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Improvement of process-driven work in Dietetics - the development of a standard model of the Unified Dietetic Care Process (IMPECD)
- Kathrin Kohlenberg-Müller, Christina Gast, Alexandra Kolm, Andrea M. Werkman, Koen Vanherle, Luzia Valentini
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E292
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Introduction:
Different models of frameworks for dietetic care are used in Europe. There is a substantial need for a consistent framework to compare research results and to cooperate on an international level. Therefore, one of the goals of the EU-funded project IMPECD was the development of a unified framework Dietetic Care Process (DCP) in order to foster a shared understanding of process-driven dietetic counselling.
Materials and Methods:Based on a literature review and in-depth analysis of different frameworks an iterative and incremental development process of finding solutions for decision-making within the consortium consisting of dietetic experts from 5 European HEI was passed. The developed DCP model was integrated in an online training course including 9 clinical cases (MOOC) to train students. The draft versions and the concluding final version DCP model were evaluated and re-evaluated by teachers and 25 students at two Intensive Study Programmes.
Results:The DCP model consists of five distinct, interrelated steps which the consortium agreed on: Dietetic Assessment, Dietetic Diagnosis, Planning Dietetic Intervention, Implementing Dietetic Intervention, Dietetic Outcome Evaluation. A standardized scheme was developed to define the process steps: dedication, central statement, aim and principles, and operationalization.
For example, Dietetic Assessment is the first step of the DCP (dedication). It is a systematic process to gather dietetically adequate and relevant information about the client by using state-of-the-art methods (central statement). The aim is to identify nature and cause of dietetic related problems of the client (aim and principles). The gathered information are documented in types of categories (client history, diet history, behavioural-environmental, clinical status) or following the ICF-model (operationalization). The clinical cases used within the MOOC proved that the DCP model is suitable to be put into practice.
Discussion:Existing different process models were analyzed to create a new and consistent concept of a unified framework DCP. The variety within the European countries represented by the consortium proved to be both a challenge in decision-making and an opportunity to integrate multinational perspectives and intensify the scientific discourse. The development of a standardized scheme with precise definitions is a prerequisite for planning study designs in health services research. Besides, clarification is essential for establishing process-guided work in practice. The evaluated MOOC is now implemented in study programmes used by 5 European HEI in order to keep approaches and process-driven action comparable. The MOOC promotes the exchange of ideas between future professionals on an international level.
In-patient nutrition counseling and therapy – Exploration of structures for process driven work in a German clinical centre
- Maren Peuker, Talitha Wiegand, Roland Radziwill, Kathrin Kohlenberg-Müller
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E666
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- Article
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AbstractIntroduction
An implementation of process driven work in dietetics requires detailed analysis and specific planning. Therefore, gathering information on structures of the institution is an essential step and prerequisite for the development of an implementation concept. Process driven work in nutrition counseling and therapy, especially the implementation of the new developments into practice becomes more and more important.
The aim of the present qualitative study was to assess and analyse structures of the in-patient setting of nutrition counseling and therapy in a German clinical centre. Subsequently, strengths and challenges for the implementation of process driven work were identified.
Materials and MethodsBased on a structured literature search, guidelines for interviews with dietitians of a clinical centre were developed. The five interviews were recorded, transcribed with f4® and analysed by using the qualitative content analysis by Mayring. Finally, strengths and challenges for process driven work were identified out of this qualitative research.
ResultsThe following strengths and challenges were identified:
Strengths: concrete responsibility for indications, flexible duration of patient-consultations, use of standardized patient information, use of a digital documentation system, continuous intra- and interprofessional exchange, participation in education and training
Challenges: variety of different activities, barriers in the access to the dietitian, often only one-time dietitian-patient-consultation, time dependent problems because of the limited in-patient therapy, deficiency of rooms for a private patient consultation, non-existing data exchange from the in-patient into the outpatient setting, knowledge deficits of dietitians regarding process-driven work
DiscussionFor the new developments for process driven work adequate structures of nutrition counseling and therapy in the in-patient setting are very important for patient care. Based on the gathered information on structures and processes, a concept for the implementation of a process model with a target and milestone planning will be helpful. Especially the appropriate access to patients as well as the fact that the dietitian-patient-consultation is mainly one-time have to be considered for the implementation concept. The integration of every process step in the in-patient setting is difficult to realize. Therefore, the prioritization of the considered process steps is necessary. Consequently, an exchange with the outpatient setting is advisable for the implementation of the complete process model.