Dietetics Practitioners Research Articles

Knowledge and Implementation of Nutrition Care Process (NCP) in Hospitals in a Philippine Province

Introduction: The Nutrition Care Process (NCP) was established and ought to be implemented by nutrition and dietetics practitioners all over the world in an effort to create a framework for critical thinking and decision-making for dieticians and nutrition professionals. Despite the advantages it offers, the implementation of NCP among dietitians is yet to occur specifically in some Asian countries. Objective: This study aimed to examine the relationship between the level of knowledge in NCP and the level of its implementation by the chief dieticians working in government and private hospitals in Laguna Philippines. It also aimed to identify the common barriers to NCP implementation. Theoretical Framework: The goal of NCP is to standardize a process describing the workflow of NCP, which includes four distinct and interrelated steps namely: nutrition assessment and reassessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation. Method: This descriptive-correlational study surveyed 30 chief dietitians in a Philippine province and used a validated and pilot-tested four-point Likert scale instrument which was converted into online questionnaire to facilitate distribution and retrieval. Ethics approval was granted in the conduct of the study. Statistical treatments used included weighted mean, Pearson r moment correlation and ranking. Results and Discussion: Results revealed that though the respondents are highly knowledgeable in NCP, there was a less implementation of NCP in Laguna hospitals, indicating a gap between theory and practice of NCP. This was supported by the test of relationship which showed that knowledge on NCP did not correlate with its implementation. Barriers to implementation include lack of manpower in the dietary department, problems in the coordination among physicians, nurses, dieticians, and pharmacists, the lack of adequate training in NCP, and the lack of awareness on the implementing guidelines of NCP as provided by the Department of Health (DOH) of the Philippine government. Research Implications: While the sample size of the study was small and the findings cannot be generalized to a wider population of dietitians, results of the study can invite researchers and policy makers to explore, in a more cross-sectional setting, how challenges in implementing NCP can affect the quality of providing nutritional care to various populations. Originality/Value: The results of this investigation could invite researchers and policy makers in nutrition to explore, in a more cross-sectional context, how challenges in implementing NCP can affect the quality of providing nutritional care to various populations and identify other variables which may affect the successful implementation of nutrition care process and the best practises exhibited by hospitals in its realisation.

What Evidence?: Qualitative Publishing in the Canadian Journal for Dietetic Practice and Research.

Background: Qualitative research involves the analysis of data in various forms (i.e.,written text such as interview transcripts, literature, or a personal diary; visual media such as photographs, maps, or memes; and audio materials such as podcasts, music, or voice notes) to describe and/or interpret phenomena and humans' perceptions and experiences of the world, including of food, health, and well-being. Dietetic-scholars have raised concerns about the dearth and quality of qualitative dietetic research.Objective: To document the availability and quality of qualitative research published in Canadian dietetic literature.Methods: A manifest content analysis of articles published in the Canadian Journal of Dietetic Research and Practice (CJDRP) between 2012 and 2021.Results: In total, 340 articles were published between 2012 and 2021 of which 43 (12.6%) used qualitative methods. Overall, the quality of qualitative articles was poor; articles frequently failed to report the methodological approach or a theoretical framework. Methods of data collection, data analysis, and strategies to ensure rigor were seldom described in detail. Reported limitations were often inappropriate for qualitative research.Discussion: Qualitative research is markedly underrepresented in the CJDPR. Efforts are needed to ensure that high-quality qualitative research evidence and publishing opportunities are available to Canadian dietetic practitioners and researchers. This study provides baseline data to evaluate the impact of future efforts.

Investigation of Precepting-Related Burnout in Dietetics Preceptors

BackgroundDietetics preceptors are at risk of abandoning their role because of potential burnout. Identifying factors associated with greater and lesser burnout can help key stakeholders identify and implement strategies to prevent or mitigate burnout in dietetics preceptors. ObjectiveThe purpose of this study was to identify factors associated with the burnout preceptors attribute specifically to the work of precepting. DesignThis study used a cross-sectional study design. A survey instrument including burnout measures, precepting measures, and items querying personal and work characteristics was distributed via e-mail to a random sample of 10 000 credentialed nutrition and dietetics practitioners. Participants settingRespondents who lived in the United States, were currently practicing, and had precepted during the past year were included in the sample (n = 310). The survey was conducted in October and November of 2022. Main outcome measuresPrecepting-related burnout was measured using scores on the Copenhagen Burnout Inventory; scores ranged from 0 to 100 and higher numbers indicated greater burnout. Statistical analyses performedFactors associated with precepting-related burnout were identified using an analysis of covariance. Pairwise comparisons with Tukey adjustments were done to determine differences across categories for the categorical variable in the model (ie, percent of interns requiring additional coaching). A stepwise variable selection process was performed to determine the best analytic models. ResultsFactors associated with lower precepting-related burnout in dietetics preceptors included higher Commitment to the Preceptor Role scores, lower percentages of interns requiring additional coaching, feeling appreciated by the dietetic interns, and higher Preceptors’ Perceptions of Support scores. A factor associated with higher precepting-related burnout was precepting a greater number of dietetic interns in the past year. For every 1-point change in each variable, the degree of change in precepting-related burnout was –7.9 for Commitment to the Preceptor Role, –3.2 for feeling appreciated by dietetic interns, –4.5 for Preceptors’ Perceptions of Support, and +1.2 for number of dietetic interns per year. The mean ± SE difference in precepting-related burnout scores between preceptors who reported < 10% of dietetic interns requiring additional coaching and those who reported > 50% of dietetic interns requiring additional coaching was –13.7 ± 3.7. ConclusionsThe factors found to be associated with precepting-related burnout scores in dietetics preceptors are potentially modifiable, suggesting this burnout might be prevented or mitigated to some degree.

Empathy in Nutrition and Dietetics: A Scoping Review

BackgroundEmpathy is fundamental to the provision of efficacious patient-centered health care. Currently, there is no comprehensive synthesis of peer-reviewed empirical research related to empathy in the nutrition and dietetics profession. Understanding empathy in the context of nutrition and dietetics care may lead to improved teaching practices that support nutrition and dietetics students and practitioners to provide high-quality, empathic, patient-centered care. ObjectiveThis scoping review aimed to understand the approaches through which empathy is conceptualized, measured, and taught in the field of nutrition and dietetics. MethodsUsing the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Reviews Statement and Checklist, a scoping review process was undertaken. Five databases were searched in February 2023: Cumulative Index to Nursing and Allied Health, Embase, Medline, PsycInfo, and Scopus, with no date limits. Eligible studies were English language-based, peer-reviewed, empirical research exploring or measuring empathy as an outcome in primary data stratified to nutrition and dietetics. Extracted qualitative data were synthesized and analyzed thematically with an inductive, interpretivist approach applied to conceptualize the interrelationship between empathy and dietetic practice. Quantitative data were extracted and summarized in a table. ResultsTwenty-six studies were included in the scoping review. Analysis identified 2 overarching themes underpinning the current literature on empathy in nutrition and dietetics that described empathy as a key skill in the application of patient-centered care, which was supported by approaches to lifelong cultivation of empathy in the nutrition and dietetics profession. A range of tools has measured empathy in nutrition and dietetics students and practitioners with no clear consensus in findings across studies. ConclusionsThis review identified the extent and nature of empathy within nutrition and dietetics, from both practitioner and patient perspectives, and the vast array of approaches used to teach and quantify empathy in students and practitioners. Insights from this review inform the need for future studies. The results of this review suggest that future research include exploring implications of empathic dietetics care on patient outcomes and identification of best practice, evidence-based curricula and strategies to support sustainable cultivation and maintenance of empathic care across the career span of nutrition and dietetics practitioners.

The Updated Global Malnutrition Composite Score Clinical Quality Measure: Its Relevance to Improving Inpatient Clinical Outcomes and Health Equity

Quality improvement has existed in health care for centuries with a dramatic transformation over time, largely motivated by the academic health quality movement. Throughout this evolution, the Centers for Medicare and Medicaid Services have been at the forefront of the development and provision of quality measures for health care in a variety of settings, including acute care. Quality initiatives aid in the evaluation of patient care to encourage quality improvement efforts, determine pay-for-performance rates, and help patients and consumers evaluate their care providers. The addition of the Global Malnutrition Composite Score as an electronic Clinical Quality Measure in 2022 highlights the key role nutrition plays in outcomes and quality of hospitalized patients. With this, credentialed nutrition and dietetics practitioners lie front and center for the development of quality improvement processes to help promote high quality standards of nutrition care, improve length of stay, and reduce health care costs and readmissions while addressing malnutrition, health equity, and nutrition care as a human right. As the Global Malnutrition Composite Score steward, it is the obligation of the Academy of Nutrition and Dietetics and the Commission on Dietetic Registration to promote the measure and support credentialed nutrition and dietetics practitioners in advocating for the implementation of this measure. Therefore, the purpose of this practice update is to provide necessary information to credentialed nutrition and dietetics practitioners and other health care leaders related to the history and implementation of the Global Malnutrition Composite Score, along with relevant updates to the measure and practice implications.

Standards of Excellence in Nutrition and Dietetics Organization Criteria: An Update

The Center of Excellence in Nutrition and Dietetics Award utilizes the Standards of Excellence (SoE) to identify and recognize organizations with exemplary leadership, outcomes, organization, and practice within the realm of nutrition and dietetics. Organizations with this designation continuously highlight and celebrate the work and expertise of the Registered Dietitian Nutritionist (RDN) and Nutrition and Dietetic Technician, Registered (NDTR) as the nutrition experts. This Award utilizes four domains in categorizing the SoE: Quality in Organization, Quality in Practice, Quality in Outcomes, and Quality in Leadership. Because these criteria can be applied broadly to a variety of practice areas, credentialed nutrition and dietetics practitioners across the care spectrum can actively participate in achieving this designation. The nature of the SoE is detail-oriented, allowing organizations and their leadership to determine opportunities for improvement and formulate action plans and long-term strategic plans to ensure excellence is at the forefront of all they do. Organizations that receive this award will have a competitive edge in recruiting and retaining credentialed nutrition and dietetics practitioners to the organization, and generate valuable metrics including benchmark data, best practices, and quality outcomes in their organizations. As this Award gains prestige and popularity, organizations will actively work to achieve and maintain this designation.

ChatGPT and Future Artificial Intelligence Chatbots: What may be the Influence on Credentialed Nutrition and Dietetics Practitioners?

Launched in November 2022, ChatGPT is an unprecedented publicly available and simple web interface that can "write" human-like texts. This AI chatbot can be used in a variety of settings, including in the field of nutrition and dietetics. This article describes ChatGPT and discusses the possible opportunities and risks of using ChatGPT in the practice of credentialed nutrition and dietetics practitioners working in public health, clinical settings, academia, and other settings.

Advancing Nutrition and Dietetics Research in Global Food and Nutrition Security: A Roundtable Meeting Report

Food and nutrition security remains a relevant issue globally, impacting nutritional status and other health outcomes. This is further complicated by various environmental factors that impact stable access to, availability of, and utilization of nutritious foods. Nutrition and dietetics practitioners play an important role in the identification and treatment of food and nutrition security and are also well positioned to advance research that can support food and nutrition security solutions. To address this important issue, the Academy of Nutrition and Dietetics’ Council on Research convened a Global Food and Nutrition Security Research Task Force (Task Force). To leverage existing information and expertise in this area and identify the need for future evidence, the Task Force hosted a virtual roundtable with key internal and external stakeholders. This 2-day event included discussions on research gaps, potential entry points for nutrition and dietetics practitioners, and important equity considerations in the area of food and nutrition security research. The identified research gaps included the need for standardized terminology for consistent data collection, the need for validated screening and assessment tools that can be used across settings and also assess diet quality, additional translational and implementation science research, multi-sectoral and multi-pronged approaches, interdisciplinary collaboration with community partners, incorporation of research into policy development, and additional evidence on food systems approaches to target food and nutrition security. To more clearly identify the entry points for practitioners, five examples from various countries were included to identify food and nutrition security issues and how nutrition and dietetics practitioners can be involved in research to address food and nutrition security. The Task Force would like this information to inform a research agenda and be leveraged by the larger scientific community to drive future funding and research opportunities for food and nutrition professionals on this topic.

Impact on diabetes outcomes and team skills of integrating dietetic services into interprofessional education and teamwork in primary care.

Diabetes is a complex disease requiring daily self-management of diet and activity, yet many patients do not receive recommended self-management education, medical nutrition therapy, or team-based care that includes registered dietitian nutritionists (RDNs). Such service deficits contribute to challenges in meeting combined diabetes care goals. We evaluated the impact of adding RDN-supervised dietetic interns to an established primary care interprofessional education/teamwork model on patients' clinical outcomes and health professions students' team skills. Electronic health records were retrospectively analyzed to evaluate the impact of interprofessional care teams including dietetic practitioners on patient outcomes and compare these changes to outcomes achieved with the previous model without such participation. Pre-test/post-test surveys were used to evaluate health professions students' self-reported changes in team skills. Patient outcomes for glycemic control, systolic blood pressure, triglycerides, and depression improved significantly, and emergency department visits decreased by 79% after interprofessional care. Average hemoglobin A1c levels decreased from 11.6% to 8.3% (p < .001), an additional 1.1% reduction over previous results, following incorporation of dietetic practitioners. Students reported increased team skills after interprofessional care participation. Health professions and dietetic program faculty should collaborate to develop interprofessional best practice primary care models for patients with diabetes.

Knowledge, attitudes, and practices of registered dietitians and nutritionists regarding enteral and parenteral nutrition support in Ghana: a needs assessment study.

There is a paucity of data on enteral and parenteral (EN and PN) nutrition support (NS) provided by nutrition and dietetic practitioners in adult acute care settings in Ghana. Furthermore, gray literature suggests that Ghanaian clinical nutrition professionals (CNPs) are seldom involved in advanced nutrition care teams. To assess the knowledge, attitudes, and practices of Ghanaian CNPs regarding EN and PN. An online cross-sectional survey was administered to Ghanaian CNPs ahead of a professional development workshop on EN and PN Support. Participants were asked questions about initiation and timing of NS, and knowledge on availability of commercial formula. A 5-point Likert scale was used to assess self-efficacy in using EN and PN. To assess practical knowledge on EN and PN, participants were asked to identify whether EN or PN was indicated for seven short case scenarios. Open-ended questions were used to assess reasons for participant self-ratings. A total of 76 dietitians, nutritionists, students, and interns completed the survey. For EN, self-efficacy scores were lowest for the calculation of enteral goal rate, and goal volume (mean 3.20 ± 1.27), and writing of EN prescriptions (mean 3.07 ± 1.29). Self-efficacy scores for the formulation of alternative formulas in lieu of commercial formula were the highest (3.63 ± 1.36). For PN, self-efficacy scores for all domains were lower than 3, with the lowest scores observed for writing PN prescriptions (2.19 ± 1.14) and determining micronutrient additives (2.12 ± 1.04). We identified limited training and lack of practical exposure to NS, limited ability to effectively monitor tube feeds, and prohibitive cost and limited availability of EN and PN formula among the barriers impacting self-efficacy scores. Given the vital role that CNPs play in the delivery of EN and PN, it is important to develop professional training programs especially focused on PN to bridge knowledge and practice gaps.

A Comparison of Experiences with Factors Related to Food Insecurity between College Students Who Are Food Secure and Food Insecure: A Qualitative Study.

Previous research has reported negative health consequences and poor academic achievement among college students who are food insecure. It is unknown if students with food insecurity's experiences qualitatively differ from students who are food secure. To qualitatively evaluate experiences of students who are food secure and food insecure with internal and external factors related to food insecurity. Trained interviewers conducted in-person qualitative interviews from February to August 2018 to gain insights about eating patterns, food environment, financial situation, and ideas for addressing food insecurity on college campuses with students who are food secure and food insecure. Students from three universities in the western United States (N= 58) who were classified as food secure (n= 28) and food insecure (n= 30) using the US Department of Agriculture's 6-item Food Security Module participated in this study. Interviews were recorded and transcribed verbatim. Data were analyzed using a conventional content analysis. A random sample of transcripts were independently coded to determine interrater reliability. Researchers divided transcripts for final coding and overarching themes were discussed. Descriptive statistics were used. Students who were both food secure and food insecure obtained food from similar sources (eg, grocery stores); had unexpected expenses that led to financial constraints; indicated transportation barriers altered the amount or package size of food purchased; and reported similar knowledge, attitudes, use, and familial history of food assistance. Students with food insecurity uniquely reported prioritizing rent or other living expenses over food, and when funds were low, reducing food intake, experiencing a variable food supply throughout the month, or using strategies like donating plasma or selling possessions to enhance financial stability. This study helps nutrition and dietetics practitioners better understand how college students' experiences with factors related to food insecurity differ by food security status. Future quantitative research is needed to confirm the coping strategies identified among students with food insecurity in this study.

Research at the Academy of Nutrition and Dietetics: What, How, and Why?

Research is essential to further advance our understanding of the role of nutrition and dietetics in maintenance and improvement of health. Research is also essential for nutrition and dietetics practitioners to create and provide evidence-based interventions, including medical nutrition therapy provided by registered dietitian nutritionists. Given this critical role of research, the Academy of Nutrition and Dietetics (Academy) has a variety of resources to assist its members in accessing, understanding, participating in, conducting, and disseminating nutrition research. These resources are comprehensive and include opportunities to participate in research (eg, Nutrition Research Network and Data Science Center), tools to aggregate practice data (Nutrition Care Process and Terminology and the Academy of Nutrition and Dietetics Informatics Infrastructure), funding opportunities to support primary research (eg, Academy Foundation), resources to understand the latest research informing evidence-based practice (eg, Evidence Analysis Center), and avenues for sharing research findings (eg, Food &amp; Nutrition Conference &amp; Expo™). The aim of this article is to encourage Academy members to get involved in research by describing Academy-based research resources and opportunities to contribute to nutrition and dietetics research, as well as describe specific examples of research conducted at the Academy. The information presented can serve as a framework to guide members in engaging in research through the Academy.

Reprint of: Social Determinants of Health: Enhancing Health Equity.

Nutrition and dietetics practitioners traditionally focus on modifying behavior to improve patient outcomes, but the Academy of Nutrition and Dietetics (Academy) also recognizes the role of social determinants of health (SDOH) when examining root causes of chronic diseases, such as high blood pressure, coronary heart disease, hepatitis, and stroke, particularly for minority and underserved populations.1

Current Topics in Health Care Law

Current Topics in Health Care Law

COVID-19 Increases the Prevalence of Postural Orthostatic Tachycardia Syndrome: What Nutrition and Dietetics Practitioners Need to Know

Postural orthostatic tachycardia syndrome (POTS) is a common complex disorder of the autonomic nervous system, also known as dysautonomia, which was estimated to affect 1 to 3 million people in the United States as of 2019.1 POTS is defined as a clinical syndrome marked by an excessive increase in heart rate (ie, tachycardia) after a shift to standing posture.1 Viral infections are an established trigger for POTS, and an unprecedented number of people have contracted viral infections due to SARS-CoV-2.

Development of Quick Guides for Assessing Food/Nutrition and Culture to Enhance Assessment of Food and Nutrition-Related History in Cross-Cultural Clients of Nutrition and Dietetics Practitioners around the World

The 2020 World Migration Report and the US Census Data Project indicated that the world’s population is steadily becoming more ethnically and racially diverse.1,2 In keeping up with these changing trends, it is imperative that credentialed nutrition and dietetics practitioners be culturally competent and that they have an understanding of cultural practices that influence nutrition (eg, food preparation, traditional healing through foods, religious and spiritual practices, dietary preferences and culinary practices).

An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care Process: Considerations for Nutrition and Dietetics Practitioners Working with Transgender and Gender Diverse Clients

An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care Process: Considerations for Nutrition and Dietetics Practitioners Working with Transgender and Gender Diverse Clients

The Social License to Practice Sustainability: Concepts, Barriers and Actions to Support Nutrition and Dietetics Practitioners in Contributing to Sustainable Food Systems

ABSTRACT There is growing recognition of the human health co-benefits of some dietary patterns considered more sustainable. Nutrition and dietetics professionals (NDPs) are well positioned to facilitate dietary change but their role in supporting sustainable food systems and diets is ambiguous. Researchers used Delphi Inquiry methods to explore how NDPs in 30 nations envision sustainable food systems, their perceived roles, barriers, and supports needed. Results indicate not all agree it is within their scope of practice, and highlight barriers across several system levels and scales, including an unsupportive professional culture, societal and ecological barriers. Strong leadership, learning, and collaboration are needed.

Three Lesson Series Improves Student Confidence in Ability to Apply Evidence-Based Practice in Dietetics

The Code of Ethics for the Nutrition and Dietetics Profession states that science-based decisions, derived from the best available evidence, are the underpinnings of ethical practice.1 Nutrition and dietetics practitioners must engage in evidence-based practice to meet professional standards and protect individual clients, the community, and the profession.1 Although the number of evidence-based nutrition guidelines continues to grow, end-user adoption of these guidelines remains a barrier to achieving consistent, evidence-based practice within the profession.

Guidance for Professional Use of Social Media in Nutrition and Dietetics Practice

Guidance for Professional Use of Social Media in Nutrition and Dietetics Practice