Ascertainment of Nutrition Care Process (NCP)Implementation and Use of NCP Terminologies (NCPT) among Hospital Dietitians in the Philippines

Background and Objective@#The Nutrition Care Process (NCP) is a systematic method used by dietitians to provide high-quality nutrition care resulting in good patient outcomes. This study aimed to assess the NCP implementation and use of NCP Terminologies (NCPT) among hospital dietitians in the Philippines. Specifically, the study aimed at assessing the knowledge, perception, and practices on NCP and use of NCPT and correlate them with the dietitians' education, and professional and employment profile; and explain the barriers and facilitators of the practice of NCP and use of NCPT among hospital dietitians in the Philippines. @*Methods@#The knowledge, perception, and practices (KPP) on NCP and NCPT of the dietitians employed in the Philippine Department of Health’s licensed level 3 hospitals were determined using a validated questionnaire. Significant factors associated with the KPP were also determined. The barriers and facilitators of the practice of NCP and NCPT were determined using focus group discussion and key informant interviews of chief clinical dietitians and hospital administrators, respectively. @*Results@#The study revealed that majority of the participants had a high level of knowledge on NCP and NCPT, positively perceived its implementation, and more than half of them implement NCP and NCPT in the hospitals. The participants’ knowledge on NCP and NCPT was significantly associated with research involvement and active membership in a professional organization. While the practice of NCP and NCPT was significantly associated with having NCP-related trainings, frequency of trainings, and active membership in a professional organization. The barriers to NCP implementation were insufficient resources; lack of orientation, trainings, and support; organizational and administrative constraints; pandemic constraints; insufficient time; and lack of confidence to conduct NCP. While the facilitators of implementation were collaboration, dedication, and commitment of the healthcare team; institutionalization of NCP laws and policies; budget allocation for NCP-related activities; monitoring and consistency of NCP implementation; and work schedule. @*Conclusion@#The findings suggest that the implementation of NCP and NCPT in the Philippines needs further support from the institution, professional organizations, and policy makers by developing strategies to cope with the barriers, and strengthen the facilitators and factors associated with practice.

Nutrition Counseling in an Academic Medical Center According to Socioeconomic Status and Grocery Shopping Consumer Behavior Decreased Relative Fat Mass in Breast Cancer Survivors

ABSTRACT Background: Body composition assessment in breast cancer survivors (BCSs) is essential to plan feasible dietary strategies for sarcopenic obesity prevention. Objective: Studying the effect of an individualized nutrition intervention according to socioeconomic status and grocery shopping behavior on BCSs relative fat mass (RFM). Methods: BCSs attending an academic medical center were studied; participants saved all 1-week supermarket tickets and answered a grocery shopping consumer preference survey. RFM was assessed at baseline and after the 3-month nutrition intervention. Nutrition plans were based on the dynamic macronutrient meal-equivalent menu method (MEM) and dietary guidelines for BCSs. Results: Thirty-three BCSs completed the study and 91% of them presented obesity or overweight at baseline. After the intervention, BCSs lost 1.6 kg (p < 0.01) of body weight, 1.8 kg (p < 0.01) of RFM, 3 cm (p < 0.01) of waist circumference, and 2.4 cm (p < 0.01) of hip circumference, while no changes were observed in fat-free mass (p = 0.6) and arm bone-free muscle area (p = 0.7). Conclusions: RFM and body weight in breast cancer survivors decreased after an individualized nutrition intervention according to socioeconomic status and grocery shopping consumer behavior. Based on the participants’ food preferences and consumer behavior, plant-based protein diet plans cost less than the animal-based protein diet plans.

Quality of nutritional care assessment among critically-ill patients in a tertiary government hospital

@#<p style="text-align: justify;"><strong>Background and Objectives:</strong> Malnutrition is prevalent both at baseline admission and because of hospitalization. It is aggravated by adverse hospital practices and results in poor outcomes, reduced quality of life, and higher treatment costs. Improving quality of care involves nutritional intervention as a low-risk, cost-effective strategy which guides providers in improving practices systems-wise. This study aims to assess the quality of nutritional care and the nutritional status of critically- ill patients admitted in a low-resource setting.</p><p style="text-align: justify;"><strong>Materials and Methods:</strong> This is a mixed methods study among adults admitted in intensive care units (ICUs) of a tertiary government hospital. Anthropometric and biochemical indicators were obtained through chart review. The degree of malnutrition was assessed using the Subjective Global Assessment. Quality indicators under Donabedian domains were assessed and compared to current standards. The length of ICU stay and mortality rate were recorded. Dietary prescription and provision practices of healthcare providers were supplemented by a focus group discussion (FGD). Factors causing provision interruptions were also identified.</p><p style="text-align: justify;"><strong>Results and Discussion:</strong> Sixty-four ICU admissions were included. Staff-to-patient ratio was not ideal. Under process-related factors, out of 49% with actual anthropometric documentations (rest were estimates), 24% had normal body mass indices (BMI), 17% were underweight, and the rest were either overweight or obese. The baseline ICU malnutrition rate was 69%. Malnutrition screening, and assessment of risk and biochemical indicators were not done routinely. Majority (92%) had baseline dietary prescription but only 69% had specific energy and macronutrient breakdown, all done through predictive weight-based equations. Nutritional supplies arrived within 8 hours in 65% of patients. Feeding was initiated within 24-28 hours in 94% of patients. Commercial formula was the preferred type of enteral nutrition (EN). Total duration on nothing-by-mouth (NPO) (hours) throughout ICU stay was significant. Supportive measures to improve gastro-intestinal (GI) tolerance were not standardized. Common factors in delaying feeding initiation were hemodynamic instability, fasting for procedures and GI bleeding. Throughout the ICU stay, fasting for procedures, hemodynamic instability and mechanical ventilation (MV)-related factors were common. ICU mortality rate was 19% and average length of ICU stay was 5 days.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Malnutrition is still prevalent in our ICUs and is affected by suboptimal healthcare practices. Staff - to-patient ratios, malnutrition risk screening and assessment, dietary referrals, documentation and minimizing interruptions in nutritional care provision needs improvement. A system review and establishment of a nutrition team is imperative.</p>

Evidence-based Nutritional Intervention Protocol for Korean Moderate-Severe Obese Children and Adolescents

Diet-related behavioral modification for healthy eating and lifestyle is required to improve childhood obesity. The present study aimed to develop customized nutritional intervention protocol and education program to find barriers to adhere healthy diet and lifestyle for moderate to severe obese children and adolescents and their families. Theoretical framework approaches can be used to change behavior and achieve goals. Previous studies that described the relationship between behavioral modification and nutrition education theory were reviewed. The social cognitive theory and transtheoretical model were employed with behavioral changes to target a healthful diet and lifestyle. The nutrition care process (NCP) model was adopted to customize nutrition care for the participants. Customized nutritional intervention protocol was developed following as the four steps of the NCP. Firstly, nutrition status of the participants was assessed by the nutrition expert. Nutrition problems were described as “inadequate energy intake,” “overweight/obesity,” or “food and nutrition-related knowledge deficit.” All nutrition sessions were designed for nutrition intervention to give nutritional knowledge and a practical mission in real life for individual goal setting and self-control. Meal planning, portion control, healthy snack selection and cooking with fruits and vegetables were consisted of five components of the nutrition education session. During each session, the participants and their families were interviewed by a nutrition expert for monitoring and evaluating diet-related goal setting and achievement. A theoretical and evidence-based nutritional intervention was developed for the secondary to tertiary prevention of childhood obesity. This nutrition intervention protocol and program might be helpful for the further research on childhood obesity. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0002111

Nutritional Intervention Using Nutrition Care Process in a Malnourished Patient with Chemotherapy Side Effects

In this case study, the process of nutritional diagnosis and intervention conducted at a hospital on a malnourished patient who underwent treatment for a chronic illness (chemotherapy for cancer treatment) was recorded. The patient received his first round of chemotherapy for colorectal cancer, and then a second round after the cancer metastasized to the liver. The patient was malnourished and had experienced weight loss (17% loss in the most recent 3 months) due to side effects of chemotherapy including stomatitis, nausea, and vomiting. Nutritional diagnosis and intervention via the nutrition care process were implemented through two screening rounds, and the quantity of oral intake increased from 28% to 62% of the recommended daily intake. The patient required continuous monitoring and outpatient care after hospital discharge. It is speculated that if a more active patient education and dietary regimen with respect to chemotherapy side effects had been offered after the patient's first chemotherapy cycle, it might have been possible to treat ingestion problems due to stomatitis during the second cycle of chemotherapy and prevent the weight loss. Henceforth, patients receiving chemotherapy should be educated about nutrition management methods and monitored continuously to prevent malnutrition.

Nutrition Diagnostic Analysis for Nutrition Care Process Model in Adults of a Health Screening & Promotion Center / 대한지역사회영양학회지

OBJECTIVES: This study was performed to examine nutrition problems and causes/contributing risk factors. METHODS: This study was conducted using data 1,863 adults visited Asan health screening & promotion center located in Seoul, Korea during May to June of 2013. We used Nutrition Care Process Model developed by the International Dietetics & Nutrition Terminology (IDNT). RESULTS: The most frequent nutrition problem in male subjects was excessive alcohol intake. Men in fifties showed the highest rate of excessive alcohol intake among the age groups examined (22.4%). By comparison, the most frequent nutrition problem in women was inadequate protein intake. Women in fifties exhibited the highest rate of inadequate protein intake (22.5%). The most common contributing factors for these observations were a low preference for dairy products followed by high preference for alcohol and a deficit in food-and nutrition-related knowledge, regardless of the sex and age. The most common nutrition problem observed among the group diagnosed with hyperglycemia or hypertriglyceridemia or hyperuricemia or fatty liver was excessive alcohol intake (p<0.001), whereas the group diagnosed with hyperglycemia or hypercholesterolemia showed significantly higher rate of inappropriate intake of carbohydrate (fructose) compared to the group not diagnosed with such disease conditions (p<0.05). The group diagnosed with hypercholesterolemia, hyperuricemia and fatty liver showed significantly higher occurrence of inappropriate intake of fat (saturated fat) than the group free of such diseases (p< 0.001). The osteopenia group showed higher rate of inadequate protein intake (p<0.001) and the fatty liver group with excessive energy intake (p<0.001). Overall, the results suggest that there is a significant relationship between nutrition problems and health conditions found in groups diagnosed with a diverse array of medical conditions. CONCLUSIONS: Therefore, we strongly suggest that dieticians should implement nutrition interventions with people visiting health screening & promotion center based on nutrition problems and the contributing factors diagnosed by dietitions in order to prevent chronic diseases in this population.

A Survey on the Status of Nutrition Care Process Implementation in Korean Hospitals

The Nutrition Care Process (NCP), developed by the American Dietetic Association, is a significant issue to dietetic professionals in many countries and there are rising needs for NCP implementation in Korea. We surveyed clinical nutrition managers of Korean general hospitals regarding the perception of NCP, the status of NCP implementation, and the opinions on NCP. The questionnaire was collected from 35 hospitals. Most clinical nutrition managers perceived NCP, but NCP implementation in hospital was at early stage. NCP was implemented in a fourth of the surveyed hospitals and many clinical nutrition managers responded that the lack of knowledge and the concern on increasing working time were major barriers to implementing NCP. To successfully implement NCP in Korean hospital, ongoing education and training programs should be developed to provide adequate knowledge and help dietitians to cope with the barriers.

Nutrition Care Process and Diabetes: Focus on Nutrition Diagnosis / 임상당뇨병

ADA's Nutrition Care Process (NCP) is defined as "a systematic problem-solving method that dietetics practitioners use to critically think and make decisions to address nutrition-related problems and provide safe, effective, high quality nutrition care." The NCP is a standardized process not standardized care. The NCP consists of four distinct but interrelated steps: (1) nutrition assessment, (2) nutrition diagnosis, (3) nutrition intervention, and (4) nutrition monitoring and evaluation. The second step, nutrition diagnosis, is the newest addition to the nutrition care process. The desired format for writing a nutrition diagnosis is a PES (problem, etiology, and signs and symptoms) statement. Nutritional management for diabetes patients is conducted differently by each registered dietitian and medical institution. If a nutritional diagnosis is identified by nutrition assessment in diabetes patients and the accompanying process, which includes implementation of nutrition intervention and monitoring and evaluation of the results of intervention, is standardized, high quality nutritional management through standardized language and documentation is expected to result.

Development of supplemental nutrition care program for women, infants and children in Korea: NutriPlus+

Onto the world-fastest ageing of society, the world-lowest fertility rate prompted a development of various policies and programs for a betterment of the population in Korea. Since the vulnerability of young children of low socio-economic class to malnutrition was clearly shown at the in-depth analysis of the 2001 Korea National Health and Nutrition Examination Survey data, an effort to devise supplemental nutrition care program for pregnant/breastfeeding women, infants and preschool children was initiated. The program was designed to offer nutrition education tailored to fit the needs of the participants and special supplementary foods, using USDA WIC program as a benchmark. Based on the dietary intake of those age groups, target nutrients were selected and their major food sources were searched through nutrient content of foods and dietary pattern analysis. As a result, we developed 6 kinds of food packages using combinations of 11 different food items. The amount of each item in a food package was determined to supplement the intake deficit in target nutrients. Nutrition education in NutriPlus + aims to improve the nutrition knowledge, attitude, and dietary behaviors of the participants, and is provided through group lessons, individual counseling sessions and home visits. Breastfeeding is promoted with top priority in education for the health of both mother and baby. The eligibility guidelines were set for residency, household income, age, pregnancy/breastfeeding and nutritional risk such as anemia, stunting, underweight, and/or inadequate nutrient intake. Income eligibility was defined as household income less than 200 percent of the Korean poverty guidelines. A pilot study to examine the feasibility of program implementation was run in 3 public health centers in 2005 and expanded to 15 and 20 in the following 2 years. The result of 3-year pilot study will be reported separately along with the ultimate nationwide implementation of the NutriPlus + in 2008.

The Development of a Quality Measurement Tool for a Contract-Managed Hospital Foodservice / 대한지역사회영양학회지

The purposes of this study were: a) to develop the a quality measurement tool for the contract-managed hospital foodservice, and b) to evaluate their performance with the developed quality measurement tool, and c) to verify the reliability and validity of the quality measurement tool. The developed quality measurement tool comprised two parts, which were foodservice management and medical nutrition care service. The foodservice management part was classified into six functional categories which were Menu, Procurement and Storage, Production and Distribution, Facility and Utility, Sanitation and Safety, and Management and Evaluation. The medical nutrition care service part indicated the medical nutrition care provided. Quality measurement tool had 91 standards and 324 indicators. The quality measurement tools were distributed to the hospital foodservice manager employed by the foodservice company. The 324 indicators were measured by foodservice manager on the 5-Likert-type scales, and then adapted to a 100 point scale. The SPSS Ver. 11.0 was used for statistical analysis. The categories whose scores were evaluated as being high were Procurement', General Sanitation', Personal sanitation' and Waste' and the categories whose scores were evaluated as being low were Diet Order Manual', Standard Recipe', Appropriateness (Facility and Utility)', Check (Facility and Utility)' and Information Management'. All the categories of medical nutrition service were evaluated as having seriously low scores. Therefore, it was necessary for the contract-managed hospital foodservice to improve its performance in the area of medical nutrition care service. For the verification of the developed quality measurement tool, the reliability obtained by calculating Cronbach's alpha was 0.8747, and the content validity was also proved by scrutiny of the modification of the Professional group's techniques.