Barriers and Enablers to Delegating Malnutrition Care Activities to Dietitian Assistants.

Alita Rushton,Jack Bell,Judith Bauer,Heather Keller,Adrienne Young

doi:10.3390/nu14051037

Abstract

Delegation of malnutrition care to dietitian assistants can positively influence patient, healthcare, and workforce outcomes. However, nutrition care for hospital inpatients with or at risk of malnutrition remains primarily individually delivered by dietitians—an approach that is not considered sustainable. This study aimed to identify barriers and enablers to delegating malnutrition care activities to dietitian assistants. This qualitative descriptive study was nested within a broader quality assurance activity to scale and spread systematised and interdisciplinary malnutrition models of care. Twenty-three individual semi-structured interviews were completed with nutrition and dietetic team members across seven hospitals. Inductive thematic analysis was undertaken, and barriers and enablers to delegation of malnutrition care to dietitian assistants were grouped into four themes: working with the human factors; balancing value and risk of delegation; creating competence, capability, and capacity; and recognizing contextual factors. This study highlights novel insights into barriers and enablers to delegating malnutrition care to dietitian assistants. Successful delegation to dietitian assistants requires the unique perspectives of humans as individuals and in their collective healthcare roles, moving from words to actions that value delegation; engaging in processes to improve competency, capability, and capacity of all; and being responsive to climate and contextual factors.

Highlights

Malnutrition can occur when patients are not meeting the increased nutrition requirements related to their condition or complications or when uptake of macronutrient intake is insufficient [1]
Our findings demonstrate that working with the human factors; balancing value and risk of delegation; creating competence, capability, and capacity; and recognizing contextual factors are key influencers of successful delegation of malnutrition care to dietitian assistants
The views, perceptions, and opinions of staff members regarding delegation to dietitian assistants influenced why ‘below-scope’ tasks are still being retained by dietitians rather than being delegated to dietitian assistants where possible and safe to do so [8,19]

Summary

Introduction

Malnutrition can occur when patients are not meeting the increased nutrition requirements related to their condition or complications or when uptake of macronutrient intake is insufficient [1]. Nutrition care practices that are dependent on specialist delivery, for example, dietitians, medical nutrition specialists, or nurse practitioners, are not sustainable for all patients with or at risk of malnutrition. This is in part due to the time- and resource-intensive nature of individualised nutrition care, increased service demand, and funding allocations for specialist nutrition services [7–10]. Malnutrition screening is foundational to supporting timely nutrition care and directing resources towards those who are malnourished or at risk of malnutrition. Overarching international, national, and statewide guidelines and recommendations support screening on admission and periodically using a tool that is validated for the setting in which it is applied [11,12]. Nutrition care practices vary from site to site and are governed by local policies, procedures, and protocols, most sites in Queensland commonly use a malnutrition screening tool (MST) for malnutrition screening, and subjective global assessment (SGA) for malnutrition assessment and diagnosis, with recommendations for screening on admission and weekly screening thereafter [8,12,13]

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Discussion

Conclusion