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Efficient and highly educated Registered Dietitians who focus on continuous quality improvement and program development.

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An invaluable resource of nutrition consultants that follow the trends in healthcare and changes in regulatory requirements.

Claxton Dietetic Solutions Articles

Rapport Galore
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A consulting dietitian is somewhat of a jack of all trades. Beyond having a full circle knowledge of clinical nutrition, sanitation and food safety policies, dietitians must also have strong relational skills to see true progress in their facilities. You might think its possible to do this job simply by going in, getting the work done and leaving with little to no interaction with the staff. That’s possible, but not what’s best for our residents or the facility. The secret to success for both yourself and your facility (s) is in the relationships.   Relationships are a tricky thing. They take time. It takes getting to know another person and making them feel heard, understood and cared for. Genuinely. This may seem a little mushy gushy for the workplace but the underlying concept isn’t. Relationship development builds trust and trust is the bridge to better communication. And let me tell you, communication is the key to EVERYTHING. So who do you need to develop a relationship with in your facilities? And furthermore, how do you do that when you are on site minimal amounts of time per week? Let’s dive in.   Who it’s important to build a relationship with at your facilities is as follows: DON/ADON, RNs, CNAs, CDM, Cooks/Aids. I know this seems like a lot of people, but let me explain why I suggest this.   -DON/ADON: They are the captains. They have a lot of pull. The DON/ADON can and will help you get information that you need if they like and trust the work you are doing. You want to be on the same team.   -RNs: They are in charge of communicating which weights need to be done and following up to ensure they were completed. In some cases they are even the ones that have to log the weights into the EMR. If the RNs like you, understand you are more than the “weight police” and care about the residents as much as they do they will help your cause. They will want to help you succeed at your job.   CNAs: This population, I believe, is one of the most important groups on the clinical side to develop relationships with. They are the ones responsible for getting your weights and reweights. And we all know we CANNOT do our job without this information. You want these people to like you, trust you and again, want to help you do your job well.   CDM: This is the most important person to develop a relationship with on the foodservice side. This person is responsible for getting you all of the information you need, for ordering, menu writing, applying recommendations, MDSs, and so much more. With a strong relationship, a CDM and RD can make a lot of positive change for a facility. But it’s important that they feel as if the relationship is one between two equals and not one between a superior and inferior.    Cooks/Aides: Consulting dietitians can sometimes feel not only like the weight police, but the cleanliness police as well. With monthly audits being done and recommendations being given, success in this area depends on whether or not the cooks/aides follow the guidelines/rules while you are away and follow them consistently. They are more likely to adhere to the rules of sanitation and food safety if they respect you as a leader and feel cared for.   Now for the how…how to get this done, with a limited amount of time available. Here are 2 quick tips to start building better relationships:   -Remember names: This one is simple. Remember the names of the staff and call them by name each time you are on site.   -Listen and ask:Listen to what is talked about during the down time (the minutes before morning meeting and/or weight meeting, at the nurses station, while CNAs are passing out trays, etc.). This does not have to seem sketchy or like you are eavesdropping. It simply means paying attention and listening to your surroundings. This is a great way to learn about your fellow staff members. Then, follow up, maybe the following week and ask them a personal question. Something that says, “I care about your life and how it is going.”   Implementing these small steps will not only help you professionally, but will help you on a personal level as well. Enjoying and trusting those you work with allows you to find more joy in your work day. Here’s to more joy!
Household Models In Long Term Care
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As the old saying goes… “There Is No Place Like Home.” Many long term care facilities have taken this saying to heart and are implementing a new wave approach to serving their residents. It is called the “household model” and it aims to create a home like environment for its residents, especially when it comes to their food. Institutional hallways and tray carts have been replaced with full service eat in kitchens and dining areas with staff prepared to serve residents what sounds best. This model was created to boost resident moral, provide a more comfortable setting to live in and decrease incidences of weight loss. And results are in—these facilities are succeeding! One LTC facility that has implemented this model is Asbury Place of Kingsport in Kingsport, Tennessee. They follow a liberalized diet philosophy, that means just what you think it would mean; residents are placed on the most liberalized diet they can be on, taking into consideration ST recommendations, acute/chronic illnesses, etc. Because of the smaller scale of residents being served at this facility, resident’s specific food preferences can better be attended to than at other facilities. Meal times mirror those at your own home, with all of the residents gathered around the table, family and staff as well, cultivating conversations and encouraging adequate PO intake. It truly does seem that the happier the residents are, the better they eat at meal and snack times. But the truth of the matter is that not all LTC facilities have the ability to implement this household model as it usually entails a complete building remodel, staff training/cross training and monetary funds that just aren’t accessible at the moment. So how can we as consultant dietitians bring the experience of these household models to our other more institutional facilities? Here are a few tips! Focus on the food preferences: Make it a point to carve out an appropriate amount of time to spend with the incoming residents to assess their food preferences. Furthermore, follow up to ensure these preferences are honored and served to the residents by the kitchen staff. If the CDM is responsible for taking food preferences, spend some time training or teaching him/her do this effectively (if needed). Call the resident by name: One thing is for sure, whenever you are at home, everyone knows your name.Do your best to get to know the resident’s names and make it a point to say hello to them (using their name) whenever you pass them in the hallway or see them in the dining room. The CDM can be very helpful with this as they typically spend more time at the facility than the dietitian does. Utilize food first: Whenever you are at home, you typically don’t eat or drink a lot of supplement drinks (Ensure, mighty shakes, magic cup). Although these items cannot be completely avoided and are completely necessary in some instances, do your best to utilize food items first (fortify if needed!) when trying to increase a resident’s calorie and protein intake. Let’s do our best to make these residents feel more at home in our facilities!
The Runner's Guide to Nutrition
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Running is one of the most popular forms of exercise, and for good reason! Running doesn't require lots of special gear, coordination, and can be done almost anywhere. However, avid runners know that good nutrition and running go hand in hand. Making sure you are fueling your body correctly is essential to get the most out of your runs, prevent injury, and aid in recovery. Whether you are new to running or have been racking up miles for years, here is a quick reference guide to the ins and outs of running nutrition.Pre-Run: Exercise requires energy and water. Having a small snack 30-60 minutes before your run ensures that you have the energy you need to complete your miles and really push your muscles. Aim for a snack with a mix of carbohydrates (15-20 grams) and protein (7-10 grams) such has an apple and cheese stick or graham crackers and peanut butter [1]. Also, make sure you are drinking plenty of water throughout the day. Nothing makes the miles seem longer than being dehydrated.During Run: Snacks: You may think that only marathon runners need to worry about nutrition during runs, but that simply isn't the case. Any time a run exceeds 60 minutes you need to start thinking about snacking during your run. After approximately 30 minutes your body will be running low on energy stores and electrolytes which can lead to fatigue, reduced performance, and increased risk of injury. Mid run snacks are all about easy to digest carbohydrates. While some people prefer to use special prepackaged supplements, it's easy to get the energy you need from simple foods like dried fruit, pretzels or other light crackers, or bananas. You can have one big snack per hour, or snack all along the way. Whatever snack you choose it's best to aim for 30-60 grams of carbohydrate for every hour you run. Hydration: It is essential that you maintain proper hydration during runs, even during the winter. Sipping on water, sports drinks, or coconut water throughout your run helps keep you hydrated and electrolytes in balance better than just chugging water before and after your run. Aim for three to six ounces of water every 15-20 minutes while running. Running water belts, water backpacks, or even hiding water bottles along your route are great ways to make sure you have what you need to stay hydrated [2]. Be sure to follow any snacks and/or energy supplements with plenty of water as well. Post Run: Providing your body with the nutrition it needs to replenish and rebuild your muscles is critical to recovery and improving future runs. Post run snacks should be a mix of carbohydrates and protein to rebuild muscle and energy stores within the muscle. Aim for 12-15 grams of protein and 35-50 grams of carbohydrates [1]. Low-fat chocolate milk makes a great post-run snack with a great balance of carbs, protein, and electrolytes. Other great post run snacks can include fruit and yogurt, pb&j sandwich, or a hummus wrap. Try to eat within 15-45 minutes of completing your run.Running for Weight Loss: Running is an excellent way to improve cardiovascular health, reduce stress, reduce the risk of osteoporosis, and reduce the risk of Type II Diabetes [3]. Running can also be an excellent addition to a weight loss program if you keep these key things in mind:~Running makes you hungry: Running is a high intensity sport that burns a high number of calories compared to other exercises. Also, as we've mentioned in this article, you need to fuel correctly to make the most of your runs. In order to reach your weight loss goals you have to pay attention to total daily calories. Be sure to include all your pre/post/ and mid run snacks in your daily meal plan. In addition, make sure that you aren't eating too few calories. If you are decreasing daily calories in addition to running you may be eating too little and setting yourself up for failure.~You may actually gain a little weight at first: When you first start running you may experience a slight weight gain. Running, like all exercise, breaks down muscles in order to rebuild them stronger. However, this initial breaking down process can cause the muscle to retain fluids and thus increase the scale slightly. As you continue to run this process begins to even out. In addition, the large muscles in your legs involved in running burn more calories sitting still than fat does. So the more you build these muscles, the more calories you will be burning on a daily basis, increasing your ability to lose weight. ~Muscle weighs more than fat: As you build more muscle your weight may go up or stay the same even as you lose inches and improve your body shape. Muscle weighs less than fat but takes up much less space. Therefore, make sure that you have multiple measurements to track your progress and don't focus solely on the scale.Working with a Registered Dietitian is a great way to ensure you are able to maximize your weight loss efforts while still meeting all of your nutritional needs. Running is awesome for the mind and the body; but the next time you lace-up make sure you are maximize your results by pairing your runs with awesome nutrition! References: 1. http://www.eatright.org/resource/fitness/sports-and-performance/fueling-your-workout/top-snacks-for-....2.http://www.runnersworld.com/hydration-dehydration/prevent-dehydration-while-running3. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: The evidence. CMAJ. March 14, 2006; Vol 174: 6.  Picture Credit: