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Nutrition Therapy and Pathophysiology | 3eNelms | Sucher | Lacey | Roth

Kathryn Sucher, ScD, RDSan Jose State University

Role of the Dietitian in the Health Care System

Chapter 1

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The Registered Dietitian in Clinical Practice

• What is the role of the clinical dietitian?– Nutrition therapy

• Nutrition care process (NCP)– Nutrition assessment– Nutrition diagnosis– Nutrition intervention– Nutrition monitoring and evaluation

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Scope of Practice Framework

• Defines roles, functions, responsibilities and activities of practitioners– Practice Management and Advancement– Practice Standards– Practice Resources

• Supported by:– Education– Credentials

• See Figure 1.1

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Clinical Nutrition Team

• Settings– Acute care facilities– Longer-care facilities

• Inpatient and outpatient • General and specialized units• Organization varies across settings• See Tables 1.1 and 1.2

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Other Health Professionals –Interdisciplinary Teams

• Members of the health care team– Medical doctor– Nurse– Pharmacist– Occupational therapist (OT)– Speech-language pathologist– Social worker– See Table 1.4

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Health Care Services andReimbursement for (MNT)

• Where does medical nutrition therapy (MNT) fit within our current health care picture?

• In 2012, among the U.S. population:– 84.6% insured– 15.4 % not insured

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Health Insurance

• Private – 64% of insured population under 65– Alliance Healthcare Initiative– Group contract- RDs can obtain

reimbursement• Public – 33% of insured population under

65– Medicare – Part B reimbursement for R.D.’s– Medicaid – varies among states

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2014 Affordable Care Act

• Allows purchase of insurance by individuals and small companies

• Expanded Medicaid in some states• Requires preventive services

– Nutrition services are likely to expand

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Critical Thinking Skills and Professional Performance

• To become an educated and trained member of the health care team– Didactic program in dietetics– Supervised practice

• Apply education in clinical setting– Learn to become a critical thinker– Become a RD (registered dietitian)– Participate in continuing education, practice,

critical thinking

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Definition of Critical Thinking

• What is critical thinking?– Specific knowledge base– Experience– Competencies– Attitude– Standards

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Components of Critical Thinking – Specific Knowledge Base

• Knowledge of nutrition and its role in health and disease– Minimum level based on Standards of

Education of the ADA set by CADE– Continually changing and expanding

knowledge and skills– Continuing Education as professionals

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Components of Critical Thinking – Experience

• Experience– Supervised practice

• Dietetic internship or coordinated program– Continued application and practice as a

professional

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Components of Critical Thinking – Competencies

• Competencies – Cognitive process to make clinical judgments– Medical problem solving

• Scientific method: critically reviewed research• Evidence-based dietetics practice• Problem solving• Decision making• Diagnostic reasoning

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Components of Critical Thinking – Attitudes and Standards

• Attitudes– Reflection of values– Consider fairness and responsibility– See Table 1.7

• Standards– Professional standards

• Code of Ethics• Standards of Professional Performance• Outcomes research

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Levels of Clinical Reasoning

• Entry-level practice—basic• More experienced—able to examine

alternatives independently, systematically, disconnecting from authority

• Highest level—analysis of the entire situation, accountability for decisions, and continuous quality of care