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Process for Nutrition and Dietetic Practice

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by

Duane Mellor

on 13 June 2014

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Transcript of Process for Nutrition and Dietetic Practice

Process for Nutrition and Dietetic Practice
Adapted from the British Dietetic Association (2012) Model and process for dietetic practice. Birmingham: BDA (Recommended Reading)
Identification
of Nutritional
Need

Assessment
Identification
of nutrition and dietetic diagnosis

Plan
nutrition and dietetic intervention

Implement
nutrition and dietetic intervention

Evaluation
Monitor
and Review

Identifying Nutritional Need - Dietetic Nutritional Assessment
"Nutritional assessment is a comprehensive process of identifying and evaluating nutritional status of an individual using appropriate and measurable methods."
It consists of gathering data using four main techniques:
History taking
Nutritional intake
Anthropometry
Physical examination
Biochemical tests
Nutritional assessment is able to quantify impairment of nutritional status"
(British Dietetic Association, 1999)
Therefore the first step is the assessment - tools include:
Referral letter/ patient notes, the patient and information systems.
A
B
C
D
E
F
Dietetic assessment
Aim: To enable the dietitian to develop a clinically reasoned nutritional treatment plan
=
Anthropometry
=
Biochemistry
=
Clinical
details past and present - including drugs and diagnoses
=
Diet
history
=
Estimation of requirements
- often consider nutrient deficit or excess
=
Family
, social and psychological history - Remember communication and to assess level of understanding
Service User's Values and
Service User/ Dietitian
Relationship -
Remember Communication Counts!
What is a nutritional diagnosis?
It is NOT the same as the medical diagnosis
Can be thought as having Three Components
1. Problem
- Described alterations in patients nutritional status (think excess or deficit)
2. Aetiology
- Relation to the disease, psychosocial or situational problem. May be useful to remember biochemistry and pathology / physiology
3.
Signs
- Identified as part of the assessment process
- Evidence of the existence of a nutritional problem

Planning a nutrition and dietetic intervention
Have a dietetic aim
- Link to expected outcomes
What are you
trying to achieve
?
Improve
knowledge
?
Change a food or lifestyle
behaviour
?
Food or nutrient intake
or consumption pattern?
Improved
nutritional status
?
Clinical or health outcome
?
Patient centred outcome
?
Economic outcome
?

The plan should be linked to an aim which will acheive one or more of these

Plans should be patient centred and negotiated

Outcomes increasingly being used to commision services
Is there a difference between the intervention and plan?
The intervention is putting the plan into action
The dietitian may carry out the plan themselves, but it more likely that the plan will be carried out by others - other healthcare professionals, carers or the patients themselves
Key aspects
Negotiate
with the patient/ carers/ other healthcare professionals

Think carefully and critically
about how it will happen
Set
SMART goals


Acceptibility
and
understanding
of plan to person who has to deliver the plan

Determining the
need for follow
up,
review and monitoring
(and who needs to do it)

Why monitor and review?
To see if the
aims
were
acheived / acheivable
by the
patient
? This should include how the plan had been implemented

If necessary
moderate
the
intervention/ plan
to
improve
its
acceptibility

Depending on the intervention,
further goals
may be set to add further to the initial nutritional intervention

Measure outcomes
- justifies need for dietetic service

Monitor
patient
reported and perceived
outcomes

This is often the area of the care process missed or overlooked by students
Evaluation - continuing to build the evidence base?
Evaluation is the systematic comparison of current findings against previous status, intervention goals and outcomes or a reference standard and takes place at the end of the process. (BDA 2012)

This can include:
Feedback from patients
/ carers, both informally and through surveys

Case study reviews
- one of the reasons they are part of placements

Audits
and service evaluations

In its simplest form, did the intervention work, is it worth using the same approach again or does it need changing?
Diet Therapy - Dietetic Process
Dr Duane Mellor RD
Lecturer in Dietetics
Full transcript