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Hand RK. Workforce needs and estimated costs/savings for nutrition care in chronic kidney disease-stage 3 through maintenance dialysis. Semin Dial 2024; 37:292-300. [PMID: 34378253 DOI: 10.1111/sdi.13005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/08/2021] [Indexed: 12/27/2022]
Abstract
The role of nutrition in chronic kidney disease (CKD) is well known. However, controversies, misconceptions, and gaps in the literature exist regarding the workforce required to provide nutrition care in CKD. This paper reviews the existing literature on this topic, focusing primarily on the United States. Topics covered in this review include the qualifications and services of the registered dietitian nutritionist (RDN), to which specific patients nutrition care should be provided in CKD and on dialysis, barriers to the utilization of nutrition services, the quantity of nutrition care needed to improve patient outcomes, and the risks of provider burnout. Controversies include whether more staffing is associated with better care and the best measures of staffing. The topics are supported with estimations for the economic impact and practicality of workforce decisions.
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Affiliation(s)
- Rosa K Hand
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, USA
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Proaño GV, Papoutsakis C, Lamers-Johnson E, Moloney L, Bailey MM, Abram JK, Kelley K, Steiber A, McCabe GP, Myaskovsky L, Jimenez EY. Evaluating the Implementation of Evidence-based Kidney Nutrition Practice Guidelines: The AUGmeNt Study Protocol. J Ren Nutr 2022; 32:613-625. [PMID: 34728124 PMCID: PMC9733590 DOI: 10.1053/j.jrn.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 12/13/2022] Open
Abstract
Evidence-based nutrition practice guidelines (EBNPGs) inform registered dietitian nutritionist (RDN) care for patients with chronic kidney disease grade 5 treated by dialysis; however, there has been little evaluation of best practices for implementing EBNPGs. In this effectiveness-implementation hybrid study with a quasi-experimental design, United States RDNs in hemodialysis clinics will document initial and follow-up nutrition care for patients with chronic kidney disease grade 5 treated by dialysis using the Academy of Nutrition and Dietetics Health Informatics Infrastructure before and after being randomly assigned to a training model: (1) EBNPG knowledge training or (2) EBNPG knowledge training plus an implementation toolkit. The aims of the study include examining congruence of RDN documentation of nutrition care with the EBNPG; describing common RDN-reported EBNPG acceptability, adoption, and adaptation issues; and determining the feasibility of estimating the impact of RDN care on nutrition-related patient outcomes. The AUGmeNt study can inform effective development and implementation of future EBNPGs. Keywords: Chronic kidney diseases; medical nutrition therapy; implementation science; clinical practice guideline; nutrition care process terminology; dietitian.
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Affiliation(s)
- Gabriela V Proaño
- Senior Research Project Manager, Academy of Nutrition and Dietetics, Chicago, Illinois.
| | | | | | - Lisa Moloney
- Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Mary M Bailey
- Research Consultant, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Jenica K Abram
- Manager, Nutrition Research Network, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Kathryn Kelley
- Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Alison Steiber
- Chief Science Officer, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - George P McCabe
- Professor Emeritus of Statistics, Purdue University, West Lafayette, Illinois
| | - Larissa Myaskovsky
- Professor, Department of Internal Medicine, Director, Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Elizabeth Yakes Jimenez
- Research Associate Professor, Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Director, Nutrition Research Network, Academy of Nutrition and Dietetics, Albuquerque, New Mexico
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Reliability and validity of a clinical competence test for dietitians caring patients with early chronic kidney disease. J Nutr Sci 2022; 11:e10. [PMID: 35291281 PMCID: PMC8889087 DOI: 10.1017/jns.2022.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022] Open
Abstract
The aim of the present study was to develop and validate a test to evaluate dietitian's clinical competence (CC) about nutritional care in patients with early chronic kidney disease (CKD). The study was conducted through five steps: (1) CC and its dimensions were defined; (2) test items were elaborated, and choice of response format and scoring system was selected; (3) content and face validity were established; (4) test was subjected to a pilot test and those items with inadequate performance were removed; (5) criterion validity and internal consistency for final validation were established. A 120-items test was developed and applied to 207 dietitians for validation. Dietitians with previous CKD training obtained higher scores than those with no training, confirming the test validity criterion. According to item analysis, Cronbach's α was 0⋅85, difficulty index 0⋅61 ± 0⋅22, discrimination index 0⋅26 ± 0⋅15 and inter-item correlation 0⋅19 ± 0⋅11, displaying adequate internal consistency.
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Kopple JD, Karupaiah T, Chan M, Burrowes JD, Kirk J, Prest M. Global Renal Internet Course for Dietitians (GRID Course). J Ren Nutr 2021; 32:131-134. [PMID: 33812799 DOI: 10.1053/j.jrn.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Joel D Kopple
- Division of Nephrology and Hypertension, Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California; The David Geffen School of Medicine at UCLA, UCLA Fielding School of Public Health, Los Angeles, California.
| | - Tilakavati Karupaiah
- School of BioSciences, Faculty of Health & Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Maria Chan
- Departments of Nutrition and Dietetics and Renal Medicine, The St. George Hospital, Kogarah, New South Wales, Australia
| | - Jerrilynn D Burrowes
- Department of Biomedical, Health and Nutritional Sciences, Long Island University-Post, Greenvale, New York
| | - Judith Kirk
- Division of Solid Organ Transplantation, University of Rochester Medical Center, Rochester, New York
| | - Melissa Prest
- National Kidney Foundation of Illinois, Chicago, Illinois
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Academy of Nutrition and Dietetics and National Kidney Foundation: Revised 2020 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nephrology Nutrition. J Acad Nutr Diet 2021; 121:529-544.e56. [DOI: 10.1016/j.jand.2020.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/18/2022]
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Pace RC, Kirk J. Academy of Nutrition and Dietetics and National Kidney Foundation: Revised 2020 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nephrology Nutrition. J Ren Nutr 2021; 31:100-115.e41. [PMID: 33642189 DOI: 10.1053/j.jrn.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Nephrology nutrition encompasses therapeutic and preventive nutrition care for individuals through the life cycle and addresses a variety of kidney disorders. Most nephrology nutrition practice focuses on care of individuals with chronic kidney disease, those on dialysis, and recipients of kidney transplants. The Renal Dietitians Dietetic Practice Group, National Kidney Foundation Council on Renal Nutrition, along with the Academy of Nutrition and Dietetics Quality Management Committee, have revised the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs working in nephrology nutrition. The SOP and SOPP for RDNs in Nephrology Nutrition provide indicators that describe three levels of practice: competent, proficient, and expert. The SOP uses the Nutrition Care Process and clinical workflow elements for delivering patient/client care. The SOPP describes the following six domains that focus on professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Specific indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs and are intended to be used as a self-evaluation tool for assuring competent practice in nephrology nutrition and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.
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Increased Frequency of Nutritional Counseling Improves Weight Status and Lipids in Renal Transplant Recipients. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jimenez EY, Kelley K, Schofield M, Brommage D, Steiber A, Abram JK, Kramer H. Medical Nutrition Therapy Access in CKD: A Cross-sectional Survey of Patients and Providers. Kidney Med 2021; 3:31-41.e1. [PMID: 33604538 PMCID: PMC7873758 DOI: 10.1016/j.xkme.2020.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
RATIONALE & OBJECTIVE Nutrition management can slow the progression of chronic kidney disease (CKD) and help manage complications of CKD, but few individuals with CKD receive medical nutrition therapy before initiating dialysis. This study aimed to identify knowledge, attitudes, experiences, and practices regarding medical nutrition therapy and barriers and facilitators to medical nutrition therapy access for individuals with CKD stages G1-G5 from the perspective of patients and providers. STUDY DESIGN Cross-sectional study composed of anonymous surveys. SETTING & POPULATION Adults with CKD stages G1-G5 and medical providers and registered dietitian nutritionists who regularly see patients with CKD stages G1-G5 were recruited by email using National Kidney Foundation and Academy of Nutrition and Dietetics databases and through the National Kidney Foundation 2019 Spring Clinical Meetings mobile app. ANALYTICAL APPROACH Descriptive analyses and Fisher exact tests were conducted with Stata SE 16. RESULTS Respondents included 348 patients, 66 registered dietitian nutritionists, and 30 medical providers. In general, patients and providers had positive perceptions of medical nutrition therapy and its potential to slow CKD progression and manage complications, and most patients reported interest in a medical nutrition therapy referral. However, there were feasibility concerns related to cost to the patient, lack of insurance coverage, and lack of renal registered dietitian nutritionists. There was low awareness of Medicare no-cost share coverage for medical nutrition therapy across patients and providers. About half the practices did not bill for medical nutrition therapy and those that did reported issues with being paid and low reimbursement rates. LIMITATIONS Results may not be generalizable due to the small number of respondents and the potential for self-selection, nonresponse, and social desirability bias. CONCLUSIONS Many patients with CKD stages G1-G5 are interested in medical nutrition therapy and confident that it can help with disease management, but there are feasibility concerns related to cost to the patient, insurance coverage, and reimbursement. There are significant opportunities to design and test interventions to facilitate medical nutrition therapy access for patients with CKD stages G1-G5.
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Affiliation(s)
- Elizabeth Yakes Jimenez
- Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
- College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Kathryn Kelley
- Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
| | - Marsha Schofield
- Governance and Nutrition Services Coverage, Academy of Nutrition and Dietetics, Chicago, IL
| | | | - Alison Steiber
- Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
| | - Jenica K. Abram
- Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
| | - Holly Kramer
- Division of Nephrology and Hypertension, Department of Public Health Sciences and Medicine, Loyola University Medical Center, Maywood, IL
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Zheng GQ, Hand RK. Registered Dietitian Staffing in Dialysis: Impact on Quality Ratings in Mandate and Nonmandate States. J Ren Nutr 2020; 31:523-528. [PMID: 33131975 DOI: 10.1053/j.jrn.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/30/2020] [Accepted: 08/22/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Texas is the only state to mandate a patient to full-time equivalent (FTE) registered dietitian (RD) ratio (<125 patients:FTE RD) in dialysis. Little research exists about the relationship between patient:FTE RD ratio and quality. Our objectives were to a) examine the effect of the mandate on patient:FTE RD ratios in Texas facilities compared to similar nonmandated facilities and b) examine the association between patient:FTE RD ratio and the patient rating of staff quality or star rating of the facility. DESIGN AND METHODS Using data from Dialysis Facility Annual Reports, we excluded facilities with less than 125 patients and matched based on region, chain/profit status, and number of patients, pairing each Texas facility with 2 non-Texas facilities. T-tests for difference of means and chi-square tests were performed to compare facility groups characteristics and assess mandate impact. We used correlation between patient:FTE RD ratio and staff quality linearized score, and ANOVA to compare patient:FTE RD ratios between the star rating levels. RESULTS The patient:FTE RD ratio was higher in non-Texas than Texas facilities (111.84 ± 40.70 vs 90.80 ± 24.02, P < .01). The Pearson correlation between patient:FTE RD ratio and linearized score rating of the dialysis center staff was essentially nonexistent (r = -0.046). We found a trend of higher patient:FTE RD ratios in facilities with lower star ratings for quality and staff but no statistical significance. CONCLUSION The mandate effectively lowered the patient:FTE RD ratio in Texas dialysis facilities with over 125 patients, indicating that states considering such a mandate may benefit from implementing it. We found no association between patient:FTE RD staffing and quality, either objectively or via patient assessment. Further research should examine whether dialysis facilities are trending toward smaller patient sizes to circumvent staffing mandates and examine the relationship between other professions' staffing ratios and quality.
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Affiliation(s)
- Grace Q Zheng
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio
| | - Rosa K Hand
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio.
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Hand RK, Albert JM, Sehgal AR. Quantifying the Time Used for Renal Dietitian's Responsibilities: A Pilot Study. J Ren Nutr 2019; 29:416-427. [PMID: 30683606 DOI: 10.1053/j.jrn.2018.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to quantify how dialysis dietitians spend their time and whether the activities that were most frequent varied based on the ratio of patient to full-time equivalent (FTE) dietitian. METHODS This study is a cross-sectional, observational, time-and-motion study carried out using the Work Activity Measurement by Activity Timing software/method for time recording. This study was carried out in 14 dialysis centers in and around Cleveland, Ohio. Fourteen registered dietitian nutritionists participated in this study. The mean time/experience of these nutritionists in dietetics was 26.6 ± 8.5 years. Percent of time in direct care (e.g., patient interaction) versus indirect care (e.g., documentation and plans of care, professional communication) versus other responsibilities (e.g., administrative work, education of self or others). RESULTS The mean number of tasks recorded per 3-hour observation session was 38.3 ± 14.0, including 18.5 ± 7.7 indirect care tasks, 7.7 ± 6.2 direct care tasks, and 9.7 ± 5.4 other tasks. The mean number of unique patients seen per observation session was 6.9 ± 5.4; the mean direct care time per patient encounter was 6.95 ± 4.05 minutes. Indirect care took the highest proportion of observed time, 56.0 ± 22.2%, followed by direct care, 24.9 ± 18.8%. Increasing the ratio of patient to FTE had a moderate negative correlation with the percent of time spent in direct patient care (r = -0.35, P = .21), but there was no relationship between the ratio of patient to FTE and direct care time per patient (r = 0.02, P = .94). CONCLUSION About 25% of dietitians' time was available for direct patient care. This is much less than that reported in previous studies and may not be sufficient to improve the nutritional status. Limitations of our study include a small sample size from a single region. Further work is needed to understand the balance of responsibilities among renal dietitians and their impact on patient outcomes.
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Affiliation(s)
- Rosa K Hand
- Department of Nutrition and PhD Program Clinical Translational Science, Case Western Reserve University, Cleveland, Ohio.
| | - Jeffrey M Albert
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Ashwini R Sehgal
- Center for Reducing Health Disparities, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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Duong TV, Wong TC, Chen HH, Chen TW, Chen TH, Hsu YH, Peng SJ, Kuo KL, Liu HC, Lin ET, Wang CS, Tseng IH, Feng YW, Chang TY, Su CT, Yang SH. Inadequate dietary energy intake associates with higher prevalence of metabolic syndrome in different groups of hemodialysis patients: a clinical observational study in multiple dialysis centers. BMC Nephrol 2018; 19:236. [PMID: 30231860 PMCID: PMC6145210 DOI: 10.1186/s12882-018-1041-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) has been established as a risk for cardiovascular diseases and mortality in hemodialysis patients. Energy intake (EI) is an important nutritional therapy for preventing MetS. We examined the association of self-reported dietary EI with metabolic abnormalities and MetS among hemodialysis patients. METHODS A cross-sectional study design was carried out from September 2013 to April 2017 in seven hemodialysis centers. Data were collected from 228 hemodialysis patients with acceptable EI report, 20 years old and above, underwent three hemodialysis sessions a week for at least past 3 months. Dietary EI was evaluated by a three-day dietary record, and confirmed by 24-h dietary recall. Body compositions were measured by bioelectrical impedance analysis. Biochemical data were analyzed using standard laboratory tests. The cut-off values of daily EI were 30 kcal/kg, and 35 kcal/kg for age ≥ 60 years and < 60 years, respectively. MetS was defined by the American Association of Clinical Endocrinologists (AACE-MetS), and Harmonizing Metabolic Syndrome (HMetS). Logistic regression models were utilized for examining the association between EI and MetS. Age, gender, physical activity, hemodialysis vintage, Charlson comorbidity index, high sensitive C-reactive protein, and interdialytic weight gains were adjusted in the multivariate analysis. RESULTS The prevalence of inadequate EI, AACE-MetS, and HMetS were 60.5%, 63.2%, and 53.9%, respectively. Inadequate EI was related to higher proportion of metabolic abnormalities and MetS (p < 0.05). Results of the multivariate analysis shows that inadequate EI was significantly linked with higher prevalence of impaired fasting glucose (OR = 2.42, p < 0.01), overweight/obese (OR = 6.70, p < 0.001), elevated waist circumference (OR = 8.17, p < 0.001), AACE-MetS (OR = 2.26, p < 0.01), and HMetS (OR = 3.52, p < 0.01). In subgroup anslysis, inadequate EI strongly associated with AACE-MetS in groups of non-hypertension (OR = 4.09, p = 0.004), and non-cardiovascular diseases (OR = 2.59, p = 0.012), and with HMetS in all sub-groups of hypertension (OR = 2.59~ 5.33, p < 0.05), diabetic group (OR = 8.33, p = 0.003), and non-cardiovascular diseases (OR = 3.79, p < 0.001). CONCLUSIONS Inadequate EI and MetS prevalence was high. Energy intake strongly determined MetS in different groups of hemodialysis patients.
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Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, No. 250 Wuxing Street, Taipei, 110, Taiwan
| | - Te-Chih Wong
- Department of Nutrition and Health Sciences, Chinese Culture University, Taipei, Taiwan
| | - Hsi-Hsien Chen
- Department of Nephrology, Taipei Medical University Hospital, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tzen-Wen Chen
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tso-Hsiao Chen
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Nephrology, Taipei Medical University- Wan Fang Hospital, Taipei, Taiwan
| | - Yung-Ho Hsu
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University- Shuang Ho Hospital, Taipei, Taiwan
| | - Sheng-Jeng Peng
- Division of Nephrology, Cathay General Hospital, Taipei, Taiwan
| | - Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu-Chi Hospital, Taipei, Taiwan
| | - Hsiang-Chung Liu
- Department of Nephrology, Wei Gong Memorial Hospital, Miaoli, Taiwan
| | - En-Tzu Lin
- Department of Nephrology, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Chi-Sin Wang
- School of Nutrition and Health Sciences, Taipei Medical University, No. 250 Wuxing Street, Taipei, 110, Taiwan
| | - I-Hsin Tseng
- School of Nutrition and Health Sciences, Taipei Medical University, No. 250 Wuxing Street, Taipei, 110, Taiwan
| | - Yi-Wei Feng
- School of Nutrition and Health Sciences, Taipei Medical University, No. 250 Wuxing Street, Taipei, 110, Taiwan
| | - Tai-Yue Chang
- School of Nutrition and Health Sciences, Taipei Medical University, No. 250 Wuxing Street, Taipei, 110, Taiwan
| | - Chien-Tien Su
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, No. 250 Wuxing Street, Taipei, 110, Taiwan.
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei, Taiwan.
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Kramer H, Jimenez EY, Brommage D, Vassalotti J, Montgomery E, Steiber A, Schofield M. Medical Nutrition Therapy for Patients with Non-Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions. J Acad Nutr Diet 2018; 118:1958-1965. [PMID: 30076072 DOI: 10.1016/j.jand.2018.05.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 01/11/2023]
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Lambert K, Mansfield K, Mullan J. Qualitative exploration of the experiences of renal dietitians and how they help patients with end stage kidney disease to understand the renal diet. Nutr Diet 2018; 76:126-134. [PMID: 29968271 DOI: 10.1111/1747-0080.12443] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 10/28/2022]
Abstract
AIM Dietary modification is integral to the management of end stage kidney disease. However, adherence to the renal diet is poor. Few studies have explored the perspectives of renal dietitians and how they work with patients to facilitate dietary change. The objectives of this study were to explore the experiences of renal dietitians about educating patients with end stage kidney disease; and to describe the strategies perceived to help patients understand the renal diet. METHODS Semi-structured interviews based on Sensemaking theory were conducted with renal dietitians (n = 27) working in Australia and New Zealand from a range of metropolitan, regional and remote areas. RESULTS Five major themes across two categories were derived from the data. The renal dietitians in this study experienced feelings of frustration, frequently worked in practice environments with limited or inadequate resources and perceived that establishing trust and demonstrating empathy were important to sense making. Renal dietitians helped patients make sense of and understand the diet by clarifying ambiguities and conflicting information; and simplifying complexity by using simple explanations, individualised advice and practical support. These strategies were considered critical to the renal diet sense making process. CONCLUSIONS The experience of providing renal diet advice to adults with end stage kidney disease was emotionally and professionally challenging. Alternative approaches to patient education may help dietitians to empower patients to better understand the renal diet. Further research exploring the experiences of learning about the renal diet from the patient and carer perspective would also help to inform future alternative approaches.
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Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Kylie Mansfield
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Judy Mullan
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Duong TV, Wong TC, Chen HH, Chen TW, Chen TH, Hsu YH, Peng SJ, Kuo KL, Wang CS, Tseng IH, Feng YW, Chang TY, Su CT, Yang SH. The cut-off values of dietary energy intake for determining metabolic syndrome in hemodialysis patients: A clinical cross-sectional study. PLoS One 2018. [PMID: 29538427 PMCID: PMC5851580 DOI: 10.1371/journal.pone.0193742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Dietary energy intake strongly linked to dialysis outcomes. We aimed to explore the optimal cut-off point of energy intake (EI) for identification of metabolic syndrome (MetS) in hemodialysis patients. The cross-sectional data of 243 hemodialysis patients from multi-dialysis centers in Taiwan was used. The dietary intake was assessed by using the three-day dietary questionnaire, and a 24-hour dietary recall, clinical and biochemical data were also evaluated. The MetS was diagnosed by the Harmonized Metabolic Syndrome criteria. The receiver operating characteristic (ROC) curve was to depict the optimal cut-off value of EI for the diagnosis of MetS. The logistic regression was also used to explore the association between inadequate EI and MetS. The optimal cut-off points of EI for identifying the MetS were 26.7 kcal/kg/day for patients aged less than 60 years, or with non-diabetes, and 26.2 kcal/kg/day for patients aged 60 years and above, or with diabetes, respectively. The likelihood of the MetS increased with lower percentiles of energy intake in hemodialysis patients. In the multivariate analysis, the inadequate dietary energy intake strongly determined 3.24 folds of the MetS. The assessment of dietary EI can help healthcare providers detecting patients who are at risk of metabolic syndrome.
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Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Te-Chih Wong
- Department of Nutrition and Health Sciences, Chinese Culture University, Taipei, Taiwan
| | - Hsi-Hsien Chen
- Department of Nephrology, Taipei Medical University Hospital, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tzen-Wen Chen
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tso-Hsiao Chen
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Nephrology, Taipei Medical University- Wan Fang Hospital, Taipei, Taiwan
| | - Yung-Ho Hsu
- School of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University- Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Jeng Peng
- Division of Nephrology, Cathay General Hospital, Taipei, Taiwan
| | - Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu-Chi General Hospital, Taipei, Taiwan
| | - Chi-Sin Wang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - I-Hsin Tseng
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Yi-Wei Feng
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Tai-Yue Chang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Chien-Tien Su
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- * E-mail:
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15
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Stevenson J, Tong A, Campbell KL, Craig JC, Lee VW. Perspectives of healthcare providers on the nutritional management of patients on haemodialysis in Australia: an interview study. BMJ Open 2018. [PMID: 29523567 PMCID: PMC5855190 DOI: 10.1136/bmjopen-2017-020023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care. DESIGN Face-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory. SETTING 21 haemodialysis centres across Australia. PARTICIPANTS 42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences. RESULTS Six themes were identified: responding to changing clinical status (individualising strategies to patient needs, prioritising acute events, adapting guidelines), integrating patient circumstances (assimilating life priorities, access and affordability), delineating specialty roles in collaborative structures (shared and cohesive care, pivotal role of dietary expertise, facilitating access to nutritional care, perpetuating conflicting advice and patient confusion, devaluing nutritional specialty), empowerment for behaviour change (enabling comprehension of complexities, building autonomy and ownership, developing self-efficacy through engagement, tailoring self-management strategies), initiating and sustaining motivation (encountering motivational hurdles, empathy for confronting life changes, fostering non-judgemental relationships, emphasising symptomatic and tangible benefits, harnessing support networks), and organisational and staffing barriers (staffing shortfalls, readdressing system inefficiencies). CONCLUSIONS Organisational support with collaborative multidisciplinary teams and individualised patient care were seen as necessary for developing positive patient-clinician relationships, delivering consistent nutrition advice, and building and sustaining patient motivation to enable change in dietary behaviour. Improving service delivery and developing and delivering targeted, multifaceted self-management interventions may enhance current nutritional management of patients on haemodialysis.
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Affiliation(s)
- Jessica Stevenson
- Westmead Clinical School, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital, Westmead, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Katrina L Campbell
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital, Westmead, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Vincent W Lee
- Westmead Clinical School, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital, Westmead, Australia
- Department of Renal Medicine, Westmead Hospital, Sydney, Australia
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16
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Pieloch D, Friedman GG, DiCecco S, Ulerich L, Beer S, Hasse J. A Standardized Framework for Transplant-Specific Competencies for Dietitians. Prog Transplant 2017; 27:281-285. [PMID: 29187093 DOI: 10.1177/1526924817715466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dietitians have extensive training and are considered the experts in medical nutrition therapy (MNT). Although dietitian competencies for MNT are well established, competencies that account for the expanded roles of dietitians working in transplantation have not been developed. These expanded roles require a better understanding of transplant processes, regulations, and even the business side of transplant, novel concepts to most dietitians. Therefore, we proposed a standardized framework of transplant-specific competencies for dietitians practicing in transplantation. These competencies can help improve and standardize initial and ongoing training for transplant dietitians moving forward, ultimately leading to improved patient care for transplant candidates, recipients, and donors.
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Affiliation(s)
- Daniel Pieloch
- 1 Robert Wood Johnson University Hospital, Transplant Center, RWJBarnabas Health, New Brunswick, NJ, USA
| | - Golnaz G Friedman
- 2 University of California Davis Medical Center, Sacramento, CA, USA
| | - Sara DiCecco
- 3 Mayo Clinic Rochester, Department of Dietetics, Rochester, MN, USA
| | - Linda Ulerich
- 4 Indiana University Health Methodist Hospital, Indianapolis, IN, USA
| | - Stacey Beer
- 5 Texas Children's Hospital, Houston, TX, USA
| | - Jeanette Hasse
- 6 Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
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17
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Lambert K, Mullan J, Mansfield K. An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. BMC Nephrol 2017; 18:318. [PMID: 29061163 PMCID: PMC5653982 DOI: 10.1186/s12882-017-0734-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/27/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. There have been no comprehensive reviews to date on this topic. The aims of this integrative review were to (i) describe the methods used to measure dietary adherence (ii) determine the rate of dietary adherence and (iii) describe factors associated with dietary adherence in ESKD. METHODS The Web of Science and Scopus databases were searched using the search terms 'adherence' and 'end stage kidney disease'. Of the 787 potentially eligible papers retrieved, 60 papers of 24,743 patients were included in this review. Of these papers, 44 reported the rate of dietary adherence and 44 papers described factors associated with adherence. RESULTS Most of the evidence regarding dietary adherence is derived from studies of hemodialysis patients (72% of patients). The most common method of measuring dietary adherence in ESKD was subjective techniques (e.g. food diaries or adherence questionnaires). This was followed by indirect methods (e.g. serum potassium, phosphate or interdialytic weight gain). The weighted mean adherence rate to ESKD dietary recommendations was 31.5% and 68.5% for fluid recommendations. Adherence to protein, sodium, phosphate, and potassium recommendations were highly variable due to differences in measurement methods used, and were often derived from a limited evidence base. Socioeconomic status, age, social support and self-efficacy were associated with dietary adherence. However, factors such as taste, the impact of the diet on social eating occasions; and dietetic staffing also appear to play a role in dietary adherence. CONCLUSION Dietary adherence rates in people with ESKD are suboptimal. Further research is required on dietary adherence in patients with ESKD from different social, educational, economic and ethnic groups. This research may identify other factors which may impact upon adherence, and could be used to inform the design of future strategies to improve dietary adherence. Future research that reports not just the rate of adherence to individual components of the nutrient prescription but also the overall quality of the diet would be useful.
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Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Level 5, Block C, Crown Street, Wollongong, NSW 2500 Australia
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute, University of Wollongong, iC Enterprise 1, Innovation Campus, Wollongong, New South Wales 2522 Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, New South Wales 2522 Australia
| | - Kylie Mansfield
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, New South Wales 2522 Australia
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18
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Describing the Roles and Responsibilities of Nutrition Staff and Nutrition Care Policies in Acute Care Facilities. TOP CLIN NUTR 2017. [DOI: 10.1097/tin.0000000000000105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sum SSM, Marcus AF, Blair D, Olejnik LA, Cao J, Parrott JS, Peters EN, Hand RK, Byham-Gray LD. Comparison of Subjective Global Assessment and Protein Energy Wasting Score to Nutrition Evaluations Conducted by Registered Dietitian Nutritionists in Identifying Protein Energy Wasting Risk in Maintenance Hemodialysis Patients. J Ren Nutr 2017; 27:325-332. [PMID: 28600134 DOI: 10.1053/j.jrn.2017.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/28/2017] [Accepted: 04/19/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To compare the 7-point subjective global assessment (SGA) and the protein energy wasting (PEW) score with nutrition evaluations conducted by registered dietitian nutritionists in identifying PEW risk in stage 5 chronic kidney disease patients on maintenance hemodialysis. DESIGN AND METHODS This study is a secondary analysis of a cross-sectional study entitled "Development and Validation of a Predictive energy Equation in Hemodialysis". PEW risk identified by the 7-point SGA and the PEW score was compared against the nutrition evaluations conducted by registered dietitian nutritionists through data examination from the original study (reference standard). SUBJECTS A total of 133 patients were included for the analysis. MAIN OUTCOME MEASURES The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (PLR and NLR) of both scoring tools were calculated when compared against the reference standard. RESULTS The patients were predominately African American (n = 112, 84.2%), non-Hispanic (n = 101, 75.9%), and male (n = 80, 60.2%). Both the 7-point SGA (sensitivity = 78.6%, specificity = 59.1%, PPV = 33.9%, NPV = 91.2%, PLR = 1.9, and NLR = 0.4) and the PEW score (sensitivity = 100%, specificity = 28.6%, PPV = 27.2%, NPV = 100%, PLR = 1.4, and NLR = 0) were more sensitive than specific in identifying PEW risk. The 7-point SGA may miss 21.4% patients having PEW and falsely identify 40.9% of patients who do not have PEW. The PEW score can identify PEW risk in all patients, but 71.4% of patients identified may not have PEW risk. CONCLUSIONS Both the 7-point SGA and the PEW score could identify PEW risk. The 7-point SGA was more specific, and the PEW score was more sensitive. Both scoring tools were found to be clinically confident in identifying patients who were actually not at PEW risk.
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Affiliation(s)
- Simon Siu-Man Sum
- School of Health Professions, Rutgers University, Newark, New Jersey; Herbalife Nutrition, Torrance, California.
| | - Andrea F Marcus
- School of Health Professions, Rutgers University, Newark, New Jersey
| | - Debra Blair
- Fresenius Kidney Care, Hampshire County Dialysis, Northampton, Massachusetts
| | | | - Joyce Cao
- Herbalife Nutrition, Torrance, California
| | - J Scott Parrott
- School of Health Professions, Rutgers University, Newark, New Jersey
| | - Emily N Peters
- School of Health Professions, Rutgers University, Newark, New Jersey
| | - Rosa K Hand
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Kawate Y, Miyata H. The importance of nutritional intervention by dietitians for hyperphosphatemia in maintained hemodialysis patients. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0095-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Beto JA, Schury KA, Bansal VK. Strategies to promote adherence to nutritional advice in patients with chronic kidney disease: a narrative review and commentary. Int J Nephrol Renovasc Dis 2016; 9:21-33. [PMID: 26893578 PMCID: PMC4749088 DOI: 10.2147/ijnrd.s76831] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chronic kidney disease (CKD) requires extensive changes to food and lifestyle. Poor adherence to diet, medications, and treatments has been estimated to vary between 20% and 70%, which in turn can contribute to increased mortality and morbidity. Delivering effective nutritional advice in patients with CKD coordinates multiple diet components including calories, protein, sodium, potassium, calcium, phosphorus, and fluid. Dietary intake studies have shown difficulty in adhering to the scope and complexity of the CKD diet parameters. No single educational or clinical strategy has been shown to be consistently effective across CKD populations. Highest adherence has been observed when both diet and education efforts are individualized to each patient and adapted over time to changing lifestyle and CKD variables. This narrative review and commentary summarizes nutrition education literature and published strategies for providing nutritional advice in CKD. A cohort of practical and effective strategies for increasing dietary adherence to nutritional advice are provided that include communicating with "talking control" principles, integrating patient-owned technology, acknowledging the typical food pattern may be snacking rather than formal meals, focusing on a single goal rather than multiple goals, creating active learning and coping strategies (frozen sandwiches, visual hands-on activities, planting herb gardens), and involving the total patient food environment.
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Affiliation(s)
- Judith A Beto
- Division of Nephrology and Hypertension, Loyola University Healthcare System, Loyola University of Chicago, Maywood, IL, USA
| | - Katherine A Schury
- Division of Nephrology and Hypertension, Loyola University Healthcare System, Loyola University of Chicago, Maywood, IL, USA
| | - Vinod K Bansal
- Division of Nephrology and Hypertension, Loyola University Healthcare System, Loyola University of Chicago, Maywood, IL, USA
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de Waal D, Heaslip E, Callas P. Medical Nutrition Therapy for Chronic Kidney Disease Improves Biomarkers and Slows Time to Dialysis. J Ren Nutr 2015; 26:1-9. [PMID: 26391566 DOI: 10.1053/j.jrn.2015.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To investigate whether medical nutrition therapy (MNT) provided by a registered dietitian experienced in chronic kidney disease (CKD) slows the progression of disease and improves nutrition-related biomarkers. DESIGN Retrospective cohort study. SUBJECTS The cohort included 265 participants from a regional nephrology center in a rural state; 147 of who received MNT were compared to a group that did not receive MNT and had started dialysis over a 10-year period. INTERVENTION MNT by a registered dietitian with expertise in CKD. MAIN OUTCOME MEASURE Average time to dialysis, based on stage of CKD at baseline, was compared between groups. In addition, the effect of MNT on the change in biochemical measures for estimated glomerular filtration rate, blood urea nitrogen, albumin, CKD Mineral and Bone Disorder (MBD) markers (phosphorous, calcium, and intact parathyroid hormone) at baseline and at follow-up (dialysis initiation or most recent laboratories if dialysis was not started) was assessed. RESULTS MNT group had less of a decline in estimated glomerular filtration rate than the non-MNT group (0.3 vs. 9.9 mL/minute/1.73 m(2), respectively) a mean difference of 9.6 (P < 0.001). When adjusted for stage using linear regression, the mean difference was greater (11.4, P < .001). Using survival analysis and Cox proportional hazards regression, the non-MNT group was 3.15 more likely to initiate dialysis. Stratified by Stages 3 and 4 that hazard ratio increased (3.47 and 3.45, respectively). Albumin and markers of CKD-MBD were more likely to be within normal limits in the MNT group. The results indicate that better outcomes occur when MNT is given at CKD Stage 3 or 4 rather than CKD Stage 5. CONCLUSIONS Results suggest that people with CKD who received MNT were less likely to start dialysis and had improved nutritional biomarkers than participants who did not receive MNT.
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Affiliation(s)
- Desirée de Waal
- Department of Nephrology, University of Vermont Medical Center, Burlington, Vermont.
| | - Emily Heaslip
- The Community Health Centers of Burlington, Burlington, Vermont
| | - Peter Callas
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
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Hand RK, Burrowes JD. Renal Dietitians' Perceptions of Roles and Responsibilities in Outpatient Dialysis Facilities. J Ren Nutr 2015; 25:404-11. [PMID: 26116426 DOI: 10.1053/j.jrn.2015.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/23/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study was designed to determine what job responsibilities renal dietitians working in outpatient dialysis facilities consider as most important and most time-consuming. We hypothesized that more time-consuming activities would not always be considered most important. DESIGN AND PARTICIPANTS An online survey was sent to 3,382 renal dietitians via professional organization e-mail lists. The survey included 30 activities that renal dietitians perform, grouped into 3 categories (general responsibilities, assessments, and interventions) and based on the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative nutrition guidelines. For each category of activities, respondents were asked to rank the 10 activities from 1 (most important or time-consuming) to 10 (least important or time-consuming). For analysis, the rankings were combined into 3 groups: 1 to 3 = most; 4 to 6 = mid; and 7 to 10 = least important or time-consuming. Demographic and professional questions were also included. RESULTS Four hundred sixty six renal dietitians responded, and represented a broad range of experience in renal dietetics and type of dialysis facility. The mean number of patients per 40 hours full-time equivalent dietitian was 115.5 ± 38.4. There was good agreement between the respondents' ranking of importance and time consumed. Those activities identified as most important were traditional dietitian roles such as diet assessment and nutrition education. Many respondents provided write-in response of other activities they considered important and time-consuming such as communicating with family members or caregivers, enrolling and managing patients in the in-house pharmacy program, and serving as a care coordinator. CONCLUSIONS It appears that the renal dietitian's role of providing nutrition assessments and counseling in outpatient dialysis facilities is being expanded to include administrative and coordination responsibilities. The impact of these changes on patient outcomes is unclear; however, previous research has indicated that administrative responsibilities take away from patient care time and decrease dietitian job satisfaction.
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Affiliation(s)
- Rosa K Hand
- Dietetics Practice Based Research Network, Academy of Nutrition and Dietetics, Chicago Illinois.
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Gates GE, Amaya L. Registered Dietitian Nutritionists and Nutrition and Dietetics Technicians, Registered, Are Ethically Obligated to Maintain Personal Competence in Practice. J Acad Nutr Diet 2015; 115:811-815. [DOI: 10.1016/j.jand.2015.02.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Indexed: 10/23/2022]
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Brody RA, Skipper A, Chaffee CL, Wooldridge NH, Kicklighter JR, Touger-Decker R. Developing an Advanced Practice Credential for Registered Dietitian Nutritionists in Clinical Nutrition Practice. J Acad Nutr Diet 2015; 115:619-23. [DOI: 10.1016/j.jand.2014.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Indexed: 10/23/2022]
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Murphy WJ, Hand RK, Steiber AL. Practicalities of Using the Nutrition Care Process in Research. J Ren Nutr 2015; 25:393-4. [PMID: 25753605 DOI: 10.1053/j.jrn.2014.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 12/23/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- William J Murphy
- Department of Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois.
| | - Rosa K Hand
- Department of Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Alison L Steiber
- Department of Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
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