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Part I Introduction to Nutrition Care in Older Adults

The supporting systems are ●

screening and referral systems and ● outcomes management systems.

The screening and referral systems can be completed by the RDN or inpatient nutrition staff; however, nutrition screening is most often completed by other health care professionals. The outcomes management systems track the progress of a group of multiple residents/clients through the NCP, as opposed to the progress of an indi- vidual. Outcomes management is an important part of the total quality management and performance evaluation. The analysis of outcomes data (evidence) helps dietetics practitioners modify performance and practice to improve the quality of care.

In brief, if a nutrition screen/referral indicates a potential problem that could benefit from nutrition care, the RDN begins the standardized NCP by con- ducting a nutrition assessment (Step 1). If the RDN then determines that there is a nutrition problem, he or she makes a nutrition diagnosis (Step 2). Next, the RDN plans and implements a nutrition intervention that addresses the identified nutrition problem/ diagnosis (Step 3). Outcomes of the intervention are subsequently monitored and evaluated (Step 4). This may reveal that the client or group needs further assis- tance from the RDN to reach recommended nutrition goals. If so, the NCP cycle should continue until goals are met. Figure 5.2 demonstrates how the NCP steps provide a framework for the provision of nutrition care for residents/clients or groups.

As described in the remainder of this chapter, each step in the NCP has its own set of critical thinking skills to assist the RDN in determining the needs of each step. The Academy’s Career Development Guide (CDG) has adapted the Dreyfus Model of Skill Acquisition to outline the progression of critical thinking skills of the RDN and NDTR as they improve their knowledge and experience with their practice. The CDG lists the fol- lowing stages of progress: novice, beginner, competent, proficient, and advanced practice/expert. The founda- tion of dietetics is developed in the novice and beginner stages. The competent stage is the entry-level knowl- edge and skills base that was developed to apply to the care settings. This stage is where the development of critical thinking skills improves as work experience is obtained. The proficient stage is when the RDN and NDTR have developed their ability to prioritize, gener- alize, apply problem-solving skills to new scenarios, and identify innovative solutions utilizing their critical thinking skills. Critical thinking skills need to be intui- tive for the RDN and NDTR to transition into the advanced practice/expert stage (4). The Academy has updated Scope of Practice and Standard of Professional

Figure 5.2 Relationships of Nutrition Care Process Steps

Relationships Nutrition

assessment

Nutrition diagnosis

Nutrition intervention

Nutrition monitoring & evaluation

Problem

Relationships Nutrition

assessment

Etiology

Signs & Symptoms

Nutrition diagnosis

Nutrition intervention

Nutrition monitoring & evaluation

Problem

Etiology

Signs & Symptoms

Source: Academy of Nutrition and Dietetics. Nutrition assessment introduction. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. NCP Step 1: Nutrition Assessment. http://ncpt.webauthor.com/pubs/idnt-en/page-001. Accessed January 25, 2016.

Practice documents for the RDN and the NDTR. The practice paper, “Critical Thinking Skills in Nutrition Assessment and Diagnosis,” on critical thinking skills related to the NCP is available at the Academy’s website (see www.eatrightpro.org) (5).

Step 1: Nutrition Assessment Nutrition assessment is a systematic method of obtaining, verifying, and interpreting data needed to identify nutri- tion-related problems, their causes, and their significance (6). As noted previously, the assessment may be initiated by a referral and/or by the screening of individuals or groups for nutritional risk factors. Following a resident/ client referral or a positive nutrition screening, the RDN uses nutrition assessment to determine whether the resi- dent/client might benefit from nutrition care and if a nutri- tion diagnosis/problem exists. If, after the initial assessment or reassessment is completed, the RDN deter- mines that a nutrition problem does not exist or has been resolved or that there is no nutrition intervention that would benefit the resident/client, then discharge or dis- continuation from nutrition care would be appropriate. Assessment data should be relevant, accurate, and

timely. The purpose of nutrition assessment is to verify and interpret the information needed to determine whether nutrition problems/diagnoses exist. The use of standardized nutrition assessment language enhances the communication between RDNs, their residents/clients,