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Clark PW, Williams LT, Brickley B, Ball L. Minimum reporting standards for process and outcomes assessments for private practice dietitians working in Australian primary care: The Thought Leader Consensus study. Nutr Diet 2023; 80:284-296. [PMID: 36217703 PMCID: PMC10952596 DOI: 10.1111/1747-0080.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Abstract
AIM To identify minimum reporting standards for assessing the processes and outcomes of Australian primary care dietetics practice. METHODS A sequential, mixed-method, exploratory process with peer-nominated Australian 'thought leaders'. A literature review was undertaken to identify possible standards, followed by semi-structured qualitative interviews with thought leaders. Content analysis was used to identify a comprehensive group of items that could inform evidence-based reporting standards. Two rounds of a modified Delphi survey were conducted with the same thought leaders to seek consensus on the most relevant items. Individual items were analysed for content validity, and those with a rating of excellent item-content validity (index >0.78) were included as evidenced-based standards for primary care practice. RESULTS Twenty-six thought leaders (response rate: 87%) from all mainland Australian states completed a qualitative interview and two rounds of modified-Delphi consensus surveys. Items were identified and categorised into three domains: business, clinical, and implementation. Content analysis identified 216 items published or used in practice by the thought leaders. After two rounds of consensus review, 97 items (45 business, 33 clinical, and 19 implementation) achieved excellent consensus ratings. Combining these items into a standardised tool, the scale-content validity index average was >0.90, which is considered excellent content validity. CONCLUSIONS This study has identified minimum reporting standards for evidence-based process and outcome assessments in primary care dietetics practice in Australia. Incorporating such standards into a standardised tool could enable benchmarking across the dietetics workforce and contribute to a broader understanding of the dietetic impact on public health.
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Affiliation(s)
- Peter W. Clark
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
- Healthier You Pty. LtdPort MacquarieNew South WalesAustralia
| | - Lauren T. Williams
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
| | - Bryce Brickley
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
| | - Lauren Ball
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
- Griffith University, Menzies Health Institute QueenslandNathanQueenslandAustralia
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2
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Nagy A, McMahon A, Tapsell L, Deane F. The therapeutic relationship between a client and dietitian: A systematic integrative review of empirical literature. Nutr Diet 2022; 79:303-348. [PMID: 35324041 PMCID: PMC9543415 DOI: 10.1111/1747-0080.12723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/11/2021] [Accepted: 01/01/2022] [Indexed: 01/03/2023]
Abstract
Aim Scientific evidence underpins dietetics practice; however, evidence of how the therapeutic relationship influences outcomes is limited. This integrative review aims to provide a comprehensive overview of the topic of the therapeutic relationship between clients and dietitians in the individual counselling context by summarising empirical literature into qualitative themes. Methods An electronic literature search of the Cumulative Index of Nursing and Allied Health Literature, PsychInfo, Scopus and Web of Science databases was conducted in October 2018 and repeated in February 2021. Studies were included if they explicitly referred to the therapeutic relationship (or associated terms), were based on study data and available in full text. Extracted data were checked by a second researcher and the methodological quality was evaluated independently by two researchers using the Mixed Methods Appraisal Tool. An iterative process of qualitatively coding, categorising and comparing data to examine recurring themes was applied. Results Seventy‐six studies met the inclusion criteria. Five themes were identified which showed the extent and nature of research in this area. Studies revealed the therapeutic relationship: (i) is valued within clinical dietetic practice, (ii) involves complex and multifactorial interactions, (iii) is perceived as having a positive influence, (iv) requires skills training and (v) is embedded in practice models and tools. Conclusion Studies show the therapeutic relationship is a valued and multifactorial component of clinical dietetic practice and is perceived to positively influence the client and dietitian. Observational data are needed to assess the extent to which the strength of the therapeutic relationship might contribute to clients' health outcomes.
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Affiliation(s)
- Annaliese Nagy
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anne McMahon
- School of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Linda Tapsell
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Frank Deane
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
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3
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Clark PW, Williams LT, Kirkegaard A, Brickley B, Ball L. Perceptions of private practice dietitians regarding the collection and use of outcomes data in primary healthcare practices: A qualitative study. J Hum Nutr Diet 2021; 35:154-164. [PMID: 34605085 DOI: 10.1111/jhn.12950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dietitians working in private practices in primary settings provide nutrition care to support individuals with the prevention and management of chronic disease. A better understanding of the type and usage of data collected by dietitians in this setting may provide insights to optimise the effectiveness and impact of the workforce. The present study explored the perceptions of leading Australian private practice dietitians on the collection and usage of data in their practice. METHODS A qualitative descriptive study of Australian private practice dietitians, recruited by snowball sampling, was conducted on their perceptions and attitudes towards collecting and using data. Data were collected by semi-structured interviews and all interview data were thematically analysed. RESULTS Twenty-three dietitians participated. Five themes emerged: (i) collecting data is challenging, nuanced, unclearly defined and therefore not routinely carried out; (ii) consistent data collection processes are impeded by the diversity of practise and practices; (iii) business-related data collection is essential for sustainable dietetic services; (iv) clinical outcomes are fundamental to dietetic services; and (v) standardised, integrated systems are needed to enable routine data collection and synthesis. CONCLUSIONS Our findings demonstrate the rudimentary role business acumen has in practice viability and provides evidence to potentially re-shape the future of dietetic education in Australia. Private practice dietitians may benefit from tools and training that enable consistent collection of data about their services. Such data could enable benchmarking across the workforce and contribute to a broader understanding of dietetic impact on public health.
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Affiliation(s)
- Peter W Clark
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Healthier You Pty Ltd, Port Macquarie, NSW, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Amy Kirkegaard
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Bryce Brickley
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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4
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Vo R, Smith M, Patton N. A model of the multidimensional nature of experienced dietitian clinical decision-making in the acute care setting. J Hum Nutr Diet 2020; 33:614-623. [PMID: 32281212 DOI: 10.1111/jhn.12756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clinical decision-making (CDM) is an essential component of dietetic practice that can significantly affect the quality of patient care. Research around CDM in clinical dietetics is scarce, with research in other healthcare professions offering limited insight into dietitian CDM in the specific setting of the acute care hospitals. The aim of this qualitative research was to deepen our understanding of the nature of the CDM of experienced dietitians in the acute care setting. METHODS The present study employed philosophical hermeneutics to guide methods situated within the interpretative paradigm. This study invited dietitians currently practising in adult acute care hospitals with at least 3 years of experience to be involved two in-depth semi-structured interviews using the principles of hermeneutics. A reference focus group session was then used to provide rigour and further interpretation of the findings. RESULTS Ten dietitians participated in the interviews and five of these same participants in the reference focus group. The findings have informed the development of A Model of the Multidimensional Nature of Dietitian CDM in the Acute Care Setting, which reflects the nature of making decisions for patient care through the synergistic relationship between five key dimensions: (i) tasks; (ii) interactions; (iii) reasoning; (iv) practitioner factors; and (v) context, all of which are managed and monitored by the higher- order reasoning process of the dietitian's clinical judgement. CONCLUSIONS Because there is scarcity of research on the CDM of dietitians in acute care settings, the present study can provide training and professional development insights to managers, educators and supervisors.
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Affiliation(s)
- R Vo
- Faculty of Science, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - M Smith
- Faculty of Science, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - N Patton
- Faculty of Science, Charles Sturt University, Wagga Wagga, NSW, Australia
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Levey R, Ball L, Chaboyer W, Sladdin I. Dietitians' perspectives of the barriers and enablers to delivering patient-centred care. J Hum Nutr Diet 2019; 33:106-114. [PMID: 31218766 DOI: 10.1111/jhn.12684] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient-centred care (PCC) is widely recognised as being important with respect to the delivery of quality health care. However, limited research has explored PCC in the dietetic context. In particular, dietitians' views of the barriers and enablers to delivering a patient-centred approach have not been investigated. Therefore, the present study aimed to explore primary care dietitians' perspectives of the barriers and enablers to delivering PCC. METHODS The present study was situated in a constructivist-interpretivist paradigm and used qualitative methods. Both convenience and snowball sampling were used to recruit Australian Accredited Practising Dietitians (APD) who were working in primary care. Individual semi-structured interviews explored dietitians' perspectives of the barriers and enablers to delivering PCC. Data were analysed thematically. RESULTS Twelve APDs were interviewed between March and April 2018. Seven themes were discovered: (i) challenges in defining PCC; (ii) valuing PCC; (iii) enacting PCC; (iv) requiring additional education in PCC; (v) evaluating one's own practice; (vi) workplace pressures and constraints; and (vii) keeping up with expectations. CONCLUSIONS These findings suggest that: (i) the meaning of PCC in dietetics should be clarified to ensure it is being practiced consistently; (ii) undergraduate curricula require a greater emphasis on PCC so that dietitians graduate with the necessary knowledge and skills; (iii) there is a need for more professional development training to facilitate uptake of PCC in practice; and (iv) quantitative measurement of PCC using validated instruments is needed to evaluate PCC in the dietetic setting. Addressing some of these factors may assist dietitians to adopt these practices.
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Affiliation(s)
- R Levey
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - L Ball
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - W Chaboyer
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia
| | - I Sladdin
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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O'Connor R, Slater K, Ball L, Jones A, Mitchell L, Rollo ME, Williams LT. The tension between efficiency and effectiveness: a study of dietetic practice in primary care. J Hum Nutr Diet 2019; 32:259-266. [PMID: 30604495 DOI: 10.1111/jhn.12617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary healthcare dietitians have a vital role to play in the prevention and management of chronic disease. Working in primary care requires efficient and effective management of practice to ensure client and practitioner needs are met. The present study aimed to explore the way in which primary care dietitians in Australia view the constructs of efficiency and effectiveness within the context of their practice. METHODS The study used an exploratory qualitative design within a pragmatist framework. Individual semi-structured telephone interviews were conducted with Australian primary care dietitians. All interviews were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. RESULTS Twenty dietitians (17 females) working as private practitioners in primary care from three Australian states participated in the present study. Three themes emerged from the data. The first theme revealed that seeking efficiency and especially effectiveness were important to primary care dietitians and that there was a tension between the two. The second theme identified that efficiency and effectiveness are influenced by personal and structural factors. The final theme explored how dietitians are actively seeking ways to be more efficient and effective, including supportive networks, as well as the utilisation of technology. CONCLUSIONS Achieving a balance between efficiency and effectiveness in primary care dietetics is challenging to practitioners, who may require further training and support to enhance productivity, time management and resource utilisation. Structured issues exist for the workface. Further studies are required to quantify these findings and to explore whether it is possible to optimise efficiency and effectiveness and achieve sustainability of the dietetic workforce in primary care.
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Affiliation(s)
- R O'Connor
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - K Slater
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - L Ball
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - A Jones
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - L Mitchell
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - M E Rollo
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.,Nutrition and Dietetics, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - L T Williams
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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