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PubMed2005

Imagination nourishes dietetic practice. 2005 Ryley-Jeffs Memorial Lecture.

Albert Einstein once stated that imagination is more important than knowledge. How important is imagination to the dietetic profession? What have been the imaginations of dietitians over the years? Where would we be today without these imaginations? Can imagination be fostered and developed? What future imaginations will shape the dietetic profession? This article explores the phenomenon of imagination and why it is important to dietetic practice.

Canada↗
PubMedDate not supplied

[Training in dietetics and nutrition from the point of view of the primary care physician].

BACKGROUND AND GOALS: Professionals in primary health care have to face a large number of patients with pathologies arising out of nutritional and dietary disorders as well as cope with society's growing interest in such issues. For this reason, we have attempted to assess the extent of the knowledge in questions of nutrition and dietetics that primary health care doctors feel they have received in comparison with what they might have considered necessary, as well as assess the capacity that these doctors feel they have to cope with clinical situations requiring a knowledge of nutrition. SCOPE AND SUBJECTS: 250 doctors working in Primary Health Care and belonging to the Tarragona Province Medical Association. ACTION: Participants received a self-administered questionnaire in which they had to: a) answer closed questions on their sense of clinical ability to handle dietary and nutritional problems; b) give a score for the importance that 62 previously-defined subjects should have in their general medical training; and c) give a score for the attention paid to these topics during their undergraduate training. RESULTS: 36 doctors (age: 38.6 +/- 10 years) with an average accumulated experience in medicine of 12.5 +/- 9.2 years replied to the survey. Respondents reported that 42.5 +/- 25% of their patients required nutritional or dietary action and only 28 +/- 24% receive the same. As for their undergraduate training in nutrition, 19.4% of them considered it to be non-existent and 58.4% described it as insufficient. Respondents reported little ability to handle different clinical situations, particularly involving the identification of patients requiring secondary vitamin therapy or nutritional support and the prescription of low lactose diets. Except for the area of biochemistry and nutritional physiology, respondents reported a great discrepancy between the attention that should have been given during their undergraduate years to the subjects proposed and the training they really received, particularly in questions of clinical dietetics, diet and the prevention of disease as well as nutritional support in disease. CONCLUSIONS: The undergraduate training in questions of dietetics and nutrition is clearly seen to be scant according to primary health care physicians. This might explain in part the insufficient clinical capacity that these professionals feel they have in such matters and the high percentage of patients who do not receive the nutritional and dietary attention these doctors feel is necessary.

Clinical Competence↗
PubMed1975

Functions of dietetic personnel in ambulatory care.

By observation in ten ambulatory care settings and a literature review, the author found that dietetic service is being delivered by a variety of personnel--trained lay aides, nurses, and physicians, as well as professional dietitians. Employers in such settings agree that nutrition is an important component of total health care but question whether it must necessarily be delivered by dietetic personnel. The dietitian, to survive, must justify on a cost-benefit basis the unique value of her competency to the outcome of patient care. Sixty-eight nutritional care functions, appropriate for dietitians and/or dietetic technicians working in ambulatory care organizations, are identified and listed. In contrast to hospital-based, in-patient care, the author concludes that performance of these functions requires greater interest in helping others and greater flexibility, and she sees such service as the wave of the future.

Allied Health Personnel↗
PubMed2003

[Longlived examples. Function and formal principles of historical exempla of old age in the early-modern dietetic literature].

Since antiquity, the exemplum can be proven in numerous types of texts, as it fulfills a notable didactic and rhetorical function: On the one hand it serves to a deductive illustration of common doctrines; on the other it is until the Enlightenment the scientific basis of cognition: in the view of medieval artistotelists, of who FRANCIS BACON was (in a special sense) one of the last champions, the exemplum takes on an inductive function: the sensual perception of the exampla generates the understanding of the universal, as the exemplum always refers to the exemplar, to the original form. Regarding the eminent deductive/inductive significance of the exempla, it is not surprising that they are an essential factor in dietetic literature. Whereas such exemples were very rare in the general literature on health care written by physicians and in specific papers of old-age assistance, they formed an integral part of texts composed for a large public by medical laymen such as (Ps.-) ROGER BACON, MARSILIO FICINO, ALVISE CORNARO or FRANCIS BACON. In these studies, the issue of a natural limit of human life was discussed intensively. In this context the "historical" sources were of high importance, even if, from a todays point of view, their use was completely non-historical. Often their crude instrumentalization and new interpretations can only be understood in the scholarly context of the time: E.g. in debates of specialists with outsiders or when serving as argument for physiological theories and therapeutical regimes. Not until late Renaissance, the historical exemple was replaced by the individual experience. It is striking that most of all historical exemples found in dietetic papers were positive. This humanistic and Christian ideal concept of old age, which completely contradicts the medical reality, had obviously a stronger fascination on the authors of early modern times than the inductive function of negative exempla (which are very important for a rational reasoning). Besides the scientific exemple, it is the idealizing one which, in the dietetic texts, gradually assumes the moral function of not discouraging the often aged readers, but of encouraging them to a constructive way of living.

Dietetics↗
PubMed1990

Nutrition education and counseling: knowledge and skill levels expected by dietetic internship directors.

Development of nutrition education and counseling skills is important in the educational preparation of dietitians. A national survey of dietetic internship directors was conducted to determine competency levels expected of students at the start of an internship, internship training given, and further preparation students need in 32 knowledge/skills areas deemed essential for delivery of nutrition education and counseling services. Completed questionnaires were received from 66 of 102 (65%) internship directors surveyed. The majority of directors expected only basic preparation for group nutrition education and individual counseling knowledge/skills areas. Internship training in nutrition education competencies was "moderate" to "extensive," whereas preparation in nutrition counseling competencies was more likely to be "extensive." Directors perceived the internship to provide adequate preparation in all but the advanced practice skills, such as behavior modification and motivational strategies, for which further preparation was recommended. The majority of internship directors reported that more than 25% of the intern practice experience was in patient counseling, with less experience in group instruction. Implications for undergraduate dietetic education are discussed in relation to internship directors' expectations as well as to present and future trends in the dietetic profession.

Counseling↗
PubMed1989

Use of a consultant to assist a dietetic association in its media and public relations efforts.

During 1987, the Philadelphia Dietetic Association (PDA) enlisted the aid of a public relations consultant to increase media contacts and thereby accomplish a threefold goal of (a) establishing the dietetic association and its registered dietitian members as the local nutrition experts; (b) distributing reliable, current nutrition information; and (c) marketing the PDA's DIAL-A-DIETITIAN service. Through the advice of the consultant, a media tipsheet, published monthly, was created. This publication, the Nutrition Informationist, effectively increased media contacts from two in 1986 to 19 in 1987 and resulted in a total of 8 hours of air time. Weight reduction, fad diets, and sports nutrition proved to be the most popular topics. Public service announcements (PSAs) concerning the DIAL-A-DIETITIAN program were developed by the consultant to assist the public in gaining access to local registered dietitians. Calls to that service increased 75% (from an average of 47.5 to 83.0 calls) the month following the distribution of PSAs to radio stations. The positive outcome of this collaborative effort shows that public relations consultants can be a useful resource for local dietetic associations, aiding them in their efforts to reach the media and the public and to improve their image.

Consultants↗
PubMed1986

A new strategy for cost-effective care: clinical dietetic staffing by diagnosis.

Conventional methods for measuring and justifying appropriate clinical dietetic staffing are enhanced by linking actual patient needs for nutrition care to clinical dietetic staffing levels. Nutrition care is categorized into basic and in-depth activities. Basic care is correlated to active diet orders and in-depth care to patient diagnoses. Data collection, including time studies, is necessary to extrapolate individual patient requirements for basic and in-depth nutrition care to total requirements characteristic of a given clinical setting. Applying a mathematical formula to data collected, final calculation of total labor requirements is achieved. This correlation of staffing to patient requirements for nutrition care has been responded to favorably by hospital administration. Further challenges lie in dietetic protocol development, which should contribute to consistently high-quality, cost-effective nutrition care.

Cost-Benefit Analysis↗
PubMed1988

Research activities and interests of dietetic educators.

Dietetic educators need to conduct research for academic promotion and tenure, and they are often called upon to provide leadership for research in the profession. A study was conducted to develop a profile of the research productivity, skill needs, and research environment of dietetic educators. Questionnaires were sent to 854 full-time faculty members in coordinated, didactic (Plan IV), technician, and graduate programs in dietetics; responses were received from 354 (41%). More than one-fourth of respondents (26.2%) reported spending no time in research, while 29.2% spent 9 or more hours per week in that activity. Those with doctoral degrees, at the rank of professor, working in major research institutions spent significantly more time in research than did other faculty members. In the previous 5 years, 67.3% had written proposals and served as principal investigator for at least one study, and 58% had received research funding. Half had written research papers, and 65% had written other publications. Only 60.2% had presented research papers, but 74.8% had given other types of presentations. Nearly 75% of educators indicated interest in collaborative studies; more than half reported a need for skills in getting funded, generating statistics, and writing research protocols. Most educators had a personal interest in research, had access to computers, and agreed that research was both rewarded and essential for academic advancement. Only 15.2% agreed that research was financially or administratively supported, and 22.8% said that they were confused about the relative importance of research in relation to teaching and service. These findings provide baseline data for setting goals and making recommendations for further research involvement.

Allied Health Personnel↗
PubMed1987

Health promotion and disease prevention beliefs and behaviors of dietetic practitioners.

Fifty-three percent of a random sample of 500 members of the Texas Dietetic Association responded to a survey designed to determine their personal health behavior, beliefs, and patient counseling practices related to health promotion and disease prevention. This article reports the responses of the 180 practitioners involved in direct patient care in order to depict the health promotion/disease prevention beliefs and behaviors of that particular group. Health habits (e.g., smoking, physical activity, and dietary patterns) of dietetic practitioners were better than those of the general female population. Personal health habits related to not smoking and to getting regular exercise were significantly associated with belief in the importance of that behavior for others. Although most of the dietetic practitioners indicated that the identified health behaviors were important to the health of the average person, only a few practitioners gave them routine attention in their practice. Respondents generally expressed a lack of confidence in their ability to educate clients about specified health behaviors, with the exception of weight control, high-fat diets, elevated blood pressure, and exercise patterns. The practitioners' confidence in their counseling skills was significantly correlated with intensity of counseling (p less than or equal to .001) and the likelihood of client compliance, except in the area of weight control. The majority of the dietitians strongly agreed that health promotion will be more important in the future.

Attitude of Health Personnel↗
PubMed1986

Computerized clinical dietetics management system.

A computerized Clinical Dietetics Management System (CDMS) was designed to support and facilitate accurate and timely delivery of clinical dietetics services. The CDMS is an integral part of a comprehensive hospital computer system that interfaces with 17 data bases. Thirty-one functions provide order processing, inquiry, calculations, message sending, charge capture, data base maintenance, and management reporting capabilities. System features include immediate and continuous access to the most current patient information, automatic routing of messages, a complete diet-order history for each patient and minimal printed output. Since implementation of the CDMS, users report benefits such as smoothing of workload peaks, fewer interruptions, fewer wasted trays, better and faster problem solving, and increased visibility in clinical dietetics services. The dynamic nature of the system allows additional applications to be added as they are developed.

Computers↗
PubMed1983

Enhancing managerial effectiveness in dietetics.

Environmental pressures from such sources as economic conditions, the government, third-party payers, and inter-institutional competition create managerial challenges. Although cost-containment has received considerable attention, long-term cost-effectiveness is probably the significant issue. Dietitians must become more cost-conscious and effective in resource management to attain desired performance outcomes. Some of the skills and characteristics essential to managerial effectiveness are a marketing orientation, systems design skill, quantitative operations management techniques, financial expertise, and leadership. These abilities facilitate decision-making and achievement of long-term cost-effectiveness. Curriculum enhancement and continuing education are two strategies for improving managerial competency in the dietetics profession. In dietetics education, study of management topics should be enhanced to provide more advanced coverage of management theories and quantitative models so that managerial performance can be at a higher level of sophistication and competency. To assure the viability of the dietetics profession, the emphasis on management must be more comprehensive and rigorous.

Cost-Benefit Analysis↗
PubMed1984

The development of clinical psychiatric dietetic technicians.

Employing dietetic technicians to complement and enhance the roles and responsibilities of clinical dietitians is not a new practice. But tailoring the training of the dietetic technician to meet the needs of a specific psychiatric institution is unique. The successful clinical psychiatric dietetic technician training program also assisted the hospital in extending the nutrition care services offered to the patients.

Dietetics↗
PubMed1984

Biochemistry for dietetic students: course content and format.

This article presents the results of a survey of the 251 undergraduate dietetic programs for course content and level of the biochemistry course most frequently used to satisfy competencies in biochemistry under Plan IV of the ADA in 1979-80. It showed that a common core of information was stressed by all biochemistry instructors, but there was great variability in content and level of material covered and the textbook chosen, depending on whether the biochemistry course was offered to dietetic majors only, in classes with other nonchemistry majors, or in classes with chemistry majors. Variability was also seen in the time allotted for biochemistry--39 to 280 hours (total lecture and required laboratory hours); laboratory requirements--only 71%; and departmental affiliation of the instructor--17 different departments, primarily of chemistry (80%), biology (8%), and home economics (4%). Topics given greatest emphasis were descriptive ones, such as definitions, simple structures, and reactions of intermediary metabolism in general terms. Topics given least emphasis were those involving mechanistic and quantitative biochemistry, such as respiratory quotient (RQ), enzyme kinetics, calculations of energy from fat and carbohydrates, and specific structures of vitamins, ketones, and metabolic intermediates. The lack of communication between biochemistry and nutrition instructors and the great differences in the preparation of dietetic majors in biochemistry are sources of concern.

Biochemistry↗
PubMed1982

Student selection in dietetic internship programs.

Recent events mandate that internship faculties review their selection criteria and processes carefully. These events include legal decisions and the implementation of federal regulations, as well as the dietetic traineeship "phase-out" and ADA's decision to rescind application restrictions. This study profiles the 1978 selection criteria and processes used by 47 of the 68 accredited dietetic internship programs. The most common criteria included (in decreasing order of importance): academic records, letters of recommendation, applicant essays, and demographic/biographic data. Standardized tests and applicant interviews were used infrequently. The reliability and validity of certain selection criteria, e.g., letters of recommendation, are questioned. Recommendation for increasing the predictive quality of the letters and other selection tools are included. Criteria of questionable legality should be reviewed and clarified or eliminated from selection processes. Finally, internship directors are encouraged to evaluate their selection processes to assure objectivity and sensitivity. The authors found that the selection criteria used by internship programs corresponded to those used by most academic and allied health professions to predict success in the programs. Although intended for internship faculties, the recommendations may be useful to coordinated undergraduate dietetics programs as they define their selection criteria.

Dietetics↗
PubMed1982

Teaching effectiveness in coordinated undergraduate program in dietetics. Assessments of students, graduates, and program directors.

The effect of practitioner experience on teaching effectiveness of faculty in coordinated undergraduate programs in dietetics (CUPs) was studied on the basis of ratings from program directors, students, and program graduates. Instruments to measure teaching effectiveness were developed that contained 36 items common to all teaching situations and 6 each related to teaching in clinical/community dietetics and to food service management. Four dimensions of effective teaching were identified using factor analysis: interpersonal skill, dietetic expertise, organizational focus, and clinical or practical orientation. Extensive practitioner experience did not contribute to teaching effectiveness.

Clinical Competence↗
PubMed1981

Interviewing and counseling functions of the dietetic technician in nutritional care. Evaluation of identified competencies.

The study was designed to identify and to evaluate the interviewing and diet counseling functions of the dietetic technician. Detailed comparisons and analyses were made of data collected from dietetic practitioners and educators and of data from the literature, curriculums, and job descriptions. Competencies were identified for further study. The videotaped performances of dietetic technician students were compared to defined criteria. The interviewing and patient education skills were satisfactory. A majority of the students lacked the counseling skills required for a client-centered approach. Curriculum inferences are presented.

Allied Health Personnel↗
PubMed2003

Position of the American Dietetic Association: Addressing world hunger, malnutrition, and food insecurity.

It is the position of the American Dietetic Association (ADA) that access to adequate amounts of safe, nutritious, and culturally appropriate food at all times is a fundamental human right. Hunger continues to be a worldwide problem of staggering proportions. The Association supports programs and encourages practices that combat hunger and malnutrition, produce food security, promote self-sufficiency, and are environmentally and economically sustainable. The Association is aware that hunger exists in a world of plenty and that poverty, gender inequity, ethnocentrism, racism, and the lack of political will are key constraints to solving the problems of global hunger and malnutrition. Recognizing that simplistic approaches are inadequate, the ADA identifies sustainable development as the long-term strategy to ending world hunger and achieving food security. Sustainable development requires political, economic, and social changes that include empowering the disenfranchised, widening access to assets and other resources, narrowing the gap between rich and poor, and adjusting consumption patterns so as to foster good stewardship of nature. Additionally, because the health status of future generations is related to the well-being of their mothers, achieving food security will also require increased access for women to education, adequate health care and sanitation, and economic opportunities. This position paper reviews the complex issues of global food insecurity and discusses long-term solutions for achieving world food security. Achieving the end of world hunger has been and is now within our grasp. There is sufficient food to feed everyone, and solutions can be realized now that will benefit all of humanity. As noted in the paper, most people who examine the costs of ending versus not ending world hunger are bewildered by the question of why humanity did not solve the problem a long time ago. The Association supports programs and encourages practices that combat hunger and malnutrition, produce food security, promote self-sufficiency, respect local cultures, and are environmentally and economically sustainable. The ADA recognizes that decisions and actions that dietetics professionals make as practitioners and consumers can help reduce the extent of poverty and hunger both here and abroad. This paper provides information, resources, and strategies to assist dietetics professionals in improving the public's understanding of key issues, becoming advocates of the poor, and influencing the political will to end world hunger.

Agriculture↗
PubMed1995

Positive association between dietetics recommendations and achievement of enteral nutrition outcomes of care.

OBJECTIVE: To identify planned dietetics outcomes of care, dietitians activities performed an recommendations made, and outcome achievement and its relationship to recommendations followed. DESIGN: A multisite, single-group prospective pilot study was conducted to describe the care provided by dietitians to patients receiving enteral nutrition care. SUBJECTS/SETTING: Participants were 172 patients (16 of whom died during hospitalization) receiving at least 75% of nutrient requirements from enteral nutrition products. Subjects were from six acute-care facilities and one rehabilitation facility in the Chicago metropolitan area. MAIN OUTCOME MEASURES: Dietitians identified planned outcomes of care to be accomplished and documented activities performed during the provision of care. Data were collected to measure outcome achievement and to determine whether dietitians' recommendations were followed. STATISTICAL ANALYSES PERFORMED: Descriptive data are reported as frequencies or means +/- standard error. Odds ratios were constructed to estimate the association between dietitians' enteral care recommendations and the achievement of planned outcomes of care. RESULTS: Whether or not enteral nutrition outcomes of care were achieved was positively associated with dietitians' recommendations. The odds of patients' achieving the recommended energy intake goal (P < .001) or increasing (P < .01) or maintaining (P < .04) visceral protein stores were at least four times greater when dietitians' recommendations were followed than when they were not. In addition, dietetics activities performed at the local level were similar to established practices. APPLICATIONS: Dietitians can identify and measure outcomes of dietetics-related care that demonstrate positive contributions to the interdisciplinary enteral nutrition care process.

Dietary Services↗