Nutrition Care Process Terminology Research Articles

Adopting Nutrition Care Process Terminology at the National Level: The Norwegian Experience in Evaluating Compatibility with International Statistical Classification of Diseases and Related Health Problems, 10th Revision, and the Existing Norwegian Coding System

Continuing Professional Education (CPE) Information The Continuing Professional Education (CPE) quiz for this article is available for free to Academy members through the MyCDRGo app (available for iOS and Android devices) and through www.jandonline.org (click on “CPE” in the menu and then “Academy Journal CPE Articles”). Log in with your Academy of Nutrition and Dietetics or Commission on Dietetic Registration username and password, click “Journal Article Quiz” on the next page, then click the “Additional Journal CPE quizzes” button to view a list of available quizzes. Non-members may take CPE quizzes by sending a request to [email protected] There is a fee of $45 per quiz (includes quiz and copy of article) for non-member Journal CPE. CPE quizzes are valid for 1 year after the issue date in which the articles are published. Advances in information technology have accelerated the use of electronic health records and activities in terminology mapping. Dietitians need to be knowledgeable about the capabilities of different terminologies to effectively capture nutrition care data. If nutrition care is not reflected in the health care system, our professional contributions will not be visible. Data documenting nutrition care needs to be visible at the patient care level, in health care records, as well as in the statistics used by decision makers at health care institutions on national and international levels. It will be increasingly important for dietitians to participate in international collaborations among health care professionals pursuing common goals. The Continuing Professional Education (CPE) quiz for this article is available for free to Academy members through the MyCDRGo app (available for iOS and Android devices) and through www.jandonline.org (click on “CPE” in the menu and then “Academy Journal CPE Articles”). Log in with your Academy of Nutrition and Dietetics or Commission on Dietetic Registration username and password, click “Journal Article Quiz” on the next page, then click the “Additional Journal CPE quizzes” button to view a list of available quizzes. Non-members may take CPE quizzes by sending a request to [email protected] There is a fee of $45 per quiz (includes quiz and copy of article) for non-member Journal CPE. CPE quizzes are valid for 1 year after the issue date in which the articles are published.

The accuracy and consistency of nutrition care process terminology use in cases of refeeding syndrome.

Using standardised terminology in acute care has encouraged consistency in patient care and the evaluation of outcomes. As such, the Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) may assist dietitian nutritionists in the delivery of high quality nutrition care worldwide; however, limited research has been conducted examining the consistency and accuracy of its use. We aimed to examine the NCPT that dietitian nutritionists would use to formulate a diagnostic statement relating to refeeding syndrome (RFS). A multimethod action research approach was used, incorporating two projects. The first was a survey examining Australian dietitian nutritionists' (n = 195) opinions regarding NCPT use in cases of RFS. To establish if results were similar internationally, an interview was then conducted with 22 dietitian nutritionists working within 10 different countries. 'Imbalance of nutrients' was only identified as a correct code by 17% of respondents in project 1. No mention of this term was made in project 2. Also 86% of respondents incorrectly selected more than one diagnostic code. The majority of respondents (80%, n = 52/65) who incorrectly selected 'Malnutrition', without also selecting 'Imbalance of nutrients', selected 'reduce intake' as an intervention, suggesting some misunderstanding in the requirement for interrelated diagnoses, interventions and goals. Our findings demonstrate that there is limited accuracy and consistency in selecting nutritional diagnostic codes in relation to RFS. Respondents also demonstrated limited knowledge regarding appropriate application of the NCP and NCPT. Implementation practices may require further refinement, as accurate and consistent use is required to procure the benefits of standardised terminology.

Patient Outcomes from Nutrition Education and Counseling Reported with NCPT (Nutrition Care Process Terminology) via ANDHII (Academy's Nutrition and Dietetics Health Informatics Infrastructure)

Patient Outcomes from Nutrition Education and Counseling Reported with NCPT (Nutrition Care Process Terminology) via ANDHII (Academy's Nutrition and Dietetics Health Informatics Infrastructure)

Nutrition Care Process Implementation: Experiences in Various Dietetics Environments in Sweden

BackgroundThe Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) are currently being implemented by nutrition and dietetics practitioners all over the world. Several advantages have been related to this implementation, such as consistency and clarity of dietetics-related health care records and the possibility to collect and research patient outcomes. However, little is known about dietitians’ experiences of the implementation process. ObjectiveThe aim of this qualitative study was to explore Swedish dietitians’ experiences of the NCP implementation process in different dietetics environments. MethodThirty-seven Swedish dietitians from 13 different dietetics workplaces participated in seven focus group discussions that were audiotaped and carefully transcribed. A thematic secondary analysis was performed, after which all the discussions were re-read, following the implementation narrative from each workplace. In the analysis, The Promoting Action on Research Implementation in Health Services implementation model was used as a framework. ResultsMain categories identified in the thematic analysis were leadership and implementation strategy, the group and colleagues, the electronic health record, and evaluation. Three typical cases are described to illustrate the diversity of these aspects in dietetics settings: Case A represents a small hospital with an inclusive leadership style and discussion-friendly culture where dietitians had embraced the NCP/NCPT implementation. Case B represents a larger hospital with a more hierarchical structure where dietitians were more ambivalent toward NCP/NCPT implementation. Case C represents the only dietitian working at a small multiprofessional primary care center who received no dietetics-related support from management or colleagues. She had not started NCP/NCPT implementation. ConclusionsThe diversity of dietetics settings and their different prerequisites should be considered in the development of NCP/NCPT implementation strategies. Tailored implementation strategies should be considered in relation to context, such as increased dietetics support and facilitation where management does not lead or support the implementation process.

Successful long-term maintenance following Nutrition Care Process Terminology implementation across a state-wide health-care system.

Three years following a state-wide Nutrition Care Process Terminology (NCPT) implementation project, the present study aimed to (i) assess changes in NCPT knowledge and attitudes, (ii) identify implementation barriers and enablers and (iii) seek managers' opinions post-implementation. Pre-implementation and three years post-implementation, all Queensland Government hospitals state-wide were invited to repeat a validated NCPT survey. Additionally, a separate survey sought dietetic managers' opinions regarding NCPT's use and acceptance, usefulness for patient care, role in service planning and continued use. A total of 238 dietitians completed the survey in 2011 and 82 dietitians in 2014. Use of diagnostic statement in the previous six months improved (P < 0.001). Perceptions of NCPT's importance (P < 0.020) and benefits of incorporating NCPT into practice (P = 0.029) increased. Time to complete NCPT documentation (P < 0.013) and access to mentors decreased (P < 0.001). Other areas including enhanced attitudes, familiarity, confidence, views, knowledge and incorporation into practice were sustained (P > 0.05). Key elements in sustaining NCPT implementation over three years included ongoing management support, workshops/tutorials, discussion and mentor and peer support. The most valued resources were pocket guides, ongoing workshops/tutorials and mentor support. Dietetic managers held many positive NCPT views, however, opinions differed around the usefulness of service planning, safer practice, improving patient care and facilitating communication. Some managers would not support NCPT unless it was recommended for practice. Immediate improvements following the NCPT implementation project were sustained over three years. Moving forward, a professional focus on continuing to incorporate NCPT into standard practice will provide structure for process and outcomes assessment.

The Nutrition Care Process Terminology: Changes in perceptions, attitudes, knowledge and implementation amongst Australian dietitians after three years.

Assessing changes in dietetic perceptions, attitudes and knowledge regarding the Nutrition Care Process Terminology (NCPT) is important to determine implementation effectiveness. This study aimed to investigate changes in the perceptions and attitudes of Australian dietitians over a three-year period, identify changes in benefits and barriers to support successful NCPT implementation and determine future directions for NCPT progression. An online survey was performed in 2011 and repeated in 2014 by recruiting members of the Dietitians Association of Australia (DAA) through an email link. The survey assessed familiarity, knowledge, attitudes, benefits, barriers, concerns and use of educational enablers around the NCPT. The survey was completed by 218 respondents in 2011 and 205 respondents in 2014. Survey respondents from both years were representative of overall DAA membership. Respondent knowledge of NCPT increased significantly over the three-years, as did confidence, preparation, access to support and training and NCPT usage. Respondent's identification of benefits to implementation increased whilst barriers reduced. Attitudes regarding NCPT implementation were conflicting. Over three years, improvements were evident in NCPT knowledge, attitudes and usage. However, not all dietitians saw reason to implement NCPT in their practice, and some attitudes have become less supportive. A collective vision is required to foster positive attitudes towards the transformational professional benefits possible from NCPT. With ongoing uptake of electronic health records, the potential for NCPT to evaluate and justify dietetic interventions is increasing.

Toward Harmonization of the Nutrition Care Process Terminology and the International Classification of Functioning, Disability and Health−Dietetics: Results of a Mapping Exercise and Implications for Nutrition and Dietetics Practice and Research

Toward Harmonization of the Nutrition Care Process Terminology and the International Classification of Functioning, Disability and Health−Dietetics: Results of a Mapping Exercise and Implications for Nutrition and Dietetics Practice and Research

Assessment of Registered Dietitians' Beliefs and Practices for a Nutrition Counselling Approach.

This study describes registered dietitians' (RDs) perceptions and use of a nutrition counselling approach (NCA) as defined by the American Academy of Nutrition and Dietetics Nutrition Care Process terminology (NCPT). A cross-sectional online survey was administered to approximately 500 RDs in Alberta, Canada. Items included demographics, job characteristics, perceived knowledge, competence, use of an NCA, training experience, and theory of planned behaviour salient beliefs. Descriptive analyses compared RDs who counselled "all or most" of their clients with those who counselled "some or none." Salient beliefs were analyzed using content analysis. Of the 349 RDs who completed the survey, 64.2% provided an NCA to "all or most" of their patients. RDs were supportive of using an NCA (mean = 8.7/10, SD = 1.9) and most RDs (84.5%) had received training on an NCA. Salient beliefs included advantages (e.g., improved behaviour change in patients) and disadvantages (e.g., inadequate time). Normative referents included colleagues (e.g., multidisciplinary team), managers, patients/clients, College of RDs of Alberta, and counsellors. The barriers and enablers were related to patients' situations, infrastructure, and RD supports. These results may enable decision makers to more effectively design and target training and implementation programs to improve RDs' NCA.

Medical Nutrition Therapy for Chronic Kidney Disease in Pregnancy: A Case Report

Medical Nutrition Therapy for Chronic Kidney Disease in Pregnancy: A Case Report

Increased familiarity, knowledge and confidence with Nutrition Care Process Terminology following implementation across a statewide health‐care system

AbstractAimInformation on attitudes and knowledge of practising dietitians regarding the Nutrition Care Process (NCP) and International Dietetics and Nutrition Terminology (IDNT) would be useful to inform effective implementation. The present study aimed to: (i) explore dietitians' expectations, perceptions and anticipated benefits of NCP/IDNT pre and post implementation; (ii) identify perceived implementation barriers and enablers; and (iii) develop and assess a train‐the‐trainer NCP/IDNT implementation approach.MethodsAll Queensland Government State hospitals from metropolitan, regional and remote areas were included in the study. Dietitian champions (n = 17) attended one face‐to‐face, train‐the‐trainer day, then led 14 one‐hour educational sessions to 279 district dietitians tailored to local situations, facilities and resources. NCP/IDNT were embedded into local processes and chart audits completed. Pre‐/post‐implementation surveys were completed by 86 dietitians.ResultsPre‐implementation results showed positive attitudes regarding the value of NCP/IDNT (mean 1.89, SD 0.67, 1 = strongly agree, 5 = strongly disagree). Dietitians identified management support; practice, tutorials and workshops; mentor support; and follow up audits as important for successful implementation. Most attendees (81%) completed ≥10/13 tutorials and 86% (415/480) of audited charts included Nutritional Diagnosis statements. Post‐implementation familiarity, confidence and knowledge of NCPT (Nutrition Care Process Terminology) significantly improved (P &lt; 0.001).ConclusionsPrior to implementation, respondents viewed the NCP/IDNT as applicable to their practice areas. The train‐the‐trainer program with frequent teleconference and email support was effective in improving knowledge, confidence, preparedness for implementing NCPT and charting behaviour. Although training was positively received and has achieved good results, dietitians identified the need for ongoing training and support to further increase confidence following implementation.

Development of a Nutrition Care Process implementation package for hospital dietetic departments

AbstractAimThe Academy of Nutrition and Dietetics has led the development and dissemination of the Nutrition Care Process (NCP), incorporating the Nutrition Care Process Terminology as the standardised language. This research investigates and compares the views of Australian dietitians pre and post NCP implementation to inform development of an NCP implementation package.MethodsDietitians from two hospitals that had undergone informal NCP implementation (post‐implementers, n = 35) and three hospitals yet to implement NCP (pre‐implementers, n = 35) completed an online questionnaire (ASK NCP) surveying demographics and constructs relating to knowledge, familiarity, confidence, support, value, barriers, training and NCP education.ResultsPost‐implementers had higher knowledge scores (P &lt; 0.05), were more familiar with NCP (P &lt; 0.01), confident to implement (P &lt; 0.01) and supported to use NCP (P &lt; 0.01) than pre‐implementers. Lack of knowledge, support, training and resources was identified as a barrier by pre‐implementers. Busy workloads and work status were identified as barriers by post‐implementers. Pre‐implementers felt they had insufficient NCP training; however, if further training and support were to be provided, almost all reported they would be more confident to implement. Keys to successful implementation included allocated time to practice and regular tutorials; support and leadership from their management and NCP department leader; and professional growth through understanding how change could benefit practice.ConclusionsThe results of the study were used to inform the development of an NCP implementation package. Kotter's eight stages of change were identified as the most appropriate change management model with the framework incorporated into the package development.

Evaluation of a Nutrition Care Process implementation package in hospital dietetic departments

AbstractAimIncorporation of the Nutrition Care Process (NCP) and NCP Terminology (NCPt) into clinical dietetics practice is advocated in Australia; however, no evidence‐based implementation process exists, which may hinder uptake. Based on formative research findings from the Attitudes Skill Knowledge (ASK) NCP survey and using a change management framework, we developed an implementation package for Australian hospital dietitians. This paper aims to report on the outcome of the pilot evaluation and efficacy of the package.MethodsDietitians from three hospitals (two tests and one control) in Western Australia who had not undergone NCP implementation were recruited. Evaluation occurred through administering the ASK NCP survey pre and post implementation in all subjects and focus groups at test sites. The Mann–Whitney U‐test was applied to determine whether the changes in the test group were significantly different to the control group. The Wilcoxon signed rank test was used to determine whether there were significant changes within groups. Focus groups were audio‐recorded, transcribed and then analysed for themes by the authors.ResultsCompared to pre‐implementation, the dietitians from the test hospitals had significantly higher NCP knowledge (P = 0.006), were more familiar with NCP (P = 0.01) and NCPt (P = 0.025), and more confident to utilise NCP practice (P = 0.011). Compared to pre‐implementation, the control group displayed significantly higher familiarity with NCP and NCPt (P = 0.041); however, significant improvements in other constructs were not observed. No significant difference was observed between groups for all constructs.ConclusionsDietitians found the package useful and would recommend it to Australian hospital dietetic departments.