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IN IT TOGETHER: ​Teamwork key to meeting complex nutritional needs

Posted Aug 20th, 2020

IN IT TOGETHER: ​Teamwork key to meeting complex nutritional needs

This is part of a series of stories profiling members of the Niagara Health team and the work they are doing as part of our response to the COVID-19 pandemic. Meet Dana Nash, a Registered Dietitian at our St. Catharines Site.

Ensuring that patients with respiratory conditions receive the proper nutrition can be challenging under normal circumstances. However, trying to do so in the middle of a pandemic with a previously unknown virus made the job even more complex.

Registered Dietitian Dana Nash and her colleagues needed to stay on top of the latest research, innovate and rely on each other more than ever to ensure patients' nutrition needs were met.

When the pandemic was declared, the Clinical Nutrition team got to work reviewing what little literature about the virus was available to come up with best practices on how to care for COVID patients. This was truly a team effort, making sure everyone knew what literature others were reviewing and how it could be implemented into patients' nutritional care plans. This was in addition to planning for a potential surge of patients that needed to be on ventilators – how the team was going to function to ensure they could meet the complex nutritional needs of these patients, as well as what impact this would have on other areas of the hospital.

Dana works on Unit 4A at our St. Catharines Site, which was designated as the COVID unit early on in the pandemic. Working in this area presented its own challenges that Dana, with help and guidance from her team, overcame to provide patients with the best care possible.

What is the role of the Clinical Nutrition Department at Niagara Health?

There are Dietitians on inpatient floors across our sites, as well as outpatient areas. We look at the science of nutrition and translate it into everyday life for patients, which includes education for those living with chronic illnesses.

We support medical treatment by providing adequate nutrition to patients - making necessary diet modifications and ordering other forms of nutrition intake when oral intake isn't possible.

How has the role of Clinical Nutrition changed during the COVID-19 pandemic?

At the beginning of the pandemic, we transitioned to using phone assessments as part of our personal protective equipment (PPE) conservation strategy. We had to adjust to completing these consultations over the phone, as a physical exam generally plays a large role in our assessments.  As the pandemic progressed, we were able to go into patient rooms – wearing the appropriate PPE – which was helpful.

In outpatient areas, we developed strategies to limit visits to the hospital, such as using technology to conduct virtual appointments when possible.

Were there any specific modifications made to your role on the COVID unit?

My role is to work with COVID patients to come up with a nutritional care plan to best support their medical treatments. I followed the PPE guidelines that were in place for COVID patients. This was difficult at times, as many patients rely on lip-reading and facial expressions to communicate.  The team on 4A went above and beyond during the pandemic. Liaising with the nurses, doctors and other allied healthcare professionals helped me provide the best nutrition I could for each patient.

I also created a handout to give to patients and their families to help ensure proper nutrition when they went home – understanding that many patients finished their recovery at home.

Describe how the team has performed during the pandemic (on and off COVID units)?

We had to adapt our practice and think about our priorities. For team members in our outpatient areas, they had to think about ways to provide care without patients coming to the hospital. This meant phone calls and using OTN. Team members shared information with each other about what worked best – to come up with a consistent approach.

We also conducted literature reviews on supporting COVID patients with nutrition. We had a master document that we all shared to make sure all team members were aware of what others were reading and how we could apply this to our work. It was a lot of learning from other countries in the beginning who had seen more COVID patients.

What precautions have you and your team taken to help keep yourselves safe during the pandemic?

Of course, we follow all the guidance from our Infection Prevention and Control team. We made adjustments to our workspace to make sure it could accommodate physical distancing. We wore the appropriate PPE at all times and made sure we had access to laptops, when possible, on units to limit contact with high-touch areas, such as computers.

What's the most challenging part about working during the pandemic?

With respiratory illnesses, patients need more energy to fuel the muscles for breathing and to meet the increased metabolic demand. However, this can be difficult, as with the increased work of breathing, these patients often fatigue quickly and may have a lack of appetite. We also have to take into account that COVID patients can have changes to their smell and taste and may have been unwell for several days before coming to the hospital for treatment. It's our job to make sure they get the appropriate nutrition despite these challenges. 

Implementing a No Visitors Policy was also difficult, as we often rely on families and volunteers to provide assistance and social interaction at mealtimes. Previously, many families would bring in the patient's favourite home-cooked food . Familiar food can be a big help when patients are not eating well. 

To try and overcome these challenges, nurses on 4A would FaceTime with families during meals.  We worked with Food Services to provide high-energy, high-protein meals and snacks, as well as nutrition supplement beverages. 

What is a learning for you and your team during the pandemic that you will continue implementing going forward?

Using OTN and virtual care more regularly will continue to play a role in our work going forward. A lot of patients found that it was helpful for them to not come into the hospital for every outpatient visit.

As a team, we learned how to adapt to changing environments – which is helpful in this field. We will take these skills and use them in our work going forward.

How do you wind down after work?

It was definitely more stressful for everyone during COVID – especially at the beginning. I would often take the long way home to listen to music. That gave me the time to wind down before going home to my three kids. I also made sure I spent time outdoors, as well as keeping up with my yoga practice.

I try my best to leave work at work and be present with my family at home – not watching the news all the time and enjoying quiet moments with my children. At work, having the support of my colleagues helped me maintain a work-life balance.

Niagara Health System