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PubMed1988

The role of the clinical dietitian: I. Present professional image and recent image changes.

This study was designed to assess the image of dietitians in the hospital setting. Fifty persons in each of six health professions responded to a telephone questionnaire. The six health professions were nutrition support dietitians, general clinical dietitians, directors of nursing, hospital administrators, chief dietitians, and physicians. Respondents were selected from relatively large hospitals (greater than 200 beds) that were distributed geographically across the United States. Results indicated that nutrition support dietitians had a more positive view of how their profession was viewed by others than did general clinical dietitians. A larger proportion of nutrition support dietitians than of general clinical dietitians believed that they were viewed as working with specialized patients (14% vs. 9%), as an important part of the hospital team (20% vs. 6%), and as acting as a resource person for the medical staff (30% vs. 13%). Physicians and chief dietitians held the strongest opinions concerning the image of the nutrition support and general clinical dietitians; both held a more positive view of the nutrition support dietitian. A greater number of physicians expressed the view that nutrition support dietitians were more competent and knowledgeable than were general clinical dietitians (24% vs. 9%) and were an important part of the hospital team (36% vs. 15%). A greater percentage of chief dietitians said that nutrition support dietitians, in comparison with general clinical dietitians, were competent and knowledgeable (40% vs. 19%) and professional, well respected, expert, and more specialized (65% vs. 44%). In comparison with 5 years ago, 76% and 69% of nutrition support and general clinical dietitians, respectively, thought that they are now viewed as more professional and as having abilities that are recognized.

Attitude of Health Personnel↗
PubMed1993

Standards of practice for the nutrition support dietitian: importance and value to practitioners.

OBJECTIVE: To determine whether the American Society for Parenteral and Enteral Nutrition (ASPEN) standards of practice for nutrition support dietitians reflect current practice. DESIGN: A mailed survey questionnaire was used to determine how important nine functions of the nutrition support dietitian are to the practice of nutrition support dietetics, how important the ASPEN standards are to practitioners, the frequency of application of each standard to patients, and demographic data of the respondents. SAMPLE: The survey was sent to 1,048 randomly selected dietitian members of The American Dietetic Association's Dietitians in Nutrition Support dietetic practice group and ASPEN. The final sample included 460 dietitians, a return rate of 44%. For purposes of comparison, dietitian respondents were categorized into three groups: nutrition support dietitians (n = 286); non-nutrition support dietitians (n = 136); and supervisors of nutrition support dietitians (n = 38). STATISTICAL ANALYSES PERFORMED: Descriptive data are reported as frequency or mean +/- standard deviation. Differences in importance ratings of the standards by nutrition support dietitians, non-nutrition support dietitians, and supervisors of nutrition support dietitians were compared with one-way analysis of variance ANOVA and Scheffe post hoc tests. chi 2 Analysis was used to compare group differences in the frequency of application of each standard to patients. Probability was set at the .05 level. RESULTS: Nutrition support functions rated as very important included performing nutrition assessments, identifying high-risk patients, implementing and monitoring parenteral and enteral nutrition, supervising transitional feeding, and documentation. The standards of practice were all rated as very important by nutrition support dietitians, non-nutrition support dietitians, and supervisors, and there was no difference in perceived importance. More than half of the respondents applied each standard with 75% to 100% of their patients; however, there was a higher frequency of application by nutrition support dietitians. APPLICATIONS/CONCLUSIONS: The findings give validity to the standards of practice. Practitioners evaluate them as being important in practice and in theory. The standards of practice for nutrition support dietitians were approved for use by the House of Delegates of The American Dietetic Association in October 1992.

Analysis of Variance↗
PubMed1976

Delegation of functions by dietitians to dietetic technicians.

Questionnaires were sent to 197 randomly selected hospitals in the continental United States. Replies were used as a basis for determinign the degree to which dietitians are willing to delegate tasks to dietetic technicians. No significant difference was found between the percentage of task functions clinical dietitians were willing to delegate to clinical dietetic techncians and the number that administrative dietitians were willing to delegate to administrative dietetic technicians. Dietitians who serve in both capacities are willing to delegate a significantly higher percentage of ther clinical task functions than their administrative functions. Comparing dietitians who graduated before 1968 with those graduating in 1968 or later, no significant difference was found between the two groups of administrative dietitians; however, the clinical dietitians who graduated in 1968 or later were willing to delegate significantly more duties. No significant difference was found in the average number of task functions dietitians working in different size hospitals were willing to delegate. For task functions which 33 per cent or more of dietitians were unwilling to delegate, it appears that those who do not feel this would be ideal also feel it is impractical. Dietitians who have performed a given function do not appear more or less willing to delegate it than those who have not performed that task. Thus, while a substantial number of dietitians were willing to delegate to the dietetic technician, there was also reservation as to the type of task functions, some of which the dietitians apparently feel should remain a function of the dietitian's role. This is especially true of the administrative dietitian.

Allied Health Personnel↗
PubMed1998

Nutrition Practice Guidelines for Type 1 Diabetes Mellitus positively affect dietitian practices and patient outcomes. The Diabetes Care and Education Dietetic Practice Group.

OBJECTIVES: Assess the acceptance and ease of use of Nutrition Practice Guidelines for Type 1 Diabetes Mellitus by dietitians in a variety of settings; determine if nutrition care activities of dietitians change when practice guidelines are available; measure changes in patient control of blood glucose level, measured as glycated hemoglobin (HbA1c); compare patient satisfaction with care and perceptions about quality of life. DESIGN: Using the approach of outcomes research, volunteer dietitians were recruited and assigned randomly to a usual care group or a practice guidelines group. Patients with type 1 diabetes were enrolled by dietitians and followed up for a 3-month period. Outcome measures included dietitian care activities, changes in patient HbA1c levels, and patient satisfaction and perceptions about quality of life. SUBJECTS/SETTINGS: Dietitians from across the United States who responded to a recruitment notice participated. Their work settings included diabetes referral centers, endocrinology clinics, primary care and community health clinics, hospitals, and a worksite clinic. They recruited patients from their setting for the study. Outcome data were available from dietitians providing care to 24 patients using the new practice guidelines and dietitians providing care to 30 patients using more traditional methods. STATISTICAL ANALYSIS: chi 2 Test, t test, and analysis of covariance. RESULTS: Dietitians in the practice guidelines group spent 63% more time with patients and were more likely to do an assessment and discuss results with patients than dietitians in the usual care group. Practice guidelines dietitians paid greater attention to glycemic control goals. Levels of HbA1c improved at 3 months in 21 (88%) of practice guidelines patients compared with 16 (53%) of usual care patients. Practice guidelines patients achieved greater reductions in HbA1c level than usual care patients (-1.00 vs -0.33). This difference was statistically significant and clinically meaningful. CONCLUSIONS/APPLICATIONS: Dietitians responded positively to practice guidelines for type 1 diabetes. Use of guidelines resulted in changes in dietitian practices and produced greater improvements in patient blood glucose outcomes at 3 months compared with usual care. Practice guidelines did not significantly influence patient satisfaction with care of perceived quality of life.

Adolescent↗
PubMed1993

Interdisciplinary perceptions of the dietitian's legal responsibility for lethal dietary prescription errors for patients with end-stage renal disease.

OBJECTIVE: To determine intergroup and intragroup consensus for interdisciplinary perceptions of dietitians' legal responsibility for lethal dietary prescription errors. DESIGN: Survey research was conducted by a mail questionnaire containing four hypothetical cases in which the dietitian provides a lethal amount of dietary potassium for an anephric patient. SETTING: Of the 90 New York State end-stage renal disease facilities contacted, 64 returned one or more questionnaires. SUBJECTS/SAMPLES: Usable questionnaires were tabulated from 51 registered dietitians, 39 registered head nurses, and 43 physician-medical directors. MEASURES: Consensus was recognized when 60% or more of the responses occurred in one extreme collapsed and dichotomized category of "yes" or "no" regarding the dietitian's legal responsibility. STATISTICAL ANALYSES PERFORMED: Intergroup and intragroup consensus levels were compared by frequency, mean, standard deviation, and Scheffe test of differences. RESULTS: The triad groups met varying levels of consensus on all four scenarios, with dissenting opinions by nurses on two scenarios. The dietitians and the physician-medical directors had mirror-image perceptions that the dietitian was not legally accountable for two cases of following foreseeably lethal dietary prescriptions "as written." Eight dietitians viewed the dietitian as legally nonculpable for causing a patient's death because of the dietitian's sole incompetence or carelessness in making a serious calculation error. Nurses met the highest levels of agreement and perceived the dietitian to be legally accountable for all four cases. The nurses, in contrast to the dietitians and physician-medical directors, held opinions of dietitian legal responsibility as consistent with the standard of care expectations of prudent health care professionals defined by professional malpractice jurisprudence. APPLICATIONS/CONCLUSIONS: The data indicate that to protect both the patient and the professional, there is a notable need for greater understanding dietetics jurisprudence.

Dietetics↗
PubMed2006

Job satisfaction among renal dietitians.

OBJECTIVE: Little is known about job satisfaction among renal dietitians. We sought to determine overall job satisfaction and specific domains of job satisfaction among renal dietitians. DESIGN: Cross-sectional study. SETTING: A total of 46 outpatient hemodialysis facilities in northeast Ohio. PARTICIPANTS: A group of 40 renal dietitians. INTERVENTION: Structured questionnaire. MAIN OUTCOME MEASURE: Overall job satisfaction; specific domains of job satisfaction, workload, and suggestions for improving job satisfaction. RESULTS: Of all responding dietitians, 78% expressed overall satisfaction with their job. Dietitians were least satisfied with opportunities for advancement (13%), supervisors' handling of employees (50%), the chance to be somebody in the community (53%), praise received for doing a good job (55%), and amount of work assigned (58%). Dietitians were most satisfied with the chance to do things for others (98%). A higher patient-to-renal dietitian ratio was associated with lower overall job satisfaction and a reduced likelihood that renal dietitians would recommend their career to others. The most common suggestions for improving job satisfaction consisted of reducing paperwork (named by 28% of dietitians), spending more time with patients (23%), and increasing time for creative projects (18%). CONCLUSIONS: Although renal dietitians generally expressed overall satisfaction with their jobs, almost all were dissatisfied with opportunities for advancement, and nearly half were dissatisfied with other specific aspects of their work. We urge local and national associations of renal dietitians to collaborate with dialysis facilities, chains, and regulatory agencies to improve job satisfaction. Further research is needed to determine the impact of job satisfaction of renal dietitians on patient outcomes.

Adult↗
PubMed2003

Dietitian-general practitioner interface: a pilot study on what influences the provision of effective nutrition management.

BACKGROUND: Effective patient nutrition management can both improve people's health and reduce the cost of health care. In Australia, general practitioners (GPs) and dietitians are in a position to provide this service. However, there is a lack of information available on what influences the provision of the service. OBJECTIVE: The objective was to determine qualitative factors that influence nutrition management by GPs and dietitians. DESIGN: A convenience sample of GPs and dietitians was surveyed using a qualitative questionnaire. The questionnaire related to issues including influences on the GP's decision to initiate nutrition management, barriers to providing nutrition counseling, influences on the GP's decision to refer to a dietitian, and barriers to referral. RESULTS: Fourteen of 20 GPs and 15 of 30 dietitians responded with usable data. The primary influence on a GP's decision to initiate nutrition management (GPs' and dietitians' responses) was the presentation of a patient who required nutrition advice. Barriers to providing nutrition counseling were time and knowledge (GP response), whereas dietitians saw time and lack of patient interest as issues. The primary influence on the GP's decision to refer to a dietitian was a patient presenting with complicated nutrition requirements (GP response), whereas dietitians considered a patient seeking nutrition knowledge as the key influencer. GPs identified cost to the patient as the main barrier to referring to a dietitian, whereas dietitians saw lack of knowledge of where to refer as the key issue. CONCLUSIONS: The differing responses suggest that more research is required to understand what influences patient nutrition management by GPs and dietitians in Australia.

Australia↗
PubMed2002

Communication between family physicians and registered dietitians in the outpatient setting.

OBJECTIVE: To elicit how registered dietitians and family physicians communicate in the outpatient setting. DESIGN: A descriptive pilot study using two mailed surveys was conducted to elicit aspects of outpatient communication between registered dietitians and family physicians. A sample of nutrition correspondence from registered dietitians to family physicians was also requested. SUBJECTS: Surveys were distributed to 504 licensed dietitians and 626 family physicians. STATISTICAL ANALYSES: Descriptive statistics were used to analyze survey results. RESULTS: Responses were received from 389 registered dietitians (77% return rate) and 235 family physicians (37.5% return rate). We received 104 sample notes of correspondence with physicians from dietitians. Among dietitians, 80% reported that they always assess a patient's lifestyle and educational level before choosing an educational approach, and 69% send the nutrition treatment plan to the referring family physician. Among family physicians, 49% often or always find the communications they receive from registered dietitians to be helpful. However, 41% of family physicians reported that they rarely receive detailed nutrition assessments or recommendations about the referred patient from the dietitian, and 54% of all family physicians surveyed often think that this lack of feedback compromises patient care. APPLICATIONS/CONCLUSION: Dietitians can improve communications with family physicians by standardizing the format and focus of nutrition correspondence and assuring that the referring family physician receives the patient's nutrition care plan. These simple changes would close a very important communication loop, forge stronger partnerships between dietitians and family physicians, and potentially improve patient outcomes.

Ambulatory Care↗
PubMedDate not supplied

Evaluation and comparison of the nutrition care process for persons with diabetes among inpatient and outpatient dietitians.

The purpose of this study was to compare the problem-solving skills used by dietitians when planning care for inpatient and outpatient persons with type II diabetes. Telephone interviews were conducted with 44 inpatient dietitians and 45 outpatient dietitians. Inpatient dietitians used more information from the medical record to make clinical judgments than outpatient dietitians. Inpatient dietitians reported condensing their assessment more frequently due to time pressure than outpatient dietitians. Inpatient dietitians were more likely to identify nutrition-related problems via information from the medical record while outpatient dietitians reported using diet history information. Outpatient dietitians more frequently identified specific behavioral goals whereas inpatient dietitians recommended general goals. The increased availability of objective, detailed information necessary for a thorough nutritional assessment is an advantage of inpatient care planning. However, outpatient diabetes education may be a preferred setting because of more time available for education and better learning effectiveness.

Diabetes Mellitus, Type 2↗
PubMed1990

A survey of the role of the dietitian in preparing patients for home enteral feeding.

Teaching home enteral feeding is a complex process involving many activities not traditionally performed by dietitians. This survey was undertaken to investigate (a) tasks performed by the dietitian in preparing patients to receive home enteral feeding, (b) the effect of various demographic factors on the dietitian's role, (c) the amount of dietitian time spent preparing a patient for discharge on home enteral feeding, and (d) the types of home enteral feedings currently in use. A questionnaire was tested for reliability and validity, then mailed to 1,168 nutrition support dietitians. Results of the survey indicated that, more often than nurses or physicians, dietitians were responsible for calculating nutrient and fluid needs, selecting formula, determining the home feeding schedule, teaching the patient to prepare blenderized formulas, and teaching the patient to recognize formula intolerance. Dietitians were less often responsible than nurses for psychomotor skills such as teaching the patient to administer the formula, operate the pump, and flush the feeding tube. Dietitians seemed to have a larger role in hospitals with more than 499 beds, in teaching hospitals, and in hospitals with a nutrition support team. Dietitians reported a smaller role when they reported to a contract foodservice company and when their job duties were divided so that more time was spent in clinical dietetics than in nutrition support. However, dietitians in all demographic groups performed all tasks. The average amount of dietitian time spent preparing patients for discharge on home enteral feeding was 168 minutes (2.8 hours) per patient. More patients received gastric feedings (76%) than intestinal feedings (22%).(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1989

Attitudes, knowledge, and problem-solving approach of Michigan dietitians about aging.

Dietitians' attitudes and knowledge about aging are important because of the potential influence on quality and quantity of nutrition services provided to older adults. Four instruments were used to survey active members of The American Dietetic Association (ADA) in Michigan. The survey was mailed to 1,408 dietitians; 738 responded (52.4%). The responding dietitians were predominantly under 40, well educated, and female, which was consistent with the 1986 national census of ADA members. The results indicated that dietitians hold positive attitudes toward older adults in most areas. An exception was that a majority of the dietitians perceived older adults as resistant to treatment. Although dietitians' knowledge about aging generally was adequate, the questionnaire revealed that dietitians lacked knowledge in the areas of economic and health status; dietitians answered that older adults have a lower income and are sicker and more institutionalized than is in fact true. These are critical areas of deficiency in knowledge by dietitians, since food and nutrition issues often involve money and health. In the problem-solving section of the study, the dietitians usually focused on one specific environment or area of concern. Neither the full range of all possible environments for older adults nor the diversity of older adults' needs was usually considered. Continuing education as well as comprehensive undergraduate courses on aging would have a positive influence on Michigan dietitians' attitudes and knowledge about aging.

Adult↗
PubMed1989

Attributes and qualifications that employers seek when hiring dietitians in business and industry.

A study was conducted to assess the employment trends of dietitians in business and industry and to identify attributes and qualifications essential to succeed in this segment of the industry. Results of the delphi process were utilized in the design of a questionnaire which would identify attributes and qualifications essential for success. The questionnaire was administered to a random sample of 300 members of the Dietitians in Business and Industry Practice Group and 300 prospective and current employers of dietitians. Response rates of 45.7% (no. = 137) and 29.0% (no. = 87) were attained for the dietitians and employers, respectively. The majority of current employers (72%) and prospective employers (62%) and dietitians (73%) responded that the trend of hiring dietitians in business and industry was increasing. Both dietitians (53%) and employers (41%) reported that new positions were being created for dietitians in their organizations. Operational experience was more important for positions in sales, whereas clinical experience was more important for positions in manufacturing organizations. Employers ranked a master's degree in business administration (MBA) as the second most important qualification; dietitians rated the MBA as fifteenth in importance. Dietitians ranked registration status (RD) as, fourth in importance; however, employers rated registration status as least important of the qualifications. Both employers and dietitians ranked communication skills as essential to succeed in business and industry positions.

Commerce↗