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Lövestam E, Orrevall Y, Boström AM. Individual and contextual factors in the Swedish Nutrition Care Process Terminology implementation. HEALTH INF MANAG J 2024; 53:94-103. [PMID: 36254749 PMCID: PMC11067422 DOI: 10.1177/18333583221133465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Standardised terminologies and classification systems play an increasingly important role in the continuous work towards high quality patient care. Currently, a standardised terminology for nutrition care, the Nutrition Care Process (NCP) Terminology (NCPT), is being implemented across the world, with terms for four steps: Nutrition Assessment (NA), Nutrition Diagnosis (ND), Nutrition Intervention (NI) and Nutrition Monitoring and Evaluation (NME). OBJECTIVE To explore associations between individual and contextual factors and implementation of a standardised NCPT among Swedish dietitians. METHOD A survey was completed by 226 dietitians, focussing on: (a) NCPT implementation level; (b) individual factors; and (c) contextual factors. Associations between these factors were explored through a two-block logistic regression analysis. RESULTS Contextual factors such as intention from management to implement the NCPT (OR (odds ratio) ND 15.0, 95% Confidence Interval (CI) 3.9-57.4, NME 3.7, 95% CI 1.1-13.0) and electronic health record (EHR) headings from the NCPT (OR NI 3.6, 95% CI 1.4-10.7, NME 3.8, 95% CI 1.1-11.5) were associated with higher implementation. A positive attitude towards the NCPT (model 1 OR ND 3.8, 95% CI 1.5-9.8, model 2 OR ND 5.0, 95% CI 1.4-17.8) was also associated with higher implementation, while other individual factors showed less association. CONCLUSION Contextual factors such as intention from management, EHR structure, and pre-defined terms and headings are key to implementation of a standardised terminology for nutrition and dietetic care. IMPLICATIONS FOR PRACTICE Clinical leadership and technological solutions should be considered key areas in future NCPT implementation strategies.
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Affiliation(s)
- Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Sweden
| | - Ylva Orrevall
- Department of Biosciences and Nutrition, Karolinska Institutet, Sweden
- Clinical Nutrition, Women’s Health and Allied Health Professionals, Karolinska University Hospital, Sweden
| | - Anne-Marie Boström
- Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, Sweden
- Research and Development Unit, Stockholms Sjukhem, Sweden
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Sweden
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2
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Aurélien C, Isabelle C, Ludivine S. Evaluation of the nutrition care process documentation in the patients' records using the Diet-NCP-Audit: experience in a medium-sized multi-site Swiss hospital. J Hum Nutr Diet 2024; 37:593-600. [PMID: 38268332 DOI: 10.1111/jhn.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/31/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The nutrition care process (NCP) is a four-step systematic approach to guide dietitians in providing high-quality nutrition care. It fosters critical thinking and enhances the consistency of dietitians' documentation. Following international recommendations, University Training Hospital of Fribourg (HFR) implemented it in 2013. This study aimed to evaluate the quality of NCP documentation in electronic patient records (EPRs) and to determine the nutrition problems dietitians most often identified while documenting their actions. METHODS The audit was performed on 92 EPRs using the Diet-NCP-Audit, which was translated into French for this study. RESULTS The documentation quality was assessed as high in 62% of the EPRs, and nutrition diagnoses were mostly documented. In half of the EPRs, nutrition assessment (step 1 of the NCP) was inconsistent with nutrition diagnosis (step 2). Dietitians often used the same nutrition problems: out of the 73 nutrition problems defined in NCP terminology, only 4 (5%) represented 58% of the 189 problems identified in the EPR audit. CONCLUSION EPRs were mostly assessed as high quality. However, the entire process requires improved consistency. The poorly documented link between the NCP steps and the restricted choices of nutrition problems dietitians identified should be addressed because they could reveal that dietitians have not fully adopted critical thinking, which the NCP stresses.
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Affiliation(s)
- Clerc Aurélien
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
- Department of Nutrition and Dietetics, University Training Hospital of Fribourg (HFR), Fribourg, Switzerland
| | - Carrard Isabelle
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
| | - Soguel Ludivine
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
- Department of Teaching, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
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3
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Al-Adili L, Nordgren L, Orrevall Y, McGreevy J, Lövestam E. Nutrition intervention goals from the perspectives of patients at risk of malnutrition: A qualitative study. J Hum Nutr Diet 2024; 37:217-226. [PMID: 37794834 DOI: 10.1111/jhn.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Nutrition counselling is characterised by a collaborative approach where the patient and the dietitian establish goals that promote health and self-management. Little is known about goal-setting in nutrition interventions of patients at risk of malnutrition. The present study aims to describe the perspectives and needs of patients at risk of malnutrition regarding goals of nutrition interventions. METHODS Semi-structured interviews were conducted with 15 patients from three primary care centres and one hospital in mid-Sweden selected through purposive sampling. Interview transcripts were analysed using reflexive thematic analysis following the six-phase guidelines of Braun and Clarke to identify patterns of shared meaning and themes in the data. RESULTS The findings highlight that the participants rarely reflected on their personal goals of the nutrition intervention. Instead, they strived to maintain strength and energy, with the nutrition counselling being seen as supportive in managing nutrition impact symptoms. They described discrepancies between their perspectives and the dietitian's regarding weight goals and the diet prescribed to gain weight. CONCLUSIONS The study findings suggest that elucidating patients' goals is key to counteracting the discrepancies between the dietitians' clinically oriented goals and patients' perspectives. Goal-setting is part of the dietitian's structured working process, whereas the patient's lifeworld is complex and unstructured. To provide person-centred nutrition care, new strategies and tools are needed to facilitate collaborative goal-setting. These approaches will bridge the gap between clinical goals and patients' individual needs, promoting better alignment and improved outcomes.
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Affiliation(s)
- Lina Al-Adili
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Lena Nordgren
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ylva Orrevall
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
- Medical Unit Clinical Nutrition, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Jenny McGreevy
- Department of Food Studies, Nutrition and Dietetics, Centre for Clinical Research Sörmland/Uppsala University, Uppsala University, Uppsala, Sweden
- Department of Dietetics, Nykoping Hospital, Nykoping, Sweden
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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Heitman K, Proaño GV, Papoutsakis C, Diaque Ballesteros P, Steiber A, Taylor CA. Learning Outcomes From a Virtual Nutrition Care Process Workshop Delivered to Nutrition and Dietetics Professionals in Mexico. TOP CLIN NUTR 2023. [DOI: 10.1097/tin.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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5
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Vinci G, Kiss CM, Orrevall Y, Lövestam E. Implementation of the Nutrition Care Process and the Nutrition Care Process Terminology among German- and French-Speaking Dietitians in Switzerland: A Secondary Analysis of the Swiss International Nutrition Care Process and Terminology Implementation Survey Data. J Acad Nutr Diet 2023:S2212-2672(23)00097-7. [PMID: 36841357 DOI: 10.1016/j.jand.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 02/03/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Successful implementation of the Nutrition Care Process (NCP) and the Nutrition Care Process Terminology (NCPT) depends on many factors, one of which is the spoken language of the users. Exploring implementation barriers and enablers in a multilingual country such as Switzerland, with a specific focus on dietitians speaking German and French, may provide valuable insights for successful implementation in other multilingual countries. OBJECTIVE The aim of this study was to compare the enablers and barriers encountered by Swiss German- and French-speaking dietitians in the implementation of NCP and NCPT in their daily work. DESIGN The multinational observational INIS study was conducted between February-April 2017 using an online survey. Swiss data from the study were analyzed in a secondary analysis in August 2021. PARTICIPANTS In Switzerland, 237 registered dietitians participated in the INIS study. In this secondary analysis, a total of 228 (German-speaking n = 144, French-speaking n = 84) questionnaires were included. Nine participants were excluded because either they had incomplete surveys or had not completed dietetics training. MAIN OUTCOME MEASUREMENTS Primary variables were barriers and enablers to the use of NCP and NCPT in their daily work. Furthermore, characteristics, familiarity with NCP and NCPT, and the extent of implementation of standardized nutrition diagnoses according to NCPT were analyzed. STATISTICAL ANALYSES PERFORMED Descriptive statistics, including summary statistics with percentages, were used. Differences between the two groups were analyzed using the Fisher exact test. RESULTS The most common barrier was lack of time; no significant differences were found between the two groups regarding implementation barriers. Some statistically significant differences were found in the frequency of mentioning enablers, such as "recommendation by the association to use NCP and NCPT" (German-speaking 89%, French-speaking 77%; P < 0.05), "requirement by the workplace" (German-speaking 75%, French-speaking 53%; P < 0.01), "allocated time to practice" (German-speaking 63%, French-speaking 43%; P < 0.05), and "electronic healthcare records" (German-speaking 81%, French-speaking 44%; P < 0.001). CONCLUSIONS Some differences in enablers were found between German- and French-speaking dietitians, although the two groups were similar for all barriers and many enablers. In multilingual countries such as Switzerland, implementation strategies may need to be adapted to the language and the dietitians' specific experiences of using NCP and NCPT to ensure optimal use throughout the country.
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Affiliation(s)
- Gioia Vinci
- Department of Clinical Nutrition, Klinik Hirslanden, Zürich, Switzerland.
| | - Caroline M Kiss
- Department of Clinical Nutrition, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
| | - Ylva Orrevall
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden; Department of Clinical Nutrition, Women's Health, and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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Zbären E, Padmanabhan S, Jent S. Monitoring/Evaluation in Nutritional Therapy for People with
Gastrointestinal Complaints: Online Survey with Dietitians. AKTUELLE ERNÄHRUNGSMEDIZIN 2022. [DOI: 10.1055/a-1895-2430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Introduction Dietary interventions are part of the therapy approach in
gastrointestinal disorders. However, guidance on what outcomes to assess (in the
form of a core outcome set) for dietitians to demonstrate the effectiveness of
their interventions is lacking. This study provides preliminary work for the
development of a core outcome set to systematically assess outcomes of nutrition
therapy in clients with gastrointestinal complaints by examining how
monitoring/evaluation are conducted by dietitians.
Methods This is a quantitative online survey for dietitians to assess the
current situation around the globe concerning monitoring and evaluation. An
online survey with 26 questions divided into six sections (rated importance,
implementation, resources/obstacles, instrument requirements,
statistical questions and experiences with the Nutrition Care Process) was
developed. The questionnaire was available in English, French and German.
Results In total 740 responses were analysed.
Monitoring/evaluation of clients with gastrointestinal symptoms was
rated by 98% to be quite important to very important. The systematic
implementation of monitoring and evaluation according to a concept/model
was rated by 57% as 'rather often' to 'very
often/always'.
Conclusion Dietitians are aware of the importance of the measurability of
dietetic interventions. The most dominant barriers are lacking time in daily
practice and lack of a suitable monitoring/evaluation instrument. A
suitable core outcome set in the field of gastrointestinal complaints is needed
to increase systematic monitoring/evaluation.
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Affiliation(s)
- Eveline Zbären
- Nutrition & Dietetics, Bern University of Applied Sciences,
Bern, Switzerland
| | | | - Sandra Jent
- Nutrition & Dietetics, Bern University of Applied Sciences,
Bern, Switzerland
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Al‐Adili L, Boström A, Orrevall Y, Lang NR, Peersen C, Persson I, Thoresen L, Lövestam E. Self‐reported documentation of goals and outcomes of nutrition care – A cross‐sectional survey study of Scandinavian dietitians. Scand J Caring Sci 2022; 37:472-485. [PMID: 36329640 DOI: 10.1111/scs.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/05/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The documentation of goals and outcomes of nutrition care in Electronic Health Records is insufficient making further exploration of this of particular interest. Identifying common features in documentation practice among Scandinavian dietitians might provide information that can support improvement in this area. AIMS To explore the associations between clinical dietitians' self-reported documentation of patients' goals and outcomes and demographic factors, self-reported implementation of the systematic framework the Nutrition Care Process 4th step (NCP) and its associated terminology, and factors associated with the workplace. METHODS Data from a cross-sectional study based on a previously tested web-based survey (INIS) disseminated in 2017 to dietitians in Scandinavia (n = 494) was used. Respondents were recruited through e-mail lists, e-newsletters and social media groups for dietitians. Associations between countries regarding the reported documentation of goals and outcomes, implementation levels of the NCP 4th step, demographic information and factors associated with the workplace were measured through Chi-square test. Associations between dependent- and independent variables were measured through logistic regression analysis. RESULTS Clinically practicing dietitians (n = 347) working in Scandinavia, Sweden (n = 249), Norway (n = 60), Denmark (n = 38), who had completed dietetic education participated. The reported documentation of goals and outcomes from nutrition intervention was highly associated with the reported implementation of NCP 4th step terminology (OR = 5.26; p = 0.009, OR = 3.56; p = 0.003), support from the workplace (OR = 4.0, p < 0.001, OR = 8.89, p < 0.001) and area of practice (OR = 2.02, p = 0.017). Years since completed dietetic training and educational level did not have any significant associations with documentation practice regarding goals and outcomes. CONCLUSION Findings highlight strong associations between the implementation of the NCP 4th step terminology and the documentation of goals and outcomes. Strategies to support dietitians in using standardized terminology and the development of tools for comprehensive documentation of evaluation of goals and outcome are required.
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Affiliation(s)
- Lina Al‐Adili
- Department of Food Studies, Nutrition and Dietetics Uppsala University Uppsala Sweden
| | - Anne‐Marie Boström
- Department of Neurobiology, Care Science and Society Division of Nursing, Karolinska Institutet Huddinge Sweden
- Theme Inflammation and Aging Karolinska University Hospital Huddinge Sweden
- Research and Development Unit Stockholms Sjukhem Stockholm Sweden
- Karolinska Institutet Huddinge Sweden
| | - Ylva Orrevall
- Department of Biosciences and Nutrition Karolinska Institute Stockholm Sweden
- Medical Unit Clinical Nutrition Women's Health and Allied Health Professionals Theme, Karolinska University Hospital Stockholm Sweden
| | - Nanna R. Lang
- Department of Nutrition and Health VIA University College Denmark
| | - Charlotte Peersen
- Department of Unit for Service and Intern Control Department of Service and Quality, Trondheim Municipality Trondheim Norway
| | - Inger Persson
- Department of Statistics Uppsala University Uppsala Sweden
| | - Lene Thoresen
- Cancer Clinic, St. Olavs Hospital Trondheim University Hospital Trondheim Norway
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics Uppsala University Uppsala Sweden
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8
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Key process features of personalized diet counselling in metabolic syndrome: secondary analysis of feasibility study in primary care. BMC Nutr 2022; 8:45. [PMID: 35534841 PMCID: PMC9081667 DOI: 10.1186/s40795-022-00540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Personalized diet counselling, as part of lifestyle change programs for cardiometabolic risk conditions (combinations of prediabetes or type 2 diabetes, hypertension, dyslipidemia and high waist circumference) has been shown to reduce progression to type 2 diabetes overall. To identify key process of care measures that could be linked to changes in diet, we undertook a secondary analysis of a Canadian pre-post study of lifestyle treatment of metabolic syndrome (MetS). Diet counselling process measures were documented and association with diet quality changes after 3 months were assessed. Results of the primary study showed 19% reversal of MetS after 1 year. Methods Registered dietitians (RDs) reported on contact time, specific food behaviour goals (FBG), behaviour change techniques (BCT; adapted from the Michie CALO-RE taxonomy) and teaching resources at each contact. Diet quality was measured by 2005 Canadian Healthy Eating Index (HEI-C) and assessed for possible associations with individual BCT and FBG. Results Food behaviour goals associated with improved HEI-C at 3 months were: poultry more than red meat, increased plant protein, increased fish, increased olive oil, increased fruits and vegetables, eating breakfast, increased milk and alternatives, healthier fats, healthier snacks and increased nuts, with an adverse association noted for more use (> 2 times/ 3 months) of the balanced meal concept (F test; p < 0.001). Of 16 BCT, goal setting accounted for 15% of all BCT recorded, yet more goal setting (> 3 times/3 months) was associated with poorer HEI-C at 3 months (F test; p = 0.007). Only self-monitoring, feedback on performance and focus on past success were associated with improved HEI-C. Conclusions These results identify key aspects of process that impact diet quality. Documentation of both FBG and BCT is highly relevant in diet counselling and a summary diet quality score is a promising target for assessing short-term counselling success. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00540-9.
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9
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Middeke J, Palmer K, Lövestam E, Vivanti A, Orrevall Y, Steiber A, Lyons-Wall P, Lo J, Devine A, Lieffers J, Papoutsakis C, Lang NR, Thoresen L, Lloyd L, O'Sullivan TA. Predictors of nutrition care process knowledge and use among dietitians internationally. J Hum Nutr Diet 2021; 35:466-478. [PMID: 34812563 DOI: 10.1111/jhn.12961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The nutrition care process (NCP) and its associated standardised terminology (NCPT, referred to collectively as NCP/T) forms a problem-solving framework fundamental to dietetic practice. Global implementation would assist in confirming outcomes from dietetic care, but implementation rates have varied between countries. We investigated which factors predict NCP/T knowledge and use among dietetic professionals in an international cohort, aiming to understand how implementation can be strengthened. METHODS The validated International NCP Implementation Survey was disseminated to dietitians in 10 countries via professional networks. Implementation, attitudes and knowledge of the NCP/T along with workplace and educational data were assessed. Independent predictive factors associated with higher NCP/T knowledge and use were identified using backward stepwise logistic regression. RESULTS Data from 6149 respondents was used for this analysis. Enablers that were independent predictors of both high knowledge and frequent use of NCP/T were peer support, recommendation from national dietetic association and workplace requirements (all p < 0.001). Country of residence and working in clinical settings (p < 0.001) were demographic characteristics that were independent predictors of high knowledge and frequent use of NCP/T. A high knowledge score was an independent predictor of frequent NCP/T use (p = 0.002). CONCLUSIONS Important modifiable enablers for NCP knowledge and use rely on organisational management. National dietetic organisations and key stakeholders such as employers are encouraged to integrate active NCP/T support in their leadership initiatives. This could take the form of policies, formalised and structured training strategies, and informatics initiatives for the integration in electronic health records.
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Affiliation(s)
- Julia Middeke
- School of Medical and Health Science, Institute for Nutrition Research, Edith Cowan University, Joondalup, WA, Australia
| | - Kayla Palmer
- School of Medical and Health Science, Institute for Nutrition Research, Edith Cowan University, Joondalup, WA, Australia
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Angela Vivanti
- Research & Development Dietitian, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Human Movement and Nutrition Studies, University of Queensland, St Lucia, Queensland, Australia
| | - Ylva Orrevall
- Department of Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden.,Department of Bioscience and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Alison Steiber
- Division of Nutrition and Dietetics, Collage of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SA, Canada
| | - Philippa Lyons-Wall
- School of Medical and Health Science, Institute for Nutrition Research, Edith Cowan University, Joondalup, WA, Australia
| | - Johnny Lo
- School of Science, Edith Cowan University, Joondalup, WA, Australia
| | - Amanda Devine
- School of Medical and Health Science, Institute for Nutrition Research, Edith Cowan University, Joondalup, WA, Australia
| | - Jessica Lieffers
- Division of Nutrition and Dietetics, Collage of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SA, Canada
| | | | - Nanna R Lang
- Department of Nutrition and Health, VIA University College, Horsens, Denmark
| | | | - Lyn Lloyd
- Auckland City Hospital, Auckland, New Zealand
| | - Therese A O'Sullivan
- School of Medical and Health Science, Institute for Nutrition Research, Edith Cowan University, Joondalup, WA, Australia
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10
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Martino J, Eisenbraun C, Hotson B, Hanning RM, Lövestam E, Lieffers JRL, On Behalf Of The International Ncp/Ncpt Implementation Study Inis Consortium. Use of the Nutrition Care Process and Terminology in Canada: A National and Regional Update. CAN J DIET PRACT RES 2021; 83:2-9. [PMID: 34286625 DOI: 10.3148/cjdpr-2021-017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: The purpose of this paper is to understand Canadian dietitians' use of the Nutrition Care Process (NCP) and terminology (NCPT) nationally and by province/territory as well as facilitators, barriers, and attitudes regarding the NCP/NCPT.Methods: Canadian dietitians were invited to complete an online survey (SurveyMonkey) on the NCP/NCPT from February to April 2017 through multiple channels. Data were analyzed using descriptive statistics and nonparametric tests.Results: Overall, there were 500 eligible respondents; the analysis focused on dietitians working in clinical care who were familiar with the NCP (n = 420). In total, 87.9% and 77.5% of respondents reported always/frequently using aspects of the NCP and NCPT in their practice, respectively. There were variations in use by province/territory (P < 0.001); use was more frequent in Alberta and Manitoba versus other provinces/territories. A main barrier to implementation was lack of time; main facilitators to implementation were peer support, management support, and required use of the NCP. The prevalence of many facilitators and barriers varied by province (P < 0.05). Attitudes regarding the NCP/NCPT were variable.Conclusions: Overall, most clinical care dietitians reported some type of use of the NCP/NCPT. There were provincial/territorial variations in use, barriers, and facilitators. These findings provide information to develop strategies to enhance use of the NCP/NCPT in Canada.
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Affiliation(s)
- Jessica Martino
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK
| | | | - Brenda Hotson
- Nutrition & Food Services, Winnipeg Regional Health Authority, Winnipeg, MB
| | - Rhona M Hanning
- School of Public Health Sciences University of Waterloo, Waterloo, ON
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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11
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Al-Adili L, Orrevall Y, McGreevy J, Nydahl M, Boström AM, Lövestam E. Discrepancy in the evaluation of explicit and implicit nutrition care outcomes for patients at risk of malnutrition: A qualitative study. J Hum Nutr Diet 2021; 35:494-503. [PMID: 34231280 DOI: 10.1111/jhn.12931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nutrition care plays a significant role in the prevention and treatment of malnutrition, although the challenge to establish the precise impact of a nutrition intervention on patient outcomes remains. Malnutrition can be associated with diverse underlying diseases and an increased risk of complications, which increases the difficulty of monitoring and evaluating the nutrition intervention. The aim is to gain an understanding of dietitians' reflections concerning nutrition care outcomes of interventions in patients at risk of malnutrition. METHODS Six semi-structured audio-recorded focus group discussions with registered dietitians from primary healthcare and hospitals (n = 29) in Sweden were held at the dietitians' place of work or at the University. Focus group transcripts were analysed thematically to reveal patterns in the data and identify themes and subthemes. RESULTS The dietitians described an approach to nutrition monitoring and evaluation of patients at risk of malnutrition that was categorised into three themes: (i) quantitative explicit outcomes, based on objective measures and described as rigorous; (ii) quantitative estimated outcomes, based on estimates and described as less rigorous and (iii) qualitative implicit outcomes, based on patients' subjective perceptions and experiences of their health and described as difficult to measure. CONCLUSIONS Findings indicate the need for new strategies to promote systematic and comprehensive nutrition monitoring and evaluation.
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Affiliation(s)
- Lina Al-Adili
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Ylva Orrevall
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden.,Medical Unit Clinical Nutrition, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Jenny McGreevy
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Region Sörmland, Eskilstuna, Sweden.,Department of Dietetics, Nykoping Hospital, Nykoping, Sweden
| | - Margaretha Nydahl
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Anne-Marie Boström
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden.,Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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12
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Gillis C, Hasil L, Kasvis P, Bibby N, Davies SJ, Prado CM, West MA, Shaw C. Nutrition Care Process Model Approach to Surgical Prehabilitation in Oncology. Front Nutr 2021; 8:644706. [PMID: 34249985 PMCID: PMC8264148 DOI: 10.3389/fnut.2021.644706] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/26/2021] [Indexed: 12/21/2022] Open
Abstract
The nutrition care process is a standardized and systematic method used by nutrition professionals to assess, diagnose, treat, and monitor patients. Using the nutrition care process model, we demonstrate how nutrition prehabilitation can be applied to the pre-surgical oncology patient.
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Affiliation(s)
- Chelsia Gillis
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Leslee Hasil
- Department of Nutrition Services, Alberta Health Services, Calgary, AB, Canada
| | - Popi Kasvis
- Department of Nutrition, McGill University Health Center, Montreal, QC, Canada
| | - Neil Bibby
- Manchester Royal Infirmary, Dietetics Department, Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Sarah J Davies
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Malcolm A West
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom.,Anaesthesia, Perioperative and Critical Care Research Group, National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospital Southampton National Health Service (NHS) Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Clare Shaw
- Department of Nutrition and Dietetics, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
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13
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Vo R, Smith M, Patton N. The role of dietitian clinical judgement in the nutrition care process within the acute care setting: a qualitative study. J Hum Nutr Diet 2020; 34:124-133. [PMID: 33009683 DOI: 10.1111/jhn.12820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/05/2020] [Accepted: 09/06/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Dietitian clinical decision making in the acute care setting likely incorporates a practitioner's clinical judgement to effectively support patient care. The term 'dietitian clinical judgement' is well used in clinical practice, yet is poorly defined and often used interchangeably with other concepts. The aim of this research was to describe the nature of dietitians' clinical judgement in the acute care setting. METHODS A qualitative design within the interpretative paradigm was used guided by principles of philosophical hermeneutics. Dietitians with at least 3 years experience were invited to participate in two 60-min in-depth semi-structured interviews which were recorded, transcribed and interpreted using hermeneutic principles. A reference group was used to increase rigour and further interpretation of the findings. RESULTS Ten dietitians participated in the interviews and five of these same participants in the reference focus group. The findings revealed clinical judgement to be a sophisticated practitioner dependent meta-reasoning process that helps the dietitian manage complexity, guide interpersonal interactions and individualise patient care. It is characterised by tacit and efficient use of various reasoning strategies reliant on the dietitian's clinical experience, used to synthesise and weigh up various types of information and knowledge with respect to delivering context-relevant care. CONCLUSIONS Dietitian clinical judgement is a necessary part of clinical decision making that extends beyond logical or critical thinking. It facilitates a person-centredness to patient care and professional relationships that are key dimensions to dietitian clinical decision making. These findings provide training and professional development insights to managers, educators and supervisors.
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Affiliation(s)
- R Vo
- Faculty of Science, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - M Smith
- Faculty of Science, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - N Patton
- Faculty of Science, Charles Sturt University, Wagga Wagga, NSW, Australia
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14
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Buchholz AC, Hendrickson M, Giroux I, Correa JA, Hanning R, Eisenbraun C, Lieffers J, Lövestam E. Simulation in Learning and Using the Nutrition Care Process/Terminology: Experiences and Perceptions of Dietitians in Canada. CAN J DIET PRACT RES 2020; 81:150-153. [PMID: 32495644 DOI: 10.3148/cjdpr-2020-010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: To investigate experiences with, and perceptions of, simulation in learning and using the Nutrition Care Process/Terminology (NCP/T) of dietitians in Canada. Methods: In February-March 2017, a convenience sample of 382 dietitians in Canada (71.8% in clinical practice) completed an online survey regarding the type(s), setting(s), and perceptions of the simulations in which they engaged in learning and using the NCP/T. Results: A majority (76.7%) of respondents had engaged in NCP/T-related simulation, most commonly case studies (85.3%) and role-play (42.0%), as part of workplace/volunteer training (51.4%) and undergraduate internship/stage/practicum (34.2%). Nearly half (49.5%) of respondents learned all 4 NCP components via simulation, with Nutrition Diagnosis being the most common individual component (57%). Over three-quarters of respondents agreed/strongly agreed that simulation helped them better understand/use the NCP/T and that NCP/T-related knowledge/skills gained through simulation are transferable to the clinical setting/dietetic practice. Conclusions: Dietitians in Canada perceive simulation to have helped them learn and use the NCP/T. Resources should be directed at further developing simulation for teaching the NCP/T in dietetics education and training. Research investigating characteristics, barriers, and facilitators of effective NCP/T-simulation, using objective (vs. perceived) learning outcome measures is needed.
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Affiliation(s)
- Andrea C Buchholz
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON
| | | | - Isabelle Giroux
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON
| | - José A Correa
- Department of Mathematics and Statistics, McGill University, Montréal, QC
| | - Rhona Hanning
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | | | - Jessica Lieffers
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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15
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Lövestam E, Vivanti A, Steiber A, Boström AM, Devine A, Haughey O, Kiss CM, Lang NR, Lieffers J, Lloyd L, O'Sullivan TA, Papoutsakis C, Peersen C, Thoresen L, Orrevall Y. Barriers and enablers in the implementation of a standardised process for nutrition care: findings from a multinational survey of dietetic professionals in 10 countries. J Hum Nutr Diet 2020; 33:252-262. [PMID: 31912581 DOI: 10.1111/jhn.12700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND To explore the barriers and enablers experienced by nutrition and dietetic professionals in the implementation of the standardised Nutrition Care Process (NCP) across 10 different countries. NCP related beliefs, motivations and values were investigated and compared. METHODS A validated online survey was disseminated to nutrition and dietetics professionals in 10 countries in the local language during 2017. Cross-sectional associations and differences between countries were explored for level of implementation, barriers/enablers and attitudes/motivation among the respondents. RESULTS Higher NCP implementation was associated with greater occurrence of enabling aspects, as well as fewer occurrences of barriers. The most common enabler was 'recommendation by the national dietetic association' (69%) and the most common barrier was 'lack of time' (39%). A longer experience of NCP use was associated with a more positive attitude towards all NCP aspects. Differences between countries were identified, regarding both the occurrence of barriers/enablers and attitudes/motivations. CONCLUSIONS Implementation efforts need to be tailored to country-specific contexts when implementing a new standard of care framework among nutrition and dietetic professionals. Additional research is needed to further assess the management and workplace strategies to support the development of nutrition and dietetics professionals in multidisciplinary healthcare organisations.
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Affiliation(s)
- E Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - A Vivanti
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
- School of Human Movement and Nutrition Studies, University of Queensland, QLD, Australia
| | - A Steiber
- Academy of Nutrition and Dietetics, Chicago, IL, USA
| | - A-M Boström
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institute, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
- Research& Development unit, Stockholms Sjukhem, Stockholm, Sweden
- Department of Nursing, Western Norway University of Applied Sciences, Haugesund, Norway
| | - A Devine
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - O Haughey
- Irish Nutrition and Dietetic Institute, Dun Laoghaire, Co., Dublin, Ireland
- Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - C M Kiss
- Clinical Nutrition, Research and Development, University Department of Geriatric Medicine FELIX PLATTER, Basel, Swiftzerland
| | - N R Lang
- Department of Nutrition and Health, VIA University College, Aarhus N, Denmark
| | - J Lieffers
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - L Lloyd
- Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand
| | - T A O'Sullivan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - C Papoutsakis
- Academy of Nutrition and Dietetics, Chicago, IL, USA
| | - C Peersen
- The municipality of Trondheim, Trondheim, Norway
| | - L Thoresen
- Cancer Clinic, Trondheim University Hospital, Trondheim, Norway
- National Advisory Unit on Disease-Related Malnutrition, Oslo University Hospital, Oslo, Norway
| | - Y Orrevall
- Function Area Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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16
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Schwartz DB, Pavic-Zabinski K, Tull K. Role of the Nutrition Support Clinician on a Hospital Bioethics Committee. Nutr Clin Pract 2019; 34:869-880. [PMID: 31464002 DOI: 10.1002/ncp.10378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Hospital bioethics committees comprise a diverse group of healthcare professionals to deal with ethical issues within the institution that arise during patient care. The nutrition support clinicians (NSCs) have an important role on a bioethics committee because of their knowledge and expertise of different nutrition routes and the benefits vs burdens and risks of these modalities, both enteral and parenteral nutrition. Ethics expertise is built on an understanding of ethical principles, when applied in clinical ethics, using critical thinking to prevent ethical dilemmas and to assist in healthcare decision making with a focus on patient-centered care. The NSCs have the opportunity to address ethics during direct patient care with their participation in the intensive care unit interprofessional rounds, family meetings, and surrogate meetings. Evident in ethical dilemmas is often the lack of advance care planning by patients and their family members concerning healthcare wishes for when the individual is unable to communicate their preferences for life-sustaining therapies, including nutrition support. NSCs, as hospital bioethics committee members, are able to support the initiative of National Healthcare Decisions Day to help educate other healthcare clinicians and the public about the importance of advance care planning with communication of healthcare wishes and completion of an advance directive. Components addressed in the article are incorporated into a comprehensive ethics case study, highlighting the role of NSCs.
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Affiliation(s)
| | | | - Katherine Tull
- Providence Saint Joseph Medical Center, Burbank, California, USA
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