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FACULTY OF NURSING

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Topic One: Introduction of science of nutrition and dietetics

Topic Objectives

By end of this topic, you should be able to:-

  • Define the terms used in nutrition and dietetics
  • Explain the history of nutrition and dietetics
  • Describe the professional requirements of nutrition
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Topic One: Introduction of science of nutrition and dietetics

Terminologies

Health: As defined by WHO is the ‘’state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’’.

Nutrition as defined by Robinson (1982) is “the science of foods and nutrients, their action, interaction and balance in relationship to health and disease, the processes by which the organism ingests, digests, absorbs, transports and utilizes nutrients and disposes of their end product”. In simple terms nutrition is the science of nourishing the body properly or the analysis of the effect of food on the organism

Nutrients are the constituents in food that must be supplied to the body in adequate amounts. These include Carbohydrates, Proteins, Fats, Minerals and Vitamins. They are obtained from food and are used in the body to provide energy and structural materials and to regulate growth, maintenance and repair of body tissues

Dietetics: - Is the combined science and art of regulating the planning, preparing and serving of meals to individuals or groups under various conditions of health and disease according to the principles of nutrition and management, with due consideration for economic, social, cultural and psychological factors. The science consists of knowledge of nutrition, food and the dietary constituents needed in different states of health and disease.

Diet: - the usual foods and drinks regularly consumed. Diet can be used to assess the nutrition status of a person. There are two types of diet

-       Normal diet: - this is the diet that supplies all the nutritional needs of a normal, healthy individuals, with due consideration for age, sex, activity and physiological needs.

-       Therapeutic diet: - diet that is manipulated or modified to suit a certain disease condition. Examples include low carbohydrate diet, sodium free diet, high protein diet, low fat diet etc.

Nutritional status is the condition of health of the individual as influenced by the intake and utilization of the nutrients.

RDAs (Recommended Dietary Allowances): Are guideline levels of intake of essential nutrients considered to be adequate to meet the nutritional requirements of practically all healthy people. They give guidelines that give safe levels of intake of essential nutrients that would keep almost all normal individuals within a group functioning normally and with adequate body stores of the nutrients.

RDIs (Recommended Dietary Intakes). Is the general term for set of reference values used to plan and assess nutrient intakes of healthy people

Serving: a portion of a meal served to someone e.g. a slice of bread is equivalent to one serving of carbohydrate.

Nutritionist or Dietician professional” means a member of the Institute issued with a Registration Certificate by the KNDI upon meeting professional qualification section 16 of the Act.


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Topic One: Introduction of science of nutrition and dietetics [Cont'd]

Consultant Nutritionist” means a nutritionist of not less than 15 years standing with advanced training in nutrition and who is recognized by KNDI.

Nutritional Technologist” means a person who has undergone professional training at diploma level with a bias in nutrition and is registered by KNDI.

Historical and current trends in nutrition and dietetics

“All recorded history shows that food has played an extraordinarily vital role in the rise and growth or the fall and decline of nations because of its effect on health and efficiency.

Since earliest times food have been considered in the light of both cause and cure of disease, and few stories are more fascinating than the gradual evolution of the science of nutrition from the maze of sage philosophy, countless fads and superstitions which have grown up through the centuries.

Medical literature from the time of Hippocrates has been replete with advice for the use of food in disease and as a measure to prevent disease. There was little true understanding of what happened to food in the body until the science of physiology explained the processes of digestion, circulation and respiration. On the other hand, the careful observations of many people gradually led to much information which proved to be fairly sound.


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Topic Two: Historical Development of Nutrition and Dietetics

historyHistory of nutrition can be explained in three eras.

  1. Chemical analysis era (1700-1900).

Dr. James Lind, a physician in the British Navy, performed the first scientific experiment in nutrition. At that time, sailors were sent on a long voyage for years and they developed scurvy (a painful, deadly bleeding disorder). Only nonperishable foods such as dried meat and breads were taken on the voyages, as fresh foods wouldn’t last. In his experiment, Lind gave some sailors sea water, others vinegar and the rest limes. Those given the lime were saved from scurvy.

Antoine Lavoisier, the father of nutrition and chemistry discovered the actual process by which food is metabolized. He also demonstrated where animal heat comes from. In his equation, he describes the combination of food and oxygen in the body and the resulting off of heat and water.

Justus Liebig of Germany, a pioneer in early plant growth studies, was the first to point out the chemical makeup of carbohydrates and proteins. Carbohydrates were made of sugars, fats were fatty acid and proteins were made up of amino acids.

2. Biological era (1900-1955)

E.V McCollum, while working for the U.S department of agriculture at the University of Wisconsin, developed an approach that opened the way to the widespread discoverer of nutrients. He decided to work with rats. Using this procedure, he discovered the first fat soluble vitamin, vitamin A.

Dr. Casmir Funk was the first to coin the term ‘vitamin’ as vital factors in the diet. He wrote about this unidentified substance present in food, which could prevent diseases of scurvy, beriberi and pellagra. The term vitamin is derived from the words vital and amines, because vitamins are required for life and they were originally thought to be amines- compounds derived from ammonia.

William Rose discovered the essential amino acids, the building blocks of protein.

3. Molecular / cellular era (1955- present)

The roles of essential nutrients as part of bodily processes have been brought to light. For example, more became known about role of vitamins and mineral as components of enzymes and hormones that work within the body.

 

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Topic Three: Professional requirements for nutritionists and dieticians.

The scope of practice is determined by:
  • Education
  • Training
  • Credentialing
  • Demonstrated and documented competence to practice

An individual with a certificate becomes a community nutrition technician, Diploma- community nutrition officer and degrees- nutritionists/dieticians

Registration is with the Kenya Nutritionist and Dietitian Institute (KNDI)- Regulatory body


  • Management is also defined as the process by which resources are mobilized, combined and coordinated to effectively to achieve organizational objectives.
  • It is a process that utilizes organizational resources in the most effective and efficient manner, in order to attain stated organizational objectives.

Efficiency and Effectiveness

  • Efficiency in management refers to optimal utilization of organization resources with minimal wastage. It is also the relationship between achieving objectives and consumption of resources.
  • Effectiveness refers to attaining specific organizational goals that are timely and challenging. It is also an outcome measure of the interventions that improve peoples health under ordinary circumstances and in ordinary settings.

    • Management versus Administration
  • Administration is part of management work but more concerned with execution.
  • A manager is said to be performing administrative work when he/she is involved in interpreting policies of the organization and putting into plans and having those plans implemented.
  • At every level of management, managers perform some work which involves execution or “doing” which is one that completes the administrative process.
  • Therefore administration is the total of planning, organizing, controlling, coordinating and also operating work.

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    Topic 1: Objectives

    At the end of this topic , the learner shall be able to:

    1. Define the community health and other terminologies used in community health nursing.
    2. understand the historical development of community health nursing globally and in Kenya.

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    Topic 1: Concept and principles of community health nursing

    • The word community means a social group that live in the same locality or environment and shares the same resources, and challenges.
    •  members of a community are guided by the same general regulations, have common interests and functions.

    • 1.0 Components of  Community.

    • 1. Geographical boundaries.
    • 2. Common values, norms and interest.
    • 3. Social structures and systems e.g leadership patterns, family patterns.
    • 4. People.
    • 5. Entities such as NGOs, GOK agencies, faith based organization and private institutions.

    community health is a branch of medicine that is concerned about the health of the whole population and prevention of diseases it suffers from.

    community health nursing deals more on the health status of the individual, family and community as influenced by:-

    1. The environmental factors.
    2. Population behavioral patterns.
    3. Rooted cultural beliefs, norms and other cultural practices.
    4. Information availability and utilization.
    5. local resource mobilization and utilization.
    1. To reduce morbidity and mortality rates due communicable and non communicable diseases.
    2. Increase life span of individuals.
    3. To empower individual, family and community to be  responsible for their own health.
    4. Identify community health problems and health needs.
    5. Plan ways of meeting community health needs.
    6. Implement activities geared towards meeting the meeting the community health needs
    7. Evaluate the impact of community health services/activities. 

    1.2 PHILOSOPHY OF COMMUNITY HEALTH.

    1. Upholding dignity of individuals and recognizing their ability to manage their own resources for improvement of their health.
    2. The individual, family and  community have great capacity for social growth and social well being.
    3. Every Individual need to struggle and improve their individual life and  their environment.
    4. Every individual possess some rights to be helped in time of need.

    1.3 CHARACTERISTICS OF COMMUNITY HEALTH NURSING

    1. Caring relationship and partnership with families and communities.
    2. People are essential participants in the process of health promotion.
    3. more focus should on improvement of health for individuals, families and communities.
    4. mutual respect and cooperation is essential practice for achieving community health goals.

    1.3.1 SCOPE OF COMMUNITY HEALTH NURSING.

    1. Domiciliary nursing.
    2. Mental health nursing.
    3. Industrial nursing.
    4. School health nursing.
    5. Mch/fp.
    6. Home care nursing.
    7. Geriatrics nursing.
    8. Rehabilitative services

    1.4 PRINCIPLES OF COMMUNITY HEALTH .

    Principles  are basic guidelines, or rules of action in a program.  Principles provide   clear frame on the roles and responsibilities health workers in the community. The principles of community health were specified in the Alma atta Declaration by WHO ( 1978)

    These included:-

    1. Active participation of individuals, and communities in the planning and provision of care.
    2. Development of maximum potentials for self care.
    3. Availability of health care for all and at a cost they can afford.
    4. Promotive and preventive aspects of health care.
    5. Integration of curative and preventive services.
    6. Using inter-sectoral approaches in health care provision in the community

    1.4.1 PRINCIPLES OF COMMUNITY HEALTH  AS PER HENTSCH DECLARATION (1995)

    In the Hentsch declaration, principles of community health were  elaborated further in order to broaden the scope and mandate of community health. These principles were:-

    1. Health care activities should be tailored around the life patterns of the community  in order to meet the needs of the community.  
    2. Primary health activities should form an integral component of the national health system.
    3.  Effective integration of  health care services, and use of collaborative approaches  in implementation of community health activities.
    4. Involvement of the community through training and  their involvement in planning, implementation and evaluation of health programs.
    5. More focus be put on community advocacy and community social mobilization for effective use of the local resources for health promotion and development.
    6. Empower the community through health education, training and participation to enable them be self sustainable and reliant in taking care of their own health.

    1.4.2 PRINCIPLES OF COMMUNITY HEALTH NURSING  

    Principles of community health nursing include the following.

    1. Community heath nursing services be available to the individual, family and community.
    2. Community health nursing program should be designed  with clear objectives, and purposes for its services.
    3. Community health nursing activities should be implemented within the framework of effective collaboration with stakeholders.
    4. There should be community involvement in planning, implementation and evaluation of a program.
    5. Community health nursing services should empower and build the capacity of the people to be self reliant in improving and maintaining their own health.
    6. Health education and counseling for individual, family and community are essential for health promotion.
    7. Community health services should be based on identified  individual, family and community health needs.
    8. Community health nursing should uphold respect and dignity for the  culture, norms and values    that are prescribed by  a community.
    9. Community health services should observe honesty and  professional ethics, e.g. there is no room for gifts, bribes from clients for services. 

    ACTIVITIES OF COMMUNITY HEALTH NURSING.

    The following are  some of activities in community health nursing.

    1. Health education.
    2. Information, education and communication.
    3. Environmental sanitation, supply of adequate clean water.
    4. Food hygiene.
    5. Vector and pest control
    6. Control of communicable diseases.
    7. Provision of school health services.
    8. Home-visiting and home based care.
    9. Occupational/industrial health. 

    FUNCTIONS OF  A COMMUNITY HEALTH NURSE.

    1. Organizing and managing health care programs.
    2. Implementing community health actions/programs in collaboration with other stake holders in the community.
    3. Creating community awareness and interest in their health.
    4. Empower the people to be elf reliant in terms of assessing their own health, mobilizing their local resources for improving their health indicators.
    5. Teaching individuals and families on issues of environmental sanitation, disease prevention and health promotion.
    6. Assess health status of the community.
    7. Identifying existing and potential health needs and problems and resources.
    8. Plan for health action with the other health team members.
    9. Evaluate the performance and impact of health activities.
    10. Conduct surveys and studies to identify health problems in the community.
    11. Train community health volunteers.

    ROLES OF A COMMUNITY HEALTH NURSE.

    1. A manager, she/he coordinates and manages health programs in the community.
    2. Health educator.
    3. Planner.
    4. Evaluator
    5. Implementer
    6. Researcher
    7. Trainer 

     

    • QUESTIONS:  
    • 1. Describe the term community.
    • 2. State four components of a community 
    • 3. State five principles of community health as  declared in HENTSCH in 1995.
    • 4. State five functions of a community health nurse.
    • 5. Explain five roles  of a community health nurse.
    • 6. Explain five ( 4  ) core activities in community health nursing.
    • 7. As a community health nurse working in  Kibera  community, describe how you  will improve  the health of kibera community.


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    Topic 1: CONCEPT AND PRINCIPLES OF FAMILY HEALTH

    Family health care is an approach to achievement of all round health for the family.

    1.1. AIMS OF FAMILY HEALTH

    1. Identify and assess the family for health problems affecting the family.
    2. Sharing vital information with all members to enable the family members to  understand their health situation.
    3. Participate in provision of health care services  for its members.
    4. Contribute materials that are needed for personal and social development of the family.
    5. Utilize the available resources to maintain all aspects of health of the family.
    6. Provide health education for the promotion of health and prevention of diseases.

    1.2. PRINCIPLES OF FAMILY HEALTH.

    1. Community health nurse should work toward successful family health care by observing the following principles.
    2.  Establishing good working relationship with the family.
    3. Plan relevant health education programs which have clear and realistic  objectives and  messages.
    4. Gather relevant information about the family which will enable them to identify health problems and set priorities.
    5. Provide need based support and services to the family
    6. Work in collaboration with other health services agencies to avoid duplication of health care. 

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    Topic 1: Summary

    Community health is a branch of medicine that is concerned with the health of the whole population.

    It focuses on provision of primary health care services to the individual, family and the community with their  own participation and using more the available resources for effective health promotion. 

    The goal of community health  is to reduce morbidity and mortality rate due to communicable and non communicable diseases. Strategies to achieve the goals of community health include making health care services available, accessible and acceptable to the community, empower the community members to be more responsive and active in their own health care programs, health educate the community with a view to improving their abilities of making good decisions in their health and to use inter collaboration approaches for program sustainability.

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    Topic 2: Objectives

    At the end of this topic, the learner shall be able to:

    1. Explain the interaction between nutrition and other careers
    2. Outline the different career opportunities of a nutritionist and dietitian
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    Topic 2: Interactions with other health professionals and career opportunities

    a)      Nutrition and medicine

    1. There have been conceptual trends in the thinking about nutrition in medicine and health. The first was the concept of deficiency- that an insufficient amount of a critical nutrient can cause disease.
    2. As an extension of malnutrition is the recognition that certain disease states or situations come with increased nutritional requirement. Example when battling cancer individuals typically have significantly increased nutritional and caloric demand.
    3. Excess nutrition- meaning getting too much of something in our diets is also a risk factor for diseases. Here the focus is on macronutrients example too much of the wrong kind of fat is a risk factor for cardiovascular diseases.
    4. The other concept that has been added to the scientific approach to nutrition is the recognition that specific nutrients may decrease the risk of developing certain diseases and may even treat an existing disease.

    b)     Nutrition and sociology

    1. Sociology involves the study of how people relate to each other as well as how the institutions of society affect behavior and attitude. Other disciplines like anthropology have much longer history of research into food and culture
    2. Food studies have been an integral part of both rural sociology and medicine sociology. For rural, food have been central in the studies of agriculture and technological changes.
    3. For medical, food and nutrition are now recognized as important factor in the study of health and wellness
    4. Sociologists examine how our nutritional habits are based on cultural identity, gender, race, ethnicity and social class.

    c)      Nutrition and research

    Without the work of research very little of our present nutrition knowledge would be available. Since technology is increasing and new health problems are coming up, there is need to improve the area of nutrition to manage and prevent these health problem. This can be done through the work and knowledge of research.

    d)     Nutrition and education

    Education knowledge help the nutritionist convey nutrition information to the community in a manner easily understood through nutrition education. Education also incorporate the nutrition information in their syllabus in school enables the students to gain the knowledge of nutrition even as they grow-up.

    Career opportunities in nutrition and dietetics

    1. Majority of registered nutritionists and dieticians are employed in health care settings (e.g. hospitals, clinics, mental health centers, rehabilitation centers, dialysis centers, extended care facilities) addressing wellness, prevention, and nutritional management of diseases and medical conditions.
    2. Nutritionists and dieticians work collaboratively as members and leaders of interdisciplinary health care teams that may include but not limited to any of the following: physicians, doctors, physician assistants, nurses, nurse practitioners, pharmacists, occupational therapists, physical therapists, psychiatrists, psychologists, social workers, dentists, dental hygienists, exercise physiologists, respiratory therapists, athletic trainers, lactation consultants, and others.
    3. Other settings in which nutritionists and dieticians work include nonprofit organizations, national and county health departments, food organizations, communities and public health agencies, child care programs, schools, home care, colleges and universities, government agencies, the military, and research.
    4. Nutritionists and Dieticians can focus on Clinical Nutrition, Community Nutrition, and Nutrition Administrators and in sports nutrition among an array of specialties

    a)      Clinical Nutrition

    1. Nutritionists and dieticians participate in, manage, and direct nutrition programs and services to identify and evaluate individuals for nutritional risk.
    2. Provide consultation to the physician and  health care team on nutrition aspects of a patient’s/client’s treatment plan.
    3. Provide dietary modifications and nutrition education and counseling, and care coordination and management to address prevention and treatment of one or more acute or chronic conditions or diseases.
    4. Nutritionists and dieticians provide and coordinate food and nutrition services and programs in healthcare settings such as hospitals.

    b)     Administrators

    1. Nutritionists and dieticians are employed as chief executive officers, directors, and managers in organizations, where they participate, manage, and direct programme activities.
    2. Nutritionists and dieticians are authors of books, professional and lay articles, print and electronic publications, newsletters, editorials and media columns.
    iii) Community and public health
    1. Nutritionists and dieticians with public health and community expertise are directors, managers, supervisors, educators, counselors, consultants, and researchers working in a variety of settings from the national to county and local levels, such as government agencies, community and professional organizations, and schools.
    2. Nutritionists and dieticians monitor, educate, and advise the public and populations about nutrition-related issues and concerns.
    3. Nutritionists and dieticians design, implement, monitor, evaluate, and supervise staff involved in nutrition programs (e.g. Supplementary feeding programmes and Outpatient therapeutic programmes)

    iv)  Sport Nutrition

    Nutritionists and dieticians educate and counsel clients of all ages and abilities regarding the relationships between food, health, fitness, physical activity, exercise, and athletic performance

    They are employed in rehabilitation; sports medicine clinics; community and medical fitness centers; and professional sport organizations;

    1. Nutritionists and dieticians evaluate dietary and sports supplements for safety, efficacy, and quality.
    2. Nutritionists and dieticians educate athletes regarding banned substances in sports
    3. Nutritionists and dieticians work in prevention and nutrition intervention of eating disorders, disordered eating, and the female athlete triad.
    4. They develop nutrition programs and counsel professionals


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    Topic 2: Further Reading

    1. A textbook of foods, nutrition & dietetics Begum R M sterling publishers pvt. ltd, 2008
    2. Shubangini A Joshi, (1998): Nutrition and Dietetics, Tata Mc Graw Hill Pub. Co. Ltd., New Delhi.


    END OF THE THE THE TOPIC

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