Nourishing Health Care
Eating is something that comes naturally to most of us. At a basic level, it is a day-to-day necessity, a fact of life. At its best, eating is an experience of true pleasure, but when a person’s health is compromised, it can become a source of anxiety and even risk. Enter the clinical nutritionist: a health care professional whose work is to manage not the medicine that heals you but the food that fuels you.
Across the adult sites of the McGill University Health Centre (MUHC), the food that all patients eat during their stay is carefully monitored by one of the nearly 50 staff members of Clinical Nutrition Services who are supervised by Janis Morelli, Manager of Clinical Nutrition. Despite the responsibility inherent in overseeing such a vast domain, Morelli has an easy smile and takes an obvious delight in her work, calling clinical nutrition “the perfect link” between two of her passions: health care and food.
A long-time Montrealer, Morelli was inspired as a young woman by the city’s world-renowned culinary scene and excellent centres of medicine. She pursued a Bachelor of Science at McGill University with a concentration in dietetics, which included practical training at the Montreal General and Royal Victoria hospitals. After a brief stint as a clinical dietitian in Ontario, Morelli returned to Montreal and took a position at the Jewish General Hospital, eventually becoming the manager of clinical nutrition. When her current post at the MUHC opened up in the summer of 2003, Morelli saw it as “the opportunity of a lifetime,” and happily returned to her alma mater. Part of the attraction was joining an institution that was integrating its adult nutritional services, bringing together the formerly independent programs of the General and the Vic into a single, MUHC-wide department. “It was an interesting time to come back,” says Morelli, “and I enjoyed the challenge of helping to bring clinical nutrition forward at the hospitals where I’d done so much of my early training.”
Today, Morelli oversees the work of 25 nutritionists (also known as dietitians) and 22 nutrition technicians, a close-knit team that plans and implements programs of nutritional care for all patients. This can range from conducting a basic overview of the meals provided to patients for whom diet is not a central concern to closely collaborating with doctors, nurses and other caregivers in the many cases where proper food management is a key issue. Examples include patients with gastrointestinal conditions such as Crohn’s disease, diabetes sufferers who must learn to manage their blood sugar through diet, and the many cancer patients whose drug therapies make it difficult to tolerate food.
From the moment these patients are admitted, nutritionists assess their medical and diet histories, establish their ability to eat and digest food, and then work closely with doctors to decide on an appropriate nutritional plan. “One of the great pleasures of working at a large university health centre like the MUHC is being part of a diverse and integrated multidisciplinary team,” says Morelli. “Working alongside doctors, surgeons, social workers, pharmacists, physiotherapists and other specialists is not only fascinating, but ensures that everyone on the team gains the broadest possible understanding of a patient’s overall health, and can therefore make recommendations that have the best chance of success.”
Once the clinical nutritionist has worked with the patient’s care team to develop a nutrition plan, it then becomes the nutrition technician’s role to help implement it. A large part of ensuring that patients follow their nutritional regime is helping them make choices from the hospital menu that will satisfy both their preferences and their dietary requirements. For example, if a patient’s nutrition plan requires a low-potassium intake and the patient orders a banana smoothie from the menu, the technician will intervene, explaining why the smoothie might be harmful and making alternative suggestions. “Our technicians are dedicated caregivers who work expertly with patients to find a balance between what they like and what they need,” Morelli says.
Although the in-hospital work of Clinical Nutrition Services often takes place behind the scenes, Morelli emphasizes one element of her team’s mandate that is front and centre: education. In fact, the teaching mandate of a university health care centre was part of what attracted her back to the MUHC four years ago, and also inspired her to return to McGill to complete a master’s degree in Adult Education with a special focus on health care. “The education of patients, nutrition students and even other health care professionals is a huge part of what we do,” says Morelli. “I consider it our forte, and I can honestly say that by any standards we do it extremely well.”
While a nutritionist or technician is readily available in the hospital to answer questions and monitor meals, once the patient returns home, adhering to the prescribed nutritional plan becomes his or her responsibility. This can be a daunting prospect, which is why approximately 1,800 patients a year meet with one of the MUHC’s nutritionists to discuss how to maintain optimum nutrition once they return to the routines of their day-to-day lives. These meetings take place in a nutritionist’s office, a unique kind of “classroom” that is often packed with sample plastic foods, vitamin bottles, empty packages of processed foods and charts explaining the principles of a balanced diet. Morelli explains, “As we all know from personal experience, making proper food choices is a challenge. We take a patient’s health, lifestyle, socio-economic situation and family life into consideration so that we can form functional plans for each patient and teach them how best to implement these plans in their everyday lives.”
We take a patient's health, lifestyle, socio-economic situation and family life into consideration so that we can form functional plans for each patient and teach them how best to implement these plans in their everyday lives.
In addition to patient education, a key part of the nutritionist’s mandate is teaching students and professionals. Several members of Morelli’s team teach undergraduate courses at McGill and the Université de Montréal, and they are also frequently asked to educate their colleagues from other departments of the MUHC in basic nutritional principles. “Because proper nutrition has implications for almost every facet of medicine, from cancer care to geriatrics to neurology, physicians, nurses and other professionals come to us for information on how they can help their patients handle these issues,” Morelli explains. “Often we can provide advice on how to manage nausea, how to encourage an elderly person with dementia to eat, and how certain drugs can affect nutritional absorption.”
Working in the context of the research-intensive McGill University Health Centre, Morelli and her team are also involved in clinical investigations aimed at establishing best practices in the field and raising standards of nutritional care. One particularly promising project the MUHC’s clinical nutritionists are involved with is a multi-centre clinical trial that tests whether glutamine and antioxidant supplements can build body cell mass and arrest wasting in patients with HIV and other conditions. If proven effective, this therapy could return quality of life to thousands of patients who have been left weak and malnourished by their illnesses. Says Morelli, “innovative research projects like this have put us on the map in our field. We frequently receive calls from other hospitals because we’re seen as a credible resource. People want to know what we’re doing at the MUHC.” This expertise is showcased in the nutritionists’ impressive list of publications, which includes the widely used Enteral Nutrition Manual – A Practical Guide for the Clinician, a standard textbook that is about to be released in its fifth edition and that is familiar to clinical nutrition students from across Quebec.
While we may not always notice it, the food we eat has a profound impact on every aspect of our lives. Similarly, although many may be unaware of it, the work of Morelli and her colleagues in clinical nutrition touches most patients who pass through the doors of the MUHC. The careful monitoring of countless patients and the education of thousands of patients, students and fellow professionals validates Morelli’s confident claim that “the work done in Clinical Nutrition reaches the vast majority in the MUHC community.”
