscle wasting, brittle nails, pale skin, hair loss, etc. Considered this information when determining the nutrition care plan.

1. Learner reviewed patient charts to obtain and interpret results from routine medical tests and procedures including (but not limited to) bronchoscopy, CT scans and stool cultures. Learner used this information to inform the head-to-toe assessment and interpreted the nutrition-related significance of these results.

2. Learner obtained medical test information from a number of sources (e.g. patient chart, rounds, conversations with the Health Care Team) and considered this information when determining the nutrition care plan.

3. Learner reviewed findings from medical imaging and tests involving the patients GI tract and any other structure that could affect recommendations for feeding (e.g. CT of the abdomen showing bowel wall thickening, evidence of GI obstruction). Learner reviewed imaging showing that NG/OG tube is in place and CT to assess GI viability and engaged in team discussion regarding feeding plans (e.g. oral feeding, PN).

1. Learner reflected on scope of practice within dietetics, and when assistance beyond scope would be needed by a Speech Language Pathologist (SLP). For example, if a patient was experiencing mucositis-related pain when swallowing foods, learner recommended alternatives such as softer food textures or oral nutrition supplements (e.g. Ensure). If chewing/swallowing was a concern, learner referred to SLP for further investigation.

2. Learner observed the SLP conduct a swallowing assessment and discussed findings and next steps once complete. Learner recommended appropriate food and fluid texture for patient in support of swallow assessment findings. Discussed texture modified diet options and their appropriateness for the patient’s condition. Asked patient about their preferences and ability to chew and swallow foods/fluids and adjusted care plan accordingly.

3. Learner gathered relevant information from patient charts to form a preliminary assessment of chewing, swallowing and eating abilities:

• Reading previous chart notes from RDs, doctors, nurses, social workers, and other team members.
• Reviewing nursing flow sheets which provide relevant daily updates and metrics including: status of mucous membranes and throat (impacted by mucositis), appetite, and % of each meal eaten. Identified other sources of information relevant to the patient’s chewing, swallowing and eating abilities.
• Speaking with nurses before visiting patients for updates on how patient is eating.
• Speaking with a patient's family members for updates on how patient is eating. Speaking with patient about current or past challenges with chewing, swallowing, eating, and oral health (including dentition). Assessed signs that may indicate difficulties with chewing and/or swallowing, such as tonal changes in voice after eating meals and/or drinking.
• Visually examining the tongue and mouth of patients experiencing mucositis and obtaining a relative assessment to understand the progression of symptoms.
• Recommended downgrade of diet texture to chopped to a patient when needed (e.g. chopped diet for patient with mucositis).

1. Learner reviewed daily patient census and prioritized patients based on diet order (e.g. therapeutic and/or texture modified diet order), food/nutrient intake (e.g. adequate intake of oral diet = less urgent, NPO for 3 days = more urgent); and orders for nutrition support (e.g. nutrition support = more urgent). Learner screened all new referrals for malnutrition risk and identified prioritization level. Learner prioritized assessment of patient(s) with an enteral nutrition support order, unless there were obvious contraindications (e.g. high lactate level preventing feeding).

2. When gathering diet history details from a patient with diabetes, learner identified the most important nutrition problems to potentially address with the patient based on their readiness to change. Common examples of prioritized nutrition problems included: i) not enough meals/snacks throughout the day to meet nutrition needs ii) not distributing carbohydrate based foods consistently and iii) not consuming enough protein, fiber and/or fat.

3. Learner reviewed patient medical history and identified the medical diagnos(es) that may impact the patients nutrition status (e.g. hypertension, diabetes, chronic kidney disease, etc.). Learner identified the nutrition problem(s), the urgency of each nutrition problem (e.g. restricting macronutrients due to high urea and triglycerides) and the impact recommended nutrition intervention(s) would have on the medical goals.

1. During patient interviews, learner determined nutrition requirements by first asking patient about their overall eating pattern (e.g. frequency of meals and snacks), followed by detailed information on the nutrition content of each eating moment. Learner inquired about other factors such as lifestyle, work schedule, alcohol/drug use, etc. to then determine the appropriate nutrition requirements.

2. Learner used patient weight to calculate energy and protein needs using the range method, used body weight or ideal body weight (IBW), adjusted body weight (ABW) when needed as per evidenced based recommendations. Learner selected the optimal range based on patient condition and medical issues.

3. Learner used a variety of equations, best practice clinical nutrition resources and academic articles related to disease conditions to calculate and justify patients' energy, protein and fluid requirements for different nutrition issues and patient populations (e.g. identified appropriate weight to use for calculations such as IBW or ABW, calculated nutrition requirements for initiation of enteral feeds, for patients with renal disease and for wound care).

1. After examining patients bloodwork and collecting a diet history, learner determined nutrition issues, prioritized them and made therapeutic supplementation recommendations. For example, a patient with poor oral intake and a high-pace/high-stress lifestyle may benefit from oral nutrition supplements such as Glucerna in order to gain adequate nourishment.

2. Based on a patients current dietary intake and physical examination (e.g. patient has open wound), learner prepared a list of relevant nutrients to target based on the literature/best practice guidelines. For example, the learner recommended increasing the patients protein intake if inadequate and considered supplementation of zinc, vitamins A and C, arginine and a multivitamin.

3. Learner recommended addition of oral nutrition supplements to the meal tray of a patient who required extra nutrition to meet their energy and protein needs (e.g patient required respiratory assistance and was fatigued).

1. Learner completed enteral nutrition (EN) calculations for patients and recommended the formula, type, rate, feeding schedule, advancement, etc., to meet the patients nutrition and medical needs (e.g. Nepro for patient with high PO4, K, Urea and low EGFR). Learner observed use of the metabolic cart to assess energy requirements. Learner monitored and made adjustments to the EN regimen as indicated by lab values, medications, refeeding risk and tolerance (e.g. Resource 2.0 recommended for volume restriction when a patient was experiencing early satiety).

2. Learner completed enteral nutrition (EN) regime for patient being transferred home on G tube feeds. This included providing recipes for home blended food for tube feeding, which was of interest to the patient and family. Learner provided patient and family members with education on how/why/when feeding tubes work and become necessary and blenderized food recipes to meet nutritional needs.

3. Learner read suggested scientific literature to better understand the impact of EN vs PN on patient outcomes; conducted thorough assessments of patient cases to determine if enteral nutrition support was appropriate; presented findings and ideas to preceptor to discuss, particularly for complex patients. Learner designed safe EN regimens for patient cases, which included safe starting rate, final goal rate, water flushes, appropriate selection of EN formula and plan for monitoring. EN recommendations were based on full nutrition assessment, including calculations of estimated nutrition needs.

1. During appointments learner asked patient questions about their diet history and gauged their level of nutrition knowledge. Learner adjusted the depth of education/teaching to meet patients learning needs. Learner noted patients strengths and highlighted these as assets to the patient as a form of encouragement and motivation.

2. Learner used nutrition assessment to determine patient and family needs and resources to support eating disorder recovery. Learner identified when patient needed more time or resources to help with meal planning for discharge from hospital. Learner planned several days of meals and snacks with patient as a resource and learning opportunity to help patient succeed as an outpatient doing individual treatment.

3. During initial and follow-up appointments with patient, learner collected diet history and level of food and nutrition knowledge and adjusted nutrition education level to meet patients learning needs (e.g. talked to patients about the importance of adequate protein intake, food safety and safe food handling to patients with weakened immune systems). Learner noted strengths to highlight as assets to the client as a form of encouragement and motivation. For example, when patients made improvements in oral intake despite symptoms of nausea, fatigue, and/or mucositis, Learner provided verbal encouragement. Similarly, Learner frequently praised and encouraged patient’s family members or caregivers for their support and efforts.

1. Learner communicated with food service personnel and the health care team when recommending therapeutic changes to patient meal plans, including entering orders into the electronic communication/documentation system for communication to kitchen staff and documenting changes in the patients medical chart.

2. Learner identified patients' food and oral nutrition supplement preferences during assessments and follow-up appointments and consulted with preceptor to update their existing diet orders to nutrition services. This was a dynamic process as patients often grew tired of the same foods, or had emerging difficulties with chewing/swallowing due to mucositis.

3. Learner consulted with the healthcare team to recommend nutrition support (EN or PN) and/or initiating trial of oral intake for patient receiving nutrition support. Learner paid attention to patients history while in hospital (e.g. medical diagnosis/reason for admission, transfer to/from ICU and surgical units), reason(s) for EN or PN recommendation and discussed reasoning and recommendation with physician, nursing and other healthcare team members on initiation, advancement and monitoring (e.g tolerance) of nutrition support.

1. When appropriate for the nutrition care plan, learner applied counselling strategies when providing basic nutritional counselling to patients regarding intake of fluids and nutrients.

2. During outpatient rotations, learner used a client centered approach when counselling patients during initial nutrition assessment and follow-up appointments to encourage behaviour change (e.g. nutritious food intake, modification of food patterns, etc.).

3. Learner applied motivational interviewing techniques exploring the patients experiences, perspectives and ideas to help identify nutritional goals. Learner was able to connect meaningfully with the patient and determine their priority nutrition care goals to develop a realistic action plan.

1. During a follow-up appointment, Learner assessed the patients' comprehension of the nutrition information provided, readiness to implement the recommended dietary modifications and made adjustments to the nutrition care plan as needed using a client-centered focus.

2. Learner worked with patient to identify the development of SMART nutrition goals; arranged for follow-up appointment to review progress with achieving these goals; and reinforced activities to support achievement of these goals through nutrition education and counselling. Learner worked with patient to identify barriers to goal achievement and made recommendations to modify goals as needed.

3. Based on nutrition care plan, learner evaluated progress in achieving patient nutrition goals by monitoring if: laboratory levels were improving and not increasing/decreasing dramatically; stools were becoming regular; and if patient was tolerating EN feeds and rate advancement. Learner assessed adequacy of energy and protein provided and potential risk of inadequate nutrition support. Learner followed up with patient when they were able to eat a regular diet to assess achievement of nutrition care goals.

1. Learner completes a situational assessment for a local community or group (e.g. completes a needs assessment for a new comer community to justify the need for a community kitchen or completes a needs assessment for a group of workers to identify strategy for improving access to healthy foods).

2. Learner identifies strategies to collect information from consumers, manufacturers, retailers and/or other stakeholders through social media platforms in order to identify opinions and marketing strategies regarding supplemented food products and natural health products.

3. Learner creates a survey to understand the nutrition needs of community members, which will inform program updates. Learner identifies information required to assess the participants knowledge on healthy eating, active lifestyle, types of physical activities, packing school snacks etc.

1. Learner uses online databases to access food surveillance data within their community.

2. Learner accesses relevant information from credible sources to better understand the needs of target population for the creation of resources.

3. Learner analyses data on fruit and vegetable consumption in children from a recent survey conducted by a dietitian at a community health centre to inform development of a new workshop.

1. Learner reviews public health unit report on health status data collected in a specific region. The Learner uses this data to inform project work.

2. Through social media Learner obtains health literacy information regarding the current level of consumer knowledge on a specific topic.

3. Interpreted health statistics from organizations including Health Canada to better understand issues facing the target audience to ensure the relevancy of created resources.

1. Learner gathers information related to food access and proximity of grocery stores/local markets for residents in supportive housing. The information is used as the basis for the creation of an affordable, nutrition lunch program.

2. Learner uses focus group information to determine the usefulness of information provided on product labels of packaged food items with focus on front of package labels.

3. Using geospatial analysis, the learner identifies barriers and supports to food access for vulnerable populations.

1. Learner develops strategies and a timeline to monitor the implementation plan for an outreach program.

2. Learner creates a logic model to organize goals, objectives, and outputs of current community programming.

3. Learner creates a Gantt chart to outline the project deliverables, timelines and team members responsibilities.

1. Learner develops evaluation surveys to determine successful achievement of goals and objectives for a community kitchen project.

2. Learner proposes a study design that would gather information on consumer and manufacturer opinions on food products using social media platforms.

3. Learner determines an in-person workshop would be most effective in reaching their target audience after considering other strategies such as: an online workshop or a print resource.

1. Learner contributes to the development of a survey that will be distributed to their target population.

2. Learner develops questions for the interview guide for a focus group.

3. Learner identifies key community members to interview following an intervention to evaluate satisfaction and community reach.

1. Learner participates in and/or supervises newly implemented activities and creates a report for the organization to suggest improvements.

2. Learner audits various workshops run by the public health unit to assess consistency and quality of delivery.

3. Learner creates a checklist to ensure all activities are completed as planned within an upcoming workshop.

1. Learner created a presentation to propose modifications to future outreach programs based on participant feedback and presents to management team.

2. Learner recommends the use of more graphics and white space on resources to align with plain language design guidelines.

3. Learner discusses their ideas with their preceptor to update client resources to improve accessibility.

1. Learner identifies diet types, food allergies and diet changes through charts and diet orders sent through the hospital system.

2. Learner identifies the following sources of information to support projects:

• Electronic sources: CBORD for pricing, menu selections, patient meal worksheets, patient preferences, and ward stock reports.
• Human sources: Preceptor, supervisors, dietary assistants, diet clerks, nutrition services staff including job descriptions and schedules.

3. Learner reviews survey containing dietary preferences for all guests attending an upcoming event and used this information to inform catering.

1. Learner considers dysphagia, eating disorders, cultural preferences, appetites, lack of required equipment etc.

2. Learner is able to articulate how a food item can change the International Dysphagia Diet Standardization Initiative (IDDSI) levels based on situational variables (i.e. refrigeration, holding time etc.. )

3. Learner can explain the importance of updating job descriptions to create role compartmentalization as it relates to food waste, inventory control and overall staff productivity.

1. Learner reviews available stock, ordering, special diets, food safety, working fridges, etc.. to determine food provision priorities.

2. Learner gathers KIP data and generates a final summary report with recommendations on optimizing food provision.

3. Learner analyzes feedback from past participants of a cooking class to determine acceptability of past recipes and to make recommendations for future events.

1. Learner creates an instructional video and arrow posters guiding participants to the correct location to help them efficiently pick up their meal kits.

2. Learner completes a community dining room project that includes: in-person observations, conversations with supervisors and nutrition service staff, reviewing job descriptions and timelines.

3. Learner creates a workplan outlining the steps they will take to meet the goals and objectives of their project.

1. Learner creates a survey for participants to identify barriers to picking up their meal kit. Learner then uses this data to make recommendations to improve the efficiency of the program.

2. Learner identifies evaluation strategies for a community dining room project (i.e.. nutrition staff job analysis, temperature audit, meal type accuracy etc.)

3. Learner conducts key informant interviews with staff to evaluate workload and contribute to updating job descriptions.

B

1. Learner inputs data on the amount of portions prepared, leftover, and waste on food production sheets.

2. Learner creates updated labels for storage areas to improve organization of inventory.

3. Learner provides recommendations for purchasing and inventory control for individual hospital wards.

1. Learner updates new menu items, and the corresponding plating guide to ensure proper implementation of the new menu items.

2. Learner leads feasibility testing of a new product to replace a discontinued one and identifies the impacts on menu planning and production schedule.

3. Learner audits LTC current cycle menu based on the requirements of the organization.

1. Learner ensures food items being used for cooking demonstrations are kept at the correct temperature, proper handwashing occurs to prevent cross-contamination of raw materials such as eggs and cook all foods thoroughly especially those with raw products such as eggs.

2. Learner completes a meal assembly assessment (temperature audit, tray accuracy check, staff safety, work flow review and tray quality) to identify possible improvements for workflow and job description modifications.

3. Learner attends a health and safety meeting and conducts an audit to identify any workplace hazards.  

1. Learner performs tray accuracy checks and waste audits on meal trays to inform changes to food purchasing.

2. Learner collaboratively, and independently completes various food safety audits for their placement.

3. Learner administers surveys to assess patients' overall experiences related to food provision.