Nutrition 411: 3rd Annual Nutrition Best Practices, Tips, Tricks, and Techniques
Sunday, 07/01/12 | 4456 reads
 0  0  0  4  
Issue Number: 
Volume 58 - Issue 7 - July 2012
 Login toDownload PDF version

Nancy Collins, PhD, RD, LD/N, FAPWCA
  In this annual “innovations” column, registered dietitians from across the United States offer their best practices, tips, tricks, and techniques for dealing with unintended weight loss and wounds to help improve the level of care we offer when faced with these challenging problems.

  Often patients with unintended weight loss, malnutrition, or wounds who live at home do not have the energy to shop for food or prepare meals. In addition, many caregivers lack cooking skills for special diets. One solution is to have meals delivered to the home. National and local meal providers are available, including Meals On Wheels, Mom’s Meals, or local providers who may deliver meals. Mom’s Meals, for example, has meals for diabetic, heart health, gluten-free, renal, vegetarian, and low-sodium diets. These fresh meals are delivered by FedEx® and keep in the refrigerator for up to 18 days. Just heat and eat. Ask the meal providers in your area if they are able to provide meals for people on special diets. — Dee Sandquist, MS, RD, LD, CDE, Fairfield, IA

  Each of the standard diets we use is listed with a description that includes high-calorie/high-protein supplements as part of the diet order. Once the attending physician signs off on the diet order, we can determine which supplements the patients will accept and start them immediately. The charge nurse gives the protein modules as part of the medication administration record (MAR) rather than giving them with meals, which the patients may not eat. In this way, we are sure of what the patients have accepted, because the nurse must initial the MAR when the item is given. — Stephanie A. Perez, MS, RD, Pomona, NJ

  For patients with reduced volume tolerance and increased nutrient needs, I developed simplified, flavorful recipes using everyday ingredients in six food categories: beverages, breads and cereals, desserts, main dishes, side dishes, and soups and sauces. Flavorful Fortified Food— Recipes to Enrich Life includes a collection of 60 tested recipes by authors Digna Cassens, MHA, RD, and Linda S. Eck Mills, MBA, RD, FADA. The recipes, from sweet to savory, are appropriate for various textures and include helpful hints to make changes to further expand the variety offered. In quantities of one or 10 portions, they are practical for home or community use. Many of these recipes become favorites of residents, staff, and families. The recipe for peanut-butter cup pudding was frequently requested by residents who were refusing any other supplement or food. A cereal recipe packs 700 calories in 1 cup and is easily accepted by the very weak and cachectic. The book also includes dairy-free recipes for those unable to tolerate dairy products. — Digna Cassens, MHA, RD, La Habra, CA

  What is effective for one resident may not work for another, which is why individualizing interventions is so important. I prefer not to use standing orders for additional food and/or supplements, but rather to review each patient and decide what intervention will work best for that individual. Some will accept food; others prefer supplements. Some residents like more meat on their tray; others want more dessert. I have one patient who has lived off Hershey’s Kisses® and chocolate Ensure®, six each day for many years! Not all interventions are food-related. Sometimes speech therapy and consistency changes, feeding assistance, or changing the dining environment is all that is needed to help a resident maintain or improve their nutritional status. — Elizabeth Friedrich, MPH, RD, CSG, LDN, Salisbury, NC

  Timeliness of nutrition interventions is my tip! The best process is when weekly weights are obtained on a scheduled day by the same person and reported by the next day. On the day of the report, weekly weight losses of 2% or more are reviewed for causation and implementation of possible new interventions. Interventions include the usual: food preferences, health shakes, fortified foods, larger portions, and the like. Usually by the next week, because of quick interventions, the weight loss has arrested.

  We have several transitional residents who may stay for only 30 days or less. They are more alert, have higher expectations, and are more invested in their well-being. Our goal: Nourish. Heal. Empower. We accomplish this by nourishing their bodies and minds. We offer a wide selection of menu options, educate them on “healthy choices,” and put symbols on the menus to signify foods that are lower in carbohydrates, sodium, and fat. We let them know they are in control of their health and we are here to assist them in healing. Because we offer a wide selection, our community uses minimal nutritional supplements. — Niki Wray, MAEd, RD, Phoenix, AZ

  Our community conducts a weekly Resident WINS (Weight/Wound Intervention and Nutrition Support) for residents at high nutritional risk. The team consists of the director of nursing, a registered dietitian or dietetic technician, the Food Service manager, Restorative Nursing, the charge nurses, and the physician. As a team, we review residents and decide on interventions. We follow up on past interventions to see if they are working. We are fortunate; our medical director attends these meetings. He often guides us to let us know we have done all we can and that the decline in unavoidable. — Anna de Jesus, MBA, RD, Tempe, AZ

  Our motto is Liberalize, Fortify, Supplement, in that order, when it comes to unintended weight loss in our elders. If a resident is on a restrictive diet, we liberalize this to a regular diet with their permission. If this does not increase intake, we fortify their foods by adding nonfat dry milk, peanut butter, half-and-half, and the like to their food. When we add margarine, we squeeze this on their potatoes, vegetables, soups, and so on as opposed to providing an extra pat of margarine on the tray, which often comes back unopened. When all these interventions fail, we supplement. — Karolyn Frye, MAEd, RD, Chandler, AZ

  We worked with our hospitalist groups to develop a series of single-paragraph “survival” discharge (D/C) diet texts for insertion into electronic D/C instructions — diabetic, renal with and without dialysis, cardioprotective, and Coumadin®/vitamin K. These texts include contact information for any patient questions after D/C, as well as additional web-based support information. If desired, hospitalists also can insert outpatient clinic information. Diabetes educators and case managers for patients with heart failure are encouraged to refer patients to a registered dietitian if they feel they do not understand the diet. In addition, the expectation is that clinical dietitians will assess education needs/appropriateness at every patient/family encounter. — Bill Swan, RD, LDN, Annapolis, MD

  Patients deserve the chance to make decisions regarding their diet and mealtimes. They should have the options of who they eat with, what foods they eat, where they eat, when and how often they eat, and how they are served. Allow patients to sit with their friends during meals. Do not underestimate the importance of presentation, paying special attention to making mechanical soft and pureed foods more visually appealing. Offer a home-like or restaurant-like atmosphere. Use plants and flowers to bring nature inside, and provide a colorful and cheerful environment with plenty of natural light. Play quiet, relaxing background music. Offer small meals throughout the day, and think about using a snack cart. Consider room-service style dining or serving each meal for a few hours each day (eg, breakfast from 7–9 a.m.). Consider giving patients the chance to help prepare some of their own food. — Elaine M. Koontz, RD, LDN, St Clairsville, OH

  Nutrition interventions can boost calories, protein, and other nutrients for individuals who cannot get enough from normal foods. You can boost the nutritional value of the foods served by using fortified food recipes, such as fortified oatmeal and calorie-dense pudding.

  Directions:
    1. Measure half-and-half, water, salt, and margarine into saucepan. Bring to a boil.
    2. Add oatmeal and cook until thick.
    3. Serve with brown sugar on top.
    4. Hold at >135° F until service.

  Note: You must puree oatmeal for level 1 pureed diets.

  Directions:
    1. Measure ingredients and blend together.
    2. Refrigerate to set.
    3. Maintain temperatures <41° F until service.

  — Becky Dorner, RD, LD, Akron, OH

  Here are some ideas for nourishments and snacks for long-term care facilities.

  Snack suggestions
    • Vanilla wafers
    • Graham crackers
    • Nutri-Grain® Cereal Bars
    • Lorna Doone® Shortbread Cookies
    • sandwich cookies
    • animal crackers
    • sugar cookies
    • oatmeal cookies
    • peanut butter crackers
    • cheese crackers
    • Rice Krispies Treats®
    • pretzels

  Beverage suggestions
    • Lemonade
    • Kool-Aid®
   • fruit juice
    • fruit punch 

 The following table provides an example of snacks for different diets.

  — Marilyn Moody, RD, LD, Cumming, GA

Nancy Collins, PhD, RD, LD/N, FAPWCA, is founder and executive director of Nutrition411.com and Wounds411.com. For the past 20 years, she has served as a consultant to healthcare institutions and as a medico-legal expert to law firms involved in healthcare litigation. Correspondence may be sent to Dr. Collins at [email protected].

This article was not subject to the Ostomy Wound Management peer-review process.

- See more at: http://www.o-wm.com/article/nutrition-411-3rd-annual-nutrition-best-practices-tips-tricks-and-techniques#sthash.sP3SC9VU.dpuf

Krause's Food and the Nutrition Care Process shared a link.

November 21 near Seattle, WA

Today is Worldwide Pressure Ulcer Prevention Day. Thanks to my friend Digna (who wrote this excellent book) for letting me know. http://www.flavorfulfortifiedfood.com/2/post/2013/11/world-wide-pressureulcer-prevention-day-november-21.html

World Wide Pressure Ulcer Prevention Day - November 21
www.flavorfulfortifiedfood.com
Pressure ulcers can be very painful for an individual.  A pressure ulcer is merely an area of the body that is subject to an excessive amount of pressure. The best way to prevent a pressure ulcer is...

 

January 22, 2013 - In the Kitchen with Maggie Green - Cookbook Author Interview: 
Digna Cassens: Listen to the experts and ask questions of your POD (print on 
demand) company,

Digna attended one of my recent teleseminars about writing cookbooks. After hearing the teleseminar she was inspired to follow her dream and write her own cookbook.  Digna embodies what I believe are positive qualities for a cookbook author: enthusiasm, willingness to work hard, and knowing when to ask for help. As a result she partnered with a coauthor and they successfully wrote and independently published their cookbook using CreateSpace. 

What is the name of your cookbook?

Flavorful Fortified Food – Recipes to Enrich Life

Is this your first cookbook?

Yes.

Did you have a food blog prior to writing your cookbook?

No, I did not have any food blogs, although I have 4 blogs they are all personal for family and my genealogy hobby.

What compelled you to write a cookbook?

There were many reasons I wanted to write a cookbook. My mother was my inspiration; she published a popular regional recipe book,Cocinando en San German and she also translated it to English,Cooking in San German. She also hosted one of the first live cooking shows in Puerto Rican television. After I left a long career in the long-term-care corporate world I decided to write about what I know best, food and nutrition and the work I’ve developed during my 50 years as an RD.  My goal was to leave my knowledge behind for others to benefit from it.

For years, I have developed hundreds of institutional and home use recipes and find it a relaxing hobby. I also have written policies and procedures, training, and disaster and emergency management manuals. I intended to start with series of training books for dietary staff and halfway through the project I heard your teleconference about writing a cookbook. That did it for me! That chat ignited my passion for recipe writing all over again and I saw the possibility became a reality.

My career has always been in long-term care and geriatrics and have always used food as the first approach to nutrition, rather than supplements or manufactured medical nutritionals. My collection includes over 200 fortified food recipes that are easy to prepare, inexpensive, and fit into any menu, and have conducted workshops and seminars on the topic. I have tried them all, find them delicious and know they work. This cookbook is only the first in a series, with more coming on other specialty topics.

Tell me more about fortified food and what types of recipes this book might contain?
Many individuals need high calorie and high protein foods due to low body weight, diminished appetites, inability to eat adequate amounts of food, and drink enough fluids. Changes in taste and smell due to illness, side effects of medications or the aging process exacerbate the problems, resulting in decreased intake and subsequent weight loss. By providing comfort foods, caregivers in the home or health care community are able to create meals that satisfy the most demanding palate, resulting in improved intake and cost savings.

Individuals engaging in extreme sports, physical fitness training, body building and long distance events need quick and easy to prepare and eat foods that are high in the most important nutrients to carry them through their training, and most importantly throughout the duration of their event. These easy to prepare and delicious recipes replace commercially manufactured canned or boxed supplements and expensive nutrition bars. Using every day ingredients and foods commonly prepared for the family table eliminates extra work and expense.

Our cookbook then is a collection of 60 well-tried and tested recipes for beverages, breads and cereals, dessert, main dishes, sauces and soups, and side dishes in one and ten portion quantities. The helpful hints with every recipe offer ideas to make changes to the flavors or serving to further expand the variety offered.

What advice do you have for an aspiring cookbook author who wants to self-publish a cookbook?

My advice for anyone aspiring to write is, “you’re not alone”, and “you can do it”! Listen to the experts that have done it before you and know, attend teleconferences, workshops and seminars and read all you can find on the subject. But then, you have to make an appointment with yourself and sit down every single day and DO IT!

What was your biggest challenge in writing your cookbook?

Lack of time and an excessive number of distractions. It was also difficult to find the right focus until I met my co-author, colleague Linda Eck-Mills, MBA, RD, CLD, FADA. She has published extensively, and we shared some of the same background in hospice and home health, so a casual discussion about food fortification, let to an excellent partnership.

What are some advantages of having a co-author?

Linda is experienced as a published author of articles and books, is an international speaker, and coach. Her skills complimented mine in all of these areas, enhancing my drive and ability, establishing firm schedules, providing a sounding board and stating opinions firmly. With her eye for detail, she is an excellent proof-reader and editor, and provided the balance needed to produce an elegant product. When considering a co-author it is essential to spend time discussing your vision, strengths and weaknesses, have a written business agreement, and be sure you both know your strengths and how you complement each other’s skills.

She helped in every step of development, networking with her professional resources as I did with mine, and helping select format, cover, even the fonts used. Having decided to use print-on-demand was an even bigger personal challenge requiring extensive reading and learning to be able to achieve the end result, the PDF version of the book had to be uploaded for printing.

What was your biggest challenge in publishing your cookbook?

Frankly, I did not know where to start. The recipes were tested and written, but without consistency, format or focus. Creating the vision of what the book would look like was the longest process I had to go through, an area in which having a co-author was of  such value.

What did you learn from self-publishing your own cookbook?

I learned a lot about myself, including the fact that I am not a detail person, preferring to focus on the big picture, so I need a meticulous editor that does not miss the details. Great lesson for the next book that’s coming.

What are some questions you would recommend that an aspiring author as a POD (print on demand) company?

• What are the up-front charges if any. Some require a deposit of quite a few hundred dollars (we did not use those services.)
• What services do they provide (cover design, convert to PDF &/or upload to their server, marketing, etc.) and what are the fees for each?
• What % royalty is paid to the authors and if the % is scaled or pro-rated by the number of book sold.
• What is the frequency of royalty payments, method used for payment, and the accounting/auditing methods to verify sales?
• Do they have option of overseas/foreign distribution, and if so what countries, and what is the cost?
• Are internet sales based through them only? What other sales venues will there be available and what is the cost?
• What are the options for formatting for eBook versions such as the Kindle or other electronic device, eBook, and PDF?  What is the cost for each and what are the requirements for conversion of the file? (How is data is entered, what programs are compatible for uploading, if conversion is needed prior to uploading, what is the fee and using what conversion programs?)
• What support does the company offer? What are the free or fee-based services? Is this a 24/7 operation? (I personally used CreateSpace 24/7 as I keep erratic hours when working or juggling schedule.)

Any thoughts you’d like to share on the marketing and sales of your cookbook?

Don’t be afraid to talk about it. The more discussion and brainstorming the better the ideas will be developed, but stay true to your concept and initial goal. Start marketing before the book is finished. It’s never too soon to talk about it, and start doing chats and presentations on the topic. Use any venue you can find, including free conference calls, networking, and social media. Any free marketing is great and will definitely increase sales. Use multiple resources, from fliers to emails to business cards in addition to social media. Don’t be afraid to give out complimentary copies, but be selective in doing so. And in the end, volume means profit, and it’s better to receive 50% of many sales, than 80% of none. Book sales so far have exceeded our expectations, and after FNCE will most likely increase. I still have many markets to pursue and slowly I’m doing so. I had to learn not to be afraid to sell a product I created and believe in.

This month’s book selection is Flavorful Fortified Food by author Digna  Cassens, MHA, RD, and contributor Linda S. Eck Mills,  MBA, RD, FADA. This is an  excellent resource for individuals who need high-calorie and high-protein  foods. The book is divided into six common recipe categories, with recipes that  focus on adding nutrients, as well as additional calories. With easy-to-follow directions and innovative suggestions, it is perfect for people of all levels  of cooking experience. Not only does this book take the guesswork out of meal  planning, but it provides appealing garnishes and satisfying additions. 

Whether cooking for one or ten, Flavorful Fortified Food provides you  with everything you need to create a delicious, nutrient-dense meal. If you  work with individuals who have low body weight, decreased appetite, or  increased nutrient needs, Flavorful  Fortified Food is a must-have.