Community Interaction - Therapeutic Nutrition
The Division of Human Nutrition offers therapeutic care to both in- and out-patients at the Tygerberg Academic Hospital. The dietitians function within a unique infrastructure, consisting of two clinical firms. Each clinical firm operates with a Consultant, and five to six dietitians. Each firm is responsible for a number of hospital wards and medical/nutritional specialties as well as for the undergradraduate practical training of BSc Dietetic students.
The Division of Human Nutrition manages the care of more than 10 000 inpatient consultations annually. The dietitians also run the scheduled general nutrition outpatient clinic twice a week and offer a daily on-call dietetic service to other specialised outpatient clinics in the hospital.
Dietitians in Tygerberg Academic Hospital are involved in the following on a daily basis:
- ward rounds
- nutritional assessment of patients
- formulation of individualised nutritional care plans
- appropriate nutritional prescriptions
- nutritional consultations
- education of in-and out-patients (individually and/or group basis)
- in-service training
Dietitians are also responsible for specialised nutrition support in the form of enteral nutrition and total parenteral nutrition.
Assistant Director of Nutrition in Tygerberg Hospital: Claudia Schübl
Firm 1 - Fields of specialty
Cardiology, Burns, Obstetrics and Gynaecology, Eating Disorders, Endocrinology (predominantly Diabetes Mellitus) and Osteoporosis, Respiratory Intensive Care, Internal Medicine, Surgery (abdominal, vascular, plastic, thoracic), Ophthalmology, Orthopaedics, Dermatology
Consultant: Madelé du Plessis
Firm 2 - Fields of specialty
Internal medicine, Nephrology, Neurosurgery, Oncology, Obstetrics and Gynaecology, Pediatrics (all areas, including Diabetes Mellitus, Gastroenterology , Infectious Diseases, Oncology, Neonatology, Nephrology, Surgery), Psychiatry, Surgical Intensive Care
Consultant: Nazeema Esau
Dietitians are responsible for the prescription of enteral feeds and special supplementary drinks calculated to meet the individual needs of patients who cannot meet their nutritional requirements via food sources. Nutrition support is practiced on an indication/contraindication approach, and patients are seen strictly on a referral basis only.
The Tygerberg Academic Hospital has a specifically designed tube feed room where specially trained personnel follow stringent standards of hygiene. To improve this service unit the tube feed room was completely renovated during 2005. The tube feed room operates 365 days of the year and prepares ±50 enteral feeds and ±45 supplemental drinks daily. The diligent personnel who are responsible for making all of these feeds are:
The Tygerberg Academic Hospital is one of the few hospitals in the public sector in South Africa with a fully accredited sterile admixture unit for the preparation of TPN admixtures.
The Nutrition Support Team (NST) provides a TPN therapy service to all other Departments in the Tygerberg Academic Hospital for those patients who are unable to meet their nutritional needs enterally. Each patient's needs are assessed individually and the appropriate admixture is prescribed on a daily basis. The NST also advises health professionals from other Institutions in the country regarding the safe and cost-effective practice of TPN therapy.
The NST also advises on the placing of Percutaneous Endoscopic Gastrostomy, gastrostomy, nasojejenal and jejunostomy tubes, as necessary. The management of specialised enteral access is centralized in order to provide an integrated, protocol-based and cost-effective service within the Tygerberg Academic Hospital. The NST also provides in-house training to nursing and medical personnel as well as education and advice to patients discharged on enteral nutrition support.
The Division of Human Nutrition (Stellenbosch University) offers therapeutic nutritional care to both in- and out-patients at the Tygerberg Academic Hospital. This service is provided by dietitians in conjunction with 4th year dietetic students, completing their internship for the course BSc in Dietetics. The course itself as well as the therapeutic nutrition component has evolved significantly over the years, allowing for national / international needs and trends, as well as alignment to the outcomes for Dietetic professionals as specified by the Professional Board for Dietetics.
Students are progressively introduced to the service-learning concept from the first year of the course.
During the professional development of the students to their final internship year, various practical tasks are completed, and case studies are presented at ward rounds based on pathophysiological principles. A hands-on approach is followed for training final year students in therapeutic nutrition and during the 14 week internship, students rotate through various medical specialties and are made responsible, under supervision, for the full nutritional care of patients in the relevant hospital wards.
Students are expected to apply the nutritional and behavioral sciences, including the study of food (as taught in the first 3 years of the course), to provide patients with total nutritional care in the form of nutrition counseling and dietary prescription. The aim is for students to develop practical skills in the four basic components of clinical dietetics - needs assessment and the planning, implementation and evaluation of nutritional care - as related to a variety of diseases.
Dietetic students are involved on a daily basis in medical and/or academic ward rounds, nutritional assessment of patients, appropriate nutritional prescriptions, nutritional consultations and education of in-and out-patients (individually and/or group basis). Students are also involved in basic patient administration by managing patient statistics and utilizing information and communication tools for acquisition of laboratory results and for ordering prescribed diets and enteral feeds. All student activities are monitored and supervised by qualified dietitians.
Dietitians and students function within a unique infrastructure, namely that of two clinical firms. Each firm is responsible for a number of hospital wards and medical / nutritional specialties. After the completion of each clinical firm, as well as at the end of the internship year, students are subjected to a practical examination, wherein they receive a hospital patient for assessment with subsequent presentation to a panel of evaluators.
This established service learning approach in therapeutic nutrition has proven to work extremely well in terms of imparting additional knowledge and skills, whilst at the same time sensitizing students to the needs of the community and enabling them to offer a much needed service at primary, secondary and tertiary levels. This combined effort by dietitians and final year students have enabled the Department to manage over 30 thousand consultations annually, thereby directly serving the community surrounding this academic platform.
