A Dietitian Down Under

A Dietitian Down Under

By Lauren McLean

imagesI remember the moment well. I’d finally realised the career I wanted. I was 27 and when I ‘grew up’ I was going to be a dietitian.

I have loved food for as long as I can remember. I love to cook and bake. I love to try different foods, buy cookbooks and explore recipes. I love visiting new restaurants, food markets and organic stores. When I was a little girl my nan taught me to cook and various family members taught me about dieting: their trial and error style of weight loss and the emotional ups and downs of a kilo on or a kilo off.  My dad and my sister taught me the food challenges they faced daily because of various autoimmune diseases, allergies and intolerances.

My passion for food had always been there but my interest in health, well-being and food as medicine really started to shine when I hit my early 20s and I realised the importance of eating nutrient dense, healthy, fresh and colourful food. I realised the connection between feeling good and eating well. It wasn’t a diet people needed it was a way of life.

I had no idea that I could make a career out of health and food so I continued working in the legal world which helped to supplement my travel addiction.

UnknownFast forward to my late 20s and I came across an article written by a dietitian. Much research later I found out that a dietitian helps individuals, with or without a medical condition, to improve their health through the food they consume. Well that was it then. I was going to be a dietitian. I had finally found the career I wanted to pursue. A little late in life, but I got there. I did as much research as I could. I discovered that dietitians study for a minimum of 4 years and are qualified to work in clinical settings whereas a nutritionist studies for 3 years and does not work in a clinical role. As a dietitian I would be able to fulfil my desire to help people. I would be able to combine my love of food and health and I would be able to work in a wide range of settings including the food industry, hospitals, private practice, public health departments and fitness or sporting centres.  I enjoy change. I enjoy continuously learning and expanding my knowledge. This seemed liked the profession for me.

So, where to study? I researched degrees in England (my home) and Australia (the country I had frequented numerous times in my 20s). I chose Australia. Why? Because I wanted an adventure. Simple as that.

So, in February 2011 I joined the University of the Sunshine Coast as a Tertiary Preparation Pathway (TPP) student. Before I could start my Bachelor of Nutrition and Dietetics I was required to do TPP studies because I didn’t have an OP. In Australia, students finish high school at 17 with an OP. This is a number that can determine whether or not you will be accepted onto your chosen degree at University. 1 being the highest. The Nutrition and Dietetics degree that I wanted to study required an OP of 8. Which tells you a little bit about the course. It would be difficult!!

For TPP, I studied Chemistry, Biology, Statistics and Academic Skills. I worked hard. I was passionate and I wanted so badly to get on to the degree and start on the road to becoming a dietitian. Grades at the University of the Sunshine Coast are High Distinction (HD), Distinction (D), Credit (C), Pass (P) or Fail (F). I am very, very happy to say that I got HD’s in all my TPP subjects. I had worked hard and devoted all my time to studying and doing well so I deserved these grades. As a result of my excellent grades, I was accepted onto the Bachelor of Nutrition and Dietetics. Yippee!

imagesI have completed 2 years of the 4 year degree. February 2014 saw me enter my 3rd year. During the first year of the degree, I studied introductory science subjects (cell biology and chemistry), more statistics, communication, physiology, anatomy and introduction to psychology.  During the second year, I studied advanced physiology and biochemistry modules, public health nutrition, nutrition assessment and basic principles of food and nutrition.

Content is assessed in a variety of ways. I have completed lots (and lots!) of group assignments (oral presentations, reports, research). I have also prepared, researched and written many scientific reports, carried out lab experiments, completed practical and written examinations, reviewed literature, critiqued articles and executed countless online quizzes.

I’ve started to think about the future. Once I finish my degree I can register with the Dietitian’s Association of Australia and will be called an Accredited Practising Dietitian.  I would love to pursue further education in Sports Nutrition or International Public Health Nutrition but in the mean time I am happy knowing I am halfway to finishing my dietetics studies and I’m currently enjoying learning all about the wonderful world of disease through epidemiology and pathophysiology this semester.

Heart healthy exercise advice can be a life saver

Seeing patients today? “Heart healthy” exercise advice can be a life saver for men, women and children

Guest blog series on physical activity and cardiovascular health: Part 2

[Many thanks to the BJSM and @exerciseworks  for sharing this excerpt]

Heart disease is the leading cause of death for both men and women.

ew4Reduction of heart disease risk in patients, is significantly linked to modifiable factors (such as tobacco use, poor diet, physical inactivity, obesity, alcohol use) or factors that can be changed to reduce the risk of further ill health and heart disease (such as appropriate blood pressure control, lipid management and the availability of essential medicines and technologies to treat cardiovascular disease). More than half of the deaths worldwide (due to heart disease) are in men.

Physical inactivity is a major contributor to all types of cardiovascular disease risk- yet regular physical activity can help maintain a healthy weight, lower cholesterol and blood pressure, and help reduce the risks that an inactive lifestyle can present. Children who are inactive are also at risk of developing heart disease and stroke risks earlier in life. A simple solution, you would think, such as helping each of your patients to exercise more, would and should work!

Providing physical activity advice and support to every patient, is an essential part in the prevention and treatment of all aspects of heart disease and stroke health care.  The World Health Organisation is clear on the physical activity message:

Every adult needs to enjoy physical activity for at least 150mins a week:

  • Adults aged 19–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.

  • Aerobic activity should be performed in bouts of at least 10 minutes duration.

  • For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity.

  • Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.

An exercise prescription can include walking, hiking, swimming, dancing, running, jogging, sports and gym activities, or physical activities in leisure time also help to promote heart health!

Every child and teenager needs to enjoy active play and opportunities to exercise:

  • Children and youth aged 5–17 should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily.

  • Amounts of physical activity greater than 60 minutes provide additional health benefits.

  • Most of the daily physical activity should be aerobic. Vigorous-intensity activities should be incorporated, including those that strengthen muscle and bone*, at least 3 times per week.

  • *For this age group, bone-loading activities can be performed as part of playing games, running, turning or jumping.

The exercise ‘prescription’ for children and young adults should emphasise active play, fun, inclusivity and less sitting.

Health professionals are skilled at supporting patients to make the right choices for their best health outcomes. There is no better preventative medicine that you can prescribe than to help encourage and support your patients to exercise daily!

The clinical benefits of regular physical activity on cardiovascular risk factors for patients have been well reviewed but you can summarise for patients as:

  • able to exercise more: regular exercise increases exercise tolerance and stamina
  • reducing body weight: a loss of just 5 to 10 percent of weight can lower your patient’s risk of coronary heart disease. Regular exercise advice together with a healthy eating programme can help your patients achieve this. Many people may need more than 150 minutes/week of moderate intensity activity a week to stay at a stable weight, as well as to lose weight or keep off weight they have lost. (U.S. Dept. of Health and Human Services. 2008 Physical Activity Guidelines for Americans, 2008)
  • a lowering in blood pressure: the average reduction in blood pressure ranges from 7.4mm to 5.8mm Hg in hypertensive study patients
  • reduction in ‘bad’ (LDL and total) cholesterol
  • increase in good (HDL) cholesterol
  • increase in insulin sensitivity: both aerobic and resistance training improve insulin action, blood glucose control, and fat oxidation and storage in muscle. This means that the risks of developing metabolic disorders and type 2 diabetes are significantly reduced with regular physical activity

And finally, as I’m a British Association Cardiac Pulmonary Rehabilitation exercise instructor….

Cardiac or stroke rehabilitation programmes (cardiac rehab) reduce the risks of a further cardiac event by stabilizing, slowing or even reversing the progression of cardiovascular disease. In the USA, only 14-35% of heart attack survivors and only 31% of coronary artery bypass surgery participate in a cardiac rehab programme. In the UK, the average attendance rate post cardiac event is 43%.

Please support, advise, engage, signpost, enable, encourage, prescribe, refer and educate patients as to the benefits of attending their local cardiac rehabilitation programme- it is life-saving medicine after a cardiac event and continuing as a lifelong prescription. Every patient should be able to access cardiac rehabilitation programmes locally, and bespoke to their cultural needs.

In summary: heart healthy exercise prescriptions are critical care medicine at their finest. Let’s start prescribing exercise and fun, physical activities and monitoring our patients at risk of heart disease, every consult they attend, and at every opportunity in their health care pathway!

And remember….. refills and repeat prescriptions of this life saving prescription are on a weekly basis of 150 minutes/week, but review as a ‘vital sign’, every consult!

Ann Gates BPharm(Hons) MRPharmS

Founder of Exercise Works! in celebration of World Heart Month February.

Member of the WHF Champion Advocates Programme – Emerging Leaders Programme.

Info graphics courtesy of the World Heart Federation Champion Advocates Programme.

ew3

The Vocational Rehabilitation Journey in Scotland: Reflections from an AHP Consultant

Untitled

The Vocational Rehabilitation Journey in Scotland: Reflections from an AHP Consultant by Jean McQueen

Essentially work is good for our health. Being out of work is detrimental to both an individual’s physical and mental health. In 2010 when I took up post not all health professionals believed this to be the case particularly for those with severe and enduring mental health needs. Few services asked their clients about their aspirations for work as part of routine practice and within Scotland there was only one service practicing an evidence based approach using the Individual Placement Support [IPS].

So armed with a passion for the topic and a background in research from my days as a research occupational therapist and practice development lead this post was a great opportunity and just the challenge I was looking for. My recent experience as a clinician in forensic mental health supporting patients with their aspirations for work really helped me appreciate the powerful impact the right work had on mental health and recovery. Providing an identity that was more than someone with a mental health condition. I remember clearly my patients talking about how they found it easier to manage their symptoms and stay well whilst involved in work related activities or the delight on one of my patient’s faces when she was invited to her work placements Christmas night out. It turned out no one had ever invited her to a night out before and to use her words she was ‘gleaming’.

Screenshot 2014-03-14 10.40.57In thinking about this blog I was also drawn to think about a discussion I had with an MSc Occupational Therapy student whose dissertation I was supervising. I can remember the puzzled look on her face when she told me about the compelling evidence she’d incorporated into her literature review on the IPS model. I had to agree with her it was puzzling that this evidence was out there and not being used in practice.

So with this AHP Consultant role I hoped to make a difference. I was no longer a clinician with responsibility for an assigned caseload, which of course is the most obvious way to make a difference. But I was sure with my skills the right support, the emphasis on welfare reform and political buy in there was the potential to offer those with mental health issues in Scotland something more than our ‘traditional’ models of practice. Here I could influence at a national level and still make a difference to patient care.

theatre

So reflecting back how would I describe my role. Well…..when you go to the theatre to see a play your attention is focused on the actors on the stage and their performance usually dictates how well you enjoy the whole production. But what about those behind the scenes the stage managers, costume designers and make-up artists, the lighting, scenery and the technicians whose performance is equally crucial in providing a satisfactory end result?

Well acting is not the only profession to need strong behind-the-scenes support. AHPs in Scotland working in forensic mental health have their own ‘backroom person’ whilst I have no ‘front of house’ clinical duties what I do is provide the foundation and props to develop truly effective evidence based vocational rehabilitation.

Evidence based practice is the conscious use of current best evidence in making decisions about the care of an individual patient. As a clinician the current pressures and demands dictate focus on clinical activity. Even with the best of intentions it is difficult for clinicians to find time to question practice, analyse the evidence and transform services and not all clinicians understand research papers and the statistics they contain.

Untitled2

So this is where I come in. My post commenced with the development of a national document ‘Towards Work in Forensic Mental Health’ and its messages were strengthened through the focus on work in the Scottish Mental Health Strategy and the AHP Delivery Plan  but of course it takes more than that for true transformational change. Clinicians have to take ownership, feel involved, supported and inspired.

So as Jacqui Lunday-Johnstone our CHPO at Scottish Government would say ‘so what’, what difference has this made to practice? Well there is compelling evidence many more AHPs in forensic mental health are asking their patients about work. It’s hard to believe now, but we really weren’t doing it. In our national survey in 2010 only 13% of AHPs were asking their service users about work and by 2012 this had increased to 81%.

But of course it’s more than that as once AHPs ask the work question they need to feel confident to deal with the answer. My role involves working with clinicians across Scotland in variety of ways:

  • supporting them to develop employability pathways
  • emphasising the importance of partnerships with local employability services
  • supporting clinicians to apply for grant funding for dedicated VR posts, arranging training and ongoing support on the IPS model, disclosure of mental health and criminal offences in the work place
  • developing national consensus on standards of practice, outcome measures used
  • supporting services to develop and transform, whilst representing AHPs at strategic level discussions on the mental health strategy or with the Department for Work and Pensions thereby linking up all the pieces of the jigsaw required to practice in a truly evidence based way.

Throughout Scotland eight health boards now offer an IPS service, but there is still some way to go even in these health boards. IPS is not available in every team. There is more work to be done not only in developing more IPS services but supporting those early implementors to evaluate and publish their outcomes.

Screenshot 2014-03-14 10.44.07I feel privileged to be on this VR journey providing the props to enable AHPs to perform well in vocational rehabilitation. I feel proud of what AHPs are achieving and lucky to be working with clinicians with a real ‘can do’ attitude. Thank you to all who are joining me on this journey, in particular Lisa Greer by fellow VR lead – we make a great double act. We still have some way to go, we’ve come far, but we now need to evaluate and measure our services though fidelity assessments, job outcomes, standardised assessments and publish our work in order to add to the evolving evidence on the impact AHPs and health has in this important agenda. Work really must be viewed as a health outcome.

Thank you for reading and if you would like to find out more, or be part of our journey please get in touch jeanmcqueen@nhs.net or follow me on Twitter @jeanahpm

Over the sea to Skye…… and other places

Advising architects, trialling trikes and travelling over the sea to Skye is all part of the average week of

Highland Council Children’s Occupational Therapist Susan Jeffrey.

 

I am a Band 6 Occupational Therapist (OT), working for The Highland Council as part of their Health and Social Care Children’s Service.  Based in Fort William with a geographical patch covering Lochaber, Skye and Lochalsh.  I have been an OT for 21 years, and a children’s OT for 18 of those years. I’ve worked in Highland for the last seven.

Our OT team is based and managed from Inverness where the majority of the Children’s OTs are located.  After almost seven years as a lone practitioner I was joined by a Band 5 OT last October – at last I have someone to share the highs and lows of the OT world in our locality.

We are based out of Fort William Health Centre – which opened in 2007.  A fantastic local facility from which to deliver our service with co-location with other therapy and health colleagues.

The world of the Children’s OT has changed a lot since I started with a real drive these days to  improve the skills of those around the child including parents, carers, and school staff.To give a flavour of what I do I’d like to share my week: Continue reading