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Enjoying

Foods while
on Dialysis
February 4, 2019

Nicole Castro-Queens College


Dietetic Internship
Assessment
– Client History (CH) 1 : Personal Data (1.1), Patient/Client/Family Medical/Health
History (2), Social History (3.1)
– Located in (Community District - 85,229 people)
– Demographics: 31% foreign-born, 65% is Hispanic, Blacks (non-Hispanic) 26% of the population,
Whites (non-Hispanic) making up 7%, Asians 1% and other 1%.2
– Hispanics mainly from Mexico, Puerto Rico, and Dominican Republic.6
– Unemployment Rate: 8.9% compared to NYC’s unemployment rate of 5.5%
– Poverty Level: 30.8% of the population live below the poverty threshold compared to NYC’s
20.3%.2
– Educational level: 13.1% have bachelor’s degree or higher; NYC’s 36.2%.3
Assessment

– Food/Nutrition-Related History7
Types of food/meals (FH-1.2.2.2)

– Mexican Cuisine: influenced by Spanish, French and indigenous cultures and uses foods such as chiles (peppers),
cocoa, tomatoes, cinnamon, garlic, onions, pork, goat, beef, poultry, beans, squash, and tortilla. 5

– Puerto Rican and Dominican cuisine: make up part of the Caribbean Hispanic cuisine. Green plantain in Puerto
Rico is used as a smash and called mofongo and in Dominican Republic called mangu.8
– Other staples: rice and beans, coconut milk, corn, yams, yucca (cassava), peanuts, guava, pineapple, black eyed peas and
lima beans.
Assessment

– Knowledge/Beliefs/Attitudes (4)7
Food and nutrition knowledge (4.1), Beliefs and Attitudes (4.3)
— Barriers: language, illiteracy, lack of insurance, cultural beliefs, mistrust, and
immigration status.4
— Communication and trust
— Religion: majority are Roman Catholic
— Values: family, religion, and spirituality
— Other beliefs: destiny; illness may be seen as God’s will or divine punishment
— Folk Healing
Assessment
– Medication and Complementary/Alternative Medicine Use (3)7
Medications (3.1), Complementary/Alternative Medicine (3.2)
– Medications are commonly used amongst friends.9
– Alternative medicine is common
– Behavior (5)7
Social Network (5.5)
– Family is involved in healthcare and dying process
– Neither prevention nor promotion is valued; typically late seek of care 9
– Include the family with prevention and intervention efforts, understand traditional gender
roles, and emphasize healthy eating with cultural foods.5
Assessment

– Factors Affecting Access to Food and/or Food and Nutrition Related Supplies (6)7
Food/Nutrition Program Participation (6.1)
– Referrals to government programs such as the Supplemental Nutrition Assistance Program,
Senior Farmers’ Market Nutrition Program, and the Commodity Supplemental Food
Program.
– Hemodialysis Center - protein supplement program on-site providing Nepro or NovaSource
nutrition shakes for people on dialysis.
Assessment

– Factors Affecting Access to Food and/or Food and Nutrition Related Supplies (6)7
Food/Meal Availability (6.2)
– Ranked the lowest in terms of health status
– Factors affecting this include: smoking, high school graduation rates/education level,
unemployment, physical inactivity and access to healthy foods.11
– Food deserts
– Food resources: Bodegas
– Other food sources: pizzerias, “Chinese food”, “Spanish Food”, fried chicken shops, and fast-food
chain restaurants.12
– Over-saturation and promotion of fast-foodscheap and convenient for consumers.
– Not #62 Campaign11
Diagnosis

– PES Statement:
Food and nutrition-related knowledge deficit (NB-1.1)13 related to limited ability to apply
nutrition information with dialysis-friendly foods as evidenced by pre-counseling sessions
showing the need for additional nutrition education activities and time to learn information.

Intervention
– To address the nutrition diagnosis of the population, an education intervention towards diet
modifications as they relate to kidney health/ dialysis diet was provided to the dialysis
patients.
– Content related nutrition education (E-1.1)14
– Nutrition influence on health education (E1.2)15
Lesson Plan
– Lesson Title/Plan: Enjoying Food While on Dialysis
– Target Audience: Dialysis Patients from Hemodialysis Center
– Date and Duration: February 4st (3 [40 minute] sessions): 5 min pretest, 20 minute presentation/interaction, 5 min post-test, and 10 min
questions.
– General Goal of Lesson: Participants will increase knowledge of nutrition management for chronic kidney disease/ end stage renal
disease.
– Specific Objectives:
– By the end of the session, through the use of a post-test, participants will be able to identify one food of each of the following criteria:
low potassium, low phosphorus, and high protein food.
– S: Specific to participants attending the nutrition workshop.
– M: Results are measurable through participants’ responses on the pre and post-tests.
– A: The objective is achievable within the time-frame of the workshop.
– R: It is realistic that participants will be able to identify 1 food item from each nutrition criteria (low potassium, low phosphorus, and
high protein) as it pertains to CKD/ESRD management.
– T: Achieving this objective by the end of the nutrition workshop is timely.
– By the end of the session, through the use of food models and post-test, participants will be able to plan one meal following Dietary
Guidelines for CKD/ESRD management.
– S: Specific to participants attending the nutrition workshop.
– M: Results are measurable through the participants’ responses on the pre and post-tests.
– A: The objective is achievable within the time-frame of the workshop.
– R: It is realistic that participants will be able to develop one meal following Dietary Guidelines for CKD/ESRD management.
– T: Achieving the objective by the end of the workshop is timely.
Specific Objectives Procedure Learning Evaluation
(Use SMART criteria) (State how each specific objective will be met) Activity Method
Introduction
Verbal Pre-test
Intern introduces self to participants and explains the purpose of the introduction to
workshop and the plan/time-frame for the workshop. Nutrition
Workshop

Body of Lesson
1. By the end of the session, through General review of Dietary Guidelines for CKD/ESRD. Verbal Education. Verbal Q&A
the use of a post-test, participants 1. Types of foods low in potassium, low in phosphorus, and high in protein.
will be able to identify one food of 2. Daily requirements and serving sizes. Educational
each of the following criteria: low 3. Health benefits of nutrition for disease management. Handouts
potassium, low phosphorus, and high a. Avoid fluid overload.
protein food. b. Maintain protein needs (albumin within normal limits) and lean Post-test
muscle mass.
c. Prevent bones from thinning, feeling weak and breaking.

2. By the end of the session, through Dietary Guidelines (CKD/ESRD)-Meal Planning Verbal Education Participants
the use of food models and post-test, Planning individual meals and activities: 1. Plan one meal
participants will be able to plan one 1. Using food models to learn portion sizes. with food models.
meal following Dietary Guidelines 2. Using food models to plate out a dialysis-friendly meal for the day. Demo meal 2. Write menu
for CKD/ESRD management. planning with on Post-test
food models

Conclusion
Verbal Open
Summarize the goal of the nutrition workshop and the information Conclusion questions/discussi
discussed. Thank the participants for attending. on
Marketing
– Product: Nutrition Education Workshop
– Price: Based on the budget that is allotted for staff, materials, etc.
Flyers/handouts provided by the Dietary Department
Food models provided by the Dietary Department were already in storage.
– Place: Waiting area of the Hemodialysis Center at
– Promotion: Through the use of flyers, both in Spanish and English, in high traffic areas such as
main hallways and front desk area of the site.
Resources
– Materials Needed: Handouts, pens/pencils, food models, plates, table, tablecloth
1. Pre/Post-test
2. Eating Right for Kidney Health
3. Potassium Tips for People with Chronic Kidney Disease
Low Potassium Foods (Visuals Handout)
4. Phosphorus Tips for People with Chronic Kidney Disease
Low-Down Phosphorus (Visuals Handout)
5. Protein Tips for People with Chronic Kidney Disease
Eat Your Protein (Visuals Handout) (Developed by Nicole Castro)
– Office supplies provided by Hospital-Dietary Department.
– Table provided by Hemodialysis center
– At the moment, no budget for snacks/food samples
Intervention-Nutrition Workshop
Monitoring & Evaluation

– Turnout Rate: 100% patients received educational handouts


– Number of Participants monitored and evaluated with Pre/Post-tests: 12 participants
– Pre-Test Results:
8 out 12 participants identified one food of each of the following criteria: low potassium, low phosphorus,
and high protein food. (67%)
6 out of the 12 participants planned one meal following Dietary Guidelines for CKD/ESRD management.
(50%)
― Post-Test Results:
10 out of 12 participants were able to identify one food of each of the following criteria: low potassium,
low phosphorus, and high protein food. (83%)
10 out of 12 participants were able to plan one meal following Dietary Guidelines for CKD/ESRD
management. (83%)
Monitoring & Evaluation

– Positive Outcomes: Participants improved their nutrition-related knowledge and


the intervention turned out to be effective.
– Improved from 67% to 83% of participants being familiar with low potassium, low
phosphorus and high protein foods.
– Improved from 50% to 83% of participants being able to plan one meal following
Dietary Guidelines for CKD/ESRD management.
– Large number of participants available to reach out to/educate
– Limitations
– Condition/Health Status of Patients: not feeling well; eyesight/illiteracy
– Space: waiting area & some distractions; table set up in the back of the room
– Lack of budget for food sampling
Health People 2020- Monitoring
& Evaluation
– Healthy People 2020 Goal: Reduce new cases of chronic kidney disease (CKD) and associated
complications, disability, death, and economic costs.
– Objective (CKD-14.1): Reduce the total number of deaths for persons on dialysis.
– 208.2 deaths per 1,000 patient years at risk on dialysis in 2007.
– Target: To reduce mortality to 187.4 deaths per 1,000 patient years at risk showing a 10 percent
improvement by 2020. (Goal already met)
– Educational nutrition intervention better management of CKD reduce mortality rates.
– Medicare alone uses about 25% of their budget to treat patients with CKD and ESRD.
Future Plans

– Promotion of the event by word of mouth and phone calls to the family members and
patients to increase event awareness and participation.
– Provide education one topic at a time.
– To include a food demo to provide participants a hands-on/visual experience of foods
that they can taste, try and prepare at home.
Resources
1. Client History. Nutrition Terminology Reference Manual. https://www.ncpro.org/pubs/2018-idnt-en/page-020. Published 2019. Accessed January 22, 2019.

2. Bronx Community District 6. NYC Planning | Community Profiles. https://communityprofiles.planning.nyc.gov/bronx/6. Accessed January 9, 2019.

3. King L, Hinterland K, Dragan KL, et al. Bronx Community District 6: BELMONT AND EAST TREMONT. Community Health Profiles 2015. https://www1.nyc.gov/assets/doh/downloads/pdf/data/2015chp-

bx6.pdf. Published 2015. Accessed January 9, 2019.

4. Juckett G. Caring for Latino Patients. American Family Physician. 2013; 87(1):48-54. https://www.aafp.org/afp/2013/0101/p48.html. Accessed January 9, 2019.

5. Nnakwe NE. Community Nutrition: Planning Health Promotion and Disease Prevention. Sudbury, MA: Jones & Bartlett Publishers; 2009.

6. Belmont Demographics. The Food Communities of NYC. https://eportfolios.macaulay.cuny.edu/lobel11neighborhoods/belmont/belmont-demographics/. Accessed January 9, 2019.

7. Food/Nutrition-Related History (FH). Nutrition Terminology Reference Manual. https://www.ncpro.org/pubs/2018-idnt-en/page-016. Published 2019. Accessed January 22, 2019.

8. Latin American Cuisines by Region. Oldways Nutrition Exchange. https://oldwayspt.org/system/files/atoms/files/TradDiet_LARegionalProfiles_0.pdf. Accessed January 9, 2019.

9. Medina C. Beliefs and Traditions that Impact the Latino Healthcare. https://www.medschool.lsuhsc.edu/physiology/docs/Belief and Traditions that impact the Latino Healthcare.pdf. Accessed January 9, 2019.

10. American Journal of Kidney Diseases. 2000;35(6):21. https://www.kidney.org/sites/default/files/docs/kdoqi2000nutritiongl.pdf. Accessed February 9, 2019.

11. The Bronx, New York: 2015 Culture of Health Prize Winner. Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/articles-and-news/2015/10/coh-prize-bronx-ny.html. Published October 28,

2015. Accessed January 22, 2019.

12. Rivera M. The Bronx: Dying from Lack of Nutritious Foods. The Huffington Post. https://www.huffingtonpost.com/migdalia-rivera/the-bronx-dying-from-lack_b_9350482.html. Published December 6, 2017.

Accessed January 22, 2019.

13. Food and Nutrition Related Knowledge Deficit. Nutrition Terminology Reference Manual. https://www.ncpro.org/pubs/2018-idnt-en/codeNB-1-1. Published 2019. Accessed February 7, 2019.

14. Nutrition Education Content (E-1). Nutrition Terminology Reference Manual. https://www.ncpro.org/pubs/2018-idnt-en/codeE-1. Published 2019. Accessed February 9, 2019.

15. Nutrition Education Application (E-2). Nutrition Terminology Reference Manual. https://www.ncpro.org/pubs/2018-idnt-en/codeE-2. Published 2019. Accessed February 9, 2019.
Resources
16. About Healthy People. Healthy People 2020. https://www.healthypeople.gov/2020/About-Healthy-People. Published February 8, 2019. Accessed February 9, 2019.

17. Chronic Kidney Disease. Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/chronic-kidney-disease. Published February 8, 2019. Accessed February 9, 2019.

18. Reddy V, Symes F, Sethi N, et al. Dietitian-Led Education Program to Improve Phosphate Control in a Single-Center Hemodialysis Population. Journal of Renal Nutrition. 2009;19(4):314-320.

https://www.sciencedirect.com/science/article/pii/S1051227608004585. Accessed February 1, 2019.

19. Caldeira D, Tiago Amaral, David C, Sampaio C. Educational Strategies to Reduce Serum Phosphorus in Hyperphosphatemic Patients with Chronic Kidney Disease: Systematic Review with Meta-analysis. Journal of Renal

Nutrition. 2011;21(4):285-294. https://www.sciencedirect.com/science/article/pii/S1051227610003079. Accessed February 1, 2019.

20. SBH Hemodialysis Center. SBH Health System. http://www.sbhny.org/patient-care/specialty-centers/sbh-hemodialysis-center/. Published 2017. Accessed January 31, 2019.

21. Boyle MA, Holben DH. Community Nutrition in Action: An Entrepreneurial Approach. Belmont, CA: Wadsworth/Cengage Learning; 2013.

22. Eating Right for Kidney Health: Tips for People with Chronic Kidney Disease (CKD). Bethesda, MD: U.S. Dept. of Health and Human Services, National Institutes of Health, National Institute of Diabetes and Digestive and

Kidney Diseases, National Kidney Disease Education Program; 2014.

23. Potassium: Tips for People with Chronic Kidney Disease (CKD). Bethesda, MD: U.S. Dept. of Health and Human Services, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases,

National Kidney Disease Education Program; 2011.

24. Saville J. The Kidney RD. Kidney RD. https://kidneyrd.com/. Published 2019. Accessed January 22, 2019.

25. Phosphorus: Tips for People with Chronic Kidney Disease (CKD). U.S. Dept. of Health and Human Services, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, National Kidney

Disease Education Program; 2010.

26. Protein: Tips for People with Chronic Kidney Disease (CKD). Bethesda, MD: U.S. Dept. of Health and Human Services, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases,

National Kidney Disease Education Program; 2010.

27. Feibig C. A dietitian's guide to protein for dialysis patients. American Kidney Fund. http://www.kidneyfund.org/kidney-today/a-dietitians-guide-to-protein-for-dialysis-patients.html. Published June 13, 2017. Accessed

January 22, 2019.