Dietetic Practicum Reports - Human Nutrition - University of Otago

ABSTRACTS
Postgraduate Diploma in Dietetics

FOREWORD
The 2009 Dietetic graduates research projects
The Dietetic Training Programme team are pleased to present you with this overview of
2008 / 2009 New Zealand student Dietitians’ research projects. These projects were
undertaken in thirteen weeks, between February and June of this year. Committed
registered Dietitians and Academic Supervisors were critical to the progress and
completion of the students’ projects. Senior academic staff assessed the completed
projects to assign a grade. We did not ask these staff to peer review the projects for
publication in an international journal!
New in 2009 was a national malnutrition project conducted in Rest Homes. Discussion
during the 2008 NZ Dietetic Association Conference on the absence of data on New
Zealand Rest Homes led to a project involving ten students. This is detailed on pages 7 to
18 of this booklet.
A number of the projects are follow-on work from last years’ projects. These projects
would not have been possible without the support of many people, organisations and
companies, who in return for their involvement received a valuable report. If you are
interested in the detail of any of these projects please contact the author directly, or
through the Dietetic Training Programme office in Dunedin. Four page summaries of
each of the projects will be available on our website, under the following link:
http://nutrition.otago.ac.nz/dietetics/nzdietitians/ by the end of November.
These newly qualified dietitians are entering the workforce, enthusiastically seeking
opportunities to put their recently acquired knowledge and skills into professional
practice. In a world of rapid change, these young members of our profession are well
equipped with lifelong learning skills to be competent dietitians throughout their working
lives. They are experienced reflective practitioners who are confident to explore the
interplay between theory and professional practice. We are encouraging them to continue
to use the research skills they developed undertaking these projects.
I am confident you will enjoy reading these reports and sharing with the students the
successful outcome of their final integrating paper of the Postgraduate Diploma in
Dietetics.
Please contact me directly to learn more about the Dietetic Training Programme and the
possibility of a student undertaking a project with your organisation in the future.
Penny Field
Director of Dietetic Training Programme
November, 2009

MULTI CENTRE PROJECT
CONTENTS
Overview: Nutrition in our rest homes — A snapshot.
Julian Jensen, Alexandra Chisholm, Penny Field………………………...
The impact of xerostomia and dry mouth on the nutritional intake in older
people: A review.
Emma Bennett…………………………………………………………….
Malnutrition and bone health of people over 65 years: A review.
Lucy Benoit……………………………………………………………….
Medication Focus. Drug-nutrient interactions in older adults: A review.
Sarah Bosma………………………………………………………………
Dehydration in the elderly, associated risk factors and methods of
prevention: A review.
Ashley Calkin……………………………………………………………….
The effectiveness of methods to increase dietary fibre as a treatment for
constipation in the elderly: A review.
Julie Hennessy………………………………………………….…………..
The effect of oral health on nutritional intake in the elderly: A review.
Danielle Lingard………………………………………………………….
Malnutrition and Depression, cause and effect: A review.
Tracey Little………………………………………………………………..
Chemo-sensory dysfunction and the nutritional implications for older adults:
A review.
Kathryn Loh………………………………………………………………
The effect of history, age and culture on older people’s health? A review.
Sarah-Jane Westbrooke…………………………………………………..
Nutritional supplementation in chronic obstructive pulmonary disease.
Effect on patient outcomes: A review.
Caroline Worth……………………………………………………………..
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NZ STUDENT DIETITIAN RESEARCH PROJECTS
Breaking the food barrier. A clinical audit of a post-stroke rehabilitation
ward over lunchtimes.
Brendan Abrams………………………………………………………..
Development of a written resource for meals on wheels clients.
Julia Bates………………………………………………………………
Development of an audio MP3 meal support resource for adolescents with
anorexia nervosa.
Kylie Becker……………………………………………………………
The cost of food waste: Impact of reduced time from ordering to receiving
meals in a medical ward at Waikato Hospital.
Debbie Coates……………………………………………………….…
Pregnancy and neonatal outcomes following hyperemesis gravidarum.
Robyn Coetzee…………………………………………………………
Infant cereals – Attitudes and practices of caregivers.
Hannah Cullinane……………………………………………………..
Preventing gastrointestinal illness in rugby players travelling to South
Africa: A review of nutritional strategies.
Tyson Edwards…………………………………………………………..
Eating your way to a healthy heart. The development of a cardioprotective
nutrition resource for the New Zealand Fire Service.
Alison Fyfe………………………………………………………………
Enteral nutrition practices in private hospitals in Counties Manukau
District Health Board: An audit of care.
Christina Heere…………………………………………………………..
Enhanced recovery after surgery: An audit of the ERAS nutrition
guidelines for elective surgery patients at Auckland City Hospital.
Meggan Helm……………………………………………………………
Thirsty work. The development of a hydration strategies resource for the
New Zealand Fire Service.
Kimberlee Kingh……………………………………………………….
The relationship between nutritional status and chemotherapy treatment
in children with Pre-B acute lymphoblastic leukaemia (ALL).
Victoria Logan…………………………………………………………
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Evaluation of a pilot diabetes group education programme in a
community-based, Maori health setting.
Genelle Lunken………………………………………………………..
First foods for South Asian babies: The development of a complementary
feeding guide.
Roshni Mistry………………………………………………………….
Development of an algorithm for nutritional support of ICU patients at
Wellington Hospital.
Sue Perry………………………………………………………………..
Breaking the food barrier: A clinical audit of a respiratory ward over
lunchtimes.
Courtenay Roberts………………………………………………………
Evaluation of the Peak Health Taranaki Dietetic Service.
Thomas Shand…………………………………………………………...
Supporting healthy eating practices in a forensic psychiatric rehabilitation
setting.
Nicky Shaw……………………………………………………………
Policy Development. A dietary supplement policy for the New Zealand
Rugby Union.
Kim-Maree Sherer…………………………………………………….
LOADDed with Nuts: The Effect of Hazelnuts in Type 2 Diabetes. A Pilot
Study.
Megan Somerville……………………………………………………..
An investigation of Breakfast Clubs in secondary schools across the
Waikato region.
Hannah Taylor…………………………………………………………..
Development of a nutrition and hydration resource for New Zealand Army
soldiers.
Sarah Windley …………………………………………………………
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Multi-Centre Project
The Eating Environment and Nutritional Risk:
Promoters and Barriers to achieving Optimum Nutrition
in the Residential Care Setting
Rest Home Locations:
Dunedin Hawke’s Bay
Christchurch Tauranga
Nelson Hamilton
Wellington Auckland
Palmerston North
4

OVERVIEW
Nutrition in our rest homes: A snapshot
JULIAN JENSEN, ALEXANDRA CHISHOLM, PENNY FIELD
There is little research on food and nutrient intakes of older New Zealanders in residential care
facilities. The 2008 NZDA Conference symposium on malnutrition identified a need for baseline
data, particularly in residential care settings which are not routinely surveyed in population-based
studies of dietary intake. The aim of this multi-centre observational study was to investigate the
eating environment in the residential care setting, to identify promoters and barriers to achieving
optimum nutrition. The study was designed as a post-graduate research project in the University of
Otago Dietetic Training Programme. Twelve registered dietitians working with Rest Homes
throughout New Zealand identifed rest homes who were contacted with details of the study and
recruitment criteria. Fifty-four rest homes in nine locations responded positively. Fifty-two were
selected, based on location and the availability of 10 final-year dietetic students. The students spent
approximately two days in each facility administering a standard 19-item questionnaire and
observing mealtimes and related activities. Survey questions addressed demographics, staffing,
dining environment, menu, meals, snacks, feeding assistance or supervision, self catering, fluids,
special dietary requirements, nutrition care, medications, regulations and policy. Data analysis is
ongoing. This is the first such study to be conducted in New Zealand. It is anticipated that the
results will be of interest to the Ministry of Health and District Health Boards who are responsible
for ensuring that meals in long-term care facilities meet the nutritional needs of this potentially
vulnerable population group.
In addition to the data collection each student undertook a literature review on a potential barrier to
adequate nutrition in older people. This topic is noted in the subtitle of each students’ abstract.
5

The eating environment and nutritional risk:
Promoters and Barriers to achieving optimum nutrition in the
residential care setting in the Canterbury region
The impact of xerostomia and dry mouth on the nutritional intake in older people: A review
by Emma Bennett
Malnutrition is common in the elderly population with several studies reporting a prevalence of 30-
60% in nursing homes. There are a number of influential factors which impact on the ability of
residents to achieve optimum nutrition in the residential care setting. A review of literature was
conducted on general nutrition in the elderly with a special focus to determine whether xerostomia
and dry mouth is a barrier to older people achieving an optimal nutritional intake. Five residential
care facilities were recruited from the Canterbury region by a local dietitian. A copy of the protocol
and a letter outlining the project was sent prior to each visit. The data were collected over a five
week period using an evidence based, peer reviewed questionnaire specifically designed for the NZ
setting and this project. Observations and discussion with key staff were carried out at each facility
in relation to the eating environment and meal service. The findings of this study highlighted the
promoters and barriers to older adults achieving an optimum nutritional intake. Some of the
promoters identified included; a menu with variety and fresh seasonal foods, a relaxed meal where
residents have ample time to complete their meal, regular meals and snacks, appropriate assistance
from staff and the availability of special dietary meal alternatives. In contrast a number of barriers
were also identified such as; poor knowledge of nutrition among staff, inadequate staffing numbers
in the dining room, poor knowledge of preparing meals with texture modification, poor application
of plate waste to meet residents preferences and a lack of dietitian input. There are many factors in
the eating environment and various promoters and barriers that have an influential impact on the
ability for older adults to achieve optimum nutrition in the residential care setting. This study
showed that opportunities for optimum nutrition amongst older people in rest home care would be
enhanced by improved nutritional awareness among staff, a welcoming and home-like eating
environment and increased dietitian input.
Academic Supervisors: Julian Jensen and Dr Alex Chisholm
Professional Supervisor: Sue Benny
Emma is working as a Clinical Dietitian at Tauranga Hospital.
6

The eating environment and nutritional risk:
Promoters and Barriers to achieving optimum nutrition in the
residential care setting in Hawkes Bay
Malnutrition and bone health of people over 65 years: A review
by Lucy Benoit
Background: International data suggests that rest homes and extended care facilities experience
high rates of avoidable malnutrition. The eating environment and a number of other modifiable
factors play a significant role in the prevention of malnutrition. There is no New Zealand specific
data about the prevalence of malnutrition in New Zealand extended care facilities or about the
eating environment and prevalence of barrier and promoters of optimal nutrition in our facilities. A
first step in addressing this issue in our facilities and developing further research and guidelines is
to gain a thorough understanding of the eating environment and possible barriers and promoters of
optimal nutrition in New Zealand extended care facilities.
Aim: To develop an understanding of the eating environment and the prevalence of barriers and
promoters for optimal nutrition in a convenience sample of five Hawke’s Bay extended care
facilities through a questionnaire and observational study.
Methods: This practicum is part of the national project and covers the Hawke’s Bay region. A
standardised, peer reviewed protocol was developed by project coordinators and distributed to ten
dietetic students across New Zealand to complete in a subset of extended care facilities with rest
home level residents in their area, covering 50 extended care facilities in New Zealand. The
protocol was completed from talking with rest home management, rest home coordinators,
registered nurses and the cooks in each facility along with the use of informal chats with residents
and independent observations of meal times and the environment.
Results: Residents enjoy eating and socialising in the dining room; 90% of rest home level
residents in four out of the five facilities ate in the dining room. Average staff: resident ratios in the
dining room are 1:5, 1:13 and 1:11 for breakfast, lunch and tea respectively. All facilities were
providing sufficient food to meet the food and nutrition guidelines. A fixed pre-planned meal
service is provided at all facilities with minimal efforts being made to individualise residents’ meals
to meet their nutritional requirements. Apart from auditing the menus dietetic input is minimal and
special diets are neither prescribed nor monitored by dietitians, in all five facilities. Weights are
usually the only measure of nutritional status recorded on admission and monthly or three monthly
thereafter. Residents in all five facilities are taking medications that have the potential to interact
with nutrients/food or may affect appetite.
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8
Lucy Benoit, Abstract continued…
Conclusion: Long-term care facilities in Hawke’s Bay are providing a basic level of nutrition care
to residents’ that includes minimal individualised care and limited choice for residents. The eating
environments are well received by residents and the social meal times are an importance part of
residents’ care.
Academic Supervisors: Julian Jensen and Dr Alex Chisholm
Professional Supervisor: Robyn Richardson
Lucy is working as a Clinical Dietitian at Palmerston North Hospital.

The eating environment and nutritional risk:
Promoters and Barriers to achieving optimum nutrition in the
residential care setting in the Otago region
Medication focus. Drug-nutrient interactions in older adults: A review
by Sarah Bosma
Introduction: There is limited research on food and nutrition intakes of older New Zealanders
living in residential care facilities. Literature suggests that medications influence the nutritional
intake of older adults by producing undesirable side-effects.
Aim: This observational study is one of ten studies carried out as part of the Multi-Centre Project.
The aim of this study was to investigate the eating environment and nutritional risk in residential
care facilities in the Otago region, and to identify promoters and barriers to achieving optimum
nutrition. This study also presented a literature focus on medications, including drug-nutrient
interactions in older adults.
Methods: Four residential care facilities in the Otago region were identified. Within three
consecutive days, observational data was collected by administering a 19-item protocol to each
facility, including residents in care category SNL level 3 or 4 or less. Analysis was completed
using qualitative data collation methods.
Results: Qualitative data highlighted similarities and differences between rest homes in relation to
nutritional risk and eating environment. There were similarities in dietetic relations and
medications prescribed; however, there were differences in staff to resident ratios and the dining
room environment. Quantitative data analysis is ongoing.
Conclusions: Features of the eating environment, such as the menu and feeding assistance and
supervision concurred with findings in the literature, and were conducive to promoting optimum
nutrition. For a final conclusion to be made, the quantitative data collected as part of this study
must be collated as part of the Multi-Centre Project.
Academic Supervisors: Julian Jensen and Dr Alex Chisholm
Professional Supervisor: Frances Wong
Sarah is working as a Clinical Dietitian at Dunedin Hospital.
9

The eating environment and nutritional risk:
Promoters and Barriers to achieving optimum nutrition in the
residential care setting in the Waikato region
Dehydration in the elderly, associated risk factors and methods of prevention: A review
by Ashley Calkin
The eating environment and nutritional risk, promoters and barriers to achieving optimum nutrition
in the residential care setting was investigated. The study was conducted in five residential care
homes from the Waikato region. A total of approximately 7 hours was spent in each home over a
three day period. An evidence based, peer reviewed questionnaire specifically designed for the NZ
setting and this project was used. Quantitative and qualitative data was collected using this
protocol. The protocol covered areas such as; staffing and environment, meals, feeding assistance
or supervision, menu, snacks, dining room environment, special dietary requirements, nutrition
care, outside activities, self catering, fluids, medications, dietitian input, regulations and policies
and any additional comments. Additionally, purchasing information on critical food items was
obtained. The collected data was analysed for each rest home. The participating rest homes were
sent an observational report on the findings of their home. Additionally, the data collected was then
compared to the latest literature related to this elderly age group. The main limitations were
accuracy of data collection, which improved with each rest home. In addition I was unable to
observe breakfast and tea meals. These factors may affect the accuracy of the data collected. As
this is a nation wide study, results from all study areas around the country will be aggregated.
Conclusions will be drawn from these collective data sets.
Academic Supervisors: Julian Jensen and Dr Alex Chisholm
Professional Supervisors: Cathy Khouri, Niki Russell, and Viv Dykes
Ashley is working as a Clinical Dietitian at Waikato Hospital, Hamilton.
10

The eating environment and nutritional risk:
Promoters and Barriers to achieving optimum nutrition in the
residential care setting in Tauranga
The effectiveness of methods to increase dietary fibre as a treatment for constipation
in the elderly: A review
by Julie Hennessy
The population of New Zealand is aging. The number of New Zealanders aged 65+ currently
residing in age care accommodation (ACA) is approximately 25,854, a figure that is thought to
increase in the near future. Research conducted overseas highlighting the high rate of malnutrition
in hospital and rest home settings raised concern for the nutritional welfare of individuals in such
institutions in New Zealand. This practicum provides data on the current nutrition situation in
selected New Zealand ACA facilities through observations on the promoters and barriers to
achieving optimal nutrition. The study was conducted in five residential care homes from the
Waikato, Coromandel and Bay of Plenty regions. A total of approximately 7 hours was spent in
each home over a three day period. An “evidence based, peer reviewed questionnaire specifically
designed for the NZ setting and this project" was used to collect data. Quantitative and qualitative
data in topic areas of staffing and environment, meals, feeding assistance and supervision, the
menu, snacks, the dining room environment, self catering, fluids, special dietary requirements,
nutrition care, outside activities, medications dietitian input and regulations and polices was
collected. The data collected was analysed and each participating rest home was sent an
observational report summarizing findings of their home. The collated data was also compared to
recent literature. The breakfast and tea meals were not observed which could limit the accuracy of
data collected. Further to this project, results from all study areas around the country will be
aggregated and analysed.
Academic Supervisors: Julian Jensen and Dr Alex Chisholm
Professional Supervisors: Fiona Boyle and Cathy Khouri
Julie is working as a Nutritionist at the Surgical Obesity Services in Wellington.
11

The eating environment and nutritional risk:
Promoters and Barriers to achieving optimum nutrition in the
residential care setting in Nelson
The effect of oral health on nutritional intake in the elderly: A review
by Danielle Lingard
The increase in the elderly population has created a great need to ensure adequate nutrition and
health for the elderly. The purpose of the present study was to explore the eating environment
within the residential care setting, for people at Special Needs Level (SNL) 3 or 4, and to identify
potential promoters and barriers to achieving optimum nutrition in the elderly.
The project was part of the Otago University Multi-Centre Residential Care project, including 50
Rest Homes and 9 centres throughout New Zealand. The present study reports the findings for 5
Rest Homes in the Nelson Marlborough region. The study was of an observational design. The
student spent two to three days at each rest home observing breakfast, dinner and tea, and between
meal snacks (morning and afternoon tea, and supper in the evening). A standardized protocol was
used to gather data.
The results revealed a number of potential promoters and barriers to optimal nutritional in intake the
elderly. Key promoters included pleasant dining room environments, adequate feeding assistance
and supportive staff, suitable menu for the elderly, provision of between meal snacks and a variety
of beverages. Potential barriers included many residents ate breakfast in bed, low staff to resident
ratios, limited food choice, and although snacks are available throughout the day residents have to
ask for these.
These results are for Nelson only, and this report is part of a major national project. Results are
being collated for a nationwide view, and it will provide good baseline data from which to develop
strategies to ensure that those in residential care have the opportunity to consume an adequate diet
and reduce their nutrition risk scores.
Academic Supervisor: Julian Jensen and Dr Alex Chisholm
Professional Supervisors: Annette Nistor and Marion van Oeveren
Danielle is working as a Dietitian for the Tararua PHO in Pahiatua.
12

The eating environment and nutritional risk:
Promoters and Barriers to achieving optimum nutrition in the
residential care setting in Wellington
Malnutrition and depression, cause and effect: A review
by Tracey Little
Malnutrition is a recognised problem in elderly, particularly those in residential settings. Multiple
factors influence the nutritional status of elderly including physiological factors such as comorbidities,
social / psychological factors such as loneliness and depression and environmental
factors including homeliness of the dining room and the level of support residents receive. The aim
of this project was to identify environmental promoters and barriers in the rest home setting that
could affect the nutritional status of residents.
The study was observational and based on a cross-sectional survey of 50 rest homes in nine centres
in New Zealand. This report focuses on six of the rest homes located in the greater Wellington
area. The questionnaire used was peer reviewed and designed specially for the project by Otago
University. At least two meals were observed at each home, one of which was the main meal. An
average of nine hours was observed at each home. Data collected related to the kitchen
environment, cooking, meal service, residents eating and the cleaning up process.
Resident numbers at each rest home ranged from 13 to 47 residents. Staff to resident ratios were
highest at the dinner meal with staff to resident ratios of between 1:6 and 1:12. Promoters identified
included allowing residents to act independently, social interaction at mealtimes and a menu
providing familiar foods. Barriers included inappropriate meal temperatures, or portion sizes, a
lack of alternatives and little dietitian input.
Staff and residents in rest homes need further education and input from dietitians.
Academic Supervisors: Julian Jensen and Dr Alex Chisholm
Professional Supervisor: Alison Pask
Tracey is working as a Clinical Dietitian at Timaru Hospital.
13

The eating environment and nutritional risk:
Promoters and Barriers to achieving optimum nutrition in the
residential care setting in Palmerston North
Chemo-sensory dysfunction and the nutritional implications for older adults: A review
by Kathryn Loh
Malnutrition is a life threatening and debilitating condition which continues to plague some sectors
of the elderly population despite being preventable and treatable. Older adults face a multitude of
physiological and psycho-social changes placing them at increased risk of falling onto the
downward trajectory of malnutrition and institutionalised elderly are particularly susceptible.
Knowledge of possible barriers to optimal nutrition in New Zealand rest homes will help to identify
areas in need of improvement, thus helping to improve the quality of nutritional care. The purpose
of the current study is to collect regional data, which will be collated with data from around New
Zealand on the promoters and barriers to optimal nutrition that exist in rest homes in New Zealand.
Five rest homes in the Palmerston North and Levin area were observed and surveyed over a 3 week
period. Data was collected regarding possible barriers and promoters to optimal nutrition based on
an extensive questionnaire, observation and informal discussion with staff and residents. A large
number of barriers to optimal nutrition were observed in the rest homes studied, with particular
areas of concern including lack of staff knowledge and nutrition education; the quality of staff
attention at meal times; limited dietetic input; inadequate nutrition screening and monitoring of
food intake; minimal choice and diminished autonomy; mealtime distractions; and diminished
anticipatory food effects. All of the barriers observed are modifiable and future research should
explore the necessary steps that need to be taken to ensure these conditions are optimised.
Academic Supervisors: Julian Jensen and Dr Alex Chisholm
Professional Supervisor: Gaye Philpott
Kathryn is working as a Community Dietitian in Hawkes Bay.
14

The eating environment and nutritional risk:
Promoters and Barriers to achieving optimum nutrition in the
residential care setting in Auckland
The effect of history, age and culture on older people’s health? A review
by Sarah-Jane Westbrooke
Background: Nutrition is important thought-out every life stage, however nutritional status often
declines in older age. Those living in residential care have been identified as a high risk group.
With the number of elderly in the 65+ age bracket increasing, it is important that factors which
influence geriatric nutrition are identified and addressed.
Aim: To investigate and identify promoters and barriers to achieving optimal nutrition in older
adults living in a residential care setting.
Design: The design of this study was an observational study looking at five rest homes within the
Auckland region as part of a multi-centre study conducted by the University of Otago. Data was
collected through observations and a standardised questionnaire.
Results: There was no evidence of any specific factors which undermine optimal nutrition in older
adults. However these results are part of a wider topic encompassing data from around New
Zealand and the results of these have yet to be analysed.
Conclusion: A formal conclusion can be drawn once the results from all around New Zealand
have been collected. Within the Auckland region, factors that could potentially affect nutritional
status were identified as staffing numbers, interaction and assistance, the dining room atmosphere,
the type of food, choices and service, and dietetic input and nutritional screening.
Academic Supervisors: Julian Jensen and Dr Alex Chisholm
Professional Supervisor: Sharon Carey
Sarah-Jane is working as a Clinical Dietitian at North Shore Hospital, Waitemata DHB, Auckland.
15

The eating environment and nutritional risk:
Promoters and Barriers to achieving optimum nutrition in the
residential care setting in Christchurch
Nutritional supplementation in chronic obstructive pulmonary disease.
Effect on patient outcomes: A review
by Caroline Worth
The elderly (65 years plus) are a growing proportion of the population with numbers in New
Zealand (NZ) expected to reach 1,181,000 by 2051. In 2021 it is expected that 29% of those aged
85 and over will be living in residential care facilities. In 2001, 76,000 elderly lived in this form of
accommodation and this is expected to rise 32% to 100,000 by 2021. Malnutrition in the elderly is a
significant problem, with estimates of prevalence ranging from 17 to 65%. There are several
contributors to malnutrition including decreased appetite, chronic disease, weight loss and
sarcopaenia, and the adequacy of staff assistance and dining ambiance in facilities. This study
aimed to identify the main promoters and barriers to achieving optimal nutrition in the elderly
living in residential care. Five facilities were recruited for each student, and an evidence based,
peer reviewed questionnaire specifically designed for the NZ setting and this project was
developed. Students spent two-three days in each facility, observing food-service practices, talking
with staff and informally chatting with residents. In the five Canterbury facilities detailed in this
report, most facilities encouraged residents to eat in the dining room except for breakfast. Dietitian
input often appeared limited, resulting in decreased adequacy of special diets such as texture
modified meals. Facilities incorporated some elements to improve dining ambiance and to provide a
homely environment whilst methods of encouraging residents to eat varied. No residents were able
to serve themselves during service and residents were rarely asked if they wanted seconds. Whilst
no major problems were identified within the facilities visited, there is scope for improvement both
within the food-service and with assistance from staff.
Academic Supervisors: Julian Jensen and Dr Alex Chisholm
Professional Supervisor: Sue Benny
Caroline is currently seeking employment.
16

NZ Student Dietitian
Research Projects
17

Breaking the food barrier: A clinical audit of a post-stroke
rehabilitation ward over lunchtimes
by Brendan Abrams
Elderly post-stroke hospital patients in rehabilitation care have a high risk of malnutrition. In view
of New Zealand’s increasing ageing population, recognising barriers to adequate nutrition for this
group is important to improve patient care and nutritional intake at mealtimes. This study observed
what practices occurred during lunch mealtimes in an elderly post-stroke rehabilitation ward that
influenced patients’ food consumption.
The Protective Meal Times Audit was used and further developed to audit what practices occur
before meals, what happened at an individual patient level and staff level during lunchtime.
Observations were conducted over a two-week period.
Fifty-two patient observations were conducted. The two main eating difficulties patients
experienced were opening food (46%) and using cutlery (33%), 70% going unnoticed. Staff
assistance occurred mostly at the point of meal delivery or for patients requiring full feeding
assistance. The most frequent interruptions were drug rounds (69%) and orderlies disrupting
patients (10%). The majority of traffic on the ward were visitors, however, most were observed to
be assisting patients with feeding. Nurse drug rounds, and ward tasks limited staff availability and
assistance during mealtimes.
Staff availability and improving care for patients requiring full feeding assistance continue to be
problematic areas during lunchtimes. Strategies recommended to improve patient care specific for
the ward were discussed at a ward meeting and support recommendations encompassing protective
mealtimes.
Key recommendations were: Re-orientation of staff breaks to increase staff availability at
mealtimes, provide supervision and the timely access of meals for patients with eating difficulties,
training to improve provision of feeding assistance, and reduce interruptions from non-urgent
assessments.
Academic Supervisor: Nicky Moore
Professional Supervisor: Margaret Knight
Brendan is currently seeking employment.
18

Development of a written resource for meals on wheels clients
by Julia Bates
Introduction: There is a lack of knowledge among Meals on Wheels (MOW) clients and health
professionals about MOW and how to best utilise this service. Yet these stakeholders need to be
well informed if the service is to reach its full potential and achieve its rehabilitative goals. The aim
of this practicum was to develop an effective MOW written resource, suitable for use by MOW
clients and health professionals within Counties Manukau District Health Board.
Methods: A literature review determined necessary development and design steps to ensure the
production of effective resources for older adults. Existing resources and health professionals were
consulted to establish the draft resource content, which was then formatted in collaboration with
design experts. The draft resource was pretested with MOW clients in semi-structured interviews,
and also with Mori and Pacific representatives in two focus groups.
Results: Interviews were held with ten MOW clients and two focus groups were conducted which
included 11 Mori representatives and eight Pacific older adults. The resource was well liked, with
suitable typography. Pretesting resulted in changes, including reworking the cover and condensing
text. More culturally appropriate pictures were incorporated and a prayer, contents page, MOW
access information and swallowing difficulties information were included. The weight monitoring
section was removed and having a magnet on the back of the resource was not favoured.
Conclusions: The resource, developed in a robust, evidence-based process, provides an array of
information and was well received during pretesting. The resource will compliment the MOW
service by educating MOW clients and health professionals about the optimal utilisation of the
service and a healthy lifestyle to couple it. Once this collaborative resource is rolled out in the
community, it will help to raise the profile of MOW as an interdisciplinary, rehabilitative service.
Its success will assist in changing MOW from a passive community service into an active nutrition
intervention. Further evaluation should be carried out before launching the booklet in CMDHB,
and then nationally.
Academic Supervisor: Dr Kirsty Fairbairn
Professional Supervisor: Kaye Dennison
Julia is working as a Community Dietitian at Home Health Care, Counties Manukau DHB, Auckland.
19

Development of an audio MP3 meal support resource for adolescents
with anorexia nervosa
by Kylie Becker
Meal times are stressful and anxious periods for individuals with anorexia nervosa.
Treatment at the Auckland Eating Disorder Service supports development of distress tolerance
strategies to help the recovering individual accept and tolerate food and eating; however adolescent
specific resources are needed. The aim of this project was to develop an adolescent appropriate,
meal support tool, to reduce meal anxiety by positively reinforcing anxiety management strategies
and concepts taught at the Eating Disorder Service. A focus group was conducted with the Eating
Disorder Service Meal Support Group. A review was conduced of literature relating to nutritional
communication, treatment, and anxiety management resources for adolescents with anorexia
nervosa. The draft resource was critiqued by the Eating Disorder Service staff and adjustments
were made. A portable, audio, anxiety management meal support tool was developed to reduce
anxiety before, during and after the meal. Nutritional, physical and cognitive support is provided
through a series of ‘sound bites’ for different stages of the meal process. MP3 technology was
used, enabling adolescents to create individualised playlists with their therapist, selecting the most
helpful and relevant sound bites for their stage of treatment. The MP3 meal support tool is an
innovative and portable resource utilising contemporary technology adolescents are familiar with
and receptive to. There is scope for further development in the future; however it is recommended
that it is used at the Eating Disorder Service for 6 months of pilot testing and evaluation.
Academic Supervisor: Dr Virginia McIntosh
Professional Supervisor: Estella Leek
Kylie is working as a Clinical Dietitian at Auckland City Hospital.
20

The cost of food waste: Impact of reduced time from ordering to
receiving meals in a medical ward at Waikato Hospital
by Debbie Coates
Introduction: Food wastage in hospitals is costly and can be associated with poorer nutritional
intake. It has been suggested that reducing the time between when a patient orders their meal and
when they receive it can reduce food waste.
Aim: The aim of this intervention study was to compare the cost of waste between the current
system where patients order three-five meals in advance (week one) to that where patients ordered
one-two meals in advance (week two).
Methods: Waste was collected from a general medical ward from breakfast, lunch and dinner over
two five day intervals (week 1 baseline and 2 intervention). Plate waste was calculated using a
combination of visual estimation from digital photographs and weighing items. A validated visual
estimation scale was used to quantify plate waste. Costs were obtained for each menu item and the
amount of plate waste was costed. Total cost of waste was calculated by summing the total cost of
plate waste and the cost of waste from trays that were ordered but not required (untouched trays).
In addition the number of meals ordered after the meal trolley arrived in the ward (call back meals)
was recorded.
Results: Reducing the meal order lag time resulted in a 10% reduction in the total cost of waste
per meal however there was little difference in the cost of plate waste alone. There was a 76 %
reduction in the number of call backs.
Conclusion: The cost of waste was reduced by enabling patients to order their food closer to meal
service time.
Academic Supervisor: Korina Richmond
Professional Supervisor: Wendy Dodunski
Debbie is working as a Clinical Dietitian at Waikato Hospital, Hamilton.
21

Pregnancy and neonatal outcomes following hyperemesis gravidarum
by Robyn Coetzee
Undernutrition during pregnancy is associated with detrimental pregnancy and neonatal outcomes
which can have long term implications for the infant. Hyperemesis gravidarum (HG), a condition
of intractable nausea and vomiting in pregnancy, may severely limit nutritional intake. The aim of
this study was to investigate the effect of HG on pregnancy and neonatal outcomes. This
retrospective case-control study compared 75 women admitted with HG and referred to a dietitian
with 142 controls matched for age, parity, ethnicity and expected date of delivery. Primary
outcomes were length of gestation and size at birth. A score of nutritional status was derived from
prospective data on nutritional intake and symptom severity in women with HG. Pregnancy and
neonatal outcomes were also evaluated against this score. There were no significant differences in
gestation length or birth weight between women with HG and controls. However, women with HG
gave birth to infants with smaller head circumference Z scores (0.02 versus 0.43; p=0.04). Women
with HG gained significantly less weight in the first trimester (-2.35 kg versus 1.55 kg; p=0.0006)
and significantly more weight in the second trimester (7.00 kg versus 4.13 kg; p=0.002). Nutritional
status score was significantly associated with total weight loss (r=0.53, p

Infant cereals — Attitudes and practices of caregivers
by Hannah Cullinane
Introduction: Iron-fortified infant cereals are a key component of infant diets, and contribute
towards dietary iron intake in particular. The high prevalence of sub-optimal iron status in New
Zealand infants is of concern. The aim of this study was to investigate the current attitudes and
practices of caregivers regarding infant cereal products.
Methods: A self-administered questionnaire to be completed by primary caregivers of infants
(aged 4-12 months) was developed and used for data collection. Participants were recruited by
inviting Auckland region Parents Centre members to participate. The questionnaire was given and
returned in person or posted and returned in the mail. Data was analysed using Microsoft Excel
2007.
Results: A total of 100 completed questionnaires were included in the data analysis. Dry infant
cereals were given to a greater number of infants who had been introduced to solids than wet infant
cereals (96% and 51%, respectively). Breakfast cereals were often given before the recommended
age of eight months (71%). Dry infant cereals were most commonly given daily (59%), whereas,
wet infant cereals were most commonly given 1-2 times a week (53%). Overall nutritional value
was considered the most important factor when selecting all cereal types. Convenience was
considered more important for wet infant cereals than other cereal types.
Conclusion: The majority of infant feeding recommendations were being followed by this sample.
Recommendations regarding the appropriate age to introduce breakfast cereals need to be
reinforced to caregivers. The high prevalence and frequency of use suggest that dry infant cereals
remain a suitable vehicle for iron-fortification. Further research on a more representative sample of
New Zealand caregivers is required.
Academic Supervisor: Associate Professor Winsome Parnell
Professional Supervisor: Julie Dick
Hannah is working as a Nutritionist at the Auckland Spinal Rehabilitation Unit (CMDHB) and as a Private Contractor
Dietitian for ABC Nutrition in Auckland.
23

Preventing gastrointestinal illness in rugby players travelling to South
Africa: A review of nutritional strategies
by Tyson Edwards
Background: Travellers’ diarrhoea (TD) is a problem commonly affecting the players of the
Highlander Super 14 rugby team during their touring trips to South Africa. The dehydration and
physical stress associated with this disease can be detrimental to game performance.
Aim: To review the literature and develop recommendations for the Highlanders Super 14 rugby
team on how to use food safety, hand washing, prebiotics and probiotics to prevent and treat TD
during their tour of South Africa.
Methods: A computer assisted literature search was conducted using the online databases Medline,
ScienceDirect, PubMed, The Cochrane library, Web of Science, and Google Scholar. From the
literature review, a short list of practical recommendations was developed for the rugby team staff.
A fourteen slide PowerPoint presentation communicating these recommendations was developed
and presented to the team’s players shortly before their departure to South Africa. The presentation
content was modified and refined in discussion with the Professional Supervisor to ensure that
subject matter was simple, informative, engaging, and relevant to the target audience. To facilitate
future research, formal record forms for diarrhoea incidence and player feedback on probiotic use
were developed.
Results and Conclusions: Hand washing, prophylactic food avoidance, and probiotic
supplementation were found to be effective in preventing or reducing the length and severity of TD
and their use is recommended. There is currently not enough evidence to warrant the use of
prebiotics. The record forms developed for the team will enable future monitoring of probiotics
supplementation and further diarrhoea education strategies.
Keywords: Travellers’ diarrhoea, athletes, probiotics, prebiotics, food safety, hand washing,
literature review.
Academic Supervisor: Dr Kirsty Fairbairn
Professional Supervisor: Fiona Simpson
Tyson is currently working Part-time as a Research Assistant in the Human Nutrition and Public Health Departments at
the University of Otago.
24

Eating your way to a healthy heart. The development of a cardioprotective
nutrition resource for the New Zealand Fire Service
by Alison Fyfe
Background: A study in 2008 investigated the association between shift work and cardiovascular
risk among New Zealand Christchurch fire fighters. Various cardiovascular risk factors including
raised total cholesterol and low-density lipoprotein cholesterol, and unfavourable dietary fat intakes
were reported to increase fire fighters cardiovascular risk. It was therefore recommended that
cardio-protective dietary information be available to fire fighters.
Aim: To develop a cardio-protective nutrition resource for the New Zealand Fire Service.
Design: Resource development.
Methods: A resource booklet was developed using guidance from the New Zealand Ministry of
Health Guidelines for nutrition resource development. Booklet content was primarily based on the
New Zealand Guidelines Group Cardio-protective Dietary Pattern. Meetings with key stakeholders,
including health professionals and focus groups with the target audience, were undertaken to gain
feedback on various draft booklets.
Results: The literature review conducted supported previous research suggesting an association
between shift work and cardiovascular risk. In addition, fire fighters were found to be at an
increased risk due to occupational exposures. Four draft booklets were designed before the final
booklet was produced. Feedback from focus groups confirmed guidance given in the Ministry of
Health Guidelines about resource content and design.
Conclusions: A suitable booklet was developed and peer reviewed, which was shown to be well
received and understood by the target audience. Supplementary material including an introductory
resource education session, and posters, were also recommended to encourage the uptake of the key
nutritional messages.
Key words: Fire fighters, cardiovascular, shift work, diet, resource development, and nutrition
resources.
Academic Supervisor: Laila Cooper
Professional Supervisor: Renee Ladbrook
Alison is working as a Clinical Dietitian at Christchurch Hospital.
25

Enteral nutrition practices in private hospitals in Counties Manukau
District Health Board: An audit of care
by Christina Heere
Introduction: Under the HPCAA (2003) the prescription of enteral nutrition is a restricted practice
in New Zealand, and in most circumstances is carried out by a New Zealand Registered Dietitian
(NZRD). In Counties Manukau, however, there have been anecdotal reports in the past of residents
receiving enteral nutrition in residential care facilities who are not under the care of a NZRD. The
aims of this study were to gain an understanding of enteral nutrition practices in residential care
facilities in the Counties Manukau District Health Board (CMDHB) catchment area and compare
these to established standards of care.
Methods: A clinical record review audit was undertaken of enterally fed residents of Private
Hospitals within CMDHB. Findings were compared to the Auckland and Northland Home Enteral
Nutrition Policy/Procedure document (2007) and the National Institute for Health and Clinical
Excellence guidelines (2006). Semi-structured interviews were also conducted with facility
Managers.
Results: Nine of the ten facilities invited participated (90% response rate), with eighteen enterally
fed residents. All the facilities had a contract NZRD and all enterally fed residents had received
dietetic review post-admission to the facility. Eleven residents received dietetic follow-up sixmonthly
or less, and three residents were monitored less than annually.
Conclusion / Recommendations: On the whole, Private Hospitals in the CMDHB area are
meeting standards of care for enteral nutrition. Availability of enteral nutrition protocols developed
by the DHB for Private Hospitals would be beneficial. It would be beneficial to extend enteral
nutrition education forums, provided by the DHB for Registered Nurses, to senior care workers.
Academic Supervisor: Associate Professor Tim Green
Professional Supervisor: Sandra van Lill
Christina is working as a Clinical Dietitian on the graduate rotation scheme for Counties Manukau DHB, Auckland.
26

Enhanced recovery after surgery: An audit of the ERAS nutrition
guidelines for elective surgery patients at
Auckland City Hospital
by Meggan Helm
“Enhanced Recovery After Surgery” (ERAS) programmes have been implemented internationally
to optimise peri-operative care of colorectal surgical patients. These programmes have shown that
post-operative complications can be reduced, resulting in a shorter length of stay, reduction in
healthcare costs and improved quality of life for patients. The aim of this audit was to assess the
current surgical practices of selected elective surgeries at Auckland City Hospital. An audit tool was
developed to assess the pre and post surgical practices within the hospital, in relation to the
nutritional parameters of ERAS guidelines. All patients (n=142) undergoing significant elective
urological, upper gastrointestinal, colorectal or gynaecological surgery on the weeks of the audits
were included in the study. The median time from surgery to first fluid intake and oral intake was
2.75 hours and 7.5 hours respectively. Patients who ate on the same day after their surgery had a
significantly shorter length of stay. Patients (88.7%) were prescribed on average 3072 mls intravenous
fluids on the day of their operation. Only 15% of patients were weighed post-operatively,
and their median body weight change was -3.1%. In conclusion, compliance to the ERAS
guidelines is variable among surgical teams at Auckland City Hospital. While early nutrition and
mobilisation is encouraged, incomplete documentation of clinical data such as weights and oral
intake make accurate patient assessment difficult. Intra-venous fluid management post-operatively
should be addressed to avoid overhydration. Regular audits should be conducted to assess the multi
disciplinary team’s compliance with evidence based guidelines and hospital protocols.
Academic Supervisor: Professor Bryan Parry
Professional Supervisor: Kerry McIlroy
Meggan is working as a Surgical Dietitian on the graduate rotation scheme at Middlemore Hospital, Auckland.
27

Thirsty work. The development of a hydration strategies resource for
the New Zealand Fire Service
by Kimberlee Kingh
Background: Fire fighters bodies are placed under huge physiological and thermogenic stress due
to the nature of their work. Dehydration and heat illness pose a severe risk to the health of fire
fighters. Currently there are no evidence based hydration guidelines for New Zealand fire fighters.
A need for a hydration education resource for fire fighters was established in a study in 2008
investigating the effect of shift work on the dietary intake of New Zealand fire fighters.
Aim: To develop a written hydration strategies resource tailored to the New Zealand Fire Service.
Method: A resource booklet “Thirsty Work” was developed based on information obtained in a
literature review, including an evaluation of current recommendations and resources available to
fire fighters. Feedback from key stakeholders, including health professionals and focus groups of
the target audience was sought.
Results: The recommendation for fluid requirements for fire fighters of 300-600 mls every 20
minutes was approximated using published sweat rates for fire fighters. The focus groups indicated
the resource was useful tool in conjunction with supplementary posters. Participants required
information to be presented in bulleted format, with simplified recommendations rather than
formula and boxes summarising the main point. The health professionals insisted language used
was simple and affirmative.
Conclusion: The resource developed was well received by the target audience. A fluid balance
study is required to determine evidence based fluid recommendations for fire fighters that will
optimise their level of hydration and thereby their physical and mental performance as well as
decrease the risk of heat illness.
Academic Supervisor: Laila Cooper
Professional Supervisor: Renee Ladbrook
Kimberlee is currently seeking employment.
28

The relationship between nutritional status and chemotherapy
treatment in children with Pre-B acute lymphoblastic leukaemia
(ALL)
by Victoria Logan
Children undergoing cancer treatment are at risk of becoming malnourished, due to the nature of the
disease and treatment side-effects. Nutritional status impacts chemotherapy tolerance. Maintaining
adequate nutritional status has the potential to improve treatment outcomes and minimise the
occurrence of adverse events. Furthermore, observational evidence suggests that children on
Children’s Oncology Group (COG) treatment protocols require more nutritional support compared
to Australia and New Zealand Childhood Cancer Study Group (ANZCCSG) Study VII protocols.
This review aimed to assess differences between ANZCCSG Study VII and COG treatment
protocols on nutritional status and need for nutritional support, and to investigate relationships
between nutritional status and treatment delays or adverse events. A retrospective review of the
case notes from 27 children, treated for Pre-B ALL under COG and ANZCCSG Study VII
protocols between 2002 and 2008 was conducted. Data collected included heights and weights
throughout treatment, information on treatment delays, adverse events and the use and effect of
nutritional intervention. Percentage weight change was used to quantify nutritional status through
treatment. Graphs and correlation coefficients assessed relationships between percentage weight
change and febrile neutropaenic episodes and treatment delays. Patients on COG protocols gained
significantly less weight during the induction phase than Study VII patients. This is concerning as
these patients receive higher steroid doses and would therefore have been expected to gain more
weight as a steroid side effect. The weight-loss may be a consequence of severe complications
related to PEG-asparaginase. Episodes of febrile neutropaenia and treatment delays occurred more
often in patients who gained less than five percent of their pre-treatment weight. Children on COG
protocols require additional nutritional intervention to maintain optimal nutritional status, ensuring
complications and treatment deviations are minimized.
Academic Supervisor: Dr Amanda Lyver
Professional Supervisor: Vicki Clarke
Victoria is currently undertaking further study with her MCApSc in Human Nutrition at University of Otago.
29

Evaluation of a pilot diabetes group education programme in a
community-based, Maori health setting
by Genelle Lunken
Introduction: Presently many individuals with diabetes are not achieving optimal outcomes and
are experiencing complications that affect their length and quality of life. The health system needs
to provide services that will help to optimize care and obtain desired behaviour change outcomes in
patients with diabetes. The Hawkes Bay Diabetes Centre has made steps towards this by
developing a pilot group education programme for individuals with type 2 diabetes.
Aim: This project aims to evaluated the programme to determine whether participants are
changing their behaviours, are satisfied with the programme and to determine if the programme is
meeting principles developed by the National Institute of Clinical Excellence (NICE).
Methods: Two questionnaires were developed, one to assess behaviour change and the other to
assess participant satisfaction. Sections of the Educator Improvement tool, developed to help
education programmes meet NICE principles, were used to evaluate the diabetes group education
programme from the perspective of the co-educators and the researcher.
Results: The diabetes group education programme was enjoyed by the participants that attended
the sessions. Low attendance rates did however mean that significance was not gained in the selfefficacy
or the behavioural sections. Despite the low numbers, participants reported significantly
fewer nutrition and exercise related barriers to change at the conclusion of the programme. The
sections of the Educator Improvement tool used demonstrated that only a few areas of the
programme needed improvement.
Discussion / Conclusion: Evaluation of the diabetes group education programme showed a trend
towards enhanced behaviour change in individuals with diabetes. By using various methods to
evaluate this programme, recommendations have been made to help enhance participants’ selfmanagement;
and therefore control of their diabetes.
Academic Supervisor: Amber Parry Strong
Professional Supervisor: Ingrid Perols
Genelle is working as a Clinical Dietitian in the areas of renal, medical and stroke at Palmerston North Hospital.
30

First foods for South Asian babies. The development of a
complementary feeding guide
by Roshni Mistry
Background: Normal growth, brain development and the prevention of illness are of critical
importance in the first year of an infants’ life. An infant should be consuming breast-milk in
addition to complementary food (CF), increasing in diversity and texture from around 6 months to
experience optimal growth and development.
Objective: To conduct questionnaire based interviews on the infant feeding practices of South
Asian families with the aim of developing a complementary feeding guide specifically tailored for
South Asian infants.
Design: Following a focus group with key informants consisting of paediatric dietitians from
Community Child Health and Disability, Auckland District Health Board, a computer based
literature search was conducted on MEDLINE, WEB of SCIENCE and Google Scholar. The
findings of a literature review were used to create a semi-structured questionnaire to assess the
complementary feeding practices of South Asian families. Seven South Asian mothers with infants
living in Auckland and Wellington were interviewed using the questionnaire. The questionnaire
results were used to develop a draft resource on complementary feeding for South Asian mothers
living in New Zealand. The readability of the draft resource was assessed using an online SMOG
test as well as being peer reviewed prior to pre-testing. A group of health professionals and South
Asian mothers pre-tested the draft resource using a Likert Scale questionnaire.
Results: The literature review, the findings from key informants and questionnaire findings all
support the diverse factors influencing the feeding choices of migrant and second-generation South
Asian migrant families. Specific nutrition related problems were found to be vitamin D and iron
deficiency and faltering growth. The draft resource addressing these issues was of the readability
level of 12.5 using the SMOG test. Pre-testing of the draft resource with health professionals and
mothers supports the need for this material in addressing nutrition related complementary feeding
issues. A simpler version is necessary for mothers with low literacy.
Conclusion: South Asian mothers (newly migrated or Westernised) share common nutrition
related issues relating to complementary feeding. Nutritional education that is holistic (addressing
dietary education as well as knowledge and attitudes) for the whole family is crucial in the delivery
of messages related to infant feeding practices. The resource booklet developed as a result of this
project can play an important part in informing future complementary feeding practices for South
Asian mothers.
Academic Supervisor: Prem Hoko
Professional Supervisor: Christine Cook
Roshni is currently undertaking further study with her Masters at University of Otago.
31

Development of an algorithm for nutritional support of ICU patients
at Wellington Hospital
by Sue Perry
Intensive care unit (ICU) patients are, by definition, critically ill. Critical illness, whatever the
primary cause, is characterised by a complex metabolic response which can lead to widespread
inflammation and multi-organ failure. In 2007, Wellington Regional Hospital (WRH) participated
in an international ICU nutrition support quality project which demonstrated inconsistencies in
nutrition support practice. The aim of the algorithm project was to devise a best-practice informed
tool covering selected nutrition support topics applicable to all mechanically ventilated, adult ICU
patients except those receiving short-term care following elective surgery.
A literature review and a questionnaire survey of New Zealand ICUs were undertaken. Results were
collated and compared with practice at WRH. Recommendations for change were generated and
incorporated into an algorithm which was tested on case data.
The literature review identified seven sets of evidence-based guidelines but no additional primary
research. Seventeen survey responses were received and demonstrated that practice in WRH was
consistent with practice throughout New Zealand.
The algorithm encompassed two evidence-based recommendations for practice change: a)
glutamine supplemented parenteral nutrition (PN); b) Oxepa ® (a formula enriched with n-3 fatty
acids and antioxidants) for enterally fed patients with acute respiratory distress syndrome, acute
lung injury or severe sepsis. Additionally, a target to begin PN if a patient is unable to tolerate
>80% of their nutritional requirements after 72 hours of enteral feeding was included. Due to
resource implications, the algorithm cannot currently be implemented fully. However, it provides a
model of good practice to inform future policy formulation.
Academic Supervisor: Professor Graham Hill
Professional Supervisor: Kate Inglis
Sue is currently seeking employment.
32

Breaking the food barrier: A clinical audit of a respiratory ward over
lunchtimes
by Courtenay Roberts
All patients have the right to presume that their dietary needs will be met during their stay in
hospital; however malnutrition is frequently experienced by inpatients. Deterioration of nutritional
status can be observed in well nourished and malnourished patients admitted to hospital. It is
therefore inherent to identify barriers patients experience in hospital over mealtimes that could be
changed to support nutritional intake. This study aimed to investigate barriers to nutritional intake
experienced by patients’ on a respiratory ward at Christchurch Hospital over lunchtimes. An
observational audit was developed, based on protected mealtime theory and current literature, and
focused on data collection of physical and environmental barriers patients experience during their
lunchtime meal. Thirty-nine patients were observed over two consecutive weeks. Thirty-five
percent of patients meal trays were out of reach, 60% of patients were interrupted during their meal
and 100% were distracted, 50% of ward traffic were visitors. A discussion with key stakeholders
refined the studies’ recommendations ensuring suitability for the ward. Key areas such as
preparation of the eating environment, increased staff availability prior and during mealtimes,
provision of a social dining environment, unnecessary staff and visitors off the ward during
mealtimes, use of visual aids for patients requiring feeding assistance and staff endeavoring to
decrease distractions, interruptions and noise, were identified as having the potential to decrease
barriers experienced by patients. The recommendations from this study are the first step to helping
protect mealtimes within this ward.
Academic Supervisor: Nicky Moore
Professional Supervisor: Clare Leighton
Courtenay is working as a Clinical Dietitian for Lea Stening Health, Christchurch.
33

Evaluation of the Peak Health Taranaki Dietetic Service
by Thomas Shand
Introduction: Peak Health Taranaki, a Taranaki Primary Health Organisation, fund a community
dietetic service which aims to provide easily accessed, free nutrition therapy to high need patients
within the community. Key outcomes sought are improved nutrition and reduced risk of disease,
decreased obesity and improved management of disease, via a culturally sensitive service. This
project aimed to investigate whether this service was achieving these outcomes and provide
recommendations for improvement.
Methods: An audit was conducted to assess whether the service is achieving its goals and to
provide recommendations for quality improvement. Qualitative data was collected through three
questionnaires. One completed by the dietitians, and two questionnaires completed by the target
population: one for those who had used the service more than once, and one for those who had been
referred to the service and utilised it once or not at all. Clinical data was collected from MedTech
and patient notes. The data was analysed and tabulated using Software Package for Social Sciences
(SPSS).
Results: The results suggest that the service is highly accessible with 92% of respondents finding
it easy to get to their appointments and 89% of respondents finding it easy to book an appointment
time that suits them. Forty-five percent of respondents reported that their health had improved over
the time that they saw the dietitian, and 50% of respondents stated that they were more confident in
their ability to make healthy food choices as a result of seeing the dietitian. Additionally, more than
half of (51%) respondents stated that other members of their household had also made positive
changes to their diet as a result of them seeing the dietitian. Only three of 62 respondents stated
that the service did not address their cultural backgrounds appropriately. Over an average of 2.5
months, 26 patients lost an average of 4.5 kg. Cholesterol markers were improved by 4-18%.
Conclusion: The service is achieving its primary aims and is rated highly by those that use it.
Results compare favourably to other similar services and support continued funding for this service.
Improved communication between doctors and dietitians would contribute to its continued success.
Moving forward the service should look to become a larger presence within the community,
assisting its clients by supporting the achievement of healthy lifestyles.
Academic Supervisor: Dr Rachel Brown
Professional Supervisor: Sara Knowles
Thomas is working as a Clinical Dietitian for Horowhenua PHO.
34

Supporting healthy eating practices in a forensic psychiatric
rehabilitation setting
by Nicky Shaw
Inconsistent nutrition advice provided by nursing staff to service users in a healthy living
programme was identified as a potential obstacle to the ongoing maintenance of physical health, in
a forensic psychiatry rehabilitation unit. This study aimed to develop recommendations that would
support nursing staff to provide evidenced-based, basic nutrition advice and practical assistance,
enabling service users to plan and prepare their own meals. Three focus groups and three one-onone-interviews
were held with healthy living programme staff. Issues explored were staff's current
nutrition practices and those of service users, the food and nutrition information necessary to assist
service users to plan and prepare healthy meals, and staff’s preferred ways of receiving information.
To identify knowledge gaps all participants completed a nutrition knowledge questionnaire. The
food and nutrition knowledge and skills of staff were poor. None had undertaken formal food and
nutrition training and all reported lacking confidence when giving advice to service users. Nutrition
issues raised by service uses were often areas of confusion for staff, resulting in the provision of
inconsistent and inaccurate advice. Formal group teaching and a food and nutrition manual were
the preferred learning methods. There is an urgent need for formal training in food and nutrition for
mental health staff in this service. Greater dietetic input is required to develop and deliver a
training programme and to provide on-going clinical oversight for staff. Up-skilling and increased
nutrition knowledge will increase the confidence and effectiveness of staff and improve the quality
of care received by service users.
Academic Supervisor: Dr Jane Elmslie
Professional Supervisor: Maria Ross
Nicky is working as a Clinical Dietitian at Waitakere Hospital, Auckland.
35

Policy development. A dietary supplement policy for the
New Zealand Rugby Union
by Kim-Maree Sherer
Aim: To research the literature and develop a current dietary supplement policy for the New
Zealand Rugby Union (NZRU) reflecting current best practice when administering dietary
supplements, accompanied by dietary supplement fact-sheets on relevant supplements used in the
rugby union environment.
Methods: Literature reviews, New Zealand government website searches and personal
communications were undertaken to gather the most current information on policy development,
and dietary supplement legislation and regulation within New Zealand. Additionally, a literature
review was completed to collate the most current information and recommendations for a predetermined
list of dietary supplements that are used to improve performance in rugby union. From
the literature searches and reviews, a preliminary policy was developed. This was distributed to
sports dietitians and nutritionists affiliated with the NZRU, and subsequently modified and refined
in accordance with feedback received. The final policy and dietary supplement fact-sheets were
given to the NZRU for distribution. Ethical approval was not deemed necessary for this project.
Results and Conclusion: A dietary supplement policy was developed along with seven dietary
supplement fact-sheets covering sodium bicarbonate, creatine, caffeine, beta-alanine, branchedchain
amino acids, sodium citrate and hydroxyl-methyl butyrate. These are presented in the Results
section.
Key words: Rugby union, supplement policy, sodium bicarbonate, creatine, caffeine, beta-alanine,
branched-chain amino acids, sodium citrate, hydroxyl-methyl butyrate.
Academic Supervisor: Dr Kirsty Fairbairn
Professional Supervisor: Katrina Darry
Kim-Maree is working as a Community Dietitian for Counties Manukau DBH, Auckland.
36

LOADDed with Nuts: The effect of hazelnuts in Type 2 Diabetes. A
pilot study
by Megan Somerville
There is little research on the effect of including nuts in the diet of people with Type 2 Diabetes.
This intervention investigated the effects of adding hazelnuts to a recommended diet based on
evidence-based dietary recommendations. Control participants from the LOADD (Lifestyle Over
and Above Drugs in Diabetes) trial were invited to participate in a 4-week intervention. Five men
and four women enrolled. After one week on the LOADD diet only, participants consumed the
LOADD diet plus 30 g/day hazelnuts. Participants completed three-day diet records at the
beginning and end of the study. The effects on blood lipids, lipoproteins, glucose, blood pressure,
and anthropometry were examined.
The intervention was well accepted by participants and compliance, was excellent. Saturated fatty
acids decreased from 9% to 7% total energy (TE) monounsaturated fatty acids increased by 5%.
Polyunsaturated fatty acid intake was maintained at 5% TE. Protein decreased by 3% to 21% TE
and carbohydrate decreased by 2% to 48% TE. Dietary cholesterol decreased by 87 mg/d and
sodium by 348 mg/d. Dietary fibre increased by 2 g.
Mean weight loss was 0.79 kg. Diastolic blood pressure decreased by 1.47 mmHg to 74.64 mmHg
and triglycerides from 1.38 mmol/L to 1.2 mmol/L. High Density Lipoprotein Cholesterol (HDL-
C) increased by 0.05 mmol/L to 1.19mmol/L (4.1%). TC:HDL-C decreased from 3.27 to 3.01
(8.0%). Total cholesterol decreased from 3.65 mmol/L to 3.56 mmol/L (2.21%), low density
lipoprotein cholesterol (LDL-C) from 1.88 mmol/L to 1.83 mmol/l (2.86%) and fasting blood
glucose from 7.49 mmol/L to 7.25 mmol/l (3.2%).
Although this group were already on optimum medication these results would indicate that a
recommended diet incorporating hazelnuts can achieve further improvements.
Academic Supervisor: Dr Alex Chisholm
Professional Supervisor: Minako Kataoka
Megan is working as a Research Technician for (Prevention of Overweight in Infancy) POI NZ study in the Department
of Women’s & Children’s Health, Dunedin Medical School, University of Otago.
37

An investigation of Breakfast Clubs in secondary schools across the
Waikato region
by Hannah Taylor
Secondary schools have shown interest in setting up breakfast clubs following concern about
students arriving at school without breakfast and the negative impact this has on their ability to
learn.
The aim of this research was to investigate how existing breakfast clubs in Waikato secondary
schools operate and to identify success factors and challenges.
Four secondary schools (urban and rural) with existing breakfast clubs were selected. Individual
interviews were held with the school principals and head organisers of the breakfast club. Focus
group discussions were conducted with student breakfast club attendees. The individual interviews
and focus group discussions were transcribed and a thematic analysis was completed.
This revealed that while the process of planning and operating a breakfast club was similar between
schools, the schools approached each stage in a different way. The stages involved were needs
assessment, consideration of funding, food supply, human resources, facilities and equipment,
promotion, and evaluation. Key success factors were conducting a formal needs assessment, having
knowledge and use of local resources, implementing the breakfast club as a student-led initiative,
and creating a supportive school environment.
Overcoming stigma associated with student attendance, and timing of breakfast club to suit students
travelling by bus were the main challenges.
Successful breakfast clubs were facilitated by thorough planning to identify key resources that
could be utilised and a supportive school environment. These results will be used to advise
Waikato secondary schools on how to successfully plan and operate a school breakfast club.
Academic Supervisor: Leanne Young
Professional Supervisor: Sheryl Hanratty
Hannah is working as a Physical Activity Coordinator for Sport Waikato in Hamilton.
38

Development of a nutrition and hydration resource for
New Zealand Army soldiers
by Sarah Windley
Background: The New Zealand (NZ) Army is currently developing a nutrition and health
framework for recruits undergoing the 16-week basic training, All Arms Recruit Course (AARC).
The framework will include comprehensive nutrition and hydration education.
Purpose: The aim of this current study was to develop an evidence based nutrition and hydration
resource, to supplement the planned formal education lessons.
Methods: Literature was reviewed on the specific nutrition and hydration issues faced by military
populations. In addition, three separate focus groups were held, with AARC recruits; AARC
instructors; and soldiers who had completed the AARC in the previous two years. This activity was
used to determine current nutrition knowledge, areas where nutrition education would be beneficial
and opinion on the content and design of a nutrition resource. Based on this information, a resource
was designed.
Results: A positive reaction to the production of a nutrition resource for soldiers was received in
all focus groups. There was large variation in knowledge amongst AARC recruits and soldiers with
regard to general healthy eating; nutrition and hydration during training and in the field; and
supplement use. Instructors had a much greater knowledge of all nutritional issues discussed. Both
recruits and soldiers favoured a simple, interactive resource, produced with specific relevance to
them.
Conclusion: Nutrition education has been identified as an area needing to be developed in the NZ
military, with soldiers showing an interest in the nutrition and hydration issues they face. Providing
recruits with such a resource at the beginning of their training will hopefully influence lifelong
healthy eating habits and ultimately enhance physical and mental performance.
Academic Supervisor: Helen Kilding
Professional Supervisor: Captain Nicola Martin
Project Consultant: Dr Jim Cotter
Sarah is working as a Clinical Dietitian at Kenepuru Hospital, Wellington.
39

Dietetic Training Programme
_______________________________
"growing the individual, feeding the Dietetic
profession"
Dietetic Training Programme,
Department of Human Nutrition,
University of Otago,
P.O. Box 56, Dunedin 9054,
New Zealand.
Email: dietetics@otago.ac.nz
http://nutrition.otago.ac.nz/dietetics