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May 2016
Dear (Editor):
Many studies have concluded that malnutrition, which is often misdiagnosed and goes untreated in hospitalized patients, can be identified and diagnosed through Nutrition Focused Physical Assessments (NFPA). Registered Dietitians are an important component in the performance and interpretation of the findings exposed in a NFPA. While physicians and nurses perform their own physical assessments on a daily basis, the dietitian brings a unique nutrition perspective that can aid in addressing underlying issues that might otherwise be overlooked. However, there is an apparent disconnect on how to appropriately identify malnutrition in healthcare settings, which mainly revolves around various barriers impacting implementation efforts.
This study shines light on the current barriers that are hindering full implementation or implementation efforts of Nutrition Focused Physical Assessment. The results of this study show implementation efforts exist, however there are many desires among Registered Dietitians and the Managers overseeing Registered Dietitians regarding NFPA.
This Nutrition Focused Physical Assessment needs assessment survey was completed as part of the Aramark Healthcare Distance Learning Dietetic Internship. The survey was administered to Registered Dietitians and Managers overseeing Registered Dietitians at site locations participating in the Aramark Dietetic Internship 2015-2016. Results of the study will help Aramark determine the steps for successful implementation of NFPA into everyday nutrition assessments. Thank you for your consideration of this manuscript.
Respectfully,
Sarah GentonDietetic InternAramark Healthcare Distance Learning Dietetic Internship710 Dr. Michael DeBakey DriveLake Charles, Louisiana [email protected]
Brooke PfestDietetic InternAramark Healthcare Distance Learning Dietetic Internship2650 Ridge Avenue Evanston, Illinois [email protected]
Ausrine PaulauskaiteDietetic InternAramark Healthcare Distance Learning Dietetic Internship2635 N 7th Street Grand Junction, Colorado [email protected]
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Research Practice and Innovation
Nutrition Focused Physical Assessments, needs, implementation efforts, Registered Dietitian
Word Count: 2,487
Nutrition Focused Physical Assessment: Needs Assessment
Sarah Genton, BS, DieteticsDietetic InternAramark Healthcare Distance Learning Dietetic Internship710 Dr. Michael DeBakey DriveLake Charles, Louisiana [email protected]
Brooke Pfest, BS, DieteticsDietetic InternAramark Healthcare Distance Learning Dietetic Internship2650 Ridge Avenue Evanston, Illinois [email protected]
Ausrine Paulauskaite, BS, DieteticsDietetic InternAramark Healthcare Distance Learning Dietetic Internship2635 N 7th Street Grand Junction, Colorado [email protected]
2
Abstract
Many studies have concluded that malnutrition, which is often misdiagnosed and goes
untreated in hospitalized patients, can be identified and diagnosed through Nutrition Focused
Physical Assessments (NFPA). Registered Dietitians play an important role in the performance and
interpretation of the findings exposed in a NFPA due to their nutritional significance. While
physicians and nurses perform their own physical assessments on a daily basis, the dietitian
brings a unique nutrition perspective that can aid in addressing underlying issues that might
otherwise be overlooked. However, there is an apparent disconnect on how to appropriately
identify malnutrition in healthcare settings, which mainly revolves around various barriers
impacting implementation efforts. This study aimed to better understand the current needs of
Aramark Registered Dietitians and the Managers overseeing Registered Dietitians concerning the
implementation efforts of Nutrition Focused Physical Assessments. A needs assessment survey
was developed and administered to Aramark Registered Dietitians and the Managers overseeing
Registered Dietitians participating in the Aramark Dietetic Internship 2015-2016 site locations.
A total of thirty-seven eligible Registered Dietitians, fourteen Registered Dietitians and twenty-
three Registered Dietitian Managers completed the survey via SurveyMonkey Pro. Managers
overseeing Registered Dietitians completed a different survey than the Registered Dietitians to
understand the management needs. Following the survey, there are many desires and barriers
that were discovered concerning the implementation efforts of Nutrition Focused Physical
Assessments into everyday nutrition practice for Registered Dietitians. The barriers, limitations,
and recommendations for future research are discussed.
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Nutrition Focused Physical Assessment: Needs Assessment
Introduction
Malnutrition in the adult patient population, regardless of the etiology, can negatively
impact patient outcomes on many different levels. These include a patient’s quality of life,
functional status, duration of hospital stay, healthcare cost, wound healing, risk of infection, and
morbidity and mortality when compared to a well-nourished patient1, 2. In 2012, the Academy of
Dietetics and Nutrition (Academy) and the American Society of Parenteral and Enteral Nutrition
(A.S.P.E.N) joined forces to produce guidelines that standardized the definition and diagnostic
criteria for the malnutrition3. The guideline highlights that physical examinations can expose the
presence of several diagnostic criteria of malnutrition such as weight loss or gain, fluid retention,
loss of muscle or fat, and other signs of a specific macro/micronutrient deficiency3. With this,
there is a developing need for Registered Dietitians to perform and apply the outcomes from
Nutrition Focused Physical Assessments (NFPA) to recognize and diagnose malnutrition 3,4,5.
Malnutrition impacts 30%-50% of hospitalized adult patients, but only 3.2% of these
patients are diagnosed upon discharge6. More specifically, research aimed at determining the
prevalence, diagnosis, and documentation of malnutrition discovered that when a Registered
Dietitian was exposed to malnourished patients only 29% of a total 45% were accurately
documented7. There is an apparent disconnect on how to appropriately identify malnutrition in
healthcare settings, which mainly revolves around the lack of training. A survey sent to Aramark
account Registered Dietitians exposed that there is a hesitance to adopt NFPA as part of their
daily assessments related to a lack of training, time, and understanding of the physical findings8.
It is imperative that Registered Dietitians are appropriately trained in Nutrition Focused Physical
Assessment to correctly identify muscle and fat wasting in a reproducible and reliable manner1,4,9.
4
While many healthcare providers perform a physical assessment on a daily basis for
relevant medical diagnosis and interventions, a Registered Dietitian is traditionally not included
in these findings1, 3,4,5. When a Registered Dietitian is able to perform and evaluate findings from
a physical assessment it allows a nutrition-related perspective of physical signs and symptoms
that otherwise could be overlooked1, 3,5.
Nutrition Focused Physical Assessment is an excellent tool for identifying and
diagnosing malnutrition3. However, since there is lack of training, resistance to touch patients,
and little knowledge of findings, it is not commonly included among Registered Dietitians’
nutrition assessments8. Due to the inconsistencies within implementation efforts in the Dietetics
profession, it is unclear exactly what resources Aramark could provide to their practicing
Registered Dietitians and their respective Managers. The intent of this research is to better
understand the current needs of Aramark Registered Dietitians and Managers overseeing
Registered Dietitians with Nutrition Focused Physical Assessments at their accounts. This is to
further investigate their current performance, comfort, knowledge of findings, training efforts,
understanding of the importance, and resources needed through a needs assessment study. Thus,
a pilot needs assessment survey will be provided to Aramark Registered Dietitians and the
Managers overseeing Registered Dietitians at the locations apart of the Aramark Dietetic
Internship 2015-2016.
Through this survey we hope to gather and identify the information that is needed to
support the implementation efforts within Aramark accounts of Nutrition Focused Physical
Assessment. We anticipate that upon the successful findings of this project, it will be made
available to all Aramark accounts providing clinical dietetic services to assess their
implementation efforts and needs.
5
Methods
Research Design
A cross-sectional study was conducted to evaluate the current needs of Registered
Dietitians and the managers overseeing the Registered Dietitians within Aramark regarding the
implementation and performance of Nutrition Focused Physical Assessment in clinical practice.
The cross-sectional design allows for an evaluation of any needs or gaps currently present with
practicing dietitians in regard to Nutrition Focused Physical Assessments. If proven beneficial,
the survey can then be administered to Aramark Healthcare accounts outside of the internship
program to assess their Nutrition Focused Physical Assessment implementation efforts and
current needs.
Study Participants
The survey was administered to a convenience sample consisting of all the managers
overseeing Registered Dietitians and Registered Dietitians involved in the Aramark Dietetic
Internship 2015-2016 year. In order to meet the appropriate inclusion criteria, the participant
must be a clinical Registered Dietitian or a manager overseeing Registered Dietitians that are
employed or managed by Aramark, providing inpatient services, and located at sites participating
in the 2015-2016 Aramark Dietetic Internship. Eligible participants included in the data analysis
were screened and met the required criteria. All participants must provide their consent to
partake in the needs assessment survey. No funding was required for the achievement of the
needs assessment survey.
Data Collection
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The needs assessment survey was developed and distributed through electronic mail
using SurveyMonkey Pro. The needs assessment survey was created to direct the manager of the
Registered Dietitians to answer a specific set of questions, to better understand a managerial
perspective of the needs. An initial question classified if the survey participant is either a
Registered Dietitian or manager and then directs the participant to the appropriate set of
questions. Implementation efforts, training background, and current obstacles with NFPAs were
part of the evaluation measures.
SurveyMonkey Pro was used to compile and organize the data after the completion of the
survey period to be analyzed. Following the submission of the needs assessment and before
analysis, surveys submitted were reviewed to ensure that the appropriate data were being
analyzed and met eligibility criteria.
Statistical Analysis
For the evaluation of the data for this study, descriptive statistics were used. The
responses from the needs assessment, collected from SurveyMonkey, were estimated to show the
total percentage of responses for each answer. Microsoft Excel-201l was then referenced to
calculate mean percentages for questions regarding years credentialed, worked for or managed
by Aramark, and Aramark contract length at the facilities. Percentage (%) response values were
calculated based upon number of responses per selection and the total amount of Registered
Dietitians or managers that answered the question.
Results
RespondentsThe detailed breakdown of the participating nutrition professionals can be seen in Table
1. 47 professionals attempted the needs assessment survey. 9 were eliminated through the
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inclusion criteria questions ending their survey, and 1 refused consent. There were a total of 37
eligible survey participants, which included 23 managers overseeing Registered Dietitians and 14
Registered Dietitians employed or managed by Aramark. The mean (average) amount of time
the Registered Dietitians and Managers have been credentialed as an RD or RDN is 11 years,
which ranges from less than 1 year to 40 years. Aramark has either employed or managed these
Registered Dietitian managers or Registered Dietitians for a mean (average) time period of 6
years, ranging from 2 months to 18 years.
Summary of Needs Assessment Respondents
Total number
of responses
Number meeting inclusion criteria
Number of Registered Dietitians
Number of Managers
overseeing the Registered Dietitians
Met exclusio
n criteria
Refused
Consent
Number of Respondent
s47 37 14 23 9 1
Table 1. Breakdown of the of the Registered Dietitians and Managers overseeing Registered Dietitians, either employed or managed by Aramark, to the Nutrition Focused Physical Assessment Needs Assessment Survey.
Registered Dietitian’s Needs
The Registered Dietitians were asked to give detail regarding their patient population and
average exposure to moderate or high nutrition risk patients (Table 2.). The most predominant
patient populations amongst the survey participants were adults and geriatrics. Of the Registered
Dietitians, 42% assess 75% of their population at a moderate and or high nutrition risk patients
on average each month.
Patient Information
Moderate and/or high nutrition risk adult patient.
Average Monthly percentage
Percentage (%) Response
8
≥ 75% 42%74-50% 21%49-25% 28%24-5% 7%≤ 5% 0
Patient PopulationPopulation Percentage (%)
ResponseAdult 85%
Geriatric 57%Pediatrics/NICU 14%
Other 0Table 2. Characteristics of the patient population and exposure to moderate and or high nutrition risk patients of the Registered Dietitians
Table 3 presents the breakdown of responses to the needs assessment survey from the
Aramark Registered Dietitians. The needs reflect an overall demand for more training and
guidance to resources with Nutrition Focused Physical Assessments. Even though 53% of the
respondents selected very motivated to receive more training in NFPA, there are two main
training barriers that Registered Dietitians face. 78% selected time away from work and 71%
selected program costs.
Some responses to the open-ended question regarding what it would take for their facility
to accept Nutrition Focused Physical Assessments included: proof of reimbursement, education
for all disciplines, formal hands-on training to all Registered Dietitians on staff, and training
starting in the internship.
The clinical nutrition department’s open-ended question concerning barriers for
implementation and performance resulted in: difficulty to perform on certain patients, non-
clinical practicing manager, more assistance from Aramark to receive the necessary training,
more staff, and more training.
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The Registered Dietitians that responded to the survey are either attempting the
performance 75-100% of the time, or less than 25% of the time. No Registered Dietitians
selected they were “very comfortable” in performing Nutrition Focused Physical Assessments,
but were only “somewhat comfortable”. The respondents were also only “somewhat confident”
interpreting the findings into the appropriate classification of well nourished, mild, moderate,
and severe. However, 53% of the Registered Dietitians understood the malnutrition diagnosis
criteria guidelines written by ASPEN and the Academy of Nutrition and Dietetics. When asked
to distinguish strengths and weaknesses the Registered Dietitians noted that strengths were
identifying muscle and fat wasting, being invasive, and motivation to learn more about NFPA.
The weaknesses included the difficulty to assess on obese, elderly, or ventilated patients, and
distinguishing between the different levels malnutrition criteria.
The Managers Overseeing Registered Dietitian Survey
Specific questions that were developed to better understand the needs and
implementation efforts reported from the managers overseeing Registered Dietitians can be seen
in Table 4. The mean (average) Aramark contract length of the 23 managers filling out the
survey was 11 years. 81% of the managers had received training in Nutrition Focused Physical
Assessment through webinars, and 51% through written materials. Some managers reported their
training was solely self-study or self-taught.
Implementation efforts for Nutrition Focused Physical Assessments have been made by
77% of the managers at their locations. However, only 31% feel they have access to resources to
successfully implement Nutrition Focused Physical Assessments at their facility.
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Registered Dietitian's Survey Responses
When did you receive training on Nutrition Focused Physical
Assessments? Select all that apply
Answer ChoicePercentage
(%) Response
Briefly in my undergraduate program 35%Graduate program 7%Dietetic Internship 21%
Continuing Education opportunities 71%Employment training 21%
I have not received any training on NFPA 7%
What training(s) or resource(s) have you received to help you learn about Nutrition Focused
Physical Assessments? Select all that apply.
Webinars 100%Virtual training/simulation 57%
Live simulations/Hands-on training workshops 50%
Seminars 42%Written materials 71%
I have not received any training or resources. 0%
Rate where your motivation is to educate yourself more about Nutrition Focused Physical
Assessments, if given the opportunity (through CEUs,
webinars, presentations at FNCE or related event, etc.).
I am very motivated 53%Motivated 38%
Somewhat Motivated 7%
I am not motivated0%
What barriers do you face to receive training for Nutrition Focused Physical Assessment?
Select all that apply.
Program Costs 71%Time away from work 78%Travel Requirements 42%
Personal Interest 0%Other Barriers 7%
Are other interdisciplinary roles (e.g. Nurses, Physicians,
Occupational Therapists, etc.) within your facility encouraging,
supportive, and respectful of Registered Dietitians performing
Nutrition Focused Physical Assessments?
Yes 24%No 0%
We are not performing NFPA 14%
I am unsure of how other interdisciplinary roles feel about RD
performance of NFPA.57%
How important is it for you to have support from other
disciplines within your facility to
Very Important 57%Important 43%
Somewhat Important 0%
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perform Nutrition Focused Not Important at All 0%
Do the physicians at your facility diagnose malnutrition according to the consensus statement guidelines
written by ASPEN and the Academy of Nutrition and
Dietetics?
Yes, physicians are using the ASPEN/Academy criteria to diagnose
malnutrition.0%
Knowledge regarding the ASPEN/Academy guidelines varies among physicians with regards to
diagnosis of malnutrition. 62%Physicians are not using the
ASPEN/Academy guidelines and, instead, are using other methods to
diagnose malnutrition (e.g. low prealbumin) 28%
Other (please specify) 7%
How often would you say your clinical nutrition department discusses what it will take to implement and/or continue
performing Nutrition Focused Physical Assessments effectively?
Almost every meeting 35%Every now and then to discuss ways to
get training 35%It has been brought up, but not in
regards to implementation 28%Hardly talked about 0%
It has never been discussed 0%How would you rate your nutrition department's compliance with the Aramark policy, Assessment and Education #3: The Nutrition Care Process for Acute Care - "During nutrition diagnosis, the RD will
complete a nutrition-focused physical exam on any patient identified as moderate or high
nutrition care level. The exam may include the examination and
evaluation of body fat, muscle mass, and fluid accumulation in conjunction with energy intake and weight loss. A minimum of two nutritional characteristics
should be obtained to support a diagnosis of malnutrition."
Full Compliance 28%
Partial Compliance 42%Poor Compliance 28%Non-Compliant 0%
I am not sure what the policy is
0%
How would you describe the support from your manager regarding implementing and
performing Nutrition Focused
Very Supportive 61%Supportive 7%
Somewhat Supportive 30%Not at all Supportive 0%
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Physical Assessments as part of your everyday nutrition
What percentage are you currently performing, or
attempting the performance, of Nutrition Focused Physical
Assessments with the patients screened out as a moderate or high
nutrition risk?
Not at all 7%<25% 38%
25-49% 0%50-74% 15%
75-100%38%
Rate your comfort level of performing Nutrition Focused Physical Assessments to assess
signs and symptoms of subcutaneous fat loss, muscle
wasting, and fluid status.
Very Comfortable 0%Comfortable 23%
Somewhat Comfortable 38%Uncomfortable 30%
Very Uncomfortable 7%Rate your understanding of how to diagnose malnutrition accurately (based on the consensus statement guidelines written by ASPEN and
the Academy of Nutrition and Dietetics for accurate diagnosis of
malnutrition).
I have a very high understanding 23%I understand 54%
I somewhat understand 23%I do not understand 0%
I have never been exposed to this criteria 0%
Rate your confidence with interpreting the findings from
Nutrition Focused Physical Assessments to their appropriate classification of well nourished,
mild, moderate, severe?
Very Confident 8%Confident 23%
Somewhat Confident 61%Not Confident 7%
Rate your understanding of how to diagnose malnutrition accurately (based on the consensus statement guidelines written by ASPEN and
the Academy of Nutrition and Dietetics for accurate diagnosis of
malnutrition).
I have a very high understanding 23%I understand 54%
I somewhat understand 23%I do not understand 0%
I have never been exposed to this criteria 0%
Table 3. Overall characteristics from the responses of the registered dietitians that completed the needs assessment survey.
Managers overseeing the Registered Dietitian's SurveyAverage Aramark Contract 11 years
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What training(s) or resource(s) have you received to help you learn about Nutrition Focused
Physical Assessments? Select all that apply.
Answer ChoicePercentage
(%) Response
Webinars 81%Seminars 27%
Written materials 50%Hands-On Training/Live Simulations 31%
Virtual Simulations 36%Other 13%
What kind of training have you provided to the Registered
Dietitians for performance of Nutrition Focused Physical
Assessments at your facility? Select all that apply.
Webinars 71%Seminars 36%
Written materials 45%Hands-on training/Live Simulations 31%
Virtual Simulations 27%I have not provided any training or
resources to my Registered Dietitians 9%
What implementation efforts have you made and found successful with Nutrition Focused Physical Assessment performance at your
facility?
Nutrition focused physical assessments are not being performed at my location 27%
Please explain efforts.77%
Have efforts been made to educate other disciplines or departments
about Registered Dietitians performing and interpreting
results from Nutrition Focused Physical Assessments?
Yes, education efforts have been made and other disciplines understand the
importance of Nutrition Focused Physical Assessments.
9%
Yes education efforts have been made, but other disciplines do not fully
understand the importance of Nutrition Focused Physical Assessments. 19%
Efforts have been made, but I am unclear about the other disciplines understanding the importance of
Nutrition Focused Physical Assessments. 23%
No, efforts have not been made. 47%Do the physicians at your facility
diagnose malnutrition according to the consensus statement guidelines
written by ASPEN and the Academy of Nutrition and
Dietetics?
Yes, physicians are using the ASPEN/Academy criteria to diagnose
malnutrition.22%
Knowledge regarding the ASPEN/Academy guidelines varies among physicians with regards to
diagnosis of malnutrition.
31%
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Physicians are not using the ASPEN/Academy guidelines and, instead, are using other methods to
diagnose malnutrition (e.g. low prealbumin) 27%
Other (Please Specify) 18%Have you experienced any barriers with other interdisciplinary roles
within your facility in your attempt to perform Nutrition
Focused Physical Assessments?
Yes 15%
No, other interdisciplinary roles have been supportive and encouraging.
85%Do you feel you have access to
resources to successfully implement Nutrition Focused Physical Assessments at your
facility?
If yes, please explain below the resources you have found most
beneficial.31%
If no, please explain why. 68%Rate your comfort level when performing Nutrition Focused
Physical Assessments (assessing signs and symptoms of
subcutaneous fat loss, muscle wasting and fluid status).
Very Comfortable 9%Comfortable 33%
Somewhat Comfortable 38%Uncomfortable 19%
Very Uncomfortable 0%Rate your understanding of how to diagnose malnutrition accurately (based on the consensus statement
guidelines written by ASPEN/ESPEN and the Academy
of Nutrition and Dietetics for accurate diagnosis of
Malnutrition).
I have a very high understanding 47%I understand 38%
I somewhat understand 14%I do not understand 0%
I have never been exposed to this criteria 0%Other 0%
What are the barriers you face in providing quality resources and
training for your Registered Dietitians about Nutrition Focused
Physical Assessments? Select all that apply.
Financial Reasons 59%Limited Time 59%
Travel Requirements 36%Personal Interest 13%
Other 22%22
Our nutrition department is in _____ percentage of compliance
with Aramark's policy for Nutrition Focused Physical
Assessments assessing fat loss, muscle wasting, and fluid status. (Assessment and Education #3:
Greater than 75% 36%50-74% 22%25-49% 22%
Less that 25% 13%I am not sure what the policy is 4%
15
The Nutrition Care Process for Please rate your comfort level when providing constructive feedback to your Registered
Dietitians about their performance and documentation of Nutrition Focused Physical Assessments?
Very Comfortable 40%Comfortable 31%
Somewhat Comfortable 13%Uncomfortable 13%
Very Uncomfortable 0%
How often would you say your clinical nutrition department discusses what it will take to implement and/or optimize
performance of Nutrition Focused Physical Assessments?
Almost Every Meeting 50%Every Now and Then 50%
It has been brought up, but not regarding Implementation 0%
Hardly talked about 0%It has never been discussed 0%
Rate your confidence with interpreting the findings from
Nutrition Focused Physical Assessments to their appropriate classification of well nourished,
mild, moderate, severe?
Very Confident 8%Confident 23%
Somewhat Confident 61%
Not Confident7%
What kind of concerns and/or consistent areas of struggle do the Registered Dietitians you oversee
express regarding Nutrition Focused Physical Assessments?
Select all that apply.
Not wanting to touch the patient 71%Not enough time 52%
Interpretation of their findings (example: know how to perform the exam, but do not feel confident in
knowing how to classify the findings of mild, moderate, severe). 61%
Accurate documentation of malnutrition. 33%
I am not sure. I have not asked how things are going with their performance
of Nutrition Focused Physical Assessments. 0%
We are not performing Nutrition Focused Physical Assessments. 14%
Other 9%Table 4. Responses from the Managers that oversee the Registered Dietitians.
DiscussionThe goal of this study was to determine the current performance, implementation efforts,
and associated barriers that Aramark Registered Dietitians and their respective managers face
16
with NFPA. The results of this pilot study are consistent with previous studies looking into
barriers and challenges of Nutrition Focused Physical Assessments for Registered Dietitians.
These barriers include resistance to touch patients, the need for hands-on training, further
education on physical findings, and financial barriers5.
The survey questions explored many avenues where potential implementation hindering
barriers could have existed with other disciplines, within the clinical department, personal
performance, training background, and specific management related questions. There were
multiple overall findings of the surveys collected from the Registered Dietitians and their
managers. First, there does not seem to be a trend in other interdisciplinary roles hindering the
implementation efforts of NFPAs from the manager or Registered Dietitians survey. However,
there is an inconsistency with the physicians at the site locations in their understanding of the
updated practices guidelines for malnutrition diagnosis. Thus, a multidisciplinary approach to
educate on the updated Academy and ASPEN guidelines for accurate diagnosis of malnutrition
with reimbursement related benefits might be warranted.
Second, it appears that nutrition departments are making the necessary efforts for the
accomplishment of NFPA into everyday nutrition assessments. Most of the managers responded
that more budget friendly hands-on training, pocket guides, malnutrition documentation
education, and resources/guidance provided by Aramark were needed for successful
implementation. This finding may indicate that there is opportunity for Aramark to provide
additional resources to the managers overseeing Registered Dietitians in order for them to better
support their clinical staff. These resources may increase the Registered Dietitians confidence
and comfort when performing NFPA, in which RDs were only “somewhat
confident/comfortable” when asked. One specific struggle noted was performance of NFPA on
17
obese/overweight patients and on critical patients in the intensive care units. This is consistent
with other studies findings that performing NFPA on patients in the ICU presents a complex
situation due to the nature of the setting and their fragile condition 5. Additionally, there are little
to no guidelines available for accurately evaluating muscle and fat loss in obese individuals 5.
Third, one of the main problems revolves around the actual performance of NFPA, and
not the knowledge behind it. The majority of Registered Dietitians were either very motivated or
motivated to be more educated in NFPA. It seems as if Registered Dietitians and managers
understand the importance, the knowledge behind, and are motivated to learn more about NFPA.
However, actually performing the invasive NFPA and interpreting that information into the
appropriate criteria is a problem area. This is consistent with majority of trainings delivered
through webinars, self-study, and written materials since application would not be involved.
Extensive hands-on training workshops with instruction and guidance would be beneficial.
However, these trainings can be extremely costly, typically are on a workday, and require travel
if not close to facility.
The strength of this study is the ability to quickly assess the needs of Aramark Registered
Dietitians and managers about NFPA. The study does have some limitations. Firstly, the data for
this survey was gathered via a self-reported questionnaire, introducing the potential for
dishonesty in questions and situational bias. Secondly, this is a pilot study with a small
convenience sample, limiting full assessment of the needs of all Aramark Registered Dietitians
and their corresponding managers.
Conclusion
Nutrition Focused Physical Assessments have not traditionally been a component of
assessments performed by Registered Dietitians, and thus inconsistencies exist with
18
implementation efforts across Aramark accounts. As our research demonstrates, it is apparent
that Aramark Registered Dietitians and the managers who oversee these Registered Dietitians are
in need of additional education and in-depth training to fully feel comfortable and confident. The
barriers that exist are cost of trainings, time, and travel. Future research will need to administer
the needs assessment survey to all Aramark accounts to fully grasp the resources, trainings, or
guidance needed with NFPA. Furthermore, develop an Aramark training program that would
address these barriers, and is able to meet the needs expressed in this study.
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