Chapter 5 Nutrition Care Process

members to review the plan of care on an ongoing basis to ensure that the most appropriate multidisci- plinary interventions are in place. To determine which interventions are the best for each resident/client or group, there should be input from the resident/client, family, other health care providers, and the care plan team. The standardized terminology for nutrition inter- vention is organized in four domains (see Box 5.7).

BOX 5.7 Four Domains of Nutrition Intervention (Step 3)

● Food and/or Nutrient Delivery ● Nutrition Education ● Nutrition Counseling

● Coordination of Nutrition Care

Source: Academy of Nutrition and Dietetics. Nutrition assessment introduction. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. Nutrition Intervention Terms and Definitions. http://ncpt. webauthor.com/pubs/idnt-en/page-061. Accessed January 25, 2016.

Nutrition interventions involve two interrelated processes: planning and implementing (9). In the plan- ning process, the RDN develops intervention goals by prioritizing nutrition diagnoses; consulting with the resident/client, family, and other health care team mem bers; using standard practice guidelines, espe- cially those found in the Academy’s Evidence-Based Nutrition Practice Guidelines (http://andeal.org); and following institution policies. Planning leads to the documentation of a nutrition prescription along with specific interventions. The nutrition prescription includes the recommended intake of energy or food/ nutrients based on current reference standards and dietary guidelines related to the patient’s/client’s health and nutrition diagnosis (8). Each intervention is designed to meet the needs of the resident/client or the group. The nutrition interventions are chosen to resolve the nutrition diagnosis and to provide the care needed to reach the desired outcomes that can be measured and evaluated. These interventions must be based on scien- tific principles and grounded in high-quality, evidence-based research.

Once nutrition interventions are planned, the RDN may implement them or delegate implementation to others. The RDN coordinates the communication of the nutrition care, continues with data collection as part of the reassessment/monitoring and evaluation process, and revises the nutrition interventions as needed to meet the goals of the resident/client. The RDN must continually judge the likelihood that the nutrition

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interventions will improve the problem and must con- sider the resident’s/client’s or group’s perception of the problem’s importance. The goals of the intervention must depend in part on the severity of the problem, any safety concerns, and the needs of the resident/client or group. Critical thinking skills are essential for the RDN, who plays a valuable role in prioritizing and setting realistic goals and ensuring the appropriate indi- vidualized and evidence-based interventions are in place (see Box 5.8).

BOX 5.8 Critical Thinking Steps During Nutrition Interventions

● Setting goals and prioritizing

● Defining the nutrition prescription or basic plan ● Making interdisciplinary connections

● ●

Initiating behavioral and other nutrition interventions

Matching nutrition intervention strategies with resident’s/client’s needs, nutrition diagnosis, and values

●

Choosing from among alternatives to deter- mine a course of action

● Specifying the time and frequency of care

Source: Academy of Nutrition and Dietetics. Nutrition assessment introduction. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. Nutrition Intervention Snapshot. http://ncpt.webauthor.com/ pubs/idnt-en/category-3. Accessed January 25, 2016.

Step 4: Nutrition Monitoring

and Evaluation The fourth step of the NCP is nutrition monitoring and evaluation. Monitoring specifically refers to the review, measurement, and documentation of the resident’s/ client’s or group’s nutritional status at scheduled (pre- planned) follow-up points. Evaluation is the systematic comparison of current findings with previous status, intervention goals, and/or reference standards. Monitoring and evaluation uses selected outcome indi- cators (markers) that are relevant to the resident’s/cli- ent’s or group’s defined needs, nutrition diagnosis, nutrition goals, and disease state. Recommended times for follow-up, along with relevant outcomes to be mon- itored, can be found in the Academy’s Evidence-Based Nutrition Practice Toolkits and other evidence-based sources.

The purpose of the nutrition monitoring and evalu- ation step is to determine the progress of the resident/ client or group and their ability to meet the intended goals. It requires an active commitment to measuring