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ICDEP Activity Reference Guide

This guide was created by compiling data from our graduate students' logbooks to assist preceptors and students in preparing for placements. This guide can be used as a reference to suggest placement activities to meet the Integrated Competencies for Dietetic Education and Practice (ICDEP) at the Competent/Independent rating level. This is not an exhaustive list of activities, but instead a selection of activities performed across diverse practice settings. For questions or suggestions related to this guide please contact megan.cowan@ryerson.ca.

Competency # Indicator Performance Indicator Example
1.01 - Comply with federal and provincial / territorial requirements relevant to dietetic practice. E Identify federal and provincial/territorial requirements relevant to practice settings.

1. Student demonstrates an understanding of the organization's policies and procedures which are guided by the Personal Health Information Protection Act of Ontario and all other applicable laws. Student understands the privilege of accessing records and the importance of protecting privacy. Public Hospitals Act: Student understands that the record of personal health information compiled in a hospital for a patient is the property of the hospital and shall be kept in the custody of the administrator.

2. Student gains insight into the Nutritious Food Basket (NFB) Protocol presented by the Ontario Ministry of Health and Long-Term Care stating provincial requirements in conducting the NFB in stores within the municipality and collecting data for public health purposes.

3. Student reviews purchasing practices to ensure food procurement complies with all provincial and federal legislation e.g. government legislated inspections; product labeling; quality specifications etc.

1.01 - Comply with federal and provincial / territorial requirements relevant to dietetic practice. F Comply with applicable legislation, regulations, and policies.

1. Student complies with Regulated Health Professionals Act to maintain confidentiality of information obtained during placement. Student complies with the Health Care Consent Act/Consent to Treatment Act to obtain voluntary informed consent and to propose treatment and determine client's capacity with respect to treatments proposed in plan.

2. Student complies with regulated provincial requirements presented by the Ontario Ministry of Health and Long-Term Care (e.g. Ontario Public Health Standards; Child Care and Early Years Act)

3. Student complies with legislation, regulation and policies by maintaining privacy and confidentiality of employee information. Student maintains proper boundaries with staff.

1.02 - Comply with regulatory requirements relevant to dietetic practice. E Identify regulatory requirements relevant to practice setting.

1. Student identifies regulatory requirements of the Dietetics Act - Scope of Practice. The student understands that the practice of dietetics is the assessment of nutrition and nutritional conditions and the treatment and prevention of nutrition related disorders by nutritional means. Student avoids language that could be perceived as a diagnosis.

2. Student completes online education and testing for Personal Health Information Protection Act (PHIPA). Student reviews Core Competencies for public health from Public Health Agency of Canada (PHAC). Student understands the difference between recognized titles in public health for registered dietitians with and without Master's degrees (Public Health Dietitian vs Nutritionist)

3. Student identifies public health regulations relevant to practice. Student reviews all quality assurance standards and regulations including: purchasing, storage, preparation/production, service/distribution, cleaning and sanitizing, equipment, facility design,etc. Student understands that standards and regulations are based on information taken from Canadian Food Inspection Agency (CFIA), Restaurants Canada, the Government of Ontario, National Advisory Committee on Microbiological Criteria for Foods, and National Food Processors Association, among others.

1.02 - Comply with regulatory requirements relevant to dietetic practice. F Comply with applicable regulatory requirements.

1. Student complies with Dietetics Act and Code of Ethics by practicing with integrity and within the scope of practice for an entry-level RD. Hospitals Act: The student understands that the record of personal health information compiled in a hospital for a patient is the property of the hospital and shall be kept in the custody of the administrator and acts accordingly. Student complies with confidentiality regulations by not discussing a patient's information with those outside of the circle of care.

2. Student complies with the Professional Standards of Dietitians in Canada regulatory requirements by remaining within scope of practice and as a professional-in-training ensuring ethical and responsible practice.

3. Student complies with food safety and public health regulations/standards in all projects and activities completed. (E.g. proper handwashing techniques, nutrition labelling regulations etc.)

1.02 - Comply with regulatory requirements relevant to dietetic practice. I Maintain client confidentiality and privacy.

1. Student maintains confidentiality and privacy of patient information by ensuring all patient information is locked in filing cabinet or disposed of in confidential paper shredder. Student maintains patient confidentiality and privacy by not discussing patients in public areas.

2. Student maintains confidentiality of business partners and organizational operations when working on project initiatives. (e.g. new product development at manufacturers, ingredient lists etc.).

3. Student maintains confidentiality of information when dealing with staff disciplinary issues.

1.02 - Comply with regulatory requirements relevant to dietetic practice. L Ensure informed consent.

1. Student gains an understanding of the intake process of patients where the intake worker obtains official consent and explains the policies of the centre. During sessions, student asks the patient if it is okay to discuss the plan with their MD.

2. Student obtains verbal consent from patient prior to involvement in nutrition counselling session.

3. Student ensures informed consent during data collection for projects (example surveys sent to RDs).

1.03 - Practice according to organizational requirements. B Provide services in compliance with designated role within practice setting.

1. Student attends rounds, attends and facilitates nutrition groups, performs nutrition assessments, completes chart notes, determines patient energy and fluid needs, etc. Student practices in the role of a dietetic intern in clinical rotations under the supervision of a dietitian.

2. Student is transparent about their title as a student and dietitian in training, carries insurance through University and maintains professionalism through competency, honesty and fairness.

3. Student identifies self as a Dietetic Graduate Student when providing information (e.g. surveying patients; in-services to staff etc.)

1.03 - Practice according to organizational requirements. C Demonstrate knowledge of policies and directives specific to practice setting.

1. Student understands the medical directives for RDs; how to complete diet orders; order supplements; order lab work etc.

2. Student attends a workshop on privacy training and reads through the Personal Health Information Protection Act, 2004 (PHIPA) and Accessible Customer Service Policy for the Municipality, applying standards as necessary within the health department and with community partners.

3. Student reviews organizational policies and procedures and demonstrates knowledge through practice activities (e.g. follows organizations' policies when sourcing a new food supplier).

1.03 - Practice according to organizational requirements. D Comply with applicable policies and directives.

1. Student completes chart notes within 24 hours, collaborates with others/participates in group discussions, visits patients in a timely manner, prioritizes patients based on risk.

2. Student complies with the Municipality's Personal Health Information Protection Act, 2004 (PHIPA) Privacy Policy and Accessible Customer Service Policy.

3. Student complies with workplace harassment policy, code of conduct, labour relations act etc.

1.04 - Practice within limits of individual level of professional knowledge and skills. B Reflect upon and articulate individual level of professional knowledge and skills.

1. Student professionally and respectfully declines request to conduct nutritional counselling when knowledge is limited (e.g. Nurse request to conduct a nutritional counselling session for a kidney transplant patient when preceptor is not present).

2. Student completes reflective journal to identify areas for improvement and discusses at weekly meetings with preceptor. Student also, discusses level of confidence of knowledge with the week's projects/presentations/meetings

3. Student self-evaluates and seeks feedback to reflect on knowledge and skills. Student requests additional opportunities to gain experience in areas that need further development (e.g. staff hiring /discipline etc.).

1.04 - Practice within limits of individual level of professional knowledge and skills. C Recognize situations which are beyond personal capacity.

1. Student recognizes inability to answer specific questions when counseling patients. Student responds to questions from patient that they are uncertain about, by informing the patient that they will research and get back to the patient with an answer.

2. Student establishes role and scope as a dietetic graduate student when partnering with the health department and when working with other professionals in public health. Student consults with preceptor when making referrals to other professionals and agencies.

3. When participating in disciplinary meetings with employees, management and union representatives, student recognizes that the situation is beyond their personal capacity and serves as an observer.

1.04 - Practice within limits of individual level of professional knowledge and skills. D Address situations beyond personal capacity by consultation, referral, or further learning.

1. Student consults with physician/allied health professionals when uncertain of a medication or a condition (e.g. NICU patient with complex syndromes unfamiliar to the intern, intern researches and discusses assessment and intervention with preceptor).

2. In times when student identifies situations beyond personal capacity, discusses with preceptor and observes preceptors approach/method of responding.

3. Student acknowledges uncertainty of developing labour budget within food services, raises specific questions with preceptor to gain a better understanding.

1.05 - Address professional development needs. B Self-assess to identify learning needs.

1. Prior to each rotation, student establishes a set of learning objectives, midway through the rotation the student self assesses learning outcomes to determine further learning needs and discusses with preceptor during mid-point meeting.

2. Student self-assesses in preparation for the mid-point and final evaluations. The student shares their self-ratings with preceptors to discuss opportunities for further development and learning.

3. Student creates a work plan to assist with meeting learning objectives. Student reviews work plan regularly reassess and updates as are completed and new goals are established.

1.05 - Address professional development needs. C Develop and pursue a learning plan.

1. Prior to each rotation, the student develops a specific learning plan and discusses with preceptor to determine if all learning objectives specific to that rotation are achievable. During the rotation, the student identifies objectives that might not be achievable due to patient conditions and pursues learning through case studies

2. Student develops a list of goals including (a) learning how to gather relevant data for a needs assessment (b) learning how to identify relevant information; (c) identifying assets, resources, and stakeholders and incorporating their perspectives when devising a population health plan (d) prioritizing health needs based on assessment (e) disseminating health information (f) delivering a population health plan effectively (g) monitoring the status of the health plan (h) evaluating objectives and revising as necessary.

3. Using google drive, student creates a work plan during the first week of placement which identifies all agreed upon projects and connects them to the ICDEPs to be achieved. Student follows through to successful completion of all goals.

1.05 - Address professional development needs. D Integrate learning into practice.

1. Student observes RD during first week of placement, identifies how she interacts with patients and conducts nutrition assessments. Student follows RD lead when performing nutrition assessments and collecting relevant data, connects with patients for effective encounters. Student responds to feedback by further researching and incorporating into practice. (e.g. uses feedback and research to recommend 3 servings of dairy products for calcium oxalate kidney stone patients)

2. Student uses new knowledge gained from Nutrition for Healthy Term Infants (NHTI) breastfeeding modules and Baby Friendly Initative (BFI) statement to create infant feeding nutrition resource.

3. Student applies learning acquired through observation and research to develop a standardized protocol for in-patient snack delivery.

1.06 - Use a systematic approach to decision making. E Obtain and interpret evidence.

1. Student obtains and interprets evidence to incorporate into patient nutrition care plan (e.g. tracks patients blood glucose levels over several days to determine a pattern and uses this information to help patient manage their diabetes).

2. Student uses the Nutritious Food Basket (NFB) 2015 report and information gathered from the Food Literacy: How can it be described and measured? Webinar to provide content to the budget wise grocery shopping website section.

3. Student researches health and safety regulations and guidelines for the proper pulling and pushing of carts. Student discusses information with Hospital's Health and Safety Officer. Student utilizes Information to develop an in-service for food service associates.

1.06 - Use a systematic approach to decision making. F Apply ethical principles.

1. Student practices in accordance with the Code of Ethics for Dietetic Practice in Canada. Working with the medical team, student 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. Student researches community assets using a non-judgmental approach.

3. Student 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.

1.06 - Use a systematic approach to decision making. H Make and justify decisions in consideration of ethics, evidence, contextual factors and client perspectives.

1. Student recognizes a patient is overwhelmed by their recent diabetes diagnosis and makes the decision to limit the amount of education provided. Student uses motivational interviewing strategies to assess the patient's readiness to change.

2. Student includes client perspectives in the trialling of a new nutritional supplement. Student takes into consideration the ethics of promoting nutritional supplements (cost implications) for patients for use after discharge.

3. Student follows the organizations' purchasing procedures when researching a capital equipment expenditure. Student outlines methodology of first developing the request for information (RFI) from a group of suppliers. Based on the information gathered through the RFI, the student assists with the development of the request for proposal (RFP).

1.06 - Use a systematic approach to decision making. I Take responsibility for decisions and actions.

1. Student recognizes that workload is too heavy and will not meet all timelines. Student meets with preceptor to discuss challenges and suggests adjusting deliverable timelines to ensure the student successfully completes all projects.

2. Student revises menu planning documents. Student provides explanation for changes by creating a notes section in the document.

3. Student justifies decisions of new created standardized ward stock recommendations with providing a "Notes" section which includes a written explanation of recommendations.

1.07 - Maintain a client-centered focus. B Respect client rights, dignity and uniqueness.

1. Student respects clients rights, dignity and uniqueness by providing a non-judgmental approach when discussing dietary choices; lifestyle etc. (e.g. patient indicates that he was not willing to incorporate whole grains into his diet because he does not like them - student respects this by listing a variety of other high fibre foods).

2. Student visits patients who receive nutrition supplements to determine patient acceptance and tolerance. Student discusses alternatives if patient is not consuming.

3. Student provides patient a list of menu item alternatives to accommodate religious practices.

1.07 - Maintain a client-centered focus. C Determine client perspectives and needs.

1. During initial assessment with patient, student uses active listening skills when asking about dietary intake. Student asks about food allergies,intolerances and food preferences. Student includes information when developing nutrition care plan.

2. Student completes patient visitation/satisfactions audit to gain patients perspectives with regards to the quality of food and service they are receiving. Student determines if patient has any special requests, dislikes or comments about food or staff.

3. Student includes appropriate questions in a survey to determine the needs of community members who access nutrition programming at the community health centre.

1.07 - Maintain a client-centered focus. D Integrate client perspectives and needs into practice activities.

1. Student asks client to collaborate on setting an agenda for the appointment. The client suggests 2 items to discuss and the student suggests 2 items. Together they prioritize the 4 items based on the appointment length.

2. Student revises patient satisfaction audit after speaking with patients to ensure appropriate answers were identified (e.g. a question asked if food was delivered at the correct temperature, patients felt the question could not be answer with yes or no, therefore student changed the potential responses to always or usually to be more representative of their true experience.)

3. Student identified that many patients were not available for patient meal selection at a certain time on a particular unit. Student proposed changes to timing of staff responsibilities in order for more patients to participate in the spoken menu meal selection procedure.

1.07 - Maintain a client-centered focus. E Identify services and resources relevant to client needs.

1. Student provides patient/family with services and resources to assist the patient with their diet once out of hospital (e.g. a patients' wife voiced difficulty with preparing meals compliant with a renal diet, student provides resources for a frozen meal delivery service and meals on wheels).

2. Student takes initiative to explore relevant guidelines and resources available to clients re: vegan diets, mindful eating.

3. Student identifies a patient with self-feeding difficulties. Student arranges for a volunteer to assist with feeding at each meal.

1.08 - Manage time and workload effectively. B Prioritize professional activities and meet deadlines.

1. Student prioritizes one-on-one client counselling sessions ensuring all preparation is complete prior to the session. Once the session is completed, charting is completed in a timely manner. Completing research, projects, case studies etc. occurs after client priorities are completed.

2. Student creates a work plan to map out all projects and activities and assign reasonable timelines.

3. Student manages time effectively by prioritizing professional activities and planning in advance for deadlines (e.g. completes assignments early in order to obtain preceptor feedback prior to submission, incorporates feedback and submits assignment by deadline).

1.09 - Use technologies to support practice. B Use technology to communicate.

1. Student uses hospital paging system to locate preceptor / allied health professionals etc.

2. Student uses messaging feature to communicate with nursing.

3. Student uses facility email to communicate confidential information with preceptor and other health professionals.

1.09 - Use technologies to support practice. D Use technology to seek and manage information.

1. Student uses hospital computer system to gain medical history, medications, bloodwork and other relevant information on patient prior to initiating an intervention. In addition, student uses computer system to document patient interactions to communicate to care team.

2. Student uses Public Health intranet server to seek information on various Public Health programs (e.g. Food Skills Service Guide, Peer Nutrition etc.).

3. Student uses reports obtained through diet office software to to determine most expensive items on patient menu.

1.09 - Use technologies to support practice. F Use technological applications in practice.

1. Student uses Electronic Medical Record to complete chart notes and send letters for patients

2. Student uses effective PowerPoint skills to create a presentation to effectively communicate projects outcomes.

3. Student uses diet office software to input patient menu selection for the following days meals. Student also uses diet office software to plan and implement menu changes.

1.10 - Ensure appropriate and secure documentation B Document relevant information accurately and completely, in a timely manner.

1. Student completes all chart notes accurately within 48 hours of assessing the patient.

2. Student is able to identify relevant information when completing a new assessment for a patient with Type 2 Diabetes, including anthropometrics, lab data, medications and 24 hour dietary recall. All information was accurate and timely.

3. takes minutes at the Working group for Food Security Network meeting and disseminates that information to members after the meeting via email.

1.10 - Ensure appropriate and secure documentation D Maintain security and confidentiality of records.

1. Student stores all confidential information in a locked cabinet and does not leave confidential information unattended.

2. Student uses their organizational email to securely communicate project details to their preceptor.

3. Student uses a numerical coding system to identify community members when collecting information for a population health needs assessment.

1.10 - Ensure appropriate and secure documentation E Identify organizational requirements for record keeping.

1. Student completed meditech training and is able to identify organizational requirements such as shredding paper notes that contain personal health information.

2. Student is aware that they must use their organization login when documenting patient assessments.

3. Student used the organization's templates when charting client encounters.

1.10 - Ensure appropriate and secure documentation G Document in accordance with legal and organizational requirements.

1. Student uses their hospital login to completes all documentation within 48 hours as outlined in the organization's policies.

2. Student followed organizational and legal requirements in charting by writing neatly, within the given space, using only specific short forms, and using strikethroughs (as opposed to scribbles) to identify mistakes on chart.

3. Student does not share client information through emails/other channels which may be compromised.

1.11 - Assess and enhance approaches to dietetic practice. C Assess effectiveness of practice.

1. Student follows up with patient nutritional intervention to determine effectiveness (e.g. reviews weights and lab values of GI/General Surgery patients to determine improvement of patient condition).

2. Student observes a community workshop and identifies areas for improvement. Prepares a report and discusses with preceptor.

3. Student increases the efficiency of completing safety audits by eliminating redundant points and audit criteria not applicable to the facility. Shares recommendations with preceptor.

1.11 - Assess and enhance approaches to dietetic practice. E Seek new knowledge that may support or enhance practice.

1. Student reviews current literature to enhance practice (e.g. vitamin and mineral losses from Enterocutaneous fistulas).

2. Student subscribes to networks and newsletters to improve understanding of research in practice (e.g. Health Evidence).

3. Student researches regulations and standards for safety of pushing and pulling of carts in the workplace. Student uses this information to brainstorm ideas and educate staff.

1.11 - Assess and enhance approaches to dietetic practice. F Propose modifications to increase the effectiveness of practice activities.

1. Student adds information/activities from external resources to increase the effectiveness of workshops for inpatients (e.g. enhances "healthy hints" workshop).

2. Student reviews tutorials that are advertised on tv monitors at the local Community Health Centre's medical service offices. Student suggests that tear-off pads with information about the tutorial be placed in the office for easy reference for clients.

3. Student researches the method of purchasing Facebook Ads to promote nutrition workshops to gain a larger audience.

1.12 - Contribute to advocacy efforts related to nutrition and health. C Identify opportunities for advocacy relevant to practice setting.

1. Student questions information in order to advocate for dietitian involvement with specific patients (e.g. identifies when a consult should be written by a physician for RD to see patient).

2. Student creates and sends a letter to MPP to advocate for increased funding for dietitians in the community.

3. Student participates in a workshop to advocate for access to healthy food in communities that are identified as food deserts.

1.13 - Participate in practice-based research B Identify research questions, methods, and ethical procedures related to dietetic practice.

1. Student develops research questions specific to patient population (e.g. identifies research questions for positive care for diabetes patients). Student outlines methods to begin preliminary research. Student outlines importance of confidentiality specific to patients and research outcomes.

2. Student acquires knowledge about 'the basic income guarantee' presented during the 2016 Nutrition Exchange. Student reviews the position statement and recommendations from the Ontario Society of Nutrition Professionals in Public Health and attends a webinar on basic income guarantee in order to identify current research, questions, methods and ethical considerations.

3. Student develops research question regarding the current availability of web-based menu resources. Student creates chart with inclusion and exclusion criteria.

1.13 - Participate in practice-based research C Source, critically appraise and interpret literature relevant to a research question.

1. Student completes an assignment on the use of probiotics on antibiotic associated diarrhea in older adults. Student sources the latest peer reviewed journal articles, critically analyses the articles, and leads a discussion of the findings and impact for practice settings.

2. Student sources and critically appraises current Canadian policies and standards, both municipally and provincially (e.g. Ontario’s Student Nutrition Program Guidelines, PPM 150 School Food and Beverage Policy etc.) Student uses this research to rationalize and advocate to include drinking water in student nutrition programs.

3. Student conducts a literature review to determine best practices for implementing a vegan diet option for geriatric residents.

1.13 - Participate in practice-based research D Summarize and communicate research information

1. Student summarizes data gathered regarding SGA assessments and presents it in a logical and organized written report.

2. Student summarizes the evidence on natural health products and communicates the information to preceptor through the development of an infographic.

3. Student summarizes data on actual staff performance with pushing and pulling of carts. Student creates a Prezi presentation to present to management.

Competency # Indicator Performance Indicator Example
2.01 - Select appropriate communication approaches. B Identify opportunities for and barriers to communication relevant to practice setting.

1. Student identifies (a) Opportunities: e.g. morning bedside rounds gets the interprofessional team together in one space for discussion
(b) Barriers: e.g. morning rounds are not as functional as they could be, constant changeover of caring residents does not facilitate clear communication, short forms and acronyms, incomplete charts.

2. Student develops and delivers an ice breaker activity for an advisory group participating in a workshop. The purpose of the ice breaker was to build trust among the group participants and the presenters. In addition, the objective was to help break comfort barriers to encourage open and active communication and participation during the workshop.

3. Student meets regularly with team members and staff to avoid miscommunication and increase efficiency.

2.01 - Select appropriate communication approaches. D Use appropriate communication technique(s).

1. Student speaks loudly to accommodate a hearing impaired client.

2. Student develops content on the Community Food Security website section on budget wise grocery shopping. Student uses communication techniques including principles of online communication such as creating precise and concise messages using clear and simple language.

3. Student creates posters and presentations for food service associates using plain language and ensures visual simplicity.

2.01 - Select appropriate communication approaches. F Demonstrate knowledge of practice-setting-related terminology.

1. Student uses abbreviations and appropriate terminology to complete patient assessments in hospital patient software system.

2. Student has a clear understanding of the responsibilities of various nutrition programs in the public health unit and utilizes appropriate terminology when referring to them.

3. Student demonstrates understanding of terminology by actively participating in team meetings.

2.01 - Select appropriate communication approaches. G Use appropriate terminology.

1. Student ensures that the language used to educate a patient is appropriate. The student may determine the need to revise the language for clear understanding (e.g. Digestion vs. GI or not working vs. suppression).

2. Student uses appropriate terminology in discussions with the working group for the Ontario Society of Nutrition Professionals. In addition, student uses appropriate jargon to promote health messages through social media.

3. Student understands and uses appropriate terminology in oral and written communication that is respectful to those living with food insecurity.

2.02 - Use effective written communication skills. C Edit written material for style, spelling and grammar.

1. Student reviews all chart notes thoroughly and edits for spelling and grammar. Student ensures correct terminology is used.

2. Student edits documents for public use re: allergies in child care, balancing menus in child care on a budget, etc.

3. Student edits workgroup emails before sending to committee. Student assists with editing Terms of Reference sheet for advisory committee.

2.02 - Use effective written communication skills. D Write clearly and concisely, in a manner responsive to the needs of the reader(s).

1. Student completes assessments and follow-up notes clearly, concisely and in a manner responsive to the needs of other health professionals. This includes using correct forms to organize information and short-forms to keep writing concise.

2. Student summarizes research findings on background information for web-based menu planning for childcare. Student categorizes research and extracts key concepts to allow for easier access for development of final report.

3. Student develops a grant application with a basic timeline with clear and concise messages, communicating proposed activities, rationales, objectives, goals, and methods for evaluation.

2.02 - Use effective written communication skills. E Write in an organized and logical fashion.

1. Student charts on patients following the format utilized by the organization (SOAP, DARP, PCARE etc).

2. Student develops a draft action plan for a grant application. Student writes content in a logical and organized fashion to highlight goals, objectives, and methods of evaluation reflective of the activities and policies proposed.

3. Student uses titles, subtitles, consistent organization, etc. to ensure logical organization when report writing.

2.02 - Use effective written communication skills. F Provide accurate and relevant information in written material.

1. Student's reports are supported by evidence-based practice and include references.

2. Student uses credible sources when creating plain-language documents on menu planning for the general public.

3. Student collects and records relevant and accurate data for the Nutritious Food Basket according to the Ontario Ministry of Health and Long-Term Care protocol.

2.02 - Use effective written communication skills. G Ensure that written material facilitates communication.

1. Student uses tables, bullet points, plain language, blank space, colour, headings, etc. when writing guiding documents to attach to sample menus for general public (i.e. on choking hazards, gluten allergies, etc.).

2. Student develops content for the Community Food Security website section on budget wise grocery shopping using short and precise messages, tips, helpful resources/links, and action words to describe steps. Student organizes the layout in a logical and clear manner to facilitate communication and audience engagement through incorporating principles of online communication.

3. Student works with communications department to ensure messaging is accurate and clear to audience.

2.03 - Use effective oral communication skills. B Speak clearly and concisely, in a manner responsive to the needs of the listener(s).

1. Student explains menu resources to advisory committee clearly, highlighting key information on each sheet without going into extensive detail. Student speaks concisely when facilitating group article appraisal by asking questions and allowing the group time to respond.

2. Student communicates using simple step-by-step instructions with use of visuals when providing an in-service to dietary aides.

3. Student speaks clearly when giving oral presentations and responds appropriately to audience questions.

2.03 - Use effective oral communication skills. D Use appropriate tone of voice and body language.

1. The student uses a positive and welcoming tone during counselling sessions to help build rapport and to show interest. In addition, the student uses body language to show interest by turning towards the patient and providing good eye contact. The student maintains open body language and a tone of voice that will best suit the patient (e.g. soothing and calm for upset or nervous patient and business like for others).

2. Student communicates the ice breaker activity for the Community Food Advisors with a projected voice to reach the back of the room, with an enthusiastic and authentic tone to engage the audience, and with open body language to project a comfortable environment for sharing.

3. Student projects their voice when giving oral presentations and recognizes participants body language to monitor engagement.

2.03 - Use effective oral communication skills. E Recognize and respond appropriately to non-verbal communication.

1. In an in-patient setting, the student recognizes patients discomfort or patient states is nauseous, student concludes counselling and makes arrangements to come back at a more suitable time.

2. Student provides written ice breaker activity directions on tables, visual cues from materials around the room, and verbal instructions for the activity. When providing the description of the activity, student recognizes the eagerness to begin and non-verbal cues of already understanding the directions for the game, and therefore responds by limiting verbal instructions.

3. Student remains patient when group participants are not engaged in discussion and attempts to bring them back into the group with prepared questions.

2.04 - Use effective interpersonal Skills B Utilize active listening.

1. Student demonstrates active listening by paraphrasing information and confirming the information with the patient.

2. Student visits schools and observes, assists, and actively listens to feedback from program coordinators regarding the Student Nutrition Program.

3. Student observes interviews with potential new employees and uses this experience to update interview questions.

2.04 - Use effective interpersonal Skills D Communicate in a respectful manner.

1. Student provides evidence of respecting the patients diversity and uniqueness by tailoring communication style to the patient (e.g. Uses translator; provide culturally appropriate foods for examples etc.)

2. Student uses respectful language in all communication with staff members including emails.

3. Student speaks to consumers in a respectful manner and engages them in the cooking class.

2.04 - Use effective interpersonal Skills F Demonstrate empathy.

1. Student demonstrates empathy when a focus group member discloses they are food insecure.

2. Student demonstrates an appropriate amount of empathy when dealing with staff concerns.

3. Student demonstrates empathy by acknowledging clients concern about eating when stressed. Student tailors nutrition care plan to increase patients ability for success.

2.04 - Use effective interpersonal Skills H Establish rapport.

1. Student develops rapport by using non verbal cues (e.g. nods) to help develop a trusting and non-judgmental relationship.

2. Student develops rapport by asking questions about patients family support and lifestyle.

3. Student develops rapport by showing genuine interest in the person or group they are interacting with.

2.04 - Use effective interpersonal Skills I Apply counselling principles.

1. Student uses the "teach back" method of interviewing by asking the patient specific diet related questions (e.g. Student asks a nephrology patient what foods they think might be increasing their serum potassium or phosphorus lab values).

2. Student uses motivational interviewing strategies such as: open ended questions, decisional balance, rolling with resistance etc.

3. Student works with patient to develop achievable goals.

2.04 - Use effective interpersonal Skills L Apply principles of negotiation and conflict management.

1. Student tries to find the middle ground when recommendations for the therapeutic diet and the patient wishes differ greatly (e.g. Patient is in need of heart healthy education but is unwilling to give up high fat, high salt traditional foods).

2. Student identifies the deferring opinions of the various stakeholders. Student uses a 'give and take' approach to achieve ultimate project goal.

3. Student applies principles of conflict management while teaching the dietary technicians how to input the data into a newly created menu ordering spreadsheet. Several dietary technicians expressed their concerns with another "make work" project, student provides clear and concise rationale for requirement of data which appeases them.

2.04 - Use effective interpersonal Skills N Seek, respond to and provide feedback.

1. Student readily seeks feedback from preceptor after each counselling session and then incorporates feedback into subsequent counselling sessions.

2. Student seeks feedback from preceptor. Student takes notes during discussions and applies changes based on consensus.

3. Student solicits feedback from Food Service Supervisors while completing shadow reports on dietary aides. Student provides feedback to both the staff member and the supervisor on what was observed.

2.05 - Contribute to the learning of others. A Recognize opportunities to contribute to the learning of others.

1. Using 3 day food record, the student identifies opportunities to educate patient (e.g. food record indicates patient frequently consumes soya sauce, provides education on low soya sauce options).

2. Student uses knowledge of Accessibility for Ontarians Act (AODA) and communication techniques in designing menu resources and Power Point slide show. Student explains purpose of blank space, plain language, limited pictures, etc. to colleagues.

3. Student provides in-service to food service staff on hand-washing best practice.

2.05 - Contribute to the learning of others. C Assess the prior knowledge and learning needs of others.

1. Student asks open ended questions to assess patients knowledge and understanding of previous education. Probes patient to identify information gaps (e.g. Provides patient with a diabetic food guide and asks the patient to identify the CHO containing foods).

2. The student conducts a pre-workshop survey to understand what the participants already know about the topic.

3. Student surveys food service staff to understand knowledge gaps and opportunities for further education.

2.05 - Contribute to the learning of others. E Select and implement appropriate educational strategies.

1. Student uses a variety of educational strategies including: counselling, drawing on the whiteboard, writing out information, handing out resources, providing website links etc. Selection of specific strategies is based on client's needs and interests.

2. Student decides training for the Cafe Community volunteers would include a discussion component and a hands-on cooking component. This was appropriate because the team needed to get together to talk out logistics, as well the team needed to be empowered and motivated which could be achieved by cooking and testing potential recipes together.

3. Student develops presentation to inform appropriate stakeholders about the snack delivery process and areas to improve upon.

2.05 - Contribute to the learning of others. G Select learning resources.

1. Student selects the sugar shock and fat shock games to support learning in the Diabetes 101 session. These games allowed participants to guess how much sugar or how much fat was included in everyday junk food such as ice caps, muffins, ice cream, coffee, and cheese.

2. Student selects recipes to use for the training as a way to guide the community cafe volunteers to begin thinking about shopping lists, budgets, equipment needs, and serving dishes/sizes.

3. Student uses on-line modules to enhance diet techs basic understanding of texture diets.

2.05 - Contribute to the learning of others. I Develop learning resources.

1. Student develops the Diabetes 101 PowerPoint presentation to deliver an education session on diabetes care within the community.

2. Student writes nutrition articles for an organizational newsletter.

3. Student develops an infographic on a topic of interest for public health education.

2.05 - Contribute to the learning of others. K Establish and assess learning outcomes.

1. Student identifies the client's learning needs, provides education and checks for understanding by asking the client to apply the education taught. Ex. Carbohydrate counting

2. Student establishes learning goals, objectives, and outcomes for the cafe and creates a logic model for the program.

3. Student sets learning outcomes of an inservices to food services staff and evaluates impact of education with a pre and post survey.

2.05 - Contribute to the learning of others. M Deliver group educational sessions.

1. Student delivers group education session (e.g. Introduction to Healthy Eating for Diabetes; lipid class and kidney stone prevention class for nephrology patients).

2. Student assists with the delivery of an educational workshop for Community Food Advisors on budget wise grocery shopping.

3. Student provides in-service to a group of food service staff on hand-washing best practice.

2.06 - Contribute productively to teamwork and collaborative processes. C Contribute dietetics knowledge in collaborative practice.

1. Student discusses patients' nutritional status and diet recall with physician (e.g. explains to general GI physician rationale for not starting patient on TPN and assists with ruling out IBD diagnosis).

2. Student shares the information on how to develop an infographic with their preceptor.

3. Student works with the food service director, supervisors, dietitians and residents on the resident food council to make menu changes.

2.06 - Contribute productively to teamwork and collaborative processes. F Draw upon the expertise of others.

1. Student seeks additional information from various allied health professionals and physicians (e.g. gains insight from physician as to why Systolic blood pressure is used for establishing Framingham Risk instead of Diastolic blood pressure; liaises with speech pathologist to determine need for diet texture upgrade for a patient with tracheostomy and swallowing problems).

2. Student meets with LTC director in charge of menu planning to seek advice on South Asian meals. Student meets with department Knowledge Broker to decide on literature search focused practice question.

3. Student obtains information from RDs; porters; dietary aides and relevant other staff to use in management project.

2.06 - Contribute productively to teamwork and collaborative processes. G Contribute to shared decision making.

1. Student discusses nutrition care plans with allied health professionals for input and feedback (e.g. Discusses TPN solutions for both start and goal TPN regimens with the pharmacist in GI/General surgery).

2. The student works as a team to make decisions impacting community programs and resources relevant to their project work.

3. Student works with others to make changes to job descriptions that more accurately reflect staff workload.

2.06 - Contribute productively to teamwork and collaborative processes. I Facilitate interactions and discussions among team members.

1. Student presents pertinent patient information at rounds for team discussion.

2. Student meets with Social Media working group of the Ontario Society of Nutrition Professionals in Public Health to present social media web analytic tool ideas to help facilitate direction of conversation.

3. Student facilitates major discussion among various stakeholders during presentation of management project.

Competency # Indicator Performance Indicator Example
3.01 - Assess nutrition-related risks and needs. B Use appropriate nutrition risk screening strategies.

1. Student uses daily census to access patients' nutrition risk. Uses results to identify and prioritize patients for RD visits.

2. Student uses the appropriate screening tools such as SGA or Framingham Risk Scores to assess patients' nutrition risk and uses results to identify and prioritize patients for RD visits.

3. Student independently differentiates between high risk patients (intubated; highly sedated; long term NPO; hemodynamically stable) and low risk patients to determine daily tasks and prioritize patients.

3.01 - Assess nutrition-related risks and needs. D Identify relevant assessment data to collect.

1. Student uses patient medical charts, identifies all patient information required to complete patient assessment including: Patient Medical History, Family history, lab work, medications, diet history, 24 hour recalls, weight changes, appetite, GI issues, and supplement use etc.

2. Student understands the need to identify certain parameters in ICU patients for prioritizing caseload and nutritional management: examples include respiratory support; intubation; hemodynamics; weight changes; previous nutrition management; medications and relevant side effects; nature of the condition (impacts on initial rate and route of nutrition delivery); biochemical parameters; visual signs of malnutrition etc.

3. Student reviews mental health diagnosis/medications, allergies/intolerances and understands patients' story. Student compares patients' intake, appetite, and bowel movements in hospital compared to that reported by patient when not in hospital in order to assess stage of change.

3.01 - Assess nutrition-related risks and needs. F Obtain perspective of client, family or relevant others.

1. Student consults with patient/family/relevant others to gain perspective of patient's diet. Student revises plan as necessary given information provided to aide with compliance.

2. Student consults with patient/family/relevant other to determine diet related priorities (e.g. weight loss/gain). Student prioritizes goals with patient input.

3. Student obtains information regarding patient through discussions with various health care team members (nurses, speech language pathologists etc.) Student asks questions to patient and family members to obtain information regarding usual weight, nutrition before admission, level of hunger etc. Student assesses the willingness/readiness of patient to discuss dietary interventions.

3.01 - Assess nutrition-related risks and needs. I Obtain and interpret medical history.

1. Student reviews the patient's chart and consults with the patient/family/relevant other to obtain and interpret medical history. The student integrates the relevant medical history information into the diet plan.

2. Student obtains medical history from patient records, patient interview and interdisciplinary rounds and correctly interprets the information to identify nutrition concerns.

3. Student in LTC reviews MDS-RAI to obtain pertinent medical history relevant to nutrition care plan.

3.01 - Assess nutrition-related risks and needs. L Obtain and interpret demographic, psycho-social and health behaviour history.

1. Student reviews the patients chart and consults with patient/family to obtain and interpret: social support; financial status; alcohol intake, smoking status, dietary practices etc. Student uses the information to recommend appropriate diet plan.

2. Student uses MDS-RAI to collect information on residents' social supports and dietary preferences to adjust nutrition care plan.

3. During patient assessment, the student obtains information regarding recent diet changes, smoking and alcohol consumption.

3.01 - Assess nutrition-related risks and needs. N Obtain and interpret food and nutrient intake data.

1. Upon screening and collecting data, student uses a 3 day food record to obtain and interpret food and nutrient intake prior to admission.

2. Student orders calorie counts for patients at risk for malnutrition who may require tube feeding or are transitioning from tube feeding back to an oral diet. Student calculates protein/energy intake and compares to estimated requirements obtained through the diet office software.

3. Student obtains and interprets food and nutrient intake through observing 3 different meal times to estimate resident intake.

3.01 - Assess nutrition-related risks and needs. P Identify client learning needs related to food and nutrition.

1. Student uses food records/24 hour recalls etc. to identify gaps and plan patient education accordingly.

2. Student identifies barriers to learning (e.g. communication barriers) and incorporates methods to overcome these barriers prior to patient/ family meeting/counselling.

3. Student listens to patients / family members and ask questions to identify nutrition related deficits. Student plans education accordingly.

3.01 - Assess nutrition-related risks and needs. R Obtain and interpret anthropometric data.

1. Student obtains patients height and weight; waist circumference; BMI; weight changes; etc. and determines nutrition related risk.

2. Student requests monthly weights for residents to assess risk of malnutrition in LTC home.

3. Student obtains and records patients anthropometric data including weight, inputs and outputs. Student uses data to track and interpret changes.

3.01 - Assess nutrition-related risks and needs. U Obtain and interpret biochemical data and results from medical tests and procedures.

1. Student obtains condition specific/relevant biochemical data; blood values (e.g.. serum K; serum PO4, Mg, Ca, oxalate, citrate, uric acid etc.) Student reviews results from tests/procedures and incorporates as appropriate into nutrition care plan.

2. Student obtains and interprets medical tests and biochemical data including results of bloodwork, fluid balance etc.

3. Student reviews patients' charts to obtain recent and relevant lab results (A1c, FBS, LDL, ACR, postprandial/random glucose checks etc.) to determine patients' diabetes management.

3.01 - Assess nutrition-related risks and needs. W Obtain and interpret information from mealtime / feeding observations.

1. Student uses calorie counts; plate waste observations etc. to assess the patients intake in order to determine nutritional requirements including need for oral supplements; total parenteral nutrition etc.

2. Student participates in meal rounds, checking patient trays to assess intake, as well as speaking directly to patient to obtain information that will help develop a nutrition diagnosis and nutrition care plan.

3. Student obtains mealtime information by asking patient open-ended questions during the diet recall. This information is incorporated into patients nutrition education plan.

3.01 - Assess nutrition-related risks and needs. Z Obtain and interpret nutrition-focused physical observation data.

1. Student observes patient to identify edema; muscle wasting etc. Student uses growth charts; SGA assessment tool etc. to interpret severity. Findings are incorporated into nutrition care plan.

2. Student observes patient for physical indicators of any nutrition related issues (e.g. fluid/edema, body fat/muscle mass) and incorporates findings into nutrition diagnosis and nutrition care plan.

3. Student observes patients physical status e.g. obesity, signs of fatigue, body fat distribution etc. The results are incorporated into potential health goals (e.g. weight loss, increased exercise etc.) Student observes patients body language when engaging patient in discussions regarding diet to determine how receptive the patient is likely to make changes.

3.01 - Assess nutrition-related risks and needs. CC Identify chewing, swallowing and feeding problems.

1. Student observes swallowing assessment conducted by speech language pathologist, identifies and discusses potential chewing, swallowing and feeding problems.

2. Student identifies the residents' chewing problems through meal time observation. Student creates a dysphagia screening tool to assess residents' chewing/swallowing difficulties.

3. Student observes several bedside swallowing assessments. Student learns to identify the reasons that a swallowing assessment is ordered (e.g. patient is at risk for aspirating, or has aspirated, a noted decline in cognitive function, ears, noes and throat surgery).

3.01 - Assess nutrition-related risks and needs. FF Determine client nutritional requirements.

1. Student calculates energy, protein and fluid requirements to be used for nutrition initiation or intervention (e.g. enteral or total parenteral nutrition).

2. Student uses appropriate parameters to determine if a patient is a normal weight; malnourished; obese etc. Student is able to calculate energy and protein requirements based on the identification of the patients nutritional status. The student is able to identify if a patient is at a risk for refeeding.

3. After an initial patient assessment, the student is able to determine the patients nutritional requirements. Student demonstrates the calculation of energy requirements for in-patient by utilizing the appropriate equation. Student is able to determine if current or adjusted body weight should be used. Student makes recommendations to patient and includes in patients chart.

3.01 - Assess nutrition-related risks and needs. HH Integrate assessment findings to Identify nutrition problem(s).

1. Student uses information obtained from a variety of sources; 24 hour food recalls, 3 day food records; laboratory values; chart notes, medical history, anthropometric data, and information obtained through discussions with patient / family to identify nutrition problem(s).

2. Student charts after assessments, charting includes the problem, etiology and symptoms (PES) statements and analysis/explanation. Also includes notes about patient stage of change.

3. Student correctly identifies nutrition related problems and discusses with preceptor.

3.02 - Develop nutrition care plans. B Prioritize nutrition care goals based upon risk and available resources.

1. Student uses all patient related assessment data to determine patient specific nutrition care goals and lists goals in order of priority. Student identifies all potential risks to patient (e.g. risks associated with initiating total parental nutrition or poorly managed diabetes) and identifies how risks will be monitored.

2. Student demonstrates ability to appropriately screen patients. Student can confidently determine when there is a need to advocate for nutrition intervention in patient care and when it is not of immediate concern.

3. Student prioritizes nutrition care goals based on patient risk. Student understands when greater success would be achieved by establishing smaller goals as a result of patient resources (e.g. money, time, motivation). Student understands when priority must be given to medications prior to focusing on nutrition care plan. (e.g. Diabetes medical regime prior to nutrition education)

3.02 - Develop nutrition care plans. D Select appropriate nutrition interventions.

1. Student uses all patient related assessment data, to identify the optimal diet order.

2. Student develops nutrition care plan based on patient's priorities; nutritional requirements; readiness to change and medical context.

3. Student identifies opportunities appropriate for both individual and group education. Student utilizes a variety of resources - such as handouts, apps and recipes etc.

3.02 - Develop nutrition care plans. F Identify appropriate textural and therapeutic diet modifications.

1. Student observes patient eating and makes recommendations for changes to food textures (minced, pureed etc.) and consistency (thin; thick etc.).

2. Student reviews lab values to make recommendations for therapeutic diets (e.g. low potassium diet for patient with ongoing elevated potassium levels).

3. Student customizes patient diet by appropriately selecting half portions at mealtimes, vegetation diet, healthy evening snacks, dental soft etc.

3.02 - Develop nutrition care plans. H Develop or modify meal plans.

1. Student works with patient to modify their current diet to create a meal plan that is consistent with patients lifestyle, schedule, needs and food preferences.

2. Student discusses satisfaction of newly developed / current meal plan with patient and as appropriate identifies modifications to improve patient satisfaction (e.g. culture preferences).

3. Student provides patients living with diabetes with meal and snacks ideas and provides resources such as handouts containing sample meal plans and healthy snack ideas.

3.02 - Develop nutrition care plans. J Determine supplementation needs.

1. Student calculates patients' energy requirement and identifies current energy intake in order to make recommendations for oral nutrition supplements.

2. Student appropriately recommends oral nutrition supplements based on patient needs (e.g. patients with poor appetite); vitamin/mineral supplements (e.g. Calcium/Vitamin D for seniors) etc.

3. Student discusses the option of oral nutrition supplements after conducting a diet history and identifying an associated weight loss.

3.02 - Develop nutrition care plans. N Design enteral feeding regimens.

1. Student designs a home enteral feeding plan for a patient needing an enteral tube which includes start rate; increase rates and goal rates.

2. Student re-assesses an enteral feeding plan for a patient with a pre-existing enteral tube. Student identifies all lab values that need to be monitored and possible complications.

3. Student calculates energy and protein requirements. Student identifies risk of refeeding and establishes an appropriate start rate. Student monitors feeds by reviewing biochemical labs and gastrointestinal tolerance. Student implements transitioning feeding plans from start to goal rate and has a good understanding of when an speech language pathologist's assessment is appropriate for progression to oral diet.

3.02 - Develop nutrition care plans. R Design parenteral feeding regimens.

1. Student designs a total parenteral nutrition feeding regime tailored to a specific patient (include start solution, increase rates and goal rates). Student identifies all lab values that need to be monitored for patient.

2. Student develops a total parenteral nutrition and enteral nutrition feeding regimen. This includes calculating the energy and macronutrient content of the total parenteral nutrition being provided. Student determines metabolic tolerance of total parenteral nutrition by monitoring blood glucose, triglycerides, electrolytes and liver enzymes.

3. Student completes a case study for a patient requiring TPN. They are able to correctly identify indications for TPN, calculate rate, select and order formula and develop a plan to initiate and monitor. Student also identifies potential complications and discusses appropriate adjustments to the plan with preceptor.

3.02 - Develop nutrition care plans. T Develop client support plan.

1. Student provides a comprehensive list of contacts of organizations/programs and practitioners that the patient can liaise with after discharge from hospital (e.g. social worker; meals on wheels; diabetes education centre etc.)

2. Student provides diet instruction to a patient awaiting discharge. Student provides contact information of a Community Care Access Centre Dietitian if the patient has questions after discharge.

3. Student initiates a patient referral to a doctor and pharmacy team for follow-up for patients experiencing chronic diarrhea /constipation /uncontrolled blood glucose etc.

3.02 - Develop nutrition care plans. V Develop client education plan.

1. Student develops a comprehensive client education plan by including current intake; lifestyle factors; identified knowledge gaps etc. (e.g. education plan based on FODMAP diet).

2. Student identifies the clients nutrition education needs and develops a suitable plan. Teaching includes the use of the plate model, carbohydrate counting etc.)

3. Student navigates the electronic medical record to obtain the client's full medical record. Interprets the data by comparing the results to appropriate targets and tailors a nutrition education plan for the patient which includes lifestyle factors.

3.02 - Develop nutrition care plans. X Identify strategies to monitor and assess nutrition care plan outcomes.

1. Student collaboratively develops specific nutrition care goals with the patient and agrees on appropriate length of time for follow up.

2. Student schedules patient follow-up appointments with RDs as a means of monitoring patient progress. Assessments are developed based on plans/goals made at the previous session. Student identifies the indicators that should be reviewed for improvement examples include; blood glucose A1C levels, weight gain/loss, improved eating habits, increased physical activity etc.

3. Student monitors ICU patients on a daily basis for gastrointestinal/metabolic/fluid tolerance.

3.03 - Manage implementation of nutrition care plans. B Implement nutrition interventions.

1. Student provides instructions to patients on the FODMAP diet for restrictive diets (e.g. renal / irritable bowel syndrome (IBS) management etc.) and provides rationale for the strict adherence to the diet.

2. Student suggests an upgrade / downgrade to a diet to the SLP.

3. Student educates client on healthy diets including DASH diet, Mediterranean diet etc.

3.03 - Manage implementation of nutrition care plans. D Identify strategies to communicate nutrition care plan with client, interprofessional team and relevant others.

1. Student attends medical rounds on units to share nutrition care plans with interprofessional team. Student liaises with physicians, nursing, pharmacy and RD's on other units.

2. Student communicates nutrition care plan in interprofessional notes section of chart.

3. Student identifies that certain patients need more/less detailed nutrition education communicated to them depending on their education level or comprehension of nutrition topics. Student identifies that modified or smaller changes may be more appropriate for pts who are limited by physical constraints, motivation, language barriers, finances, time, or interpersonal relationships. As an example, the student provides a first time T2DM patient extra materials (label reading, GI foods, carbohydrate counting) because the patient was fully engaged as was evidenced by the multiple lifestyle changes already made and interest in learning how to count carbohydrates.

3.03 - Manage implementation of nutrition care plans. E Coordinate implementation of care plan with client, interprofessional team and relevant others.

1. Student facilitates a family meeting to discuss a resident's nutrition care plan and address questions from the family.

2. Student meets with pharmacist to discuss feeding solutions for a specific patient currently receiving total parenteral nutrition and integrates agreed upon changes into care plan.

3. Student sends an electronic message to the patient's family doctor to suggest a referral to social work.

3.03 - Manage implementation of nutrition care plans. F Provide nutrition education and counselling.

1. Student provides nutrition education and counselling on a variety of diets (e.g. ileostomy diets for post-operative patients).

2. Student provides hearty healthy diet education to cardiac rehabilitative patients.

3. Student practices motivational interviewing strategies; open ended questions, decisional balance, scaling, rolling with resistance.

3.04 - Evaluate and modify nutrition care plan as appropriate. A Evaluate client progress in achieving plan outcomes.

1. Student determines success of achieving nutrition care plan goals by evaluating progress indicators for each specific goal (e.g. regular weight checks for weight management; assessing blood glucose and diet records for people with diabetes).

2. Student reviews daily lab work results to determine effectiveness of nutrition care plan.

3. Student is able to appropriately identify outcomes that would indicate success in meeting the nutrition care plan.

3.04 - Evaluate and modify nutrition care plan as appropriate. B Identify factors impacting the achievement of outcomes.

1. Student consults with patient to determine barriers to achieving goals (social, physical, financial etc.). Student discusses with patient what worked and what did not. Student determines patients' confidence and conviction to achieve goals.

2. Student is able to identify complications related to disease condition that are impacting achievement of outcomes. Ex. poor intake and patient low level of consciousness.

3. Student identifies factors affecting intake including holding of feeds for tests/procedures; patient concern of aspiration etc.

3.04 - Evaluate and modify nutrition care plan as appropriate. C Identify necessary changes to nutrition care plan.

1. Student reviews nutrition care plan and provides possible suggestions to meet nutritional goals (e.g. in order to improve nutritional status for patients unable to consume sufficient food, student suggests appropriate oral nutrition supplement).

2. Student suggests transition to oral diet from enteral nutrition when appropriate.

3. Student identifies the patient is struggling with implementing dietary changes due to their new work schedule. Student works with the patient to identify healthy snacks they can take with them to work.

3.04 - Evaluate and modify nutrition care plan as appropriate. D Implement changes to nutrition care plan.

1. Student changes the enteral nutrition regimen to meet the patient's nutrition requirements.

2. Student incorporates changes to patient nutrition care plan/goals at conclusion of follow-up appointments. For example, adding carbohydrates to breakfast, increasing exercise, and eating more fruits and vegetables (fibre), decreasing sweets/refined carbs etc.

3. Student identifies need to alter supplement amounts to better meet patients needs.

Competency # Indicator Performance Indicator Example
4.01 - Assess food and nutrition related issues of groups, communities and populations. B Identify information needed to assess food and nutrition-related issues of a group, community and populations.

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

 

4.01 - Assess food and nutrition related issues of groups, communities and populations. D Obtain and interpret stakeholder perspective.

1. Student organizes and helps facilitate a community member focus group or key informant interviews to obtain and interpret their perspective on a community initiative.

2. Student serves as a note-taker for a focus group targeted to health care providers. The purpose of the focus group is to determine the current level of health knowledge regarding supplemented food. Student gains insight into the current level of health literacy of supplemented foods held by nurses. Student gains an understanding of the qualitative research process of gathering stakeholder opinions.

3. Student reviews a report to obtain participant feedback on a community program. Student uses the report to inform project work.

4.01 - Assess food and nutrition related issues of groups, communities and populations. F Obtain and interpret food and nutrition surveillance, monitoring and intake data.

1. Student reviews Canadian Community Health Survey (CCHS) or other relevant community or group data.

2. Student uses HootSuite or other platform to monitor social media keywords on Twitter and Instagram. Student uses HootSuite to collects data on consumer and manufacturer opinions regarding supplemented food products to include in research project.

3. Student creates a survey for a Portuguese mothers' group to assess fruit and vegetable intake, how and where fruits and vegetables are obtained and level of food security. The results are compared to national surveillance data from the CCHS and used for discussion in group sessions.

4.01 - Assess food and nutrition related issues of groups, communities and populations. H Obtain and interpret health status data.

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

2. Via social media, student obtains health literacy information regarding the current level of consumer knowledge on a specific topic.

3. Student obtains a copy of a survey report that discusses statistics regarding food bank use and food security in a community. With this information, student gains a better understanding of the degree of food insecurity present when developing nutrition care plans and programs for future practice.

4.01 - Assess food and nutrition related issues of groups, communities and populations. J Obtain and interpret information relating to the determinants of health.

1. Student reviews and discusses information collected by a community organization that focuses on the determinants of health (e.g. employment, income and social status, housing, health status, social supports, gender, culture etc.).

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

3. Student completes the online module "Model of Health and Wellbeing" offered through The Association of Ontario's Health Centres (AOHC) which includes the topic of determinants of health.

4.01 - Assess food and nutrition related issues of groups, communities and populations. L Obtain and interpret information related to food systems and food practices.

1. Student 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, nutritious lunch program.

2. Student 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. Student attends meetings in which student learns about food systems and how various programs affect food access for vulnerable populations.

4.01 - Assess food and nutrition related issues of groups, communities and populations. N Identify relevant group, community or population assets and resources.

1. Student completes an assets map for a local community (e.g. meets with community centre organizers to discuss specific needs and resources within the community).

2. Student attends and summarizes a focus group regarding community group needs and supportive resources available to members such as professional organizations which may be able to help members with understanding healthy eating or accessing healthy foods.

3. Student reviews and updates the community food resources and program lists in a cookbook geared to the male population. Using a needs assessment survey, student obtains feedback from mothers on existing programs that are currently available in the community to augment a program being developed for a subset of the population.

4.01 - Assess food and nutrition related issues of groups, communities and populations. P Integrate assessment findings to identify priorities for population health approaches related to food and nutrition

1. Student creates a proposal for a community enhancement initiative (e.g. written proposal integrating needs assessment information to justify the need for a community kitchen).

2. Student integrates the findings of social media report to draw conclusions regarding the current level of health literacy and consumer opinions of supplemented food products.

3. Student analyses needs assessment results to identify the types of recipes and exercises to include in a new program for a mothers group.

4.02 - Develop population health plan. B Identify goals and objectives for population health related to food and nutrition.

1. Using the results of a needs assessment, student identifies the goals and objectives of a community kitchen.

2. Student develops objectives for 'supplemented foods' report. Student makes recommendations including educational strategies and health professional involvement in online discussions.

3. Student develops an outline of a needs assessment for a mothers group in which the goals and objectives of the program are identified.

4.02 - Develop population health plan. D Identify appropriate strategies to meet goals and objectives for population health.

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

2. Student develops methodologies to create a study design that would provide information regarding consumer and manufacturer opinions on supplemented food products using social media platforms.

3. Student collaborates with the mothers group facilitator to identify appropriate ways to meet the goals of each of the 'Families Get Together' sessions (e.g. choosing appropriate dietary suggestions to meet the needs of the mothers, babies, and toddlers, connecting with other health professionals in Continuing Health Care (CHC) organization etc.).

4.02 - Develop population health plan. E Develop action plan for population health.

1. Student develops a step-wise action plan to implement a lunch program in partnership with community support groups for a local community.

2. Student develops a Work Plan that outlines each step of their action plan and corresponding timelines for completion.

3. Student creates an implementation plan for outreach activities that can be applicable to any new program. Student identifies the tasks to be completed, the timeline, staff to be involved, intended results, and monitoring strategies.

4.02 - Develop population health plan. G Identify strategies and timelines to monitor and evaluate effectiveness of action plan.

1. Student develops a Gantt Chart to document timelines corresponding to the action plan. Student develops evaluation criteria to monitor the success of the project.

2. Student creates a timeline for a trial of archived data collection from a social media management system which includes an initial attempt to export this data to Excel in a structured format. After successful completion of the trial, student schedules a data collection date range to capture the data.

3. Student develops strategies and a timeline to monitor the implementation plan for an outreach program.

4.03 - Implement population health plan. B Contribute to the coordination and delivery of population health activities related to food and nutrition.

1. Student trials a lunch program for community residents.

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

3. Student works with the mothers group facilitator to adapt a program to meet the participants' needs. Student contributes to the coordination and delivery of a cooking program by helping to plan and facilitate the nutrition education and cooking sessions. Student plans and delivers a workshop on introducing solid foods to infants for a community program.

4.04 - Evaluate and modify population health plan as appropriate. B Contribute to evaluating the effectiveness of population health activities for a group, community or population.

1. Student develops evaluation criteria to monitor the success of a project. (e.g. number of participants accessing the program, participant satisfaction, community engagement, cost of running the program, number of volunteers trained etc.).

2. Student informally discusses consumer satisfaction with recipe they are handing out during the grocery store food demo.

3. Student contributes to the evaluation of 2 different programs by soliciting participant responses at the evaluation stations, recording responses of the focus group, analyzing themes from qualitative data, and evaluating the pre and post nutrition knowledge surveys.

4.04 - Evaluate and modify population health plan as appropriate. C Propose modifications to population health activities to increase effectiveness.

1. Once the data from the evaluation is collected, the student writes a report with recommendations to modify the program for enhanced operation.

2. Student suggests modifications to future in-store food demos or other events, based on consumer feedback.

3. Student synthesizes data from evaluation sessions of the program and suggests future directions based on the results.

Competency # Indicator Performance Indicator Example
5.01 - Assess strengths and needs of programs and services related to dietetics. B Utilize strategic and operational planning principles to analyze goals, objectives and activities of programs or services related to dietetics.

1. Student utilizes strategic and operational planning principles to develop goals, objectives and an action plan for a new snack delivery system.

2. Student reviews the goals and strategic plans for the (1) the Managed Food Services Company (2) hospital account and demonstrates an understanding as to how both are incorporated into the activities performed by food service.

3. Student reviews the annual strategic plan for a healthcare organization. Gains an understanding as to how stakeholders input helped shape short-term and long-term objectives, specifically with focus on waste reduction and energy conservation. Student understands the need to develop assessment criteria specific to food services to ensure objectives are met.

5.01 - Assess strengths and needs of programs and services related to dietetics. D Identify relevant assessment information.

1. Student collects data from various stakeholders involved in a snack delivery system. The student identifies the relevant assessment data and incorporates findings into a presentation to food service management.

2. Using a pre-existing patient visitation/satisfaction audit, student identifies and revises questions to capture a better representative assessment of patients.

3. Student prepares a report for the food service department that identifies potential areas for improvement. Assessment data was gathered by: (a) reviewing the healthcare organizations strategic plan, (b) personal observation and assessment of inventory, ordering, receiving, and food preparation, and (c) patient satisfaction information.

5.01 - Assess strengths and needs of programs and services related to dietetics. F Obtain and interpret stakeholder perspective.

1. Student obtains and analyzes information concerning the snack delivery process from RD's, unit staff and patients on in-patient units.

2. During renovations of healthcare centre, student attends a meeting hosted by hospital senior management discussing goals, barriers and mitigation strategies for the completion of the renovations. Student meets with preceptor to discuss implications to the various stakeholders when the food service department is relocated to a different floor.

3. Student use quantitative and qualitative data from patient satisfaction survey to obtain patient perspective. Student uses this information to provide suggestions for improvement to the Finger Food menu.

5.01 - Assess strengths and needs of programs and services related to dietetics. H Obtain and interpret financial information.

1. Student obtains current costs associated with snack delivery system (including labour costs; food costs etc.) to compare with projected costs of newly created snack delivery system.

2. Student reviews the quarterly budget with management and understands the components that contribute to the overall cost of food services in this organization.

3. Student obtains receipts, records, and profit from cafeteria sales. Inputs information into financial software. Student completes an analysis of hourly sales, coffee sales, customer count, average cheque, etc.

5.01 - Assess strengths and needs of programs and services related to dietetics. J Obtain and interpret relevant standards and compliance information.

1. Student analyzes standards as they apply to chemical usage. Student develops procedures to ensure all staff are adhering to Workplace Hazardous Material Information System (WHMIS) requirements.

2. Student reviews safety standards and provides an in-service to staff addressing workers safety.

3. Student completes all relevant training modules regarding standards and compliance of information prior to starting placement; including policies on: Theft, Personal Property, Service Excellence, Health and Safety in the Workplace, Personal Protective Equipment, Occupation Health and Safety, and Emergency Preparedness. Student educates new staff member on standards and compliance information.

5.01 - Assess strengths and needs of programs and services related to dietetics. L Obtain and interpret nutritional, cultural, physical and other demographic client information.

1. Student plans and conducts a taste panel with a variety of stakeholders. Utilizing participant evaluations from the taste panel, student determines items suitable for the patient menu.

2. Student gains a further understanding of appropriate packaging and containers which are suitable for patients with impaired physical abilities by completing a workshop on dementia.

3. Student gains insight into culturally appropriate foods and texture/liquid options through discussions with food services staff.

5.01 - Assess strengths and needs of programs and services related to dietetics. N Obtain and interpret stakeholder satisfaction information.

1. Student plans and conducts a taste panel to determine suitable items to add to current menu. Student includes a variety of stakeholders to participate in the taste panel (e.g. dietitians, manager, supervisors, kitchen staff, nursing etc.). Student develops an evaluation form to collect feedback and analyzes results to make recommendations.

2. Student conducts food satisfaction audits to determine patients' satisfaction with the quality, presentation, temperature and overall food service experience.

3. Student gains patient's perspective on various aspects of food services through meal rounds. Student codes information into a spreadsheet for analysis.

5.01 - Assess strengths and needs of programs and services related to dietetics. P Obtain and interpret human resource information.

1. Student determines staffing requirements for snack delivery process by calculating full time equivalent (FTE) .

2. Student screens external staffing applications in order to select suitable candidates for an interview for a casual dietary aide position. Student assists with interviewing potential candidates.

3. Student discusses procedures around recruitment, orientation, discipline, and unionized environments with preceptor. Student discusses characteristics specific to unionized environments, example seniority. Student updates job description for a dietary aid position.

5.01 - Assess strengths and needs of programs and services related to dietetics. R Obtain and interpret technical / equipment information.

1. Student compares current dishwashers available from a variety of suppliers, identifies essential attributes and makes recommendations for purchase.

2. Student obtains the technical requirements for software programs to analyze nutritional information. Student creates a report of the pros and cons for each program and makes a recommendation to purchase.

3. Student investigates current issue of frequent chipping of china dishware. Student sources new plates and mugs. Student obtains quote, receives approval to purchase and places order.

5.01 - Assess strengths and needs of programs and services related to dietetics. T Analyze or integrate information to develop goals and objectives for food and nutrition services and programs.

1. Student analyzes current cafeteria retail sales and uses data to develop goals and objectives for an additional retail venue.

2. In order to streamline the departmental auditing process, student combines the monthly food safety audit with the equipment audit. This revised audit increases efficiency while meeting the departmental auditing goals.

3. Student shadows various staff performing dietary aide duties and outlines suggestions for improvement. The outline includes setting objectives for time requirements for a variety of duties, interaction with patients etc.

5.02 - Manage programs and projects. B Identify appropriate goals and objectives for a program or project.

1. Student identifies appropriate goals and objectives for the snack delivery process.

2. Student develops a method to collect data related to frequency and duration of food service staff taking patient meal orders. Student utilizes data to develop staff goals for time taken for meal selection.

3. Student develops goals and objectives to implement a kids cooking camp.

5.02 - Manage programs and projects. C Identify strategies to meet goals and objectives for a program or project.

1. Student identifies strategies for improving snack delivery for in-patients.

2. Student identifies strategies to modify recipes to meet the needs of clients who are vegan and gluten free who access their preceptor's website.

3. Student develops a strategy to reduce the repetitive task of changing meal tickets in Computrition. Student is successful at improving the efficiency for the diet clerks.

5.02 - Manage programs and projects. E Develop an action plan for a program or project.

1. Student creates a step-by-step action plan for improving the snack delivery process.

2. Student creates an action plan to create, implement and evaluate a Canada Day meal for residents in LTC.

3. Student develops a work plan for a project to update an RDs private practice website to create increased traffic.

5.02 - Manage programs and projects. G Develop a budget for a program or project.

1. Student obtains previous years' financial data for charges to nursing unit cost centres for patient snacks. Based on the information obtained, student develops a budget for snacks for each nursing unit for the next fiscal year.

2. Student gains insight into the hospital budgeting process and the relationship with the contracted food service companies budget process. Student assists with the budgeting process by entering current year actuals into a budget comparison document.

3. Student is provided with a budget to use in planning the Canada Day meal for LTC residents.

5.02 - Manage programs and projects. I Contribute to a marketing plan for a program, event or product.

1. Student creates numerous social media posts to promote an event or program.

2. Student prepares a marketing plan for Canada Day. Student creates posters to promote the special Canada Day menu to residents.

3. Student works with the in-store dietitian to create a plan to market seasonal vegetables to consumers through displays and demos.

5.02 - Manage programs and projects. J Coordinate implementation of an action plan for a program or project.

1. Student develops and implements an action plan for the Canada Day meal.

2. Student develops an action plan for the in-store demo on seasonal produce.

3. Student coordinates plan for the Nutrition Month display.

5.02 - Manage programs and projects. L Provide orientation and direction to staff or volunteers.

1. Student reviews and revises the orientation guide for staff and/or utilizes guide to orient a new staff member.

2. Student provides orientation to new Ryerson students by hosting them at their placement site.

3. Student provides direction to staff on how to properly complete a task.

5.02 - Manage programs and projects. N Provide training or education to staff or volunteers.

1. Student educates dietary staff by providing an-in-service on proper temperature monitoring.

2. Student provides training to incoming student to introduce them to the organization.

3. Student leads a staff huddle to re-educate and emphasize the importance of providing correct food textures for patients.

5.02 - Manage programs and projects. P Contribute to staff or volunteer recruitment activities.

1. Student reviews dietary aide applications and selects suitable candidates to interview. Student assists with the interview.

2. Student assists with interview to fill the position of cleaner in housekeeping. Student identifies pros and cons of two potential candidates.

3. Student updates a job or volunteer description to reflect the current workload and expectations.

5.02 - Manage programs and projects. R Contribute to staff or volunteer development or performance management activities.

1. Student reviews all staff attendance records over past year, identifies staff with attendance management issues and summarizes for attendance management review.

2. Student completes shadow reports for dietary aides to ensure they are completing all aspects of their jobs correctly, efficiently and safely. Student provides feedback of shadow reports to staff.

3. Student develops a checklist to help volunteers ensure they complete all required tasks.

5.02 - Manage programs and projects. T Contribute to organizational planning or development activities.

1. Student assesses and evaluates food wastage as a result of over production. Student provides suggestions to reduce food waste including changes to forecasting and purchasing practices.

2. Student assists preceptor to meet monthly activity goals for consumer interaction. Ex. food demos, cooking classes, recipe development etc.

3. Student attends Nursing Week meeting. Student contributes ideas for the provision of nutrition information during Health Clinics. Student presents a plan to offer a nutrition table with relevant nutrition information and food samples.

5.02 - Manage programs and projects. V Develop a plan to monitor expenditures, equipment and materials usage relative to budget and activity plan.

1. Student develops a plan to determine cost of operating a dishmachine; reviews labour; chemical and maintenance expenses and compares to budget.

2. Student compares ward stock supplies provided by food services at 10 hospitals. Student develops recommendations to improve standardization of supplies while minimizing costs.

3. Student develops a plan to monitor expenditures, equipment, and materials with the implementation of a kids cooking camp

5.03 - Manage food services. B Identify the food service needs of a client group based upon their nutritional, cultural and physical characteristics.

1. Student identifies the food service needs of 'Meals on Wheels' customers by analyzing nutritional, cultural and physical characteristics of the clientele as identified by the organization. Ex. large Italian population in service area.

2. Student creates a report that identifies how the food and service offered at the healthcentre meets the nutritional, cultural, and physical needs of the patient/client.

3. Student meets with resident council to determine cultural preferences of food items for inclusion on the patient menu.

5.03 - Manage food services. D Identify human, financial, technical and equipment resources required for the provision of food services.

1. Student identifies required resources to organize a cooking demo for a community outreach event.

2. Student completes a grant proposal for funding for a community garden project. The student creates a budget for all equipment and resources required.

3. Student identifies the shifts and the staff required each day for the food service department. Student identifies financial resources required (e.g. weekly cost of food, reimbursement for catering events, quotes/approval for new supplies etc). Student identifies technical resources required (e.g. Computrition, Microsoft Outlook, etc.). Student identifies equipment required (e.g. blenders, puree machines, etc.)

5.03 - Manage food services. F Create and modify menus using menu planning principles.

1. Student researches and proposes menu modifications to the current thickened fluid product offerings.

2. Student modifies regular patient menu (4 week rotation) to identify non-finger food items and suggest alternatives. Student follows current menu format (e.g. replaced meat with meat, vegetable with vegetable, etc.) to ensure patients receive all food groups, balanced meals and a variety of options.

3. Student creates a Canada Day Resident menu based on available items, budget, special/therapeutic diets, and enjoyment for patients. Student reviews all patient menus to ensure the information is accurate, up-to-date, and appropriate for each diet.

5.03 - Manage food services. H Contribute to purchasing, receiving, storage, inventory control, and disposal activities for food products.

1. Student completes an audit that includes all control procedures for the proper receiving; storage and issuing of food products.

2. Student conducts an inventory of donated food products to the community centre and makes a plan to utilize in programming. Student purchases additional food items as needed.

3. Student assists with procedures from inventory, through to storage of received items. Student ensures all proper documentation is followed. Student assists with inventory count and inventory control including checking production sheets for following week requirements etc. Student participates in a meeting which focuses on composting procedures of food, student gains insight into the disposal of plate waste.

5.03 - Manage food services. J Contribute to food production and distributing activities.

1. Student develops procedures for the production of meals for meals on wheels including quantity and quality standards.

2. Student leads a cooking demonstration and assists in food preparation and distribution of samples.

3. Student participates in checking and auditing trays on patient tray beltline.

5.03 - Manage food services. K Contribute to improvement initiatives related to food services.

1. Student contributes to the improvement of food services by developing a snack delivery protocol.

2. Student develops standardized ward stock amounts and eliminates nonessential supplies that are currently provided to the wards by food service. Student is able to achieve a reduction in overall supply costs.

3. Student revises patient meal tickets (ordering of items) for easier reading which increases meal tray accuracy.

5.03 - Manage food services. L Contribute to activities related to compliance with health and safety requirements.

1. Student completes a departmental sanitation audit and identifies all areas that are not in compliance with health and safety requirements. Student reviews findings with preceptor.

2. Student completes a monthly food safety and operations audit. Student follows up with non-compliant issues.

3. Student assists with monthly Health and Safety departmental inspection which includes checking of fire extinguishers, examining chemical room and updates to Material Safety Data Sheet (MSDS) binder. Student randomly asks employees questions to assess their knowledge of health and safety.