connections - dhccdpg.org perception of our meals was less than favorable. ... dards for rds and...

ConnectionsVolume 34 • Issue 1 • Fall 2009

CONNECTIONS FALL 2009

Message From The Chair .............................2

Standards of Practice/Standards of Profes-sional Performance (SOP/SOPP): How dothey impact YOUR Practice? .......................3

Standards of Practice and Standards ofProfessional Performance ...........................8

CONTINUING DOWN THE HIGHWAY FORCULTURE CHANGE - Words Do Make aDifference..........................................................9

Are you Linked In? .......................................12

“Communication is the key to success.” .....................................................13

DHCC Networks ...........................................14

National Pressure Ulcer Advisory Update ..........................................17

Catering’s Food-Safety Rules of the Road.....................................................20

Learn How to Be Happy.............................21

A Story of a Dining Transformation

By Cheryl Havens, RD

Founded by the Benedictine Sisters in 1957, the Benedictine Nursing Centerbegan with a deep commitment to an education mission. This focus led tothe creation of a nationally recognized skilled “teaching nursing home,”which has contributed to advancing long-term care issues nationallythrough research and application. Today, after a becoming part of the Provi-dence Health System, Providence Benedictine Nursing Center (PBNC) servesmore than 1200 elderly and disabled persons annually, with nearly 300 em-ployees.

As an industry leader in skilled long-term care, PBNC provides expertise inareas such as dementia and pain management. Healing is approachedholistically, addressing an individual’s physical, emotional and spiritualneeds. PBNC is the only long-term care facility like this in Marion County,Oregon, operating as a non-profit entity. More than 55% of the elderly resi-dents at PBNC are served through Medicaid. In addition to the skilled nurs-ing facility, the PBNC campus also includes a Home Health Agency, anationally accredited Child Development Center serving 40 children ages 6weeks to 12 years and an assisted living center.

The dietary department at PBNC recently underwent major dining transfor-mations to help enhance the quality of life of those whom we serve. Thegoal of these systems changes was to continue on our path of providing res-idents the ability to direct their own cares and make their own decisionsthroughout the day. We planned these changes so residents could eat whenthey wanted and what they wanted. Toward that end, we developed threedistinct styles of service from which residents can choose: choice menu,room service and a full service restaurant in-house.

We began this journey several years ago when we received feedback thatpatient/resident perception of our meals was less than favorable. In addi-tion, we felt that our dining experience had become very routine and clini-cal in nature. As we continually do, we were questioning our routines andservices and asking if they really were the best we could provide, and theanswer generally was not in our favor. Observing our nursing units and the

continued on page 4

Dear DHCC Members:

I would like to thank each of you who have chosen torespond to the ADA Alerts sent out the past fewmonths. We all have a voice and we need to share it.Please visit the ADA Website www.eatright.org to readthe health care message from President Jessie M.Pavlinac, MS, RD, CSR, LD, and to review the ADAAlerts. Then decide how you can best support the As-sociation and your own positions on health care re-form. Everyone’s input counts. Make your message(s)direct and to the point. The needed nutritional carereforms are up to us, the current members.

It is hard to believe, but ADA’s Food & Nutrition Con-ference & Expo (FNCE) is almost here! October 17-20,2009, ADA members will be heading to Denver Col-orado, for our annual convention. DHCC has beenworking hard to set up special events for our mem-bers. Cutting edge speakers and topics have been se-lected for our Pre-FNCE “Mountains of Hot Topics”(October 17, 2009) and our FNCE priority session “Indi-rect Calorimetry: Setting the Stage for Long TermCare” (October 19, 2009). I hope that you can join usfor these educational sessions. DHCC is going “GREEN”this year. All of the handouts you need for Pre-FNCEare available for attendees review, downloading anduse during and after Pre-FNCE. Please visit www.dhc-cdpg.org (essentials, then my account login) to accessthis information.

DHCC will have a booth (#1516) on the Exhibit Flooragain this year. Stop by, say hello, discover what theDPG is doing this year and look at our materials. Wehave revised the Pocket Resource for Nutrition As-sessment (PRNA) this year.

You don’t want to miss our member reception Octo-ber 18, 2009, 7-9 pm. Come in and meet your Execu-tive Committee (EC). Tell us what you like, whatadditional tools or resources you would like DHCC tooffer, what your areas of interest are, and enjoy thiswonderful networking session. Our 2009 Awards will

be presented during the reception, so come and con-gratulate our winners. DHCC has many wonderfulsponsors. They will be available during Pre-FNCE andthe Member Reception. Please stop by and thankthem for all of their support.

I am happy to announce that DHCC will be one of thefirst DPGs to have a delegate for the House of Dele-gates (HOD) starting June 1, 2010. The EC has decidedthat this will be an elected position. The HOD Dele-gate will also serve on your EC. The DHCC nominatingcommittee, led by Lorie A. Stake, MS, RD, LDN, is cur-rently working on our next ballot.

Current DHCC projects include updating the Ade-quacy Hours for the Consultant Dietitian Worksheet,writing SOP/SOPP for our DPG and developing educa-tional Webinars. The Webinars are being planned tohelp increase your knowledge and prepare you forthe changes ahead. Topics we are currently workingon are legal issues and NCP. If you have any other sug-gestion/requests, let us know.

I am looking forward to meeting you at our Pre-FNCEand FNCE events in Denver. If you are unable to joinus this year, you can contact me by email or phone. Iwould be happy to discuss DHCC, our many projectsand your ideas/suggestions. Hope to see you in Den-ver.

Sincerely,

PAGE 2 - CONNECTIONS FALL 2009

Chair Updateby Carol H. Elliott, RD, LD/N

ADA’s SOP in Nutrition Care and SOPP 1 serve as blue-prints for the development of practice-specific Stan-dards for RDs and assist individuals in self-assessment.They do not supersede laws and policies; however,they can serve as a resource for the development ormodification of laws, policies, and guidelines. TheStandards do not constitute a basis for institutionalcredentialing or for adverse or exclusionary decisionsregarding privileging, employment opportunities orbenefits, disciplinary actions or determinations ofnegligence or misconduct.

What’s next for DHCC?DHCC is currently developing practice-specificSOP/SOPP for the RD in extended care settings. Notonly will it provide guidelines, it will also delineatestandards for the generalist, specialty, and advancedlevel practitioner. An ADA approved workgroup of ex-pert practitioners in long-term care has been formed

Imagine this ScenarioIris Elder, an 87-year-old female, was diagnosed withdementia about 2 years ago. Iris went through thevarious stages of dementia; wandering, loss of ap-petite, weight loss, loss of mobility and swallow func-tion. Iris developed a pressure ulcer, was placed on atube feeding, and eventually expired. The family wasdevastated with the loss of their matriarch. Out of de-nial and anger they sued the facility and caregivers forwrongful death.

Darcy R. Dietitian worked with Iris during all phases ofher natural decline. She obtained food preferences,bought favorite foods from the grocery store for Iris,and talked to family and staff about the decreased ap-petite and pros and cons of tube feeding. Darcy isdevastated by the lawsuit and wonders what will hap-pen next.

Was Darcy negligent in her care of Iris? By what stan-dards will Darcy be evaluated?

The American Dietetic Association (ADA) and Stan-dardsThe American Dietetic Association developed stan-dards against which the quality of practice and per-formance of Registered Dietitians (RDs) and DieteticTechnicians, Registered (DTRs) can be evaluated. TheRevised 2008 Standards of Practice in Nutrition Careand the Standards of Professional Performance(SOP/SOPP) for RDs and DTRs 1and ADA’s Code ofEthics 2 are decision tools within the Scope of Dietet-ics Practice Framework 3 that guide the practice andperformance of RDs and DTRs in all settings.

The SOP in Nutrition Care and SOPP reflect the mini-mum competent level of dietetics practice and profes-sional performance for RDs and DTRs. The SOP inNutrition Care is composed of four standards repre-senting the four steps of the Nutrition Care Process(NCP); the SOPP consists of six standards representingsix domains of professionalism. (Table 1)

FALL 2009 CONNECTIONS - PAGE 3

continued on page 7

Standards of Practice/Standards of Professional Performance(SOP/SOPP): How do they impact YOUR Practice?by Linda Roberts, MS, RD, LDN

Iris went through the

v The

f Out of denial and anger they sued the facility a

She obtained food p

Darcy is devastated by the lawsuit and w

By what standards will Darcy be evaluated?

The

S

They do not supersede laws and policies; however, t

The Standards do not constitute a basis for i

Not only

w An ADA approved workgroup of expert practitioners in long-term care has been formed to

t Our aim is for project completion within a year.

Table 1 SOP/SOPP Standards Standards of Practice in Nutrition Care 1. Nutrition assessment 2. Nutrition diagnosis 3. Nutrition intervention 4. Nutrition monitoring &

evaluation Standards of Professional Performance 1. Provision of services 2. Application of research 3. Communication and

application of knowledge 4. Use & management of

resources 5. Quality in practice 6. Competence &

accountability !

A Story of a Dining Transformation continued from page 1

dining room during mealtime, we saw hurried andrushed staff, crowded units and a dining room withvery few residents in attendance. Of those who didmake the trek to the dining room, none were capableof self-feeding or capable of making a choice of whereto dine or what to eat. In addition, some of our lowestscores on our resident/patient satisfaction surveyswere from dietary services. We knew it was time tomake some improvements in how we served our resi-dents and how we prepared the meals, and that it wastime to transform our dining services program fromthe traditional model of tray line and incorporate away to provide food to residents when they want itand what they want. After much consideration, weasked what our residents wanted and what would fitin with our philosophy of resident directed care. Afterfocus group discussion with residents, staff and fami-lies, we came up with three styles of service to bettermeet the needs of our residents.

We received outside funding, including a grant fromthe Oregon Community Foundation, as well as sup-port from individual businesses and donors, whichenabled us to invest time in to building a programthat we felt would better meet the needs of our resi-dents and patients.

Choice MenuThe first step in our process was to implement ChoiceMenus. We now offer this to those who live on ourlong-term units and choose not to eat in our maindining room. Each resident is given a menu that in-cludes 3-5 entrées choices, 5 side dish options and upto 4 desserts per meal. If needed, nursing staff assistthe resident with completing the choices, perhaps byreading the menu to the resident, or by simply mark-ing the selections once made. This provides an op-portunity for relationship development and socialinteraction between the resident and staff. Selectionsare made each day for the following day. This processis more efficient in providing residents with food pref-erences because they are given a wider option ofchoices, and the residents tell us what they want. Thisprogram has been very successful, as we have de-creased food complaints, decreased food waste and

decreased incidence of weight loss of those who par-ticipate with this program.

Room ServiceThis program is offered to our skilled unit patients. Itis set up very much like room service in a hotel. Whenpatients are hungry, they call dining services (all therooms on this unit have a phone) and order from acomprehensive menu, complete with 19 meal optionswith up to 12 sides available at every meal. We com-mit to delivering the meal within 45 minutes, al-though typically delivery is 10-20 minutes from thetime the order is placed. Implementation required ex-tensive preparation. We use a computerized menusystem that tracks preferences, allergies, likes and dis-likes for each resident/patient. Most of our grantfunding went to staff time for data entry to build ourcomputer system that allows us to do this system effi-ciently. We also had to completely reconfigure ourkitchen to allow “short-order” cooking verses tradi-tional tray line. We trained our cooks in the conceptsof short order cooking. Now, when a person orders ameal, the order is entered directly into the computer.Not only does this track what is ordered, but alsoalerts us if someone, for any reason, does not order ameal so we can act accordingly.

Because this is offered to our patients in the skilledunit, we have feedback from those we serve fre-quently. Many have said that they would come backbecause the food and meal service is so outstanding.They enjoy selecting their meal; it gives them an activ-ity and something to anticipate. The dietitian alsouses the menus as an educational tool for those withdiabetes to prepare them for preparing meals athome, or to empower a resident to identify and selectfoods with a higher concentration of calories and pro-tein for their own wound healing or weight mainte-nance. This teaches what foods to eat therebyreducing the need for liquid nutritional supplements.We have virtually eliminated the routine use of liquidnutritional supplements in this facility with the helpof this program. This is beneficial because it offerswhole foods rather than liquid artificial nutrition,which is more healthful and ensures a better quality

PAGE 4 - CONNECTIONS FALL 2009 continued on page 5


of life and an improved, less institutional, dining ex-perience.

The creation of a restaurant experience:The last part of our transition was to completelychange the way dining services were offered in ourdining room. There were two parts to this transition:a physical transformation of the dining room itself,and a complete overhaul in the service we provide inthat location.

The physical environment previously looked institu-tional. Tables were of varying sizes and heights, light-ing was dated and space was not well used. Tochange this, we incorporated warmer colors, im-proved lighting, added new tables and chairs and theaddition of couches and arm chairs to encourage peo-ple to use the room for social gatherings.

The overhaul in the way we provide service in our din-ing room included training of staff and the implemen-tation of a full menu. We had to change our mindsetfrom serving a pre-selected option of food to beingwait staff, taking orders and being part of creating adining experience for the people in the dining room.We have specially trained dining staff in the sameprinciples as restaurant servers. It is different than arestaurant because our customers are our residentsand we have the unique ability to get to know ourcustomers quite well. Our servers have come to reallyenjoy this benefit of serving them. We aim to wait onall our guests as if they were in a fine restaurant, togive them the gift of eating out, off the unit, out oftheir room and hopefully feel like they are out of thefacility. This new approach also offers a place for fam-ilies to gather and eat with their loved one.

Residents who historically had one main entrée andone alternate to choose from, and who typicallychose to eat on the unit where they lived, are comingto our dining room and ordering from a full menu. Inaddition, they have a two-hour time frame for lunchand dinner during which they can choose to dine.Historically, our dining room was underutilized.Presently, it is filled to capacity for every meal, oftenwith families present as well.

Results:To our knowledge we are the only facility of our typethat offers room service with a full menu. Most otherlong-term care settings are also making changes tothe dining programs, but most are doing buffet styleor home style dining. We have taken it a step furtherwith room service to allow even greater flexibility inwhat and when they eat.

We have seen many indicators that these new pro-grams are a success. As previously mentioned, foodcomplaints have decreased, weight loss has de-creased, food waste has decreased and the use offood supplements has virtually been eliminated. Butthere is more! Our food costs have remained rela-tively stable during a time of rapid inflation of foodcosts. We are purchasing 2-3 times more fresh fruitsand vegetables as compared to when we servedmeals in the traditional tray line. We are servingabout one-half as much of the “special of the day,”which would have historically been the entrée served,and are making more soups, sandwiches, and saladsper individual choice. This is what has contributed todecreased food waste.

Our satisfaction scores have increased dramatically.Mealtime on the units is calmer and more efficient.Because of the number of residents needing assis-tance, it used to take up to 2 hours to complete amealtime, and now it takes about 45 minutes. This islargely due to residents choosing to leave the unit togo to the “restaurant”, creating more time for staff togive attention to those who really need it. Activitylevels have increased of those who go to the restau-rant. We encourage everyone who is able to safelywalk or self propel themselves down the hallways. Weoften see residents helping each other to the diningroom, either helping push in a wheelchair or walkhand in hand. Some residents are even “dressing fordinner.” As we hoped, we have seen improved social-ization among residents, and much more family par-ticipation in meals.


continued on page 6



Examples of success:A fiercely independent resident, who has lived herefor several years and is now on hospice, was one ofthe worst critics of our dining program. Althoughmuch time was spent trying to understand her prefer-ences and honor those, she rarely ate what we servedher and often chose instead to eat candy, cookies,soda pop and other junk foods from the vending ma-chine between meals, which was not the best foodchoice for someone with diabetes. With the imple-mentation of choice menu, and then the creation ofthe new dining experience in our dining room, shenow gets what she wants and essentially when shewants it. This has been SIGNIFICANT for her. She issomeone in her last days, doing what she wants! Shenever complains about the food anymore, and isnever at the vending machine supplementing hermeals.

Another resident with a diagnosis of depression wastypically very withdrawn. She rarely came out of herroom, took very little part in her own care. When weopened the new dining room, we convinced her tocome for a meal. She started coming to the restau-rant regularly, and now is socializing, smiling and de-ciding what she wants to eat. Not only that, she isnow self-directing her care! We were completely sur-prised to see that empowering her at mealtime wouldalso carry over to other areas of her life.

Yet another resident, who was self-isolating, bed-bound by choice, never coming out of her room, hasundergone a complete change with our dining roomtransformation. We also convinced her to try the newrestaurant. She now dresses up, puts on make up,and comes to the restaurant for lunch and dinnerdaily. In addition, she joined a group on her unit thatplays games together after meals. All the people thatare part of this group have lived together for a longtime, but now they are socializing together as well,simply because of the restaurant experience.

We have many other examples of relationships devel-oping, appetites increasing, and residents doingthings they had not done in a long time, all resulting

from this experience and empowerment that is pro-vided through the dining experience.PBNC has witnessed, first hand, the impact on our res-idents that a positive dining experience involvingfood choices, timing, presentation and a pleasant eat-ing environment can have in the overall health andsatisfaction of nursing home residents. While many re-gional hospitals have adapted a “Room Service” sys-tem, this system is not prevalent in nursing facilitiesbecause of the cost of implementation. Involvementwith this project has offered to dietary staff the abilityto observe and reflect on the benefits of enhancingthe social and aesthetic aspects of dining for our resi-dents. Or dietary staff has blossomed in this new sys-tem, even by improving their job experience bycreating value in relationships made with residentsand family members.

As a recognized leader in our commitment to innova-tive, person-centered care, PBNC strives to offer thehighest quality of life for elderly residents of MarionCounty, Oregon, and the vicinity. PBNC continues totest the boundaries we, as an industry, have createdfor long-term care and find that they are moveable.Residents as well as staff respond positively to this ap-proach. Providence Benedictine would like to thankthose who funded this project Oregon CommunityFoundation, Mt. Angel Telephone, as well as theanonymous friend who made this transformation pos-sible.

Cheryl Havens graduated from Oregon State Univer-sity with a B.S. in Food and Nutrition Management; Di-etetics in 1997. Cheryl consulted at several long-termcare, rehab facilities and assisted living centers in thestate of Oregon and Southern Washington. In 2001she went to work for Providence Benedictine NursingCenter and has been there ever since. Cheryl lives inWilsonville, Oregon with her husband and two chil-dren.


to take on this process. Our aim is for project comple-tion within a year.

Back to Litigation Against DarcyWhen it comes time for the expert witness to developa case for or against Darcy, practice standards for thenutrition care of the resident (Iris) in an extended caresetting will be examined. The ultimate questions be-come, “Did Darcy apply her knowledge of theSOP/SOPP? And did she apply her knowledge of theNCP? Did Darcy develop her portfolio learning planbased on her area of practice and competency goals,and was she able to demonstrate competency in pro-viding nutrition care? Lastly, did Darcy apply currentevidence based practices in her treatment of Iris andcommunicate appropriately with the family andhealth care team?”

If the answers to these questions are yes and theother standards were appropriately applied to this in-dividual resident, then Iris received the proper nutri-tion care for that period of time in that healthcarecommunity.

It’s important for each practitioner to review theSOP/SOPP for their practice area and to apply them totheir practice. In long-term care, regulatory compli-ance is king. CMS’s F281 4 Professional Standards reg-ulation mandates that practitioners followprofessional standards of quality developed by pro-fessional organizations such as ADA. CMS’s F325 4 Nu-trition interpretive guidelines provide an excellentoverview of nutrition care in the long-term care set-ting.

DHCC’s SOP/SOPP for extended care settings will gobeyond F325 by providing the RD with specific stan-dards in their area of practice. Through self-evalua-tion, each RD can use the SOP/SOPP for extended caresettings in the development of his or her 5-year port-folio plan.

Why does ADA recommend developing theSOP/SOPP for RD’s in extended care settings?

The answer is simple: the resident. RDs applying theSOP/SOPP will demonstrate competencies as nutri-tion practitioners, provide the most comprehensiveand up-to-date nutrition care, and enhance the qual-ity of life for residents like Iris.

Linda Roberts, MS, RD, LDN, president Linda Roberts &Associates, Inc., a nutrition and food service consult-ing firm in Illinois; Chair DHCC 2008-2009; Chair of theSOP/SOPP Workgroup for extended care settings.Visit RDoffice.net for long-term care resources.

ReferencesAmerican Dietetic Association Revised 2008 Stan-dards of Practice for Registered Dietitians in NutritionCare; Standards of Professional Performance for Regis-tered Dietitians; Standards of Practice for the DietTechnician, Registered, in Nutrition Care; Standards ofProfessional Performance for Diet Technicians, Regis-tered. J Amer Diet Assoc. 2008;1081538-1542.e9.

Code of ethics for the profession of dietetics. J Am DietAssoc.1999:99:109-113.

Maillett JO, Skates J, Pritchett E. American Dietetic As-sociation: Scope of Dietetics Practice Framework. JAmer Diet Assoc. 2005;105:634-640.

Centers for Medicare & Medicaid Services. State Oper-ations Manual, Guidance to Surveyors for Long TermCare Facilities, Appendix PP. Revision 48, 6-12-09.http://www.cms.hhs.gov/manuals/downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed September 24, 2009.

Standards of Practice/Standards of Professional Performance(SOP/SOPP): How do they impact YOUR Practice?continued from page 3


The Standards of Practice (SOP) in Nutrition Care andStandards of Professional Performance (SOPP) forRegistered Dietitians (RDs) and Dietetic Technicians,Registered (DTRs)1 are minimum competent levels ofdietetics practice and professional performance thatguide RDs and DTRs in all practice settings. The stan-dards apply to all credentialed dietetics practitioners,and are to be used for professional development andself-evaluation for education and skills needed toprogress one’s individual level of practice. The SOPand SOPP are to be used as part of the Commissionon Dietetic Registration’s Professional DevelopmentPortfolio to develop goals and to focus continuing ed-ucation efforts.

The SOP in Nutrition Care relate directly topatient/client care and are based on the four steps ofthe Nutrition Care Process: Nutrition Assessment, Nu-trition Diagnosis, Nutrition Intervention, and NutritionMonitoring and Evaluation. The SOPP apply to dietet-ics practitioners in all areas of practice and relate toprofessional roles or behaviors in: provision of serv-ices, application of research, communication and ap-plication of knowledge, utilization and managementof resources, quality in practice, and competency andaccountability.

The SOP and SOPP are not regulations. They are con-sensus standards, which were developed using groupopinion based on expert knowledge and experience.Although these Standards are not regulations, federalregulatory agencies (CMS) are looking at these Stan-dards, as well as Standards from other professional or-ganizations, as a way to ensure competency ofpractitioners.

The SOP in Nutrition Care and SOPP for RDs1 serve asblueprints for the development of practice specificSOP and SOPP. These practice specific standards iden-tify the generalist, specialty and advanced levels of di-etetics practice and professional performance for RDs.These practice specific standards are written by ex-perts in the nutrition field, and again, are developedand accepted via consensus. Currently published

practice specific standards include Diabetes Care, On-cology Nutrition Care, Behavioral Health Care, Nutri-tion Support, Management of Food and NutritionSystems, Sports Dietetics, Educators of Dietetics Prac-titioners, Pediatric Nutrition, and Nephrology Care.Future practice specific standards for publication in-clude Eating Disorders, Intellectual and Developmen-tal Disabilities, Integrative and Functional Medicine,and Extended Care Settings.

To view these SOP and SOPP, visit the ADA Web siteat www.eatright.org/standardsofpracticeandperfor-mance

If you have further questions regarding the SOP andSOPP, please contact Cecily Byrne, Manager of QualityManagement at the American Dietetic Association [email protected] or Sharon McCauley, Director ofQuality Management at [email protected].

1 The American Dietetic Association Quality Manage-ment Committee. American Dietetic Association Re-vised 2008 Standards of Practice for RegisteredDietitians in Nutrition Care; Standards of ProfessionalPerformance for Registered Dietitians; Standards ofPractice for Dietetic Technicians, Registered, in Nutri-tion Care; and Standards of Professional Performancefor Dietetic Technicians, Registered. Journal of theAmerican Dietetic Association. 2008;108(9):1538-1542,1542.e1-e9.

Standards of Practice and Standards of Professional Performance

! Pocket Resource for Nutrition Assessment

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administration record), PO (by mouth), PRN (as needed), qd (every day) and BID (2 times per day), etc.

My goal in writing this article is to provide you with afew words and their culture change synonym that willmake you think about how the words are interpretedby our customers or even the general population.Our customers are people like you and me whosephysical and/or mental faculties no longer allow themto live without assistance. They are your Mom or Dad,your favorite Aunt or Grandma, your neighbor orteacher, your lawyer or doctor, your brother or grand-child. They are all of us; they are the people whom wework for.

Let’s start at our department name. Most commu-nity’s food production area, in my experience, istermed “Dietary.” The dietary manager is the depart-ment director and the dietitian is often “The Food Po-lice.” The root word “Diet” has a negativeconnotation to the general public and is treated bymany as a four-letter word. Dining or Culinary Serv-ice(s) seem more appropriate as we move away fromthe medical model of providing nutrition withinhealthcare.

The section of the chart where I document medicalnutrition therapy assessements is labeled Dietary. Iam neither Dietary nor the Food Police. When I chart Iam noting my suggested medical nutrition therapy(MNT) assessment and prescription that will assist theresident to achieve his or her goal(s).

Following are some terms directly related to commu-nities and nutrition and their synonyms for you toconsider:

I hope you have become active in Cultural Change, ifnot you will be the frog in warming water! (Confused?Keep reading and you will understand!)

I am practicing terminology for culture change inhealthcare with concerted effort. I have observedboth how words hurt and how they help to achievepersonal and business goals.

I had the opportunity to work outside of traditionalhealthcare when I was in the position of a food brokerand food distributor. I still refer to the non-healthcarebusiness segment as the “Real World of Business.” Words and what they mean to different people, cul-tures, and industries can be confusing I write andspeak in the English language primarily, but not thesame English language of business. Specific examplesof my experiences with these differences include thefollowing:

• My boss was conducting one of his usual pep talk sales meetings with an emphasis on the need to make appointments and sell product. I mentioned that “I have visits planned with a variety of clients.” As a businessperson he stated, “Idon’t want you to make visits; I want you to make sales.” My point of reference was obviously healthcare and “visits” to me meant I was scheduled to work with a patient/customer to achieve their/my goals. I was doing what he wanted and making sales, but I was not communicating in a language that he understood.

• The importance of terminology was never more apparent to me than when the company secretarydescribed my writing style as “RDineez.” She was avery successful secretary who had worked in several industries, but had difficulty interpreting my abbreviations and medical terms. I wrote rapidly and used abbreviations that are common to us all in healthcare such as c/o (complained of ), Na (sodium), HS (hour of sleep), MAR (medication

continued on page 10

CONTINUING DOWN THE HIGHWAY FOR CULTURECHANGE - Words Do Make a Differenceby Susan McCorkell Worth, RD, LD


One community where I work has a culture changecommittee that meets on a monthly basis. The com-mittee discusses what they would like to see, whathas been accomplished and concerns that arise fromcontinuing on the culture change highway. One ofthe resident assistants (CNA) on the committeepointed out that she did not feel that we were re-specting a particular resident’s dignity by continuallyencouraging her to eat. The woman was an adultwith a lifelong eating pattern of snacking. She had al-ways been small, liked being thin, was her own powerof attorney for both medical and financial and had lit-tle decline in cognition. After this was brought up inthe committee, I monitored a noon meal and ob-served that there were seven people with eleven dif-ferent approaches encouraging or requesting her toeat. It really made me think that the third or fourthperson would have ended up wearing the plate offood if had been me.

An important aspect of culture change is to involve allstakeholders in developing and achieving the estab-lished goal(s). For me this has always been familiar as“The Buy In.” An example: In order to have peoplewash their hands frequently, correctly, and com-pletely, you need to:

1. Identify the issue. Issue: Correct and Frequent Handwashing

2. Identify the goal. Goal: Provide safe food 3. Involve all stakeholders to achieve goal: Learning

circles, communication with staff to understand what is preventing correct and frequent handwashing.

4. Educate/improve understanding of those who willcarry out the task. Education: Physically show how and how long you want people to wash their hands

5. When: Discuss and show when hands should be washed.

6. Establish the why or the ‘what is in it for me’: Handwashing is the most effective and important thing you can do to keep your residents and your family safe from food borne illness.

7. Verify understanding: Have the staff or person show and tell you how to wash your hands.

8. Evaluate/ Monitor follow through: Spot check informally and formally through continuous quality improvement (CQI) percentage of completion and frequency of illness both inside the department and within facility staff and residents.

9. Identify why it is not working: Learning circles and data gathering to improve “The Buy In” goal.

CONTINUING DOWN THE HIGHWAY FOR CULTURECHANGE - Words Do Make a Differencecontinued from page 9


The c

One of the resident assistants (CNA) on the committee p

The woman was an adult with a lifelong eating pattern of snacking. She had a

After this was brought up in the committee, I monitored a noon meal a

It really made me think that the third or fourth person would have ended up w

For me this has always been familiar as “The Buy In.” An example: In order to have

p 1 Issue: Correct and Frequent Handwashing 2 Goal: Provide safe food 3

Education: Physically show

h

6

7 Have the staff or person show and tell you how to wash your hands. 8

Dietary, Food Services Culinary or Dining Service

Bib Napkin, clothing protector

Refused to eat/drink Declined the meal and beverages

Is a feeder Mr./Mrs./Ms (insert the persons name) needs help to eat

Feeders, feeder table People who need assistance or help to eat

The lady in 22 A Mrs. (A person’s name) living in Apartment 22 near the door

Seating location Reservation or the table reserved for you Mr. Jones is ______.

The diabetic in 22 A No person is only their disease, Mrs. Jones in apartment 22

Food dislikes Food Preferences

Self help feeding devices Self-help eating devices


10. Repeat, starting at step one!

So… I was hired as a team member to consult in ahealth care community that had not yet started onthe culture change highway, but was being moni-tored monthly by the state agency. I had worked withthe Administrator, Director of Nursing Service, Culi-nary Director and other staff to plan specific ideas toimprove the quality of dining. I suggested simplesteps such as music in the dining areas, tablecloths,napkins, improved lighting, improved plate appear-ance, real glasses, etc. and providing customer serv-ice. After ideas were discussed and chosen by thecommunity staff, they began implementing theteam’s recommendations.

Three months later I followed up with an onsite visitto the community. When I asked how the improveddining program was progressing, the Culinary Direc-tor stated, “We tried that and had mass revolt fromthe residents. They even got the ombudsmen in-volved.” Further questions resulted in the Culinary Di-rector reporting that they started the new programon a “Monday and were back to the old program byThursday.” They had initiated music, napkins, table-cloths, lighting and several other steps all at oncewith no involvement from the residents.

Initially, the Culinary Director and I talked about thefact that you can’t create culture change in a singleday, but that it is a continuing process and that a few,agreed upon changes at a time, may be more success-ful. In addition, in communicating steps and ideas forculture change, I had failed to adequately emphasizethat the most important aspect of culture change wasresident input and involvement as one of the stake-holders before any changes are implemented.

My “ah-ha” moment about this situation came as Iwas researching culture change terminology, I readan article by Ernst Mohr an educator and President ofthe University of St. Gallen, Switzerland, IncrementalInnovations: Changing the Culture of Teaching andLearning. Mr. Mohr started the article with the para-

ble of the boiled frog. “A frog exposed to water that istoo hot to live in will quickly jump out of it. However,if a frog is put in cold water and the water is warmedslowly, the frog will stay in so long that by the time itrealizes the circumstances have changed, it is unableto act. And therein lies the challenge of every changeinitiative:If change is too drastic, the resistance to changemight be too high.If the change is too slow, the involved stakeholderswon’t move anymore. They will sit in their warmwater, without recognizing that the environment ischanging and that they needed to act.”

Culture change in long term care must include thewords/terminology that represent the changes as anessential step to successful outcomes for all stakeholders.

I suggest meeting with the Culinary and Nutritionteam in one community and discuss what wordsmean. I often find it is the new staff that provides thebest insight as they are not yet institutionalized to thewords and procedures of the health care industry.

Lead by example and do what is best for the resident.What is best for the customer is not necessarily whatis the easiest, most productive, or most convenient forthe department.

How am I progressing? I was in a monthly summarymeeting recently in a CCRC with an Administrator andCulinary Director reviewing recommendations forstreamlining initial documentation by diet techni-cians at the community and the consultant RD. Al-though, I truly believe that the people we serve inhealth care communities are our customers/residents,after I had said the word “patient” the administratorcorrected my wording by stating “resident” on at leastthree occasions in the one hour meeting. I think I hita bump on the highway to culture change, which re-quires that I continue to be diligent about changingold terminology! At no time are any of us perfect in




anything we do, but striving to improve is the founda-tion of continuous quality improvement and bestpractice.

The Pioneer Network website has a summary fromProvidence Mount St. Vincent of Seattle, Washingtonon their highway to culture change entitled Chal-lenges and Lessons Learned. “Change doesn’t happenovernight and leadership must stay the course. It’snot a magical practice. It’s consistency. For example,adopting language like ‘home’ and ‘neighborhood’takes time but it is important to transform action.”

References:Mohr E. Incremental innovations: changing the cultureof teaching and learning. Educause Review, Vol. 42,no.5 (September/October 2007).

Brawley E. What culture change is and why and agingnation cares. Aging Today, Vol XXVIII, No.4. 9-10.

Snow K. “People First Language.” Kids, Together, Inc.Information and Resources for Children and Adultswith Disabilities. 1-2005.

Pioneer Network: Providence Mount St. Vincent Chal-lenges and Lessons Learned (http://www.pioneernet-work.net/Providers/CaseStudies/Providence/ChallengesLessons/ Accessed 21 September 2009.

Susan McCorkell Worth, RD, LDCREATIVE FOOD OPTIONSBeaverton, OR [email protected]


A Rookie’s Guide to using Social Media To Grow your Business and Advance your Career

Love it or Hate it; Embrace it or Fear it; Clueless or Cut-ting Edge; Useful or a Time Waster...whatever your at-titude is toward social media, one thing that is sure, itis here to stay. If you ignore it, you will be left behind.Depending upon your familiarity and experience,using social media may be as natural as breathing ormay create fear, trepidation, confusion, and avoid-ance.

I was sitting on the sidelines of social media until late2008. The consumer Innovators (2.5% of consumersare Innovators *) were deeply immersed in the tech-nology. I had profiles on Facebook and LinkedIn butwith few connections and very little information. I hadnot even considered sending a “tweet.” I am not avery ‘social’ person- a Myers Briggs introvert - so whatwould I be doing on social media sites anyway!

I then read an article in the Wall Street Journal aboutTwitter business applications and began to give socialmedia a second look. Around that same time, a col-league posted a message on my Facebook page com-menting on what a “sad site” it was! As an EarlyAdopter*(13.5% of consumers are Early Adopters*) Idecided that it was time to look into this phenome-non and determine how I could leverage it to growmy business. I spent a little time and effort, supple-mented my bios, added photographs to my profiles,and then got a Twitter address. Soon, I was meetingand talking to current and new colleagues, some fromother countries. I quickly realized using social mediafor business and career applications had great poten-tial - so I set a goal to learn more. Here is some ofwhat I have learned. (Social Media Innovators maywant to stop reading here!)

Definition of Social Media: Because this is a rookie’sguide, (and I am only an advanced rookie), let’s begin

Are you Linked In? by Author Jean Caton, MS, MBA, RDCareer, Business, Life Coach and Speaker



How many times have you heard that? It’s a funda-mental concept in just about everything we do, bothin our professional and personal lives. From DHCC’sperspective, communication is key to achieving ourmission:

Empower DHCC members to be the nation’s food and nutrition leaders.

How can DHCC support you to be leaders? Let’s talkabout it!

Under our new Executive Committee (EC) structure, Ihave been appointed as the new CommunicationsCoordinator. This means I am responsible for how wellwe communicate with our members, as the EC strivesto fulfill our mission. Our current vehicles of commu-nication are highlighted below:

Website (www.dhccdpg.org)Learn about events and webinars, search for (and ad-vertise) professional resources, find other colleaguesin your area of practice – these are just a few exam-ples of the type of information provided online for thepublic, and our members. But we have many ideas tohelp this evolve. How can we improve upon this, tomake the website a more valuable professional toolfor you?

Forum EML (Electronic Mail List)Participate in our online discussion, which connectsover 1000 DHCC colleagues from around the world.Pose a question about a unique situation you’re deal-ing with, share best practices, read about recommen-dations for products, or just monitor the topics tokeep up with the trends of our field.

With features that allow you to manage your free ac-count – such as updating your email address, receiv-ing a digest (e.g., all emails from a day are compiledinto one email) or individual emails, suspending/re-suming the EML when you need to take a break andsearching for topics in the archives – you have accessand control over a wealth of information from DHCC

members. Join the EML by subscribing on our websiteunder the “Members Only” area.

“Connections” NewsletterConsistently cited by members as the best memberbenefit, our newly named “Connections” newsletteris mailed to members quarterly, and covers a broadrange of topics pertinent to working in health carecommunities. Not only can you stay abreast of currentissues, but continuing education (1 - 2 CPEUs) is alsoavailable with each issue.

Themes for upcoming issues are Management (win-ter) and Technology (spring). Do you have expertise inthese areas? If so, please consider contributing to thenewsletter – we welcome new authors!

UPDATE!To keep you updated in between our newsletters, wealso send out electronic mini-newsletters, to passalong important announcements and reminders tomembers.

Communication tools used to link people haveevolved over time. Face to face communication is themost effective way, but unfortunately we don’t havethat luxury often. While we utilize the above tools tocommunicate with you, are there other preferred ven-ues for discussion and sharing of ideas? Do you havesuggestions about how we can more effectively useour existing tools?

We want to be successful in supporting you. Pleaseshare your thoughts and talents, and be a key to oursuccess!

Amy Buehrle Light, RD, LDNDHCC Communications [email protected]

“Communication is the key to success.”by Amy Buehrle Light, RD, LDN


CURRENT DHCC NETWORKS AND REPRESENTATIVES

American Association of Diabetes Educators,Home Health Care Specialty Practice Group(AADE) www.aade.orgNetwork Representative: Gretchen Cararie, MS,RD/CDE, LDN

Gretchen is active in this Specialty Practice Group(SPG) as a speaker and writer for their newsletter. Shehas been working on a set of teaching tools/methodsthat can be utilized with AADE and DHCC. She is alsoinvolved with their Plan of Action which includessome of her network representative goals.

The American Association of Diabetes Educators(AADE), founded more than 35 years ago, by and fordiabetes educators, has approximately 12,000 multi-discipline professional members, who share an inter-est in Diabetes Education. The organization hasapproximately 100 local chapters in various states,with 20 Specialty Practice Groups (SPG), similar toADA’s DPGs. The Home Health Specialty Practice Group(HHSP) is one of these SPGs. The HHSP promotes dia-betes education as a specialty program offered by HomeHealth agencies. They support member development bypromoting diabetes teaching skills and helping mem-bers attain CDE certification.

American Health Care Association (AHCA)/Na-tional Center for Assisted Living (NCAL) www.ncal.orgNetwork Representative: Edna Cox RD/LDN

The American Health Care Association (AHCA), a non-profit federation of affiliated state health organiza-tions, represents more than 10,000 non-profit andfor-profit care providers serving assisted living, nurs-ing, developmentally-disabled and sub-acute facilitiesthat care for the elderly and disabled.

I would like to introduce myself and my new role asthe DHCC Network Liaison Coordinator. DHCC mem-bers elected me as Area 5 Coordinator this year; how-ever, along with the name change to DHCC, theorganizational structure is changing as well. I am astrong believer in networking, so I am excited to rep-resent DHCC in this new role.

DHCC has ‘network’ relationships with many organiza-tions that have mutual interests and benefits to serveour members and our clients. DHCC has member rep-resentatives for each of the selected network organi-zations. The representative participates at variouslevels within the organizations, joining as a member,being a speaker at their meetings, writing for theirpublications or serving as a committee chairperson. .

Over the years, network relationships have changed.Some groups now have a direct networking relation-ship with ADA rather than with DHCC. These groups,such as Joint Commission on Accreditation of Health-care Organization- Professional and Technical Advi-sory Committee for Long Term Care (JCAHO-PTAC),National Commission on Correctional Health Care(NCCHC) and National Pressure Ulcer Advisory Panel(NPUAP) have a networking relationship with ADAand our practice group provides a representative towork with each group.

The DHCC Networks Committee is reviewing these or-ganizations, along with others, to evaluate and maxi-mize the mutual benefits for both organizations tobetter serve our members. The DHCC Networks Com-mittee will be seeking members who may have an in-terest in becoming a Network Representative as someof the terms for the current representatives will cometo an end in 2010. If you are interested or know some-one who may be please contact me [email protected].


DHCC Networks by Barbara A. Wakeen, MA, RD, LD, CCFP, CCHP - DHCC Network Liaison Coordinator


have all members of the health care team at the tablefor input and discussions. As a result, she will beworking with the AMDA Education Department onobtaining CDR approval for RDs and DTRs for futureeducation sessions. She plays a key role in keepingdietetics and nutrition professionals in the forefrontof AMDA by being an active participant in their organ-ization.

Association of Correctional Food Service Affiliates(ACFSA) www.acfsa.orgNetwork Representative: Joseph W. Montgomery, MS, RD, LDN, CCFP

Joe is a Past-President of ACFSA and as network rep-resentative maintains the relationship betweenACFSA and DHCC by keeping the ACFSA Presidentand Management Team aware of events atDHCC/ADA that may affect correctional food serviceand vice versa. Joe attends international and regionalconferences; provides guidance on ACFSA policy andparticipates at conferences to promote “correctionaldietetics” concerning nutritional health issues andmember growth.

ACFSA just celebrated its 40th Anniversary in August!It is an international non-profit organization formedto enhance, represent and promote the professionalgrowth of its members who are correctional foodser-vice employees, spread across North America, and in-cluding Mexico, Australia, Bahamas, Puerto Rico, andan expanding international market. ACFSA’s 745members are employed in all types of correctionalvenues and agencies - federal, state, private, con-tracted, and municipal prison/jail systems. RDs makeup approximately 5% of the membership.

ACFSA supports the Dietitians in Corrections (DIC)Networking Group and a “Dietitians’ Corner” columnin their quarterly publication, the Insider. . DIC has aworldwide Correction electronic mailing list (EML),queries between this EML and DHCC EML’s are often

AHCA represents the long-term care community tothe public, government and business leaders. Whileserving as a power for change, AHCA provides infor-mation, education, and administrative tools that en-hance quality care to the elderly and disabled.

The assisted living voice of AHCA, the National Centerfor Assisted Living (NCAL), serves the needs of the as-sisted living community through national advocacy,education, networking, professional developmentand quality initiatives. NCAL also supports state-spe-cific advocacy effort through its national federation ofstate affiliates. These state affiliates aid their assistedliving members to improve quality and promote theirbusinesses through local education, advocacy on be-half of assisted living providers and the direct sup-port.

NCAL and AHCA have the largest, most influentiallong-term care federal relations team in Washington,D.C.

American Medical Directors Association (AMDA) www.amda.comNetwork Representative: Suzanne Cryst, RD, CSG, LD

The American Medical Directors Association (AMDA),which was formed in 1978, is the professional associa-tion of medical directors, attending physicians, andother “team members,” practicing in the long termcare continuum, is dedicated to excellence in patientcare and provides education, advocacy, information,and professional development to promote the deliv-ery of quality long term care medicine. AMDA has in-corporated a strategic planning process andphilosophy into its ongoing operations that includes ayearly review of strategic progress at the Board of Di-rector’s interim meeting held in the late Fall.

Suzanne is currently involved with AMDA on the state(Ohio Medical Directors Association Advisory Commit-tee) and National levels. She has been a speaker,roundtable facilitator and poster presenter at AMDAAnnual Symposiums. The recent initiative of AMDAhas been to create a true interdisciplinary focus, to


DHCC Networks continued from page 15


Pioneer Network has built a national support networkfor over 30 state coalitions in their respective statesand has strategic partnerships with leading organiza-tions including The Commonwealth Fund, Centers forMedicare & Medicaid Services (CMS), and The Ameri-can Medical Directors Association (AMDA) to advancetheir goals and principles into practice.

National Association for Home Care & Hospice(NAHC)www.nahc.orgNetwork Representative: Constance A. Laux, Med, RD,CSR, LD

The National Association for Home Care &Hospice(NAHC), founded in 1982, is the nation’slargest trade association representing the interests ofhome care agencies, hospice providers, home careaide organizations and medical equipment suppliers.NAHC advocates for senior citizens and other vulnera-ble groups to receive health care and social services intheir own homes, so far as this is possible. Membersare mainly corporations or other organizational enti-ties directly providing home care, in addition to statehome care associations, medical equipment suppliersand schools. Services range from professional devel-opment to regulation at both the federal and statelevels.

NAHC also offers individual memberships and forumsfor home care professionals such as social workers,nurses, and home care aides who are employed byhome care agencies or who may have an interest inhome care to serve the specific needs of these fields.

National Citizen’s Coalition for Nursing Home Re-form (NCCNHR) www.nccnhr.orgNetwork Representative: Dorothea M. Rourke MS, RD,LDN

The National Citizens’ Coalition for Nursing Home Re-form (NCCNHR) was formed in 1975 at a meeting of12 citizen action groups expressing concern aboutsubstandard care in nursing homes. Now NCCNHR’s

topics for the Dietitians’ Corner. I chair the DIC Net-working Group, write the Dietitian’ Corner and coordi-nate the EML.

Dietary Manager’s Association www.DMAonline.orgNetwork Representative: Mary Rybicki, MS, RD, LDN

Dietary Managers Association (DMA) is a nationalnon-profit association, established in 1960, withmembership of more than 14,000 professionals work-ing in hospitals, long-term care, schools, correctionalfacilities, military and other non-commercial foodser-vice settings. DMA is dedicated to providing optimumnutritional care through education, advocacy, net-working and research for food service management.

In healthcare settings, Dietary Managers work in col-laboration with RD’s and the healthcare team in pro-viding care. DHCC has a long-standing relationshipwith DMA.

Pioneer Network www.pioneernetwork.netNetwork Representative: Linda Roberts, MS, RD, LDN

Linda is very active in this small long-term care organ-ization. Most recently, she presented ‘Honoring FoodPreferences’ at their national conference and is coordi-nating a Pioneer /CMS Dining Symposium to be heldin February 2010. Linda is the ‘nutrition/dietetics/foodservice’ go-to person for ADA & DHCC for the PioneerNetwork.

Pioneer Network, formed in 1997, is a small advocacygroup of prominent professionals in long-term carewhose focus is to change the culture of aging. TheNetwork is aiming for when our family membersmove to a long-term care setting, they will thrive andexperience a continued quality of life regardless ofage, medical condition or limitations. This Network iscomprised of a wide spectrum of long-term careproviders including CEOs and administrators, con-sumers and family caregivers, doctors and nurses, anddirect care providers.




NCCNHR is comprised of 200 member groups and in-dividual members of more than 1,000 from 42 statesincluding local citizen action groups, state and locallong-term care ombudsmen, legal services programs,religious organizations, professional groups, nursinghome employees’ unions, concerned providers, na-tional organizations, and growing numbers of familyand resident councils.


20-member board, includes nursing home residentsand represents the grassroots membership of advo-cates for quality long-term care nationwide. NCCNHRis an informational and leadership source on federaland state regulatory and legislative policy develop-ment, and models and strategies to improve quality ofcare and life for residents of nursing homes and otherlong-term care facilities.

move from being on the cutting edge of pressureulcer beside care, pubic policies and research to beingthe cutting edge. They also reflect our goal of beingmore influential in pressure ulcer public policy mak-ing.”

The new goals were incorporated into the work plansof the three standing NPUAP committees during theirAugust semi annual meetings. The Public Policy, Edu-cation and Research Committees identified specificactivities they will incorporate into their existing ini-tiatives towards achieving the new goals. One ofthese activities involves an area that is very pertinentto the practice DHCC members. The panel will issue aposition paper on the recent and upcoming Medicarecuts that may affect the quality of care of the elderly.

The International Guidelines for the Prevention andTreatment of Pressure Ulcers were first released at the2009 NPUAP Biennial Conference in February and allattendees received a draft copy of the guidelines. Thefinal printed copy will soon be available on the NPUAPwebsite.

NPUAP is an independent, not-for-profit organizationdedicated to the prevention and management ofpressure ulcers through education, research and pub-lic policy. Formed in 1987, the NPUAP Board of Direc-tors is comprised of leading authorities representing

The National Pressure Ulcer Advisory Panel (NPUAP)held its recent meeting in Washington, D.C. on August20-22, 2009. The American Dietetic Association is acollaborating organization on the Panel. There arecurrently six (6) registered dietitians who attend thepanel meetings. Mary Ellen Posthauer, NPUAP BoardSecretary, Becky Dorner, NPUAP Board member,Melissa Temkin, with the American Health Care Asso-ciation, Nancy Munoz, Genesis Health Care, TracySmith, Abbott Laboratories and myself.

The National Pressure Ulcer Advisory Panel finalizedits strategic plan goals for the period 2010 – 2012. Sixkey goals were developed. Those goals are:

1. Become the international authority and thought leader in the field of pressure ulcers

2. Create a consistent vision and voice in US public policy

3. Become the leading educator in pressure ulcers4. Provide preeminent expertise in pressure ulcers

research5. Increase effectiveness in the Panel by engaging

multidisciplinary experts in implementing a culture of sustainability

6. Maintain the current financial base of NPUAP and expand the resources to support new activities

“The new goals are not entirely different from ourpast goals.” states Laura Edsberg, NPUAP President.“However, they emphasize our organization’s desire to


National Pressure Ulcer Advisory Updateby Lynn Carpenter Moore, R.D., L.D. - ADA NPUAP Alliance Representative

tion on NPUAP goals and activities can found on theirweb site at www.npuap.org or by calling the NPUAPoffice at 202-521-6789.

various disciplines, including medicine, nursing, occu-pational and physical therapy, nutrition, biomedicalengineering, research and education. More informa-

over 55, up 175.3% in the last 120 days (February,2009).

At the rate of growth, using a statistic that is over sixmonths old can almost seem obsolete!

Non-social uses of Social Media: Although once thedomain of teens and the college crowd, business ap-plications are rapidly expanding. The following aretwo examples of relevant Facebook postings fromNewsweek magazine:

Pharma’s Facebook: Pharma industry recruitingfor Clinical Trials. Research 2.0: How drug companies are using socialnetworks to recruit patients for clinical research. (http://www.newsweek.com/id/187882 )

Out of the Shadows: After meeting for years onanonymous and secret Web sites, pro-anorexiagroups are now moving to more public forums likeFacebook. By Tina Peng | Newsweek Web Exclusive(http://www.newsweek.com/id/170528 )

30 Thoughts on Social Media for Rookies

1. Be open to using social media. At least understandthe basics of the technology so you won’t be left behind.

2. Don’t have a clue how to do all this? It’s really quite easy. There are countless excellent online resources that are more up to date. Check the resources at the end of this article.

with a definition. What better place to turn for a defi-nition of social media than Wikipedia: Social Media: A category of sites that is based onuser participation and user-generated content.They include social networking sites like LinkedInor Facebook, social bookmarking sites likeDel.icio.us, social news sites like Digg or Reddit, andnumerous other sites that are centered on user in-teraction.

There are many variations of the definition of this rap-idly evolving category.

Growth of Social Media: The growth of social mediais exploding. Hence the change in terminology fromthe more commonly used term - social networking.Not that long ago, the largest and popular sites wereprimarily networking sites, MySpace, Facebook, andLinkedIn. Now the number of sites has grown andthere are countless new applications that go beyondnetworking. There are even sites that let you createyour own social network for anything -www.ning.com.

According to an online resource Dan Frommer Feb. 2,2009, Facebook is growing seven times faster thanLinkedIn. He reports “Assuming Facebook’s growthhasn’t fallen off a cliff, it’s now signed up 160 millionusers. As of early January, it was signing up about430,000 new users a day or 10 million users every 23days. LinkedIn is growing by about 1 million usersevery 17 days.”

Source www.insidefacebook.com February, 2009

Facebook is growing in every age/gender demo-graphic and the fastest growing segment is Women


National Pressure Ulcer Advisory Updatecontinued from page 17

Are you Linked In? continued from page 12




sites and post tips in these groups. (My most successful tactic so far).

20. Follow the rules for face to face networking - give before getting, be a resource for others.

21. Promote your business programs in discussions if the group permits.

22. For optimum business leverage, combine email newsletter, websites and social media.

23. Use LinkedIn special applications. Slide Share is anapplication that allows you to share PowerPoint slide presentations.

24. By making your slides available on Slide Share only to your connections you can attract new quality connections.

25. Twitter, a mini-blog, that allows you to tweet amaximum of 140 characters - typically using realwords not text abbreviations. Using Twitter is really easy!

26. Twitter has generated countless offshoots. Mr. Tweet is a networking assistant. Follow Mr. Tweeton Twitter and it will suggest people you shouldalso be following with similar interests.www.Twellow.com is a place to find people to follow on Twitter.

27. Grow your followers strategically. Just because someone follows you, you don’t have to follow them. Some people just collect followers as anumbers game.

28. Too many followers are just clutter. When you periodically check your account, the messages from those you are truly interested in will be buried with irrelevant posts.

29. Comment on discussions adding relevant information. Don’t just post a response for the sake of posting. Don’t attempt to be an expert on everything.

30. Deal with your FUD (Fear, Uncertainty and Doubt) and do it anyway.

Social Media is a rapidly evolving technology. There islikely at least one obsolete fact in this article by thetime it is published!

Reprinted with permission, NE DPG Ventures newslet-ter (Fall 2009, Volume XXVI, number 2)

Additional resources * Lists popular posts on social media. www.whosbloggingwhat.com * Facebook know how http://tinyurl.com/mp3nbt andhttp://www.techforluddites.com/

3. Be cautious buying books to learn about this topic. Everything is changing so fast.

4. Go on some of the popular sites and explore. You may want to start with www.Linkedin.com, www.Facebook.com, or www.Twitter.com.

5. Determine which one fits you the best and uploada profile – it’s easier than you think.

6. Be strategic when using social media sites. Know what you stand for and post only on related topicswhen using social media for professional purposes.

7. The site(s) you use depends on your goals and where your target audience “hangs out.”

8. Discipline yourself. Set aside a designated amount of time each day or week to work on your profile, learn more, and communicate.

9. Notice how much time you can waste once you get going. (One way I avoid drifting into spending too much time is to fill those 10-15 minutes beforean appointment.)

10. Know what you want to get out of the time you are investing.

11. Differentiate between personal and professional use of social media.

12. Remember these are public forums. Even your tweets can show up when someone searches yourname on Google™.

13. Be cautious with personal information. Don’t put anything on social media sites you wouldn’t want your mother or potential employer to see!

14. You can set up a fan page on Facebook to use for business as well as a personal profile.

15. Get your Facebook vanity address if your name is still available (I thought Jean Caton was a unique name - it isn’t!) My vanity address:www.Facebook.com/Jean.Caton

16. If you are a business, know what you stand for (your brand) before you start using social media - this way others will get the right impression of you and your brand from your posts.

17. Build a network by joining relevant groups. Networking is a good way to learn about new career opportunities and best practices. There are numerous RD-related groups on LinkedIn alone.

18. Join groups on Facebook and LinkedIn that you think may appeal to your ideal customers.

19. Talk, network, attract attention to your expertise, ask and answer relevant questions on social media



• Use transporters that are easy to clean. Clean and rust-free equipment inhibits the growth of harmful bacteria.

• Pans should be shallow (2 to 2/1/2 inches) with fitted lids.

• Document adequate temperature control for all perishable and potentially hazardous foods — and make sure that thermometers and logs are available to do this.

• Catering vehicles should be clean and sanitary.• Regularly inspect all equipment.

Enforce personal hygiene standards for employees, including drivers.

Once your food is safely delivered to the service loca-tion, you still have a few more safety considerations.Is your establishment handling service of the food? Ifso, require your customer to provide a proper storagearea. You may need access to steam tables, chafingdishes, refrigerators, coolers, etc. Remember that allfoods, beverages, utensils and related equipmentmust be stored at least six inches off the floor. If youare delivering food for someone else to serve, it’s agood practice to document the temperatures of yourfood when you arrive.

Good personal hygiene for all employees, which in-cludes anyone transporting food, is key to reducingthe spread of foodborne illness. Hand-washing is thesingle most important means of preventing thespread of infection. Be sure adequate hand-washingfacilities are available at your catering site. Always en-force the rule of no-bare hand contact with ready-to-eat foods, including removal of food from carts.Remember that ice is considered a food and shouldnot be handled with bare hands.

In summary, when detailing your catering food safetyplan:• Keep hot foods hot and cold foods cold. • Don’t cross-contaminate.• Focus on personal hygiene and hand-washing.

Keeping food safe during transport can be really easy,and one less source of worry for you, if you just re-member a few simple rules.

Transportation is an often-neglected food-safety riskfor those who prepare food at one location and serveit at another. Poor temperature control and cross-contamination can easily happen when food is transported. Off-premises caterers need to emphasizeproper procedures for conveying food just as theywould stress the usual safety standards for vendors,storage, preparation and service. Following these recommendations can help minimize the risk of foodborne illness during transport.

If you are cooling hot food prior to transferring it forreheating at the service location, pay close attentionto your cooling techniques. To avoid growth of harm-ful bacteria, potentially hazardous foods must becooled from 140°F to 70°F within two hours and from70°F to 41°F within four hours (six hours total). Be surethe food is below 41°F before transporting it. Thisshould be fairly easy if you are cooking in smallbatches; however, cooling larger batches can requiremore attention. To cool food properly, divide food intosmall batches and place it in a refrigerator, freezer orice-water bath in a shallow metal pan and stir often.

Good equipment and standard operating procedurescan help avoid both poor temperature control andcross-contamination. Improper control of safe hold-ing temperatures can cause rapid growth of harmfulbacteria. Food not securely covered can be contami-nated by spills from other foods, or even by dirt andpests, compromising quality and safety. The followingrecommendations can effectively reduce points ofcontamination.

• Use insulated carriers/transporters for hot and cold foods to ensure proper holding temperatures.• Cold foods — maintain food temperatures at 41°F, or below.

• Hot foods — maintain food temperatures at 135°F, or above.

[Note: Always follow manufacturer instructions to preheat or pre-chill your transporters before loading.]

• Label the outside of each transporter to minimize door opening and closing.

• Use transporters with easy-to-close doors and latches.

Catering’s Food-Safety Rules of the Road by Dana Fillmore, RD, CP-FS


an instruction manual on how to deal with our emo-tions. And if we as adults don’t do it well, we will notbe able to teach our children how to be emotionallycompetent.

Mastering your emotions is part of your human expe-rience. The learning starts when you are a child. Youlearn by watching your parents and how they dealwith emotions. You also learn through instruction.What were some of the messages you learned grow-ing up? What response or reaction did you receivewhen you expressed an emotion? How was angerhandled in your home? What about sadness, disap-pointment, or frustration? How did your family mournlosses? Were people generally happy? Did they knowhow to enjoy themselves?

Being told, “Don’t cry,” when you were sad has madean impact on you and may have created a beliefabout how you are supposed to deal with sadness. Ifyour parents screamed at each other all the time, thenyou learned something about how couples get along.If no one talked to one another for days on end whenthey were angry, then that has left its mark on you aswell. Unearthing your hidden beliefs about emotionsand learning to be at choice rather than at the mercyof these old, unhealthy patterns will help you to feelin control about your emotional state.

Emotions are inner messages. They provide you withinformation which you can use to guide your behav-ior. Emotions enrich the experience you have whileyou are in your human form; they permeate every as-pect of being human. There are no “bad” emotions.Emotions just are. We judge them as “bad” becausewe may not like to feel them or we fear them becausewe don’t have the skills to manage these emotionswhen they show up.

But people have just as much trouble with the “good”emotions such as happiness and joy as they do withso-called “bad” emotions such as anger, grief, or de-pression. We find ourselves spending most of ourtime worrying, full of anxiety, in a state of fear, and fullof self-doubt. And because this is what we are used

Learn How to Be Happyby Julie Fuimano, Personal Development Expert & Coach

“He’s simply got the instinct for being unhappy highlydeveloped.”

~ Saki, British author (1870 - 1916)

Happiness is not about what you own, who you mar-ried, or what you collect. Happiness is feeling good –not having your life look good – and it can only be feltright now, in this moment. It cannot be projected intothe future or relived from the past. Interestingly, peo-ple don’t necessarily know how to be happy. We arebusy. We know how to do stuff and get things done.Generally, there is a pervasive discontent in society aswe struggle to keep up with our own expectations,society’s expectations, and our family’s expectations.And when we cannot meet the unrealistic expecta-tions about who we should be and what we shouldbe doing, we feel bad. Guilt, shame, fear, disappoint-ment, self-doubt even self-loathing erupts in us re-sulting in constant movement because if we stop, wemight have to actually feel these “bad” feelings andthat’s too upsetting to consider!

Inevitably, reality hits us, usually with a series ofevents meant to smack us in the face so we have noother option but to face our reality. These can be anillness, the sudden death of someone you know, acancer scare, a friend’s affair or divorce, or even turn-ing a certain age. It can be your weight when you stepon the scale. Whatever the event, suddenly your worldis turned upside down and you can no longer denythat you are not happy living the way you are living.

Interestingly, it may not be what you are doing that’smaking you unhappy. You may have a great life. How-ever, how you think about your life and what you aredoing may be your difficulty. In other words, yourthoughts and your beliefs are what may be causingyour angst and your discontent.

Your Emotional Message SystemAs humans, we are blessed to have such a wonderfulemotional system to inform us of things that requireour attention. Many of us, however, are completely ill-prepared to handle this system and have not learnedhow to use it to our benefit. So we fumble aboutdoing the best we can. It’s not like we are born with continued on page 22


Learn How to Be Happycontinued from page 21

want from us. It makes communication really, reallydifficult. And we wonder why there are so many sin-gle people and the divorce rate is so high!

At the most basic level, the path to happiness is toidentify and eliminate the things that feel bad andidentify and include the things that feel good. Eachday, you have the opportunity to discover new thingsthat you like and don’t like. Practice by being on thelookout for how you feel. It will take time, but witheach choice you make to be happy in that moment, itwill become easier and eventually, it will becomehabit. Then you’ll start looking for things that feelgood and add value to your life and you’ll actuallyrepel things that don’t. You’ll become attractive togood things! It may be hard to imagine, dependingupon how you feel today, but one day at a time, withfocus and a desire for change, you will succeed athappiness.

Julie Fuimano, MBA, BSN, RN, CSAC is named one of theTOP 100 THOUGHT LEADERS in personal leadership de-velopment. Your happiness and success is her business!Her coaching clients experience dramatic and profoundresults in their productivity, level of confidence, and theirrelationships. As a certified coach, accomplished writer,and motivational speaker, Julie empowers your personalbest and teaches you simple, practical tools for meetingyour goals, communicating effectively with others, andenjoying yourself at work and at home. Visit www.Nur-turingYourSuccess.com to learn more about coachingwith Julie or contact [email protected] have her speak at your next meeting or conference.Subscribe to her blog at www.NurturingYourSuccess-Blog.com.

to, we are habituated; it’s more comfortable and fa-miliar than happiness, joy and love. In order for us tochange, to learn to be happy, then we must createnew habits, habits that support our ability to embraceand experience the “good” emotions.

The Path to HappinessThe path to happiness – to respect, to inner peace, tofeeling good about yourself and to being confident –is by honoring yourself and doing the things thatmake you feel good or comfortable. And when some-thing feels bad, don’t do it. Choose to spend time withpeople who you enjoy being around. And whensomeone does something that feels bad, then tellthem about it and, if need be, instruct them on whatwould feel good for you. If they don’t want to obligeand continue to do things that are of no value to youor that hurt you, then instead of trying to get them tochange, just stop spending time with that person.

It sounds so simple, doesn’t it? So, why is it so hard?

It’s hard because there are so many things that get inthe way of eliminating what feels bad and moving to-ward what feels good. We get in our own way. Most ofthe time, our heads get in the way; we do a lot of sec-ond guessing and we don’t trust ourselves or our feel-ings. So we behave in ways that do not reflect whatwe truly want and, therefore, our results are not whatwe want. This makes us unhappy and we don’t knowhow to make it better.

In addition, other people have their own heads andthoughts to contend with. They don’t do or say whatthey really mean either and we spend a lot of timeguessing and making assumptions about what they

Shelly Marie, MS, LDN, RD sends invitations on Facebook to her CollegeLifestyle events.

Pat Katepoo,, RD shares her good news as status updates on her mediacontacts - most recently her www.Forbes.com interview.

Make use of the feature that allows you to block others. I have used it toblock one of the few people I follow on Twitter. He posted innumerabletimes a day meaning I had to dig to read the posts of others. I alsoblocked a colleague on Facebook whose posts I considered in poortaste.

* LinkedIn Small Business Resource http://socialmediasonar.com/* *More on Innovators, Early Adopters, and the Rogers Innovation Adoption Curve see http://tinyurl.com/3a6h22

Some Relevant ApplicationsTweet to announce your teleclasses.

Use Twitter for immediate feedback to a question. One of my clientssent a Tweet and got a great name for a Virtual Group she is starting.

Kelley Biondolillo, RD tweets relevant Health and Wellness stories daily.


1. DINING SKILLS MANUAL: Practical Interventions For The Caregivers Of The Eating - Disabled Older Adult (3rd Edition, 2001) #5003 $30.00

Filled with suggestions for the health care team to address eating problems. Utilizes the multi-discipline team approach; RD, RN, OT, and SLP. Updated information on dysphagia, finger foods, checklist for compliance with dining skills, staff competency and more.

2. DINING SKILLS: Restoring Pleasure to Mealtime: Techniques for

Helping the Older Adult VHS (1993) #5001 $15.00 DVD # 5035

Excellent cross-training tool for all health care providers who strive to host independent dining skills.

3. POCKET RESOURCE NUTRITION ASSESSMENT— (6th Edition, 2005)

#5006 $25.00 Now in its 6th Edition! Spiral-bound; sized to fit in a pocket. Expanded to meet your changing needs. Guidelines are included for: developmentally disabled, anthropometric assessments, medications and labs, basic nutrition requirements, enteral and parenteral feeding assessments and more.

4. NUTRITION CARE OF THE OLDER ADULT, Second Edition #5009 $66.00 ADA Members $50.50 Covering everything the health-care provider needs to know when working with the older adult either at home or in an extended care facility. Covers factors affecting nutrition, nutrition and disease, nutritional assessment, dining challenges and regulatory compliance. Scientifically sound and practical resource for new and experienced professionals includes new forms, resources, the food guide pyramid for older adults and an index of tables.

5. NUTRITION CARE OF THE OLDER ADULT, 2E, CPE Questions #5031 $20.00 ADA Members $15.50 This companion piece to Nutrition Care of the Older Adult, 2e includes questions, an answer key, a form for reporting CE hours and a certification of participation. Approved for 21 hours of CPE credit.

6. NUTRITION RISK ASSESSMENT FORM, GUIDES, STRATEGIES & INTERVENTIONS (1999) #5014 $9.95

Material developed by the ADA Long Term Care Task Force and CMS. 7. POCKET RESOURCE FOR MANAGEMENT (2006) #5016 $18.00

A quick reference for food service management. Essential information for all areas including personnel, education, kitchen design, quality, cost control, survey information, emergency management, etc. Newly updated and revised.

Buy with the POCKET RESOURCE FOR NUTRITION ASSESSMENT and get both for $35.00 #5090

8. Nutrition and Foodservice Management in Correctional Facilities 3nd

edition (2008) #5023 $25.00 Designed for the dietetic professional working in the correctional arena.

Pertinent to both the newcomer and those familiar with corrections. 9. DIETARY DOCUMENTATION POCKET GUIDE (2004) # 5024 $21.95 Basics of documentation for the novice as well as more experienced dietetics

professional. Developed with DMA. 3 CPE credits available through CDR and DMA.

10. STEPS TO SUCCESS - THE BUSINESS OF CONSULTING (2002) #5025 $10.00 Overview of what a consultant needs to know: developing a business, & marketing plan, setting fees, IRS information, etc. Includes contracts, forms, etc.

11. STEPS TO SUCCESS: FOOD SERVICE SYSTEMS (2004) #5030 $10.00 A well-run, financially sound operation serving attractive, appetizing food can mean success. Features up-to-date information, classic guidelines, & sample forms to complement your knowledge of equipment, food preparation techniques, budgeting, kitchen design, and quality improvement.

Buy BOTH STEPS TO SUCCESS for $15.00 #5091 12. INSERVICE MODULE 1 – SANITATION (2002) #5026 $10.00

Revised & expanded! Concentrates on basic sanitation: Standard Precautions, Personal Hygiene, Damp Mopping, etc. Pre-tests, post-tests, and handouts. A great addition to your educational library.

13. INSERIVCE MODULE 2 – FOOD SAFETY (2002) # 5027 $10.00 Concentrates on safe food handling: HACCP, food temperatures, storage, leftovers, foodborne illness, etc. Pre-tests, post-tests and handouts.

14. INSERVICE MODULE 3 - DIETARY STAFF: ESSENTIAL EDUCATION (2005) #5032 $10.00 Concentrates on essential, basic information for dietary staff including department orientation, HIPAA, resident rights and much more!

15. INSERVICE MODULE 4 – MEDICAL NUTRITION THERAPY (2006)

#5033 $10.00 The 4th module in the series of Inservice sessions for the nutrition services department. This module focuses on medical conditions that may be impacted by nutrition interventions, special diet needs, etc.

Buy ALL 4 INSERVICE MODULES for $15.00 # 5092

16. EATING MATTERS: A Training Manual For Feeding Assistants (2003) #5028 $18.00 A comprehensive guide for the professional who is training feeding assistants for those residents who need help during mealtime. Developed in response to CMS regulations.

17. MANUAL FOR FEEDING ASSISTANTS (2003)

#5029 $7.00 Designed for each feeding assistant to use during training and afterwards as a reference. Includes learning activities and important information taught in #5028.

18. SURVIVAL SKILLS FOR NUTRITION SERVICES (2006) #5034 $20.00 Are you new to the nutrition services department or do you need to increase your overall knowledge? Is the dietary manager new? This manual is just what you are looking for to help! Gives a broad overview of Systems Management, Clinical, Management, Compliance and Evaluation.

19. NUTRITION ESSENTIALS FOR THE HOME CARE DIETITIAN # 5036 $28.00 Do you work in Home Care? Are you considering this growing field? This manual is beneficial for both the dietitian new to Home Care and those already working in the field.

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ChairCarol H. Elliott, RD, LD/NOrmond Beach FL [email protected]

Chair-ElectBrenda E. Richardson, MA, RD, LD, CDPekin IN [email protected]

Past ChairLinda Roberts, MS, RD, LDNWheaton IL [email protected]

SecretaryMary M. Rybicki, MS, RD, LDN Wakefield MA [email protected]

TreasurerSharon Emley, MS, RD, LDPowell OH [email protected]

Membership Coordinator*Dana Fillmore, RD, CP-FSWyoming MI [email protected]

Professional Development Coordinators*Cindy Thomas, RD, CD Bellingham WA [email protected]

Kathy Weigand, RD, LD/N Valrico FL [email protected]

Communications Coordinator*Amy C. Buehrle Light, RD, LDNCary NC [email protected]

* These members were elected as Area Coordinatorsand have been redirected to these responsibilitiesper the new governance structure.

+ Do not attend EC Meetings

Public Policy Coordinator*Angela Sader, MBA, RD, LDWichita KS [email protected]

Regulatory +

Lynn Moore, RD, LDPort Gibson MS [email protected]

Network Liaison Coordinator*Barbara Wakeen, MA, RD, LD, CCFP, CCHPN. Canton OH [email protected]

Sponsorship CoordinatorCynthia Piland, MS, RD, CSG, LDLa Grange TX [email protected]

Sales+

Katheryn R. Adams, RD, CSG, LDLaGrange [email protected]

Health Care Communities Coordinator*Ellen Butler, RD, CSG, LDN Beverly MA [email protected]

Corrections Sub-Unit +

Diane Benfield, MS, RD, CDWalla Walla [email protected]

Home Care Sub-Unit +

Carolyn M. Yanosko, MS, RD, LDEuclid [email protected]

DPG/MIG/Affiliate Relations ManagerSusan DuPraw, MPH, RDAmerican Dietetic Association Chicago IL 800-877-1600 ext 4814, 312-899-4814312-899-5354 (F)[email protected]

ADA Web Page:www.eatright.orgDHCC Web Page:www.dhccdpg.org

Connections (Newsletter)Managing EditorMarilyn Ferguson-Wolf, MA, RD, CSG, CD Seattle WA [email protected]

Assistant EditorBonnie H. Gunckel, RD, CDFort Wayne IN [email protected]

Cont. Ed. Editor: Cynthia Piland, MS, RD, CSG, LD

Newsletter ReviewersSusan DuPraw, MPH, RDCarol Elliott, RD, LD/NBrenda Richardson, MA, RD, LD, CDLinda Roberts, MS, RD, LDNMary Rybicki, MS, RD, LDN

AdvisorDiane Tallman, RDAbbott NutritionHudson OH [email protected]

Executive DirectorMarla Carlson2219 Cardinal DrWaterloo IA 50701-1007319-235-0991, 319-235-7224 (fax)(Central time zone)[email protected]

Dietetics in Health Care Communities (DHCC)Executive Committee and Officers 2009-2010

If you have moved recently, or had a change ofname, please notify ADA Membership Team assoon as possible by [email protected] or at ADA’s Web site atwww.eatright.org “Edit Profile.”

© 2009 Dietetics in Health Care Communities, adietetic practice group of the American Dietetic Association.

Viewpoints and statements in these materials donot necessarily reflect policies and/or official positions of the American Dietetic Association.

connections - dhccdpg.org perception of our meals was less than favorable. ... dards for rds and...

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