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OBJECTIVE: To identify planned dietetics outcomes of care, dietitians activities performed an recommendations made, and outcome achievement and its relationship to recommendations followed. DESIGN: A multisite, single-group prospective pilot study was conducted to describe the care provided by dietitians to patients receiving enteral nutrition care. SUBJECTS/SETTING: Participants were 172 patients (16 of whom died during hospitalization) receiving at least 75% of nutrient requirements from enteral nutrition products. Subjects were from six acute-care facilities and one rehabilitation facility in the Chicago metropolitan area. MAIN OUTCOME MEASURES: Dietitians identified planned outcomes of care to be accomplished and documented activities performed during the provision of care. Data were collected to measure outcome achievement and to determine whether dietitians' recommendations were followed. STATISTICAL ANALYSES PERFORMED: Descriptive data are reported as frequencies or means +/- standard error. Odds ratios were constructed to estimate the association between dietitians' enteral care recommendations and the achievement of planned outcomes of care. RESULTS: Whether or not enteral nutrition outcomes of care were achieved was positively associated with dietitians' recommendations. The odds of patients' achieving the recommended energy intake goal (P < .001) or increasing (P < .01) or maintaining (P < .04) visceral protein stores were at least four times greater when dietitians' recommendations were followed than when they were not. In addition, dietetics activities performed at the local level were similar to established practices. APPLICATIONS: Dietitians can identify and measure outcomes of dietetics-related care that demonstrate positive contributions to the interdisciplinary enteral nutrition care process.
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Two hundred years ago, the United States was just emerging as a new nation. Chemistry and biology, on which the science of nutrition is based, were also just beginning or in their infancy. Dietetics and nutrition education, being applied sciences, were concerned then--as they are now--with the solution of practical problems of everyday living. Dietetics was an important part of medical practice in colonial days. Much of the teaching then about the value of diet in health and disease was provided by pithy statements, based on empiricism backed by authority, by which the science of medicine was taught to students, and by which health instruction was offered to the public. The experimental method of studying "Nature," promulgated by Francis Bacon, was just beginning to be employed in studies of nutrition. Delay in accepting experimental results, such as Lind's demonstration of the value of citrus fruits in the treatment of scurvy, may be attributed in part to a lack of understanding of the experimental method. In part, it may have been due to the absence of animal experimental methods that are capable of providing clear-cut and convincing evidence. Three of the greatest experimental scientists of the eighteenth century--Lavoisier, Count Rumford, and Benjamin Franklin--busied themselves with matters of concern to dietitians and home economists. Their work and that of others provided a firm foundation for the advances in scientific knowledge during the last two hundred years.
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OBJECTIVE: To identify leadership qualities of clinical nutrition managers and associate these leadership qualities with selected demographic variables (eg, training/degree, length of time in management, number of people supervised, income, and participation in advanced practice activities). DESIGN: The theory of transformational leadership, that is, leadership that incorporates specific interpersonal behaviors of the leader and his or her actions within the organization, provided the framework for the study. Specific transformational leadership qualities--leader behavior, leader personal characteristics, and the effect of the leader on organizational functioning and culture--were measured using the Leadership Behavior Questionnaire (LBQ). The reliability and validity of the LBQ have been reported previously. Other data were obtained using two demographic surveys. SAMPLE: Demographic surveys were mailed to 1,599 members of the Clinical Nutrition Management dietetic practice group. From the 951 (59.8%) respondents, a study sample of 150 clinical nutrition managers and their subordinates was selected to receive the LBQ; 116 (77.3%) instrument sets were used for analysis. STATISTICAL ANALYSIS: Descriptive statistics were used to analyze the demographic surveys. A specified mixed linear model repeated measures Statistical Analysis System procedure was used to compare the clinical manager and subordinate LBQ scores. Association of the selected demographic variables with leadership qualities was measured by lambda, a predictive value measure, using the BMDP 4F program. RESULTS: Clinical nutrition managers exhibited transformational leadership qualities as rated by the LBQ, rating lowest on the communication leadership score and highest on the respectful leadership score. Most of the clinical nutrition manager self LBQ scores were significantly higher than the clinical nutrition manager LBQ scores rated by subordinates. The selected demographic variables appeared to have the strongest predictive effect for the visionary culture building subscore of the LBQ. The visionary culture building subscore is a measure of how well the leader interacts with and affects the functioning of an organization. APPLICATIONS/CONCLUSIONS: More research is needed to define leadership in dietetics: this study can serve as a possible model. One way clinical nutrition managers may be able to enhance their leadership behaviors is to strengthen their skills in communicating their vision. Programs are needed to help clinical nutrition managers shape their organizations to foster leadership development in their subordinates.
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The objective of the study was to develop and validate a 21-item nutrition knowledge test to measure people's knowledge of the fat content of food-products. After pretesting and provisional development, the test was administered twice to study test-retest reliability. Furthermore, various sub-populations with expected differences in nutrition knowledge completed the test in order to study the construct validity of the questionnaire. The subpopulations consisted of lay-people (N = 81), students of human nutrition and dietetics (N = 108), and professional experts (N = 79) on human nutrition. The internal consistency and uni-dimensionality of the test were determined by calculating the KR-20 statistic and the log-likelihood ratio statistic for the Rasch model. Pearson's correlation and gross misclassification between T1 and T2 were calculated to assess the test-retest reliability. Analysis of variance was used to test for differences in mean knowledge scores between subpopulations. Test-retest reliability was found to be sufficient (R = .85). The internal consistency was moderate (KR20 = .68). According to the Rasch model, two items had to be removed from the test before the log-likelihood ratio statistic of the Rasch model indicated that knowledge about the fat content of food products as assessed by the questionnaire is a uni-dimensional construct. The differences in mean knowledge scores between the subpopulations were significant (p < .01) and in the expected direction (experts > students > lay people). It can be concluded that the test is a reliable and valid instrument to measure knowledge about total fat content in food products and that the Rasch model is a comprehensive method to indicate the reliability of nutritional knowledge tests.
This paper presents two studies in a quality management project that aims to diminish malnutrition among hospitalized patients. The objective of study 1 was to investigate what information was available on the nutritional status of patients submitted for dietetic services for reasons other than obesity (n= 167) and of study 2 to evaluate a nine-question screening sheet for malnutrition in patients (n= 115) within 48 h of admission to the hospital. In study 1 sufficient data to evaluate nutritional status was found for 17% of the patients submitted for dietetic services. In study 2 the screening sheet identified 21% of the patients as malnourished and a full nutritional assessment of seven anthropometrical and biochemical measurements 20%. The screening sheet could be simplified to six questions and then had a sensitivity of 0.69, a specificity of 0.91 and a positive predictive value of 0.65. It is concluded that evaluation of nutritional status in hospitalized patients has been disregarded and a simple screening sheet can be used to identify patients in need of further nutritional assessment and treatment.
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