Lecture 22 Flashcards
Nutrition Care process Overview
How do we asses the nutrition status of an individual?
Usually through individual consultations where we ask a series of questions
what do the consultations require
-effective communication
-Accurate information gathering
-Problem solving
-Using knowledge and evidence
You need a framework for the consultations to guide….
us through this process so that we not only assess the individuals nutrition status but also provide a solution to their needs
the nutrition care process provides ….
a systematic, problem solving framework for nutrition related problems
the nutrition care process facilitates
critical thinking and decision making
The nutrition care process enables
safe, effective, high quality nutrition care
the nutrition care process provides a standardised
a standardised process but does not mean all clients get the same nutrition support
What does the central core of the nutrition care process diagram represent
Individual/Population interacts with Nutrition Professional
Outer rings of the nutrtion care process
-Individuals environment
-Strengths and weaknesses of the practitioner
-Inputs/outputs
Four steps of the nutrition care process
-Assessment
-Nutrition Diagnosis
-Intervention
-Monitoring & Evaluation
What is meant by the patient centered care approach
- exploring clients history, needs, values and environment
- while promoting active client participation (collaborative approach with the client)
- via shared decision making and lifestyle education
communication with the client should be …
- articulate
- accessible / understandable
- emotionally balanced
- professional
Inputs to the process
Screening and Referral system
INPUTS: What are the factors of the screening and referral system of nutrition care process
-identify risk factors for nutrition related problems
- use appropriate tools and methods to identify these risk factors
- may involve interdisciplinary collaboration between health professionals
-May be carried out by non-nutrition health professionals
what does the outer ring represent in the nutrition care process
social and environmental factors impacting the clients ability to receive and benefit from nutrition care
- practice settings
- health care systems
- economics (may not be able to afford)
- social systems
What are the middle rings of the nutrition care process
- Describes the qualities and attributions that differentiate nutrition professionals from other practitioners
what are the professional strengths and possibly weaknesses of the nutrition professional
- nutrition and dietetics knowledge
- communication
- evidence based practice
- critical thinking
- documentation
- collaboration
- code of ethics
Outputs of the nutrition care process
-Undertaken by non-nutrition professionals e.g researchers
-Provides quality improvement of the NCP model in healthcare setting and organisations
what is step 1 of the nutrition care process
nutrition assessment (and re assessment )
what happens during nutrition assessment (and re assessment)
systematically obtains, verifies and interprets relevant information against recognised standards to identify nutrition related problems
what are the 5 domains of data to collect during nutritional assessment (ABCDE)
- anthropometric assessment
- biochemical data, medical tests, procedures
- clinical - nutrition focused physical findings
- diet - food/nutrition related history
- extra information - client history
Nutritional assessment (length of time)
The longest part of the consultation
what can be used to ensure that there is nothing forgotten in the consultation
Consultation form
data collected during nutritional assessment should be compared to
evidence based standards such as eating and activity guidelines, NRV’s and food composition tables, BMI or growth standards
what is step 2 in the nutrition care process
nutrition diagnosis
what is nutrition diagnosis
identifies the specific nutritional problem -need to think about what?
nutrition diagnosis is not
a medical diagnosis
In a nutritional diagnosis do we say hypertension or excessive sodium intake
excessive sodium intake
what are the range of possible reasons for a nutrition diagnosis
- intake : energy, macronutrient, fluid, fibre etc
- clinical : test results, anthropometry, observations
- behavioural / environmental : lifestyle, social, knowledge, access to food
- other
Decide on the best nutritional diagnosis based on the
Aetiology (root cause or origin of the problem)
how do we communicate the nutritional diagnosis in a standardised, clear and effective manner
PASS statements
what does PASS statement stand for
problem (what ?)
aetiology (why ?)
signs and symptoms (how do I know ?)
what is meant by the problem in a PASS statement
state the problem
can the practitioner impact, improve or resolve the nutrition : if they can’t they shouldn’t provide advice on what to do
in the PASS statement what is meant by aetiology
state the nutrition related factors that are contributing to or causing the problem
what is meant by signs and symptoms in PASS statement
- quantifiable data, basis for monitoring and evaluation outcomes
- will they indicate if the problem is resolved or improved
- signs are objective data, whilst symptoms are subjective
what is step 3 in the nutrition care process
nutrition intervention
what is the basic characteristics of the nutrition intervention
- selection of nutritional strategies to resolve or improve the nutrition diagnosis
- formulate SMART goals and determine a plan of action with the client
what are the four categories of the nutrition intervention strategies
- nutrition intervention
- nutrition education
- nutrition counselling
- coordination of nutrition care
hat are examples of nutrition intervention strategy
- meals and snacks
- oral or vitamin / mineral supplement
- environmental
- nutrition related medication management
- physical activity
what is examples of nutrition education as a nutrition intervention strategy
- what was provided ?
- what resources were given ?
what are examples of nutrition counselling as a nutrition intervention strategy
- theoretical basis, such as Cognitive Behavioural Therapy, RAVES etc
- strategies, such as counselling and goal setting
what is examples of coordination of nutrition care as a nutrition intervention strategy
coordination of care with other health professionals or referral
what are SMART goals
a framework for designing goals so that they are attainable within a certain time frame and meaningful to the client
what does SMART goals stand for
S = specific
M = measurable
A = achievable
R = relavant
T = timely
what is step 4 in the nutrition care process
nutrition monitoring and evaluation
the nutrition monitoring and evaluation determines
progress being made by the client and whether goals and outcomes are being achieved
the nutrition monitoring and evaluation requires active ..
commitment to measuring and recording appropriate outcomes and indicators relevant to signs and symptoms
during the nutrition care process, progress should be …
monitored, measured and evaluated on a planned schedule
what are the aspects of monitoring progress
- is the intervention working ?
- does the client understand what they are supposed to do?
- identify any changes in the clients condition
->
- may require gathering additional information
- May require diagnosis and intervention changes
when measuring outcomes, what needs to be measured
- direct nutrition outcomes (knowledge gained, behaviour changes, food and nutrient intake changes, improved nutritional status)
- clinical / health outcomes (lab values, anthropometry, body composition, blood pressure etc)
- client centred outcomes (satisfaction, self management)
- health care cost outcomes (medication changes, health care visits, special procedures)
what is meant by evaluating outcomes
- have any or what changes have occurred as a result of the intervention you put in place?
- were these effective ?
- explore why changes may not have been effective
- document the outcome for the client
what is a useful way to remember the steps of nutrition care process and what does it stand for
(ANDIME)
Step 1:Assessment
Step 2:Nutritional diagnosis
Step 3:Interventions
Step 4:Monitor &Evaluate
