Experiences and perceptions of dietitians for obesity management: a general practice qualitative study.

BACKGROUND: Multi-component lifestyle interventions are the first line treatment for obesity. Dietitians are ideally placed healthcare professionals to deliver such interventions. However, only a small proportion of patients with obesity are referred by general practice to dietitians, and the reasons for this are not clear. The present study aimed to explore general practice healthcare professionals' (GPHCPs) experiences and perceptions of dietitians in the context of obesity management. METHODS: A convenience sample of GPHCPs practicing in the UK was recruited via a targeted social media strategy, using virtual snowball sampling. Data were collected using semi-structured interviews and analysed using framework analysis. RESULTS: In total, 20 participants were interviewed (11 general practice nurses and nine general practitioners). Experiences of referring patients with obesity for dietetic intervention resulted in two main themes: (i) access barriers and (ii) the dietetic consult experience. Three themes emerged from participants' perceptions of a role for general practice dietitians: (i) utilising dietetic expertise; (ii) access to dietitian; and (iii) time. Participants experienced barriers to accessing dietitians for obesity management and felt that having a dietitian working within their general practice team would help address this. Having a dietitian embedded within their general practice team was perceived to have the potential to alleviate GPHCPs' clinical time pressures, offer opportunities for upskilling, and may improve patient engagement with obesity management. CONCLUSIONS: GPHCPs perceived that embedding a dietitian within their general practice team would be valuable and beneficial for obesity management. Our findings provide support for the funding of general practice dietitian roles in the UK.

Assessing Cultural Intelligence and Study Abroad Experiences of Dietetics Students and Professionals.

OBJECTIVE: To assess the relationship between study abroad participation and levels of cultural intelligence (CQ) of dietetics students and professionals. METHODS: Participants were recruited via e-mail to complete an online survey, which included the Cultural Intelligence Scale and an additional 21 items developed and partially validated by the researchers. A mixed-method analysis was used to examine relationships between CQ levels, study abroad program participation, and international travel experiences. RESULTS: Participation in study abroad programs and international travel experiences were related to higher levels of CQ in metacognitive (P = 0.003; P < 0.001), cognitive (P = 0.001; P = 0.001), motivational (P < 0.001; P < 0.001), and behavioral (P = 0.02; P < 0.001) dimensions. CONCLUSIONS AND IMPLICATIONS: Results suggest that participation in study abroad programs and international travel experiences may result in high CQ levels and may equip students and practicing dietitians with skills, knowledge, and resources for practicing in culturally diverse communities. Future experimental research implementing study abroad programs and international travel opportunities for this population may help determine how these experiences impact dietetics practice in the long term.

Listen and Change

In the aftermath of the killing of George Floyd and other Black Americans, the world has risen up in pain and anguish to condemn social injustice and racism that has systematically impacted the lives of people of color. Many of you have shared your outrage and impatience regarding lack of diversity in our profession, structural racism in our American culture that leads to inequities, and the need for a lasting systemic change. You have asked for implicit bias training, cultural humility, and frank conversations. You have asked us to look internally as individual members and as an organization. And you have asked us to listen.

Developing National Conceptual Understanding to Describe Entry-to-Practice Dietetics Competence.

OBJECTIVE: Develop consensus on entrustable professional activities (EPAs) and milestones for students, practice educators, and academics that need shared understanding to assess entry-level competence in dietetics. DESIGN: An iterative, pragmatic, 3 key-phase approach involving workshops, a consensus survey with job description and consultation. SETTING: Australia. PARTICIPANTS: A total of 58 academics and 43 practitioners with expertise in competency-based assessment in dietetics were purposefully selected to participate in 4 national workshops. Of those selected, 36 completed a survey that sought consensus on the EPAs and milestones drafted at the workshops (36% response rate). PHENOMENON OF INTEREST: Support for competency-based assessment. ANALYSIS: Level of agreement on the survey was set at ≥70%. These comments were triangulated with content analysis from 98 entry-level job descriptions. RESULTS: Consensus on 4 key tasks of the profession with associated descriptions of the level of performance were included to implement a nutrition intervention; facilitate a food, nutrition, and/or lifestyle conversation; perform professional activities and projects; and work as part of a team. CONCLUSIONS AND IMPLICATIONS: Identification of the key minimum tasks of a dietitian upon entry-to-practice, together with developmental descriptors of performance, provides clarity in the expected progression and end point of assessment. This resource will support competency-based assessment decisions. The international transferability of this warrants further investigation.

Academy of Nutrition and Dietetics: Revised 2019 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Clinical Nutrition Management.

Clinical nutrition management (CNM) encompasses the varied roles of registered dietitian nutritionists (RDNs) with administrative responsibilities for clinical nutrition services within an organization. Although RDNs in CNM are typically employed in acute care, they are also employed in settings where management of nutrition services is required, such as foodservice departments, ambulatory clinics, telehealth services, public health organizations, post-acute and long-term care, rehabilitation, and correctional facilities, or specialty departments, for example, dialysis units or cancer centers. RDNs in CNM aim to create work environments that support high-quality customer-centered care, attract and retain talented staff, and foster an atmosphere of collaboration and innovation. The CNM Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has revised the Standards of Professional Performance (SOPP) for RDNs in CNM for three levels of practice: competent, proficient, and expert. The SOPP describes six domains that focus on professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Indicators outlined in the SOPP depict how these standards apply to practice. The standards and indicators for RDNs in CNM are written with the leader in mind-to support an individual in a leadership role or who has leadership aspirations. The SOPP is intended to be used by RDNs for self-evaluation to assure competent practice and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.

Debriefing about the challenges of working in a remote area: A qualitative study of Australian allied health professionals' perspectives on clinical supervision.

BACKGROUND: The benefits of clinical supervision are more pronounced for health professionals in rural and remote areas. Most clinical supervision studies to date have occurred in metropolitan centres and have used the survey methodology to capture participant experiences. There is a lack of qualitative research that captures participants' lived experiences with clinical supervision at the frontline. METHODS: Participants were recruited from rural and remote sites of two Australian states using a purposive maximum variation sampling strategy. Data were collected through individual, semi-structured interviews with participants. Data were analysed using content analysis and themes were developed. Sixteen participants from six professions completed the interviews. RESULTS: Eight themes were developed including the content of supervision, context of supervision, value of supervision, increased need for professional support and unique characteristics of rural and remote clinical supervision. CONCLUSIONS: This study has highlighted the value of clinical supervision for the rural and remote health professional workforce. Furthermore, it has shed light on the unique characteristics of clinical supervision in this population. This information can be used by organisations and health professionals to ensure clinical supervision partnerships are effective thereby enhancing rural and remote workforce recruitment and retention.

Implementing a best-practice model of gestational diabetes mellitus care in dietetics: a qualitative study.

BACKGROUND: Translating research into clinical practice is challenging for health services. Emerging approaches in implementation science recognise the need for a theory-driven approach to identify and overcome barriers to guideline adherence. However, many clinicians do not have the capacity, confidence, or expertise to realise change in their local settings. Recently, two regional sites participated in a facilitated implementation project of an evidence-based model of gestational diabetes mellitus (GDM) care in dietetics, supported by a team at a metropolitan centre. This study describes (i) stakeholder experiences', and (ii) learnings to inform implementation of the model of care (MOC) across Queensland. METHODS: This qualitative descriptive study utilised semi-structured telephone interviews with staff involved in implementation of the MOC project at two regional sites. Eight participants were recruited; five participants were from one site. Interviews were transcribed and analysed to identify recurrent themes. RESULTS: Four main themes were derived: (1) catalyst for positive change, (2) managing project logistics, (3) overcoming barriers, and (4) achieving change. CONCLUSIONS: A model of external facilitated implementation using an evidence-based decision making tool is an effective method of fostering health service change and is acceptable to staff. Key elements of the facilitation were building confidence and capacity in local implementers, through regular contact, encouraging local networking, linking to higher management support and assessing and/or influencing workplace or organizational culture. However, the balance between delivering clinical care while participating in a service change project proved challenging to many participants.

Importance and use of reliable food composition data generation by nutrition/dietetic professionals towards solving Africa's nutrition problem: constraints and the role of FAO/INFOODS/AFROFOODS and other stakeholders in future initiatives.

Despite the rich biodiversity of the African continent and the tremendous progress so far made in food production, Africa is still struggling with the problems of food insecurity, hunger and malnutrition. To combat these problems, the production and consumption of nutritious and safe foods need to be promoted. This cannot be achieved without reliable data on the quantity and quality of nutrients and other components provided through these foods. Food composition data (FCD) are compiled as food composition tables (FCT) or food composition databases (FCDB). These are subsequently used for a variety of purposes, ranging from clinical practice, research, public health/education, food industry to planning and policy, as well as nutrition monitoring and surveillance. To perform these functions effectively, the importance of reliable FCT/FCDB cannot be overemphasised. Poor quality FCT/FCDB have serious consequences on the health of the population, and provide skew evidence towards developing nutrition and health-related policies. The present paper reviews different methods to generate FCT/FCDB, their importance and use in assisting nutrition/dietetic professionals in solving Africa's nutrition problems; current status of FCT/FCDB generation, compilation and dissemination in Africa, constraint to their use by professionals and the role of FAO/INFOODS/AFROFOODS and other stakeholders towards improvement and future initiatives. The information provided will create awareness on the need for up-to-date and high-quality FCT/FCDB and facilitate the identification of data gaps and prioritisation of future efforts in FCD generation, compilation and dissemination in Africa and subsequent strategies for the alleviation of the food and nutrition problems in Africa.

Towards a standardized nutrition and dietetics terminology for clinical practice: An Austrian multicenter clinical documentation analysis based on the International Classification of Functioning, Disability and Health (ICF)-Dietetics.

BACKGROUND: High quality, continuity and safe interdisciplinary healthcare is essential. Nutrition and dietetics plays an important part within the interdisciplinary team in many health conditions. In order to work more effectively as an interdisciplinary team, a common terminology is needed. This study investigates which categories of the ICF-Dietetics are used in clinical dietetic care records in Austria and which are most relevant to shared language in different medical areas. METHOD: A national multicenter retrospective study was conducted to collect clinical dietetic care documentation reports. The analysis included the "best fit" framework synthesis, and a mapping exercise using the ICF Linking Rules. Medical diagnosis and intervention concepts were excluded from the mapping, since they are not supposed to be classified by the ICF. RESULTS: From 100 dietetic records, 307 concepts from 1807 quotations were extracted. Of these, 241 assessment, dietetics diagnosis, goal setting and evaluation concepts were linked to 153 ICF-Dietetics categories. The majority (91.3%) could be mapped to a precise ICF-Dietetics category. The highest number of ICF-Dietetics categories was found in the medical area of diabetes and metabolism and belonged to the ICF component Body Function, while very few categories were used from the component Participation and Environmental Factors. CONCLUSIONS: The integration of the ICF-Dietetics in nutrition and dietetic care process is possible. Moreover, it could be considered as a conceptual framework for interdisciplinary nutrition and dietetics care. However, a successful implementation of the ICF-Dietetics in clinical practice requires a paradigm shift from medical diagnosis-focused health care to a holistic perspective of functioning with more attention on Participation and Environmental Factors.

Unmet Needs in Nutritional Care in African Paediatric Oncology Units.

BACKGROUND: Up to 50% of children diagnosed with cancer in low- and middle-income countries are malnourished, which likely affects survival. SUBJECTS AND METHODS: An online survey to paediatric oncology units (POUs) in Africa was done regarding nutritional assessment and care. RESULTS: Sixty-six surveys were received from POUs in 31 countries. Only 44.4% had a dedicated dietician for nutritional assessment and support; 29.6% undertook routine nutritional assessment during treatment. None reported defined criteria for nutritional intervention. Total parenteral nutrition was not available for 42.6% of POUs, while 51.8% did not have access to commercial enteral nutrition for inpatients, and 25.9% of the hospitals could not supply any home-based nutritional supplements. CONCLUSION: Nutritional assessment in POUs in Africa is neither routinely undertaken nor are there defined criteria to initiate nutritional interventions. Standardized guidelines for nutritional assessment and interventions are needed for African POUs to enable improved outcome.

Dietitians' opinions regarding refeeding syndrome, clinical guidelines and extended scope of practice.

AIM: Refeeding syndrome (RFS) prevalence rates vary across studies depending on the criteria used for assessment and identification. For registered dietitians, the assessment and management of RFS is highly reliant on daily serum electrolyte values; however, registered dietitians working within Australia do not currently possess laboratory test ordering privileges. We aimed to examine the opinions of registered dietitians regarding RFS identification, management and guidelines and the option of using extended scope of practice to order electrolyte monitoring autonomously. METHODS: A multi-method action research approach was used, incorporating two projects. The first was a survey examining Australian registered dietitians' (n = 187) opinions regarding RFS identification, management and guidelines, and autonomous electrolyte monitoring. To establish if results were similar internationally, an interview was conducted with 22 registered dietitians working within 10 different countries. Data were analysed using chi-square tests and thematic analysis. RESULTS: Australian registered dietitians (75%) identify patients at risk of RFS at a high rate of more than once per fortnight, with 74% reporting that they have previously worked with a patient diagnosed with RFS. Results varied internationally, with respondents from eight countries reporting that RFS is a problem within acute care versus respondents from five countries having never treated a patient with RFS. The majority (≥89%) of registered dietitians desire new guidelines and the option to order patient electrolyte monitoring autonomously. CONCLUSIONS: Our findings suggest that more stringent tools for the identification of RFS are necessary. There was limited uniformity across countries, and updated practice guidelines are needed.

Clinically relevant improvements achieved from a facilitated implementation of a gestational diabetes model of care.

AIM: Medical nutrition therapy is a cornerstone treatment in gestational diabetes; however, most Australian women diagnosed with gestational diabetes do not receive this. The project evaluated adaptation of a successful evidence-based gestational diabetes model of care implementation from a tertiary centre into regional sites with varied demographics, population size and service capacity. METHODS: The project used a hub (project team)-spoke (sites) model in Far North Queensland (Site 1) and regional South-East Queensland (Site 2). Sites selected demonstrated strong gestational diabetes team cohesiveness and project commitment. The project phases were consultation, baseline, transition and implementation. A best practice decision tree tool was provided to assess/manage barriers to the model of care and clinical outcomes captured through a project database. RESULTS: Role clarification of site members, management engagement, site visits, decision tree and database refinement were completed in the project's first phase. Unexpected organisational and team barriers prevented timeline implementation as planned. Sites negotiated relevant reallocation of resources to achieve project deliverables. The proportion of women seen according to best practice increased from 3.5 to 87.8% (P < 0.001) (Site 1) and nil to 4.8% (P = 0.09) (Site 2), and those on medication dropped by 3.4 (Site 1) and 9.1% (Site 2). CONCLUSIONS: This project demonstrates a successful implementation using a facilitated and rigorous approach. Support, engagement and tools at many levels were keys to success at both sites. The present study illustrates the opportunities and challenges of conducting implementation research within routine clinical care, particularly in resource-challenged sites.

Improving nutritional discharge planning and follow up in older medical inpatients: Hospital to Home Outreach for Malnourished Elders.

AIM: Nutritional decline during and after acute hospitalisation is common amongst older people. This quality improvement initiative aimed to introduce a dietitian-led discharge planning and follow-up program (Hospital to Home Outreach for Malnourished Elders, HHOME) at two hospitals within usual resources to improve nutritional and functional recovery. METHODS: Prospective pre-post evaluation design was used. Medical patients aged 65+ years at-risk of malnutrition and discharged to independent living were eligible. Participants receiving nutrition discharge planning and dietetic telephone follow up for four weeks post-discharge ('HHOME') were compared to usual care ('pre-HHOME'). Nutritional (weight and mini nutritional assessment (MNA)), functional (gait speed, handgrip strength and modified Barthel index) and assessment of quality of life-6D (AQoL-6D) outcomes were measured on discharge and six weeks later. RESULTS: At six weeks, no significant difference in nutritional status was observed between pre-HHOME (n = 39) and HHOME cohorts, although the HHOME cohort on average maintained weight while pre-HHOME cohort lost weight (0.4 ± 2.9 kg vs -1.0 ± 3.7 kg, P = 0.060). Greater improvement in gait speed was seen in HHOME group (+0.24 ± 0.27 vs +0.11 ± 0.22, P = 0.046) with no other significant outcome improvements. Across both cohorts, half were readmitted to hospital and 10% died within 12 weeks post-discharge. CONCLUSIONS: The nutritional discharge planning and dietetic follow up provided to older community-living malnourished patients made a small impact on nutritional and functional parameters but clinical outcomes remained poor.