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Role of Dietitian In Healthcare Team

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					    Role of Dietitian In
     Healthcare Team
       Eleni P Andreou,RD,LD
 President of Cyprus Dietetic Association
2nd Cyprus Dietetic Association Conference
     With International Participation,
               26-28/4/2002
             Eleni P Andreou, RD
26/10/2011
               Clinical Dietitian
                 Preview
 Introduction:meaning of the health care
  team
 Definition of the dietitian according to the
  leading professional bodies
 Role of the dietitian
 Benefits of the health care team in relation
  to dietetics
 Dietitian in Cyprus
                   Eleni P Andreou, RD
26/10/2011
                     Clinical Dietitian
                Objectives
  Define dietitian and his/her areas of
  expertises
 Identify the role of the dietitian and state the
  process of practice in the health care team
 Determine the benefits of the health care
  team


                    Eleni P Andreou, RD
26/10/2011
                      Clinical Dietitian
                        PHYSICIAN
                        & MEDICAL PROFESSIONALS

PHYSICAL THERAPIST/                             PSYCHOLOGIST
CL. EXERCISE
PHYSIOLOGIST

                        Healthcare team
NURSE                                                  DIETITIAN
                             Patient
                                                    MEDICAL
                                                    TECHNICIANS
SOCIAL WORKERS
                                     PHARMACIST/
               OTHERS                MICROBIOLOGIST/
                                     CHEMIST
                         Eleni P Andreou, RD
  26/10/2011
                           Clinical Dietitian
             Health Care Team
 Health care team (HCT) refers to a group of
  trained professionals , including a doctor, nurse,
  dietitian, social worker, psychologist, pharmacist,
  technician, and other health care providers.
       Helpers of the team: a receptionist or
  secretary or aids.
 The professionals provide the patient with the
  diagnosis and instructions or necessary procedures
  for his/her treatment.
                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
        The HCT: Playing to Win
 Most important person in HCT: the patient.
 Patient is the “lead-player.”
 Family, friends are the “supporting players.”
 Health care professionals are the “coaches” who
  direct for success – for the good health.




                    Eleni P Andreou, RD
26/10/2011
                      Clinical Dietitian
             Eleni P Andreou, RD
26/10/2011
               Clinical Dietitian
             What Is a Dietitian?
   “A dietitian is a person
    with a legally
    recognised
    qualification (in
    nutrition and dietetics),
    who applies the science
    of nutrition to the
    feeding and education
    of groups of people and
    individuals in both
    health and
    disease”.Dietetics is a
    paramedical
    profession
                        Eleni P Andreou, RD
26/10/2011
                          Clinical Dietitian
   What is a dietitian?
     “A dietitian is a person with a legally
    recognised qualification (in nutrition
    and dietetics), who applies the science
    of nutrition to the feeding and education
    of groups of people and individuals in
    both health and disease”.

                   Eleni P Andreou, RD
26/10/2011
                     Clinical Dietitian
         Dietitians Fields of Work
 Dietitians with clinical training work with
  physicians and other healthcare team
  members to provide appropriate diet therapy
  to patients within hospitals and other clinical
  settings(EFAD).
 Other fields of work for dietitians include
  advising caterers on the nutrition of healthy
  people, promoting healthy nutrition within
  local communities, working within the food
  industry or the media.
                    Eleni P Andreou, RD
26/10/2011
                      Clinical Dietitian
             Dietetics: Paramedical
                   Profession
 Also,
 The profession of dietetics has an
  official definition established by the
  international labour office in Geneva. It
  is classified among the paramedical
  professions and has been coded under
  group 0.69.

                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
      British Dietetic Association
                           According to BDA,
                                  “Dietitians work with
                                   people and
                                   science”. Their
                                   special skill is
                                   translating scientific
                                   and medical
                                   decisions relating to
                                   food and health into
                                   terms which
                                   everyone can
                Eleni P Andreou, RD
26/10/2011                         understand.
                  Clinical Dietitian
 American Dietetic Association
   “Registered dietitians (RDs) are food
    and nutrition experts who have met the
    following criteria to earn the RD
    credential”:




                  Eleni P Andreou, RD
26/10/2011
                    Clinical Dietitian
                    ADA
   Complete a minimum of a bachelor's
    degree at a US regionally accredited
    university or college and course work
    approved by the commission on
    accreditation for dietetics education
    (CADE) of the American dietetic
    association (ADA).

                  Eleni P Andreou, RD
26/10/2011
                    Clinical Dietitian
                     ADA
   Complete a CADE-accredited or -
    approved supervised practice program
    at a healthcare facility, community
    agency, or a foodservice corporation, or
    combined with undergraduate or
    graduate studies.


                   Eleni P Andreou, RD
26/10/2011
                     Clinical Dietitian
                  ADA
 Pass a national examination
  administered by the commission on
  dietetic registration (CDR).
 Complete continuing professional
  educational requirements to maintain
  registration.


                Eleni P Andreou, RD
26/10/2011
                  Clinical Dietitian
             Dietitians Credentials
   Some RDs hold additional certifications
    in specialized areas of practice, such as
    pediatric or renal nutrition, nutrition
    support, and diabetes education. These
    certifications are awarded through CDR,
    the credentialing agency for ADA,
    and/or other medical and nutrition
    organizations and are recognized within
    the profession, but are not required.
                    Eleni P Andreou, RD
26/10/2011
                      Clinical Dietitian
             Dietitians Credentials
   In addition, many states have regulatory
    laws for dietitians and nutrition
    practitioners. Frequently these state
    requirements are met through the same
    education and training required to
    become an RD.


                    Eleni P Andreou, RD
26/10/2011
                      Clinical Dietitian
             Dietitians in Workforce
 RDs work in:
 Hospitals, and other health care facilities,
  educating patients about nutrition and
  administering medical nutrition therapy as
  part of the health care team. They may also
  manage the foodservice operations in these
  settings, as well as in schools, day-care
  centers, and correctional facilities, overseeing
  everything from food purchasing and
  preparation to managing staff.
                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
             Dietitians in Workforce
   Sports nutrition and corporate wellness
    programs, educating clients about the
    connection between food, fitness, and
    health.




                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
             Dietitians in Workforce
 Food and nutrition-related businesses and
  industries, working in communications,
  consumer affairs, public relations, marketing,
  or product development.
 Private practice, working under contract with
  health care or food companies, or in their own
  business. RDs may provide services to
  foodservice or restaurant managers, food
  vendors, and distributors, or athletes, nursing
  home residents, or company employees.
                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
             Dietitians in Workforce
 Community and public health settings
  teaching monitoring, and advising the public,
  and helping to improve their quality of life
  through healthy eating habits.
 Universities and medical centers, teaching
  physicians, nurses, dietetics students, and
  others the sophisticated science of foods and
  nutrition.

                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
             Dietitians in Workforce
   Research areas in food and
    pharmaceutical companies, universities,
    and hospitals, directing or conducting
    experiments to answer critical nutrition
    questions and find alternative foods or
    nutrition recommendations for the
    public.

                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
             Academic Qualifications
   Dietitians study a variety of subjects, ranging
    from food and nutrition sciences, foodservice
    systems management, business, economics,
    computer science, culinary arts, sociology,
    and communication to science courses such
    as biochemistry, physiology, microbiology,
    anatomy, and chemistry.




                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
 Employment Opportunities.
 Dietitians work in a wide variety of
  employment settings, including health care,
  business and industry, public health,
  education, research, and private practice,
  media.
 Many work environments, particularly those in
  medical and health care settings, require that
  an individual be credentialed as an
  RD/SRD(ADA, BDA).
                   Eleni P Andreou, RD
26/10/2011
                     Clinical Dietitian
         Dietitians in Health Care
                   Team
 Dietitians, as part of the health care
  team, consult people in hospital or in
  the community.
 They promote good health by
  educating the public and other health
  professionals about diet and nutrition.


                  Eleni P Andreou, RD
26/10/2011
                    Clinical Dietitian
  What Is the Role of a Dietitian, a
              Community
Nutritionist and a Clinical Nutritionist?
 :The title clinical dietitian refers to a professional
  who has a degree in dietetics AND finished an
  internship at a recognized hospital AND is
  registered .
 A dietitian can also use the title "nutritionist".
  However, a nutritionist does not necessarily have a
  degree in dietetics nor finished an internship nor is
  registered.

                      Eleni P Andreou, RD
26/10/2011
                        Clinical Dietitian
  What Is the Role of a Dietitian, a
              Community
Nutritionist and a Clinical Nutritionist?
   Therefore, anyone can claim to be a
    nutritionist but only professionals with
    appropriate credentials can call oneself a
    dietitian.




                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
  What Is the Role of a Dietitian, a
              Community
Nutritionist and a Clinical Nutritionist?
 The role of a dietitian includes patient and public
  education in nutrition and food service
  administration.
 A community nutritionist should have the
  qualification of a dietitian.
 The role of the community nutritionist should
  include public education in nutrition, helping with
  the government to set health policies.
  Community nutritionist can do consultation with
  school children and the elderly.
                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
  What Is the Role of a Dietitian, a
              Community
Nutritionist and a Clinical Nutritionist?
   A clinical nutritionist must have the qualification
    of a dietitian since he/she has to deal with
    nutrition therapy,
    for example teaching patients the diabetic diet,
    renal diet, low fat diet, low cholesterol diet,
    low purine diet, weight reduction diet,
    feeding patients by enteral nutrition,
    parenteral nutrition etc.


                       Eleni P Andreou, RD
26/10/2011
                         Clinical Dietitian
  What Is the Role of a Dietitian, a
              Community
Nutritionist and a Clinical Nutritionist?
   In addition, a clinical dietitian is
    also responsible for nutrition management
    in special conditions such as coma,
    hepatitis, liver cirrhosis, cancer,
    HIV infection, stroke, metabolic diseases
    etc.


                    Eleni P Andreou, RD
26/10/2011
                      Clinical Dietitian
                Diet Therapy
   Normal life-cycle conditions
   Dietary practices and miscellaneous conditions
   Special pediatric conditions
   Neurological and psychiatric conditions
   Pulmonary disorders
   Cardiovascular disorders
   Gastrointestinal disorders
   Pancreatic, hepatic, and Biliary disorders
   Endocrine disorders
   Weight control and malnutrition

                      Eleni P Andreou, RD
26/10/2011
                        Clinical Dietitian
                 Diet Therapy
   Musculoskeletal, arthritic, and collagen disorders
   Hematology: Anemias and blood disorders
   Leukemias, lymphomas, and cancer
   Surgical disorders
   Hypermetabolic, infectious, traumatic, and febrile
    conditions
   Renal disorders
   Enteral and Parenteral nutrition
                       Eleni P Andreou, RD
26/10/2011
                         Clinical Dietitian
    Interaction of the Dietitian in the
           Health Care Team
 Referral for nutritional consultation from the
  physician and/other health professionals based on
  medical diagnosis , laboratory tests,
  physical/mental status, preliminary diet order by
  physician
 Nutritional intervention
 Communication with the members of the health
  care team for the effective treatment of the patient

                      Eleni P Andreou, RD
26/10/2011
                        Clinical Dietitian
             Nutritional Intervention
                     S-O-A-P
   1.Gathering of the subjective data
    Patient interview, establish rapport with pt,
    report diet history, food likes and dislikes,
    weight history, knowledge of pt regarding
    nutrition and nutritional problem, realize
    patient’s ability for cooking, identify dietary
    habits and ability to eat, observe physical
    signs for malnutrition
                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
             Nutritional Intervention
   2.Gathering of the objective data
    Anthropometric measurements, review
    medical chart for diagnosis and physical
    symptoms, laboratory tests, medications,
    nurses notes for appetite status and daily
    consumption of food and liquid intake ,
    urine output and other physical symptoms
    or conditions regarding food intake.
                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
             Nutritional Intervention
 3. Nutritional assessment.
      Calculate ideal body weight/healthy weight
  and energy, fluid, and nutrient needs.
       Assess weight, nutritional deficiencies or
  excess, state drug nutrient interaction, physical
  signs of malnutrition, appropriate dietary needs
  and diet description based on findings.
        Consider medical, social and dietary factors
  affecting nutritional status

                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
       Nutritional Intervention
   4.Planning
        Diet and nutritional supplement
    recommendations
        Dietary and behavior modification,according to
    the problem
         Communicate clinical evaluation of nutritional
    status and recommendations to healthcare team
         Request further investigation or biochemical
    tests based on nutritional evaluation
          Team action plan
          Nutrition education of the patient and follow
    up
26/10/2011
                          Eleni P Andreou, RD
                       Clinical Dietitian
    Dietitians Role in Health
Promotion and Disease Prevention
Primary prevention (health promotion)
   empowering communities, families, and individuals to develop
   and maintain maximum health and functioning by reducing
   biologic, economic, social, and environmental risk factors that
   are related to disease and injury. Health promotion is a
   population-based approach that promotes enhancing behaviors.
   Examples of primary prevention activities include:
    • Nutrition classes at the local adult education center.
    • Environmental changes to provide low-fat entree choices in
       worksite lunchrooms.
    • Local 5 A day for better health campaign to increase
       availability of fruits and vegetables from farmer's markets.


                           Eleni P Andreou, RD
26/10/2011
                             Clinical Dietitian
    Dietitians Role in Health
Promotion and Disease Prevention
Secondary prevention (risk appraisal and risk reduction)
  risk appraisal and screening to detect preclinical disease, and
  early intervention to promote the health and well-being of people
  at risk of illness who are beginning to encounter health-related
  problems. Examples of secondary prevention include:
    • Nutrition counselling programs for individuals or groups at
       risk of developing cardiovascular disease.
    • Cholesterol screening for persons with a family history of
       cardiovascular disease.
    • Diabetes education programs for women with a history of
       gestational diabetes.



                          Eleni P Andreou, RD
26/10/2011
                            Clinical Dietitian
    Dietitians Role in Health
Promotion and Disease Prevention
Tertiary prevention (treatment and rehabilitation)
  treatment and rehabilitation for persons experiencing illness or
  injury to promote maximum health and prevent further disability
  and secondary conditions resulting from the initial health
  problem. Examples of tertiary prevention include:
    • Medical nutrition therapy for persons with kidney disease.
    • Cardiac rehabilitation for persons who have had a coronary
       bypass.
    • Comprehensive diabetes education for persons recently
       diagnosed with type 2 diabetes mellitus.
Definitions and examples of nutrition in health promotion and disease
   prevention programs. Adapted from Kaufman M, ed. Nutrition in public
   health: A handbook for developing programs and services. Rockville,
   Md: aspen publishers; 1990 and Shamansky SL, Clausen C. Levels of
   prevention: examination of the concept. Nurs outlook. 1980;28:104-
   108.
                             Eleni P Andreou, RD
26/10/2011
                               Clinical Dietitian
Summary: Role of the Dietitian
     on Health Team
 Assess needs and status. Listen to patient, family,
  and physician. Establish nutritional diagnosis.
 Establish a nutritional care plan, pending
  completion of a home-based or recent nutritional
  history. Evaluate previous nutritional practices,
  knowledge of diet and of normal nutrition, and
  need for further instructions. Establish a realistic
  goal with the physician; Consult with the
  physician as needed regarding special nutritional
  supplements or feeding methods.
                      Eleni P Andreou, RD
26/10/2011
                        Clinical Dietitian
Summary: Role of the Dietitian
     on Health Team
 Chart pertinent information from the nutritional
  care plan.
 Give formal diet instructions when needed.
  Include the definition of the diet, an explanation
  of the relation between diet and disease, an
  explanation of the dietary treatment specific to the
  patient, instructions in how to follow the diet in
  other settings, and instruction of family members
  and significant other persons.
                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
Summary: Role of the Dietitian
     on Health Team
 Consult with the physician about other necessary
  referrals.
 Maintain medical team communication by
  making rounds or attending conferences.
 Conduct group classes and outpatient conferences
  when needed. Use appropriate A-V aids, and
  teaching tools.
 Monitor the patient’s nutritional progress: portion
  control, ingredient control, meal quality, delivery
  system (oral, EN, PN).
                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
 Summary: Role of the Dietitian
      on Health Team
 Audit nutritional care-when feasible, give a
  follow-up call to the patient after discharge, or
  conduct a home visit. Evaluate which goals, if
  any, have been met. Monitor efficacy of therapy
  and nutritional interventions.
 Manage and evaluate resources, plans, and
  outcomes. A multidisciplinary case-management
  approach is best.




                     Eleni P Andreou, RD
26/10/2011
                       Clinical Dietitian
             The Dietetic Process
 Assessment
 Plan
 Implementation
 Evaluation
 Reassessment
 Discharge Planning


                    Eleni P Andreou, RD
26/10/2011
                      Clinical Dietitian
   Benefits of Health Care Team
 in Relation to Dietetic Profession
 Cost –benefit and cost-effectiveness
 Prevention and treatment of chronic
  diseases more effectively
 Global treatment
 Nutritional education of the patient




                  Eleni P Andreou, RD
26/10/2011
                    Clinical Dietitian
   Dietetics is a
    “helping” profession
    concerned primarily
    with providing
    services beneficial to
    individuals and
    society, and dedicated
    to improving the
    nutritional status of
    people.
                      Eleni P Andreou, RD
26/10/2011
                        Clinical Dietitian
                        PHYSICIAN
                        & MEDICAL PROFESSIONALS

PHYSICAL THERAPIST/                             PSYCHOLOGIST
CL. EXERCISE
PHYSIOLOGIST

                        Healthcare team
NURSE                                                  DIETITIAN
                             Patient
                                                    MEDICAL
                                                    TECHNICIANS
SOCIOLOGIST
                                     PHARMACIST/
               OTHERS                MICROBIOLOGIST/
                                     CHEMIST
                         Eleni P Andreou, RD
  26/10/2011
                           Clinical Dietitian
             Dietitian in Cyprus
   A dietitian is the specialist who holds a
    university degree in dietetics and is
    recognized as being responsible for a
    person’s nutrition.




                   Eleni P Andreou, RD
26/10/2011
                     Clinical Dietitian
             Dietitian in Cyprus
   A clinical dietitian is the dietitian who,
    after having obtained a university
    degree, completes his training at a
    hospital and is academically qualified in
    dietetics, is successful in the relevant
    international examinations and obtains
    the RD title (USA) or SRD title (great
    Britain).



                   Eleni P Andreou, RD
26/10/2011
                     Clinical Dietitian
             Dietitian in Cyprus
   A nutritionist is the person who holds a
    university degree with specialization in
    the discipline of nutrition. According to
    international bodies, a nutritionist is not
    able to practice this particular
    profession unless he/she is a holder of
    the RD/ SRD title or any other
    corresponding/equivalent certificate or
    diploma.

                    Eleni P Andreou, RD
26/10/2011
                      Clinical Dietitian
                 30

                 20

                 10

                  0
                       D        CD          DP      S   Sub

             Series1   18       24          16      6    2


                D= Dietitian
                CD= Clinical Dietitian
                DP= Dietitian (by Prof.)
                S= Student
                Sub= Subscriber
                             Eleni P Andreou, RD
26/10/2011
                               Clinical Dietitian
              References
  1. Your Health Care Team
     Http:/www2.sw.org/dnet/manage/team.htm
  2. Paul E. Teschan, MD: Health Care Team:
    Playing to Win
http:/www.kidney.org/patients/healhcareteam.cfm
  3. The American Dietetic Association: Team
    health care equals dollars saved, 1997
  4. The American Dietetic Association : A New
    Look at the Profession of Dietetics
    Report of the 1984, Study Commission on
    Dietetics, 1985

                  Eleni P Andreou, RD
26/10/2011
                    Clinical Dietitian
               References
   5.Betsy B. Holli, Richard J. Calabrese:
   Communication and Education Skills The
   Dietitian’s Guide, 1986
   6. Eleanor Noss Whitney, Ph.D, RD and
   Sharon Rady Rolfes, MS, RD: Understanding
   Nutrition, Sixth Edition, 1993
   7. Sylvia Escott-Stump MA, RD: Nutrition and
   Diagnosis –Related Care Third Edition, 1992
   8.European Federation of the Associations of
   Dietitians (EFAD)
                   Eleni P Andreou, RD
26/10/2011
                     Clinical Dietitian
             References
   9.    British Dietetic Association
  10. American Dietetic Association
  11.    Commission on Diabetic
   Registration
  12. Cyprus Dietetic Association



                 Eleni P Andreou, RD
26/10/2011
                   Clinical Dietitian

				
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