An exploration of the language used alongside the Process for Nutrition and Dietetic Practice (PNDP) to describe nutrition-related problems
An exploration of the language used alongside the Process for Nutrition and Dietetic Practice (PNDP) to describe nutrition-related problemsR Lindop1 & J McClinchy21Shrewsbury and Telford Hospitals Trust, The Royal Shrewsbury Hospital, Shrewsbury, UK and 2University of Hertfordshire, Hatfield, Hertfordshire, UKBackground: The Process for Nutrition and Dietetic Practice (PNDP), based on the Academy of Nutrition and Dietetic’s Nutrition Care Process (NCP)1, provides a systematic approach to patient-centred care with emphasis on formulating a ‘Nutrition Diagnosis’ (ND). Unlike the American NCP, a standardised language has not been formally adopted for use alongside the PNDP in the UK. The British Dietetic Association (BDA) have however recently introduced UK-focused nutrition diagnosis terms (NDT) for nutrition-related problems 2. The aim of this study was to explore the use of nutrition diagnosis terms in the PAS statement. Design: A mixed methods design was chosen consisting of an audit of dietetic records and a focus group with eight registered dietitians. To facilitate group discussion across a range of patients and to enable standardisation of the audit tool, participants identified three dietetic record cards of current patients with type 2 diabetes. Twenty four NDs were audited from the anonymised dietetic patient records. The audit-tool was designed to measure the inclusion and accuracy of the problem, aetiology and signs and symptoms within each PAS statement, with the International Dietetics and Nutrition Terminology (IDNT)1 forming the standard for accuracy. Data from the audit also helped formulate the topic guide which explored the dietitians’ experiences of using the PNDP and their views about IDNT and NDT. The focus group was recorded and transcribed verbatim and analysed using thematic analysis. Ethical approval was given by the University of Hertfordshire Ethics committee. Results: Just two of 24 NDs were accurate when compared to IDNT standards. Emergent themes of ‘Being an autonomous practitioner’; ‘Finding using the nutrition diagnosis challenging’; and ‘Considerations for standardised nutrition diagnoses’ demonstrated deeper meaning: While the dietitians valued the ND for working as autonomous practitioners, qualitative investigation highlighted a poor understanding for effective application amongst some participants. Barriers preventing the correct application of, and more negative attitudes towards the ND appeared to arise where there was a poorer understanding of the PAS statement and difference between the medical and nutrition diagnosis. Most participants found the American standardised language impractical and longwinded, preferring unambiguous and concise characteristics for standardised NDs. Although they agreed the BDA’s NDT fitted this description, the participants were currently unaware of the NDTs development.Discussion: The results suggest that a flexible approach is being taken towards the use of the ND. In line with previous research, participants with a good knowledge of the PAS statement tended to display more positive feelings towards its use3. To support the use of the ND, the BDA could provide tools to help implementation, utilise dietetic experiences of ND application through continued research, and incorporate marketing and promotion to raise awareness of their new NDT.Conclusion: The link between knowledge and positive approach towards the ND demonstrates a need for further education regarding the application of PAS statements, and suggests a benefit of introducing a UK-focused standardised language for nutrition related problems to promote uniformity of documentation.References1. International dietetics & nutrition terminology (IDNT) reference manual. Standardized language for the nutrition care process. Chicago: American Dietetic Association; 2008.2. Nutrition and Dietetic Process Terminology [Internet]. BDA 2015 March 4. Available from: https://www.bda.uk.com/ professional/practice/terminology.3. Aylesbury H, McClinchy J. An exploration into dietitians’ knowledge about, attitudes towards and experiences of the nutrition and dietetic care process (NDCP). In: British Dietetic Association Annual Conference Research Symposium Abstracts: 2012 Nov 30. Cheshire, U.K. J Hum Nutr Diet 2012; 25(6): 569–605.