Dietetic Management and Creativity in Cystic Fibrosis Camps

Introduction

A camp manager oversees a staff of 20 seasonal employees during the summer months, for a period of approximately four months, at a camp for children overcoming cystic fibrosis (CF). Recently, the camp has identified a shortage of qualified staff capable of providing nutritional guidelines and creative menu plans for children who suffer from CF. The regional program manager has indicated that without adequate staff, more pressure will be placed on current counselors to develop creative ways to incorporate a healthy diet and encourage children to eat more fiber and energy-dense foods — approaches that studies suggest may help children with CF (Gavin, 2002).

The additional workload would require that current staff members work directly with students to create a new menu plan that is easily followed, and overtime hours would be required. In addition, recent budget cutbacks have reduced the funds allocated to purchasing literature on the benefits of fiber and other nutritional products on colonic function and other health aspects relevant to children with CF. As a result, counselors must find new ways to educate students without the literature they previously relied upon.

The regional manager should not expect individual counselors to single-handedly meet all of the educational requirements necessary to support camp participants. Studies suggest that nutritional education alone is not sufficient to teach children with CF the critical elements of good nutrition (Duff, 2002). Nutritional care teams are essential to help children modify their mealtime behavior and ensure that CF management complies with recommended dietary guidelines. In addition, children with CF are notably at risk for behavioral feeding difficulties; they tend to delay meals and have particularly long mealtimes compared to children without a chronic illness (Duff, 2002).

Values and Principles

The regional manager, as a leader in the camp community, should act in a manner that serves the best interests of both participants and the counselors currently working. From an ethical standpoint, the manager has an obligation to do whatever is necessary to ensure the well-being of all participants.

In this case, it does not appear wise to cut the budget with regard to nutritional and dietary staff. Trained personnel should be maintained who are capable of addressing the specific and unique requirements of children with CF. It is unreasonable for the regional manager to assume that ordinary counselors would have sufficient background in medical nutrition to successfully guide participants through a sound nutritional program. Furthermore, failing to hire adequate nutritionists puts the health and safety of CF attendees at risk, creating a potential legal liability for the organization.

Reflections on Budget Decisions

The regional manager does have options available and should consider, at a minimum, examining other areas where budget reductions can be made. For the purposes of creative education and nutrition programming, the director could look into hiring at least one expert per year. With regard to the literature normally provided to students on the importance of certain dietary elements for CF patients, there is a strong possibility that, as a camp director, the regional manager could identify a number of sources willing to donate free literature for the camp staff to read and distribute to participants.

In this particular case, it is certainly unfair for the manager to lay the burden of developing creative approaches to a nutritionally balanced diet on the shoulders of ordinary, untrained staff members. Though certain budget reductions are necessary, the manager should explore other options — including maintaining at least one dietetic expert on staff, charged with developing creative meal plans and obtaining literature to help participants manage the obstacles they face with CF.