Clinical Practice: Acute & Chronic Care

Clinical Work Settings

What are the major job settings for clinically-based dietitians?

Clinical Work Settings

Health care facilitiesAcute care/in-patient care

short term care delivered to patients who experience sudden illness or trauma

Long term care managing chronic conditions

Ambulatory clinics managing chronic conditions or disease prevention in community dwelling

Responsibilities in Clinical Dietetics

Nutrition Screening

Nutrition Assessment

Nutrition Care Plan

Monitoring Progress

Nutrient Analysis

Responsibilities in Clinical Dietetics

Nutrition ScreeningScreening process to identify nutritional risk

Nutrition Screening Example

DiseaseEating poorlyTooth loss or mouth painEconomic hardshipReduced social contactMultiple medicationsInvoluntary weight loss or gainNeed for assistance in self careElder years (>80)

Nutrition Assessment

Evaluation of collected information

Prioritize nutritional problems

Nutrition Assessment Example

24 hour recallGuided interview to recall all foods and beverages consumed in past 24 hours (or typical day)

Times, amounts, preparation methods

Prompting

Responsibilities in Clinical Dietetics

Nutrition Care PlanBased on diagnosis

care plan for nutrition interventioni.e. special diet therapy, meal plan

Includes plan for ongoing monitoring and evaluation (follow up)

Monitoring ProgressFollow-up on progress of plan to meet set goals

Nutrient AnalysisEvaluate nutritional content of foods consumed

Work time in Clinical Dietetics

Average time involved in tasks

51% client-related activities

10% managerial functions

1% professional activities

5% non-professional activities

20% transit time

Nutrition Professional as Team Member

Team approachNeed integrated efforts to achieve desired outcomes

No one can work entirely on their own

Advancement Opportunities

Entry-level dietitian

Specialization

Team/Service Leader

Clinical Nutrition Dept Manager

Future of Clinical Dietetics

↑ self-employed dietetic counselors↓ out-patient services

Client education changingvenues

timing

↑ need for long-term care

↑ employment by MD offices

Specialized Nutrition Support

Enteral nutrition

receiving nutrients via GI tract

oral, tube, catheter, stoma

Parenteral nutrition

receiving nutrients via vein

large, central OR smaller, peripheral

Goals of Health Care

What are the two major goals of health care?

Maximize human flourishing Curative medicine

Minimize human sufferingPalliative care

–care of the terminally ill aimed to improve quality of life

Reflection Comments

How understanding may affect future practice?Sp/punc/gram/awkTerminology

“eat healthy”“junk food”

Proof read before submittingSpelling

DietitianThen vs. ThanDesert vs. Dessert

Ethical Theories

3 ethical theories that affect attitudes towards health care delivery and services:

Formalist

Utilitarian

Virtues

Bioethical Principles

Autonomy

Justice

Nonmaleficience

Beneficence

Ethical Issues

Is provision of nutrition morally obligatory or morally optional?

Does this change with length of support?

Do ethical guidelines differ for children, older adults, pregnant women, etc.?

Living Will or Advanced Health Directive

Appoints individual to take over health care decisions

Specific directives for course of treatment

Terri Schiavo case (brain injury in mid 20s)

Living wills still taken to court

Dietitian’s Roles

Responsibilities of PDt/RD?

What knowledge, skills, & attitudes needed for debate?

Required Readings

Duester. (1997). Building your business – Setting your fees.

Gross, & Ostrowski. (2008). Getting started in private practice.