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PubMed2000

Self-perceived Competence of Clinical Dietitians to Participate in Research: A Needs Assessment.

The recent focus on clinical outcomes has prompted the need for investigation into the effectiveness of all clinical activities and dietitians are being challenged to justify the services they provide. Participation in research is critical to the evaluation process, and thereby to the continued existence and development of dietetic practice. Although practitioners are in the best position to ask relevant research questions, research has seldom been integrated into the clinical dietitian's role. Our experience was that workplace efforts to remove barriers to participation in research did not increase clinical dietitians' participation in research. The purpose of this study was to assess clinical dietitians' self-perceived competence to participate in research, with a view to identifying strategies that would ultimately increase research participation. A survey instrument was developed and administered to clinical dietitians working in hospitals in Greater Vancouver and Victoria. Respondents had a favourable attitude toward research, yet actual participation in research was low. Respondents believed research to be important to the profession and they were interested in participating. Barriers to participation included those that are internal to oneself, such as lack of self-confidence, and environmental barriers, including lack of access to computers, statistical support and staff relief. Results indicated that programs to increase participation should provide knowledge and skills training, as well as aim to enhance self-confidence, networking and mentoring.

Journal Article↗
PubMed2000

Customer Perception of a Supermarket Nutrition Centre Staffed by a Registered Dietitian.

The purpose of this study was to examine consumers' attitudes toward a supermarket nutrition centre staffed full time by a registered dietitian. A questionnaire was administered over three consecutive days in that store and in a control store that was similar to the experimental site in every way, except for the absence of a nutrition centre. Participants were chosen randomly at timed intervals in specific areas of the store. Of 428 customers approached, 232 agreed to participate in the survey. At the experimental site, 75% of the participants were extremely satisfied with the registered dietitian's services and 69% ranked having a registered dietitian on staff in any store as extremely important, compared to 31% at the control site (p < 0.05). In ranking the importance of 13 required and optional services offered by the supermarkets, 15% of participants at the experimental site ranked having a registered dietitian on staff in the top five, compared with 4% at the control site (p < 0.05). The findings suggest that participants at the experimental site view the nutrition centre as a valuable service. There may therefore be an expanded role for registered dietitians in the supermarket setting.

Journal Article↗
PubMed2001

Legume promotion in counselling: an e-mail survey of dietitians.

Little is known about dietitians current practice in counselling clients about the use of legumes in a low fat, high fibre diet. An exploratory e-mail questionnaire was sent to members of Dietitians of Canada to assess: dietitian use and preferences for legumes, dietitian practice, opinions about clients attitudes and preferences, and resource needs. Counsellors (n=256) had high personal use of legumes (64% > or = 1 serving/week) and frequently recommended legumes in counselling. The legumes most preferred by respondents and their clients were: peanuts, kidney beans, split peas, chickpeas, and lentils. Respondents often recommended canned bean products (76%) and tofu (61%), but other legume grocery products were less often recommended. The most common client issues identified were: flatulence (87% agreed), lack of familiarity (85%), and knowledge of preparation (82%). Dietitians were not satisfied with current resources to support practice, especially those respondents providing primarily clinical counselling services. The most requested resources were: recipes (90%), pamphlets (82%), food demonstrations (75%) and Internet sites (63%). Client level research is now needed to confirm the importance of the issues identified and to develop and test strategies for legume promotion in counselling.

Attitude of Health Personnel↗
PubMedDate not supplied

[Installation of Clinical Nutrition and Dietetics units in Spanish hospitals and the presence of dietitians in the same].

GOALS: The appropriate nutritional status of hospitalized patients bears a close relationship with the existence of specialized Clinical Nutrition and Dietetics units or departments at health centres. The presence at these units of professionals with specific training to carry out tasks in the sphere of nutrition and dietetics, as is the case of dietitians, implies and evident strengthening of their capacity and operation. The main goal of the present paper to identify the number of Nutrition and Dietetics Units in the leading Spanish hospitals and also the presence of graduates in dietetics or nutrition specialists. SCOPE: Spanish hospital installations selected from the national hospital index. RESULTS OF THE TRIAL: It can be inferred that the implementation of the said services is not as complete as might be desired, and the presence of specifically qualified professionals (dietitians or nutritionists) is even lower. In this context, one is struck by the growing number of outsourced catering services at Spanish hospitals and the hiring of dietitians by these private companies, often at the request of the hospital itself. CONCLUSIONS: All of the data obtained show an ever greater importance of dietitians in hospital nutrition, with an uneven geographical distribution and implementation in Spain because of the peculiar policy adopted by the health authorities with regard to the recognition of these professionals. In Spain, these departments continue to be scorned and the role of the dietitian ignored.

Attitude of Health Personnel↗
PubMed1992

Development of financial management competencies for entry-level and advanced-level dietitians.

The major purposes in this study were to develop a list of financial management competencies for entry- and advanced-level dietitians, determine hospital foodservice directors'/chief dietitians' (practitioners) perceived importance of these competencies at both levels of practice, and determine educators' perceived importance of these competencies at the entry level. Drawing from the literature and the judgment of eight experts, we developed a list of 50 financial management competencies. Written questionnaires that included importance scales for the competencies were mailed to (a) practitioners in a random sample of 1,500 member hospitals of the American Hospital Association and (b) directors of Plan IV/V, Approved Preprofessional Practice, and Dietetic Internship programs. Response rates were 34% for the practitioners and 47% for the educators. Practitioners rated 8 competencies as important or very important for entry-level dietitians and 26 as important or very important for advanced-level dietitians. Practitioners rated all competencies higher for advanced-level dietitians than for those at the entry level, and educators rated all competencies higher than did practitioners. Content areas, identified by factor analysis, were similar for both levels of practice. Our findings indicate that emphasis in undergraduate and practice programs should be given to the eight competencies identified by practitioners and educators as most important. Our results also may be used for development and evaluation of graduate and continuing education programs and for specialty certification in foodservice management.

Dietetics↗
PubMed1991

Feeding the terminally ill: dietitians' attitudes and beliefs.

Medical, legal, and bioethical discussions have focused on withholding or withdrawing nourishment from adults who are terminally ill or in persistent vegetative states, yet few discussions have considered the dietitian's role. In June 1990, the Supreme Court upheld an individual's right to refuse life-prolonging procedures, provided those wishes had been clearly documented. This decision, and The American Dietetic Association's 1987 guidelines for feeding the terminally ill, may enable dietitians to evaluate complicated situations regarding feeding and nonfeeding of patients. A survey sent to 590 registered dietitians in The American Dietetic Association's Nutrition Support dietetic practice group resulted in a 42% (n = 250) response rate. In general, dietitians were more willing to discontinue total parenteral nutrition than to discontinue enteral, noninvasive enteral, or oral feedings. They thought that feeding could be discontinued if it causes pain or worsens the condition, if death is imminent, or if the patient has requested that feeding be stopped. University courses and continuing education programs on the ethics and legalities of feeding terminally or critically ill adults will enable dietitians to take active roles in the decision-making process and to promote awareness of relevant issues with patients and families.

Analysis of Variance↗
PubMed1990

Nutrition care planning: comparison of the skills of dietitians, interns, and students.

A written case study--or patient management problem--was used to examine how the nutrition care planning process is influenced by increasing clinical experience. The sample consisted of 45 students in diet therapy courses, 46 dietetic interns, and 44 experienced clinical or generalist dietitians. The patient management problem tested data gathering, with sections containing information needed to assess nutritional status, and nutrition care planning, in which subjects identified and evaluated problems and selected short- and long-term goals. Performance was scored by comparing subjects' answers with those of five dietetic experts. Dietitians scored highest and students scored lowest on efficiency of data gathering. Dietitians and interns scored higher than students on proficiency of data gathering and nutrition care planning. Overall, dietitians and interns performed better than students. Only in tasks requiring the highest levels of information processing and/or confidence in clinical judgment were differences between dietitians and interns consistently found. These findings demonstrate that basic nutrition care planning skills are acquired during dietetic internships, but advanced skills are added with clinical experience.

Dietary Services↗
PubMed1979

The consultant dietitian in nursing homes. I. Methodology and general information.

The functions of the consultant dietitian and the foodservice supervisor were studied by surveying dietitians consulting in nursing homes and the administrators of each dietitian's nursing home accounts. Data were available from consultants and administrators in 297 nursing homes in a twelve-state, midwestern region. Almost 60% of the homes had employed a consultant for three to eight years, and nearly half had employed the present consultant for the same length of time. Generally, the dietitians made one to three visits to the homes a month, for a total of 3 to 12 hr. The administrators listed personnel, cost of department operation, and facilities as problem areas in foodservice. Dietitians reported greater concern than did administrators in all of the rated problem areas except cost. Problem ratings of the two groups reflected differences in interest and expertise.

Consultants↗
PubMed1984

Decision-making styles of dietitians.

Four decision-making styles (technician, planner, teacher, artist) were distinguished with Myers-Briggs Type Indicator (MBTI) results for 61 dietitians and 55 dietetic students. The "technician" style (impersonal, matter-of-fact analysis expressed in technical skills) was preferred to other styles by the greatest percentage of subjects studied. Subgroups of clinical dietitians, those 40 years old or older, and dietetic internship graduates preferred the "technical" style that is related to academic achievement in applied and physical sciences. Dietitians in administration, consulting, education, and public health indicated a preference for the "artistic" style (an insightful approach to possibilities expressed in an ability to communicate well with others). CUP graduates indicated the most diversity in style preferences. The "planner" style identified with researchers was preferred to the "artistic" style by students. Available data from groups of dietitians studied by other investigators supported these findings and indicated similarities among dietitians, school administrators, and medical technicians. Comparison between students in this and other samples indicated more differences than similarities, which may be due to differences in programs. Since all styles are useful within the profession, it is suggested that the identification and adaptation of style be included in education programs for dietetic students and practitioners.

Adult↗
PubMed1984

Intervention specialist: new role for dietitians' counseling skills.

Dietitians who want to expand their clinical responsibilities beyond dietary counseling should consider the role of the intervention specialist. The role is a logical expansion of the duties of the dietitian who is already serving as a health behavior counselor. The concept of dietitians' functioning as intervention specialists originated in clinical trials, when they served as adherence counselors. The intervention specialists in the clinical trials used the health behavior counseling process to help research participants adhere to the trials' protocols. This counseling process uses a systematic, problem-solving approach to assess, diagnose, intervene, and follow up on a targeted behavioral problem. Dietitians can prepare for the expanded counseling role of intervention specialist through interviewing and counseling skill assessment and further training. They must take an active role in defining how the services of an intervention specialist can be beneficial to physicians as well as to their patients. They should address the cost-effectiveness of behavior counseling in order to justify the increased initial costs. Dietitians will need to actively promote the role of intervention specialist in the medical community if they want this opportunity for increased professional responsibility.

Behavior Therapy↗
PubMed1992

Dietitians' perceptions about and personal nutrition practices for cancer risk reduction.

This study was undertaken to examine the beliefs and practices of dietitians in relation to cancer risk reduction through nutrition. Respondents to the national survey (N = 384, 70 percent) were similar in demographic, educational, and professional characteristics to the American Dietetic Association census data. They reported a strong preventive health orientation: mean performance on 10 preventive health behaviors was 77.5 on a 100 point scale. Half (53 percent) believed cancer would be serious if they developed it, 47 percent believed it was not likely that they would. About 20 percent of the respondents felt that the role of nutrition in cancer etiology was unclear. Dietitians believed strong research support existed for increasing whole grains, fruits and vegetables, and fiber to reduce cancer risk but that little evidence supported use of dietary supplements. Dietitians regularly practiced 75 percent of nutrition recommendations they believed to be effective in reducing cancer risk. Beliefs about the effectiveness of a recommendation accounted for the largest percentage of variance on nutritional practices. While dietitians reported many preventive health practices, including following nutrition recommendations, they seemed to be doing so for reasons other than preventing cancer.

Adult↗
PubMed1993

Evaluating the performance of clinical dietitians.

The purposes of this study were to describe how clinical managers evaluate the performance of clinical dietitians and to examine managers' opinions about performance appraisal. Managers from 55 acute-care hospitals in seven midwestern states responded to a telephone survey about their appraisal of the performance of clinical dietitians. Most of the clinical managers had developed criteria with written standards for evaluating performance. Respondents evaluated the dietitians once a year and relied primarily on chart audits, other work samples, and critical incidents to judge performance. Managers in 32 of the hospitals asked their subordinates to complete a self-appraisal, and almost all of the managers negotiated with the dietitians to identify goals for professional improvement. Respondents' reasons for conducting performance appraisals were indicative of a participative management style. During the interviews, many clinical managers requested help in improving their performance appraisal systems, which suggests a need for additional training in conducting performance appraisals. The findings indicate that most clinical managers were following recommended guidelines for conducting performance appraisals.

Clinical Competence↗
PubMed1994

Benefits of dietitian home visits.

The home health-care client's nutrition needs have increased because of the acuity of his or her medical problems and nutrition-related diagnoses upon release from the hospital. In the home health-care industry, nutrition services have been addressed most often by the nursing profession and to a lesser degree by the dietetics profession. To promote dietitians' skills to a home health-care agency, benefits of nutrition services must be identified. A survey of home health-care nurses showed that 11 of 16 respondents were not confident teaching complex diets (eg, diet for diabetes). Furthermore, 5 of the 16 respondents stated that they were not qualified to teach complex diets. Home health-care nurses might require assistance by a dietitian in addressing complex nutrition issues. The client would benefit as a result of receiving comprehensive nutrition services by a trained professional. A second benefit is that reimbursement of nutrition home visits can be a source of agency revenue. The home health-care agency could also use dietitians as a marketing tool to potentially increase physician referrals. The Home Health Visiting Nurse Association generated $32,483 in agency revenue over 1 year because a dietitian was employed to provide home visits. Alliances should be formed among home health-care administrators and nursing and dietetics professionals to promote high-quality, cost-effective nutrition care for the homebound client.

Community Health Nursing↗
PubMed1992

Registered dietitians' teaching and adherence promotion skills during routine patient education.

Even following education sessions, dietary adherence among medical patients is generally poor. One contributor to this problem may be the quality of teaching and adherence promotion skills employed by Registered Dietitians, whose behavior during routine patient interactions was evaluated in this observational study. Thirty dietitians were videotaped with one of their patients. Twenty operationally defined skills were rated on a scale from 0 (skill absent) to 3 (excellent). Dietitians' interpersonal skills were good (mean = 2.1, S.D. = 0.35), but all other skills were performed significantly less well (mean scores less than 1.0). Adherence promotion skills were rarely observed. Dietitians need supplemental training to improve teaching and adherence promotion skills.

Adult↗
PubMed2006

Impact of gestational diabetes mellitus nutrition practice guidelines implemented by registered dietitians on pregnancy outcomes.

Nutrition practice guidelines were developed for gestational diabetes mellitus by registered dietitians from the Diabetes Care and Education and the Women's Health and Reproductive Nutrition dietetic practice groups. To validate the guidelines, a clinical trial was designed with clinic sites randomly assigned to either nutrition practice guidelines care (12 sites) or usual nutrition care (13 sites), with diabetes, obstetric, and other clinic types represented in both groups. Volunteer dietitians served as study coordinators and recruited women diagnosed with gestational diabetes mellitus. The nutrition practice guidelines define medical nutrition therapy (MNT) for gestational diabetes and emphasize three areas-definition of MNT clinical goals with indexes to modify or advance MNT and criteria to start insulin; use of self-monitoring tools; and provision of three nutrition visits. Usual care sites provided prenatal nutrition care according to usual practice. The effect of nutrition care (sites following the nutrition care guidelines) and type of clinic site on changes in glycated hemoglobin and infant birth weight, adjusted for other covariates, were evaluated using linear regression. Differences in insulin use and other infant outcomes between treatment groups were evaluated using logistic regression. Generalized estimating equations were used to accommodate nonindependence within randomized clusters of patients within clinic sites. Data from 215 women indicated less insulin use at diabetes clinic sites in the nutrition practice guidelines groups and improved glycated hemoglobin control during the treatment period in diabetes clinics compared with obstetric or other clinics. A higher proportion of women in the usual care group had glycated hemoglobin levels that exceeded 6% at follow-up compared with women in the nutrition practice guidelines group (13.6% vs 8.1%), although not statistically significant (P=0.26). A significant clinic type and treatment group effect was found for birth weight. Nutrition practice guidelines for gestational diabetes mellitus reflected nutrition care already being provided by registered dietitians in diabetes clinics prior to this study because outcomes at these clinics were not impacted. Use of the guidelines by dietitians at obstetric and other clinics tended to improve outcomes at these sites.

Adult↗
PubMed2002

Exploring clinical dietitians' day-to-day practice through the critical incident technique.

This exploratory study was related to dietitians' day-to-day clinical practice using the Critical Incident Technique (CIT). The method consisted of asking 25 clinical dietitians to describe events which had occurred in their professional practice that they judged to be either favorable or unfavorable. Results showed that positive incidents were mostly associated with: being involved with patients, their families, physicians and nurses; with their impact on patients' quality of life and health; and with the recognition of the importance of the role of dietitians. Negative incidents were associated with being involved with the same factors, as well as with speech and language specialists. They were also linked to interpersonal and role conflicts, complaints and lack of communication.The relevance for dietitians of developing communication, debating and negotiation skills was highlighted. The classification scheme used to categorize data would be useful in conducting a repeat of the study on a larger sample.

Attitude of Health Personnel↗
PubMed1995

Cost-effectiveness of medical nutrition therapy provided by dietitians for persons with non-insulin-dependent diabetes mellitus.

OBJECTIVE: To conduct a cost analysis and cost-effectiveness study based on a randomized clinical trial of basic nutrition care (BC) and practice guidelines nutrition care (PGC) provided by dietitians in outpatient clinics. DESIGN: Subjects with non-insulin-dependent diabetes mellitus (NIDDM) from three states (Minnesota, Florida, Colorado) were randomly assigned to a group receiving BC or a group receiving PGC for a 6-month clinical trial. Along with data about medical and clinical outcomes, data about cost resources were collected. The cost-effectiveness of PGC compared with BC was calculated using per-patient costs and glycemic outcomes for the 6 months of the study. A net cost-effectiveness ratio comparing BC and PGC, including the cost savings resulting from changes in medical therapy, was also calculated. SUBJECTS: The study reports on a sample of 179 subjects with NIDDM between the ages of 38 and 76 years who completed the clinical trial. RESULTS: Patients in the PGC group experienced a mean 1.1 +/- 2.8 mmol/L decrease in fasting plasma glucose level 6 months after entry to the study, for a total per-patient cost of $112. PGC costs included one glycated hemoglobin assay used by the dietitian to evaluate nutrition outcomes. Patients in the BC group experienced a mean 0.4 +/- 2.7 mmol/L decrease, for a total per-patient cost of $42. In the PGC group, 17 persons had changes in therapy, which yielded an average 12-month cost savings prorated for all patients of $31.49. In contrast, in the BC group, 9 persons had changes in therapy, for an average 12-month prorated cost savings of $3.13. Each unit of change in fasting plasma glucose level from entry to the 6-month follow-up can be achieved with an investment of $5.75 by implementing BC or of $5.84 by implementing PGC. If net costs are considered (per-patient costs--cost savings due to therapy changes), the cost-effectiveness ratios become $5.32 for BC and $4.20 for PGC, assuming the medical changes in therapy were maintained for 12 months. APPLICATIONS: These findings suggest that individualized nutrition interventions can be delivered by experienced dietitians with a reasonable investment of resources. Cost-effectiveness is enhanced when dietitians are engaged in active decision making about intervention alternatives based on the patient's needs.

Adult↗
PubMed1995

Registered dietitian time requirements in the Modification of Diet in Renal Disease Study.

OBJECTIVE: To assess time expended by registered dietitians to conduct clinical and research activities during the Modification of Diet in Renal Disease (MDRD) Study. DESIGN: Two randomized, controlled clinical trials among persons with diminished levels of renal function using a factorial design to evaluate effects of dietary protein restriction and blood pressure control on progression of renal disease. In study A, subjects with moderate renal insufficiency were randomly assigned to a diet of usual protein (1.30 g/kg per day) or low protein (0.58 g/kg per day) and to either a usual or low blood pressure level. Study B involved subjects with advanced renal insufficiency who were randomly assigned to the low-protein diet or a very-low-protein prescription (0.28 g/kg per day) with a ketoacid-amino acid supplement (0.28 g/kg per day) and to either the usual or low blood pressure level. A time-log form designed by MDRD Study dietitians was completed for each participant at 36 monthly follow-up visits. SETTING: Fifteen clinical centers throughout the continental United States. SUBJECTS: Eight hundred forty adults aged 18 to 70 years with chronic renal diseases participated in the MDRD Study--585 in study A and 255 in study B. STATISTICAL ANALYSES: One-way analyses of variance and t tests were used to evaluate significant time requirement differences by diet groups, diagnosis, and sociodemographics. RESULTS: Mean total time for all participant visits declined from 183 +/- 1 minutes per visit during months 1 through 4 to 116 +/- 41 minutes per visit during months 25 through 36. Significantly more dietitian time was required for participants consuming the low-protein and very-low-protein diets than for those consuming the usual-protein diet. Age, gender, race, marital status, and renal diagnosis did not influence time requirements. A significant inverse association between education level and dietitian time was apparent. APPLICATIONS: The MDRD Study time-log data should be useful when determining staffing patterns for nutrition management in clinical and research settings.

Adolescent↗