Registered dietitians' roles in decision-making processes for PEG placement in the elderly.

PURPOSE: The role of registered dietitians (RDs) in decision-making for percutaneous endoscopic gastrostomy (PEG) placement was explored. The ethical climate in their workplace and the relationship between decision-making and the ethical climate were examined. METHODS: The survey included 67 RDs in complex continuing care and long-term care settings in Ontario. Descriptive statistics were used to describe roles, ethical climate, and professional characteristics. Pearson's and nonparametric correlations were used to examine relationships between roles, ethical climate, and professional characteristics. RESULTS: Among the respondents, 97% thought RDs had a role in decision-making processes. The majority of RDs were usually or always involved in two roles: identifying relevant nutrition issues (91.2%) and discussing feeding options and alternatives (80.7%). Dietitians' roles in decision-making processes were more extensive when their relationship with physicians was positive (r=0.321, P=0.016), they had adequate knowledge (r=0.465, P<0.001) and adequate skills (r=0.520, P<0.001), and they were more satisfied with their role (r=0.554, P<0.001). CONCLUSIONS: Registered dietitians performed a variety of roles in decision-making processes concerning PEG placement in the elderly. A positive working relationship with physicians, knowledge, skills, and role satisfaction significantly increase RDs' involvement with patients and families.

An exploration of quality of life and the experience of living with home parenteral nutrition.

INTRODUCTION: The aim of this research was to achieve a deeper understanding of the experience of adults living with home parenteral nutrition (PN) and to define their quality of life (QOL). METHODS: The research design was qualitative, using content and interpretative phenomenological analysis. The sample included adults with intestinal failure, stratified by length of home PN dependency. Sampling continued until data saturation was achieved. A second reviewer independently coded a subset of narratives (kappa = 0.684). RESULTS: Participants included 24 adults receiving home PN because of short bowel syndrome (95.8%) and pseudo-obstruction (4.2%). Twenty-five percent received PN for < 2 years, 20.8% for 2-5 years, 25% for 5-10 years, and 29.2% for > 10 years. Respondents viewed home PN as a "lifeline" and "nutritional safety net." QOL was defined as "enjoying life"; "being happy, satisfied, or content with life"; and "being able to do what you want to do, when you want to do it." Participants described their QOL as "good" to "wonderful." Lifestyle was affected by health, stamina, diarrhea, having an ostomy, and the amount of flexibility there was with the infusion schedule. There was a strong desire to achieve normalcy in life among all participants. CONCLUSIONS: Qualitative methodology provides new insights and richness of data regarding adults receiving home PN. The positive description of QOL in this study contrasts with the published nutrition literature. It is important for healthcare practitioners to understand and discuss the realities of home PN and lifestyle adaptation.

Effect of an oral health assessment education program on nurses' knowledge and patient care practices in skilled nursing facilities.

This pilot intervention study measured the impact of an oral health education intervention on nurses' knowledge and patient care practices in regard to oral assessments of institutionalized elders. Two 1-hour education sessions were completed over a 3-week period; a pretest and a posttest were administered immediately preceding the first session and immediately following the second session. Medical records were reviewed prior to and after the intervention to assess practices including completeness of oral health assessment and congruency with the Minimum Data Set 2.0 (MDS). Nine nurses attended the education intervention. Retrospectively, 176 records were reviewed preintervention and 80 postintervention. There was no significant change in knowledge from the pre- to posttest (p= .262). Completeness of all oral health assessment variables increased significantly (p= .001) as did the congruency of data between the nursing assessment (NA) and MDS assessments (p= .002). Providing nurses with education on oral health assessments in skilled nursing facilities has a positive impact on completeness of data and congruency between the NA and the MDS.

Evaluation of diet quality and weight status of children from a low socioeconomic urban environment supports "at risk" classification.

This cross-sectional study evaluated diet quality and weight status in 248 randomly selected low-income urban children, aged 7 to 13 years, who were participating in a larger study on the effectiveness of multivitamin supplementation on school performance. Food frequency questionnaires were used to determine intake of total calories and food groups, selected micronutrients, and amount and percent of calories from sweets. Results were compared to age-appropriate recommendations of the Food Guide Pyramid and to the Dietary Reference Intakes. Height, weight, and ages obtained from current-year student health records were used to calculate body mass index (calculated as kg/m(2)) percentile for age. Of 193 participants with usable food frequencies and available weight, height, sex, and age, 22% (n=43) were at risk for overweight and 36% (n=69) were overweight. More than 75% of participants failed to meet recommended servings for grains, vegetables, dairy, and fruit groups, and mean intake of each of these food groups was significantly less than recommendations (P<0.001). Twenty-five percent or more of subjects did not meet Recommended Dietary Allowances for iron and folate. Mean intake of calcium was below the Adequate Intake for calcium and 76% of children 8 years old and younger and 93% of children 9 years old and older did not meet the Adequate Intake for calcium. Mean calorie intake was 1,723 kcal (standard deviation+/-924) and mean percent of calories from carbohydrate, protein, and fat was 57%, 13%, and 32%, respectively. No correlation was found between total calories, total dietary sugar, or percent of calories from sweets and body mass index. Results of this study suggest that these urban children may be "at risk," based on the high percentage who are overweight and have insufficient food group consumption and micronutrient intake.

Evaluation of high-school health science careers program impact on student retention and careers.

The purpose of this research was to longitudinally measure the impact of the University of Medicine and Dentistry of New Jersey-School of Health Related Professions high-school Health Science Careers program on student retention in health careers. Students (n = 1,218) who earned college credit in the program from 1996 to 2002 were surveyed. The response rate was 17% of the total and 21% of the deliverable surveys. Students were equally distributed between vocational, comprehensive, and academy-type schools. Ninety-seven percent of the students continued their education after high school, with 70% attending 4-year colleges. Forty-nine percent of those entering 2-year colleges and 57% of those entering 4-year colleges pursued health-related careers. Ninety-five percent perceived the Health Science Careers program as valuable. The findings suggest that the Health Science Careers program was helpful in guiding students toward health-related professions. The evaluation helped to understand the impact and to realize the positive and negative aspects of the program by the respondents.

Ethical issues in nutrition and human immunodeficiency virus.

Ethical dilemmas often arise in the provision of healthcare. In view of the advances in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) medical management since the late 1990s, many of the challenges and ethical dilemmas encountered by healthcare professionals have changed from terminal or end-of-life issues to long-term management issues. This article presents 5 case scenarios on common ethical issues faced by those providing nutrition care to people living with HIV/AIDS and addresses key questions to ask in the ethical deliberative process. Ethical dilemmas surrounding the use of complementary and alternative medicine, providing aggressive nutrition support, dealing with third-party payers for supplement reimbursement, and managing patients with mental health disorders and substance abuse issues are discussed, with possible solutions presented from an ethics point of view.

Position of the American Dietetic Association: ethical and legal issues in nutrition, hydration, and feeding.

It is the position of the American Dietetic Association that the development of clinical and ethical criteria for the nutrition and hydration of persons through the life span should be established by members of the health care team. Registered dietitians should work collaboratively to make nutrition, hydration, and feeding recommendations in individual cases. Registered dietitians have an active role in determining the nutrition and hydration requirements for individuals throughout the life span. When patients choose to forgo artificial nutrition and hydration, or when patients lack decision-making capacity, and others must decide whether or not to provide artificial nutrition and hydration, the registered dietitian has an active and responsible professional role in the ethical deliberation around that decision. There is strong clinical, ethical, and legal support both for and against the administration of food and water when issues arise regarding what is or is not wanted by the patient and what is or is not warranted by empirical clinical evidence. When a conflict arises, the decision to administer or withhold nutrition and hydration requires ethical deliberation. The registered dietitian's understanding of nutrition and hydration within the context of nutritional requirements and cultural, social, psychological, and spiritual needs provides an essential basis for ethical deliberation on issues of nutrition and hydration.