Among all the professions in the health care field, Dietetics may be one of the most misunderstood. This is partly because the role of a dietitian can vary greatly depending on whether they work in the community or a hospital, and the varying needs of the patients or clients they see.
As community health practitioners, North East CCAC dietitians see patients with a broad assortment of issues. Stroke, head and neck cancers, post-surgical issues (particularly with bowel or gut), Crohn's disease or colitis, diabetes, colostomies – the list is long, and very often involves co-morbidities. Surprisingly, one of their main tasks is to help people gain weight, not lose it, where they encounter loss of appetite due to dementia, depression, cancer treatments, or even tasted changes or stress from hospitalization.
"At the moment, a large number of patients on my caseload are cancer patients who have lost a lot of weight because of their illness," explains Jenna Cormier, North East CCAC dietitian. "My goal is to help them get better by eating right for optimal health, so they can stay healthy or help their body fight the disease."
Jenna's colleague, Taylor Clark, says there really is no 'typical' day for a dietician working in the community. "On our home visits we may see someone who requires texture modification of their food due to difficulty swallowing (dysphagia) and will teach the patient or their caregivers to safely prepare their food so they don't aspirate," says Taylor. "Then it may be over to someone who is receiving enteral nutrition via G-tube, or providing a wound care patient with a high protein diet plan so they heal better. We are continually creating nutrition care plans that work for each individual patient, whatever their needs might be."
Community dietitians provide a great deal of education about diets and nutrition to patients and their families. "Unlike clinical or institutional care, we can't simply submit an order for a specific diet to be delivered from the kitchen," says Jenna. "We work closely with patients and families to understand their lifestyles and their goals, what their relationship is to food, etc."
Taylor agrees. "At home, patients have the choice as to whether or not they wish to comply and what they choose to eat or not eat," she states. "So, sometimes it means finding a middle ground that keeps the patient as safe as possible and ensuring we are still practicing effective nutrition care plans."
Dietitians often work directly with speech language pathologists (SLPs) who will assess swallowing capability and determine what diet or food texture or fluid modification they believe is required for a patient with dysphagia. It then becomes the job of the dietitian to go into the home and support the implementation of the diet with the patient and family. Dietitians not only teach food preparation, but also how to make it more appetizing so the patient does not become discouraged and more likely to give up. According to both dietitians, this is one of the most rewarding parts of the job.
"Nobody wants to be on a minced or pureed diet," says Taylor. "It comes down to helping patients enjoy their food. Food is more than sustenance – it has such important social dynamics as well. It has a direct impact on quality of life."
Jenna tells the story of one young patient who required a feeding tube, but was going to be transitioned to a solid diet on his birthday. "He was so excited!" she recalls. "His first solid food was going to be his birthday cake. The difference between seeing someone who is being tube fed, and then seeing them just a few weeks after they transition back to solid food can be remarkable.".
There are challenges to the profession - fad diets, non-compliant patients, families who are not as supportive as they could be – but overall, both dieticians love the work, and enjoy working for the CCAC.
"Community health care provides an amazing variety of experiences that no other setting could duplicate," concludes Jenna.
Adds Taylor, "We get thrown a curve ball every day, and I wouldn't change it for the world."