Nutritionist

Nutritionist

Local Health Systems Sustainability Activity (LHSS)

Scope of Work for Short Term Technical Assistance – Consultant:

Specialized Training Program for Nutritionists in Intensive Care Units (ICUs).

Consultant	Nutritionist
Justification for Selection	Open Competition
Counterpart	Sadouf Farraj
Area of TA	Nutrition, ICU nutritionist, training,
Budget line Item
Level of Effort	22 Days

Background and Rationale

LHSS assisted the Government of Jordan (GOJ) in key COVID-19 response activities related to critical care, including addressing the need for specialized health care provider staff offering critical care services in intensive care units (ICUs). The Activity worked to strengthen health care providers’ capacity within three MOH hospitals and RMS facilities for COVID-19 critical care, respiratory therapy (RT) and mechanical ventilation (MV). To further institutionalize and sustain the initial LHSS training activities, LHSS worked closely with the MOH to develop a competency-based framework (CFW) for ICU interdisciplinary teams.

A study published by PubMed Central (PMC) in 2019 Data indicate that prevalence of malnutrition in the ICU ranges from 38% to 78% and is independently associated with poor outcomes1, which in turn is associated with significant increases in mortality, ICU stays, and ICU re-admissions. An effective nutritionist within an ICU identifies patients who are malnourished and at nutritional risk and implements appropriate nutritional treatment plans.

The ICU interdisciplinary team approach has been identified as important element to improve services within ICUs. A qualified and competent interdisciplinary team includes a nutritionist as a crucial team member. The Ministry of Health, in close collaboration with USAID LHSS, has developed a competency framework of the technical and functional competencies needed for ICU interdisciplinary team members, and is implementing a training program to ensure that these teams representatives possess the necessary core competencies.

LHSS, in collaboration with Medical Education and Training Directorate and the Institutional Development and Quality Control Directorate at the MOH and RMS management, will continue supporting the MOH and RMS to implement the ICU Competency Framework. Part of this work will be to build the capacity of nutritionists to be part of the ICU interdisciplinary team, and to strengthen the nutritionists’ capacity to use the standard competencies as outlined in the MOH CFW.

LHSS is looking for a consultant to develop and implement a CPD accredited specialized competency-based training program for nutritionists from the central MOH, three targeted MOH hospitals in three regions: Al-Basheer hospital, Princess Basma Hospital, and Al-Karak Hospital, along with RMS nutritionists from selected facilities. The criteria for selecting participants should include nutritionists who are working in the targeted MOH hospitals and RMS facilities, work in ICUs, have at least five years of experience, and who are committed to attend the full course including theoretical and onsite visits.

Goal:

Strengthen the capacity of the nutritionists in central MOH, three targeted MOH hospitals in three regions: Al-Basheer hospital, Princess Basma Hospital, and Al-Karak Hospital, along with RMS nutritionists from select facilities to actively perform their role as an important member of the ICU interdisciplinary team in care management of critically ill patients at ICUs. The training program will cover but not be limited to the goals of nutritional support in critically ill patients, essential elements of nutrition planning for critically ill patients, nutritional screening and assessment, and the identified competencies for a nutritionist outlined in the MOH CFW. The expected outcome of the above-mentioned training is to train 20 MOH and 15 RMS nutritionist to work as members of interdisciplinary team at the ICUs

Objectives:

• Create a specialized CPD-accredited competency-based training package for nutritionists.
• Train 20 MOH nutritionists and 15 RMS nutritionists on a specialized competency-based training program,
• Train on how to implement the nutrition component of ICU patients’ care plan as an effective member of the ICU interdisciplinary team

Course Description

This training course consists of two phases: Theoretical part and a follow up implementation workshop to ensure applicability of acquired skills.

Theoretical phase:

Each training course is expected to be in person over five days with each session focusing on identified competencies of nutritionist outlined in the ICU MOH CFW for interdisciplinary teams working in ICUs.

this course will ensure all participants are familiar and acquire the identified competencies of the nutritionist outlined in the ICU MOH CFW. The training course to be developed could also cover the following subjects or modules:

• Nutrition assessment and malnutrition in the critically ill patients,
• Estimating energy and protein needs in critically ill patients,
• Nutrition support recommendations for the critically ill patient,
• Enteral nutrition in the ICU,
• Challenges that might preclude provision of enteral nutrition in the ICU,
• Managing refeeding syndrome,
• Parenteral nutrition support in the ICU,
• Biomarkers in critical illness for nutrition therapy,
• Micronutrient supplementation in the ICU,
• Use of probiotics in critical illness,
• Nutrition management in critically ill patients with COVID,
• Nutrition management in critically ill patients with Cystic fibrosis.

Follow up implementation workshop:

Post theoretical training, there will be assignments for the trainees to implement at their onsite work location to implement the acquired skills and competencies. The consultant is required to hold a one-day workshop for each group to assess and discuss the assignments and how they were implemented on how the nutritionist competencies and skills identified in the MOH CFW are being applied.

Learning objectives of this training course:

By the end of the training course, participants should be able to:

• Acquire the standard nutritionist competencies as outlined in the ICU MOH CFW document including but not limited to:
  • Understand process of nutrition assessment and malnutrition for critically ill patients.
  • Estimate protein needs in critically ill patients.
  • Determine both Enteral and Parenteral nutrition for critically ill patients in ICU, and challenges that might preclude provision of enteral nutrition.
  • Provide micronutrient supplementation in the ICU.
  • Use of probiotics in critical illness.
  • Provide the nutrition management of critically ill patients.

• Adopt the interdisciplinary approach in managing critically ill patients in ICU and implement the nutrition component of ICU patients’ care plan as an effective member of the ICU interdisciplinary team.

Tasks

• Develop a training plan that includes, course curriculum outlining the learning objectives and methodologies, the timeline, agenda, pre and post-test, course evaluation form, design special assignment to assess the acquired skills and competencies and develop the follow-up workshop agenda and design, training material covering the topics described in the course description,
• Obtain LHSS, MOH, RMS approval on material, provide necessary requirements to ensure obtaining the CPD accreditation of the training program.
• Conduct two (five-day) training courses on specialized competency-based training program for nutritionists, one course targeting 20 nutritionists from MOH and one course targeing15 nutritionist from RMS.
• Conduct a one-day follow up workshop for each group after two weeks of completion of the theoretical part. In this workshop the consultant should evaluate participants utilization of the acquired skills by discussing the assignments delivered.
• Evaluate effectiveness of the training through: Pre- and post-test results analysis, assessing the acquired skills and competencies during the follow-up workshop, and overall workshop general evaluation analysis, determine certificate eligibility for each participant.
• Provide LHSS with the final report containing all details as mentioned above.

Deliverables & Schedule:

The below table demonstrates deliverables and the due date the consultant will follow, this has been calculated to show the maximum allowable timeframe. If the consultant can perform the tasks in a quicker manner, this is welcomed and will be discussed in the approved timeline.

Deliverables	LOE (days)	Due Date
Detailed Training plan with timeline, Training materials and presentations developed using the templates approved by LHSS, CPD accreditation requirements to be able to submit the training program for accreditation. Pre and post-test, Overall training course evaluation form, Follow up workshop design and agenda with details of the specific assignment.	5 Days 1 Day	March 1st, 2023
Implement two (five-day) training courses, submit 20 pre and post training tests completed by MOH participants, and 15 pre and post training tests completed by RMS participants, analysed, and submitted to LHSS.	10 Days	May 15th, 2023
Implement two (one-day) follow up workshops	2 Days	May 30th, 2023
Final training reports with two sections for the MOH and the RMS submitted to LHSS to include: Summary of all training activities with analysis of the evaluation tools (Pre & Post-test, overall training evaluation, follow up workshop), list of participants who achieved the requirements to receive a certificate to LHSS, Lessons learned and recommendation for future improvement.	4 days	June 15th, 2023
Total LOE	22 Days

Required qualifications

1. The consultant should have a PhD or a Master’s degree in nutrition science
2. Subspeciality/ Training course in nutritional care of critically ill patients in ICU preferred.
3. Proof of five years’ experience in implementing training workshops.
4. Experience in the government sector or Royal Medical Services in ICU units is preferred.
5. Has strong communication and interpersonal skills.

Reporting

• The consultant will report to Health systems Advisor.

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