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 respects clients rights, dignity and uniqueness by providing a non-judgmental approach when discussing dietary choices; lifestyle etc.

2. Learner provides patient a list of menu item alternatives to accommodate religious and/or cultural practices.

3. Learner communicates with fellow staff appropriately and respectfully. Learner extends the same respect to patients and families.

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 practices in accordance with the Code of Ethics for Dietetic Practice in Canada. Working with the medical team, Learner discusses ethical dilemmas for patients with advanced dementia and decreased intake with the goal of determining the suitability of initiating or withdrawing dialysis treatment.

2. Learner researches community assets using a non-judgmental approach.

3. Learner applies beneficence, non-maleficence, respect for autonomy, fairness and justice to the decision making processes with the revision of meal and snack offerings and delivery schedules.

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 conducts themselves in a professional manner in accordance with the professional guidelines set by provincial regulatory body.

2. Learner demonstrates integrity, non-discriminatory, honest, trustworthy, client-centred behaviours daily.

3. Learner maintains a compassionate and caring nature with all patients and their families

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. The Learner acts with sensitivity and humility with regard to diverse cultural groups by considering the cultural implications of food and how that might impact their nutrition care plan.

2. The Learner actively seeks out opportunities to learn more about cultural preferences and practices of community members they interacted with.

3. The Learner develops population public health messaging and resources with sensitivity and diversity in mind.

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 obtains verbal consent from patients prior to participating in patient satisfactory surveys.

2. Learner clearly explains new information and/or changes to a patient to ensure they understand the information before asking if changes made to the care plan are acceptable.

3. Learners ensures informed consent by ensuring that new clients have completed consent forms when meeting them for the first time.

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 includes patient in decision making, and ensures they are consulted prior to changes being made to care plans.

2. Learner asks client to collaborate on setting an agenda for the appointment. The client suggests two items to discuss and the Learner suggests two items. Together they prioritize the four items based on the appointment length.

3. Using ideal client profiles, Learner identifies the values, pain points, demographics, and other characteristics of five different subgroups of clients in order to understand what key messages are applicable to them.

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 reads and is able to discuss legislation relevant to food and nutrition in long-term care (LTC) settings.

2. Learner reads and is able to contrast provincial Code of Ethics and Standards of Practice.

3. Learner adheres to temperature audit procedures to ensure foods and beverages were kept and served at the appropriate temperature.

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 uses the organization's method of documentation to document relevant nutritional assessment information in patient online charts.

2. Learner accurately documents food waste audit data using printable templates and Microsoft Excel/Google Sheets documents within the same day of obtaining the data from food service pantries.

3. Learner takes physical notes during patient visits and completes chart notes in patient medical record within 24 hours as per Hospital policy.

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. The Learner takes note of infection control precautions from rounds and notices them posted at doorways before entering patient rooms.

2. The Learner completes temperature audits to ensure all foods are being held at the correct temperature to maintain food safety.

3. Learner identifies food safety risks and knife skills risks when children are cooking on their own, frequently reminds participants in live Zoom sessions to seek help of adult when using a knife, oven or stovetop.

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 is able to self-identify tasks to be completed in downtime and uses time efficiently to get tasks completed.

2. Learner creates a workplan to map out all projects and activities to determine which activities have higher priority.

3. Learner attends bullet rounds to identify patients who may need RD consult for feeds and diet optimization. Learner follows the hospital priority matrix when prioritizing time and caseload.

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 consults preceptor and uses other resources (e.g., previous course notes, peer reviewed texts etc.) prior to making decisions.

2. Learner uses research to determine best language and practices to use when helping children build a positive relationship with food, such as normalizing eating all foods, not referring to foods in a dichotomous way due to increased risk of eating disorders.

3. Learner is able to make evidence-informed decisions when determining if a patient is able to tolerate thin (level 0) fluids based on information obtained from a speech language pathologist (SLP) assessment note in the patient's chart.

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 develops goals for each placement, such as improving charting speed time and increasing confidence and knowledge when interacting with clients. To improve practice, the Learner accesses evidence-based websites and resource to expand their knowledge.

2. Learner develops a goal to improve food service and business skills; they reviewed resources on how to properly write a briefing note to provide a well-written, effective note to propose a transition from self-service to full service vending.

3. Each week, the Learner reflects on their progress and determines readiness to increase involvement during the following week. They review chart notes every week and discuss cases they want to work on with preceptors.

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 recognizes when they are unable to answer specific questions during counselling. Learner informs the patient that they will research or consult with preceptor and follow up.

2. Learner serves as an observer when participating in situations which are clearly beyond their personal capacity.

3. Learner refers a patient to social work after the patient discloses they are struggling with their mental health and would benefit from additional supports.

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 uses plain language to communicate clearly and effectively with the target audience.

2. Learner uses appropriate and correct organizational abbreviations.

3. When providing diabetes education to a client, Learner explains acronyms prior to using them in teaching. For example, the Learner explains that A1c is a 3 month average of blood sugar.

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 critically evaluates information that is to be used for resources creation, based off validity of research, credibility of source, and relevancy to the topic.

2. Learner critically appraises information relevant to practice by assessing literature relating to adopting a HAES approach for type 2 diabetes management.

3. Learner critically appraises the breakfast menu by creating a survey and surveying patient's satisfaction regarding the new breakfast ordering system and offerings.

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 Google Classroom to manage program content and participant interactions, as well as maintaining an organized Google Drive folder with all content and projects worked on during placement period. 

2. Learner can navigate hospital electronic medical record with minimal support to gather data for nutrition care.

3. Learner uses a program called CBORD for nutrition services, to order census sheets and request test trays for audits.

Competency #

Indicator

Performance Indicator

Example

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 creates clear and concise resources using terms relevant to the target audience.

2. Learner selects graphics and text to communicate key nutrition messages to community members.

3. Learner promotes effective communication by demonstrating active listening and empathy.

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 uses language tailored to target audience to communicate key messages quickly and effectively.

2. Learner completes written assignments as requested in a timely manner.

3. Learner incorporates additional graphics to support written text to make handouts further accessible to more community members.

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 provides reassurance, support and redirection to residents during interactions when residents show signs of distress and confusion.

2. Learner creates an educational slideshow for staff, Learner makes presentation concise only containing necessary information to ensure the attention of the audience is kept.

3. Learner is observing the body language and comments of the audience, to gauge their understanding during and after speaking.

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. Learner creates an instructional video on how to make homemade salad dressing.

2. Learner uses software that supports practice. (i.e.. EPIC/EMR, Point click care, Zoom, Teams, etc.)

3. Learner creates accurate health promotion content. They follow social media regulations and organizational policies.

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. Learner observes the body language and emotion of those they are speaking to and does not simply listen to the words they say.

2. Learner is mindful of their tone and reactions when speaking with others.

3. When debriefing with preceptor, Learner is able to identify non-verbal cues demonstrated by client, co-worker, peers etc.

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 makes efforts to create connections with clients/patients and staff through empathy, similarity, shared experiences, etc.

2. The Learner uses all four methods from Calgary-Cambridge guide to establish rapport with clients.

3. Learner listens to the clients' goals/ reasons for appointment, without interrupting or directing response.

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 asks specific questions when seeking feedback, as well as follow up questions if there is any uncertainty.

2. Learner self-reflects through reviewing and discussing individual rotation evaluation forms with preceptor.

3. Learner understands the relative efficacies of different approaches to evaluate meal satisfaction (questionnaire, focus groups, plate waste audit, etc.). Learner recommends and implements an approach and examines the response to the feedback provided.

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

2. Learner took initiative to help in dish room and tray line when teams became overwhelmed.

3. Learner's group contract evaluation demonstrates equitable contribution to team deliverables.

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 contributes professional knowledge to discussions and interactions with staff members or clients.

2. Learner creates a lunch and lean for medical Learners on the role of iron in infant nutrition.

3. Learner outlines food safety issues with the menu planned for a community event.

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 participates with staff in discussion and decision making. e.g., planning a new cafeteria special and collaborating with the cook and supervisor on recipe, ingredients, and feasibility with scheduling/staffing, equipment, etc.

2. The Learner collates a list of stakeholders for the community health fair planning committee to support decision making.

3. The Learner shares the results of taste testing of new menu items with the procurement team.

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 and applied food service department attendance support policies to address employee attendance concerns.

2. Learner conducted environmental scan of guidelines for clinical dietitian staffing of long term care facilities and presented findings to management.

3. Learner reviewed the new food service employee orientation processes, led aspects of the orientation and assisted in completing the orientation checklist.

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 recommended the appropriate physical resources (e.g. computer, lighting, cooking utensils and appliances, ingredients) needed to facilitate a food skills development class (e.g. community teaching kitchen, cooking class).

2. Learner recommended physical resources needed for clinical dietitian(s) to perform a nutrition focused physical assessment on children and/or adults (e.g. length board, weigh scale, skinfold caliper, etc.).

3. Learner developed a contingency plan for food service equipment (e.g. fridge, stove) in the event of a breakdown or failure.

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 interpreted findings from an assessment of nutrition education materials (e.g. handouts, presentations) to make recommend changes aligning with best practice (e.g. government standards, clinical practice guidelines, etc.).

2. Learner interpreted findings from an audit of food service indicators or processes, communicated results of concern and proposed actions to address concerns to preceptor and/or food service manager.

3. Learner identified challenges to integrating best-practice nutrition care processes (e.g. nutrition risk screening, subjective global assessment) into practice and proposed actions to clinical dietitians on how to address the identified challenges.

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 plan to establish a consistent review of nutrition education materials (e.g. handouts and presentations reviewed every 2 years) and evaluate their effectiveness at achieving the intended outcome (e.g. increase target audiences knowledge of a specific nutrition topic).

2. Learner developed a plan, including outcomes, outcome measures and timelines, to address concerns resulting from audit of food service indicators or processes (e.g. food temp audits meeting established standards; education developed and incorporated into new staff orientation).

3. Learner identified outcome measures (e.g. data/information) to determine if goals of a specific nutrition project have been met (e.g. number of referrals for 'nutrition risk screening' sent to a clinical dietitian).

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. Learner critically appraised ideas, points of view and data presented in the literature to inform the development or revision of a best practice nutrition resource.

2. Learner used a validated critical appraisal tool (e.g. AMSTARII) to assess the quality of a systematic review.

3. Learner applied the GRADE approach to assess the strength and quality of evidence of a clinical nutrition intervention.

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 analyzed information gathered (through research methodology) and interpreted findings to inform a nutrition practice issue or answer a research question. 

2. Learner determined the clinical significance of an intervention, as well as the statistical significance.

3. Learner interpreted scientific and nutrition information and made sound recommendations to inform the development of or revisions to clinical nutrition practice guidelines.

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 assessed a patients food and nutrition knowledge relevant to a therapeutic diet during an individual nutrition assessment and tailored the nutrition education provided based on the assessment.

2. Learner identified the food preferences, literacy and skills of participants scheduled to attend a teaching kitchen (e.g. food/recipe demonstration) to inform the recipes that would be prepared and information to be delivered.

3. Learner conducted a survey among healthcare professional staff to assess their knowledge, attitudes and practices with respect to nutrition care of hospitalized patients.

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. In partnership with a health advocacy group, the learner identified an opportunity to positively impact food, nutrition and/or health systems, policies and decisions (e.g. prepared pre-budget consultation letter for Government with recommended food/nutrition actions).

2. Learner advocated for increased diversity of hospital menu offerings after identifying that food/beverage options did not support the dietary beliefs and/or practices of certain patient populations.

3. During a clinical placement, the learner identified patients who require assistance eating their meals and advocated for mealtime assistance with the preceptor or care team.

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 implemented Nutrition Month (or other health week/month) advocacy campaign, including identifying the advocacy topic, target audience (e.g. public, decision makers), the message to be translated, and the dissemination process (e.g. social media, public information booth).

2. Learner engaged with culturally and/or religiously diverse patient populations to understand the changes needed to diversify the hospital food service menu and shared findings with food service management via an in-person presentation.

3. Learner facilitated an in-person presentation on the need for a hospital unit volunteer meal assistance program to decision makers (e.g. food service and unit managers) and key stakeholders (e.g. volunteer coordinators, dietitians).

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 assessed healthcare professional staff knowledge, attitudes and practices with respect to nutrition care of hospitalized patients and identified opportunities for learning on this topic.

2. Learner determined learning needs and assets of food service staff to support the delivery of safe and quality food services by using audits, reports and surveys (e.g. audits of food safety practices of food services staff).

3. Learner led a focus group discussion among expecting parents to learn about their nutrition and food knowledge, skills and opportunities to address their identified needs.

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 implemented strategies (e.g. emails, presentations, posters) to educate food service staff and healthcare professionals on new therapeutic and/or texture modified diet changes.

2. Learner implemented strategies (e.g. presentations, sample action plans, best practice resource list) to educate dietitians on new clinical or nutrition practice guidelines.

3. Learner implemented strategies (e.g. social media posts, grocery store food demonstrations, nutritious cafeteria meal specials and recipe cards) to educate the public on food/nutrition during Nutrition Month.  

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 identified a series of interactive games that could be used by elementary school teachers to teach Learners about healthy eating habits.

2. Learner assessed the learning styles, food/nutrition knowledge gaps and nutritional needs of community dwelling older adults to develop food literacy resources for this target audience.

3. Learner recommended use of recipe cards to promote increased variety and intake of vegetables among patrons of a rural grocery store.

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 selected appropriate nutrition education/teaching resources for instruction with a client of Indigenous identity.

2. Learner sourced culturally acceptable food items to offer on a Long Term Care facility menu, based on feedback from residents and their families.

3. Learner demonstrated understanding of cultural impact on a clients/patients/residents food preference and intake and provided appropriate recommendations (e.g. therapeutic menu modifications) to support this.  

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 analyzed the nutritional content of products marketed as gluten free to ensure they met the inclusion criteria for a dietitians' gluten free nutrition resource list.

2. Learner recommended foods/beverages for a school breakfast club that met the school food guidelines and had appropriate food/nutrition messaging for the Learner population.

3. Learner analyzed messaging and marketing in the food service retail space on its influence on a patron's food choice.

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 created a video demonstrating how to prepare nutritious blenderized tube feeding recipes for home tube fed adults and children.

2. Learner facilitated a cooking class demonstrating how to prepare gluten free meals for individuals with celiac disease.

3. Learner demonstrated how to thicken beverages to varying consistencies for individuals with dysphagia.

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.

1. Based on nutrition risk screening findings or consult/referral, Learner conducted a review of the patients chart and identifies key information needed for nutrition assessment (e.g. relevant bloodwork, medications, past nutrition assessments/interventions/care plans, weight change history, etc.)

2. Learner reviewed scientific literature relevant to nutrition within the population of hematology and stem cell transplant patients which provided a theoretical foundation of knowledge. Attended rounds, spoke with members of their care team including nurses and doctors, and reviewed patient charts for:

• Notes from RDs including nutrition interventions
• Notes from doctors, nurses, speech language pathologist (SLPs) and other health care professionals (HCPs)
• Notes from previous encounters/admissions
• Nursing flowsheets
• Lab results/biochemical data
• Imaging and medical test results
• Observing patient meal trays to see what/how much is eaten
• Used a funnel approach to narrow down the relevant information by doing a head-to-toe analysis to inform an early impression, and identify missing information to ask the patient. With patients during assessments and follow-ups I sought out missing information, progress updates on existing nutrition interventions, and interpreted what patients and/or family/caregivers told me for relevance.

3. Learner used a standardized nutrition assessment form that included key information to be collected when conducting a nutrition assessment in the patient population (e.g. neonatal/pediatrics, adult acute care, palliative end of life).

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 assessed the surgical procedure performed on a patient and how that could affect their nutrition status (e.g. Bowel resection affecting feeding/absorption). Learner asked patient/family about patients medical/surgical history to fill in any gaps.

2. Learner reviewed patient medical chart, including dietitian and other healthcare professional notes to obtain the full history of patients hospital admission (e.g. past medical history, previous health system encounters). Interpreted this knowledge, including how it would affect potential nutrition interventions (ex. history of chronic kidney disease and unstable phosphate and potassium labs would impact the type of oral or enteral nutrition supplements recommended).

 3. Learner gathered information from the patient medical record about patient’s past medical history including diagnosis of T1DM, recent visits to emergency (in relation to hyper/ hypoglycemia) and other relevant diagnoses including hypothyroid disease and celiac disease. Confirmed information with the patient / family. Considered and applied this information when making the nutrition care plan.

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 calculated an estimated treatment goal weight (TGW) using previous growth patterns and trends on a growth chart and considered other indicators of healthy weight such as medical stability (vitals) and regular menstruation/ amenorrhea. Able to interpret current weight, weight change over the day and over the week, % of TGW to make decisions about daily nutrition requirements.

2. Learner determines patients’ length/height and weight using standing scale with stadiometer and assessed trends when making nutrition recommendations.

3. Learner demonstrated ability to calculate IBW, BMI, precent (%) weight change and used this information to calculate patients energy requirements.

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 uses results of nutritionally significant lab values to assess and update patient care plans. For example, in patients diagnosed with an eating disorder, the learner assessed the patients blood work results to evaluate risk of refeeding syndrome, iron deficiency and Vitamin D levels related to bone mineral density. Learner adjusted the nutrition care plan based on findings.

2. Learner obtained biochemical information from the patient record before seeing the patient and discussed dietary and health implications of these findings (e.g. elevated tricylgerides) with the patient during the visit. Together, the learner and patient made a plan to address the lab results and set a date for follow up.

3. Learner reviewed all relevant laboratory data before making a nutrition recommendation for a patient receiving nutrition support (EN or PN) and explored why a certain lab value could be what it is. For instance, PO4 increases due to receipt of a bolus; K+ decreased due to dextrose and insulin given; Na was lowered due to excess fluid). Learner continued to monitor labs for patients on EN and/or PN to assess kidney and liver function, lactate levels (ischemia indication), risk of refeeding, tolerance of EN, and recommended adjustments as needed.

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 reviewed patient charts to identify regularly scheduled and PRN medications, used best practice resources (eg. NIH's Medline Plus, Health Canada, library resources) to research and understand the purpose of each medication in the context of the patient population/medical diagnosis and interpreted the impact on nutrition status.

2. During appointments, learner asked patients about their medications (e.g. name, dosage, frequency) and updated the patient’s chart with any required changes. Considered this information when determining the nutrition care plan.

3. Learner reviewed the Medical Administration Record (MAR) of the electronic documentation system to identify all medications ordered for a patient in hospital. Learner identified medications that would impact: how the patient is fed, including the type of feed (e.g. patient receiving pressors due to hypotension may affect gut perfusion, resulting in the need for a semi-elemental formula) and if feeds need to be held (e.g. due to cipro, levo, etc). Learner reviewed changes in labs and fluid inputs/outputs and investigated the potential cause for the change (e.g. some meds are K+ wasting, such as Lasix, some could be a source of carbohydrates or lipid such as D5 or propofol impacting energy provision).

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 considered and integrated information from a variety of sources to identify patient's nutrition problem(s) including: diet history, medical history, anthropometric data, laboratory values, information obtained in team rounds and discussions with patient and their family. Learner identified barriers to nutrition, including food restrictions and weight preoccupation.

2. During patient interviews, learner used relevant assessment data to identify and prioritize nutrition problems. For example, used biochemical data (e.g. A1c, blood glucose monitoring data, lipids, etc.), anthropometric data (e.g. weight change), clinical data (e.g. medical procedures) and subjective data (e.g. patients knowledge, attitudes, readiness to change) to identify nutrition problems.

3. Learner considered all relevant medical information to identify issues impacting nutrition status. For instance, the learner interpreted the medical diagnoses (e.g. stenotic mesenteric artery) to infer what that would mean for the patients nutrition status and absorption (e.g. less blood flow leading to potential ischemia and inability to use the gut); learner interpreted the medical procedure(s) and its impact on nutrition status (e.g. NPO due to bowel obstruction); and, learner interpreted findings from labs to indicate nutrition issues (e.g. water flushes required to feeds to counteract high sodium).

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. Learner determined nutrition goals in collaboration with the patient (e.g. 1:1 discussion about how nutrition would be able to support them or not based on evidence and the patient's medical status) and the medical team (family meeting).

2. Learner pre-formulated nutrition goals before seeing the patient to support healthy blood glucose based on reviewing patient chart. Learner reassessed these goals after interviewing patient and made adjustments as needed based on information provided.

3. Learner considered evidence based practice (e.g. ICU enteral nutrition feeding guidelines) and the medical interventions planned (e.g. intubated and ventilated) and the patient's current medical status (e.g. elevated Na and glucose, NG tube insitu) to determine nutrition 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. Based on nutrition assessment, learner added oral nutrition supplement to patient’s tray to help meet protein and calorie requirements to promote wound healing and considered patient's dietary modifications including allergies, cultural dietary modifications (e.g. Halal, vegetarian, kosher).

2. When relevant diet history notes were available in the patient chart, learner pre-formulated 1-3 ideas for dietary modifications and then corroborated these ideas based on patient interview and ultimately made appropriate recommendations. For instance, the learner may recommend a patient pair carbohydrate foods with a source of fat/fibre/protein (e.g. nuts) to slow the absorption of glucose to keep their blood glucose values within normal range.

3. Learner recommended changing PN/EN based on patient lab values, tolerance, acuity, nutrition risk (e.g. refeeding), medical issues (e.g. renal failure). Learner recommended changing: Peptamen AF to Nepro due to high K and urea, low EGFR and patients history of CKD; Peptamen AF to calorie dense and volume restricted such as Resource 2.0 when patient expressed feeling full and nauseous; method of nutrition delivery as the patient status and their active issues changed (e.g. discontinued EN and initiated PN due to development of post op ileus).

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 connects with the child life specialists and social work team members to discuss supportive accommodations related to nutrition support. Able to make and implement recommendations such as eating in a different room, timing of meals, engage in conversation with pt about feelings towards food/ eating in hospital, eating food from home, comfort etc.

2. Learner collaborates with preceptor and the health care team to support a patient being discharged on home EN support.

3. Learner identifies resident with feeding difficulties and recommends a volunteer to assist them with feeding at meal times.

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. Learner calculated a new PN prescription including completion of energy and macronutrient needs based on patient weight, height and medical issues and determined micronutrient additions based on patient medical condition and labs. Learner considered anything that could affect electrolytes (e.g. continuous renal replacement therapy (CRRT), acute kidney injury (AKI), ischemic heart disease (IHD)). Made adjustments to PN prescription based on monitoring labs results (e.g. removed K when elevated and needed to be shifted into cells, removed PO4 out when patient switched to IHD from CRRT). Accounted for refeeding risk and made recommended adjustments as needed.

2. Learner determined PN was indicated; selected appropriate access (e.g. peripheral, central, PICC, etc.), determined appropriate formulation and rate to meet nutrition macro and micro nutrient requirements; considered patient quality of life, medical goals, fluid requirements and medication regimen.

3. Learner read suggested scientific literature to better understand the impact of EN vs PN on patient outcomes; conducted thorough assessment of patient cases to determine if parenteral nutrition support was appropriate and presented findings and ideas to preceptor to discuss, particularly for complex patients. Designed safe Parenteral Nutrition regimen for patient(s) including custom 3-in-1 PN solution, PN rate/total daily volume, metabolic/compatibility compounding checks and PN monitoring plan. Learner demonstrated knowledge of guidelines to follow and where to find appropriate resources to guide decision making.

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. During a nutrition assessment/patient interview, Learner identified the patient did not have a full kitchen and struggled with meal preparation. Learner researched and proposed meal delivery services (e.g. Heart to Home, Meals on Wheels) that could provide diabetic meal options to meet their therapeutic goals.

2. Learner consulted with preceptor and care team to determine appropriate resources and supports for an inpatient that was being transferred home with a tube feed. Learner consulted and collaborated with the health care team, patient/family and home care to support this transition (e.g. completed forms to support financial coverage of enteral nutrition supplements, consulted with community pharmacy to inquire about supplement availability, sent referral to community dietitian for follow-up).

3. In collaboration with the hospital unit social worker, Learner sent a referral to an appropriate service to support the patient's food insecurity and therapeutic nutrition needs when they were to be discharged from hospital.

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. Learner practiced and delivered virtual nutrition education to patients with gestational diabetes regarding managing blood sugar during pregnancy, demonstrating how to use a blood glucose meter, counting carbohydrates and understanding the risks of poor blood glucose control.

2. Learner provided education to in-patients who were immunocompromised (e.g. patients receiving transplant and/or chemotherapy treatment) using best practice nutrition education handouts (e.g. obtained from PEN, standardized from the organization) that included recommended brands of protein powders, high calorie/protein-rich recipes and food safety considerations.

3. Learner provided in-person nutrition education to a group of patients in Cardiac Rehabilitation including engaging them in interactive label reading activities, reviewing recommended therapeutic diet(s), reviewing appropriate recipe ideas and answering nutrition-related questions from the group.

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. Learner identified key strategies to monitor effectiveness of nutrition interventions including: recommending regular patient weight checks by nursing, monitoring biochemical data, reviewing food/supplement intake records, attending patient rounds and maintaining regular communication with physicians, nursing and the care team.

2. Learner considered best practice guidelines and feedback from patient when determining indicators to monitor and identified key strategies for monitoring patient self-care. Learner taught patients how to monitor their blood glucose values using a capillary blood glucose monitor which is a crucial indicator of effectiveness of nutrition interventions for diabetes.

3. Learner determined strategies to monitor a patients nutrition care plan based on acuity of current medical issues, planned nutrition intervention(s) (e.g. EN or PN) and information available through routine patient care on the unit (e.g. laboratory data, in/outs, bowel movements, emesis, medical chart notes, information received in patient rounds).

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. During a follow-up outpatient appointment, Learner identified a patient was experiencing challenges impacting their ability to achieve the goals outlined in their nutrition care plan since the last appointment. Learner explored challenges with the patient to understand their impact on meeting the patient's nutrition care goals and worked with the patient to identify adjustments that supported their current situation.

2. Learner recommended changes to a patients nutrition support (e.g. EN or PN) prescription based on laboratory data, ins/outs, medical status change, etc. to support patients changing nutritional needs (e.g. recommending change in feed type, rate and route of feeding).

3. Learner recommend appropriate adjustments to a nutrition intervention for patient with diabetes including: snack/meal adjustments in alignment with prescribed insulin adjustment; improving accuracy of carbohydrate counting pre/post physical activity; and general healthy eating tips. Learner discussed recommendations with preceptor and patient to determine what interventions were appropriate and realistic.

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 creates a survey including relevant questions to determine who in the population can benefit from nutrition education sessions and resources.

2. Learner participates in community events, receives feedback from those who could benefit from further outreach and plans accordingly.

3. Learner identifies stakeholders to ensure content created serves all involved.

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 uses Canadian Community Health Survey (CCHS) data to identify trends that can become goals for community programing.

2. Learner performs statical analysis of survey data to assess intake of specific nutrients.

3. Learner uses qualitative and quantitative methods on survey data to identify barriers to accessing to nutritious foods within the community.

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 obtains health literacy information focusing on food products and information provided to consumers that may be inappropriate. Learner discusses education and social determinants of health in nutrition care plan.

2. Learner completed "Population and Public Health Needs Assessments Course 2019" through Dietitians of Canada.

3. Learner completes an environmental scan to access health care services and programming to support new comers to Canada.

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 creates a proposal for a community kitchen using results from community needs assessment.

2. Learner completed the "Food is Our Medicine" Learning Journey to explore the complex relationships between Indigenous foodways, reconciliation, healing, and healthcare.

3. Learner completes an environmental scan to inform the development of a new community garden initiative at the community health centre.

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 leads a meeting with key community members to develop goals and objectives for a community engagement project.

2. Learner develops an outline of a needs assessment for a specific group in which goals and objectives are identified and developed.

3. Based on a SWOT analysis, the learner proposes changes to program objectives to better align with target population needs.

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 completes an assets map for a local community.

2. Following a focus group, the learner lists community assets that support members with nutritious eating and accessing healthier foods.

3. Learner identifies human resource needs for an event and develops a posting to recruit student volunteers to meet this need.

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 trials a lunch program for community residents.

2. Learner delivers a food demo to consumers on how to incorporate pulses into your diet at a local grocery store.

3. Learner delivers a nutrition education workshop to teen mothers on introducing solids.

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 creates evaluation criteria to monitor the success of the project.

2. Learner conducts a focus group of community members following a new cooking class.

3. Learner analyzes the feedback from a recent survey and writes a report to recommend improvements to programming.

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 uses HR management system to revise foodservice worker job facts sheet.

2. Learner uses data collected from waste audits for breakfast service to identify trends in food waste.

3. Learner accesses online ordering system to assess the quality and quantity of menu items available for upcoming education event.

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 completes monthly and quarterly food safety audits.

2. Learner identifies changes and requirements for food provision resulting from statutory holidays and product shortages, such as longer delivery windows, ordering earlier in the week etc.

3. Learner can explain the food provision requirements in the community dining room including scheduling needs, interdisciplinary communication (i.e. between nutrition services and nursing), and logistics (staff roles, responsibilities, dining room setup, and standard operating procedures (SOPs)).

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 collaborates with preceptor and other relevant parties to develop goals related to updating menus, plating photos and instructions for plating guides.

2. Learner participates in the development of program goals such as efficient meal kit pick-ups by participants and determination of cost-effective, easy to make recipes for participants.

3. Learner works with preceptor to develop goals and objectives for ward stock project. Learner is able to adjust goals and objectives as new information and data arises.

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 identifies the several resources to support current work: special projects from past learners, the cook's knowledge, kitchen equipment manuals, the food service management book, nutrient analysis software, and Health Canada nutrient profile of common food.

2. Learner identifies required resources and supports for food provisions, such as people power, and cellular device to film and to create a point of view (POV) walking video (for the future). Also, support of volunteers needed to aid in timely food provision on site.

3. Learner lists the resources (i.e. Standard recipe for level 04 thick, International Dysphagia Diet Standardisation Initiative (IDDSI) compliant Hormel thickener recipes and mixing instructions, and IDDSI syringe test protocol, supports (food service supervisor, speech language pathologist (SLP), kitchen tools and equipment (scale, cups, whisk, fridge space)) needed for ISSDI level 02 &03 recipe test.

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.

1. Learner can identify each piece of equipment and has a general understanding of how they operate.

2. Learner participates in a tour of the hospital kitchen facility with a nutrition services supervisor to identify the layout and required equipment for food production (dry storage, cold storage, freezers, food assembly areas, retherm carts, dishwashing areas, etc..). This information is important when considering implications of recommendations for changing job routines.

3. Learner considers available space and resources when planning a virtual cooking class. They will need to ensure they have all required equipment to film. Equipment and ingredients should be readily accessible to participants.

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 tests and standardizes recipes for the new seasonal menu.

2. Learner works to develop a standardized recipe for International Dysphagia Diet Standardization Initiative (IDDSI) levels 02 & 03 thickened ice cream using IDDSI protocols.

3. Learner tests and demonstrates a smoothie recipe for athletes looking for post workout recovery on the go.

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 completes a food service order and properly puts it away. Learner identifies spoiled or damaged stock upon arrival and notifies necessary parties.

2. Learner completes a ward stock project to assess number of food items being distributed to each ward/clinic across all sites.

3. Learner participates in a cooking class and distributes samples to all participants to enjoy.  

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 assists with inventory, ordering of foods, and storage of purchased products.

2. Learner monitors food provision activities over 6 separate days to collect qualitative and quantitative data related to scheduling, adherence to job descriptions and proposed service timelines.

3. Learner monitors youth at a summer cooking camp while they learn how to prepare simple recipes safely.  

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.

1. Learner proposes menu changes based on food waste audit results and feedback from staff and patients. Learner identifies frequently disliked and high waste items, and suggests changes in meal combinations.

2. Learner analyzes qualitative and quantitative data collected when observing meal service over 6 days, creates a summary report, and proposes future recommendations to optimize efficiency.

3. Learner completes a report for their preceptor with recommendations to improve the experience for future cooking camp participants.