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Departmental Training Course: Physical Assessment of Adults in Clinical Practice

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Physical Assessment of Adults in Clinical Practice –

A Training Programme for Dietetic Departments,

 Available from 27th January, 2025

The INDI Physical Assessment of Adults in Clinical Practice (PAACP) blended learning programme was developed by dietitian experts* under the direction of the  Nutrition Physical Assessment Steering Group, as it was recognised that there was a gap, in terms of knowledge, skills and confidence of dietitians with the physical assessment component of nutrition assessment. 

Improving physical assessment skills of dietitians, enables more comprehensive nutrition assessment and identification of malnutrition and its severity in individuals. This is crucial, as it is estimated that 1 in 3 adults admitted to Irish hospitals are at risk of malnutrition, and 145,000 people live with, or are at risk of malnutrition (majority in the community) in Ireland1.

Our progress so far:

Since December 2023, 112 dietitians from across all clinical settings have participated in PAACP training. In the first quarter of 2025, a further two programmes (which are full to capacity) will be rolled out to 40 more dietitians. A third programme will be delivered in September 2025, and it is anticipated that places will be filled by those dietitians currently on our waiting list.

Increasing access to PAACP training via dietetic teams/departments: 

With the ongoing high demand for this training, and the need to embed physical assessment skills across the profession for the benefit of adult patients/service users, a training package for dietetic teams and departments has been developed separately. This approach will increase capacity and facilitate dietitians’ access to PAACP training in a more timely manner. This training package will be launched and available from January 27th 2025,and will be available going forward.

The key points to consider for a department or team PAACP training package are as follows:

The workshop components will need to be co-ordinated, conducted and delivered within your dietetic department/team by an eligible dietitian(s) who acts as facilitator(s). 

Your chosen facilitator(s) must be:

Working in practice for more than 3 years.

Have had prior training in physical assessment skills

Be incorporating these skills into their practice for more than 6 months.

Be confident that they have necessary skills and expertise to deliver this training 

The training uses a peer model approach, so training will be carried out in pairs. There can be up to 5 pairs of dietitians per facilitator within your department/team.

All materials, resources and the e-module as well as certificate of completion, will be provided and available to dietitians from your department/team through access to the INDI’s e-learning centre. 

Guidance documents (facilitator handbook) and workshop slides will be provided by the INDI for the support of the delivery of the programme. 

In order to allow flexibility, a department/team will have access to the training package on INDI’s E-learning site for a 12-month period - during which training can be scheduled and delivered at times that suit the department/team, in 14 week blocks to pairs.

The cost of this option will be €110 for each INDI member and €180 for each non-INDI member within your department

If you would like further details, e.g. a breakdown of the learning objectives and training components, or if you wish to proceed with this training for your department or team, please contact info@indi.ie and copy cpd@indi.ie to register your interest. We will revert to you to ensure eligibility and provide all details.

*Dietitian Expert Content Developers

Nicola Dervan, Specialist Lecturer/Practice Tutor, UCD

Jenny Caffrey, Clinical Specialist in Critical Care, SVUH

Fatma Omar, Acting Clinical Specialist Dietitian, Heart/Lung Transplant & CTS, MMUH. 

With review by, and acknowledgement to: Barbara Gillman, Dietitian Operations Manager, MMUH, Professor Clare Corish, Clinical Nutrition and Dietetics, UCD and Mary McKiernan, Dietitian Manager, MMUH

References

Rice N & Norman C 2012. JPHN 15(10):1966-1972; Russell CA & Elia M 2012. BAPEN 2012

INDI National Nutrition Survey 1990

This cover image may be familiar to some of you. We have recently uncovered one of the last remaining copies of the 1990 Irish National Nutrition Survey - a gold standard for nutrition and dietary surveys and one which is still used by many dietitians working in research on food surveys today almost 35 years later. We were thrilled to get our hands on Ms Kay Cunningham's original copy - Kay, who was the Chairperson of INDI at the time,  worked with the late Prof. Mike Gibney and a team of dietitians, statisticians and nutrition advisors to produce this seminal report. To keep it as a reference guide for future research we had the report scanned and we are delighted to now have a digital copy here on the website for you to  access easily. There are lots of other familiar dietitians who were involved in there , including Ms Mary Moloney and Ms Philomena Flood. It is a huge testament to the work of all those involved at the time that this report is still being cited today.

You can check out the report for yourself at the link below.

Download the INDI National Nutrition Survey 1990

INDI Fresenius Kabi Research Symposium 2025: Call for Abstracts and Nominations Now Open!

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We are delighted to announce that the 10th Annual INDI Fresenius Kabi Research Symposium will take place in TUD on Wednesday May 14th 2025 and the call for Abstracts is now open!

Nominations are also open for the prestigious Research Dietitian of the Year and the Research & Quality Improvement in Dietetic Practice Award awards.

Please submit your abstracts and nominations at the link below. We are looking forward to a great event and can't wait to see you there.

Research_Dietitian_of_the_year_2025_Nomination_Form.docx

RQI_in_Dietetic_Practice_Award_2025_Nomination_Form.docx

Upload Your Abstracts Here

SAVE THE DATE: Practice Placement Education Update

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Save the Date: Friday September 20th 2024

 

We are holding another meeting for all Dietitian managers (and their practice educators) on Friday  September 20th to discuss practice placement updates and to share information on placement ideas being tried and tested. There will be an opportunity for Dietitians to work within their CHO groupings to discuss placement opportunities and to make a plan for how we can support each other into the future.

The venue is the Richmond Hospital,Dublin 1. Email info@indi.ie to book your place.

It is hard to believe that it is almost a year since we published the Practice Placement Position paper.  As you know this document was developed by a group of managers, placement practice educators and the INDI in response to the current vacancy crisis and the pressures that we are all facing in the workplace. More Dietitians need to be graduating in Ireland each year to fill vacancies across the country and to build a sustainable workforce. This means that we must train more students. Our goal is to support dietitians so they feel that they can provide practice placements  for  students from any HEI. We want to optimise capacity so we can all reap the benefits of having diverse, confident and competent new graduates who can work across all settings.

As you may remember we ran a workshop in the Aisling hotel in February 2023 “Practice Placement – the way forward” for dietitian Managers/ in charge.  This allowed managers to come together to discuss how we can work together to increase student training capacity across the country. This was followed up by a webinar in April, for all dietitians. The feedback from both events was very positive and great ideas have been generated and shared as result.

 

Without doubt, there is much we can do to increase practice placement capacity. This has been demonstrated by those who shared with us the different approaches they have taken to sustain, and in comes cases increase, practice placement capacity despite current day challenges, such as staff shortages.  

We know that since last year’s meeting, many of you have been putting some of these ideas and approaches into practice. We have tried to capture this information in 4 sub-groups of the T&F group set up at the start of this year. Initially each group was HEI aligned and led by 1-2 Task group members. These subgroups gave dietitians from all settings and opportunity to discuss ways of working together to increase potential placement opportunities. As two of these subgroups were very large, more recently we have started to look at this potential placement capacity across CHO areas. Many of you will have contributed to this work to date. If not, we welcome your input as we continue to expand this exercise. This is important work to undertake as there no data on current practice placement in Ireland.

 

There were a number of positive outcomes from the work that we have done so far. 

Department of Further and Higher Education, Research, Innovation and Science (DFERIS) engagement

We reached out to directly to DFERIS to discuss the need to graduate more Dietitians in Ireland and to advocate for additional HEI resourcing for same. This engagement led to the commencement of discussions between the HEi representatives and DFERIS. In turn this led to a commitment from the undergraduate programme to offer 5 additional places in September 2023.. 

HSE National HSCP office engagement

We have been working with the HSE National HSCP Office to advocate for more supports, to explore different routes into  dietetics and to quantify the number of potential  placements available. 

It is the goal of the HSCP office to develop a national database on all practice placements for all HSCPs across the country. A HSCP Practice Placement Database Working group has been established for this purpose. Sinead Feehan is the T&F group representative on this group, which has opportunity to brief the HSCPO on the work happening across Dietetics and the approach taken to date.  As result, the HSCPO is now conducting a services of interviews with HSCP managers across the country to gain a better understanding of the barriers and enablers to increasing practice placements in all professions.

HEI Engagement 

We have met with the programme Directors from the 4 HEIs delivering Dietetic Programmes i.e. TCD & TUD, UCD, UCC and UL. The have been briefed on the approach being taken by this T&F to increase practice placement capacity and have invited representatives to join our sub groups. We have also advocated strongly on your behalf for common assessment forms to be developed and we understand that this work is in progress.

Advocacy

The T&F group continues to advocate for the supports that Dietitians require in order to provide a sustainable practice placement programme for students across the country, as outlined in our position paper launched last year. 

HSE funded Regional coordinator posts to ensure seamless integration of placements across all locations.

HSE funded Practice placement tutor posts to overcome current challenges and increasing numbers

Formal arrangements between HEIs, placement sites and the HSE e.g. MOUs

Review of the current requirement for 1000 hours of clinical placement and the structure and timing of placements

Supports for accommodation for the greater Dublin area

Reinstatement of training allowance

Coordinated partnership approach between the HEIs, the regulator, the HSE and the profession.

Common assessment processes and documentation across all HEIs

Administrative supports in departments, to ensure that clinical training resources are optimised

Adequate office accommodation and technology within training sites

While we continue to work together to implement these recommendations, we need input from all stakeholders, from the HEIs the HSE, the government departments and most importantly from dietitians and student dietitians.  Our position is that we should be coming together to overcome barriers to PPE and that all dietitians should be training students.

PLEASE JOIN US ON SEPTEMBER 20th.

Increase in malnutrition among patients entering hospital

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Increase in malnutrition among patients entering hospital

Patient nutrition now better managed within hospitals

Mandatory malnutrition screening should be extended to all oncology settings

More than a third of patients are malnourished when being admitted to hospitals in Ireland and the level is increasing – according to a new survey being launched today by the Irish Society for Clinical Nutrition and Metabolism (IrSPEN).

The survey carried out in November 2023 with data from 3,662 patients across 26 public hospitals in Ireland found an increase in hospital admission malnutrition to 34%, compared to previous surveys in 2011 (32%) and 2010 (28%).

However, it also found a significantly reduced rate of malnutrition in patients in long stay or rehabilitation wards, 21% compared to 36% on all other wards, and also in those admitted from other hospitals rather than from home at 26% compared to 35%.

This showed that mandatory national malnutrition screening and treatment protocols introduced in public hospitals in 2020 are working.

Launching the National Malnutrition Screening Survey 2023, IrSPEN is calling for malnutrition screening to be expanded to other clinical settings such as in outpatients, daycare and primary care settings, particularly for cancer patients and frail older people.

Report Co-author and IrSPEN Director Niamh Rice said the survey identified two major reasons for the rise in patients with risk factors for malnutrition: “The first is an increase in the age demographic of patients presenting at hospitals, with older people more likely to be malnourished and secondly a higher incidence of cancer, resulting in more cancer patients within the general hospital population (22% in November 2023 versus 16% in 2011), with this patient cohort also more likely to suffer nutritional problems resulting in malnutrition.

“The level of malnutrition presenting at our public hospitals remains too high and some is preventable if we pay more attention to improving the nutritional status of patients in the community. We need to expand screening and treatment for malnutrition to all settings where cancer patients receive care, particularly in day wards where they receive systemic anti-cancer therapy (SACT), to facilitate rapid access to specialist cancer dietitians, of whom we have just a handful across the country.

“A secondary recommendation is to resource an expansion of targeted malnutrition screening and treatment for older people living with frailty, particularly those living alone and requiring home care support.

“These patients typically present to their GP and to hospital emergency departments more frequently, and at significant cost to the healthcare system, due to falls and an increasing need for care. In many cases, loss of muscle due to increased nutritional requirements or poor dietary intake – malnutrition – is a key factor resulting in poorer quality of life, increasing frailty and an increased healthcare costs.”

IrSPEN has also today made a 2025 pre-budget submission on these recommendations – calling for additional malnutrition interventions to be supported and funded.

Meaning of malnutrition

Co-Author and King’s College London Lecturer & Cancer Research Dietitian Dr. Erin Stella Sullivan RD, said there is also a lot of confusion regarding what malnourished means, which she knows first-hand from supporting patients with cancer.  

“It is often incorrectly thought of as meaning being underweight or ‘skinny’. However, if patients are not eating what they need during illness, muscle is broken down in an attempt to keep the tissues supplied with the protein building blocks needed to keep everything functioning normally. This happens even if patients have higher BMI and can even be hidden in those cases.

“The effect of a screening and treatment programme is that patients who are losing weight or failing to eat sufficient protein, energy or other nutrients, which are typically required in higher amounts during illness – are identified early, so that appropriate nutritional supplementation or support can be provided.

“The impact of an improved nutritional status is significant health gain for these patients – improving their resilience, ability to complete treatment courses and enhancing their quality of life. There are also benefits to the healthcare system as healthier, stronger patients, have fewer complications and better outcomes.”

Screening works

A welcome finding in the survey is significantly lower rates of malnutrition in hospital long-stay patients (21% in 2023 compared 35% in 2011), pointing to the impact of mandatory malnutrition screening and treatment protocol in all public hospitals, following introduction of National Clinical Guideline 22 in 2020.

Ms Rice said: “Thankfully this points to Ireland bucking the international trend of worsening nutritional status within hospital patients. We need to build on this positive impact and expand it into other settings targeting those which the survey has identified as most at risk.”

Further survey details:

  1. Older people now represent 15.6% of our population, at 806,300 over 65s in 2023, an increase of 50% since 2011, when the last survey of malnutrition in hospitals was conducted. This upward shift in median age of the inpatient population, explains the higher prevalence of malnutrition in those entering the hospital system, since old age is an independent risk factor for disease related malnutrition.

  1. The higher proportion of patients reported to have cancer (one in five in the survey) is also a significant contributor to malnutrition rates on entry into hospital, with the risk of malnutrition detected in 44% of those with cancer, versus 30% of those without, irrespective of age.

  1. Lower rates of malnutrition in those admitted from other hospitals and in rehabilitation or long stay hospitals is very positive and reflects improvements in nutritional care, from earlier detection on point of entry into the hospitals due to screening and better follow through with appropriate nutrition support (from oral nutrition support to tube feeding or even intravenous / parenteral nutrition where needed).

The survey was carried out by IrSPEN with the support of the Irish Nutrition and Dietetic Institute (INDI) which is the professional organisation for registered dietitians in Ireland. The National Malnutrition Screening Survey Republic of Ireland 2023 is available to view HERE

  

INDI Statement of Values 2024

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The Irish Nutrition and Dietetic Institute (INDI) is the nationally recognised independent professional association for over 900 registered dietitians/ dietetic students in Ireland. INDI restructured in 2013 to transition  from an organisation that was volunteer run to a more business structure. This provides oversight, governance and accountability via the INDI Board.  At that time, we took the decision to not accept sponsorship of any kind, including funds, from companies who manufacture commercial foods that are high in sugar, salt and fat. 

Regulated Profession

Dietetics became a regulated profession here in Ireland in 2014 and are Dietitians are the only profession regulated to give nutrition advice to patients and the public. To ensure that we maintain the high standards of ethical and professional conduct expected of registered dietitians, we in INDI have further limited commercial activities over the last decade.

Commercial Relationships

Since 2017 we only engage with companies who employ registered dietitians and registered nutritionists, and we operate under very strict criteria. Our current partners for 2024 are Abbott Nutrition, Fresenius Kabi, National Dairy Council, Nutricia Advanced Medical and safefood. This was a decision taken by the dietetic profession in Ireland who then supported INDI by paying higher membership fees to mitigate the shortfall of company sponsorship funds. The INDI have no investments or stocks/shares and no commercial relationships with any food companies.  

Conflict of Interest

In 2018 we updated our Code of Practice and we go further than the statutory regulators code and are more restrictive in terms of conflict of interest.  We clearly state that all information given to the public must be evidence based and that no dietitian should “endorse a product purely for reasons of personal or commercial benefit”.  Acceptance and observation of the provisions of the Code are a condition of membership of the INDI.

Trusted Source of Information

Our Code also stipulates that advice given by dietitians should be “balanced and unbiased.” INDI does not engage in promotion of branded products. Any advertising in our professional journal is compliant with the standards set by the Food Safety Authority of Ireland, 'Guidance for Foods governed under Regulation (EU) No 609/2013'. INDI employs a part-time registered dietitian who does not undertake any commercial work as a media spokesperson. This helps to ensure the integrity of and trust in the information coming from the profession.

We have worked hard in the INDI over the last decade to advocate for the recognition of dietitians as the experts in nutrition.  We have had success with numerous dietitians now volunteering on and contributing to national clinical programmes and health policy in Ireland and beyond.

Into the Future 

INDI looks forward to hosting The 20th International Congress of Nutrition and Dietetics in Dublin in 2028. Our theme is Food, Integrity and Sustainability  and our conference partners will reflect  this theme and our organisational values. When ICND2024 concludes in Canada on 15th June 2024, we will launch our ICND2028 expression of interest website and further information on themes and details will be available.