Clinical Practice: Acute & Chronic Care. Clinical Work Settings What are the major job settings for...
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Transcript of Clinical Practice: Acute & Chronic Care. Clinical Work Settings What are the major job settings for...
Clinical Practice: Acute & Chronic Care
Clinical Work Settings
What are the major job settings for clinically-based dietitians?
Clinical Work Settings
Health care facilitiesAcute care/in-patient care
short term care delivered to patients who experience sudden illness or trauma
Long term care managing chronic conditions
Ambulatory clinics managing chronic conditions or disease prevention in community dwelling
Responsibilities in Clinical Dietetics
Nutrition Screening
Nutrition Assessment
Nutrition Care Plan
Monitoring Progress
Nutrient Analysis
Responsibilities in Clinical Dietetics
Nutrition ScreeningScreening process to identify nutritional risk
Nutrition Screening Example
DiseaseEating poorlyTooth loss or mouth painEconomic hardshipReduced social contactMultiple medicationsInvoluntary weight loss or gainNeed for assistance in self careElder years (>80)
Nutrition Assessment
Evaluation of collected information
Prioritize nutritional problems
Nutrition Assessment Example
24 hour recallGuided interview to recall all foods and beverages consumed in past 24 hours (or typical day)
Times, amounts, preparation methods
Prompting
Responsibilities in Clinical Dietetics
Nutrition Care PlanBased on diagnosis
care plan for nutrition interventioni.e. special diet therapy, meal plan
Includes plan for ongoing monitoring and evaluation (follow up)
Monitoring ProgressFollow-up on progress of plan to meet set goals
Nutrient AnalysisEvaluate nutritional content of foods consumed
Work time in Clinical Dietetics
Average time involved in tasks
51% client-related activities
10% managerial functions
1% professional activities
5% non-professional activities
20% transit time
Nutrition Professional as Team Member
Team approachNeed integrated efforts to achieve desired outcomes
No one can work entirely on their own
Advancement Opportunities
Entry-level dietitian
Specialization
Team/Service Leader
Clinical Nutrition Dept Manager
Future of Clinical Dietetics
↑ self-employed dietetic counselors↓ out-patient services
Client education changingvenues
timing
↑ need for long-term care
↑ employment by MD offices
Specialized Nutrition Support
Enteral nutrition
receiving nutrients via GI tract
oral, tube, catheter, stoma
Parenteral nutrition
receiving nutrients via vein
large, central OR smaller, peripheral
Goals of Health Care
What are the two major goals of health care?
Maximize human flourishing Curative medicine
Minimize human sufferingPalliative care
–care of the terminally ill aimed to improve quality of life
Reflection Comments
How understanding may affect future practice?Sp/punc/gram/awkTerminology
“eat healthy”“junk food”
Proof read before submittingSpelling
DietitianThen vs. ThanDesert vs. Dessert
Ethical Theories
3 ethical theories that affect attitudes towards health care delivery and services:
Formalist
Utilitarian
Virtues
Bioethical Principles
Autonomy
Justice
Nonmaleficience
Beneficence
Ethical Issues
Is provision of nutrition morally obligatory or morally optional?
Does this change with length of support?
Do ethical guidelines differ for children, older adults, pregnant women, etc.?
Living Will or Advanced Health Directive
Appoints individual to take over health care decisions
Specific directives for course of treatment
Terri Schiavo case (brain injury in mid 20s)
Living wills still taken to court
Dietitian’s Roles
Responsibilities of PDt/RD?
What knowledge, skills, & attitudes needed for debate?
Required Readings
Duester. (1997). Building your business – Setting your fees.
Gross, & Ostrowski. (2008). Getting started in private practice.