4. cultural and religious dietary needs · 4. cultural and religious dietary needs this topic...

4. Cultural and Religious Dietary Needs This topic covers information about:

Profile of the Community

Diet and Religion

Cultural and Religious Menu Planning

Activities in this topic cover the following performance criteria:

Identify client group, use correct terminology and observe cultural customs

Consider cultural groups and general characteristics of their cuisine

Identify dietary regimes and factors associated with cultural and religious groups that may influence food choices

Plan and modify meals and menus to meet specific cultural and religious needs of client group in line with organisational guidelines

Follow processes defined by dietitian to evaluate meals and menus to ensure they meet cultural and religious needs of the clients

4.1 Profile of the Community Australia is a multicultural society. Cultural groups in our society include but are not limited to:

Asian

Aboriginal and Torres Strait islander

Caucasian/European

Indian

Mediterranean

Middle Eastern

South Sea Islanders

South American

African

There are many factors that may influence food choices of different cultural backgrounds including:

Background – where did they come from?

Migration pathway – did they come straight here or spend time in another country?

Was it a choice to migrate or forced migration?

Allied Health Nutrition & Dietetics Skill Set Electives pre-requisite units for Certificate IV in llied Health Assistance – Combined Learner Guide for HLTAHA 018, HLTAHA019, HLTHA020, HLTAHA021 - 186 -

How old were they?

Did they have children and if so how old are their children?

Can they speak the language?

What is their level of education?

Are they able to work and if so do they work outside of the home?

Are there other community members here and if so can they access that community?

Are there other family members?

Are familiar foods available?

Are shopping facilities familiar?

Are cooking facilities familiar?

What is their income?

What are the pressures to conform?

Do specific cultural foods have different cultural values?

(ASeTTS, 2007)

These factors may vary significantly from country to country and region to region and also within a country. Each cultural group may also have special food traditions; specific ways of preparing, cooking, serving and eating food; special occasions of food celebration (feast); and times of fasting or avoidance of certain foods/drinks (e.g. Lent or Eid).

Modern changes to the traditional diet are not always healthier particularly when more processed western food is used, which tends to be higher in saturated fat, salt and sugar. Many people prefer bland or traditional foods (i.e. or food from childhood) when they are unwell (such as steamed or sticky rice in some Asian diets). Education about the positive aspects of the traditional diet alongside suitable modern choices can be provided in hospital and may help improve intake during admission and on discharge.

Queensland is considered a culturally and religiously diverse state (Australian Bureau of Statistics, 2011:

26.3 % (1 in 4) Queenslanders were born overseas in more than 230 countries (↑ from 17.9% 2006 survey and 16.7% 1996)

23.2% of Qld population spoke a language other than English at home

Recently Queensland Health published a document on community profiles for health providers for Queensland Health and is a useful introductory reference.

http://www.health.qld.gov.au/multicultural/health_workers/profiles-complete.pdf


http://www.health.qld.gov.au/multicultural/health_workers/profiles-complete.pdf

Arrivals in Queensland

People from New Zealand and the United Kingdom have been constantly arriving since before 1970.

Pre 1970 - Dominated by European arrivals

1970’s – PNG (following independence from Aust) and Vietnam (following Vietnam war)

1980’s – Philippines, Fiji and China

1990’s – Asian countries (Philippines, Taiwan, Vietnam, China) and South Africa

2000’s – China, India, Philippines, South Korea, Japan

Religious affiliations in Queensland (Australian Bureau of Statistics, 2011)

Christianity (62.0%)

Buddhism (1.5%)

Islam (0.8%)

Hinduism (0.7%)

Other (1.2%)

No religion (22.3%)

Not stated (12.7%)

More than 147,313 (3.4%) people in Qld followed a religion other than Christianity

Between 2006 - 2011 the fastest growing religions were Islam and Hinduism

Increasing cultural, linguistic, and religious diversity in the Queensland population means that to be safe, health services need to be culturally appropriate and responsive. Research indicates a strong link between:

Figure 9: Link between cultural background and Nutrition (Johnston and Kanitsaki 2005)

Cultural incompetence

Poor quality health outcomes and

significant risks


Levels of adherence to a religious or cultural custom are a personal decision. Whilst some clients prefer to be strict and follow their religious beliefs to be 100% compliant, others may be less strict.

Islam, Hinduism, Sikhism, and Buddhism are universal religions which are practiced in many countries around the world

Each of these religions place responsibility on the individual to practice his/her religion

Varying degrees of orthodoxy exist; people who follow particular faiths may follow food related customs fully or in part.

Personal and cultural variations make it difficult to provide definitive rules and regulations that apply to all patients that identify with a particular religion. Therefore it is best to consult a patient on an individual/personal level for religious observances.

For example, a Muslim from West Africa may have a slightly different way of observing Islam when compared to a Muslim from Bosnia, Indonesia, or Iran.

It is important that healthcare providers do not stereotype their clients.

Stereotypes assume that all people from certain race, nationality, social group, religion, or culture automatically share the same beliefs and values. Do not assume dietary preferences:

Even if the client appears to comes from a specific group, or is perceived to have certain cultural affiliations

As with all clients, it is best to identify a patient’s individual dietary preferences/customs and religious observances

Appropriate terminology is vital when communicating with clients from different cultures. It is essential to be politically correct and non-discriminatory with all clients to reduce the risk of offending clients and their families. Effective communication occurs when clients and carers have common terms of reference and it is the healthcare providers responsibility (within reason) to learn and use the terminology that will be used and understood by clients, which includes food and food terminology.


A Nutrition Assistant is unable to assist a client with food preferences if they do not recognise/understand what the client is requesting.

Resources available to assist with communicating with patients from culturally-diverse backgrounds include:

Interpreters

– Be aware of your healthcare facilities protocol to access interpreters as usually booking in advance is required.

– Via phone contact

– Face to face – a Nutrition Assistant may be involved directly or indirectly via Dietitian

Ward Communication tool

Communication tools developed by individual facilities

Queensland Health provides a list of interpretive resources on their website. http://www.health.qld.gov.au/multicultural/public/language.asp

http://www.health.qld.gov.au/multicultural/support_tools/WCT.asp


http://www.health.qld.gov.au/multicultural/public/language.asp

http://www.health.qld.gov.au/multicultural/support_tools/WCT.asp

The following pictures/tools are courtesy of Mater Health Services who developed these tools to help communicate dietary preferences with West African inpatients.

Figure 10a: Dietary preference communication tool (West African) (Mater Health Service, 2008)


Figure 10b: Dietary preference communication tool (West African) (Mater Health Service, 2008)


There are several factors that influence food choices and these include:

Availability

Accessibility

Familiarity

Beliefs and Values

Food advertising

Cultural preferences

Therapeutic diet requirements

Cultural preferences

Special food traditions/customs

Different religious needs

Specific ways of preparing, cooking, serving and eating food

Holy Days/Festivals/Special Occasions which impact on food intake

Fasting or avoidance of certain foods/drinks


Observing Cultural Customs

Nutrition Assistants can provide better nutrition care if they are aware of Holy Days/Festivals/Special Occasions that have an impact on food intake.

Festive Occasions and Holy Days

– Can carry great significance for many people and the need to acknowledge them is important.

– The ability to accommodate special customs and customary foods at this time will contribute to quality of life, to what the clients recognise to be a normal lifestyle.

– Particularly important in Residential Care.

Fasting

– Ramadan in the ninth month in Islamic year during which most Muslims fast. It is iImportant to know this when monitoring a patient’s intake.

A religious Calendar is published in the Queensland Health Multicultural Clinical Support Resource folder.

http://www.health.qld.gov.au/multicultural/support_tools/mcsr.asp


http://www.health.qld.gov.au/multicultural/support_tools/mcsr.asp

Activity 20 – Factors Influencing Food Choices

Select a member of your local community (can be a friend, family member, etc.) who has been raised in a county other than Australia. Ask them if they would agree to be interviewed by you regarding their experiences as a child and then as an adult in Australia regarding their food experiences.

1. In what country was this person born? (or has experience with)

2. What types of foods did this person eat in their home country? (Ask them to outline for you a typical day’s menu)

Breakfast

Morning Snack

Lunch

Afternoon Snack

Evening Meal

Supper

3. What new foods has the person introduced into their daily menu as a result of moving to Australia? (Ask them to outline for you a typical day’s menu)

Breakfast

Morning Snack

Lunch

Afternoon Snack

Evening Meal

Supper

4. Ask the person to list three (3) factors that have influenced their food choices.

a)

b)

c)


Cultural Overview

The following overviews of different cultures allow you to gain an understanding of the diverse range of foods and fluids one culture may prefer compared to another culture. It allows you to see any overlap of foods in the cultures that may be available for selection on a hospital menu and those that may not be accessible or readily available.

Some of the cultures you may be working with include:

Aboriginal and Torres Strait Islander diet

The Aboriginal and Torres Strait Islander diet has changed from a hunter-gather lifestyle to a more westernised diet that is typically a high kilojoule, low nutritional lifestyle. Traditionally, Aboriginal and Torres Strait Islander peoples enjoyed a healthy diet of high in carbohydrates, protein, and nutrients, and low in fat and sugars. With white settlement came flour, sugar and processed meat (NHMRC, 2000).

Characteristics of Hunter-Gatherer and Western Lifestyles

Hunter gatherer lifestyle Western lifestyle

Physical activity level High Low

Principle characteristics of diet

Energy density Low High

Energy intake Usually adequate Excessive

Nutrient density High Low

Nutrient composition of diet

Protein High Low-moderate

Carbohydrate Moderate High

Simple Carbohydrate Usually low High

Dietary fibre High Low

Fat Low high

Sodium: potassium ratio Low High

(NHMRC, 2000)


When providing nutrition support for indigenous Australians, involve local Aboriginal and Torres Strait Islander Cultural Liaison Officers, local indigenous communities or health organisations wherever possible. They can provide specific information about cultural and spiritual needs and methods of catering for the dietary needs of these people.

Mediterranean Diet

The Greek and Italian communities are well-established in Australia. There is a large amount of integration with mainstream communities, with second and third generation migrants growing up and sending their children to Australian schools (ASeTTS, 2007)

Italian (Gallegos & Perry, 1995)

Common foods patients prefer may vary slightly depending on the region in Italy the patient is from, and the degree of influence from living in Australia for many years. Preferences may include:

Pork, veal, chicken, fish, cold meats e.g. salami, prosciutto, mortadella etc., are popular served with olives, cheeses, pickled vegetables.

Vegetables – many people grow their own

– E.g. radicchio (bitter lettuce), lettuce, spinach, artichokes, peas, capsicum, tomato, broccoli, broad beans, eggplant, and zucchini.

– Pulses - eaten in soups and served with pasta e.g. Lima beans, broad beans, chickpeas and lentils.

Bread – usually present at every meal

Sweets – served on special occasions.

– May be rich liqueur soaked cakes or fritter type pastries.

– May contain cream or ricotta cheese.

Fruit – the usual ending to a meal.

Beverages

– Strong black coffee or coffee with milk.

– Tea (in Australia). Herbal teas are used for ailments and insomnia.


Greek (Gallegos & Perry, 1995)

Environment and regions determine the type of diet. Common foods often preferred may vary slightly depending on the region the patient may be from and include:

Meats including lamb, chicken, fish, and pork. Beef is used less often. Meat may be baked, braised boiled, fried, or grilled.

Salty seasonings such as anchovies, caviar, cheese, sardines, and salt are very popular.

Vegetables

– Many vegetables (e.g. tomato, capsicum, zucchini, and eggplant) are stuffed with a meat and rice filling as a main course.

– Leafy greens e.g. chicory and endive with lemon juice and olive oil dressing and salads.

Fruit – dried fruit and nuts are popular

Bread is popular

Sauces

– Traditionally tomato, olive oil, garlic, herbs (oregano and parsley) or egg and lemon.

– Herbs and flavourings – parsley, oregano, garlic, celery, mint and bay leaves.

Sweets

– Often covered in honey syrup. E.g. Greek walnut cake, semolina cake, Halva, filo-pastry with custard, baklava, Greek shortbread.

Beverages

– Coffee (Greek or instant) and cocoa.


Polish

Meat

– Meat, pork in particular.

– Baked or fried meats usually come with gravy (red meat), sour cream sauce (white meat); boiled meat is cooked with black peppercorns, salt and bay leaves.

– Cold meats such as ham, polish salami and jellied meat like pigs trotters.

– Chicken, duck, and game are enjoyed in traditional recipes.

– Fish, baked or fried in butter, tinned herrings are popular.

Vegetables

– Boiled in salted water, sautéed in butter, sprinkled with breadcrumbs, and usually cooked with sugar, salt, vinegar and cream.

– Popular vegetables include cabbage, beets, onions, mushrooms, tomatoes, carrot, spinach, beans, cauliflower, turnips, peas, parsnips, potatoes, capsicum, celery, cucumber, and eschalots.

– Salad with lettuce, tomato, onion, cucumber, and radish eaten with sour cream; may accompany main meal.

Sweets

– Puddings, Kisiel (opaque jelly containing flour), poppy seed cake, jelly, fruit, ice cream.

– Yeast cakes and torts are served at festivals.

(Gallegos & Perry, 1995)


Bosnia-Herzegovina, Republic of Croatia, Republic of Serbia

Each of these groups is unique in their culture (Gallegos & Perry, 1995).

The following is aimed as a guide to possible eating habits and is not a clear definition.

General characteristics of the diet:

Crusty white bread is common and usually eaten at most meals.

Pickled or preserved foods are common.

Vegetables are usually dressed with a sauce or fried with onion and garlic and may have other sauces with them.

Commonly eaten vegetables include potato, silver beet, cabbage, capsicum, beans, peas, sauerkraut, tomatoes, squash, eggplant, pumpkin, cauliflower, and corn.

Soups, stews, and goulashes are favoured.

Moussakas, pastries, and rice dishes are all commonly eaten.

Cornmeal dishes similar to polenta and pasta are also enjoyed.

Turkish coffee and sweet desserts and cakes such as baklava are frequently eaten.

Condiments and herbs such as fresh tomato sauce, olive oil, paprika, dill, parsley, rosemary, basil and bay leaves are common.


Asian examples

Chinese

There are a number of regions in China that all have different ways of preparing food.

Rice is the almost always the basis of a meal.

Foods are commonly steamed, boiled or stir fried.

Meat and chicken are cut up finely.

Beef, pork, and chicken are used in traditional cooking.

Fish – whole, steamed with fresh ginger, shallots, dry sherry.

Fresh green prawns are preferred to the cooked variety.

Stir-fry seafood combinations usually contain scallops, squid, prawns with ginger along with shallots and Chinese broccoli.

Sauces add flavour, e.g. light or dark soy sauce, soybean paste, black bean sauce, prawn paste, oyster sauce, peanut or sesame oil and salty bean curd are often used in cooking.

Soups based on stock with meat and vegetables. Noodles and dumplings are added for substance.

Wheat flours (noodles, dumplings) are available in northern China while rice is more available in southern China.

Vegetables – many varieties are enjoyed for example; Chinese cabbage, Chinese spinach, Chinese broccoli, English spinach, eggplant, snake beans, French beans, celery, carrot, capsicum, marrows, pumpkins, tomatoes, shallots, chives, onion, bamboo shoots, lotus, water chestnuts, sweet potatoes, yams, soybean, mung bean sprouts, garlic, ginger, chilli, and shallots.

Beverages

– Chinese tea or plain water.

– Soups are sometimes drunk as refreshers during the meal.

– May enjoy fruit juice in Australia. Soft drinks rare at home.

Sweets – fruit and sweet snacks, sweet bean soup, sesame seed balls, egg rolls.


Vietnamese

Rice forms the basis to the diet and is often eaten at each meal although noodles are sometimes used as an alternative.

Meats

– Pork and poultry such as chicken or duck.

– Fish and shellfish are popular. Shellfish and fish bones are a source of calcium in the diet. Prawn shells and fish bones are used to make stock.

Vegetables

– E.g. Spring onions, celery, capsicum, mushrooms, cauliflower, cabbage, onion, Chinese cabbage, Chinese mustard greens, bean sprouts, snow peas. Legumes are frequently used.

– Salads are usually sprinkled with fresh herbs like parsley or peppermint leaves.

– Popular salads include: cabbage, lettuce, watercress, or bean sprouts.

Breads – crusty French bread sticks are preferred.

Sauces – soy sauce and fish sauce is used for most dishes for flavour.

Sweets

– Rice cakes and sticky rice dishes are part of festive occasions.

– Fresh fruit especially the tropical varieties such as mango, banana, and water melon.

Beverages – Chinese tea or coffee with condensed milk.


African examples

IMPORTANT: Be aware that some of this information will not be tribe specific, for example, Sudan consists of one geographical country but is populated by more than 200 different language groups. Ethnicities can have very different cultures and practices which will not all be described here (ASeTTS, 2007).

The following is a list of foods that are either not common in an Australian context or are used in different ways in Africa. It is not an exhaustive list. Some people from this part of the world are Muslim and may require access to Halal foods.

Bread and cereals

– Maize flour can sometimes be called mealie meal and is used to make porridge.

– Millet flour.

– Flour is used to make the staple porridge eaten alone or as an accompaniment. Sorghum flour is another variety used to make porridge.

– Teff is a grain used in Ethiopia to make injera. It is grown in Australia as animal feed but is currently unavailable for human consumption. Quinoa may be an adequate substitute.

– Injera is the Ethiopian/Eritrean name given to flat, fermented bread.

– Asida is one of the South Sudanese names for the porridge.

Pulses

– Black-eyed beans are used extensively both in cooking and as a snack.

– All other pulses.

– Seeds and nuts.

– Tahini is used as a spread and as an addition to stews and vegetable dishes.

Fruit

– Plantain is like a large green banana. It is quite starchy and is always cooked.

– Tamarind Available from Asian food markets in fresh, puree or dried form.

– Used to flavour porridge, as a drink or to eat.

Dairy

– Camel’s milk may be consumed by those coming from Ethiopia, Eritrea, Somalia and parts of Kenya.

– There is no commercial dairy in Australia.


Vegetables

– Sweet potatoes are eaten extensively as are the leaves.

– Amaranth also called Chinese spinach.

– Cassava is a starchy woody shrub used as flour or grated in savoury or sweet dishes.

– Okra.

– Molokhia is a small green leaf which is used to thicken stews.

Meat

– Dried fish is used in many dishes and is often used to flavour stews.

– Goat meat is eaten by a number of different African groups. It can be found in some selected butcher’s shops. Italian butchers sell goat as capreto.

– Camel meat may be consumed by those coming from Ethiopia, Eritrea, Somalia and some parts of Kenya. Camel meat may be locally available but this will need to be checked depending on the location of your health service.

Fats and Oils

– Red Palm Oil is used especially in West Africa and gives food a distinctive taste. It is not readily available but there are some local importers emerging.

(ASeTTS, 2007)


Middle Eastern examples

The following foods are either not common in an Australian context or are used in different ways in the Middle East. It is not an exhaustive list. Many people from this part of the world are Muslim and may require access to Halal foods.

Name in English Name in Arabic Availability

Bread Khoboz wa Samoon

Bread Samoon Many different varieties of bread are used. Some are leavened breads and others are flat breads. In Afghanistan there is a variety which is called naan which is similar to what is called Turkish bread in Australia.

Lebanese Bread Khoboz Lubnani

Turkish Bread Samoon turky

Rice and Flour Rooz wa Taheen

Fruit Fakiha

Apricot and Dried apricot

Mishmish wa mishmash mojefef

Dried fruit is a common feature in the Middle East. It is usually eaten as a snack

Dates Temor

Prune Injas

Sultanas Kishmish

Fig and dried Fig Teen wa teen mojefef

Vegetable Khothrewat

White Cabbage Lehana

Available fresh from Asian food markets. Also available frozen or canned. Okra is cooked quickly to retain its crispness or for longer to draw on its mucilaginous properties.

Leek Korath

Turnip Shelgum

Okra Bamya

Dairy Alban

Yoghurt Leben Plain yoghurt is used extensively

Spreadable yoghurt, is available in some supermarkets

Many different varieties of milk are used including cow, sheep, goat and camel

Labneh Leben Mokethef

Milk Haleeb


Pulses Bokool

Black-eyed Beans Lobya Yabsa (Beatha)

All pulses are used extensively as side dishes, additions to main dishes or as snacks.

Broad Beans (dried) Bagilla Yabsa

Broad Beans Bagilla khethra

Cannellini Beans Fasolya Yabsa (Beatha)

Chick Peas Hommos

Haricot Beans Lobya khethra

Lentils Adass

Mung Beans Mash

Yellow split peas Hommos Majroosh

Seeds And Nuts Al Mukeserat

Tahini Rashi Paste made from sesame seeds used as a spread or a flavouring

Walnuts Joz

Meat Lehem

Chicken Dejaj

Goat Lehem Maez Often sold as capreto at Italian or speciality butchers

Lamb Lehem Igel

(ASeTTS, 2007)


Indian

Food in India varies from region to region and is strongly influenced by religion and custom. The wide variety of food that is eaten and the regional variation presented in India is too complex to specify, therefore general differences between northern and southern India are identified (Gallegos & Perry, 1995).

Item Northern India Southern India

Staple Wheat – eaten as chapattis Rice

Curry Usually dry so can be eaten with chapattis

Usually wet so that the rice can soak up juices

Salad Raira made from yoghurt to which fruit and seasonings are added

Sambal a mixture of a relish and a salad

Fruit and vegetables A wide variety are eaten throughout India

Meat Mutton, Chicken, pork. No Beef Mainly vegetarian

Fish River Fish Ocean Fish

Dairy Ricotta cheese, yoghurt Yoghurt at every meal

Fat Ghee

No coconut

Oil

Coconut

Drinks Tea

Lassi (yoghurt drink)

Coffee

Buttermilk

In addition most meals are served with an array of different dishes including pappadums, pickles, relishes, and raitas. Curries are eaten regularly.


Activity 21 – Meeting Cultural and Religious Dietary Needs

1. List three places where you could source information on the cuisine of various cultural and religious groups that are found in Australian society.

2. Describe how you could access interpreter services for a client in your health care facility?

3. What other services could help you assist culturally diverse clients?

Activity continues on the next page.


Activity 21 – Meeting Cultural and Religious Dietary Needs continued

Select a religious group which follows dietary restrictions or protocols and answer the questions below. If possible select a group that you have seen represented in the patients at your hospital.

4. What is the religious group that you have selected? Why?

5. What foods or fluids are restricted or forbidden?

6. Complete the following sentences.

a) According to the Islamic faith, Muslims should:

Use ___________________ meat

Avoid all _________________ products

Avoid drinks and food containing ___________________________.

b) _____________________ food is food that conforms to Jewish dietary laws.

c) Most Hindus do not eat _______________ or items containing _________ products.


4.2 Diet and Religion There are a number of religious groups within Australian society who may follow particular dietary restrictions. These include, but are not limited to:

• Some Christian denominations e.g. Seven Day Adventists • Jewish • Muslim • Hindu

There is often:

• Food laws and traditions that are observed. • Variability in the level of restriction within religious groups. • Changes to food and eating behaviour as a result of feast and fasting occasions

(these may occur many times over the year).

Christianity

Practices vary between Christian-religious groups, e.g. Protestant, Catholic, Mormon (Latter Day Saints), and Seventh-Day Adventists. Some groups celebrate Easter and Christmas with feasts whilst others do not. Fasting and abstinence practices differ within the specific religions too, for example, fasting for one hour before communion; avoiding stimulants such as caffeine (Mormon, Seventh-Day Adventists); avoiding meat on a Friday (Catholics) etc.

Christian Seventh Day Adventists

(Adventists) Latter Day Saints

(Mormons) Jehovah’s Witness

Christian dietary habits tend to be culturally rather than religiously determined. However, some African and South Asian Christians may avoid pork.

Lacto-Ovo Vegetarian

Not usually vegetarians but will eat meat sparingly, avoiding products with much blood

Abstain from eating blood, i.e. blood sausage, and from animal meat if the blood has not been properly drained.

Alcohol is forbidden according to some Christian groups, although drinking wine (in moderation) plays a symbolic religious role in Holy Communion.

Avoid coffee, tea, alcohol.

Concern over the effects of stimulants, do not drink alcohol, tea or coffee. Some avoid hot drinks.

Apart from this there is no restriction on what is to be eaten


Judaism and Kosher food

There are both liberal and orthodox traditions with both fasting (24 hours during Yom Kippur -Sept/Oct) and feast days (e.g. Rosh Hashana and Passover). Fruit, vegetables, and unprocessed foods are usually permitted. Some foods are contentious, especially with stricter groups e.g. no gelatine, kosher-only food products, etc.

Food Laws – Judaism

Kosher approved diet:

Meat must be slaughtered in the religiously appropriate fashion.

Certain foods must not be mixed (i.e. meat and dairy).

Strict use of cooking utensils and machinery (i.e. separate pans for meat and

dairy items).

Pork, camel, hare, shellfish, and fish without fins are forbidden.

Food without blood is permitted, i.e. no bloody meat; often meat is salted to

draw out excess blood, blood-spots in egg, etc.

Muslim (Islamic)

The degree to which some practices are followed within the Muslim religion may vary. Foods are either lawful (halal) or unlawful (haram) and guidance is provided via the Holy book (Quran) (Queensland Health, 2010).

Fasting occurs during the month of Ramadan. The date changes slightly every year. Fast takes place from Dawn to Dusk, however there are exemptions for people who are sick, menstruating, pregnancy, breastfeeding, children, travelling, or have diabetes. A feast called Eid ul-Fitr (Eid) occurs for three days at the end of Ramadan.

Food Laws – Muslim

The only foods explicitly forbidden are:

• Any meat that is not slaughtered in the Halal way. • Blood. • The meat of pigs or foods that may contain pork (i.e. some forms of gelatine). • Alcohol. • Foods prepared with unclean utensils or those that have cooked forbidden foods.


Food groups - Comparing Muslim and Jewish Diets

Muslim Jewish

Fats and Oils

Mono and Polyunsaturated margarine/butter Other vegetable oils e.g. Olive, peanut, etc. Avoid lard, dripping, suet

Mono and Polyunsaturated margarine/butter (if it is a meat dish use vegetable margarine) Other vegetable oils e.g. Olive, Peanut, etc. Avoid lard, dripping and suet

Fruit and Vegetables

All raw, dried, canned or cooked using water, vegetable fats and butter


Breads and Cereals

All breakfast cereal, bread, cakes, biscuits, rice, pasta that do not contain any animal fat except butter can use vegetable fats

All breakfast cereal, bread, cakes, biscuits, rice, pasta that do not contain any animal fat except butter, can use vegetable fats

Meats Beef, Lamb, Chicken (All must be Halal)

Beef, Lamb, Chicken (Must be Kosher and NOT cooked with milk products)

Seafood All seafood Any fish with fins

Eggs All (boiled or cooked in butter or vegetable oils)

No blood spots Avoid contamination with ham/bacon

Dried Beans, lentils, baked beans, tofu

All (avoid dishes that contain bacon bones, ham, or stock made from avoided foods e.g. pork)

All (avoid dishes that contain bacon bones, ham, or stock made from avoided foods e.g. prawns, pork)

Hinduism

The degree to which practices are followed within the Hindu religion may vary. Feast

days have regional variation and fasting; depends on your caste (social standing) and

days of religions or personal significance (Queensland Health 2011).

Food Laws – Hinduism

Beef is forbidden – meat from animals is avoided. Also avoid gelatine and eggs.

Dairy products are allowed.

Strict Hindus are vegetarian.

Alcohol, onion, and garlic are avoided or restricted.

Prohibited animal products vary from one region to another (e.g. duck or crab).

Foods prepared with cooking utensils that have cooked forbidden foods are not

permitted.


Buddhism

Buddhism is more a life philosophy than religious doctrine. Rules depend on the branch

of Buddhism and differ between countries. Feast days vary from one place to another.

Fasting tends to only apply to monks, who fast in the afternoon.

Food laws – Buddhism

Most Buddhists are vegetarian.

Some Buddhists avoid meat and dairy – others only avoid meat.

Alcohol must be avoided.

Sikhism

Dietary practices can vary depending on individual beliefs/customs (Queensland

Health, 2011).

• Holy Days – Sikhs observe a number of holy days and festivals – they don’t affect food intake – No specific day of worship.

• Fasting – Do not fast for religious reasons

Food Laws - Sikhism

• Many Sikhs follow strict vegetarian diet – No fish, meat, eggs. – Do eat dairy products.

• Non-vegetarians – may choose to avoid pork, beef

• ALL Sikhs are prohibited from eating meat that has been ritually slaughtered including Halal/Kosher.

• Prohibited from consuming alcohol, or other intoxicants. Summary of Religious Food Requirements

Faith Dietary Practices Islam Halal and must avoid pork

Buddhism +/- vegetarian

Hinduism Vegetarian

Judaism Kosher and avoid pork

Sikhism Vegetarian/meat eating must abstain from halal/kosher

Christianity (Seventh Day Adventist) Vegetarian (ovo-lacto)


4.3 Cultural and Religious Menu Planning Planning a Menu around Different Cultures

Whilst cultural/religious requirements are considered when menu planning is undertaken, a hospital cannot always provide all the foods preferred or chosen by an individual client. It is the role of the Nutrition Assistant to explain and assist the client as much as possible as to what foods and fluids are available for selection for the individual client.

Muslim Menu Planning

The following table summarises some examples of important aspects that need to be considered for planning for a Muslim menu. Please note, this information is not exhaustive.

Food Group Muslim (Halal Approved) Muslim (Haram prohibited)

Meats Beef, lamb, chicken (all must be Halal)

Pork or pork products e.g. sausages, salami, ham, bacon Non-halal meat

Seafood All seafood

Eggs All (boiled or cooked in butter or vegetable oils

Dried Beans, lentils, baked beans, tofu All

Avoid dishes that contain bacon bones, ham or stock made from avoided foods e.g. pork

Fats and Oils Mono and polyunsaturated margerine/butter Other vegetable oils e.g. olive

Avoid lard, dripping, suet and other animal fats

Fruits and vegetables All raw, dried, canned or cooked using water, vegetable fats and butter

Breads and cereals

All breads and cereals that do not contain any animal fat except butter, can use vegetable oils

Avoid cakes, biscuits with fats other than butter

Desserts

Ice-cream if Halal i.e. Halal gelatin used All without alcohol, vanilla essence, gelatin

Avoid any with alcohol, vanilla essence or gelatin, lard, dripping or suet

Drinks Water, milk, tea, coffee, juices, softdrinks, cordial, soda and mineral water

Avoid alcohol (bitters)

Milk and Milk products Milk, yoghurt, cheese, ice-cream made without animal fat e.g. Gelati and sorbet

ice cream made with animal fat or vanilla essence or non-halal gelatine


For more information refer to the Queensland Health multicultural page on the

following website www.health.qld.gov.au/multicultural

Jewish Menu Planning

Food Group Jewish approved Prohibited

Meats Beef, lamb, chicken (all must be kosher and NOT cooked with milk products)

Pork. Beef, lamb, chicken cooked with milk products

Seafood Any fish with fins Shellfish (filter feeders); rabbit, camel, birds that seize prey

Eggs Eggs without blood spots Egg with blood spots; or if contaminated with ham/bacon

Dried Beans, lentils, baked beans, tofu

All

avoid dishes that contain bacon bones, ham, or stock made from avoided foods e.g. (prawns, pork)

Fats and Oils

Mono and Polyunsaturated margarine/ butter (if it is a meat dish – use vegetable margarine) Other vegetable oils e.g. Olive, Peanut, etc.

Avoid lard, dripping and suet

Fruits and vegetables


Breads and cereals

All breakfast cereals, bread, cakes, biscuits, rice, pasta that do not contain any animal fat except butter*, can use vegetable fats

Desserts

fruit based, custards, gelati, sorbets, pudding made with vegetable margarine or butter, egg dishes, and rice dishes. Egg-based dishes (neutral – so can be consumed with either meats or milks),

Desserts made with gelatin, (pork)

Drinks Cold water, milk#, tea, coffee, juices, soft-drink, cordial Alcohol is permitted

Avoid alcohol (bitters)

Milk and Milk products

Milk, yoghurt, cheese, ice-cream made without animal fat (e.g. Gelati, Sorbet)

Any dairy products that have come in contact with meat/ utensils meat has touched. Milk and meat cannot be combined at the one meal


http://www.health.qld.gov.au/multicultural

Assisting Patients from Varying Cultures and Religions to Select Meals

• Liaise with Nursing Staff and other Health Professionals to ascertain a client’s religion or cultural preference where possible.

• Consider the cultural group and general characteristics of their cuisine during meal and menu planning.

• Liaise with the client and family members to identify cultural or religious factors or customs that may influence food choices.

• Utilise existing resources, either pictorial or specific to culture or religion, to assist the client in choosing preferred foods from the menu.

• Utilise an interpreter or family member if required to assist the client with preferred meal selection.

• Review the client and evaluate the client’s food intake and acceptance of foods provided.

• Maintain regular contact with the client and or family members to assist with food options and intake for the duration of the client’s hospital admission.

• Modify meals and menu selection where possible to accommodate the client’s religious or cultural needs – for example kosher approved foods at all times.

• When language is a barrier, make an attempt to speak to the client in a simple language to gather basic food and fluid preferences.

• Leave a bulk of blank menus for the family to complete when they visit. • Ask the Dietitian or Nursing Staff to gather some food preferences when using

interpreters with the client.


Activity 22– Cultural and Religious Menu Planning

Select a religious group that follows dietary restrictions or protocols and answer the questions below. If possible select a group that you have seen represented in the patients at your hospital.


2. Review your facility’s menu. Can you plan a one day menu for a person from the religious group you have selected from your facility’s menu?

Yes – Outline it below

No - Plan a one day menu for this person based on information in this guide

Breakfast

Lunch

Evening Meal



Activity 22 – Cultural and Religious Menu Planning continued

3. What mid-meal snacks would be appropriate for this patient?

4. How would you communicate the hospital’s suitability of menu items with regard to religion to the patient? Who would you speak to about this issue?

5. What tools or resources would you use? (Attach a copy of any sheets you would use to your workbook)

Select a religious group that follows dietary restrictions or protocols and answer the questions below. If possible select a group that you have seen represented in the patients at your hospital.



Activity 22– Cultural and Religious Menu Planning continued


7. Review your facility’s menu. Can you plan a one day menu for a person from the religious group you have selected from your facility’s menu?

Yes – Outline it below

No - Plan a one day menu for this person based on information in this guide

Breakfast

Lunch

Evening Meal


Key Points • Cultural factors may vary significantly from country to country and region to region

and also within a country. • Each cultural group may also have special food traditions; specific ways of

preparing, cooking, serving and eating food; special occasions of food celebration (feast); and times of fasting or avoidance of certain foods/drinks (e.g. Lent or Eid).

• Modern changes to the traditional diet are not always healthier, particularly when more processed western food is used which tends to be higher in saturated fat, salt and sugar.

• Education about the positive aspects of the traditional diet alongside suitable modern choices can be provided in hospital and may help improve intake during admission and on discharge.

• Personal and cultural variations make it difficult to provide definitive rules and regulations that apply to all patients that identify with a particular religion. Therefore it is best to consult a patient on an individual/personal level for religious observances.

• It is important that healthcare providers do not stereotype their clients, even if the client appears to comes from a specific group, or is perceived to have certain cultural affiliations

• Consult a patient’s individual dietary preferences/customs and religious observances.

• It is essential to be politically correct and non-discriminatory with all clients to reduce the risk of offending clients and their family members.

• Effective communication occurs when clients and carers have common terms of reference and it is the healthcare providers responsibility (within reason) to learn and use the terminology that will be used and understood by clients.

• There are a number of religious groups within Australian society who may follow particular dietary restrictions.

• There is often: – Food laws and traditions which are observed. – Variability in the level of restriction within religious groups. – Changes to food and eating behaviour as a result of feast and fasting occasions

(these may occur many times over the year).


5. Nutrition risk screening and implementation of nutrition support

This topic covers information about:

• Malnutrition • Nutrition risk screening tools and how to use them • Providing nutrition support services for at risk clients

Activities in this topic cover the following performance criteria:

• Confirm the client group for screening with a dietitian • Monitor the nutrition status of clients using standard and validated tools and

nutritional indicators • Report the progress of client nutritional status to the dietitian, and/or other health

professional according to organisational protocols and timeframes • Use the organisation’s established screening documentation to gather client

information • Consult with other appropriate staff before conducting the screening • Explain the screening purpose and process to the client and seek feedback to

determine their understanding • Conduct the screening using language appropriate to the client’s needs • Seek appropriate assistance if client participation issues arise • Use screening results to determine level of risk for clients • Inform dietitian of at risk clients in a timely manner and according to organisation

protocols • Complete screening forms and organise screening information • Select appropriate nutrition support item or services • Implement nutrition intervention and communicate with food services • Prepare nutrition support item • Use and clean any equipment according to manufacturer’s requirements • Store materials and equipment according to manufacturer’s requirements and

organisation protocols • Report equipment problems or faults to appropriate person • Use appropriate terminology to document client response to screening


Malnutrition is a state in which a deficiency of nutrients such as protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome/increases vulnerability to disease/recovery from diseases/or illness (National Collaborating Centre for Acute Care, 2006).

Risk Factors for Malnutrition

Chewing or swallowing problems:

• Poor appetite or nausea • Dementia, Depression and other Mental Health issues • Unable to shop for food and/or unable to afford food • On a special or texture modified diet • Increased nutritional requirements (e.g. burns) • Diarrhoea • Drug interactions • Forgetting to eat • Inability to feed themselves

(National Collaborating Centre for Acute Care, 2006).

Physical effects of malnutrition may be:

• Progressive weight loss – o especially muscle wasting (i.e. loss of muscle – notably at the temples,

shoulders, shoulder blades and collar bone, legs (thigh and calf)) o as well as loss of fat, especially under the eyes, over the ribs and from

the arms (triceps) • Weakness and apathy • Loss of temperature regulation • Impaired ability to regulate salt and fluid • Impaired ability to regulate periods • Increased risk of developing pressure ulcers • Reduced immune system - risk of urinary tract infection or pneumonia • Poor wound healing • Oedema (fluid status)

(Elia & Smith, 2009; Banks, Ash, Bauer & Gaskill, 2007; Detsky et al, 1987)


Malnutrition is an independent risk factor for:

• Increased complication • Increased length of stay (16.7 +24.5, median 9 days vs 10.1+11.7 days, median 6

days) • Increased mortality • Increased costs – 60% higher for meal daily expenses to 300% with treatment

costs (Correia & Waitberg, 2003)

Goals of the management of malnutrition include

• Improved nutrient intake – energy – protein – fluid

• Improved nutritional anthropometry – i.e. body weight

• Improved nutritional biochemistry • Prevention of pressure ulcers • Improved wound healing • Reduced infections and use of antibiotics • Decreased nausea, vomiting and/or diarrhoea • Improved quality of life • Improved mood • Improved physical function • Improved cognition • Improved life expectancy

(Dietitians Association of Australia, 2009)


Malnutrition Screening

Well-nourished people have adequate intake of nutrients to meet optimal body functioning. In contrast, malnutrition is a state in which a deficiency of nutrients such as energy, protein, vitamins, and minerals causes measurable adverse effects on body composition, function, or clinical outcome. It is both a cause and a consequence of ill health (National Collaborating Centre for Acute Care, 2006).

Individuals ‘At Risk’ of malnutrition are in a state in which a continued poor intake and/or increased nutritional needs will result in malnutrition. Malnutrition is serious. It was found to be present in approximately 30% of acute (hospital) patients, and 50% of more than aged-care residents, in a number of public facilities in Queensland (Banks, Ash, Bauer & Gaskill, 2007).

Studies show that prevalence of malnutrition increases as the hospital length of stay increases, and increases hospital costs (Lazarus & Hamlin, 2005) estimated between 35 – 75%. It also results in poorer patient outcomes, including pressure ulcers/injuries (Queensland Health, 2011).

Health professionals have a responsibility to be actively involved in the identification, prevention, and management of malnutrition. There are number of nutrition assessment tools, which explore weight changes/loss, dietary intake changes, symptoms of nutrition impact and physical well-being. Although tools are often used to make a complete nutritional diagnosis, other factors must also be taken into account.

These factors include dietary habits, biochemistry, the clinical condition, and other co-morbidities, along with the existence of circumstances that increase nutritional requirements, e.g. pressure areas or ulcers. A Dietitian should be able to review these factors for inclusion into the Nutrition Care Plan of relevant patients.

Review the malnutrition screening tool at this site. https://www.health.qld.gov.au/nutrition/resources/hphe_mst_pstr.pdf


https://www.health.qld.gov.au/nutrition/resources/hphe_mst_pstr.pdf

Activity 23 – Determining risks of malnutrition

Match up the reasons which may increase risk of poor intake during admission with the cause that best explains how a patient’s lifestyle, health or well-being might affect their nutrition/food intake.

Life Factors

Risk of Poor Intake

Mouth ulcers Will not eat certain menu items

Recently widowed Bored with the menu

Broken arm Unable to swallow

Stroke with dysphagia Unable to chew hard foods

Muslim/Islam or Jewish Not able to cook for themselves

Long-stay patient in a hospital Unable to feed themselves

Activity continues on the next page


Activity 23 – Determining risks of malnutrition continued

Please examine the following case study below and answer the following questions

Case Study: Young women, nausea and vomiting

Christine is a young woman who has been admitted to hospital due to nausea and vomiting. She has been having trouble keeping down solids for the past 5 days and states that food has no taste or appeal.

She has lost 7 kg in the past 3 weeks and now weighs 57 kg. She is 170cm tall. She has recently moved from Melbourne with her partner.

She is a lacto/ovo vegetarian and says she has never liked meat very much although says she used to eat fish occasionally. She enjoys the traditional Chinese cuisine her mother used to cook when she was growing up but also includes some Western style foods in her diet.

1. What is the Malnutrition Screening Score for this patient? (Fill out the table below)

Have you lost weight recently without trying?

No

Unsure

0

2

If yes, how much weight in kilograms have you lost

1-5

6-10

11-15

>15

Unsure

1

2

3

4

2

Have you been eating poorly because of a decreased appetite?

No

Yes

0

1

TOTAL


Activity continues on the next page

2. At what Malnutrition Screening Score should action be taken?

3. Describe the actions that should be taken based on this screening score and why?

4. Christine has not touched any of the food on her dinner tray. She says that the smell of the Beef Stroganoff she received made her vomit. She said she wouldn’t eat it anyway because she is vegetarian.

List two factors may be affecting Christine’s acceptance or tolerance of this meal?

One:

Two:


Remember, if a client cannot communicate it may be a sign they are at risk of

malnutrition:

The assessment of malnutrition requires a thorough evaluation by a Dietitian and is time-consuming. It can also be a difficult process as some of the data that needs to be collected is not readily or immediately available (e.g. weight measure on a bed-bound patient). To improve the ability to manage malnutrition in hospital and other facilities, reliable screening methods must be employed by trained staff on a regular basis.

The effectiveness of some Nutrition Screening Tools (NST) may be limited in that their cost-effectiveness has not been proven. In addition, they may not identify all ‘at risk’ patients and the tool may not provide consistent results. Additionally, some of the things being screened for are based on ‘clinical judgement’ and intuition rather than reproducible measures (e.g. weight, height etc.).

Common Nutrition Assessment Tools (NAT) include

Tool Use

Prognostic Nutritional Index (PNI)

Prognostic Inflammatory and

Nutritional Index (PINI)

Nutritional Risk Index (NRI)

All predict morbidity in peri-operative

patients.

Subjective Global Assessment (SGA)

Only clinical method that has been validated

as reproducible and that evaluates nutritional

status (and severity of illness).

Patient Generated Subjective Global

Assessment (PGSGA)

Patient involved in the assessment process

and the numerical scoring assists in

monitoring improvements in nutritional status

thereby proving a numerical scoring system

for triaging.


For more information on these methods review the QHEPS document

‘Validated Nutrition Assessment Tools: Comparison Guide’ (2009) developed by QLD

Health Dietitians: http://www.health.qld.gov.au/nutrition/resources/hphe_asst_tools.pdf

Some NATs are developed for specific groups of patients and may not be relevant for other groups (e.g. burns versus oncology patients). If they are used without an appropriate system for the management of malnutrition being in place, they may end up becoming complicated, time intensive, and invasive.

Malnutrition Screening in Healthcare facilities

Some health care facilities use Nutrition and Dietetic Assistants to conduct ongoing malnutrition screening (using tools such as the Malnutrition Screening Tool) for new patients. Once identified as ‘at risk’, the patient is then usually referred to the Dietitian who assesses the patient and organises Medical Nutrition Therapy as relevant. At other healthcare facilities, nursing staff are required to screen new patients for malnutrition.

Consider the following questions:

• What system of Malnutrition Screening exists in your facility? • Who performs this screening process? • How frequently are these patients reviewed for malnutrition during admission? • Is the Dietitian involved with high-risk patients? If so, what process or tool/s do

they use for their assessment?

Malnutrition Screening Tool (MST)

This screening tool is commonly used in many Queensland Health Care facilities and is advantageous in that it:

• can be used in a mixed group of adult patients • uses data that is routinely available • is convenient to use; simple, quick and easy if performed by non-professional

staff, patients or family • does not require blood test results and therefore is inexpensive • is valid and reproducible (i.e. the same results can be obtained when a different

person uses the tool)

It is recommended that screening should be performed within 24 hours of hospital admission using the MST (Ferguson, Capra, Bauer, & Banks, 1999).


http://www.health.qld.gov.au/nutrition/resources/hphe_asst_tools.pdf

The following is an example of the script that is used to implement the MST at one healthcare facility.

Begin by introducing yourself to the patient:

‘Hello, I’m ________ from the ___________ department. I am conducting a simple

nutrition screen, do you mind if I ask you a couple of questions about your weight and

appetite?’

There are only three questions.

Have you been eating poorly because of a decreased appetite? Yes

No

1

0

Have you lost weight recently without trying?

(recently can be defined as the last six months)

Yes

No

Unsure

1

0

2

If yes, how much weight have you lost?

(in kilograms)

1.0 – 5.0

6.0 – 10.0

11.0 – 15.0

15.0

Unsure

1

2

3

4

2

Total Score:

For weight conversion: 1 kilogram = 2.2 pounds and 1 pound = 0.45 kilograms

Action required depending on the MST score

This will be different in different institutions and will be determined by the Dietitian.

MST Score 0 – 1 Re-screen every 7 days

MST Score 2

Provide either selective mid-meals or Flavoured Milk (e.g.

‘Breaka’) at lunch and tea (or other type of extra)

Provide high protein menu

Intensive mealtime monitoring

MST Score 3 – 5

Provide selective mid-meals

Provide extras at lunch and tea

Provide high protein menu

Intensive mealtime monitoring


An advantage of using the scoring system is that patients can be seen in order of priority e.g., patients with a higher score will require attention that is more urgent. The action taken by the Dietitian may be different for different wards/units. Check what procedure is in place at your institution.

What Dietitians do with the MST:

• For all positive screens >/=2 - 3 → A comprehensive nutritional assessment is completed

• Aim to see by next working day / <48 hours if over weekend

• Priority determined by score of MST – higher scores seen first which shows the importance of all 3 questions being asked.

Patient Generated Subjective Global Assessment (PGSGA)

• Identifies patients at nutritional risk

• Measures nutritional status

• Can track changes in nutritional status over time

• Focuses on nutrition impacting symptoms (i.e. nausea, early satiety, etc.) → able to tailor nutrition recommendations


Common eating problems that patients may experience that may lead to poor food intake and malnutrition include:

Problem Things that can help

Unable to self-feed Open containers, cut up food, organise finger foods or food in a bowl

Drowsy Speech Pathology assessment and medication assessment with the Doctor and Pharmacist

Problems Swallowing Speech Pathology assessment

Difficulty chewing Softer diet

Poorly fitted dentures Softer diet

Poor Appetite/satiety Smaller meals offered more often

Offer only nutritionally dense foods versus non-nutritious drinks such as tea or coffee

Sore throat or mouth

Softer diet or liquid diet

Avoid very hot and very cold foods

Avoid acidic or spicy foods that sting avoid rough or course foods

Nausea and vomiting Smaller frequent meals

Sip cold clear fluids in between meals

Dry or coated mouth

Suggest moist foods like casseroles or soups

Provide gravy, sauces or spreads to moisten food

Provide drinks to sip through meals dunk bread, toast, biscuits in soup, milk, tea, coffee

Loss or alteration of taste

Cold protein foods may be better than hot ones

Sweeter protein foods

Utilise a straw to bypass taste buds


Providing a high energy and protein diet assists clients with eating problems to meet nutritional requirements.

This can be achieved by:

• Providing a special high energy/high protein diet rather than the general/standard diet

• Making sure that the patient is selecting a sufficient quantity of food

• Encouraging the patient to select energy and protein-rich choices from the menu

• Providing extra foods at meals

• Providing high-energy/protein mid-meals

• Providing tube feeds in addition to meals

Nutrition Assistants may be directed by the Dietitian to discuss these options with patients and implement one or more the strategies.

It is important to understand the nutritional value of the ‘supplemental’ foods and drinks available in the health facility. Patient acceptability and supplement cost should also be taken into account.

Every-day food items commonly used as nutritional supplements include:

• Dairy desserts, custards, yoghurts, ice cream

• Flavoured or fortified milks or milkshakes such as ‘Breakas’ or ‘Milo’

• Crackers with cheese

• Chocolates, chips

• Muffins, cakes, biscuits

Clients will develop taste-fatigue if provided with the same supplement and flavours all the time. Some tips for assisting the client maintain an intake of high protein/high energy foods may include:

• Offer the ‘best’ choice first (e.g. highest protein)

– This will contribute most to nutritional status

– Exchange to similar or lesser choices if necessary

• Ability to select

– Best to show the patient the items that are available for selection e.g. Selective mid-meals/displayed on trolley/brochure with options

– Limit choice to 3 to 4 items. More can overwhelm.


• Choices consistent with Nutrition Care Plan (NCP)

– Dietitian may prescribe a particular nutrition supplement that is not interchangeable

– Nutrition Assistant needs to be aware of the NCP


Activity 24– Ranking Protein and Energy in Certain Foods

Using the list provided, rank the following mid-meal snacks in order of protein content and then do the same for energy content.

Mid-Meal Snack Protein Ranking Energy Ranking

Sustagen Drink

Breaka drink

Jatz and cheese

Soft drink

1 piece of fresh fruit


Types of commercial supplements:

• Milk based, vitamin and mineral fortified e.g. Sustagen, Nutridrink, Fortisip

• Soy based, vitamin and mineral fortified e.g. Resource plus, Ensure

• Clear fluid, vitamin and mineral fortified e.g. Enlive plus, Fortijuice

• Vitamin and mineral fortified puddings e.g. Forticreme

Patients require a choice of different supplements:

• Patients become tired of the same supplements and flavours if they are not provide with some variety

• Sometimes a particular supplement item is required to meet the specific therapeutic diet needs of the patient e.g. novasource renal for renal patients for clinical reasons

• Offering too many choices can be overwhelming; three (3) to four (4) is sufficient and these can be rotated on a delivery schedule

• Offer the best choice (e.g. highest protein) first because this is more likely to be selected

• Where possible show the patient the items that are available for selections e.g. Displayed in a basket or on a trolley

• Queensland Health Hospitals provide supplements as negotiated on state-wide tender

The Dietitian should be informed:

If the patient is not happy with the supplement ordered by the Dietitian and changes to supplements that have been provided by the Nutrition Assistant. They should also be informed of the reasons for the change

Refusal of the supplemental foods and fluids especially when there is a pattern of refusal or a build-up of supplements at the bedside or wastage of supplements

Documenting your involvement, in a timely manner, of anything from a Malnutrition Screening Tool result, to involvement in education sessions or communication about a patient’s food/fluid intake, or understanding of a nutrition principle protects you as an employee, by providing evidence of what was said/found and when.


When to provide nutrition education feedback to the Dietitian:

Always - if there are concerns or questions arising from the information presented (e.g. does the patient/carer not seem to understand the significance of the advice presented such as issues of safety in enteral feeding or measuring the correct quantity of thickener)

If the patient seems to be disinterested or unable to take in the education provided

If the education is not completed and follow-up appointments need to be arranged

If other staff requested subsequent assessment of the patient

If the patient or any staff asks for an explanation of the rationale, risks and options of Nutrition and Dietetic Care or Services

If the patient reveals they are unlikely to follow the advice you have explained or it conflicts with something s/he has been told by another member of staff or their religion/cultural or social belief system; and

Before education - feedback if it is obvious that additional information has become available that will require interpretation and may impact the advice given (e.g. new blood test results or diagnoses)


Activity 25 – Monitoring Nutrition Support

Read the Case Study below and answer the questions that follow.

1. Please list two factors that may affect Lucia’s acceptance or tolerance of meals:

One:

Two:

2. When you are collecting the patient’s menus, you notice that Lucia’s menu has been left blank. When you talk to Lucia she tells you that she cannot read English so is unable to fill in the menu. What would you do? (List two possible solutions)

One:

Two:


Case Study: Woman, 78 years, NESB, recent stroke.

Lucia is a 78 year old woman born in Italy who immigrated to Australia with her husband and five children after World War II. She was admitted to the rehabilitation unit after suffering a stroke. The stroke has left her with right sided paralysis. Lucia says she was eating well before the stroke. She does not think her weight has changed because her clothes fit about the same. She currently weighs 85kg and is 152cm tall.

She tells you she loves to cook traditional Italian dishes for herself and her family. She was diagnosed with Type II diabetes about twenty years ago.


Activity 25 – Monitoring Nutrition Support continued

3. List three issues that might affect Lucia’s ability to meet her nutritional requirements during her hospital admission. Then list how you might address this in your role as Nutrition and Dietetic Assistant.

Issue that may affect intake How this might be addressed

4. On the following pages is a record showing the types and amounts of food and drink consumed by Lucia over the past 48 hours. Study the record carefully and then answer the proceeding questions.


Food and Fluid Intake Record Day: Wednesday Patient: Lucia

Breakfast

Type or Other Items

Consumed (please circle) Pro kJ

Official use only

Comments

Juice thickened None ¼ ½ ¾ All

Fruit - None ¼ ½ ¾ All

Cereal porridge None ¼ ½ ¾ All

Yoghurt Fruit yoghurt None ¼ ½ ¾ All

Bread - None ¼ ½ ¾ All

Drink Thickened milk None ¼ ½ ¾ All

Supplement - None ¼ ½ ¾ All

Morning Tea

Food - None ¼ ½ ¾ All

Drink - None ¼ ½ ¾ All

Supplement thick shake None ¼ ½ ¾ All

Lunch

Soup - None ¼ ½ ¾ All

Meat Vitamised meat None ¼ ½ ¾ All

Vegetables Mashed potato None ¼ ½ ¾ All

Sandwich - None ¼ ½ ¾ All



Dessert Puree fruit and custard None ¼ ½ ¾ All

Drink thick cordial None ¼ ½ ¾ All


Afternoon Tea

Food None ¼ ½ ¾ All

Drink thick shake None ¼ ½ ¾ All


Supplement None ¼ ½ ¾ All

Dinner

Soup None ¼ ½ ¾ All


Vegetables potato and carrot None ¼ ½ ¾ All

Sandwich None ¼ ½ ¾ All

Bread None ¼ ½ ¾ All

Fruit Puree fruit None ¼ ½ ¾ All

Dessert None ¼ ½ ¾ All

Drink thick juice None ¼ ½ ¾ All


Supper

Food None ¼ ½ ¾ All




Food and Fluid Intake Record Day: Thursday Patient: Lucia

Breakfast

Type or Other Items

Consumed (please circle) Pro kJ

Official use only

Comments

Juice thickened None ¼ ½ ¾ All


Cereal porridge None ¼ ½ ¾ All

Yoghurt fruit None ¼ ½ ¾ All




Morning Tea



Supplement thick shake None ¼ ½ ¾ All

Lunch



Vegetables mashed potato None ¼ ½ ¾ All




Dessert custard None ¼ ½ ¾ All

Drink thick cordial None ¼ ½ ¾ All



Afternoon Tea


Drink thick shake None ¼ ½ ¾ All asleep


Dinner



Vegetables potato and carrot None ¼ ½ ¾ All



Fruit Puree fruit None ¼ ½ ¾ All

Dessert - None ¼ ½ ¾ All

Drink thick juice None ¼ ½ ¾ All


Supper




Activity continued on the next page



Answer the following questions in relation to the above Food and Fluid Intake Records for Lucia

4. Does the intake record indicate that Lucia is:

a) eating well and probably meeting her nutritional and fluid requirements

b) not eating as well as she could, but nothing to me too concerned about

c) not eating or drinking well and could be dehydrated

d) none of the above

5. The correct action to take would be to:

a) stop monitoring her intake because her intake is satisfactory

b) continue to monitor her intake

c) tell the Dietitian or other relevant person that Lucia is not eating and drinking well

d) none of the above

6. Give two possible reasons why Lucia may not be eating very well:

One:

Two:

7. List two suggestions you have that may help Lucia

One:

Two:

Activity continued on the next page



8. Based on the Food and Fluid Intake Chart are there any foods or fluids that Lucia appears to prefer over other options?


Activity 26 – Delivery of Nutrition Support

Please answer the following questions about the delivery of nutrition support items

1. List two pieces of information that are required for the preparation and/or delivery of nutrition support items.

One:

Two:

2. How do you ensure that only nutrition support items that are within their use-by dates are given to patients?

3. What do you do when you find out-of-date nutrition support items?



Activity 26 – Delivery of Nutrition Support

4. Ron’s nurse suggests you look in the bottom drawer of his bed-side table. When you do so you find a stash of vanilla flavoured unopened nutrition support items and you notice a range of flavoured drinks have been ordered for the patient. You also notice an array of half eaten supplements both food and fluid over his meal tray and side table. What would you do in this situation?

5. .On your nutrition support delivery, a patient tells you that he is going home tomorrow. He says he has been enjoying the protein fruit drinks he has been receiving while in hospital and would like to know where he can get them when he goes back to the hostel. What would you tell Jack?


Activity 27 – Provision of Nutrition Support

Read the Case Study below and answer the questions that follow.

Case Study: Woman, 79 years, fractured NOF after fall

Edna is a 79 year-old lady who was admitted to the ward last week after tripping over her cat and falling heavily. She suffered a fractured neck of femur (#NOF) when she fell. Edna lives in her own home with her 81 year-old husband who has Type II diabetes. Edna is her husband’s carer as he has almost completely lost his sight. Meals on wheels has been organised for him while Edna is in hospital and services will go in daily to shower and dress him. Edna is worried about her husband and anxious about who will feed her cat.

None of Edna’s children live close enough to assist them with daily activities. Edna and her husband receive support from members of their local church who assist them with cleaning and shopping.

At home Edna usually cooks lunch of meat and 3 vegetables for herself and her husband and has black tea and toast for tea. She has plain sweet biscuits for morning and afternoon tea. Edna weighs 44kg, is 154cm tall and has dentures, but they are loose so she prefers not to wear them.

You perform a malnutrition screening on Edna, which reveals the following:

Have you lost weight recently without trying? No Unsure

0 2

If yes, how much weight in kilograms have you lost 1-5 6-10 11-15 >15 Unsure

1 2 3 4 2

Have you been eating poorly because of a decreased appetite? No Yes

0 1

TOTAL 3



Activity 27 – Provision of Nutrition Support Continued

Please answer the following questions

1. Is Edna is at risk of malnutrition? Yes No

Why/ Why not? (Provide at least two reasons)

One:

Two:

2. List two factors that may affect Edna’s acceptance or tolerance of her meals?

One:

Two:

3. The Dietitian has requested that Edna receive a high protein high energy diet during her admission. When collecting the lunch orders you notice that Edna has ordered a salad.

a) Is this an appropriate choice? Yes No

Why/ Why not?




b) What would you say to Edna?

4. Would you provide feedback to the Dietitian if Edna’s food intake remains low or if her selection of foods at meal times is not in line with a high protein/energy diet?

a) Yes No

Why/ Why not?

5. During her admission Edna develops an MRSA infection and is in isolation. What visual cues would there be outside Edna’s room to alert you to the fact that she is in isolation?




6. What contact precautions are necessary? (List at least two)

One:

Two:

7. What special precautions would be necessary before you entered Edna’s room?


Key Points

Malnutrition

• is a state in which a deficiency of nutrients such as protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome/increases vulnerability to disease/recovery from diseases/or illness (National Collaborating Centre for Acute Care, 2006).

• Risk factors for malnutrition can include a variety of functional e.g. chewing or swallowing, and physical e.g. weight loss, incapacities that render the person unable to eat or drink sufficiently to meet their energy and nutrient requirements.

• Malnutrition is an independent risk factor for increased complications, length of stay, mortality and costs of treatment.

Malnutrition Screening

• Use of a validated malnutrition screening tool on admission and repeated weekly, identifies clients at risk of malnutrition.

• Implementing nutrition support as per organisational protocols as early as possible will help to correct the malnutrition.

• Referring at risk clients to a dietitian for malnutrition assessment as per the screening protocol will assist the dietitian to focus on the most at risk clients and to develop a Nutrition Care (Individualised) Plan as and if required.

Nutrition Support

• Nutrition support can range from ordering the client a high protein high energy diet, arranging higher energy and protein mid-meals, providing specialised supplements to the patient being started on enteral or parenteral support by the dietitian or medical team.

• If you are asked to prepare nutrition support items for the client, ensure you follow the correct procedures and protocols.

Monitoring Nutrition Support

• Regardless of the type of nutrition support, it is important to review the client’s progress and report this to the dietitian according to your organisations protocols. This may involve filling out a food and fluid chart or checking supplement wastage or preferences with the client.

Reporting on Client Tolerance of Nutrition Support

• Always feedback to the dietitian or other appropriate health professional, the client’s tolerance of or any issues that arise with providing the client with nutrition support.

• Document all progress in the client’s progress notes or medical chart according to organisational protocols.


Self-Completion Checklist Congratulations, you have completed the topics for:

HLTAHA018 Assist with planning and evaluating meals and menus to meet recommended dietary guidelines.

HLTAHA019 Assist with monitoring and modification of meals and menus according to individualised plans

HLTAHA020 Support food services in menu and meal order processing

HLTAHA021 Assist with the screening and implementation of therapeutic diets.

Please review the following list of knowledge and performance criteria for the units of competency you have just completed. Indicate by ticking the box if you believe that you have covered this information and that you are ready to undertake assessment.

Essential Knowledge Covered in topic

Organisation policy and procedures in relation to infection control as it relates to the AHA role assisting with foodservices and menu and meal planning, food, nutrition and special food guidelines

� Yes

Specific organisation policies or procedures relating to supervisory and reporting protocols � Yes

Feedback processes or systems used within the organisation

� Yes

Legal and ethical considerations in relation to privacy, confidentiality and disclosure

relevant to allied health � Yes

Legal and ethical considerations in relation to work health and safety - manual handling including identification and control of manual task risk factors

� Yes

Safe food handling � Yes



Australian Dietary Guidelines and other relevant organisational food, nutrition and special diet guidelines

� Yes

Principles of nutrition, diet therapy, nutrition supplements and factors that place clients at risk of malnutrition and inadequate hydration � Yes

Aspects of physical and mental conditions, which might affect a client’s ability

to eat and/or feed oneself, including

• Arthritis • Broken bones • Confusion • Pain • Poor dentition • Pressure injuries • Recovery from stroke • Swallowing problems

� Yes

Principles of the impact of diet on

• health, • fluid intake, • rehabilitation and • an individualised plan

� Yes

How to recognise malnutrition � Yes Workings and protocols of the food service system including: • range of menus and menu items and different types of menu management

systems • Food preparation and food service systems • Cooking methods and equipment • Standardised recipes • Costing (portion size, mathematics) procedures

� Yes

Common fluids and food restrictions � Yes



Oral nutrition support products (supplements), their equivalents and enteral feeds and their use � Yes

Inter-relationships between food services and nutrition services/dietary departments concerning menu/meal order processing procedures, food production and delivery

� Yes

Special diets and their importance to a client’s health including: • Texture modified diets (TMDs) and national standards for TMD • High energy, high protein • Modified salt, protein or potassium • Diets for food intolerances including gluten free, fructose malabsorption

(FODMAPS), and lactose free

� Yes

Various cultural and religious requirements in relation to food, relevant to the profile of the community served by the organisation including halal, types of vegetarianism, kosher

� Yes

Organisation policies and procedures in relation to screening and assessment

� Yes

Significance of nutritional risk indicators, including weight loss, weight gain, appetite, bowel function, biochemical indicators, allergies and intolerances, swallowing issues

� Yes

Essential Performance Criteria Covered in topic

Comply with personal hygiene requirements of food safety program � Yes

Wear clothing and footwear appropriate for food handling tasks and according to the food safety plan � Yes

Report health conditions and/or illness according to the food safety program � Yes

Identify and report processes and practices that are not consistent with the food safety program � Yes

Take corrective action according to the food safety program and within level of responsibility � Yes

Prepare, supply and deliver nutrition supplements according to organisation � Yes



procedures and dietitian’s instructions and provide support services according to the food safety program

Discard out of date nutrition support items and information � Yes

Report any significant wastage to the appropriate personnel in accordance with role and organisation requirements � Yes

Maintain the workplace in a clean and tidy order to meet workplace standards � Yes

Provide feedback to the dietitian regarding client progress � Yes

Seek assistance when client presents with needs or signs outside limits of own authority or competence � Yes

Use accepted protocols to report information in line with organisation requirements � Yes

Maintain client records according to organisation requirements � Yes

Use organisation’s established screening documentation to gather client information � Yes

Categorise foods according to food groups, identifying key nutrients by each food group and individual foods within that group � Yes

Identify recommended serves of various food groups for client groups, in consultation with a dietitian � Yes

Identify the conditions commonly encountered by the client group requiring an individualised plan or dietary modification � Yes

Identify dietary factors associated with common lifestyle diseases and/or diet related chronic diseases and other nutrition-related conditions, food intolerances, allergies

� Yes

Identify special nutritional and dietary needs encountered by the client group � Yes

Report dietary and nutrition issues and needs to the dietitian � Yes

Consult with dietitian to address the identified risks and needs of client groups � Yes

Report the acceptability, tolerance and consumption of meals by the client to the dietitian or relevant health professional � Yes



Identify problems which may affect the client’s ability to eat or dinrk to the dietitian and/or other relevant health professional, according to organisation policies and procedures

� Yes

Provide feedback on consistently poor client meal choices to the dietitian � Yes

Follow systems designed by a dietitian to monitor and document on client nutritional status � Yes

Distribute menus to clients, or use meal order systems, according to established routines and procedures � Yes

Provide guidance to client, to ensure that meal choices are consistent with the individualised plan � Yes

Provide all assistance according to the instruction of dietitian and the individualised plan � Yes

Collect menus and/or meal orders and assist clients with placing orders and marking menus as appropriate in line with role � Yes

Distribute and collect menus for clients receiving diet or nutrition care according to established routines and procedures � Yes

Record and provide feedback regarding food preferences and consistently poor menu and/or meal choices to the appropriate person � Yes

Report client difficulties and concerns to the dietitian � Yes

Implement variations to the individualised plan under the direction of the dietitian � Yes

Collate menus and meal orders, including orders for clients receiving diet therapy or nutrition support � Yes

Provide information to support the delivery of menu items chosen by the client, according to established routines and procedures � Yes

Check meal orders for accuracy against the individualised plan developed by a dietitian, or other health professional � Yes

Tally, collate and report menu items � Yes

Maintain knowledge of client admissions, transfers and discharges � Yes



Process meal orders for food services � Yes

Provide information to support the delivery of chosen menu items to the food service within the required time frame � Yes

Provide feedback about changes to, needs, food preferences and individualised plan to food services and to dietitian � Yes

Plan menus according to menu planning principles � Yes

Select food preparation and cooking methods in consultation with food production personnel to maintain maximum nutritional value of foods � Yes

Plan meals and menus to minimise nutrient imbalance, incorporating relevant dietary guidelines � Yes

Plan meals and food group serves to meet the nutritional needs of individuals within client groups � Yes

Discuss and confirm menu plans with the dietitian � Yes

Follow processes defined by dietitian to evaluate meals and menus to ensure they meet nutritional requirements of client groups � Yes

Follow processes defined by dietitian to evaluate meals and menus to ensure client satisfaction

� Yes

Evaluate meals and menus to ensure feasibility of production in relation to equipment, time and skills as well as budgetary constraints � Yes

Make adjustments to menu according to findings and the dietitian’s directions � Yes

Modify meals and menus to meet the nutritional and dietary needs of the client group using relevant guidelines � Yes

Assess meals and menus for their suitability for texture modification to meet special nutritional and dietary needs, using relevant guidelines � Yes

Incorporate sufficient choices of dishes and drinks in to menus for special needs, using relevant guidelines � Yes

Provide information regarding individualised plan to client when appropriate and as directed by dietitian or relevant health professional � Yes

Monitor the nutrition status of clients using standard and validated tools and � Yes



nutritional indicators

Report the progress of client nutritional status to the dietitian, and/or other health professional according to organisational protocols and timeframes � Yes

Collect client satisfaction, using standard and validated tools � Yes

Regularly monitor overall levels and changes in client satisfaction � Yes

Provide feedback regarding overall levels and changes in levels of satisfaction to the appropriate person � Yes

Use relevant feedback from clients to revise menus � Yes

Identify client group, use correct terminology and observe cultural customs � Yes

Consider cultural groups and general characteristics of their cuisine � Yes

Identify dietary regimes and factors associated with cultural and religious groups that may influence food choices � Yes

Plan and modify meals and menus to meet specific cultural and religious needs of client group in line with organisational guidelines � Yes

Follow processes defined by dietitian to evaluate meals and menus to ensure they meet cultural and religious needs of the clients � Yes

Confirm the client group for screening with a dietitian � Yes

Monitor the nutrition status of clients using standard and validated tools and nutritional indicators � Yes

Report the progress of client nutritional status to the dietitian, and/or other health professional according to organisational protocols and timeframes � Yes

Use the organisation’s established screening documentation to gather client information � Yes

Consult with other appropriate staff before conducting the screening � Yes

Explain the screening purpose and process to the client and seek feedback to determine their understanding � Yes

Conduct the screening using language appropriate to the client’s needs � Yes



Seek appropriate assistance if client participation issues arise � Yes

Use screening results to determine level of risk for clients � Yes

Inform dietitian of at risk clients in a timely manner and according to organisation protocols � Yes

Complete screening forms and organise screening information � Yes

Select appropriate nutrition support item or services � Yes

Implement nutrition intervention and communicate with food services � Yes

Prepare nutrition support item � Yes

Use and clean any equipment according to manufacturer’s requirements � Yes

Store materials and equipment according to manufacturer’s requirements and organisation protocols � Yes

Report equipment problems or faults to appropriate person � Yes

Use appropriate terminology to document client response to screening � Yes


Workplace Observation Checklist Workplace Supervisor to date and sign

Essential Skills and Knowledge The learner demonstrates the following skills and knowledge:

1st observation date and

initial

2nd observation date and

initial Comments *FER

Appropriate level of knowledge to deliver nutrition support services to client groups (019:1.1)(019:1.2)(019:1.3)(019:1.4)(019:2.2)(019:2.3)(019:2.4)(018:1.1)(018:1.2)(018:2.1)(018:2.2)(018:2.3)(018:2.4)(018:3.1)(018:3.2)(018:3.3)(018:3.4)(018:EK)(019:EK)(EK:020)(EK:021)

Has a sound knowledge of food, nutrients, serve sizes appropriate for the clients and can assess and modify meals and menus to meet the nutritional and dietary needs of the client group using appropriate guidelines including for those with common lifestyle related conditions.

Has an understanding of the Australian Dietary Guidelines and other relevant Guidelines used in the organisation and how to apply them appropriately to the conditions commonly encountered by the organisations clients that require a Nutrition (individualised) Care Plan or dietary modification

Has an appropriate level of knowledge of various cultural groups common to the client profile including using correct terminology, observing common customs as appropriate, and understands and applies requirements in relation to food, meals and menus to meet specific cultural and religious needs for the clients.

Has an appropriate level of knowledge of principles of the impact of diet on health including fluid intake, and health on dietary intake including arthritis, broken bones, pain, confusion, poor dentition, pressure sores, recovery from stroke, swallowing problems and rehabilitation.




initial



Has an appropriate knowledge of therapeutic diets and their importance to a client’s health including but not limited to , texture modified diets and national standardised language for these, high energy and protein, modified salt, protein and potassium, allergy and intolerance diets.

An appropriate knowledge of the food service system including usual cooking and preparation methods and equipment and their influence on nutrition, the range of menus and menu items, the use of standardised and costed recipes and different types of menu management systems.

Has an awareness of the significance of nutritional risk indicators and can report on these as appropriate including: weight loss/gain, appetite, bowel function, biochemical indicators, allergies and intolerances and swallowing issues.

Has an appropriate knowledge of supplements and supplement equivalents used in the organisation.

Can evaluate Meals and Menus to meet client nutritional requirements (018:4.1)(018:4.2)(018:4.3)(018:4.4)(018:4.5)(018:2.5)

Follows dietitian approved processes and protocols to evaluate meal and menus to ensure they meet client’s nutritional, cultural and are feasible according to the organisations resources.

Can make adjustment to meals or menus according to findings and following dietitian’s directions to meet the client requirements to their satisfaction within the organisations resources.

Discusses and confirms meal and menu plans with the dietitian as appropriate.




initial



Distributing, collecting menus from clients (020:1.1) (020:1.4)(020:1.5) (020:5.1)

Update admissions, transfers, discharges and distributes correct menu to patients, or uses meal order system, according to established routines and procedures.

Collect menus and/or meal orders.

Providing guidance and assistance to clients when they are completing their menu (020:1.2)(020:2.2)(020:1.3)(020:5.2)(018:EK)

Access policies, procedures, work procedures and special dietary resources within the workplace

Provide guidance (if required) to clients to ensure meal choices are consistent with Nutrition (individualised) Care Plan

Provide assistance (if required) to clients with marking menus or placing meal orders

Provide information to support the delivery of menu items chosen by the client, according to established routines and procedures

Recording and checking client food preferences and meal orders for accuracy (020:1.6)(019:3.1)(019:2.4) (020:2.3)

Record and respond to client food preferences according to workplace procedures

Can incorporate sufficient choices into menus for special needs using relevant guidelines

Routinely check meal orders for accuracy to ensure choices are consistent with the Nutrition




initial



(individualise) Care Plan.

Providing feedback to Dietitian or other relevant Health Professional on consistently poor client food choices, and consumption and acceptability of meals (020:1.6) (019:3.2)(019:3.4)

Provide feedback to the Dietitian if consistently poor food choices are made by the client

Provide feedback to the Dietitian on poor acceptance/tolerance of food by the client

Collating, tallying and reporting meal orders and special meals to Food Services (020:2.4)(020:2.1)(020:2.2)(020:5.2)(020:5.3)(019:3.1)

Tally, collate and report menu items to Food Services according to established routines and procedures

Provide Food Services with diet order information, including needs, changes and food preferences within designated time frames

Provide feedback about changes to , needs, food preferences and Nutrition (individualised) plan to dietitian.

Monitors client satisfaction with foodservices according to organisational requirements (0202:6.1)(020:6.2)(020:6.3)(020:6.4)

Collects client satisfaction using standardised and validated tools according to organisational protocols

Regularly monitors ad hoc client satisfaction and reports to the appropriate person/s according to organisational protocols

Preparing and delivering nutrition support/ menu items (020:4.1),(021:3.1) (021:3.2)(020:3.3)(020:3.4)(021:5.1)(021:5.2)(021:5.3)

Select and prepare and deliver appropriate nutrition support item or service according to organisations procedures and dietitian’s instructions

Implement nutrition intervention and communicate with foodservices as




initial



appropriate

Routinely check nutrition support items and discard out-of-date nutrition support items

Report any significant wastage to the appropriate personnel in accordance with role and organisation requirements

Maintain the workplace in a clean and tidy order to meet workplace standards

Use, clean and store materials and equipment according to manufacturer’s requirements and organisation protocols

Report any equipment or material issues to appropriate person

Monitor and report on client status and acceptance of Nutritional (individualised) Care Plan (019:1.5)(019:3.4)(019:3.5)(019:3.7)(019:3.6)(019:2.1)(019:3.3)

Follow systems designed by a dietitian to monitor, document and report on progress of client nutritional status or nutrition and dietary issues to dietitian and/or other HP

Use validated tools and nutrition indicators to monitor the nutrition status of client eg. weight, height, food and fluid intake charts

Consults with dietitian to address the identified risks and needs of client groups and identifies problems which may affect the client’s ability to eat or drink and reports these to the dietitian or other relevant HPs

Assists with nutrition risk screening and providing nutrition support to at risk clients (021:1.1) (021:1.2) (021:1.3)(021:1.4)(021:2.1)(021:2.2)(021:2.3)(021:2.4)(021:3.1)(021:3.2)(021:3.3)(021:4.3)(021:4.6)(021:6.2)

Carries out nutrition risk screening including rescreening appropriately according to organisation protocols




initial



Identify clients at nutrition risk, reports to appropriate staff and/or records these results utilising organisational protocols

Implements appropriate nutrition support for at risk clients according to dietitian or organisation protocol

Seeks client feedback about tolerance of nutrition support intervention and implements variations according to dietitian’s directions or organisational protocols

Communicates effectively to complete allocated tasks (21:1.1)(021:1.3)(021:1.4)(021:1.5)(021:2.2)_(021:3.2)(021:4.1)(021:4.5)(021:6.1)(021:6.3)

Communicates with staff and clients in a helpful and polite manner according to organisation policies and protocols

Uses appropriate oral (clear and concise) and written language for the audience

Provides all assistance to the client according to the dietitians instruction or the Nutrition Care (Individualised) Plan or organisational protocols

Seeks clarification or assistance where required, or where client participation issues arise.

Access information from internal and external sources to solve routine problems

Documents and maintains client records according to organisation




initial



requirements and protocols.

Comply with Organisational Policies and Procedures to Ensure Safety Work Practices(020:4.4)(020:4.2)(020:4.3)(020:4.5)(020:4.6)(021:1.6)(021:4.4)(021:4.5)(019:2.5)(020:EK)

Treat clients and colleagues in accordance with the Qld Health Code of Conduct

Complies with infection control processes and procedures

Complies with personal hygiene standards and food safety program

Identifies and reports processes and practices that are not consistent with the food safety program and takes corrective action as appropriate

Complies with legal and ethical considerations relevant to allied health including but not limited to, privacy, confidentiality and disclosure

Complies with work health and safety requirements

Complies with AHA scope of practice including complying with supervisory requirements such as seeking assistance when is presented with a client or situation outside limits of authority or competence

*FER – Further Evidence Required


Appendices


Appendix A: HLT43015 Certificate IV in Allied Health Assistance Qualification HLT43015 Certificate IV in Allied Health Assistance

This qualification covers workers who provide therapeutic and program related support to Allied Health Professionals. The worker is required to conduct therapeutic and program-related activities under the guidance of an Allied Health Professional. Supervision may be direct, indirect or remote and must occur within organisation requirements. The worker is required to identify client circumstances that need additional input from the Allied Health Professional.

This qualification is suited to Australian Apprenticeship pathways.

Occupational titles for these workers may include:

3) Therapy Assistant 4) Podiatry Assistant

5) Physiotherapy Assistant 6) Speech Pathology Assistant

7) Occupational Therapy Assistant 8) Allied Health Assistant

9) Nutrition Assistant 10) Dietetic Assistant

11) Community Rehabilitation Assistant

The importance of culturally aware and respectful practice

All workers undertaking work in health need foundation knowledge to inform their work with Aboriginal and/or Torres Strait Islander clients and co-workers and with clients and co-workers from culturally and linguistically diverse backgrounds. This foundation must be provided and assessed as part of a holistic approach to delivery and assessment of this qualification. Specific guidelines for assessment of this aspect of competency are provided in the Assessment Guidelines for the Health Training Package.


PACKAGING RULES

16 units of competency are required for award of this qualification, including:

• 7 core units

• 9 elective units

A wide range of electives is available and can be packaged to provide either:

– a generic qualification that covers a range of work functions, or

– a qualification tailored to address specific workplace requirements

Packaging for each specialisation:

• All Group A electives must be selected for award of the Certificate IV in Allied Health Assistance (Physiotherapy)

• All Group B electives must be selected for award of the Certificate IV in Allied Health Assistance (Podiatry)

• All Group C electives must be selected for award of the Certificate IV in Allied Health Assistance (Occupational therapy)

• All Group D electives must be selected for award of the Certificate IV in Allied Health Assistance (Speech pathology)

• All Group E electives must be selected for award of the Certificate IV in Allied Health Assistance (Community rehabilitation)

• All Group F electives must be selected for award of the Certificate IV in Allied Health Assistance (Nutrition and dietetics)

Core units

CHCCOM005 Communicate and work in health or community services

CHCDIV001 Work with diverse people

CHCLEG003 Manage legal and ethical compliance

HLTAAP001 Recognise healthy body systems

HLTAAP002 Confirm physical health status

HLTWHS002 Follow safe work practices for direct client care

BSBMED301 Interpret and apply medical terminology appropriately


• Where 2 (or more) specialisations are completed, award of the qualification would read, for example, Certificate IV in Allied Health Assistance (Physiotherapy, Occupational Therapy)

• All electives chosen must contribute to a valid, industry-supported vocational outcome.

Elective units

Group A electives – PHYSIOTHERAPY specialisation

HLTAHA003 Deliver and monitor a client-specific physiotherapy program

HLTAHA005 Support the delivery and monitoring of physiotherapy programs for mobility

Group B electives – PODIATRY specialisation

HLTAHA006 Assist with basic foot hygiene

HLTAHA007 Assist with podiatric procedures

HLTAHA008 Assist with podiatry assessment and exercise

Group C electives – OCCUPATIONAL THERAPY specialisation

HLTAHA010 Assist with the development and maintenance of client functional status

HLTAHA016 Support the fitting of assistive equipment

Group D electives – SPEECH PATHOLOGY specialisation

HLTAHA012 Support the development of speech and communication skills

HLTAHA013 Provide support in dysphagia management

HLTAHA014 Assist and support the use of augmentative and alternative communication systems

Group E electives – COMMUNITY REHABILITATION specialisation

HLTAHA004 Support client independence and community participation

HLTAHA024 Work within a community rehabilitation environment

Group F electives – NUTRITION and DIETETICS specialisation

HLTAHA018 Assist with planning and evaluating meals and menus to meet recommended dietary guidelines


HLTAHA019 Assist with the monitoring and modification of meals and menus according to individualised plans

HLTAHA020 Support food services in menu and meal order processing

HLTAHA021 Assist with screening and implementation of therapeutic diets

Other electives

CHCAGE001 Facilitate the empowerment of older people

CHCAGE005 Provide support to people living with dementia

CHCAOD001 Work in an alcohol and other drugs context

CHCCCS001 Address the needs of people with chronic disease

CHCCCS002 Assist with movement

CHCCCS004 Assess co-existing needs

CHCCCS006 Facilitate individual service planning and delivery

CHCCCS009 Facilitate responsible behaviour

CHCCCS020 Respond effectively to behaviours of concern

CHCCCS023 Support independence and wellbeing

CHCCCS027 Visit client residence

CHCCOM002 Use communication to build relationships

CHCDIS007 Facilitate the empowerment of people with disability

CHCDIV002 Promote Aboriginal and/or Torres Strait Islander cultural safety

CHCHCS001 Provide home and community support services

CHCLAH001 Work effectively in the leisure and health industries

CHCLAH002 Contribute to leisure and health programming

CHCLAH003 Participate in the planning, implementation and monitoring of individual leisure and health programs

CHCMGT001 Develop, implement and review quality framework

CHCMGT002 Manage partnership agreements with service providers


CHCMHS001 Work with people with mental health issues

CHCPOL003 Research and apply evidence to practice

CHCPRT002 Support the rights and safety of children and young people

CHCPRT003 Work collaboratively to maintain an environment safe for children and young people

CHCSET001 Work with forced migrants

CHCSOH001 Work with people experiencing or at risk of homelessness

CHCYTH001 Engage respectfully with young people

HLTAHA001 Assist with an allied health program

HLTAHA002 Assist with the application and removal of casts

HLTAHA009 Assist in the rehabilitation of clients

HLTAHA011 Conduct group sessions for individual client outcomes

HLTAHA015 Deliver and monitor a hydrotherapy program

HLTAHA017 Assist with social work

HLTAHA022 Prepare infant formulas

HLTAHA023 Support the provision of basic nutrition advice and education

HLTAHA025 Contribute to client flow and client information management in medical imaging

HLTAHA026 Support the medical imaging professional

HLTAID001 Perform cardiopulmonary resuscitation

HLTAID002 Provide basic emergency life support

HLTAID003 Provide first aid

HLTAID006 Provide advanced first aid

HLTAUD001 Assess hearing

HLTAUD002 Conduct play audiometry

HLTAUD003 Assess and respond to occupational noise risk


HLTFSE001 Follow basic food safety practices

HLTFSE005 Apply and monitor food safety requirements

HLTFSE008 Conduct internal food safety audits

HLTINF002 Process reusable medical devices and equipment

HLTOHC001 Recognise and respond to oral health issues

HLTOHC002 Inform and support patients and groups about oral health

HLTOHC003 Apply and manage use of basic oral health products

HLTOHC004 Provide or assist with oral hygiene

HLTOHC005 Use basic oral health screening tools

HLTOHC006 Apply fluoride varnish

BSBAUD402 Participate in a quality audit

BSBFIM501 Manage budgets and financial plans

BSBFLM306 Provide workplace information and resourcing plans

BSBINM301 Organise workplace information

BSBINN301 Promote innovation in a team environment

BSBLDR402 Lead effective workplace relationships

BSBMED401 Manage patient recordkeeping system

BSBMGT401 Show leadership in the workplace

BSBMGT406 Plan and monitor continuous improvement

BSBWOR204 Use business technology

BSBWOR502 Lead and manage team effectiveness

SISCAQU008 Instruct water familiarisation, buoyancy and mobility skills

SISFFIT003 Instruct fitness programs

SISFFIT019 Incorporate exercise science principles into fitness programming

SITXFSA401 Develop and implement a food safety program


TAEDEL301A Provide work skill instruction

TAEDEL402A Plan, organise and facilitate learning in the workplace


Appendix B: Food and Fluid Intake Record


Appendix C: Australian Food Safety Essentials - Script

SAFE FOOD HANDLING (8min) The greatest threat to food safety is food poisoning bacteria. Food poisoning bacteria gro

This includes raw and cooked meat, poultry and seafood; dairy products, food made

from eggs, nuts or beans; small goods, cooked rice, fresh and cooked pasta;

processed fruit and vegetables or any other foods with these ingredients.

These foods are called potentially hazardous foods - or PHF’s, because they support

bacterial growth well. You need to keep these foods cold, at 5oC or less, or keep them

hot, at 60oC or more.

In this module, we look at safe food handling of potentially hazardous foods and their

temperature control during:

• Food Receipt

• Storage

• Preparation

• Cooking

• Serving, and

• Handling of Leftovers

Food Receipt

• Food should be delivered in appropriate packages or containers, to protect it from contamination.

• The label tells you what the food is and names the supplier, so that in the case of a recall, food can be traced back to its source.

• Do random checks on regular deliveries. If you have a new supplier, check the initial deliveries as well.

• Reject deliveries where the packaging around the food is damaged. • Look out for unusual smell or discoloration, or signs of vermin. • Make sure frozen food is frozen solid. • Chilled foods should be 5º C or less • It's a good practice for a staff member to be present when food is delivered, so

that potentially hazardous food is not left lying at room temperature

Food Storage

• Store food off the ground on shelves. • Food should be stored in appropriate containers, covered or sealed. • Put older stock in front of recently received goods to allow for good stock rotation. • Storerooms should be kept clean and tidy to avoid attracting pests.


Refrigeration:

• Keep the fridges or cool room running at 5oC or less. • Store raw or thawing food on the bottom shelf of the fridge or cool room. From here,

the row juices cannot drip onto other food and contaminate it.

Freezing:

• Food should be frozen hard. • Freeze food to -15oC or less, or follow the recommended storage temperatures on

the label. Food Preparation:

• Before handling food, wash and dry your hands thoroughly. • Wash all fruit and vegetables thoroughly to remove dirt and bacteria. • Work only on clean, sanitised and dry surfaces and use only clean, sanitised and

dry equipment and utensils. • Don't use the same chopping boards or utensils for raw and then ready-to-eat food. • If you have to use the same utensils, clean, sanitise and let them dry before reuse. • Check food for spoilage before you use it. Look out for discoloration, mould or

infestation. • Keep the time that food is out of the refrigerator to a minimum. • Put food back into the fridge as soon as it is ready.

Thawing Food:

• Make sure food is thawed entirely before you use it • The safest place to thaw frozen food is in the refrigerator or cool room - on the

bottom shelf. • You need to plan ahead, as it takes time for food to thaw completely throughout. • You can also use a microwave oven; however, you must cook the food immediately

afterwards. Cooking

• Cook foods thoroughly. • This is usually achieved if the core of the food reaches 75o C or hotter. • You can check the temperature with a probe thermometer. • Remember, the probe must be clean and sanitised before use. • In poultry, minced meats, rolled meats and sausages, bacteria can be found

completely throughout. These foods must be thoroughly cooked, so that the juices run clear.

• Solid meat cuts are more likely to be contaminated with bacteria only on the cut surfaces. Searing the meat on all surfaces will reduce the number of bacteria to a safe level.

• Cool food quickly. Divide food into smaller portions or pour in shallow containers. You can leave it to cool for 20 - 30 minutes before placing into the cool room or freezer.

• To speed up cooling, keep space between foods, so that cold air can circulate well.

Serving When holding ready-to-eat food, remember the rules:

1. Keep cold foods cold: at 5º C or less. 2. Keep hot foods hot: at 60º C or hotter.


For potentially hazardous food that is held between 5º C and 60º C you have two choices:

1. If you want to use it at a later stage, you must put it into the fridge within a total of 2 hours of being at a temperature between 5 o C and 60 o C and that includes preparation and delivery time.

2. If it is for immediate consumption, it may stay between 5o C and 600 C for 4 hours - and again that would include preparation and delivery. After 4 hours you must throw it out.

Here is an example:

a) It takes one hour to prepare these sandwiches in the morning for a lunchtime function.

b) The sandwiches are then refrigerated. c) They are taken out of the cool room at 11.30 am, and held at room

temperature over lunch. Because preparation of the sandwiches took one hour, they can only be held at room temperature for a further 3 hours. By 2.30 pm, all uneaten sandwiches are then thrown out

• Use tongs or other barriers when handling ready-to-eat food. • Serve all food with clean utensils. All crockery and cutlery must also be clean. • Covers, packaging or sneeze guards must protect food on display from

potential contamination by the consumer. • Don't refill trays, mixing old food with fresh food; replace the tray with freshly

prepared food. Handling Leftovers Refrigerate leftovers within 2 hours of cooking. Use all refrigerated leftovers within three days.

• REMEMBER: If in doubt, throw it out. • If you have to re-heat leftovers, it’s a good practice to cook it for at least 2

minutes if possible - steaming hot. • Potentially hazardous food shouldn't be cooled and re-heated more than once.

PERSONAL HYGIENE (4 min) In this module we will talk about hand hygiene, gloves and hygienic conduct.

• When you handle food with contaminated hands, you can transfer bacteria. • A simple but very effective way to prevent contamination of food is by washing

and drying your hands thoroughly. • You must wash your hands immediately before handling food. Even when you

handle food with gloves, tongs or utensils, your hands must be clean. How Well Do You Wash Your Hands? Here's a simple test:

• We're putting a gel on this person's hands. • When dry, this gel is invisible to the naked eye. • However, it will show up under ultra-violet light. • Let's see how much of the gel is still there after a casual hand wash. • As you can see, there is still gel left on the hands. And just like bacteria, unless

you wash and dry your hands properly, you still leave it on your hands. • This time the hands were washed properly.


Hand Washing Use warm water and soap. All surface areas of your hands must be washed:

a) The wrists b) Between your fingers c) The palms of your hands d) The fingers and tips, and e) The back of your hands

• Rinse thoroughly with warm water. • It is important that you dry your hands well with a disposable or single use

towel. • It is very effective if you use these in combination with a blow dryer. • Don't wipe your hands dry on your clothes, as they can contain bacteria.

When To Wash Your Hands You must wash your hands immediately before handling food. Here are some other reasons to wash your hands:

• After touching raw meats, poultry and vegetables • After blowing your nose or touching other parts of your body, like ears, mouth or

hair • After eating • After smoking • After going to the toilet • After putting away the rubbish • After any unhygienic practice

You are encouraged to wash your hands frequently during your shift. Don't forget to dry them properly. Gloves

• Use barriers when handling ready-to-eat food. • You may also use gloves, but wash your hands first before putting them on. If

your hands are dirty, you will transfer bacteria onto the gloves you put on. • The gloves must be clean, and not ripped or torn. • To prevent cross-contamination, use a new pair of gloves for each new task.

You should never use the same gloves for raw meats and then for ready to-eat foods.

• Disposable gloves should not be worn for longer than one hour. • Wear disposable gloves over brightly coloured dressings to protect minor cuts

or wounds. Hygienic Conduct

• Keep your fingernails short and clean. • Wear only minimal jewellery, such as a plain-banded ring. Bacteria hide easily

on jewellery, making it harder for you to wash your hands thoroughly. • Long hair should be tied back. • Wear clean protective clothing. • Take it off when you put out the rubbish, go to the toilet or when on a break. • Don't eat where you prepare food. • Don't cough or sneeze over food.


• If you suffer from an illness report it to your supervisor. For example

• You must not work with food if you have diarrhoea or gastroenteritis. CLEANING AND SANITATION (5min) In this module we focus on cleanliness of the premises, fixtures and fittings; cleaning and sanitation; and the maintenance of equipment.

• Make sure that the premises, fixtures and fittings are clean. • There should be no build-up of grease or dirt, of food waste or mould. Clean not

only the obvious areas, but also behind equipment and in areas less easy to reach.

It is a good practice to clean up spills as soon as possible. For an efficient cleaning program you must have a daily and weekly cleaning routine of.

• Wiping and sanitation bench tops • Mopping floors • Cleaning back splashes and stove tops • Clean at least once a day at the end of the shift, or as often as necessary. • Range hoods must also be cleaned regularly. Fluff and grease collect in the

fitters, and the build-up is a fire hazard, Small bits could fall into the food underneath. Change or clean filters regularly.

• When dishcloths get dirty, they are a good nourishing ground for bacteria. Exchange them for fresh ones frequently.

• Remove rubbish at least once a day. Rubbish bins and containers for recyclable material should not overflow. It's best to have a lid on them.

• Food scraps and general untidiness attract pests, can cause slips and trips and may even be a fire hazard.

Utensils and Equipment

• All eating and drinking utensils must be cleaned and sanitised before being used.

• To be clean, a utensil has to look clean, smell clean and feel clean. • Cleaning removes food particles and grease, but does not kill or remove all the

bacteria and viruses. • Sanitation is required to reduce the number of micro-organisms present on a

surface to a safe level. This is a level that does not allow the spreading of a contagious disease and does not endanger food safety.

• You also have to clean and sanitise surfaces that come into contact with food. • Think of chopping boards, storage containers, cooking or processing or

other equipment, and things like thermometer probes.

• To sanitise, you can use heat or sanitation chemicals or both. The choice is yours.

• Use proper sanitation procedures and follow the manufacturer's instructions on correct use and dosage of cleaning and sanitation chemicals. Always add the active agent to the water last.

• Store chemicals separate and away from food. • Many commercial dishwashers will both clean and sanitise.


• If you wash dishes by hand, complete the following steps: 1. Scrape off any food remains 2. Wash with hot water and detergent 3. Rinse 4. Sanitise according to manufacturer's instructions, and 5. Air dry

• After sanitation, all equipment should be air-dried thoroughly. If you use towels,

they must be clean and dry. Equipment Maintenance Slicers, grinders, mixers and other equipment need to work safely.

• Don't operate machinery where the machine guarding has been removed or where protective parts are missing.

To clean machinery,

• Scrape off any food remains and wipe surfaces. • Disassemble, wash and sanitise the equipment according to the manufacturer's

instructions. It is important to disassemble the equipment. Food particles can get stuck in corners, folds and creases and become a bacterial breeding ground that contaminates the food you process. The equipment, especially the crockery,

• Should not be cracked, chipped or broken. • Broken or chipped parts could end up in the food, or cracks in the eating and

drinking utensils could impede efficient cleaning and sanitation • This would endanger food safety.

TEMPERATURE MONITORING (3min) • Potentially hazardous foods need to be kept under temperature control. • For this reason you must have a thermometer in the kitchen and it must be

easily available. A thermometer helps you:

1. to check the temperature of foods upon delivery 2. to ensure that foods are cooked, cooled and re-heated at safe temperatures,

and 3. to check that potentially hazardous foods are held at correct temperatures use a

probe thermometer and insert it into the centre of the food.

Thermometer Use a) Insert the probe right into the core of the food, and wait a moment for the

reading to stabilise. b) The probe should be cleaned, sanitised and dried before each and every use.

This is important when checking different foods to avoid cross contamination. c) Wipe off food remains and wash the probe with warm water and detergent. d) Sanitise according to the manufacturer's instructions.

When you sanitise the probe with an alcoholic wipe, wait until the alcohol has


evaporated. • You may also sanitise the probe by leaving it in hot water above 77o C for 30

seconds. • Let the probe air dry or dry thoroughly with a disposable towel. • When checking temperatures of hot and cold food with the same probe, it

should reach room temperature between measurements.

Fridges, cooling or holding units can distribute temperatures unevenly. It is a good practice to check the temperature of foods in different areas of the unit. In the case of sealed food or frozen food,

• You may place the length of the probe in between the packages. This method will give you a close indication of the temperature at the core of the food.

Thermometer Check

• The thermometer must be accurate to +/- 1oC. Here's a simple test to check the accuracy of your thermometer:

a) Fill a container with equal amounts of crushed ice and water and wait 5 minutes.

b) Place the probe into the mixture and leave it in a few minutes. An accurate thermometer will read 0oC.

c) If the display shows a temperature outside the range of – 1oC to + 1oC, the thermometer is not accurately calibrated. You should not use it for temperature control.

An incorrect reading could be the result of a flat battery.


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Resources

Queensland Health Resources

Nutrition Education Materials Online (NEMO) http://www.health.qld.gov.au/nutrition/

Validated Nutrition Assessment Tools: Comparison Guide’ (2009) developed by Queensland Health Dietitians:


Queensland Health Foodservices Best Practice Guidelines

http://qheps.health.qld.gov.au/statewidefoodservice/docs/june-2015/food-bp-guide-2015.pdf

Department of Health Strategic Plan 2016 -2020.

https://www.health.qld.gov.au/publications/portal/strategic-plan/strategic-plan-16-20.pdf

National Health and Medical Research Centre Resources

Dietary Guidelines for all Australians https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n55_australian_dietary_guidelines_130530.pdf

A New Food Guidance System for Australia – Foundation and Total Diets

www.nhmrc.gov.au/_files_nhmrc/file/guidelines/consult/consultations/draft_foundation_total_diets_public_consult.pdf

Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010)

http://www.nhmrc.gov.au/guidelines/publications/cd33

Miscellaneous

Diabetes Australia http://diabetesaustralia.com.au/

Australian Heart Foundation www.heartfoundation.org.au


http://www.health.qld.gov.au/nutrition/



http://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/consult/consultations/draft_foundation_total_diets_public_consult.pdf



http://www.nhmrc.gov.au/guidelines/publications/cd33

http://diabetesaustralia.com.au/

http://www.heartfoundation.org.au/

Continuous Improvement Form Clinical Education and Training Queensland is committed to providing quality resources to support the national vocational education and training sector. If there is any way we can improve this guide to meet your specific needs and requirements, please complete the form below and return to VET Team, Clinical Education and Training Queensland, Allied Health.

Organisation:

Name:

Address:

Phone:

Email:

Are there any changes that you think could improve this guide?

Are there any other units that could be supported by the types of learning topics, checklists and activities included in this guide?

Unit Code Unit Title

Please return form to:

VET Team, ClinEdQ Allied Health

GPO Box 48 Brisbane 4001

Fax: 07 3131 6890

Email [email protected]


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