Dietitians' Change in Practice: A Challenge or a Threat?

Integrating Systems Thinking in Nutrition and Dietetics Education

INTRODUCTION

Integrating systems thinking, which emphasizes recognizing interconnections, gaining diverse perspectives and considering the big picture, can enhance curricula and better prepare practitioners. Despite its benefit and growing support, systems thinking is not yet a required part of dietetics accreditation or entry-level practice. This qualitative study sought to understand educators' views on incorporating systems thinking into nutrition and dietetics education.

METHODS

Thirteen Registered Dietitian Nutritionists from various US census regions and accredited program types were recruited. Semi-structured interviews were audio-recorded and transcribed verbatim. Grounded theory methodology and iterative coding analysis were used to analyse the transcriptions in Excel.

RESULTS

Three interrelated themes emerged from educator perspectives: (1) individual characteristics (personal attributes; multi-, inter- and transdisciplinary experiences; perspective seeking; relationship building), (2) nutrition and dietetics education (training, resources, accreditation requirements, value awareness) and (3) the dietetics profession (organizational culture, education and practice integration, continuing education, professional guidance).

CONCLUSIONS

Integrating systems thinking into nutrition and dietetics education can be facilitated across three levels: individual, education and the profession through training, resources, accreditation competencies and awareness. However, implementation requires fostering a cultural shift within the profession and overcoming resistance to change.

Examining dietitians' knowledge, skills and attitudes regarding working with older adults in residential aged care facilities and home care services: An integrative review

BACKGROUND

The Australian 2021 Royal Commission identified that the dietetic workforce needs to grow in size and capacity to support nutrition care in older adults. However, little is known about dietitians' knowledge, skills and attitudes (KSA) regarding working with older adults in residential aged care facilities (RACFs) or their homes. This review describes dietitians' KSA regarding older adults in RACFs and home care services.

METHODS

A systematic literature search was conducted in August 2021 to identify studies examining any aspect of dietitians or student dietitians' KSA working in RACFs and home care services. No restrictions were applied to methodological design, language, location or publication year. Studies were assessed for quality using the Johanna Briggs Institute Quality Appraisal Tools. Study findings were analysed thematically using meta-synthesis.

RESULTS

All 17 studies that met the inclusion criteria explored dietitians' attitudes towards their role, three studies examined perceived knowledge, although no studies objectively explored dietitians' skill levels. Five themes were developed inductively: (1) recognising their contribution as dietitians; (2) lacking clarity about the boundaries of their role; (3) all team members have a role to play in nutrition care; (4) assumptions and biases about working with older people; and (5) needing to build capacity in the workforce.

DISCUSSION

Dietitians have mixed attitudes about working in RACFs and home care services. Future directions include evaluating dietitians' role in RACFs, reviewing education and training and practical opportunities for student dietitians, and assessing the impact of more dietitian support on an older person's dietary intake and nutrition.

The Informal Champion’s Role in Promoting the Care of Inter-Professional Teams

This study aimed to examine how allied healthcare professionals as informal leaders can lead reforms to improve patient care on an interprofessional team. With 284 interprofessional team members working in 59 geriatric facilities, our findings demonstrated that informal leaders exhibiting more championship behaviors gained higher innovation success scores. In addition, the champion’s professional tenure and institutional size were both negatively associated with innovation success. We discuss important implications for this understudied issue in interprofessional team research: how a low-status informal leader can direct reform aimed at improving patient care within a healthcare organization.