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Gheller, Brandon JF, Phillip Joy, and Daphne Lordly. "A Qualitative Study Exploring the Experience of the Male Dietitian from Student to Professional." Canadian Journal of Dietetic Practice and Research 79, no. 2 (June 1, 2018): 55–59. http://dx.doi.org/10.3148/cjdpr-2018-003.
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Purpose: In Canada, dietitians serve a sex-diverse population despite the profession being predominately female (>95%). It is unknown why there are so few male dietitians. The objective of the present study was to explore the experience of the male dietitian, as a minority, in female-dominated dietetics.Methods: Two semi-structured interviews were conducted, approximately 6 weeks apart, with Nova Scotian male dietitians. The interviews prompted participants to reflect on their experience of being a male dietitian. Interviews were analyzed using Interpretative Phenomenological Analysis.Results: Male dietitians with between 1 and 17 years of experience participated (n = 6). Participant experiences were expressed as 4 themes: (i) feelings of difference and otherness, (ii) adapting to the female-dominated culture, (iii) constructing a professional identity, and (iv) passion as the driver for success. A theoretical framework for understanding the male dietitian’s experience was outlined.Conclusion: The experience of the male dietitian is unique and is a consequence of training and practicing in a female-dominated space. The effect of adaptation and construction of a professional identity that is a response to female-dominated cultural norms is wide ranging and may be constraining for male practitioners thereby affecting their contributions to the field.
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PIRES, Patrícia Fernanda Ferreira, Anabelle RETONDARIO, Claudia Choma Bettega ALMEIDA, Suely Teresinha SCHMIDT, Marcia Regina BEUX, and Sila Mary Rodrigues FERREIRA. "Professional practice of dietitians in the Brazilian School Feeding Program: A multiple case study." Revista de Nutrição 30, no. 4 (August 2017): 499–510. http://dx.doi.org/10.1590/1678-98652017000400009.
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ABSTRACT Objective: To assess dietician’s numerical parameters for school feeding and discuss limitations and possibilities for professional practice in the municipalities of Vale do Ivaí, in Northern Paraná, Brazil. Methods: This is a multiple case study. A semi-structured interview was administered to dietitians working at the School Feeding Program in nine cities located in Vale do Ivaí, Paraná, Brazil. Resolution nº 465/2010, from the Brazilian Federal Board of Dietitians, was used to calculate the adequacy of working hours of dietitians. The legistation of the Brazilian School Feeding Program was applied to discuss professional practice. Results: All the cities had at least one dietitian responsible for the School Feeding Program. The percentage of adequate working hours was from 20 to 66%. Some dietitians were involved in management activities, administration, procurement, and accounting, in addition to dietitian assignments for the School Feeding Program. Most dietitians worked in other sectors of the municipalities such as the health system, social assistance, and at events. This practice could compromise compliance of technical activities that must be met by the dietitians of the School Feeding Program. Conclusion: The number of dietitians in most of cities working at School Feeding Program is not sufficient to meet the number of students. The insuficient workload and excessive activities could hinder the development of dietitian’s private activities. The hiring of nutrition and dietitian technicians and administrative assistants for bureaucratic activies is recommended.
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Larson, Dagny, Jacqueline Henning, and Marissa Burgermaster. "Optimal App Use by Dietitians Limited by Payment Structures, App Usability, and Lack of Dietitian Familiarity With Available Apps: A Qualitative Thematic Analysis." Current Developments in Nutrition 5, Supplement_2 (June 2021): 979. http://dx.doi.org/10.1093/cdn/nzab051_023.
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Abstract Objectives To expand on previous survey-based research that provided a basic understanding of dietitian perspectives on app use by exploring factors that are influencing dietitian decision-making regarding the use and recommendation of apps with individual clients. Methods 20–60-minute semi-structured interviews conducted in-person, over the phone, or via videoconferencing from November 2019 to July 2020 with U.S. dietitians (n = 20) working in outpatient practice. Interview audio transcribed verbatim. Qualitative thematic analysis of interview transcripts. The creation of an audit trail, memos, and peer debriefing were used to enhance trustworthiness. Results Years in practice ranged from 2–42. Weight management and diabetes were most common counseling topics. Several factors that influence dietitian decision-making appear to limit a dietitians’ optimal use of apps, including current payment structure, limited app usability, and a dietitian's familiarity with available apps. Current payment structures typically don't compensate dietitians for time spent outside of visits to review app data or communicate/provide feedback to clients via the app. Participants described having difficulty finding apps for non-English speaking clients, clients with low literacy, and clients with complex dietary restrictions. A dietitian's familiarity with available apps also influenced if they were able to find apps that included desired features. Conclusions Despite noting potential benefits of app use, dietitians are not utilizing apps as frequently as desired due to current payment structures, app feature and usability limitations, and the overabundance of apps without sufficient time or guidance for assessing available apps. Future research and policies to address these limitations could greatly improve the efficacy and use of apps in dietetics. Funding Sources None
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Rushton, Alita, Adrienne Young, Heather Keller, Judith Bauer, and Jack Bell. "Delegation Opportunities for Malnutrition Care Activities to Dietitian Assistants—Findings of a Multi-Site Survey." Healthcare 9, no. 4 (April 10, 2021): 446. http://dx.doi.org/10.3390/healthcare9040446.
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Approximately one-third of adult inpatients are malnourished with substantial associated healthcare burden. Delegation frameworks facilitate improved nutrition care delivery and high-value healthcare. This study aimed to explore knowledge, attitudes, and practices of dietitians and dietitian assistants regarding delegation of malnutrition care activities. This multi-site study was nested within a nutrition care implementation program, conducted across Queensland (Australia) hospitals. A quantitative questionnaire was conducted across eight sites; 87 dietitians and 37 dietitian assistants responded and descriptive analyses completed. Dietitians felt guidelines to support delegation were inadequate (agreement: <50% for assessment/diagnosis, care coordination, education, and monitoring and evaluation); dietitian assistants perceived knowledge and guidelines to undertake delegated tasks were adequate (agreement: >50% food and nutrient delivery, education, and monitoring and evaluation). Dietitians and dietitian assistants reported confidence to delegate/receive delegation (dietitian agreement: >50% across all care components; dietitian assistant agreement: >50% for assessment/diagnosis, food and nutrient delivery, education, monitoring and evaluation). Practice of select nutrition care activities were routinely performed by dietitians, rather than assistants (p < 0.001 across all nutrition care components). The process for care delegation needs to be improved. Clarity around barriers and enablers to delegation of care prior to implementing reforms to the current models of care is key.
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Cantwell, Barbara, Carol Clarke, and Jane Bellman. "Building a Vision of Dietitian Services In Primary Health Care." Canadian Journal of Dietetic Practice and Research 67, S1 (September 2006): S54—S57. http://dx.doi.org/10.3148/67.0.2006.s54.
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Purpose: Primary health care (PHC) reform, especially efforts to implement interdisciplinary teams, has implications for dietetic practice. A consistent, clear vision of the registered dietitian’s (RD’s) role in PHC is needed to develop a successful advocacy agenda. Methods: The Dietitians of Canada (DC) Central and Southern Ontario Primary Health Care Action Group organized a four-step process to engage dietitians in developing an advocacy agenda for RD PHC services in Ontario. Two facilitated workshops brought together dietitian opinion leaders to enhance the understanding of current roles, find common ground, and develop a shared vision. All DC members were invited to review the draft vision, and feedback was integrated into a revised vision. Results: Registered dietitians saw PHC reform through many lenses, and were uncertain about how reforms would affect their practices. In a national review, the majority of reviewers (approximately 85% of 270) supported the draft vision; additional clarity was needed on resources and the breadth of services that RDs would provide. Conclusion: Development of a PHC vision for RDs should be helpful in advocating for dietitian services in PHC.
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MacLellan, Debbie, and Daphne Lordly. "Dietetic Students’ Understanding: Of What Becoming a Dietitian Means." Canadian Journal of Dietetic Practice and Research 74, no. 2 (July 2013): 96–97. http://dx.doi.org/10.3148/74.2.2013.96.
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Purpose: We explored dietetic students’ beliefs about what becoming a dietitian means. Methods: A phenomenological approach to inquiry was used. Thirteen undergraduate students enrolled in a dietetics program were interviewed, and data were analyzed thematically. Results: The overarching theme was students’ expectations of what being a dietitian means and how those expectations change throughout their education. Exposure to a variety of dietitians in practice helped shape participants’ understanding of being a dietitian. Conclusions: For dietetic students to develop a strong identity as dietitians and to strengthen the profession, they must be exposed to practising professionals early and often.
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Long, Zhiwen, Shan Huang, Jie Zhang, Deng Zhang, Jun Yin, Chengyuan He, Qinqiu Zhang, et al. "A Digital Smartphone-Based Self-administered Tool (R+ Dietitian) for Nutritional Risk Screening and Dietary Assessment in Hospitalized Patients With Cancer: Evaluation and Diagnostic Accuracy Study." JMIR Formative Research 6, no. 10 (October 26, 2022): e40316. http://dx.doi.org/10.2196/40316.
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Background Malnutrition is a common and severe problem in patients with cancer that directly increases the incidence of complications and significantly deteriorates quality of life. Nutritional risk screening and dietary assessment are critical because they are the basis for providing personalized nutritional support. No digital smartphone-based self-administered tool for nutritional risk screening and dietary assessment among hospitalized patients with cancer has been developed and evaluated. Objective This study aims to develop a digital smartphone-based self-administered mini program for nutritional risk screening and dietary assessment for hospitalized patients with cancer and to evaluate the validity of the mini program. Methods We have developed the R+ Dietitian mini program, which consists of 3 parts: (1) collection of basic information of patients, (2) nutritional risk screening, and (3) dietary energy and protein assessment. The face-to-face paper-based Nutritional Risk Screening (NRS-2002), the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), and 3 days of 24-hour dietary recall (3d-24HRs) questionnaires were administered according to standard procedure by 2 trained dietitians as the reference methods. Sensitivity, specificity, positive predictive value, negative predictive value, κ value, and correlation coefficients (CCs) of nutritional risk screened in R+ Dietitian against the reference methods, as well as the difference and CCs of estimated dietary energy and protein intakes between R+ Dietitian and 3d-24HRs were calculated to evaluate the validity of R+ Dietitian. Results A total of 244 hospitalized patients with cancer were recruited to evaluate the validity of R+ Dietitian. The NRS-2002 and PG-SGA-SF tools in R+ Dietitian showed high accuracy, sensitivity, and specificity (77.5%, 81.0%, and 76.7% and 69.3%, 84.5%, and 64.5%, respectively), and fair agreement (κ=0.42 and 0.37, respectively; CC 0.62 and 0.56, respectively) with the NRS-2002 and PG-SGA-SF tools administered by dietitians. The estimated intakes of dietary energy and protein were significantly higher (P<.001 for both) in R+ Dietitian (mean difference of energy intake: 144.2 kcal, SD 454.8; median difference of protein intake: 10.7 g, IQR 9.5-39.8), and showed fair agreement (CC 0.59 and 0.47, respectively), compared with 3d-24HRs performed by dietitians. Conclusions The identified nutritional risk and assessment of dietary intakes of energy and protein in R+ Dietitian displayed a fair agreement with the screening and assessment conducted by dietitians. R+ Dietitian has the potential to be a tool for nutritional risk screening and dietary intake assessment among hospitalized patients with cancer. Trial Registration Chinese Clinical Trial Registry ChiCTR1900026324; https://www.chictr.org.cn/showprojen.aspx?proj=41528
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Murray, Rebecca, Amanda Baker, Sean Halpin, Ben Britton, Kristen McCarter, Kerrin Palazzi, and Alison K. Beck. "Therapeutic Alliance Between Dietitians and Patients With Head and Neck Cancer: The Effect of Training in a Health Behavior Change Intervention." Annals of Behavioral Medicine 53, no. 8 (November 5, 2018): 756–68. http://dx.doi.org/10.1093/abm/kay083.
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Abstract Background The relationship between a clinician and their client—the “therapeutic alliance” is a robust predictor of outcome in healthcare settings; yet, few interventions to improve alliance have been tested. Motivational interviewing is a client-centered approach that embodies many principles and strategies consistent with a strong therapeutic alliance. Purpose To examine whether alliance is enhanced by training dietitians to deliver a motivational interviewing informed health behavior change intervention (“Eating as Treatment”; EAT) as part of routine consultations with patients with head and neck cancer. The predictive ability of motivational interviewing techniques was also assessed. Methods A secondary analysis of the EAT stepped-wedge cluster-randomized controlled trial was conducted. Patients with head and neck cancer undergoing radiotherapy (n = 307) were treated by radiotherapy dietitians (n = 29) during the control (Treatment as Usual) or intervention (EAT) phase. Alliance was rated during the first and final weeks of radiotherapy, and again 4 and 12 weeks post-radiotherapy. Dietetic sessions were audiotaped. Week one sessions were objectively rated for dietitians’ use of motivational interviewing techniques. Results Generalized linear-mixed effects regressions found no effect of EAT on dietitian-rated alliance (p = .237). After excluding outliers, patient-rated alliance was 0.29 points lower after EAT training (p = .016). Post hoc analyses revealed lower patient ratings on perceived support and dietitian confidence. Hierarchical multiple regressions found that no specific motivational interviewing techniques predicted patient-rated alliance. Dietitian acknowledgment of patient challenges was related to dietitian-rated alliance (β =.15, p =.035). Conclusions Patient and dietitian ratings of alliance were high after EAT training, but not significantly improved. Further research is needed to better understand the differential impact of intervention training and delivery on patient and clinician ratings of therapeutic alliance. Clinical Trial information Trial registration number ACTRN12613000320752
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Fraser, Kathryn, and Jennifer Brady. "Exploring Social Justice Advocacy in Dietetic Education: A Content Analysis." Canadian Journal of Dietetic Practice and Research 80, no. 1 (March 1, 2019): 2–7. http://dx.doi.org/10.3148/cjdpr-2018-027.
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Purpose: To explore the extent to which knowledge- and skill-based learning regarding social justice and/or social justice advocacy is included in the course descriptions of required courses of accredited, English-speaking dietitian training programs in Canada. Methods: This study is a mixed-methods content analysis of required course descriptions sampled from university academic calendars for accredited, English-speaking dietitian training programs across Canada. Results: Quantitative analysis showed that required course descriptions (n = 403) included few instances of social justice-related terminology (n = 63). Two themes emerged from the qualitative analysis: competing conceptualizations of social issues and dietitians’ roles; prioritization of science-based knowledge and ways of knowing. Conclusions: Accredited, English-speaking dietitian training programs in Canada appear to include little knowledge- or skill-based learning regarding social justice issues and advocacy. Supporting future dietitians to pursue leadership roles in redressing social injustices and socially just dietetic practice may require more explicit education and training about social justice issues and advocacy skills.
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Alia, Souheir, Habiba I. Ali, Taoufik Zoubeidi, and Mariam Ahmed. "Nutrition Knowledge and Satisfaction Levels of Postbariatric Surgery Adults in the United Arab Emirates: A Pilot Study." Journal of Nutrition and Metabolism 2019 (April 1, 2019): 1–7. http://dx.doi.org/10.1155/2019/9148459.
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Research assessing the nutrition knowledge of postbariatric surgery patients is limited, although this category of patients is predisposed to malnutrition. In this pilot study, we explored postbariatric nutrition knowledge, satisfaction levels with dietitian nutrition counseling, and decision to undergo bariatric surgery of 83 patients who attended a postbariatric outpatient nutrition clinic in Dubai, United Arab Emirates (UAE). A cross-sectional design involving gender-stratified random sampling method was used to recruit 83 postbariatric surgery participants. A self-administered questionnaire was employed to collect information about nutrition knowledge related to dietary recommendations after bariatric surgery as well as participant views on dietitian nutrition counseling, their decision to undergo bariatric surgery, and nutrition-related complications experienced after the surgery. The mean (SD) knowledge score of postbariatric diet was 9.7 (2.05) out of a maximum possible score of 14. The majority of the participants (78.3%) correctly identified which foods are recommended during the first stage of the postbariatric surgery diet, and more than 90% knew about the importance of high-protein supplements after bariatric surgery. Female participants had significantly higher mean knowledge score compared to males (p=0.02). Although nearly 80% of the participants reported regular follow-up with their dietitian, only 10.8% reported high adherence to the dietitian’s instructions. Moreover, more than two-thirds of the participants (71.1%) rated dietary advice provided by dietitians as vague. The most common complication experienced by the participants after bariatric surgery was nausea (61.4%). Furthermore, the majority of the participants (83.4%) found their daily and leisure activities to be more enjoyable after bariatric surgery. Ways of improving the quality of information delivery by dietitians should be explored to enhance patient comprehension and adherence to postbariatric surgery diet recommendations. Future research involving a larger and more representative sample to extend our findings are needed.
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Kwon, Jin Hee, Rah Il Hwang, and Jaehyeon Ryu. "A Comparison of Status of Nutrition Management in Long-Term Care Facilities With and Without Dietitian." Journal of Health Informatics and Statistics 47, no. 1 (February 28, 2022): 27–34. http://dx.doi.org/10.21032/jhis.2022.47.1.27.
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Objectives: The study was performed to compare the status of nutrition management with and without dietitian in residential facilities in order to provide basic data for high quality of nutrition management services across the country.Methods: Among long-term care facilities with claims of benefits, 747 samples were extracted through a proportionate stratified sampling method based on region, agents of foundation, types of food service, and facility size.Results: The subjects of the survey were dietitian, general managers, or facility directors. Nutrition evaluation, nutrition intervention, and nutrition monitoring were performed by professional staff at the residential facilities with a dietitian. On the other hand, it was found that the rate of nutrition management performance was relatively low in residential facilities where no dietitian was assigned, and it was performed by non-professional personnel such as nurse aids and social workers.Conclusions: The results of this study suggested that developing strategies is required to reinforce the safe minimal standard of dietitians’ staffing levels for systematic nutrition management.
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McCarthy, N., M. Schultz, and C. Wall. "P601 Are Inflammatory Bowel Disease patients’ expectations met by dietetic services?" Journal of Crohn's and Colitis 15, Supplement_1 (May 1, 2021): S547. http://dx.doi.org/10.1093/ecco-jcc/jjab076.722.
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Abstract Background Guidelines recommend that Inflammatory Bowel Disease (IBD) patients should have access to specialised dietitian support. Literature suggests that patients are often dissatisfied with their access to reliable nutrition information and dietitian services. Our aim was to assess whether New Zealand (NZ) dietetic services were meeting the expectations of patients. Methods In early 2020 an electronic survey to explore experience of dietetic services was disseminated to approximately 2000 patients (and parents) by Crohn’s and Colitis NZ and IBD health professionals. Quantitative responses were analysed via non-parametric methods and qualitative responses were analysed via inductive analysis. Results Responses were received from 407 IBD patients. Participants were asked if it ‘is useful for patients diagnosed with IBD to have access to a dietitian for nutrition advice?’ with 86% responding ‘Yes’ and 12% ‘Maybe’. Almost all (95%) patients had nutrition topics that they would like to discuss with a dietitian but only 52% had seen a dietitian and 45% had never been referred. Patients were interested in various nutrition topics (Table 1). Most (65%) would like access to a dietitian whenever a new nutrition issue arises. The most frequent nutrition advice received was to follow a specific diet, most commonly a low fermentable carbohydrate diet followed by a low residue diet, or general nutrition advice. Two-thirds (66%) of respondents found the dietitian advice at least moderately useful while 18% reported it was not at all useful. Patients who saw a dietitian in a private clinic were more likely to find the advice useful (p=0.0001), as were those who had received written advice (p<0.0001). Common themes in response to open-ended questions included: frustration at difficulty accessing dietetic services; desire for routine dietitian referral at diagnosis and ongoing access; the need for dietitians to have specialist knowledge of IBD; a perception that some medical staff believe nutrition is not relevant in IBD management. Conclusion Many patients have never been referred to a dietitian and a proportion of patients did not find dietitian advice useful. Dietitian advice appears to be on the topics most commonly of interest to patients. Access to dietetic services needs to improve and exploration is needed to elucidate why some aspects of services are not meeting patient expectations.
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Brady, Jennifer, Daphne Lordly, Debbie MacLellan, and Jacqui Gingras. "New Dietetic Practitioners’ Perspectives: On Their Education and Training." Canadian Journal of Dietetic Practice and Research 73, no. 3 (September 2012): 117–21. http://dx.doi.org/10.3148/73.3.2012.117.
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Purpose: To elucidate the complex phenomenon of dietitian professional socialization, we examined factors that influence people’s decisions to pursue a career in dietetics and how education and training processes influence the professional socialization of dietitians. Methods: Participants (n=12) had less than three years of work experience and included alumni from three Canadian universities representing different models of entry to practice. Three one-on-one interviews were conducted with each participant. Results: The key influencing factor in participants’ decision to pursue dietetics was the perceived congruence between dietetics and other aspects of their lives, including early interests and experiences (sports, food and cooking, an eating disorder), career aspirations (science, health care), and social networks (the desire to be a professional). A pivotal experience during high school or while enrolled in or after graduation from another program prompted participants’ awareness of and subsequent decision to pursue a career in dietetics. Supportive relationships were vital to participants’ professional socialization. Conclusions: Recruitment materials and education opportunities should help aspiring dietitians develop a clear idea of what being a dietitian means. Dietetic educators must attend to the informational and relational aspects involved in shaping future practitioners’ dietitian identities.
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Reid, Robert, George Fodor, Kathleen Lydon-Hassen, Monika Slovinec D'Angelo, Jennifer McCrea, Mary Bowlby, and Loretta Difrancesco. "Dietary Counselling for Dyslipidemia in Primary Care: Results of a Randomized Trial." Canadian Journal of Dietetic Practice and Research 63, no. 4 (December 2002): 169–75. http://dx.doi.org/10.3148/63.4.2002.169.
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This study compared the effectiveness of physician advice versus dietitian advice for a fat-reduced diet, and of dietitian advice for a fat-reduced diet versus a soluble fibre-enhanced diet in patients with moderate dyslipidemia. A total of 111 men and women took part in this 26-week, three-group, randomized, clinical trial. The physician advice fat-reduced diet group (n = 38) and the dietitian advice fat-reduced diet group (n = 35) received dietary advice based on the American Heart Association (AHA) Step II guidelines. The dietitian advice soluble fibre-enhanced diet group (n = 38) consumed one-third cup per day of psylliumcontaining cereal and was advised to increase soluble fibre intake to over 10 grams a day. LDL-C, TC/HDL-C ratio and body weight reductions over six months were –5.3%, –4.6%, and –1.9%, respectively, regardless of whether a physician or a dietitian provided advice, or whether advice was focused on a fat-reduced diet or a soluble fibre-enhanced diet. Both dietitians and physicians can help moderately dyslipidemic patients make clinically meaningful changes in blood lipid levels. Soluble fibre enhancement of the usual diet leads to similar reductions in LDL-C and TC/HDL-C ratio compared to interventions focused on fat reduction.
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Watson-Jarvis, Katherine (Kay), Lorna Driedger, and Tanis R. Fenton. "Evaluation of Dietitian Counselling Access Revealed Reduced Pediatrician-Reported Hospital Admissions and Increased Parental Knowledge and Confidence." Canadian Journal of Dietetic Practice and Research 78, no. 2 (June 1, 2017): 81–85. http://dx.doi.org/10.3148/cjdpr-2016-036.
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Based on a 1999 needs assessment a pediatric community-based outpatient dietitian counselling service was created. By 2010 annual referrals had grown to almost 1500 (62% from physicians; 38% from public health nurses). An evaluation was undertaken to gather perspectives of practitioners and parents about access, satisfaction, referral practices, and changes in knowledge, attitudes, behaviour, and child well-being. Health professionals surveyed via email were 62 pediatricians (response rate 71%), 25 family physicians (21%), 87 public health nurses (31%), and 7 dietitian providers (100%). Parents (n = 93, response rate 75% of those contacted) were interviewed by telephone. Pediatricians reported a significantly lower rate of 7% (95% confidence interval (CI), 0.8%–23%) for admitting children to hospital to access a dietitian, compared to 1999 of 39% (95% CI, 22%–59%) (P = 0.005). Health professionals reported a high degree of agreement on benefits of the service to their practice and on child health problems and a high degree of satisfaction with the service. Parents reported gaining knowledge (76%), confidence (93%), and making behaviour changes in foods offered (77%). Our evaluation demonstrated health practitioners saw a need for access to dietitians for pediatric dietitian counselling and parents reported more confidence and improved child feeding practices after dietitian counselling.
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Rushton, Alita, Judith Bauer, Adrienne Young, Heather Keller, and Jack Bell. "Barriers and Enablers to Delegating Malnutrition Care Activities to Dietitian Assistants." Nutrients 14, no. 5 (February 28, 2022): 1037. http://dx.doi.org/10.3390/nu14051037.
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Delegation of malnutrition care to dietitian assistants can positively influence patient, healthcare, and workforce outcomes. However, nutrition care for hospital inpatients with or at risk of malnutrition remains primarily individually delivered by dietitians—an approach that is not considered sustainable. This study aimed to identify barriers and enablers to delegating malnutrition care activities to dietitian assistants. This qualitative descriptive study was nested within a broader quality assurance activity to scale and spread systematised and interdisciplinary malnutrition models of care. Twenty-three individual semi-structured interviews were completed with nutrition and dietetic team members across seven hospitals. Inductive thematic analysis was undertaken, and barriers and enablers to delegation of malnutrition care to dietitian assistants were grouped into four themes: working with the human factors; balancing value and risk of delegation; creating competence, capability, and capacity; and recognizing contextual factors. This study highlights novel insights into barriers and enablers to delegating malnutrition care to dietitian assistants. Successful delegation to dietitian assistants requires the unique perspectives of humans as individuals and in their collective healthcare roles, moving from words to actions that value delegation; engaging in processes to improve competency, capability, and capacity of all; and being responsive to climate and contextual factors.
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Fowler, Jennifer K., Susan A. Anderson, and Janet H. Geggie. "Nutrition Services in Canadian Neonatal Follow-up Programs." Canadian Journal of Dietetic Practice and Research 65, no. 3 (September 2004): 118–21. http://dx.doi.org/10.3148/65.3.2004.118.
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The benefits of nutrition assessment and support of the high-risk infant are well established. The premature infant remains vulnerable for poor growth and developmental disabilities, thus requiring consistent monitoring, intervention, and follow-up care. The purpose of this study was to determine the registered dietitian’s role in neonatal/perinatal follow-up programs. A survey was sent to the 26 follow-up programs in Canada. The questionnaire response rate was 81%. Registered dietitians were involved in 67% of these programs. Of these dietitians, 43% were assigned to neonatal/perinatal follow-up programs while 57% were involved only by consult. The average time that assigned registered dietitians devoted to programs was 0.35 full-time equivalents. Over 80% of the dietitians did ongoing development, evaluation, and modification of nutrition care plans; 71% screened new patients for nutritional risk, and 100% instructed patient families and developed teaching materials. The study findings will assist program planners who wish to establish a dietitian position in a neonatal/ perinatal follow-up program. For registered dietitians already working in such programs, the results may provide some guidance on role definition and expansion.
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de Kruif, J. Th C. M., and A. Vos. "An algorithm for the clinical assessment of nutritional status in hospitalized patients." British Journal of Nutrition 90, no. 4 (October 2003): 829–36. http://dx.doi.org/10.1079/bjn2003959.
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Upon admission to hospital, 30–50% of patients either are or become malnourished. There is no generally accepted definition of malnutrition or guidelines on the best way to establish nutritional status. We consider it self-evident that the nursing staff have an important role in screening patients at risk of malnutrition on admission and thereafter at regular times. This is why we developed the nursing nutritional screening form (NNSF). The NNSF was tested by nurses, dietitians and clinicians, in pairs, to establish the extent of agreement in two phases on sixty-nine and forty patients. Later, the form was used in practice by nursing staff on five wards (334 patients). Based on the results of the NNSF, patients were referred to a dietitian. The dietitian established whether the patient was indeed at risk, or was actually malnourished, using a complete nutritional history. The degree of concurrence within pairs was reasonable to good. The same applied to the concurrence between nursing staff and dietitians, but concurrence between clinicians and nursing staff was less. In total, 334 patients were screened and sixty-nine of them were referred to the dietitian. It was established that 86% of the referred patients were potentially at risk of malnutrition or were malnourished. Without the NNSF, 39% (n 27) of the patients referred to the dietitian would not have been referred, or would have been referred much later. The NNSF makes it possible for nurses to detect malnourished patients or patients at risk of malnutrition at an early stage of their hospitalization.
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Werstuck, Michele Macdonald, and Cindy Steel. "Dysphagia Identification and Assessment in Adults in Primary Care Settings—A Canadian Study of Dietitians." Canadian Journal of Dietetic Practice and Research 82, no. 2 (June 1, 2021): 84–89. http://dx.doi.org/10.3148/cjdpr-2021-002.
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Dysphagia affects up to 35% of older adults living in the community and is considered a significant risk factor for malnutrition and aspiration. Early intervention is important, yet dietitian referrals for dysphagia management in primary care are disproportionately low considering the prevalence of dysphagia and its risk factors. As little is known about dietitian’s current dysphagia identification and assessment practices in Canada, an online survey was developed. Registered dietitians practicing in primary care were invited to participate. Of the 70 surveys completed, nearly 75% do not have a dysphagia screening process where they practice, and only 8% reported performing noninstrumental, clinical swallowing assessment (CSA). Lack of competency or skills required to complete dysphagia screening and assessment was the most reported barrier. Many respondents were unsure or did not believe CSA fell within their scope of practice, and over 70% reported needing hands-on dysphagia screening and assessment training. Current practices in primary care could be placing individuals with dysphagia, and those at risk, in jeopardy of being overlooked. Initiatives to increase dysphagia awareness, create screening processes, and increase awareness of dietitian’s scope of practice are needed to enable primary care dietitians to develop competency in dysphagia screening and assessment.
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MacLellan, Debbie, Jacqui Gingras, Daphne Lordly, and Jennifer Brady. "On Beginning to Become Dietitians." Critical Dietetics 2, no. 1 (March 16, 2014): 8. http://dx.doi.org/10.32920/cd.v2i1.771.
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This paper explores beginning dietetic practitioners’ perspectives on the process of becoming dietetics professionals through the use of vignettes to illuminate the complex process of professional socialization. Embedded in these vignettes are three themes related to the socialization process that occurs in the early years of dietetic practice: congruence, resilience, and relationships. Our findings indicate that new dietitians struggle to develop their dietitian identity. They feel unprepared for the relational and practice realities of the workplace and find the transition from dietetic intern to dietitian challenging. They seek many ways to cope including seeking support from others and planning for the future but some consider leaving the profession. It is important to understand the professional socialization and identity formation processes that occur during the early years of practice to ensure that dietitians feel prepared and supported as they begin their careers.
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Nitta, Ayasa, Saeko Imai, Shizuo Kajiayama, Mikuko Matsuda, Takashi Miyawaki, Shinya Matsumoto, Shintaro Kajiyama, Yoshitaka Hashimoto, Neiko Ozasa, and Michiaki Fukui. "Impact of Dietitian-Led Nutrition Therapy of Food Order on 5-Year Glycemic Control in Outpatients with Type 2 Diabetes at Primary Care Clinic: Retrospective Cohort Study." Nutrients 14, no. 14 (July 13, 2022): 2865. http://dx.doi.org/10.3390/nu14142865.
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The aim of this retrospective cohort study was to evaluate the effect of 5-year follow-up of dietitian-led medical nutrition therapy (eating vegetables before carbohydrates) on glycemic control in outpatients with type 2 diabetes (T2DM) at a primary care clinic. A total of 138 patients with dietitian-led medical nutrition therapy (intervention group) and 104 patients without dietitian-led nutrition therapy (control group) were compared for glycemic control, serum lipid, blood pressure, and diabetic complications for 5 years. Each patient in the intervention group received dietary education focused on food order (eating vegetables before carbohydrates) by dietitians. A significant improvement in HbA1c after 5 years in the intervention group [8.5 ± 1.7% (69 mmol/mol) to 7.6 ± 1.1% (59 mmol/mol), p < 0.001] was observed, whereas no change was observed in the control group [7.9 ± 1.2% (62 mmol/mol) to 8.0 ± 1.2% (63 mmol/mol)]. Dietary intake of protein, fat, carbohydrates, cholesterol, and salt in the intervention group demonstrated significant reduction, while the intake of dietary fiber significantly increased after the dietary education. Simple dietary education of ‘eating vegetables before carbohydrates’ presented by dietitians achieved good glycemic control after a 5-year period in outpatients with T2DM at primary care clinic.
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Skrzypek, Michał, Lucyna Pachocka, Karolina Goral, and Adamina Partycka-Skrzypek. "Selected determinants of the professional identity of dietitian in the context of legal regulations on the practice of dietitian in Poland and the European Union." Polish Journal of Public Health 128, no. 2 (June 1, 2018): 63–68. http://dx.doi.org/10.2478/pjph-2018-0011.
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Abstract The subject of the article is the present status of the profession of dietitian in the Polish healthcare system, taking into account the analysis of the current legislation in force that defines the principles of employment of dietitians and the practice of the dietitian in Poland in the context of relevant provisions of the EU law, with emphasis on the position of dieticians in the health-care systems of selected European Union countries. The study advances the thesis that the current status of the profession of dietitian in Poland reflects its incomplete professionalization manifested in the lack of legal regulations on the principles of its practice that are applied in the case of other medical professions. A consequence of the present, comparatively low status of the profession of dietitian in Poland is, inter alia, the hindered availability of professional clinical dietetics counseling under public health insurance, as well as the practice of the profession as a business activity by individuals whose professional qualifications are not subject to verification by professional regulatory bodies. This produces a risk to patients, arising from the fact that interventions not verified by the EBM paradigm are nevertheless implemented as part of dietary counseling.
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Gingras, Jacqui. "The passion and melancholia of performing dietitian." Journal of Sociology 46, no. 4 (November 23, 2010): 437–53. http://dx.doi.org/10.1177/1440783310384450.
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Dietitians provide nutritional care in various contexts and it is expected that dietetic subjectivity shapes and is shaped by health/nutrition discourse, but this has not been sufficiently explored. The purpose of this study was to further understand dietetic subjectivity, dietitians’ experiences of their education and relationships between educational and practice discourses. Twelve dietitians were recruited to participate in semi-structured research interviews. Feminist theoretical perspectives informed the research including the interpretation of data, which was analyzed according to the Listening Guide, a feminist voice-centered relational method. A theory of dietitian performativity informed by Butler (1999) emerged whereby dietitians expressed passion and melancholia for their practice. Also, participants experienced discontinuity between educational and practice contexts, which highlighted the need to integrate embodied epistemic perspectives throughout undergraduate education. These findings support a critical gesture in dietetic educational discourse away from positivism towards embodiment as a means for highlighting and reinforcing the complexity and fluidity of dietetic performativity.
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Lieffers, Jessica R. L., Helen Haresign, Christine Mehling, Jose F. Arocha, and Rhona M. Hanning. "A Qualitative Evaluation of Contact Centre Dietitian Support and Electronic Motivational Messaging for eaTracker My Goals Users." Canadian Journal of Dietetic Practice and Research 79, no. 2 (June 1, 2018): 67–73. http://dx.doi.org/10.3148/cjdpr-2017-035.
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Purpose: To conduct a qualitative evaluation of adjunct supports (brief motivational messaging regarding goals delivered by email/website, contact centre dietitian assistance) offered by EatRight Ontario (ERO) for users of a website-based nutrition/activity goal setting/tracking feature (eaTracker “My Goals”). Methods: One-on-one semi-structured interviews were conducted with My Goals users in Ontario (n = 18) and Alberta (n = 5) recruited via the eaTracker website and ERO contact centre dietitians (n = 5). Interview transcripts were analyzed using content analysis. Results: Participants had mixed experiences and perspectives with ERO motivational messaging. Messages targeted towards specific goals (e.g., tips, recipes) were generally well-liked, and generic messages (e.g., eaTracker login reminders) were less useful. No interviewed users had contacted ERO dietitians regarding goals, and dietitians reported encountering few callers asking for assistance while using My Goals. Limited user knowledge was one explanation for this finding. Participants provided suggestions to enhance these supports. Conclusion: Electronic motivational messaging and contact centre dietitian assistance have the potential to support achievement of goals set with website-based features. When considering using electronic messaging, researchers and practitioners should consider message content and delivery tailoring. Marketing that focuses on how contact centre dietitians can assist website users with their goals is needed when services are used in naturalistic settings.
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Kwon, Jinhee, and Sanghee Park. "A Comparative Analysis on the Management Performance of Meal Service with or without a Dietitian at the Day and Night Care Centers." Korea Gerontological Society 42, no. 3 (June 1, 2022): 435–53. http://dx.doi.org/10.31888/jkgs.2022.42.3.435.
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This study is the secondary data analysis using data collected from 710 day care centers for the elderly for the research on Meal Service Management of long-term care institutions carried out by National Health Insurance Service(NHIS) in the Republic of Korea in 2020. The purpose of the study was to analyze the current status of dietitian meal service at day care center, where the recipients are under the long-term care insurance. The main results are as follows. First, the dietitian placement at day care centers was statistically significantly related to the ownership, size, and operation type of the centers. Second, in the case of a dietitian, the proportion of responses that there is the meal service quality management manager was significantly higher. The percentage the dietitian who answered that they were responsible for meal service quality management was statistically significantly higher as well. Third, the ratio of day care center to consigned meals was 30.6%, which was higher than 25.0% of long-term care facilities and 11.5% of elderly group homes. Based on this, the following suggestions were made to improve the quality of meal services of day care centers: to manage the meal service by professional personnel, such as dietitians, to prepare operation standards and quality management plans for consigned meals, and to research and develop policies for meal services.
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Pieloch, Daniel, Golnaz G. Friedman, Sara DiCecco, Linda Ulerich, Stacey Beer, and Jeanette Hasse. "A Standardized Framework for Transplant-Specific Competencies for Dietitians." Progress in Transplantation 27, no. 3 (July 6, 2017): 281–85. http://dx.doi.org/10.1177/1526924817715466.
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Dietitians have extensive training and are considered the experts in medical nutrition therapy (MNT). Although dietitian competencies for MNT are well established, competencies that account for the expanded roles of dietitians working in transplantation have not been developed. These expanded roles require a better understanding of transplant processes, regulations, and even the business side of transplant, novel concepts to most dietitians. Therefore, we proposed a standardized framework of transplant-specific competencies for dietitians practicing in transplantation. These competencies can help improve and standardize initial and ongoing training for transplant dietitians moving forward, ultimately leading to improved patient care for transplant candidates, recipients, and donors.
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Nakamura, Tomiyo, and Nobuko Amano. "Proposal for preventing malnutrition in individuals on a texture-modified diet." Nutrition and Health 25, no. 4 (September 13, 2019): 241–43. http://dx.doi.org/10.1177/0260106019871732.
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Background: The energy and protein provided by texture-modified diets decreases dramatically as the stage increases. To prevent malnutrition in individuals on texture-modified diets, nutrition management detailing the amount of energy and protein required and consumed is needed; however, this has not yet progressed. Aim: To consider the factors responsible for the lack of progress in nutrition management. Methods: We reviewed the work content of the registered dietitian in Japan. Results: It takes over an hour a day to make calculations for the amount of energy and protein consumed for all of these patients, but it turned out that this time cannot be extracted considering the daily work of the registered dietitian. Conclusion: To prevent malnutrition, it is necessary to increase the number of registered dietitians.
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Culkin, Alison. "Supplementary prescribing by dietitians: a case study." Journal of Prescribing Practice 1, no. 1 (January 2, 2019): 16–20. http://dx.doi.org/10.12968/jprp.2019.1.1.16.
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In February 2016, registered dietitians in the UK gained supplementary prescribing rights. The aim of this case study is to describe the prescribing process by a registered dietitian supplementary prescriber. A 46-year-old male was transferred to a tertiary referral centre for a surgical review due to intra-abdominal tuberculosis resulting in bowel obstruction. The registered dietitian performed a nutritional assessment, estimated nutritional requirements and formulated a bag of parenteral nutrition to meet his needs. The patient remained an inpatient to complete a 6-month course of treatment for tuberculosis and then underwent surgery to resolve the obstruction. He was prescribed parenteral nutrition, which improved his nutritional status ready for restorative surgery. Post-operatively, he was weaned from parenteral nutrition onto an oral diet and was discharged.
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Simmons, Dean. "Ethical dilemmas in food choice: A dietitian’s reflexive journey." Critical Dietetics 1, no. 1 (April 24, 2011): 35–43. http://dx.doi.org/10.32920/cd.v1i1.840.
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This paper will explore, from the perspective of food systems sustainability, ethical dilemmas contained within dietitians’ healthy eating advice as framed by Canada’s Food Guide. The author’s own experience as a dietitian, who is also situated within the discourse of sustainability, is described to illustrate ethical dilemmas that arise when deciding ‘what is the right thing to do?’ regarding our food choices.
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Mujlli, Gadah, Dara Aldisi, Ghadeer S. Aljuraiban, and Mahmoud M. A. Abulmeaty. "Impact of Nutrition Care Process Documentation in Obese Children and Adolescents with Metabolic Syndrome and/or Non-Alcoholic Fatty Liver Disease." Healthcare 9, no. 2 (February 9, 2021): 188. http://dx.doi.org/10.3390/healthcare9020188.
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This study evaluated the Nutrition Care Process documentation used by dietitians for obese pediatric patients diagnosed with metabolic syndrome (MetS) and/or non-alcoholic fatty liver disease (NAFLD) and its impact on the achievement of nutritional goals. This retrospective cohort study utilized data retrieved from three tertiary care hospitals in Riyadh. A total of 142 obese pediatric patients aged 8–18 years diagnosed with NAFLD and/or MetS were evaluated. Data on weight, height, blood pressure (BP), lipid profile, and liver enzymes were collected. A validated audit was used to assess the documentation quality. Twenty-seven (46.6%) dietitian notes received a high score, 21 (36.2%) received a medium score, and 10 (17.2%) received a low score. There was no significant effect of dietitian audit scores on nutritional outcomes, however, the change in body mass index from 6 to 12 months follow-up period was inversely correlated with the audit score (r = −0.761, p = 0.007), and alkaline phosphatase was inversely correlated with the audit score (r = −0.819, p = 0.013). In conclusion, there was a clear variation in the quality of dietitians’ documentation and the impact of documentation scores on nutritional outcomes.
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Hoekx, S., J. Vanderstappen, J. Wellens, B. Verstockt, F. Marc, S. Vermeire, and J. Guedelha Sabino. "N18 Introduction of inflammatory bowel disease specialized dietitian and nutritional status in a multidisciplinary IBD team." Journal of Crohn's and Colitis 16, Supplement_1 (January 1, 2022): i624—i625. http://dx.doi.org/10.1093/ecco-jcc/jjab232.860.
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Abstract Background Qualitative inflammatory bowel disease (IBD) care is marked by a multidisciplinary approach including physicians, nurses, psychologists and dietitians. Specialist IBD dietitians can address the specific needs of patients with IBD, with an emphasis on nutritional status, disease activity, and functional symptoms. We wanted to obtain a snapshot of the IBD population referred to the dietitian at our IBD clinic. Methods Since February 2021, two specialist IBD dietitians were hired at the multidisciplinary IBD-team of our tertiary referral centre. Data from all IBD patients seen by the IBD-dietitians were prospectively collected. Patients with IBD were referred to the IBD dietitians for dietary advice concerning optimization of nutritional status, modulation of diet-induced abdominal symptoms, and IBD-related problems (e.g. high output stoma, obstruction, enteral or parenteral nutrition). Malnutrition as reason for referral was defined as an abnormal body mass index (BMI <18.5 or >25 kg/m²). Results From 1 February 2021 until 16 November 2021, 219 IBD patients (58.4% women, median age 38 years, 127 Crohn’s disease, 92 ulcerative colitis) were seen by the IBD-dietitians. Patient characteristics are described in table 1. A total of 303 contacts were registered, including 82% in-hospital consultations (16% in-patient clinic, 66% outpatient clinic) and 18% remote consultations (via telephone or email). The median BMI at first consultation was 23.49 kg/m2. In this cohort, 46.6% of IBD patients had a normal BMI, 37% were obese or overweight, and 13.2% has underweight. Males had a significantly higher BMI than females (BMI 24.5 vs 22.5 kg/m2, p-value 0.048). The main reasons for referral were IBD-related symptoms or disease activity (46.6%), malnutrition (26%), functional symptoms (16.4%), and patient’s interest in receiving more information on diet (9%). Of note, none of the patients were being treated with enteral nutrition at time of referral, and only 5 patients were being treated with parenteral nutrition. Most patients received dietary advice (92%) and only 1 patient was started with enteral nutrition. Conclusion The introduction of IBD-dietitians in our multidisciplinary IBD care program has allowed IBD-patients with or without malnutrition, to be assessed by a specialist IBD dietitian who can provide appropriate dietary advice. Of note was that despite an already expert IBD center with a multidisciplinary team in place, the prevalence of malnutrition in this selected IBD cohort was very high. Nevertheless, IBD disease activity and IBD-related symptoms were the main reason for referral to the IBD-dietitian, reflecting the need for tailored nutritional advice complementary to medical or surgical treatment.
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Williams, Lauren, Katelyn Barnes, Lauren Ball, Lynda Ross, Ishtar Sladdin, and Lana Mitchell. "How Effective Are Dietitians in Weight Management? A Systematic Review and Meta-Analysis of Randomized Controlled Trials." Healthcare 7, no. 1 (February 1, 2019): 20. http://dx.doi.org/10.3390/healthcare7010020.
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Effective, evidence-based strategies to prevent and treat obesity are urgently required. Dietitians have provided individualized weight management counselling for decades, yet evidence of the effectiveness of this intervention has never been synthesized. The aim of this study was to examine the effectiveness of individualized nutrition care for weight management provided by dietitians to adults in comparison to minimal or no intervention. Databases (Cochrane, CINAHL plus, MedLine ovid, ProQuest family health, PubMed, Scopus) were searched for terms analogous with patient, dietetics and consultation with no date restrictions. The search yielded 5796 unique articles, with 14 randomized controlled trials meeting inclusion criteria. The risk of bias for the included studies ranged from unclear to high. Six studies found a significant intervention effect for the dietitian consultation, and a further four found significant positive change for both the intervention and control groups. Data were synthesized through random effects meta-analysis from five studies (n = 1598) with weight loss as the outcome, and from four studies (n = 1224) with Body Mass Index (BMI) decrease as the outcome. Groups receiving the dietitian intervention lost an additional 1.03 kg (95% CI:−1.40; −0.66, p < 0.0001) of weight and 0.43 kg/m2 (95% CI:−0.59, −0.26; p < 0.0001) of BMI than those receiving usual care. Heterogeneity was low for both weight loss and BMI, with the pooled means varying from 1.26 to −0.93 kg and −0.4 kg/m2 for weight and BMI, respectively, with the removal of single studies. This study is the first to synthesize evidence on the effectiveness of individualized nutrition care delivered by a dietitian. Well-controlled studies that include cost-effectiveness measures are needed to strengthen the evidence base.
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Braakhuis, Andrea J., Kelly Meredith, Gregory R. Cox, William G. Hopkins, and Louise M. Burke. "Variability in Estimation of Self-reported Dietary Intake Data from Elite Athletes Resulting from Coding by Different Sports Dietitians." International Journal of Sport Nutrition and Exercise Metabolism 13, no. 2 (June 2003): 152–65. http://dx.doi.org/10.1123/ijsnem.13.2.152.
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A routine activity for a sports dietitian is to estimate energy and nutrient intake from an athlete’s self-reported food intake. Decisions made by the dietitian when coding a food record are a source of variability in the data. The aim of the present study was to determine the variability in estimation of the daily energy and key nutrient intakes of elite athletes, when experienced coders analyzed the same food record using the same database and software package. Seven-day food records from a dietary survey of athletes in the 1996 Australian Olympic team were randomly selected to provide 13 sets of records, each set representing the self-reported food intake of an endurance, team, weight restricted, and sprint/power athlete. Each set was coded by 3–5 members of Sports Dietitians Australia, making a total of 52 athletes, 53 dietitians, and 1456 athlete-days of data. We estimated within- and between- athlete and dietitian variances for each dietary nutrient using mixed modeling, and we combined the variances to express variability as a coefficient of variation (typical variation as a percent of the mean). Variability in the mean of 7-day estimates of a nutrient was 2- to 3-fold less than that of a single day. The variability contributed by the coder was less than the true athlete variability for a 1-day record but was of similar magnitude for a 7-day record. The most variable nutrients (e.g., vitamin C, vitamin A, cholesterol) had ~3-fold more variability than least variable nutrients (e.g., energy, carbohydrate, magnesium). These athlete and coder variabilities need to be taken into account in dietary assessment of athletes for counseling and research.
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da Silva, Liz, Christina Edmunds, Talise Grossman, Lynn Kelly, Cathryn Nattrass, and Delara Saran. "Are Dietitians Documenting Malnutrition Based on Subjective Global Assessment Category?" Canadian Journal of Dietetic Practice and Research 80, no. 2 (June 1, 2019): 91–94. http://dx.doi.org/10.3148/cjdpr-2018-038.
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Purpose: This study reports on dietitian use of the Nutrition Care Process Terminology (NCPT) diagnosis of malnutrition based on Subjective Global Assessment (SGA). Methods: Nutrition assessment reports for adults in medical, surgical, and cardiac units in 13 Canadian hospitals were retrospectively examined for a 6-week period in 2014. Reports with a SGA and NCPT diagnosis were included regardless of why the patient was seen by the dietitian. Results: Of the 932 nutrition assessment reports, 857 (92%) included an SGA. Based on SGA, the prevalence of mild to moderate malnutrition (SGA B) and severe malnutrition (SGA C) was 53.4% (n = 458) and 10.0% (n = 86), respectively. When categorized as severely malnourished, the most common NCPT diagnoses were “malnutrition” (n = 55, 72.4%), “inadequate oral intake” (n = 11, 14.5%), and “inadequate protein-energy intake” (n = 10,13.1%). Among those with SGA B and C, the assignment of the NCPT malnutrition diagnosis was 19.8% (n = 95). Conclusions: Dietitians play a key role in the prevention, identification, and treatment of malnutrition in the hospitalized patient and are well positioned to take a leadership role in improving its documentation. Ongoing audits, staff support, and training regarding NCPT use may improve the application of the malnutrition diagnosis. Future research examining dietitian barriers to using the malnutrition diagnosis would be valuable.
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Salam Khan, Abdus. "Processes in Ranking Nutrients of Foods in a Food Data Base." Nutrition and Health 11, no. 1 (April 1996): 59–72. http://dx.doi.org/10.1177/026010609601100105.
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Depending on the type of user, it is possible that there are many purposes for retrieval of foods from a computerised nutrient data base. A Dietitian on one occasion may need to come up with a qualified assessment of foods in the process of diet construction so that the process of balancing nutrients for the diet takes less time. On another occasion the dietitian may want to recommend a food for a client which requires knowledge of the standing of that food with respect to one or more of its contents of nutrients. A dietitian is not able to memorise all the foods and their nutrient content. Moreover if the number of foods is many then the dietitian's ability to refer foods according to their standing may become impossible. Ranking foods with respect to their nutrient contents within a reasonable number could be very useful for dietetic purposes. This paper discusses the processes of ranking of foods as high, medium and low only, and proposes guidelines which can be referred to for rejecting inappropriate ranking schemes of foods. The proposed guidelines are based on the results of experiments which are included in this paper.
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Norman, E. "P025 A review of the newly implemented Inflammatory Bowel Disease dietetic service." Journal of Crohn's and Colitis 16, Supplement_1 (January 1, 2022): i148—i149. http://dx.doi.org/10.1093/ecco-jcc/jjab232.154.
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Abstract Background Nutrition plays an important role in the onset and later the management of inflammatory bowel disease (IBD). Patients are becoming progressively interested in non-pharmacological methods of managing IBD and the dietary advice around this. It is reported that only 7% of services have enough dietitians to meet the IBD Standards recommendation. A year after the implementation of a new dietetic post at Whipps Cross Hospital, it was decided to review the effectiveness of this post for patients with a survey. Methods The inclusion criteria were patients with a diagnosis of IBD, reviewed at least twice by the IBD dietitian and patients who are under the IBD team at Whipps Cross Hospital. Patients were telephoned and asked if they consented to providing their email address for the anonymous survey link to be sent to. The survey was emailed to 40 patients. Six questions were asked on the survey, the survey provider was Survey Monkey. Results The final cohort included a 53% response rate to the survey. Age range was 18–64 years old. 95% of patients felt their consultation time was long enough. 95% of patients thought they had sufficient dietetic contact. 95% of patients felt the dietitian involved them in decision making. 67% of patients thought nutrition input improved their health/quality of life, with 29% being unsure. 100% thought having access to an IBD dietitian was useful. 71% of patients rated their dietetic care as excellent and 29% rated it as good. Conclusion The response from the majority of IBD patients was that nutrition input was helpful; with all patients finding the care provided by the dietitian was either good or excellent. All patients found it supportive to have dietetic access as part of a multidisciplinary approach to their IBD care. These findings support the best practice guidelines for having a dietitian post as part of the IBD team.
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Levonyak, Nicholas, Mary P. Hodges, Nicole Broome, Muhammad Shaalan Beg, Radhika Kainthla, Aravind Sanjeevaiah, Navid Sadeghi, et al. "A nutrition-focused quality improvement program to improve rate of documented nutrition plan at a safety-net hospital gastrointestinal (GI) oncology clinic." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 289. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.289.
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289 Background: Patients with GI cancer have amongst the highest rates of malnutrition, which contributes to decreased quality of life, increased morbidity and mortality, as well as higher healthcare costs. In the GI Oncology clinic at Parkland Health and Hospital System (PHHS), the number of patients with a documented nutritional plan by a registered dietitian was 7%, and there was no standardized screening method for malnutrition in place. Methods: The aim was to increase the rate of documented nutritional assessment by a registered dietitian to 25%. Multidisciplinary sessions involving physicians, registered dietitians, registered nurses, and hospital administration were arranged to identify barriers to nutritional interventions for GI Oncology clinic patients. Results: Prior to QI interventions, between October-December 2018, the total number of GI cancer patients referred to registered dietitian clinic was 11- 30 referrals, which accounted for 7-10.1% of GI cancer patient in the respective month. As part of first PDSA cycle, a registered-dietitian was assigned to GI oncology clinic. The total number of documented nutrition plan after first intervention was 22 GI cancer patient (15% of GI cancer patients). We then developed an adapted-version of the Malnutrition Screening Tool (MST) and implemented it through the institute electronic medical record. The nursing staff and physicians were educated about administering the screening tool and the referral process to a registered-dietitian after a positive MST screen. After the first month during which MST was implemented, the rate of nutritional assessment increased to total of 20.5% of GI cancer patients (total 37 referrals). Twenty out of the 37 referrals (54%) were due to the positive MST screening tool. Conclusions: Through a nutrition focused QI program, we doubled the rate of a documented nutritional plan for PHHS GI cancer patients in a month of starting the 2nd PDSA cycle intervention. Through future PDSA cycles, we plan to further increase patient access to nutritional assessments and then broaden our efforts to the entire PHHS oncology clinic.
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Poraj-Weder, Magdalena, Grażyna Wąsowicz, and Aneta Pasternak. "Why it is so hard to lose weight? An exploration of patients’ and dietitians’ perspectives by means of thematic analysis." Health Psychology Open 8, no. 1 (January 2021): 205510292110244. http://dx.doi.org/10.1177/20551029211024406.
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The present paper is aimed at understanding the importance of motivation (perceived qualitatively) in ensuring the success of the dietary change process. This study expands on previous research by confronting the perspective of persons dieting to lose weight with the perspective of professionals providing support (dietitians). We interviewed 13 respondents (six patients, seven dietitians) and performed a thematic analysis. The study’s results show that understanding motivational mechanisms is a prerequisite for a consistent narrative in the patient–dietitian dyad. The research results could help in developing effective dietary interventions that could facilitate effective and permanent dietary change.
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Spencer, Lisa, Marie-Claire O'Shea, Lauren Ball, Ben Desbrow, and Michael Leveritt. "Attendance, weight and waist circumference outcomes of patients with type 2 diabetes receiving Medicare-subsidised dietetic services." Australian Journal of Primary Health 20, no. 3 (2014): 291. http://dx.doi.org/10.1071/py13021.
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The aim of the present study was to investigate the participation and weight and waist circumference outcomes of patients with type 2 diabetes (T2D) receiving Medicare-subsidised dietetic services. A prospective observational study was conducted between January and September 2011 involving three private practice dietitians who provided services at 11 medical centres in south-east Queensland. All patients with T2D who were referred by their general practitioner (GP) to one of the dietitians as part of their team care arrangements were asked to participate. Participants’ attendance at consultations was recorded for the study duration. The dietitian collected weight and waist circumference measures at each consultation. In all, 129 participants (mean age 58.9 ± 15.7 years; mean body mass index 32.2 ± 5.6 kg m–2) were included in the study. The most frequent number of consultations allocated to a dietitian was two. Small, but significant reductions in bodyweight (1.9 ± 2.9 kg; P ≤ 0.05) and waist circumference (2.0 ± 4.8 cm; P ≤ 0.05) were observed from the initial to final consultation. Participants who attended more than two consultations lost significantly more weight than those who attended two consultations only (3.7 ± 4.2 vs 1.1 ± 1.6 kg, respectively; P ≤ 0.05). Almost one-third of participants (n = 38; 29%) did not complete the allocated number of consultations available through their referral. Modest weight and waist circumference reductions are achievable for patients with T2D receiving Medicare-subsidised dietetic services. The clinical significance of these reductions requires further investigation. Patients who attend more consultations with a dietitian may experience further improvements in weight and waist circumference outcomes. However, many patients do not complete the number of consultations allocated. Further research is required to explore the determinants of attendance at consultations in order to maximise potential improvements in health outcomes for patients receiving Medicare-subsidised dietetic services.
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MacLellan, Deborah, Catherine Morley, Karol Traviss, and Theresa Cividin. "Toward Evidence-based, Client-centred Nutrition Education Guidelines: Dietitian and Consumer Survey Results." Canadian Journal of Dietetic Practice and Research 72, no. 3 (September 2011): 111–16. http://dx.doi.org/10.3148/72.3.2011.111.
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Purpose: Dietitian and consumer perspectives on nutrition education needs and preferences were explored, as these relate to health status. Methods: Phases 1 and 2 of a three-phase, mixed-methods study are reported. Phase 1 was a national online survey of dietitians, which was designed to inform the development of a consumer survey (Phase 2). Consumers responded to an online survey about their demographics, medical conditions, and nutrition education needs (what they wanted to learn) and preferences (how they wanted to learn). Phase 3 involved teleconferenced discussion groups with dietitians across Canada to develop guidelines for nutrition education. Results: Dietitian respondents (n=441) perceived that consumer health status was important in predicting needs and preferences for nutrition education; emotional support was considered most important for consumers with life-altering medical conditions. Consumers (n=680) expressed interest in an array of nutrition education approaches; cooking tips, recipes, and supplement advice were the most popular. Respondents with and without medical conditions had similar nutrition education needs and preferences. Conclusions: Because of the complexity of nutrition education and consumers’ preference for a spectrum of approaches and delivery methods, evidence-based nutrition education guidelines are important to inform dietetics training for the provision of client-centred nutrition education.
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Selinger, Martina, and Shawna Berenbaum. "Dietetic Scope of Practice in Saskatchewan: Dietitian Perceptions." Canadian Journal of Dietetic Practice and Research 75, no. 4 (December 1, 2014): 167–72. http://dx.doi.org/10.3148/cjdpr-2014-013.
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Purpose: The purpose of this study was to explore the concept of scope of practice for dietetics in Saskatchewan. Methods: Using interpretative description methodology, data were collected through 4 phases. This article reports on phases II and III. In phase II, 92 Saskatchewan Registered Dietitians (RDs) participated in an online survey on scope of practice. In phase III, 8 Saskatchewan RDs participated in a 3-week online focus group. Results: Results from phases II and III indicate that participants saw numerous opportunities in defining, understanding, and working with a scope of practice. Without a scope of practice, participants were interpreting their role from a combination of documents (e.g., ethics, research) and stakeholders (e.g., employers and colleagues). Current confusion amongst employers, other health professions, and RDs themselves regarding the role of dietitians was identified. Conclusion: Most participants believed a scope of practice would provide guidance to employers, other health professions, the public, regulatory bodies, and RDs themselves about the role of a dietitian. Dietetic regulators should continue to provide clear guidelines to their members and employers on safe dietetic practice. Dietitians need to be certain they are safely practicing within provincial policies and their own professional knowledge and skill at all times.
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Ramezani Kapourchali, Fatemeh, Ali Malekshahi Moghadam, Anoush Dehnadi Moghadam, Shahrokh Yousefzadeh-Chabok, Fatemeh Toorang, Mohammad Hassan Javanbakht, and Sara Ramezani. "The Role of Dietitian in Improving Energy and Protein Intake in Traumatic Brain Injury Patients Admitted to the Neurosurgical Intensive Care Unit." Iranian Journal of Neurosurgery 5, no. 3 And 4 (July 1, 2020): 109–16. http://dx.doi.org/10.32598/irjns.5.3.3.
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Introduction:Early and sufficient nutritional support is vital to improve outcomes in patients with traumatic brain injury. This study aims to determine the effects of dietitian involvementin the nutritional and clinical outcomes inpatients with traumatic brain injuries admitted tothe neurosurgical ICU. Materials &Methods: Forty-eight male patients with traumatic brain injuries admitted to Poursina Hospital neurosurgical ICU were studied, retrospectively. Patients were divided to either receive dietitian intervention or without any nutritional recommendation(control). Demographic information, Glasgow Coma Scale and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, the timing of initial enteral feeding, the amount of energy and protein intakeon day 4, the duration of mechanical ventilation and ICU length of stay were recorded. Results:Patients under the dietitian recommendation had significantly lower timing of initial enteral nutrition compared to the other cases (P=0.02). The average energy or protein intake and the percentage of target energy or protein intake on day4 appeared to be significantly lower in the subjects in the control group than in those with nutritional intervention(P≤0.001). There was no statistically significant difference in the duration of mechanical ventilation and ICU length of staybetween different groups of patients. Conclusions:Instead of occasional consultations for exclusive cases, the daily attendance of dietitians during multidisciplinary rounds of ICU is required to assess the nutritional needs of patients.
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Kobayashi, Minatsu, Sayo Uesugi, Reiko Hikosaka, and Rieko Aikawa. "Relationship between professional experience as a practicing dietitian and lifestyle and dietary habits among graduates of a department of food science and nutrition." Nutrition & Food Science 45, no. 5 (September 14, 2015): 716–27. http://dx.doi.org/10.1108/nfs-02-2015-0013.
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Purpose – This paper aims to examine the effects of professional job experience on the lifestyle and dietary habits of participants who have studied food science and nutrition and acquired a dietitian license. The dietary habits of students of departments of food science and nutrition have been reported. However, no study has compared the dietary habits of graduates with and without actual clinical experience. Design/methodology/approach – In total, 206 participants who graduated from the department of food science and nutrition of a university located in Tokyo between 1975 and 1984 completed a questionnaire on food and nutrient intake and lifestyle habits in 2011. Findings – Total fat and SFA intake adjusted for energy intake or frequency of snack and fast food intake differed among participants with and without experience as dietitians, indicating that dietitian experience influenced the dietary habits of participants for approximately 30 years after graduation. Nutritional knowledge and skills acquired during attendance at a dietitian school are effective in maintaining favorable behavior for a long time. However, nutritional knowledge and skills were enhanced by later professional experience. Originality/value – The refining effect of clinical experience appears to contribute to the maintenance of daily dietary habits and health. Professional experience can contribute to the prevention of lifestyle-related diseases not only personally but also for other people in terms of public health nutrition or nutritional education.
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Eglseer, Doris, and Silvia Bauer. "Predictors of Dietitian Referrals in Hospitals." Nutrients 12, no. 9 (September 18, 2020): 2863. http://dx.doi.org/10.3390/nu12092863.
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Dietitian involvement has considerable benefits for hospitalized patients, resulting in better health outcomes and improved quality of life. However, dietitian referral routines are often inappropriate in hospitals. The aim of this study was to identify predictors for dietitian referrals in hospitalized patients. This study was performed on data collected in an annually conducted cross-sectional study (in the years 2017, 2018, 2019). A standardized questionnaire was used to collect data, and logistic regression and a generalized estimating equation (GEE) model were used to calculate the associations between the patient characteristics and dietitian referrals. In the final GEE model, the following predictors for dietitian referrals remained significant: diabetes diagnosis (OR 1.80), cancer diagnosis (OR 1.76), digestive disease diagnosis (OR 2.03), presence of a pressure injury (OR 1.58), risk of malnutrition based on body mass index (BMI) and weight loss (OR 1.72), risk of malnutrition based on the malnutrition universal screening tool (MUST) (2.55), and the application of any malnutrition screening at admission to hospital (2.20). Total dietitian referral rate was 16.8%. The highest rate of dietitian referrals was found in patients with a risk of malnutrition (37%). This study included a large sample of hospitalized adult patients and revealed a low dietitian referral rate among these patients. These results indicate that dietitian involvement in hospitalized patients with nutrition-related conditions urgently needs to be improved.
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Lim, Cassandra, Rebecca Brody, Joachim D. Sackey, Riva E. Touger-Decker, Winnie SS Chee, Seong-Ting Chen, and Jennifer Tomesko. "Changes in Nutrition Focused Physical Examination Knowledge and Practices of Dietitians Who Completed an In-Person Workshop With 1-Year Online Follow-Up in Malaysia." Current Developments in Nutrition 5, Supplement_2 (June 2021): 480. http://dx.doi.org/10.1093/cdn/nzab040_004.
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Abstract Objectives Nutrition-focused physical examination (NFPE) is a component of nutrition assessment performed by dietitians. There is limited research globally on NFPE practices of dietitians. This study explored changes in NFPE knowledge and practices over 1-year among clinical dietitians in Malaysia who completed a hybrid NFPE training program. Methods This was a secondary analysis of data from a pilot study. Participants attended a 2-day in-person workshop in Malaysia with quarterly online follow-up over 1-year. A 50-item multiple-choice knowledge test was completed by participants before and immediately, 6- and 12-months post-training. They completed data collection forms with self-reported performance of 43 NFPE practice tasks conducted during patient assessments before and 6- and 12-months post-training. Descriptive statistics, one-way repeated-measures ANOVA for knowledge assessment scores and Chi-square tests for changes in frequencies of NFPE performance were used for analyses; statistical significance was P ≤ 0.05. Results Of the 16 clinical dietitian participants who enrolled, 81.3% (n = 13) completed the study. Participants had a mean of 9.3 ± 6.4 years ofclinical practice; 81.3% (n = 13) had no prior NFPE training. Mean NFPE knowledge scores increased significantly from before (33.8 ± 3.9) to immediately post-training (44.0 ± 3.2; P < 0.001); this increase was sustained to 12-months post-training (43.3 ± 2.9; P < 0.001). Performance of all 43 NFPE practice tasks increased significantly from before to 12-months post-training (P < 0.001). Conclusions Clinical dietitian participants in this study increased their knowledge and practice of NFPE from before to 12-months post-training. In-person NFPE training with 1-year online follow-up is feasible for training clinical dietitians in Malaysia. Future research should explore using a control group to examine the effectiveness of a hybrid NFPE training program in this population. Funding Sources Rutgers Global Grant.
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Marchello, Nicholas, Christine Daley, Jinxiang Hu, Debra Sullivan, and Heather Gibbs. "Improving Patient Satisfaction Through Nutrition Literacy Assessment: A Pilot Study." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1329. http://dx.doi.org/10.1093/cdn/nzaa059_046.
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Abstract Objectives Nutrition literacy is the capacity to apply nutrition information to dietary choices and is associated with diet quality. Understanding patient nutrition literacy deficits may help dietitians provide a more patient-centered intervention and improve patient satisfaction with their nutrition care. This pilot study examined the effects of nutrition literacy assessments on patient satisfaction. Methods Participants (n = 89) were patients scheduled for an appointment with an outpatient dietitian. All participants completed the validated Nutrition Literacy Assessment Instrument (NLit) prior to their visit with a dietitian. Intervention-arm dietitians accessed patient NLit results to focus interventions towards individual nutrition literacy deficits. Control-arm dietitians did not access NLit results and provided traditional interventions. All participants returned one month later to retake the NLit and a modified version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, a patient-centered satisfaction survey developed by the Agency for Healthcare Research and Quality (AHRQ). Correlations were used to examine relationships between patient satisfaction and baseline NLit scores, change in NLit scores, and randomization. Bootstrapped multiple linear regression models were used to examine relationships between patient satisfaction, changes in NLit score, and sociodemographic variables. Results Mean patient satisfaction score for the cohort was 9.01 (10-point scale). Patient satisfaction was correlated with improvements in NLit score (Spearman's r = 0.265, P = 0.012). Partial correlations showed a positive relationship between changes in NLit score and patient satisfaction (r = 0.302, P = 0.006) when controlling for randomization, age, sex, education, income, and ethnicity. Regression models showed a positive association between patient satisfaction and change in NLit score (adjusted r2 = 0.087, P = 0.036). Conclusions Improved nutrition literacy may improve patient satisfaction. Nutrition literacy assessments may aid dietitians to focus nutrition interventions, individualizing nutrition education, and improve patient satisfaction. Funding Sources This work was supported by a CTSA grant from NCATS and the School of Health Professions.
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Harris, Cathy Paroschy. "Happy Dietitian Day!" Canadian Journal of Dietetic Practice and Research 71, no. 1 (March 2010): 2. http://dx.doi.org/10.3148/71.1.2010.2.
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Augustine, MaryBeth. "Nutritionist/Dietitian Analysis." Integrative Cancer Therapies 1, no. 1 (March 2002): 54–55. http://dx.doi.org/10.1177/153473540200100109.
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Marecic, Maryfrances, and Robin Bagby. "The Professional Dietitian." Nutrition Today 24, no. 2 (March 1989): 39. http://dx.doi.org/10.1097/00017285-198903000-00009.
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&NA;. "The Professional Dietitian." Nutrition Today 24, no. 2 (March 1989): 39. http://dx.doi.org/10.1097/00017285-198903000-00010.
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