Nutrition Care Process
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Contents |
[edit] Nutrition Care Process and Model
[edit] The Nutrition Care Process
The Nutrition Care Process (NCP) is a framework for critical thinking and decision making that Registered Dietitians (RD) use to guide practice. The American Dietetic Association (ADA) adopted the NCP in order to support RDs in providing high quality nutrition care by doing the right thing at the right time, in the right way, for the right person, with the goal of achieving the best possible results of that care. The NCP can be used in a variety of practice settings, from the hospital to the community and applies to individuals as well as groups.
The NCP improves the ability of RDs to utilize evidence based medicine (EBM) techniques that support high quality care. Use of the NCP is enhanced when RDs adopt the Standardized Language of Dietetics, which is a dietetics-specific terminology that provides a common language for RDs. The NCP and Standardized Language of Dietetics allow the profession of dietetics to better describe the benefits to patients and clients when medical nutrition therapy is provided by RDs.
[edit] Characteristics of the Nutrition Care Process
The NCP is a cyclical four-step process that occurs at each appointment or interaction with an RD. The NCP consists of the following steps:
- Nutrition assessment
- Nutrition diagnosis
- Nutrition intervention
- Nutrition monitoring and evaluation
Each step builds on the previous step, yet the process is not linear. The RD can revisit and revise information from each of the steps as more information is gathered and interpreted throughout the patient/client appointment. The NCP may occur multiple times at subsequent appointments with the RD in a course of Medical Nutrition Therapy.
[edit] Steps of the Nutrition Care Process
RDs are familiar with each of the steps of the NCP with the exception of nutrition diagnosis. Nutrition assessment, intervention, and monitoring have been an integral part of dietetics practice for some time. Nutrition diagnosis has been added to provide a target to clarify the results of the nutrition assessment and to provide a target for the nutrition intervention. Nutrition diagnosis should not be confused with the medical diagnosis.
[edit] Nutrition Assessment
Nutrition assessment is a systematic process used by RDs to make decisions about the presence and extent of nutrition-related problems. Dietitians often use assessment tools such as the Subjective Global Assessment (SGA) to assist in gathering and interpreting data. The types of data gathered during the assessment process will vary depending on the patient/client and setting, but often include evaluation of weight, nutritional adequacy of diet, health status, co-existing conditions or diseases, and selected laboratory values.
[edit] Nutrition Diagnosis
Nutrition diagnosis is the identification and labeling that describes an actual occurrence of a nutrition problem that dietetics professionals are responsible for independently treating. The RD evaluates data gathered during the assessment and determines the presence of a nutrition diagnosis. The components of the nutrition diagnostic statement are 1) the problem, 2) etiology, and 3) signs and symptoms (defining characteristics). The nutrition diagnostic statement is a brief, concise statement that includes the problem, etiology, and signs and symptoms (PES).
The problem
The RD uses the Standardized Language of Dietetics to describe the problem(s) identified during the assessment. The Standardized Language of Dietetics contains 62 terms organized into three domains (Intake, Clinical, and Behavioral) that describe nutrition problems (American Dietetic Association 2007). Examples of nutrition problems include "Inadequate protein intake", "Swallowing difficulty", and "Food and nutrition-related knowledge deficit". The RD is responsible for independent treatment of each nutrition problem.
Etiology
The etiology portion of the nutrition diagnostic statement contains the factors thought to contribute to the development of the nutrition problem. In the nutrition diagnostic statement, the etiology is linked to the diagnostic label by the words "related to". Identification of the etiology provides guidance and focus for the RD to select the correct nutrition intervention.
Signs and Symptoms
The signs and symptoms are also referred to as the "defining characteristics". The signs and symptoms consist of the patient/client description of the problem and the clinical and/or biochemical parameters indicative of a nutrition diagnosis that are seen by the RD on nutrition assessment. Appropriate nutrition intervention will alleviate the signs and symptoms.
[edit] Nutrition Intervention
Nutrition intervention consists of the activities and actions the RD undertakes to address the nutrition problem. Depending on the skills and training of the RD, the intervention might involve recommending or ordering a change in diet for a hospitalized patient, working with a community to improve food security, or collaborating with other health care professionals such as Occupational Therapists to ensure that adaptive feeding devices are available.
The RD prioritizes nutrition diagnoses based on factors identified in the nutrition assessment, develops a plan for nutrition intervention and implements the intervention. The intervention should focus on alleviating the etiology of the nutrition diagnosis.
The Standardized Language of Dietetics contains terms that are used to describe the actions of the RD in completing the Nutrition Intervention. The intervention terminology has four domains: Food and/or nutrient delivery, nutrition education, nutrition counseling, and coordination of nutrition care. An example of a nutrition intervention might be to "order vitamin/mineral supplement".
[edit] Nutrition Monitoring and Evaluation
Nutrition monitoring and evaluation consists of the review and measurement of the effectiveness of the nutrition intervention in order to determine if the goals of the intervention have been met. If goals are not met, the RD uses critical thinking skills to determine if a new nutrition diagnosis exists or if the intervention might need to be revised or intensified. Data gathered from the monitoring and evaluation step are also used to study the effectiveness of nutrition interventions in given patient/client populations.
Monitoring and evaluation terms might include measurement of Vitamin C intake to determine if an intervention of "order vitamin/mineral supplement" was effective.
[edit] Implications of the Nutrition Care Process
The RD documents the NCP in the medical record or some other suitable document and solidifies the role of the RD as the unique provider of nutrition care and Medical Nutrition Therapy. Use of the NCP ensures that care provided by the RD is appropriate, timely, and measurable. Quality of care can be measured in part by evaluating the outcomes of care and the degree to which providers adhere to an accepted care process (Lacey & Pritchett 2003). It is hoped that use of the NCP will result in less variation in practice, improved outcomes of Medical Nutrition Therapy, and development of databases needed for evaluation of care provided.
[edit] The Nutrition Care Model
The Nutrition Care Model illustrates the concepts of the NCP and shows how the NCP fits into the context of dietetics practice. The screening and referral system serve as the entry portal to the NCP. The relationship between the RD and the patient/client are the central core of the Model. The two outer rings represent the unique skills and knowledge of the RD as well as socio-economic factors that might impact the NCP. Outcomes management systems are those processes that provide mechanisms for continuous quality improvement.
[edit] References
- American Dietetic Association. Nutrition Diagnosis and Intervention: Standardized Language for the Nutrition Care Process. American Dietetic Association, Chicago, IL, 2007.
- Lacey K, Pritchett E. Nutrition care process and model: ADA adopts road map to quality care and outcomes management. J Am Diet Assoc. 2003; 103(8):1061-1072.
