Dietitians' practices in dialysis units in Brazil: nutritional assessment and intervention / Práticas de nutricionistas em unidades de diálise no Brasil: avaliação e intervenção nutricionais

ABSTRACT Introduction: The importance of dietitians in dialysis units is indisputable and mandatory in Brazil, but little is known about the practices adopted by these professionals. Objective: To know practices adopted in routine nutritional care, focusing on nutritional assessment tools and treatment strategies for people at risk or diagnosed with malnutrition. Methodology: Electronic questionnaire disseminated on social media and messaging applications. It included questions that covered dietitians' demographic and occupational profile characteristics and of the dialysis unit, use and frequency of nutritional assessment tools, nutritional intervention strategies in cases of risk or diagnosis of malnutrition, prescription and access to oral supplements. Results: Twenty four percent of the Brazilian dialysis units (n = 207) responded electronically. The most used nutritional assessment tools with or without a pre-established frequency were dietary surveys (96%) and Subjective Global Assessment (83%). The strategies in cases of risk or presence of malnutrition used most frequently (almost always/always) were instructions to increase energy and protein intake from foods (97%), and increasing the frequency of visits (88%). The frequency of prescribing commercial supplements with standard and specialized formulas was quite similar. The availability of dietary supplements by the public healthcare system to patients varied between regions. Conclusion: Most dietitians use various nutritional assessment tools and intervention strategies in cases of risk or malnutrition; however, the frequency of use of such tools and strategies varied substantially.

Resumo Introdução: A importância da atuação do nutricionista em unidades de diálise é indiscutível e obrigatória no Brasil, porém pouco sabemos sobre as práticas adotadas por esses profissionais. Objetivo: Conhecer práticas adotadas na rotina dos atendimentos nutricionais, com foco nas ferramentas de avaliação nutricional e nas estratégias de tratamento das pessoas com risco ou diagnóstico de desnutrição. Metodologia: Questionário eletrônico divulgado em mídias sociais e aplicativos de mensagens. Incluiu questões que abrangiam características do perfil demográfico e ocupacional do profissional e da unidade de diálise, utilização e frequência de ferramentas de avaliação nutricional, estratégias de intervenção nutricional em casos de risco ou diagnóstico de desnutrição e prescrição e acesso a suplementos alimentares orais. Resultados: Foram recebidos eletronicamente o equivalente a 24% das unidades de diálise brasileiras (n = 207). As ferramentas de avaliação nutricional mais utilizadas com ou sem frequência pré-estabelecida foram inquéritos dietéticos (96%) e Avaliação Global Subjetiva (83%). As estratégias em casos de risco ou presença de desnutrição utilizadas com mais frequência (quase sempre/sempre) foram a orientação de incremento energético e proteico por meio de alimentos (97%) e o aumento da periodicidade das visitas (88%). A frequência de prescrição de suplemento industrializado de fórmula padrão e especializada foi bastante semelhante. A disponibilização de suplementos alimentares pelo Sistema Único de Saúde aos pacientes variou entre as regiões. Conclusão: A maior parte dos nutricionistas utiliza diversas ferramentas de avaliação nutricional e estratégias de intervenção em casos de risco ou desnutrição, porém a frequência de utilização de tais ferramentas e estratégias foi bastante variada.

Demographic and occupational profile of dietitians working in dialysis centers in Brazil / Perfil demográfico e ocupacional de nutricionistas que atuam em unidades de diálise no Brasil

ABSTRACT Introduction: In 2004, the Ministry of Health stipulated that dialysis centers were required to have at least one dietitian on their staff. However, the regulation did not include recommendations regarding the number of dietitians or the workload based on the number of patients assisted. Objective: To describe the demographic and occupational profiles of dietitians working in dialysis centers in Brazil. Methodology: An electronic questionnaire was disseminated in social media and messaging apps with questions about the demographic and occupational profile of dietitians working in dialysis centers and matters related to patient care. Results: A total of 207 questionnaires were answered, covering 24% of the dialysis centers in Brazil. More than half of the dietitians (58%) had worked for more than five years in dialysis centers, and 83% reported additional training in Nephrology. The median (interquartile range) number of patients per monthly working hour was 1.6 (1.0-2.3). Considering all dialysis centers, 64% of the patients were seen at least once a month. Differences in demographic/occupational profiles and patient care were associated with workload, the main source of dialysis funding, and Brazilian geographical region. Conclusion: Most dietitians were experienced and trained in Nephrology. Substantial variability was found in the number of patients per dietitian workload, and proportion of patients receiving monthly nutritional care. Further studies are needed to discuss the demands of dietitians, dialysis centers, and patients.

RESUMO Introdução: Em 2004, o Ministério da Saúde estabeleceu que cada serviço de diálise deve ter no mínimo um nutricionista vinculado a ele. Porém, a regulamentação não incluiu recomendações em relação ao número de profissionais ou à carga horária de acordo com o número de pacientes assistidos. Objetivo: Conhecer o perfil e as práticas de nutricionistas que atuam em unidades de diálise brasileiras. Metodologia: O questionário eletrônico divulgado em mídias sociais e aplicativos de mensagens incluiu questões que abrangiam características do perfil demográfico e ocupacional do profissional e da unidade de diálise, além de perguntas relacionadas ao atendimento dos pacientes. Resultados: Foram recebidos eletronicamente 207 questionários, o equivalente a 24% das unidades de diálise brasileiras. Mais da metade dos nutricionistas (58%) atuava havia mais de cinco anos em unidades de diálise e 83% referiram formação complementar na área da Nefrologia. A mediana (interquartis) do número de pacientes por hora mensal de trabalho foi 1,6 (1,0-2,3). Considerando todas as unidades, o percentual de pacientes atendidos mensalmente foi correspondente a 64%. Diferenças no perfil e nas práticas foram encontradas de acordo com a carga horária, principal fonte financiadora da unidade de diálise e região demográfica brasileira. Conclusão: A maioria dos nutricionistas tem boa experiência e formação na área. Foi encontrada uma grande variabilidade em relação ao número de pacientes por carga horária do profissional e do percentual de indivíduos que recebiam atendimento nutricional mensal. São necessárias investigações que avaliem questões relacionadas tanto às demandas dos profissionais quanto às das unidades contratantes e dos pacientes.

Profesionalismo en el nutricionista: ¿Qué es y cómo incorporarlo en la formación de pregrado?

RESUMEN El profesionalismo es un pilar fundamental en la formación y ejercicio profesional de un nutricionista que implícitamente se ha incluido y desarrollado en los estándares de práctica. Recientemente se ha intentado establecer una terminología común para su definición, esta se basa en cuatro aspectos centrales: a) atributos personales como empatía, autoconciencia e inteligencia emocional, b) comunicación interpersonal, tanto con pares, otros profesionales de la salud y usuarios, c) actuar centrado en la práctica, que considera el entorno laboral en cuanto a las leyes y normativas que rigen el actuar profesional y 4) compromiso con el aprendizaje permanente, como el proceso de reflexión y autoevaluación del propio trabajo. Para garantizar un actuar profesional, la enseñanza del profesionalismo debe ser considerada de manera formal en el plan curricular, implementando distintas técnicas educativas y evaluaciones correspondientes que permitan la adquisición de conocimientos y habilidades necesarias. En el proceso formativo cobra especial relevancia el contexto y ambiente en el que se desempeñan los estudiantes para un óptimo uso de recursos.

ABSTRACT Professionalism is a fundamental aspect in the training and professional practice of a dietitian that has been implicitly included and developed in standards of practice. However, recently, an attempt to establish a common terminology for its definition has been made. The concept of professionalism is based on four central aspects: a) personal attributes such as empathy, self-awareness and emotional intelligence, b) interpersonal communication, both with peers, other health professionals and users, c) approach to practice, which considers the laws and regulations that govern professional actions, and 4) commitment to lifelong learning, such as the process of reflection and self-evaluation. To guarantee professionalism in dietitians, the teaching of professionalism must be considered formally in the plan of study, implementing different educational techniques and corresponding evaluations that guarantee the acquisition of necessary knowledge and skills. In the training process, the context and environment in which students work is especially relevant for an optimal use of resources.

Carbohydrate counting in type 1 diabetes mellitus: dietitians' perceptions, training and barriers to use

Objectives A study was undertaken to determine the perceptions, training and barriers regarding the use of carbohydrate counting in the dietary management of type 1 diabetes mellitus (T1DM) among dietitians in KwaZulu-Natal (KZN). Design A cross-sectional, descriptive study was conducted. Setting Dietitians who were registered with the Health Professions Council of South Africa (HPCSA), and working in the province of KZN at the time of the study, were invited to participate. Methods Data were collected using a self-administered electronic questionnaire distributed through SurveyMonkey, an Internet-based survey programme. Results Dietitians agreed that carbohydrate counting was a useful dietary management approach for diabetes (p < 0.05) and that it was essential to manage T1DM (p < 0.05). However, they felt it was a difficult concept for patients with T1DM to understand (p = 0.001) and teaching it to patients was time consuming (p < 0.05). Although dietitians believed that there was a strong evidence base for teaching carbohydrate counting to patients with T1DM (p < 0.05), they indicated a need for further training or education in it (p < 0.05). Barriers to using carbohydrate counting included a lack of training, confidence and experience, financial resources, time, blood glucose records and poor patient motivation and patient illiteracy (p < 0.05). Conclusions Overall, dietitians who participated in the study had a positive perception towards the use of carbohydrate counting in the management of T1DM. However, further training needs to be addressed for carbohydrate counting to be used with confidence by dietitians in KZN to optimize their management of T1DM.

Progress of clinical nutrition support management and corresponding data analysis in a tertiary (A) children's hospital in Shanghai in the past ten years / 中华临床营养杂志

Objective:To analyze the paradigm and changes of enteral nutrition support for hospitalized children in Shanghai Children's Medical Center affiliated to School of Medicine of Shanghai, Jiao Tong University in last ten years, so as to provide guidance for nutritionists and dietitians on the application and management of enteral nutrition.Method:Relevant data were collected and analyzed from 2011 to 2020 in the Clinical Nutrition Department of Shanghai Children's Medical Center, including the implementation status of parenteral and enteral nutrition as well as the types and distribution of different enteral nutrition formulas and diet.Results:The Clinical Nutrition Department of our hospital provided seventy-five types of diet for hospitalized children. The utilization of ordinary diets and specialized diets has been stable at about 76,000 cases per year. In the past decade, twenty-one ordinary formulas and special formulas were provided every year by the Clinical Nutrition Department in our hospital and the utilization has been stable at 46,000 cases per year. The total consumption of ordinary formulas and the proportion of ordinary formulas users showed a descending trend. The proportion of specialized formulas users among discharged patients remained at 10%, with an upward trend in the proportion of high-calorie formulas and extensively-hydrolyzed formulas.Conclusions:The enteral nutrition formulas and inpatient diets are important components of nutritional treatment. The evolution of its clinical application to some extent reflects the changes of disease spectrum and the development of clinical disciplines. In short, the dietitians play a significant role in the nutrition support team.

Determinants of research capacity and involvement of hospital dietitians in selected hospitals in Metro Manila

@#<p style="text-align: justify;"><strong>Objective:</strong> This study aimed to: 1) describe the current state of research activity/involvement and capacity among selected tertiary level government and private hospital dietitians; 2) identify factors associated with research capacity and involvement; and 3) develop policy recommendations to improve the current research activity/involvement towards evidence-based practice among hospital dietitians.</p><p style="text-align: justify;"><strong>Methods:</strong> This is a cross-sectional descriptive study. A total of randomly selected 181 hospital dietitians from selected hospitals in Metro Manila completed a pre-tested structured self-administered questionnaire, which elicited the socio-demographic characteristics, research activity/involvement, research capacity, perception, attitude and knowledge (PAK) of the respondents.</p><p style="text-align: justify;">Descriptive statistics were generated. Pearson Correlation was determined between socio-demographic characteristics and research activity/involvement score and research capacity score. Linear multiple regression analysis was conducted to test whether perceptions, attitudes and knowledge score are factors that predicted research activity/involvement and research capacity.</p><p style="text-align: justify;"><strong>Results:</strong> No significant difference was observed in hospital dietitians' research capacity scores based on gender, age, educational attainment, hospital affiliation, and job description. Majority (97%) of the hospital dietitians had very little participation (10%) or involvement in any type of research activity/involvement. The significant factors that were predictive of research activity/involvement scores and research capacity scores were percent of time for research and hours per week devoted to research, respectively. Percent of time for research was significantly predictive of research knowledge of respondents.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The findings in this present study showed the research activity/involvement and capacity of hospital dietitians in Metro Manila were dismally low. The significant factors that were predictive of research activity/involvement scores and research capacity scores were percent of time for research and hours per week devoted to research, respectively. To support the development of research capacity and involvement of hospital dietitians, policy-makers and healthcare organizations can optimize capability-building strategies at the academic level, hospital dietitian level, and institutional level.</p>

Necessary Knowledge and Skills for Dietitians in Saudi Arabia: A Qualitative Study

@#Background: Dietitians play a major role in health promotion and chronic diseases prevention. Graduates from clinical nutrition and dietetics major should be equipped with the necessary knowledge and skills for their role to be more effective. The purpose of this study is to investigate the knowledge and skills needed by current and future graduates in clinical nutrition and dietetics. Methods: In this qualitative study, structured interviews by focus groups were conducted. Dietitians from different governmental and private sectors were invited to participate in the study. Focus groups were stratified based on the participants’ gender and years of experience to promote self-disclosure. Abridged transcript of relevant and useful points was performed. The transcripts were coded and cross-validated by two researchers. Results: A total of four focus groups were conducted. Two focus groups comprise 9 male participants and the other two comprise 10 females. The age of participants ranged 25–40 years old. Participants were employees in Riyadh city with experience that ranged 3–10 years old. Nine themes of the necessary knowledge and skills were identified. Conclusion: It is recommended for the Saudi government to create standards specialised for clinical nutrition and dietetics undergraduate and graduate programmes.

Contexto, desarrollo y alcances del primer curso de dietistas en Chile (1939) / Context, development and scope of the first dietitian course in Chile (1939)

RESUMEN El objetivo fue reconstruir la creación del primer curso de dietistas creado en Chile en 1939 y que a comienzos de la década de 1940 se transformó en escuela. Para ello se busca dar a conocer los dos modelos de formación de dietistas existentes en el periodo, señalando las razones de la contratación del húngaro Esteban Kémeny. Además, se ofrecen los diagnósticos críticos que se hicieron durante los años 1930 sobre la alimentación hospitalaria y la necesidad de capacitar al personal en la técnica dietética. El artículo muestra la fuerte vinculación existente entre la urgencia de reformar la cocina hospitalaria y la oferta académica del curso, el cual buscaba capacitar a las enfermeras y otras profesiones femeninas, las que se entendían como auxiliares del médico, sin autonomía profesional.

ABSTRACT The aim was to reconstruct the creation of the first course for dietitians created in Chile in 1939, which in the early 1940s became a school. Two models of training of dietitians in the period are presented, which indicate the reasons for the recruitment of the Hungarian, Esteban Kémeny. In addition, critical suggestions on hospital feeding and the need to train staff in the dietary technique were offered during the 1930s. The article shows the strong link between the urgency to reform the hospital kitchen and the academic offering of the course, which sought to train nurses and other female professionals, which were understood as auxiliaries of the physician, without professional autonomy.

Stakeholder's Demand for School Breakfast Programs in High School at Chungcheong Areas

The purpose of this study is to observe students' eating habits and to evaluate the necessity of high school breakfast service by surveying concerned persons such as high school dietitians, parents, and students to find practical solutions to decrease the breakfast-skipping rate of the high school students in Chungcheong. The data were collected from 75 dietitians, 584 students, and 420 parents. Parents and students participated the survey more positively, and the more monthly income participants' families had, the probability of participation increased by 1.5 times (OR=1.452). Parents suggested that breakfast should be offered at a lower price (1,000~2,000 won) than school lunch, and for the school breakfast cost, they preferred to bear the expense together with schools. For the type of breakfast, the dietitians preferred convenient foodservice (40.0%), the students preferred simple meals such as bread, milk, fruit and salad (3.97), and Kimbap, Joomukbap et al (3.93) rather than Korean traditional foods (3.76) such as rice, soup and side dish. The dietitians answered ‘needed’ and ‘very much needed’ to the necessity of breakfast relatively low by 30.7%. As the result of the study, the researchers suggest the execution of school breakfast program should start first for the students who cannot have breakfast at home. Moreover, more studies should be conducted to reduce the constantly increasing rate of breakfast-skipping rate of high school students.

Professional practice of dietitians in the Brazilian School Feeding Program: A multiple case study / Atuação do nutricionista no Programa Nacional de Alimentação escolar: estudo de casos múltiplos

ABSTRACT Objective: To assess dietician's numerical parameters for school feeding and discuss limitations and possibilities for professional practice in the municipalities of Vale do Ivaí, in Northern Paraná, Brazil. Methods: This is a multiple case study. A semi-structured interview was administered to dietitians working at the School Feeding Program in nine cities located in Vale do Ivaí, Paraná, Brazil. Resolution nº 465/2010, from the Brazilian Federal Board of Dietitians, was used to calculate the adequacy of working hours of dietitians. The legistation of the Brazilian School Feeding Program was applied to discuss professional practice. Results: All the cities had at least one dietitian responsible for the School Feeding Program. The percentage of adequate working hours was from 20 to 66%. Some dietitians were involved in management activities, administration, procurement, and accounting, in addition to dietitian assignments for the School Feeding Program. Most dietitians worked in other sectors of the municipalities such as the health system, social assistance, and at events. This practice could compromise compliance of technical activities that must be met by the dietitians of the School Feeding Program. Conclusion: The number of dietitians in most of cities working at School Feeding Program is not sufficient to meet the number of students. The insuficient workload and excessive activities could hinder the development of dietitian's private activities. The hiring of nutrition and dietitian technicians and administrative assistants for bureaucratic activies is recommended.

RESUMO Objetivo: Verificar a adequação dos parâmetros numéricos de nutricionistas na alimentação escolar e discutir limites e possibilidades da atuação profissional no Programa de Alimentação Escolar em municípios do Vale do Ivaí, Norte do Paraná. Métodos: Estudo de casos múltiplos realizado por meio de entrevista semiestruturada com nutricionistas da alimentação escolar de nove municípios do Vale do Ivaí. A Resolução nº 465/2010, do Conselho Federal de Nutricionistas, foi utilizada como base para cálculo da adequação da carga horária do nutricionista. A legislação do Programa Nacional de Alimentação Escolar foi utilizada para discussão da atuação profissional. Resultados: Os municípios contavam com nutricionista responsável técnico pelo Programa de Alimentação Escolar, porém, o percentual de adequação da carga horária variou de 20 a 66%. Foram evidenciadas atividades de gestão, licitação e contabilidade, além das atribuições do nutricionista previstas para o Programa. A maioria dos nutri-cionistas também atendia a outras áreas dos municípios, como saúde, social e eventos, o que sugere um comprometimento das atribuições do profissional e, consequentemente, da execução do Programa. Conclusão: O número de nutricionistas no Programa Nacional de Alimentação Escolar nos municípios investigados é insuficiente em relação ao número de alunos. A carga horária insuficiente e a demanda excessiva de atividades podem impedir que o desenvolvimento de atividades privativas do nutricionista. A contratação de técnicos em nutrição e dietética e auxiliares administrativos para tarefas burocráticas deve ser incitada.

Beef Usage and Dietitians' Perceptions of Beef Quality in Institutional Foodservice

The purpose of this study was to compare the usage of beef and foodservice managers' perceptions of beef quality by foodservice type. A survey was conducted on 546 dietitians, and 499 acceptable responses were used for data analysis. By weight, pork was the most used meat in foodservice institutions, followed by poultry and beef. More than half of the foodservices selected meat suppliers by competitive bidding. Approximately 85.8% of the respondents used Hanwoo beef, followed by Australian beef and Youku beef. Beef type differed significantly by foodservice type (P<0.001): most of the schools and social welfare facilities used Hanwoo beef, whereas most hospitals and business/industry operations used Australian beef. When purchasing beef, safety of beef was rated the most important, while eco-friendliness was rated the least important. Most of the dietitians understood that marbling is one of the determinants of the beef quality, but were not aware of other components. Dietitians that selected Hanwoo and Youku beef were more satisfied with quality, taste, nutrition, freshness, country of origin, package, customer, preference, and availability for various menus than those who used imported beef. Dietitians who used Hanwoo beef were the most satisfied with country of origin, whereas the others were the most satisfied with safety. Since the dietitians are in charge of planning menus and selecting meat suppliers at foodservice institutions, they should make knowledgeable decisions by understanding meat supply systems and quality of beef.

Eating disorders and body image satisfaction among brazilian undergraduate nutrition students and dietitians

The objective of this study was to evaluate the prevalence of risk behaviors related to eating disorders and body image satisfaction among Brazilian dietitians and undergraduate Nutrition students. The national representative sample was composed of 427 undergraduate students of Nutrition and 318 dietitians. Data were collected via an online questionnaire. Body image satisfaction was assessed by the Body Shape Questionnaire, and attitudes suggestive of an eating disorder (called positive EAT) were assessed by the Eating Attitudes Test. Adjusted Prevalence Ratios were performed by Poisson’s regression. More than 50.0% of women were dissatisfied with their body image, but severe dissatisfaction was more prevalent among students (26.7% versus 16.0%). There was no difference in the prevalence of positive EAT test between both groups. Students with positive EAT had more chance of body dissatisfaction (PRadj 1.31; 95%CI 1.03-1.66). Dietitians with positive EAT had 35% more chance of being dissatisfied with their body image (PRadj 1.35; 95%IC 1.01-1.80). Undergraduate Nutrition students and dietitians are likely to develop attitudes suggestive of an eating disorder and being dissatisfied with their body image. The susceptibility of developing an eating disorder might have a relation with their professional field(AU)

O objetivo deste estudo foi avaliar a prevalência de comportamentos de risco relacionados com distúrbios alimentares e satisfação com a imagem corporal entre mulheres nutricionistas e estudantes de Nutrição brasileiras. Adotou-se uma amostra representativa nacional, composta por 427 estudantes de Nutrição e 318 nutricionistas. Os dados foram coletados por meio de um questionário on-line. A satisfação com a imagem corporal foi avaliada pelo Body Shape Questionnaire, e as atitudes sugestivas de transtorno alimentar (denominadas EAT positivo) foram avaliadas por meio do Eating Attitudes Test. Razões de Prevalências Ajustadas foram calculadas usando Regressão de Poisson. Mais de 50,0% das mulheres estavam insatisfeitas com sua imagem corporal, mas a insatisfação severa foi mais prevalente entre as estudantes (26,7% versus 16,0%). Não houve diferença na prevalência de EAT positivo entre os grupos. Estudantes com EAT positivo tinham mais chances de ter insatisfação corporal (PRadj 1,31; 95%CI 1,03-1,66). Nutricionistas com EAT positivo tinham 35% mais chances de estarem insatisfeitas com sua imagem corporal (PRadj 1,35; 95%IC 1,01-1,80). Estudantes de Nutrição e nutricionistas tendem a desenvolver atitudes sugestivas de transtornos alimentares e estarem insatisfeitas com sua imagem corporal. Sua susceptibilidade a transtornos alimentares pode ter uma relação com sua área de atuação profissional(AU)

Job importance, job performance, and job satisfaction in dietitians at geriatric hospitals or elderly healthcare facilities in Jeju / 한국영양학회지

PURPOSE: This study analyzed job importance, job performance, and job satisfaction in 38 dietitians working at geriatric hospitals and elderly healthcare facilities in Jeju surveyed from September 15-24, 2014 with the aim of providing basic data for improving the quality of meals and nutrition management for elderly patients. METHODS: Data were analyzed using descriptive analysis, χ²-test, t-test, ANOVA, and Pearson's correlation coefficients using the SPSS Win program (version 12.0). RESULTS: Regarding job importance, the average score was 4.29 (out of 5), indicating that hygiene and safety management scored the highest at 4.77 (out of 5), and nutrition management scored the lowest at3.86. In terms of job performance of subjects, the average score was 2.87 (out of 5), indicating that cooking operation management scored the highest at 4.42 (out of 5). Regarding the Importance-Performance Analysis (IPA) of job importance and job performance, hygiene and safety management and cooking operation management scored high for importance and performance (B quadrant) menu management, human resource management, and nutrition management scored low for importance and performance (C quadrant) and purchasing management and financial management were included inD quadrant and A quadrant, respectively. For the level of job satisfaction of subjects, the average score was 3.37 (out of 5), indicating that relationships with colleagues scored the highest at 3.72, and improving professionalism scored the lowest at 2.95. Additionally, job importance and performance of subjects were positively correlated withjob satisfaction (r = 0.395, r = 0.386, both p < 0.05). CONCLUSION: In conclusion, scores for job importance and job performance of nutrition management were low, and job satisfaction of improving professionalism scored low. Therefore, continuous training and education programs of nutrition management should be provided to improve professionalism of dietitians at geriatric hospitals and elderly healthcare facilities.

Investigation into Korean School Milk Program Management and Dietitians' Perception of School Milk Program Improvement

This study was aimed to investigate management conditions and dietitians' perception for improvement of school milk programs. Using an online sampling method, collected data from 1,723 dietitians nationwide were analyzed. The results show that 44.4% of respondents carried out the cyclic school milk program, providing various types of dairy products either weekly or monthly. Further, 80.3% of respondents answered that preference survey results were a determining factor in their choice of school milk provider, and 55.9% said that a school steering committee made the decision on relevant facts of the school milk program. For diversification of school milk type, 60.5% of respondents wanted to maintain the current system, and 39.5% answered that milk type needed to be diversified. The respondents preferred fermented milk products, functional milk, and processed milk, in order, if school milk type is diversified. To improve perception and knowledge about milk, 66.0% of respondents thought that nutrition education by a nutrition teacher would be the most effective, and parent's letters or a nutrition newsletter would be helpful. More than half of respondents (55.0%) disagreed with a merged program for school foodservice and milk.

Identifying Dietitian’s Experiences and Views of Other Health Professionals (HCPS) Giving Nutritional Advice (2013).

Background: There is an increase in dietary related long term conditions with insufficient numbers of dietitians to see all the patients requiring dietary advice. Previous research has highlighted that dietitians are uncertain as to the ability of healthcare professionals (HCPs) to give nutritional advice and that aspects such as training need improvements to increase the effectiveness of advice Doherty et al., [1]. The aim of this study is to expand on this research by identifying the HCPs dietitians commonly work with, whether dietitians think it is suitable for these HCPs to give nutritional advice and the role of dietitians in facilitating HCPs giving advice and any barriers to this role. Methods: An online questionnaire using the Bristol Online Survey Programme was developed. The participants were registered NHS dietitians in the Eastern Region. Verbal permission for the dietitians to participate was gained through their dietetic managers via a telephone call. Subsequent information and the questionnaire’s link was then e-mailed to participants via their dietetic manager. In total 300 dietitians were recruited. The data collected was then analysed using descriptive statistics and categorisation into key themes, Dey [2] & LoBiondo-Wood and Haber [3]. Ethics: Ethics approval was gained from the University of Hertfordshire’s Health and Emergency Professions Ethics Committee. Results: 84 dietitians responded (28% of those recruited), working in different dietetic settings alongside a wide range of HCPs, with the top 3 HCPs, the dietitians worked with, being diabetes nurses (69% respondents), General Practitioners, GPs, (64% respondents) and Speech and Language Therapists (66% respondents). Also, through the use of the “other” option, dietitians added addition HCPs such as health visitors, community carers, education programme leads (1% respondents). Overall, 91.7% of dietitians believed that HCPs giving advice is beneficial. The qualitative data gained highlighted two main themes; “HCPs involvement in first-line advice” and “implications of incorrect advice”. Discussion: Overall dietitians were positive about other HCPs providing first line nutritional advice. However concerns were raised with regards to incorrect advice being given by HCPs, due to barriers for dietitians in facilitating support such as limited time for training and high turnover of staff members. Dietitians were concern as incorrect, non-upto- date information given to patients could have a negative impact on patients Hankey, Eley, Leslie, Hunter and Lean, [3]. The dietitians’ classification of HCPs was also unclear. The original HCP list was composed using the HCPC register with the addition of doctors and nurses; however some participants classed other advisory sources such as health programme trainers as HCPs. This questions whether dietitians are aware of all potential advisory sources giving nutritional advice and also questions whether these sources have appropriate nutritional training. Conclusion: Overall, Dietitians believe that HCPs are beneficial when giving out first-line nutritional advice but were concerned with HCPs giving out more in-depth, complex advice. The dietitians’ definition of an HCP was also unclear, questioning whether dietitians are aware of all sources of nutritional advice. This is therefore a potential area that could be explored through further research.

Being Heard’ Dietitians Involvement in Making Decisions about Artificial Nutrition and Hydration.

Background: Decisions about artificial nutrition and hydration (ANH) can be difficult to make. Team working, good communication and listening to other team views are recommended in non-emergency decisions relating to ANH (Royal College of Physicians and British Society of Gastroenterology [1]. The experience of dietitians’ involvement in these decisions has not been investigated. This research aims to explore the lived experience of dietitians’ involvement in decisions related to ANH. Methods: 16 registered dietitians were interviewed as part of a qualitative phenomenological study exploring their experiences of involvement in decision-making related to ANH. Convenience sampling via an email advert to the West Midlands Branch of the British Dietetic Association membership enabled participants’ with a range of clinical experience and from a range of clinical settings to be recruited. Interviews were fully transcribed and analysed within an interpretive phenomenological framework van Manen [2]. Ethical approval was obtained from Coventry and Warwickshire Research ethics committee. Results: ‘Wanting to be heard’ was a key theme which was made up from the subthemes of ‘being heard’, ‘trying to listen’ and ‘not being heard’. The sub-theme of ‘being heard’ is reported here. For my participants successful involvement in decision-making meant their voice ‘being heard’. This did not necessarily mean having their view accepted and adopted, but to them it meant being listened to and respected. Participants who were listened to and respected were known by the team and had positive working relationships with them. This was facilitated by have a physical presence in the clinical setting and being seen to make a difference to patient care. Many felt they needed to prove their worth to the team. For my participants, ‘being heard’ was also about speaking up for what they believed was right. For example if it was appropriate to initiate, continue with or withdraw a feed which may be related to end of life situations. Discussion: For these participants positive team relationships were needed to enable them to be heard. Attendance at team meetings where the clinical benefits of dietetic input on patient care could be discussed helped relationships to develop. Time was a barrier to this for some participants. Speaking up about appropriate use of ANH is interesting as implies that participants are not just thinking about ANH as fluid and fuel for the body, but ethical aspects as well. It might be expected that dietitians would promote the initiation and continuation of feeding as they are trained to detect, treat and prevent malnutrition. However, many participants took a more holistic view, showing courage to speak up and ethical sensitivity that it might not be right to feed some patients in certain situations. For some participants ‘being heard’ enabled them to demonstrate expert power. Mandel and Garey’s survey of New Jersey dietitians suggests this is important for dietitians, Mandel and Garey [3]. Conclusion: Dietitians want to have their opinions heard to inform the decision making process. However having opinions respected and listened to appeared to be more important than if their decision which was implemented. Developing relationships with the team and showing clinical benefits of dietetic input on patient care facilitated them ‘being heard’. Time may be a barrier to this. Many participants had the courage to speak up for what they believed was right.

Dietitians’ Perceptions of Developing Best Practice in Communication Skills.

Background: The communication skills of health care practitioners, such as Registered Dietitians (RDs) are increasingly recognised as fundamental to patient care and monitoring the effectiveness of these skills is recommended [1,2]. The aim of this study was to explore experienced RDs views on best practice in relation to the use of communication skills for behaviour change (CSBC) and the assessment of these skills in practice. Methods: This qualitative study recruited eight RDs from the East Midlands and Yorkshire to participate in semi-structured interviews. The study was part of a larger mixed methods study which developed and validated a tool for the assessment of CSBC in dietetic consultations, DIET-COMMS. The details of sampling, recruitment, ethics and research methods including data collection, data management and data analysis have been reported elsewhere [3]. Participants had viewed and assessed 20 video recorded mock dietetic consultations. This study is a preliminary report of their opinions of those consultations, the importance of CSBC in dietetics, what best practice is and possible methods for professional development in this area. Interviews were transcribed verbatim and subject to inductive thematic analysis. Results: Preliminary analysis identified three main themes. Theme 1: Concern about consultations viewed. Although there was great variation, participants were disappointed and sometimes ‘shocked’ by the poor skill level observed in some consultations. They felt passionately that RDs should be highly skilled in CSBC throughout patient consultations to be effective. Theme 2: Communication skill development and assessment: ready or not? Participants felt that post-registration training and assessment of CSBC was desirable throughout the profession at all levels and in all specialities but they had strong reservations about the acceptability of this and perceived it needed to be ‘handled very sensitively’. Theme 3: Knowledge versus communication skills: one or the other or both? This theme related to the development and use of knowledge and/or CSBC. Participants perceived that knowledge was more highly valued and CSBC sometimes neglected. Poor ability to implement CSBC throughout the whole patient consultation was observed and thought to have a negative effect on patient dietitian relationships and patient outcomes. Discussion: Despite concerns at some of the communication skills viewed participants were still not overwhelmingly supportive of radical action such as regular, compulsory assessment in practice. Concern for how RDs would ‘feel’ about assessment was stronger than concern about the effectiveness and outcomes of consultations. Theme 3 suggests that participants recognise that both knowledge and skills are important but observed a lack of ability to use CSBC beyond ascertaining the patients’ reason for attending the consultation. This suggests a need to support RDs to integrate these skills throughout the consultation for optimal effectiveness and patient outcomes. Post-registration training and development of these skills, including tailored assessment, may be beneficial, if challenging to implement. A change in the behaviour of RDs may be necessary in order to facilitate more behaviour change in their patients. Conclusion: Although it may be challenging to implement in practice, the development and assessment of CSBC in RDs post-registration is an area for improvement in dietetics.

Student Dietitians’ Experiences of Patient Death Whilst on Placement.

Background: Evidence suggests that health care students experience a degree of trauma after experiencing a patient death [1] and they keep their feelings and concerns about patient death to themselves [2]. Rivers, Perkins and Carson [3] suggest that students may be inadequately prepared to deal with patient death during their placements. The aim of this study was to explore dietetic students’ experiences of patients dying whilst on placement. Methods: A qualitative phenomenological approach was used to explore the experiences of 4th year undergraduate student dietitians. Recruitment was opportunistic and data was collected using semi-structured interviews with topic guide and field notes to capture nonverbal communication. Ethical approval was given by Coventry University’s ethics committee and written consent was obtained from all participants. Interviews were audiotaped and transcribed verbatim using thematic analysis as guided by Braun and Clarke [4]. Peer review of findings was undertaken with the second author. Findings: Three female students were interviewed. The main themes identified were: the reaction to patient death, support, personal experience and personal beliefs. The reaction to patient death included feeling shock and upset, as the patient death was unexpected. Participants reported feeling unprepared for their patient’s death. ‘…he was palliative …I didn't really think… he is going to pass away… that was a really difficult one …’ P3. Support was obtained from debriefing to friends or educators or by formal reflection on their experience, which was aided by presenting the patient as a case study. ‘…writing the case study…helped…it’s kind of like you’re thinking about all your actions...almost reflecting on what I’d done… it’s nice to be reassured that I did everything that I should have done.’ P3. However, the students found it difficult to open up to their educators without being prompted to do so. Patient confidentiality was identified as a barrier to debriefing to friends. Reflection was found to be helpful for participants who found it difficult to approach their educators. Participants felt that preparation could only be achieved through personal experience rather than class room discussion. ‘I don’t think the university can prepare you, it’s more about life experience … it’s something you can’t learn in a class room ...’ P1. Personal beliefs helped some participants cope with the experience. Discussion: Students reported being unprepared for death, which was partly due to a lack of experience and because they felt the death was unexpected. Students anticipated patient’s death by the way the patient looked and acted, rather than using the clinical information which indicated the patients ill health; this was a strong contributing factor to the feeling of shock. Student preference for learning about death was through experience is in line with Rivers, Perkins and Carson [3]. The shock of patient death might be reduced by honest discussion by the educators of how ill patients are. The research is limited by a small sample size due to a low response rate; therefore data saturation is unlikely to have been obtained. Conclusion: Students may require support from clinical educators when faced with a patient death but may find this support difficult to access. Clinical educators have a role in supporting students through debriefing, but students may find it difficult to show their feelings. Inviting the student to talk through their experience and offering reassurance may be helpful.

Implementation and Evaluation of Nutrition Capacity Training Program for Dietitians and Related Professionals Working at Customized Home Visiting Health Services / 대한지역사회영양학회지

The purpose of the study was to implement and evaluate a nutrition capacity training program for dietitians and other professionals working at customized home visiting health services (CHVHS). This program focused on nutrition services for hypertension or diabetes mellitus patients including topics regarding CHVHS, and composed of 10 sessions with lectures, discussion and practice. Dietitians (n = 54) and other professionals (n = 20) participated in the program and completed the questionnaire to assess their understanding of nutritional management, nutrition services and CHVHS before and after the program, and to examine program satisfaction and education needs. Subjects were mostly women (98.6%) and college or university graduates (93.2%). Total score (p < 0.001), as well as all items (p < 0.001 or p < 0.01) of understanding regarding nutritional management, nutrition services and CHVHS, were significantly increased after the program both in dietitians and in other professionals. Subjects were generally satisfied with the program, showing more satisfaction with items regarding subject's participation, acquiring new knowledge, usefulness of the program for CHVHS, and education materials. In future nutrition capacity training programs, subjects wanted to have classes regarding nutrition services for specific chronic diseases, development of education materials, methods for dietary life education, modifying eating habits and so on. Other professionals compared to dietitians, showed higher education needs in meal management (p < 0.01) and nutrition counseling skills (p < 0.05). This study showed the effectiveness of a nutrition capacity training program for home-visiting dietitians and other professionals, and suggests the need and direction for future nutrition capacity training programs.

Different Perceptions of Clinical Nutrition Services between Doctors and Dietitians in the Busan-Gyeongnam Area

The purpose of this study was to evaluate the difference in perception of clinical nutrition service (CNS) between doctors and dietitians working in hospitals in Busan and the Gyeongnam area. Research was performed through questionnaires (from November to December 2011) at over 100 beds. 73.3% of dietitians were aware of the Nutrition Support Team (NST), while only 15.6% of doctors were aware of it. Due to heavy work and lack of medical staff, doctors didn't participate in NST, although most of them recognized the necessity of NST. 61.7% of dietitians screened and managed malnourished patients, whereas only 29.8% of doctors did. The main reason dietitians didn't treat malnourished patients was the absence of a treatment system in the hospital. Less than 50% of dietitians participated in the doctor's round to malnourished patients. As for why dietitians didn't participate in doctor's rounds, 71% of doctors chose understaffed dietitians and 38.1% of dietitians chose the doctors' unawareness of the importance of the dietitian in doctor's rounds. For the lower rate of nutrition counseling in provincial regions, compared to the capital region, 46.8% of doctors cited a lack of connection between doctors and clinical dietitians, while 43.3% of dietitians cited the lack of doctors' awareness on the importance of nutrition counseling. Although 87.3% of the doctors and 91.6% of the dietitians answered that CNS is important for treatment, the perception of onsite performance status on CNS was found to be low in both groups. 48.9% of doctors and 50.0% of dietitians regarded dietitians in the hospital as personnel in charge of food services, rather a member of the medical team. To improve the awareness of the importance of the CNS, and the image of clinical dietitians, 31.2% of doctors answered "to introduce a professional dietitian license for each disease" and 26.7% of dietitians answered "to change the system in the hospital". Most subjects found that a separation of clinical nutrition services from the food service part is needed. These results suggest that it is important to narrow the difference in perceptions of clinical nutrition services between doctors and dietitians for an organized clinical nutrition management of patients in hospitals in Busan and the Gyeongnam area.