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PubMed1988

The role of the clinical dietitian: II. Staffing patterns and job functions.

On the basis of responses to a telephone questionnaire, this study evaluated--from the viewpoint of nutrition support dietitians, general clinical dietitians (dietitians who are not members of a nutrition support team and who provide general clinical dietetic services), and other health professionals--the current job functions that nutrition support and general clinical dietitians perform in hospitals. Anticipated staffing needs and desired job functions were also assessed. For the nutrition support and general clinical dietitians, as viewed by themselves and other health professionals, there was considerable overlap in many job activities. However, a significantly larger proportion of directors of nursing thought that nutrition support dietitians were more involved than general clinical dietitians in the evaluation of nutritional status (42% vs. 14%) and in contributing expertise to medical team discussions (48% vs. 12%). A significantly larger proportion of physicians viewed the nutrition support dietitian as more involved than the general clinical dietitian in in-service programs for medical and nursing staffs (32% vs. 6%). A large proportion of directors of nursing (62%), hospital administrators (34%), and physicians (56%) believed that dietetic involvement in the supervision of food preparation, especially by general clinical dietitians, was much greater than did the dietetic staff. The outlook for the future suggests a greater participation by both the nutrition support and the general clinical dietitian in direct patient care functions and less involvement in food preparation and clerical tasks.

Dietetics↗
PubMed2005

Development and validation of a questionnaire to test knowledge and practices of dietitians regarding dietary supplements.

OBJECTIVE: We developed a questionnaire to evaluate dietitians' knowledge and practices about the use of dietary supplements in light of new draft regulations in South Africa that will allow dietitians to prescribe supplements for the management of nutrition-related diseases. METHODS: A cross-sectional validation study was carried out in two phases: 1) questionnaire planning and development and 2) determination of reliability (internal consistency). The study sample comprised 48 nurses, 105 dietetic interns, and 367 registered dietitians. An expert academic group comprising nine dietitians with research and teaching experience rated the academic relevance and importance of knowledge questions in an item pool of 355 questions to ensure face and content validity. Criterion validity was measured by testing the knowledge questions (KQs) on 48 nurses and 105 dietetic interns. Thereafter questions were deleted based on their difficulty, discrimination, and Cronbach's alpha values. The final questionnaire, which at this point included a test of 50 KQs, was mailed to registered dietitians (n = 1450) in South Africa to determine internal consistency of the final KQs. RESULTS: Criterion validity of the KQs was indicated by a significant difference (P = 0.000) in the mean test scores between nurses (36.9, 95% confidence interval 24.2 to 39.6) and dietetic interns (40.2, 95% confidence interval 38.8 to 41.7). Item discrimination was attained by the deletion of NQs having a minimum correlation of 0.20 with overall test score. Further, item difficulty was controlled for by removal of questions correctly answered by more than 80% (too easy) or fewer than 20% (too difficult). Internal consistency of the KQs, after completion by 367 dietitians, was 0.87 (Cronbach's alpha). The mean knowledge score of dietitians ranged from 56.5% to 62.5%, with the oldest group (> or =40 y) having the highest score (P = 0.018). Thirty-eight percent of dietitians recommended dietary supplements at least 3 times a week; 51% consumed dietary supplements themselves; and 17% sold them to clients. CONCLUSIONS: A valid and reliable questionnaire that tests knowledge and practices of dietary supplements was developed for dietitians. This tool can be used by academic institutions to evaluate the knowledge and practices of final-year students. It can also be used on a representative sample of dietitians in South Africa and possibly elsewhere within the profession.

Adult↗
PubMed1991

Image and role of the consultant dietitian in long-term care: results from a survey of three Midwestern States.

Consultant dietitians and other health care professionals in three states were surveyed to determine the image and role of consultant dietitians in long-term care. Data were derived from telephone interviews with nursing home personnel in Illinois, Indiana, and Ohio. Chi 2 Analysis was used to determine whether health professionals' perceived image and job functions of consultant dietitians were significantly different from the perceptions of consultant dietitians. Overall, respondents held positive views of consultant dietitians. More than half of the respondents said the image of consultant dietitians had improved over the past 5 years. More than half of nursing directors, dietitians, dietary managers, and medical directors responded that consultant dietitians spent adequate time in facilities to do their jobs. Results of the study indicate that consultant dietitians believe that they are viewed by other health professionals as they actually are: competent, knowledgeable, well-respected, and involved in direct patient care functions. The next challenge is for more consultant dietitians to build on this base and become proactive, developing strong franchises and more opportunities for the profession.

Attitude of Health Personnel↗
PubMed1986

Nutrition support service: role of the clinical dietitian.

A study was undertaken to determine: the qualifications necessary to function on a nutrition support team as perceived by clinical dietitians working in this capacity, the actual role of the clinical dietitian on a nutrition support team, the ideal role of the clinical dietitian on a nutrition support team, and the extent to which clinical dietitians perceive differences between the ideal role expectation and actual performance. A questionnaire was developed and sent to a random sample of 300 clinical dietitians listed as members of a nutrition support service. The respondents indicated that the clinical dietitian should have at least a B.S., R.D., and 2 years' prior work experience before assuming responsibility on a nutrition support team. The dietitians indicated that they consistently take and evaluate diet histories and assess energy and protein needs. Moreover, they viewed these tasks as appropriate. They rarely administer or interpret antigen skin tests and do not perceive this as a function of the dietitian. For all other tasks, dietitians indicated that they should perform the duty or responsibility more often. Over half reported that they did not have adequate educational preparation to assume all of the responsibilities of the clinical dietitian on a nutrition support team.

Adult↗
PubMed1993

Home health care: a new worksite for dietitians monitoring nutrition support.

Dietitians have been practicing in the home setting for many years. However, monitoring patients receiving home parenteral and enteral nutrition has been performed primarily on an outpatient basis by dietitians affiliated with hospital-based nutrition support teams. Changes in physician familiarity with these specialized therapies and expansion of the home infusion therapy industry have resulted in opportunities for dietitians to monitor nutrition support in a patient's home. This article describes the role of the home nutrition support dietitian, the work environment, and the training needed to prepare the practitioner for effective work in this field. Practical concerns of interest to the dietitian monitoring home nutrition support include equipment, resources, and communication tools. Home visits impact several benefits to dietetics practice by enriching the contact between patient and dietitian. A case study describes a dietitian's involvement in and potential cost-effectiveness of treatment of a patient whose parenteral nutrition therapy was initiated and completed without hospitalization. The home is emerging as a worksite for dietitians who monitor nutrition support. As providers of home infusion therapy continue to expand, widespread availability of dietitians' services for patients receiving parenteral and enteral support at home must be ensured.

Adult↗
PubMed1993

Expanded role of the dietitian in the Diabetes Control and Complications Trial: implications for clinical practice. The DCCT Research Group.

Initially, the dietitians' role in the Diabetes Control and Complications Trial (DCCT) was specifically defined to include evaluation of potential study volunteers, collection of dietary histories, provision of nutrition education, and participation in team management meetings. As the study progressed, recognition of the importance of adherence to diet in achieving hemoglobin A1c goals and the occurrence of undesirable weight gain in patients assigned randomly to intensive therapy provided an opportunity for dietitians to use their skills intensively and broadly. The need for dietary adherence made DCCT teams aware that dietitians needed to become more active in recruiting and selecting study volunteers and in implementing and evaluating all aspects of intensive diabetes treatment. Increased involvement in these activities allowed dietitians to develop relationships with research patients that were necessary to negotiate treatment goals and improve insights into dietary issues affecting care. Recognition of the importance of dietitians to the DCCT and the empowering nature of the annual meeting of DCCT dietitians fostered continued expansion of the dietitians' role in the clinical centers and in studywide activities such as promotion of dietary adherence, ancillary studies, and publications. Dietitians participating in clinical trials are encouraged to develop their communication and counseling skills, seek out alliances with other team members, and explore opportunities for ancillary research. Such efforts will help to perpetuate this expanded model of the dietitians' role in clinical trials.

Blood Glucose Self-Monitoring↗
PubMed2004

Linking active living and nutrition counselling: dietitians' perceptions.

Healthy eating and active living have become key concepts in health promotion, and, increasingly, the two messages are being combined. Dietitians are in an ideal position to promote physical activity as an adjunct to nutrition counselling. Focus group interviews were used to identify dietitians' perceptions and needs related to incorporating active living messages into their practices. Six focus groups, involving 42 participants (40 registered dietitians and two dietetic interns), were conducted in cities throughout Alberta. Issues explored during the interviews included the dietitian's role in promoting active living, barriers to promoting physical activity, opportunities for collaboration between dietitians and exercise professionals, and dietitians' perceived needs for integrating active living messages into their practices effectively. Findings indicate strong support for incorporating active living messages into nutrition counselling. However, lack of knowledge was identified as a barrier to dietitians' proactive role, and concerns were raised about public and professional perceptions if dietitians counselled on this issue. Participants felt that they required additional knowledge and training in physical activity in order to promote it effectively. Development and implementation of programs designed to meet these needs would help dietitians integrate active living messages into their practices.

Alberta↗
PubMed1994

A survey of management tasks completed by clinical dietitians in the practice setting.

OBJECTIVE: To investigate clinical dietitians' involvement in completing management tasks in a practice setting. DESIGN: A random sample of 1,599 self-designated clinical dietitians was selected to receive the survey. The survey instrument consisted of 54 management tasks divided into four management categories: personnel, materials, financial, and organizations. For each task, the respondent was to indicate frequency of task completion and setting that contributed the most in providing competency for task completion. STATISTICAL ANALYSIS: A 38% response rate was achieved and 526 surveys were submitted for data analysis. Responses for number of respondents completing each task, frequency of task completion, and training setting were generated for position title, number of years as a registered dietitian, number of employees supervised, and size of hospital. chi 2 Analysis was used to determine degree of association among variables. RESULTS: Every task listed on the survey was completed by at least some of the respondents. Financial management tasks had the lowest incidence of response. Clinical dietitians were found to be assuming management responsibilities to varying degrees in the practice setting; 50% or more of the respondents performed tasks in the personnel area. The position title of the dietitian influenced which tasks were completed in the practice setting but was independent of frequency of task completion. Work experience was the setting that contributed the most to attaining skills needed for task completion. CONCLUSIONS: Management is a viable component of clinical dietitians' responsibility. Knowledge of activities and requirements of the workplace is essential if dietitians are to be competitive in the professional job market. With the current drive for cost-effective, quality patient care, clinical dietitians will be expected to have competent management skills.

Dietetics↗
PubMed2005

Education by a dietitian in patients with heart failure results in improved adherence with a sodium-restricted diet: a randomized trial.

BACKGROUND: Multidisciplinary heart failure (HF) programs reduce hospital readmission and improve clinical outcomes. Although dietitians are often members of such teams, no randomized studies have demonstrated the independent benefit of dietitian-administered dietary counseling for patients with HF. The purpose of this study was to evaluate the effect of dietitian education on adherence to a sodium-restricted diet in ambulatory patients with stable HF. METHODS: Patients with HF (left ventricular ejection fraction < 35%) were randomized into a dietitian education group (n = 23) or a usual care group (n = 24), then observed for 3 months. Both groups received a 2 g/d dietary sodium prescription. The usual care group received nutrition advice by way of self-help literature, whereas the dietitian education group returned for 2 counseling sessions with a dietitian. RESULTS: Dietitian education resulted in a significant decrease in sodium intake at 3 months (2.80 +/- 0.30 to 2.14 +/- 0.23 g/d, P < .05). In contrast, there was no change in sodium intake in the usual care group (3.00 +/- 0.31 to 2.74 +/- 0.35 g/d, P = ns). CONCLUSIONS: Dietitian-administered counseling was more effective than providing literature in reducing dietary sodium intake in patients with stable HF.

Diet, Sodium-Restricted↗
PubMed2000

Role of registered dietitians in dysphagia screening.

OBJECTIVE: To examine the ability of registered dietitians to identify patients at risk for dysphagia and make appropriate diet/feeding recommendations in comparison with the speech-language pathologist, and to determine screening criteria for the registered dietitian to use for prediction of dysphagia risk. DESIGN: The dietitian and speech-language pathologist performed dysphagia screening on subjects independently through questioning and/or mealtime observation to identify signs and symptoms of dysphagia. Presence of dysphagia risk and diet/feeding recommendations were determined and results from the dietitian and speech-language pathologist were compared. SUBJECTS/SETTING: Thirty-four patients admitted during a 2-month period to a neuroscience unit at an urban teaching hospital were analyzed prospectively. STATISTICAL ANALYSES PERFORMED: kappa Statistics were used to assess agreement between the dietitian and speech-language pathologist. A kappa level of less than 0.4 indicated weak agreement, 0.4 to 0.7 indicated moderate agreement, and greater than 0.7 indicated strong agreement. Logistic regression methods were used to evaluate screening criteria as potential predictors of dysphagia risk. RESULTS: Moderate agreement (0.61) was found between the dietitian and speech-language pathologist in determination of dysphagia risk. The dietitian predicted the ability of the patient to consume an oral diet with strong agreement with the speech-language pathologist (1.0); various diet consistencies with moderate agreement (0.61); and the need for liquid restrictions with strong agreement (1.0). The most significant screening variables for prediction of dysphagia risk (P < .05) were age (P = .018), history of dysphagia (P = .042), difficulty swallowing solids (P = .0007), observed facial weakness (P < .0001), and a change in voice quality (P = .0007). Self-reported screening variables significantly related to dysphagia risk included drooling of liquids (P = .0009) and solids (P = .0080), facial weakness (P = .0006), change in voice quality (P = .0010), and prolonged eating time (P = .0157). APPLICATIONS/CONCLUSIONS: Dietitians can effectively identify patients with dysphagia. Screening for dysphagia can be implemented as part of standard nutrition assessments and may aid in decreasing dysphagia-related complications.

Age Factors↗
PubMed2000

Management of obesity: attitudes and practices of Australian dietitians.

OBJECTIVE: To document attitudes and current practices of Australian dietitians in the management of overweight and obesity, and to examine their training needs. DESIGN: Cross-sectional postal survey of a randomly selected sample of members of the Dietitians Association of Australia. SUBJECTS: 400 dietitians (66% of those surveyed). MEASURES: Questionnaire-based measures of dietitian's views of obesity, education and training in weight management, definitions and perceptions of success, professional preparedness, approaches to weight management, strategies recommended for weight management, and problems and frustrations experienced. RESULTS: Dietitians viewed themselves as potential leaders in the field of weight management, and saw this area as an important part of their role. While they considered themselves to be the best-trained professionals in this area, many felt that their training was poor and many were pessimistic about intervention outcomes. Despite this, most dietitians held views that were current, and regularly employed many of the elements of known best practice in management. However, important areas of weakness included: providing opportunities for long-term follow-up; providing a range of management interventions; promoting self-monitoring of diet and exercise; and promoting opportunities for social support. CONCLUSIONS: This study suggests that training in and advocacy for the management and prevention of overweight and obesity are priority areas for dietitians, and that formal studies to evaluate dietitians' effectiveness in management should be undertaken.

Adult↗
PubMed2005

Interprofessional education in undergraduate healthcare programmes: the reaction of student dietitians.

BACKGROUND: Interprofessional education (IPE) is a novel teaching and learning initiative where students of more than one health profession learn interactively together. However, despite its potential for improving interprofessional relationships, there is little information regarding the participation of student dietitians in IPE. The aim of this paper was to consider the reaction of student dietitians to an IPE course in order to stimulate debate between dietitians regarding the issues relating to IPE. METHODS: Student dietitians participated in an IPE course consisting of seven sessions on communication and ethics in health care together with students of medicine and nursing. Student dietitians completed an evaluation questionnaire following each session that surveyed their reaction to the session using both a Likert scale and free-text comments. RESULTS: Twenty-six student dietitians completed the IPE course. All sessions were rated positively for interest value (P < or = 0.14), learning experience (P < or = 0.036) and value for clinical practice (P < or = 0.05). The limited number of free-text comments indicated some positive experiences regarding interprofessional learning, teaching content and teaching strategy. CONCLUSIONS: This is one of very few evaluations to describe the reaction of student dietitians to IPE. Student dietitians had largely positive reactions to the IPE course. Further research is required to evaluate whether these positive reactions were a direct consequence of the inclusion of students from other health professions and whether these translate into positive effects on learning, behaviour and results. The opportunities for the dietetic profession posed by students' involvement in IPE are discussed.

Adult↗
PubMed2001

Food biotechnology: dietitians' resource needs as determined by selected Canadian key informants.

In a 1996 quantitative survey, we assessed selected Canadian dietitians' knowledge and attitudes toward biotechnology, particularly genetically altered foods. The results showed that, on average, dietitians held unfavourable attitudes and were concerned about safety and labelling issues. In the current study, qualitative methodology was used to explore dietitians' views on controversial issues and to investigate the adequacy of current biotechnology resources. Nationwide telephone interviews of 22 key informant dietitians were conducted in February and March 1999. Issues covered were food safety and quality, labelling, regulations, food production, education, and biotechnology resource needs. Findings indicated that dietitians' perspectives on biotechnology are diverse nationwide. Views about how biotechnology may affect small producers, the local economy, food choices, and food quality varied from very positive to very negative. Dietitians indicated a need for more education through discussions involving critical analysis and debate by various stakeholders. Respondents agreed that the national organization, Dietitians of Canada, has a role to play in continuing education. Most participants felt that more concise, balanced, and objective resources are needed. Further exploration of dietitians' educational needs would help in the development of appropriate educational materials and programs for nutrition professionals.

Canada↗
PubMed1990

Empathy in clinical dietitians and dietetic interns.

On the premise that empathy is important in patient care and nutrition counseling, the empathy levels of 217 clinical dietitians and 168 dietetic interns were measured using the Davis Interpersonal Reactivity Index. The Interpersonal Reactivity Index is designed to measure four aspects of empathy: empathic concern (EC), fantasy (FS), personal distress (PD), and perspective-taking (PT). Personal and professional characteristics were surveyed to determine possible influence on empathy. The instrument was mailed to 26 randomly selected internship programs. All of the dietetic interns and clinical dietitians who spend 80% of their time in patient care were requested to participate. The mean ages of the dietitians and interns were 35 and 25 years, respectively. Interns scored significantly higher on the EC (29.06, p less than .05) and FS (24.65, p less than .0005) scales than the dietitians (EC = 28.20, FS = 22.53). There was a highly significant negative correlation (r = -0.26, p less than .0001) between fantasy and age for dietitians and interns and between fantasy and experience for the dietitians (r = -0.23, p less than .0005). Dietitians and interns who had had graduate coursework in counselling, psychology, and/or educational psychology had significantly lower mean scores on the PD (17.14, p less than .05) and EC (27.82, p less than .05) scales and a significantly higher mean score on the PT (27.06, p less than .05) scale. Responses to an opinion question indicated that the mean for ideal percentage of time spent in direct patient contact was 70.1 for dietitians and 61.4 for interns, a highly significant difference (p less than .0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

Role ambiguity, role conflict, and job satisfaction of dietitians.

The purpose of this research was to study the relationship between role ambiguity and conflict and job satisfaction as perceived by dietitians in the United States. Role ambiguity scores for all dietitians were consistently low. Generalist dietitians, however, scored significantly higher in role ambiguity than dietitians who were heads of departments and dietitians who were in the other/private practice group. Role conflict scores were considerably higher for all dietitian groups than scores for role ambiguity. Yet, for most groups, role conflict scores were only slightly higher than mid-point. Generalist dietitians scored significantly higher in role conflict than did six other groups of dietitians. There were no significant correlations between role ambiguity or conflict and job satisfaction.

Conflict, Psychological↗
PubMed1994

Multiple factors affect dietitians' counseling practices for high blood cholesterol.

OBJECTIVE: To examine the association of factors from social cognitive theory with dietitians' counseling practices for high blood cholesterol. DESIGN: A cross-sectional mail survey of 1,500 dietitians that included a 67-item, specially designed questionnaire to collect data. SUBJECTS: The sample comprised clinical dietitians and dietitians in consulting and private practice who were members of The American Dietetic Association and were practicing in Pennsylvania; Delaware; Washington, DC; Maryland; North Carolina; and Virginia (N = 1,500). Questionnaires were returned by 1,011 (67%) respondents; the 508 respondents (50%) who counseled adults for high blood cholesterol completed the entire questionnaire. STATISTICAL ANALYSES PERFORMED: Statistical analyses proceeded in three steps: descriptive statistics on questionnaire items, calculation of composite index scores, and bivariate and multivariate analyses. RESULTS: Of the key hypothesized factors, greater self-efficacy, higher levels of outcome efficacy, and greater adherence expectations significantly correlated with compliance-enhancing counseling practices. Outpatient dietitians used more compliance-enhancing counseling practices than did inpatient dietitians. Stepwise multiple regression analysis showed that the outpatient setting, a greater number of counseling sessions, follow-up counseling, and a charge to patients for counseling positively correlated with compliance-enhancing counseling practices. APPLICATIONS: Recommendations suggested by the findings include structuring professional training and continuing education programs for dietitians to strengthen self-efficacy, providing more feedback to improve perceived outcome efficacy, and changing the organization of the delivery of nutrition counseling services for prevention to allow more outpatient counseling.

Adult↗
PubMed2000

Provision of nutrition counseling, referrals to registered dietitians, and sources of nutrition information among practicing chiropractors in the United States.

OBJECTIVE: To investigate US chiropractors' provision of nutrition counseling and referrals to registered dietitians and sources of nutrition information. Chiropractors' perceptions of the minimum educational requirement for registered dietitians and nutrition training received in chiropractic school were also examined. DESIGN: A descriptive study was conducted by use of a nationwide, mailed survey. SUBJECTS/SETTING: Surveys were sent to 1,590 practicing chiropractors in the United States, selected randomly from The National Directory of Chiropractic. Of the 410 responses received, 375 were usable (response rate = 23.6%). STATISTICAL ANALYSIS: Descriptive statistics were used to summarize data along with the Pearson chi 2 test and Kendall tc rank correlation to determine associations for categorical questions. RESULT: Nearly 90% of respondents provided nutrition counseling to their patients, even though the majority believed that they were inadequately trained in nutrition. One-on-one dietary instruction was the most common method of providing nutrition counseling, and supplement use was the most common health-related situation/condition for which nutrition counseling was used. Most respondents did not correctly select the minimum educational requirement for registered dietitians, did not refer patients to registered dietitians, and did not use registered dietitians as a source of nutrition information. Nevertheless, 65% of respondents anticipated increased collaborations between registered dietitians and chiropractors. APPLICATIONS/CONCLUSIONS: Chiropractors provide nutrition counseling to a large number of patients each year; thus, they have the potential to substantially affect patients' nutritional status. There is a clear need and opportunity for registered dietitians to collaborate with chiropractors.

Adult↗
PubMed2002

Nutrition support at the end of life: opinions of Louisiana dietitians.

The purpose of this study was to determine the opinions of registered dietitians in Louisiana concerning nutrition support at the end of life. A questionnaire was mailed to the 777 active members of the Louisiana Dietetic Association. Questions addressed 3 issues: removal of nutrition support, the role of patients and family in decision making, and the role of the dietitian in decisions to use nutrition support for the terminally ill. A mean composite score was determined for each category. Kruskal-Wallis 1-way ANOVA was conducted on the composite scores to determine differences in responses by age, years of practice, and area of current practice. At least 60% of the respondents agreed with foregoing, withholding, or withdrawing nutrition support at the end of life. Most of the dietitians agreed that the patient or family is more qualified than the health care professional to make decisions about nutrition support at the end of life. More than 95% of the dietitians agreed that the dietitian should be involved in the decision-making process. However, only 50% of the dietitians felt fully qualified to provide the information needed to help a patient or family make the decision about nutrition support at the end of life. Differences of opinions about the removal of nutrition support were found by age, number of years of practice, and current area of practice. Results from this study may encourage dietitians to explore their own attitudes and seek continuing education on ethical dilemmas to enable them to make better decisions, provide better care, and become better patient advocates.

Adult↗