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At least 109 records · Page 6Linked to original sources
PubMed2005

Evidence-based practice: what are dietitians' perceptions, attitudes, and knowledge?

OBJECTIVE: The objective of this study was to measure dietitians' perceptions, attitudes, and knowledge of evidence-based practice (PAK score), and to determine whether antecedent factors (eg, sociodemographic characteristics, education and training, professional experiences, and employment setting) predicted PAK score. DESIGN: This cross-sectional, descriptive study used the Dietitian Research Involvement Survey following the Tailored Design Method. SUBJECTS/SETTING: This study surveyed 500 randomly selected registered dietitians from seven dietetic practice groups of the American Dietetic Association. STATISTICAL ANALYSES PERFORMED: Bivariate relationships were examined between antecedent factors and PAK score. Multiple linear regression analyses were conducted to test whether these factors predicted PAK score. RESULTS: Higher PAK scores were associated with registered dietitians who completed more years of education (r=0.28, P<.0005), had taken a research course (r=0.28, P<.0005), frequently read research articles (r=0.41, P<.0005), earned an advanced-level board certification (r=0.18, P=.004), worked full-time (r=0.26, P<.0005), or belonged to professional organizations (r=0.18, P=.003). The strongest predictors for PAK score were "last time read research" (beta=.33, P<.0005), work status (beta=.20, P<.0005), level of education (beta=.19, P=.001), and association memberships (beta=.14, P=.01). CONCLUSIONS: Results indicated that dietitians' ability to incorporate an evidence-based approach is largely determined by their education and training, work experience, and professional association involvement. This study identified a need to integrate concepts and principles of evidence-based practice into dietetics curriculums so that practitioners are able to routinely apply research findings to clinical practice.

Adult↗
PubMed2000

Research and the clinical dietitian: perceptions of the research process and preferred routes to obtaining research skills.

The art and science of dietetics are rooted in research, yet clinical dietitians do not generally participate in the research process. Focus group methodology was used to identify clinical dietitians' perceptions about incorporating research into clinical practice and to identify potential barriers to participation in research. In a series of 9 focus group sessions with 50 registered dietitians and 3 dietetic interns, attendees recognized the importance that research findings play in their practice. Barriers such as lack of time and low comfort levels with initiating and conducting research were discussed, and possible solutions to these barriers were suggested. Collaboration with academic dietitians or with research mentors was viewed as a useful and realistic pathway to increased participation in the research process. According to participants, increased involvement in research could also be facilitated by a supportive administrative structure within the facility, clinical management that is supportive of the research process, and collaboration among members of the dietetics staff. The findings of this qualitative investigation indicate that the central tenet of successful integration of clinical practice and research is collaboration-within dietetics departments, across the strata of facilities, and in particular, between clinical and research-oriented registered dietitians.

Data Collection↗
PubMed1995

A community-based, interagency approach by dietitians to provide meals, medical nutrition therapy, and education to clients with HIV/AIDS.

Dietitians have the opportunity to be leaders in providing medical nutrition therapy and home-delivered meals for people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the community setting. Four community agencies developed the Visiting Nurse Service HIV/Home Delivered Meals Program. Fifty clients with the diagnosis of HIV and/or AIDS were served for a 6-month period. The program provided convenient, energy-enhanced nutritious meals. Participants received daily hot and cold, energy- and protein-enhanced home-delivered meals; weekly high-energy, high-protein, shelf-stable Snack Packs; a Medical Nutritional Supplement Sampler Pack; and two home visits from dietitians. Different diet options were available. Dietitians completed 47 initial nutrition assessment and food safety education visits 1 to 2 weeks after meal delivery began, and 35 participants received follow-up nutrition counseling visits 4 to 8 weeks later. Participant data (including weights) were self-reported. Dietitians reported that 13 of 35 participants gained weight (mean = 6 lb), 11 of 35 remained the same weight, and 11 of 35 lost weight (mean = 5 lb). Initially, 14 of 35 participants were considered to be "doing well"; this improved to 19 of 35 participants 1 to 2 months later. Snack Packs were effective means to help participants meet some of their increased nutrient needs. The Medical Nutritional Supplement Sampler Pack was effective in familiarizing each participant with available products. Medical nutrition therapy by registered dietitians helped most participants improve their food consumption.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Perspectives on history: Army dietitians in the European, North African, and Mediterranean theaters of operation in World War II.

World War II necessitated the mobilization of hundreds of dietitians to serve in military hospitals in the United States and in theaters of war all over the globe. Although initially military dietitians had civilian status, on December 22, 1942, Congress passed Public Law 828, which authorized military status for Army dietitians with relative rank in the Medical Department for the duration of the war and 6 months thereafter. This article chronicles the role of Army dietitians who supported the allied troops in military hospitals in England, Europe, and North Africa during World War II. Recollections of military dietitians who served in the war are included to illustrate the circumstances under which these professionals lived and the dedication with which they worked.

Africa, Northern↗
PubMed1996

Order writing for parenteral nutrition by registered dietitians.

OBJECTIVES: The purpose of the study was to describe the involvement of registered dietitians in parenteral nutrition (PN) orders, to identify characteristics of those who write orders; and to rank education, training, and support elements that dietitians believe facilitate PN order-writing skills. DESIGN: Mail survey method. SUBJECTS: Usable returned questionnaires (n = 266) represented randomly sampled membership of the Dietitians in Nutrition Support (a dietetic practice group of The American Dietetic Association) and registered dietitian membership of the American Society of Parenteral and Enteral Nutrition. STATISTICAL ANALYSIS: Data were analyzed using basic frequency displays on all questionnaire items, Pearson correlations between the quantitative variables, and one-way analysis of variance with each of the categorical variables and the quantitative variables. Detail exploration among variables was done by chi(2) analyses and two-tailed t tests. RESULTS: "Recommend" was the most frequent response to a query about participation in PN orders. An average of 37% of respondents sometimes or always wrote orders for nutrients. Specialists were more likely to write orders than clinicians and managers. No relationship was found between those who wrote orders and educational level, and writers had been registered for a shorter length of time. Agreement on the training and support needed for order-writing skills was nearly unanimous. APPLICATIONS: The PN skills of respondents who were specialists distinguished them from managers and clinicians. Specialists did not fit criteria for advanced practice, and specialty practice in metabolic nutrition care may be too broad to define their practice. Educators must recognize the importance of including PN training in didactic and clinical training programs. Registered dietitians with PN skills will be well positioned to play an active role in the evolving health care system.

Analysis of Variance↗
PubMed1998

Nutrient Intake Report: a coordination of patient dietary assessment between physicians and registered dietitians.

The Nutrient Intake Report (NIR) is based on a 7-day dietary recall questionnaire used previously in research for dietary assessment and adapted for clinical use. Used to provide information and counseling as part of total patient care, the NIR acts as a cornerstone for dietary education and interaction between physician, registered dietitian, and patient. The NIR is ordered by physicians or registered dietitians, scanned and assessed by a registered dietitian, and incorporated into the laboratory section of the medical record. It documents the patient's dietary intake in the context of his or her diagnosis and general health status. The NIR also opens a dialogue between physicians and registered dietitians. Incorporation of the NIR into the medical record makes the work of the registered dietitian available to other health practitioners, which is welcome in an era when licensing and reimbursement are contingent on systematic documentation of dietary assessment and its role in patient care.

Diet Records↗
PubMed1998

The dietitians' philosophy and practice in multidisciplinary weight management.

Dietitians are developing a philosophy and a practice protocol of weight management. A professional philosophy of weight management addresses questions about the social, psychological, and biological spectra of weight management: Should overweight be considered in terms of size acceptance or gluttony and sloth? How should emotional overeating and obsessive restriction be managed? Should obesity be considered a chronic disease, or should the idea that health at every size is possible be espoused? A professional practice protocol addresses another set of questions: Is obesity to be viewed as a short-term and long-term health challenge? Regarding the spectrum of antiobesity agents and antidieting approaches of weight management, what professional position and individual practice will be adopted? Should professional contact with patients be continuous or aimed toward self-care? What measures of successful outcomes will be used: weight change or life quality improvement? How should professional responsibility be balanced with personal concerns about eating and health behaviors that affect body weight? What are examples of closing the gap between the vision and the reality of the roles and goals of the dietitian on a weight management team? Dietitians are translating philosophy into practice. Because dietary control alone has a record of limited success in weight loss and less success in maintaining weight loss, the dietitian's expanded role includes helping patients manage weight with coping skills, motivation techniques, physical activity, and food behavior change. The challenge is integrating functional components of practice with dietitians' unique food and nutrition skills that include selection of alternative foods, portion control, and preparing acceptable, tasty foods for lifelong weight management.

Dietary Services↗
PubMed2002

Implementation research for 'evidence-based' guideline development by dietitians: a pilot study to test an instrument.

AIM: To improve the quality of dietetic care, dietitians in the University Medical Center Utrecht (UMCU) are encouraged to develop and implement 'evidence-based' guidelines. The aim of this pilot study was to develop and test a questionnaire for implementation research to monitor the process of developing and implementing these guidelines. METHODS: A questionnaire was developed and distributed to 15 dietitians, who have started developing an 'evidence-based' guideline. The questionnaire measures determinants of dietitians' behaviour and the presence of conditions facilitating the development of a guideline. Cronbach's alpha with a cut-off point of 0.7 was used to analyse the internal consistence between the items related to behavioural determinants. A panel of professionals such as a member of staff from the UMCU, a communication expert and project-managers ensured the completeness of the questionnaire. RESULTS: The internal consistency was high (alpha > 0.7) between the items related to the determinants of behaviour. The questionnaire gives a structured overview of factors affecting positively or negatively the process of guideline development. Although dietitians have a positive behaviour towards guideline development, they perceived barriers related to the presence of conditions to develop a guideline. CONCLUSION: We concluded that the applied questionnaire is appropriate for implementation research and has given a structured overview of factors that influence the development of dietetic guidelines by dietitians in the UMCU.

Attitude of Health Personnel↗
PubMed2002

Dietitians' views of overweight and obese people and reported management practices.

OBJECTIVES: To examine dietitians' views of overweight and obese people, to explore the role of level of severity on these perceptions (overweight vs. obesity), and to explore the relationship between dietitians' views and their reported weight management practices. DESIGN: An independent measures survey, questioning dietitians about either overweight or obese people. PARTICIPANTS: One-hundred and eighty-seven members of the British Dietetic Association. MEASUREMENTS: A questionnaire exploring beliefs about the causes, attitudes, perceptions of responsibility and reported weight management practices. RESULTS: Physical inactivity was identified as an important causative factor for both overweight and obesity. Mood, eating too much of the wrong foods, repeated dieting and interpersonal factors were also seen as relatively important for both groups. Attitudes were mixed, but were generally neutral to positive. The most negative attitudes were described in terms of perceived reduced self-esteem, sexual attractiveness and health. Dietitians rated obese people more negatively than overweight people. They viewed both overweight and obese people as being responsible for their excess weight. They also reported very similar management practices for overweight and obese people. Beliefs about the causes of overweight explained more of the variance in practice than dietitians' attitudes towards or perceived responsibility of overweight and obese people. However, these associations were not consistent and strong, and other factors not investigated here are likely to have a greater influence on weight management practices.

Affect↗
PubMed2003

Knowledge and use of evidence-based nutrition: a survey of paediatric dietitians.

OBJECTIVE: To survey paediatric dietitians' knowledge and use of evidence-based nutrition (EBN). DESIGN: Cross-sectional survey using reply-paid questionnaires. SUBJECTS: Paediatric dietitians in Australian teaching hospitals. MAIN OUTCOME MEASURES: Age, sex, appointment, clinical practice, research activities; attitudes to, training in and use of EBN; and perceived barriers to use of EBN. STATISTICAL ANALYSIS: Data were analysed using descriptive statistics (SPSS). RESULTS: Fifty-nine (86%) of 69 questionnaires were returned. Most (97%) dietitians were women working full-time (63%), mean age 37 years (+/-9 SD). Most (75%) dietitians encountered knowledge gaps less than five times per week and most (87%) questions related to therapy. The majority (95%) performed their own literature searches, less than five times per month. All had access to >or=1 electronic literature databases including Medline (n = 58, 98%), Cochrane Library (n = 44, 75%) and CINAHL (n = 35, 59%). Information sources used most often were Medline and consultation with colleagues. Reported barriers to using EBN were lack of time (n = 53, 90%) or lack of skills for critical appraisal of published articles (n = 51, 86%) or literature searching (n = 48, 81%). While 53 (90%) believed in an evidence-based approach, 43 (73%) either did not practise EBN or rated themselves as beginners. CONCLUSION: Most dietitians favoured evidence-based practice, but reported lack of time, skills or rapid access to electronic databases as barriers to its practice.

Adult↗
PubMed2004

The opinion of Dutch dietitians about functional foods.

OBJECTIVE: To obtain information about Dutch dietitian's attitudes, perceived knowledge, training preferences, counselling procedures, opinions about post-launch monitoring, and personal consumption of functional foods. DESIGN: A self-administered, 62-item, postal survey in 2002. SUBJECTS: Five hundred randomly selected registered dietitians. The response rate was 49% (n = 238). RESULTS: The responders (mean age +/- SD: 40 +/- 9 years) had regular contact with clients (90%), and many (71% of 90%) advised about functional food use. Sixty-nine per cent hardly consumed any functional food themselves. Eighty-seven per cent of the responders would greatly appreciate courses given by scientists. Confusion existed about usage practices, target groups, safety, efficacy, and claims: between 42 and 89% agreed with the statements about uncertainties. Nonetheless, 69% felt that functional foods could theoretically contribute to good bodily functioning. Ninety per cent thought post-launch monitoring (PLM) important, but ideas about a common dietetic contribution to PLM did not emerge. CONCLUSIONS: Although functional foods potentially contribute to a healthful diet, there is still confusion among dietitians about claims, safety, efficacy and product-handling aspects. It is time to meet dietitians' repeated requests to provide education by noncommercial experts. In the meantime, dietitians themselves should have more say in the PLM debate because they should and could play an important role.

Adult↗
PubMed2002

Dietitians in New South Wales: workforce trends 1984-2000.

Complete surveys of the dietetic workforce in NSW were conducted in 1984 and 1991 and have now been updated with a new survey in 2000. In the nine years since 1991, the total active workforce grew by 48%. Although there were significant improvements in the ratios of hospital dietitians per 100 acute beds (from 0.88 to 1.08) and dietitians per million population (from 69.7 to 96.5), the supply of dietitians does not yet reach recommended levels, especially in rural areas. Other trends were significant increases in the proportion of dietitians employed outside hospitals (to 38% in 2000) and in non-clinical work (50% in 2000), and declines in the number of technical support staff for dietitians.

Allied Health Personnel↗
PubMed2003

Massachusetts registered dietitians' knowledge, attitudes, opinions, personal use, and recommendations to clients about herbal supplements.

OBJECTIVE: To assess the knowledge, personal use and recommendations of herbal supplements among registered dietitians (RDs) in Massachusetts. DESIGN: A descriptive, cross-sectional study conducted by a self-administered survey. SUBJECTS: One hundred and fifty-eight RDs from active members of the Massachusetts Dietetic Association (MDA). STATISTICAL ANALYSIS: One-way analysis of variance (ANOVA), Kruskal-Wallis tests, and multivariate regression identified statistical significance and examined the association between the dietitians' test scores from eight herbal knowledge questions with their personal herbal use and recommendations to clients and their age, education, work experience, and work status. RESULTS: We obtained a 53% response rate. The dietitians scored an average of 5.4 of a possible 8 on the herbal knowledge questions. Seventy-three percent (73%) perceived themselves to have little or no knowledge of herbal supplements. Only 37% reported using herbs and 22% recommending herbs to clients in the past year. A significant positive association was observed between herbal supplement knowledge score and frequency of personal use (p = 0.004), and recommendation to clients (p = 0.001). Eighty-nine percent (89%) agreed that herbal supplement education should be incorporated into dietetic curricula. DISCUSSION: The majority of the dietitians may lack herbal supplement familiarity. Therefore, these dietitians may be reluctant to personally use or recommend herbs to clients, even though the majority believe herbs can be effective for specific illness and health maintenance. These results may indicate a need to include more extensive education in the dietetic curricula and to continue education regarding herbal supplements in response to the increasing consumer herbal supplement use.

Adult↗
PubMed2005

The role of the dietitian in the intensive care unit.

PURPOSE OF REVIEW: The role of the intensive care unit registered dietitian has evolved over the past few years to become a vital component of the intensivist-led multidisciplinary intensive care unit team. The purpose of this review is to define the level of clinical practice and skill set of the intensive care unit dietitian, which defines them as a clinician, educator and researcher worthy to practice alongside their colleagues on the intensive care unit team. RECENT FINDINGS: An intensive care unit registered dietitian must be a dedicated professional with advanced training in critical care nutrition, the ability to read critically and evaluate new literature, a willingness to think 'outside the box', the fortitude to be an active participant in the intensive care unit team, the aptitude to educate colleagues and students from all disciplines, and the desire to participate in clinical research. Intensive care unit registered dietitians have published research concerning the nutritional assessment of the critically ill patient, the route of nutritional support, nutritional access, fluid and electrolyte issues, speciality enteral products, and optimal blood glucose control. They continue to attain skills and knowledge to extend their scope of practice and improve the quality of care in the intensive care unit. Recent guidelines adapted to the nutritional care of critically ill patients have been published for guidance. SUMMARY: The scope of practice of intensive care dietitians defines them as clinicians, educators and researchers. Their skill set is a unique and vital component of the intensivist-led multidisciplinary intensive care unit team.

Critical Care↗
PubMed2003

Variability in estimation of self-reported dietary intake data from elite athletes resulting from coding by different sports dietitians.

A routine activity for a sports dietitian is to estimate energy and nutrient intake from an athlete's self-reported food intake. Decisions made by the dietitian when coding a food record are a source of variability in the data. The aim of the present study was to determine the variability in estimation of the daily energy and key nutrient intakes of elite athletes, when experienced coders analyzed the same food record using the same database and software package. Seven-day food records from a dietary survey of athletes in the 1996 Australian Olympic team were randomly selected to provide 13 sets of records, each set representing the self-reported food intake of an endurance, team, weight restricted, and sprint/power athlete. Each set was coded by 3-5 members of Sports Dietitians Australia, making a total of 52 athletes, 53 dietitians, and 1456 athlete-days of data. We estimated within- and between- athlete and dietitian variances for each dietary nutrient using mixed modeling, and we combined the variances to express variability as a coefficient of variation (typical variation as a percent of the mean). Variability in the mean of 7-day estimates of a nutrient was 2- to 3-fold less than that of a single day. The variability contributed by the coder was less than the true athlete variability for a 1-day record but was of similar magnitude for a 7-day record. The most variable nutrients (e.g., vitamin C, vitamin A, cholesterol) had approximately 3-fold more variability than least variable nutrients (e.g., energy, carbohydrate, magnesium). These athlete and coder variabilities need to be taken into account in dietary assessment of athletes for counseling and research.

Diet Records↗
PubMed2005

Management of osteoporosis: a national survey of Israeli dietitians' knowledge and perceptions.

The aim of this study was to assess Israeli dietitians' knowledge and attitudes regarding osteoporosis. Participants were 320 dietitians responding to a mail survey. Israeli dietitians scored highly on the Facts on Osteoporosis Quiz-FOOQ. Israeli dietitians' dietary knowledge regarding calcium (recommended dietary allowance, content in food and in supplements) was fairly high; unlike knowledge regarding vitamin D. Israeli dietitians had a firm positive opinion of their role in the prevention and treatment of osteoporosis.

Adult↗
PubMed2002

Weight management in childhood: Canadian dietitians' practices.

Canadian dietitians specializing in pediatric practice were surveyed to provide a preliminary profile of the strategies they use to manage overweight youth. The survey was mailed to 298 dietitians belonging to the Dietitians of Canada's (DC) Pediatric Nutrition and Consulting Dietitians' Networks and to the head dietitians in Canadian pediatric hospitals across the country. It was also posted on the DC website and sent by electronic mail. Of the 164 respondents, 65 reported that they provide an intervention program to overweight youth. Growth charts, ideal body weight, and body mass index were mostly used to assess and monitor overweight. However, about 20% of the respondents did not define overweight in their client population. The majority of the clients were girls aged seven to 18. Most respondents used the healthful lifestyle approach via one-on-one consultation, included parents and collaborated with two or more health professionals for the management of these children. As the discussion on best practices for the prevention and treatment of overweight youth continues, we need further evidence to determine what strategies, if any, support positive outcomes in this group.

Adolescent↗
PubMed1986

Marketing the professional services of the dietitian.

Professionals are beginning to realize that a good service does not necessarily sell itself and that active strategic marketing is often needed. It is no longer sufficient for a dietitian to be up-to-date and provide high quality services; cost effectiveness of sound nutrition must be demonstrated and the services of the dietitian aggressively marketed. A strategic market plan based on an assessment of opportunities and capabilities should be developed and continuously adjusted. This article discusses the steps in strategic market planning with practical examples for the dietitian. Dietitians should examine the marketing strategies being implemented by other professional groups since many can be adapted to marketing nutrition services. There exists much opportunity and unprecedented challenges for all dietitians, calling for creativity, innovation, and professionalism.

Canada↗