Standardised nutrition diagnosis terminology: implications for dietetics practice

Research Doctorate - Doctor of Philosophy (PhD)Standardised Nutrition Diagnosis (SND) as part of the Nutrition Care Process (NCP) has been implemented in the United States by the American Dietetic Association (ADA). This study is the first investigation of the potential for SND to be implemented beyond the United States. Research was conducted in two phases: (1) a case study of Australian dietetics practice and (2) a cross-sectional mail survey designed to investigate the extent of, and potential for, international SND implementation. Phase 1 involved application of descriptive case study methodology to an existing dataset of 274 patient records from three Australian hospitals. Of these records, 85 showed evidence of attendance by a dietitian. Results revealed incomplete documentation of the NCP in Australian dietetics practice, lack of understanding of the Nutrition Diagnosis step and use of non-standardised terms in documentation of nutrition care. In Phase 2, a convenience sample (n=420) of clinical dietetics practitioners in Australia, Canada, Malaysia, New Zealand, the United States and the United Kingdom was mailed a pre-tested and piloted self-administered questionnaire. Completed questionnaires were returned by a total of 85 practitioners from Australia (55.3%), Canada (25.9%) and Other Countries (18.8%). The questionnaire was also completed by a comparison sample (n=37) of third-year Australian dietetics students. When asked to identify, define, justify and rank NDTs using information provided in a case scenario, most practitioners, regardless of country of practice, did not demonstrate ability to accurately apply SND. Level of experience with medical nutrition therapy was demonstrated to have no impact on whether practitioners correctly identified, justified or ranked NDTs; however, less-experienced practitioners (≤10 years) were more likely to provide valid definitions for NDTs than more-experienced (>10 years) practitioners. The Australian dietetics students were no more or less adept at SND application than the Australian dietetics practitioners. This research highlights widespread lack of awareness and understanding of the NCP and SND. Complexity of SND is flagged as a potential obstacle to successful international adoption, and a strong case is made for supporting implementation with rigorous educational programs and systematic ongoing professional training. Anticipated challenges to SND implementation are far outweighed by the opportunities it presents to ensure that care of patients is translatable within and across settings, and that dietetics professionals are able to effectively and convincingly communicate their distinct role in patient outcomes