Definition of Nutrition
Nutrition is the science that interprets the nutrients and other substances in food in relation to maintenance, growth, reproduction, health and disease of an organism. It includes food intake, absorption, assimilation, biosynthesis, catabolism and excretion.
The diet of an organism is what it eats, which is largely determined by the availability and palatability of foods. For humans, a healthy diet includes preparation of food and storage methods that preserve nutrients from oxidation, heat or leaching, and that reduces risk of foodborne illnesses. The seven major classes of human nutrients are carbohydrates, fats, fiber, minerals, proteins, vitamins, and water. Nutrients can be grouped as either macronutrients or micronutrients (needed in small quantities).
In humans, an unhealthy diet can cause deficiency-related diseases such as blindness, anemia, scurvy, preterm birth, stillbirth and cretinism, or nutrient excess health-threatening conditions such as obesity and metabolic syndrome; and such common chronic systemic diseases as cardiovascular disease, diabetes, and osteoporosis. Under nutrition can lead to wasting in acute cases, and the stunting of marasmus in chronic cases of malnutrition.
Medical nutrition therapy (MNT) is a therapeutic approach to treating medical conditions and their associated symptoms via the use of a specifically tailored diet devised and monitored by a registered dietitian, nutritionist. The diet is based upon the patient’s medical record, physical examination, functional examination and dietary history.
The role of MNT when administered by a physician or dietitian, nutritionist is to reduce the risk of developing complications in pre-existing conditions such as type 2 diabetes as well as ameliorate the effects any existing conditions such as high cholesterol. Registered dietitians started using MNT as a dietary intervention for preventing or treating other health conditions that are caused by or made worse by unhealthy eating habits.
On the other hand, Medical nutrition is a broader term describing nutrition in a medical context.
Role of Dietitian in health care
A dietitian (or dietician) is an expert in dietetics; that is, human nutrition and the regulation of diet. A dietitian alters their patient’s nutrition based upon their medical condition and individual needs. Dietitians are regulated healthcare professionals licensed to assess, diagnose, and treat nutritional problems.
A registered dietitian (RD) or registered dietitian nutritionist (RDN) is a dietitian who meets all of a set of special academic and professional requirements, including the completion of a bachelor’s degree with an accredited nutrition curriculum, an internship at an approved health-care facility, foodservice organization, or community agency, and satisfactory performance on a registration exam.
Roughly half of all RDNs hold graduate degrees and many have certifications in specialized fields such as nutrition support, sports, pediatrics, renal, oncological, food-allergy, gerontological nutrition. After learning about a patient’s health history, favorite foods, eating and exercise habits, the RD helps the person to set goals and to prioritize. Follow-up visits often focus on maintenance and monitoring progress.
Most RDs work in the treatment and prevention of disease (administering medical nutrition therapy, as part of medical teams), often in hospitals, health-maintenance organizations, private practices, or other health-care facilities. In addition, many registered dietitians work in community and public-health settings, and/or in academia and research. A growing number of dietitians work in the food industry, journalism, sports nutrition, corporate wellness programs, and other non-traditional dietetics settings.
Clinical dietitians work in hospitals, outpatient clinics, nursing care facilities and other health care facilities to provide nutrition therapy to patients with a variety of health conditions, and provide dietary consultations to patients and their families. They confer with other health care professionals to review patients’ medical charts and develop individual plans to meet nutritional requirements. Some clinical dietitians will also create or deliver outpatient or public education programs in health and nutrition.Clinical dietitians may provide specialized services in areas of nourishment and diets, tube feedings (called enteral nutrition), and intravenous feedings (called parenteral nutrition) such as total parenteral nutrition (TPN) or peripheral parenteral nutrition (PPN). They work as a team with the physicians, physician assistants, physical therapists, occupational therapists, recreational therapists, pharmacists, speech therapists, social workers, nurses, dietetic technicians, psychologists and other careers to provide care to patients. Some clinical dietitians have dual responsibilities with patient nutrition therapy and in food service or research (described below).
Community dietitians work with wellness programs, public health agencies, home care agencies, and health maintenance organizations. These dietitians apply and distribute knowledge about food and nutrition to individuals and groups of specific categories, life-styles and geographic areas in order to promote health. They often focus on the needs of the elderly, children, or other individuals with special needs or limited access to healthy food. Some community dietitians conduct home visits for patients who are too physically ill to attend consultations in health facilities in order to provide care and instruction on grocery shopping and food preparation.
Food Service dietitians
Foodservice dietitians or managers are responsible for large-scale food planning and service. They coordinate, assess and plan food service processes in health care facilities, school food-service programs, prisons, restaurants, and company cafeterias. These dietitians may perform audits of their departments to ensure quality control and food safety standards, and launch new menus and various programs within their institution to meet health and nutritional requirements. They train and supervise other food service workers such as kitchen staff, delivery staff, and dietary assistants or aides.
Gerontological dietitians are specialists in nutrition and aging. They work in nursing homes, community-based aged care agencies, government agencies in aging policy, and in higher education in the field of gerontology (the study of aging).
Pediatric dietitians provide nutrition and health advice for infants, children, and adolescents. They focus on early nutritional needs, and often work closely with doctors, school health services, clinics, hospitals and government agencies, in developing and implementing treatment plans for children with eating disorders, food allergies, or any condition where a child’s diet factors into the equation, such as childhood obesity.
Research dietitians may focus on social sciences or health services research, for example, investigate the impact of health policies or behaviour change, or evaluate program effectiveness.They may survey food-service systems management in order to guide quality improvement. Some research dietitians study the biochemical aspects of nutrient interaction within the body. In universities, they also may have teaching responsibilities. Some clinical dietitians’ roles involve research in addition to their patients care workload.
The Nutrition Care Process (NCP) is a systematic approach to providing high quality nutrition care. The NCP consists of four distinct, interrelated steps:
- Nutrition Assessment: The dietitian collects and documents information such as food or nutrition-related history; biochemical data, medical tests and procedures; anthropometric measurements, nutrition-focused physical findings and client history.
- Nutrition Diagnosis: Data collected during the nutrition assessment guides the RDN in selection of the appropriate nutrition diagnosis (i.e., naming the specific problem).
- Nutrition Intervention: The dietitian then selects the nutrition intervention that will be directed to the root cause (or etiology) of the nutrition problem and aimed at alleviating the signs and symptoms of the diagnosis.
- Nutrition Monitoring/Evaluation: The final step of the process is monitoring and evaluation, which the dietitian uses to determine if the client has achieved, or is making progress toward, the planned goals.
Using the NCP does not mean that all clients get the same care. Use of a care process provides a framework for the dietitian to individualize care, taking into account the client’s needs and values and using the best evidence available to make decisions. Other disciplines in healthcare, including nursing, physical therapy and occupational therapy have adopted care processes specific to their discipline.
At first the Nutrition Care Process may seem like a linear approach; however, during the course of an interaction/appointment with a client, the dietitian will often complete the assessment and diagnosis steps, and may begin a Nutrition Intervention when a client reveals another piece of new assessment data/information that will cause the dietitian to re-assess, and re-diagnose and perhaps modify the plan that he/she had started discussing with the client.
Dietary needs and disease processes
Normally, individuals obtain the necessary nutrients their bodies require through normal daily diets that process the foods accordingly within the body. Nevertheless, there are circumstances such as disease, distress, stress, and so on that may prevent the body from obtaining sufficient nutrients through diets alone. In such conditions, a dietary supplementation specifically formulated for their individual condition may be required to fill the void created by the specific condition. This can come in form of Medical Nutrition.
In most cases the use of Medical Nutrition is recommended within international and professional guidelines. It can be an integral part of managing acute and short-term diseases. It can also play a major role in supporting patients for extended periods of time and even for a lifetime in some special cases.
Medical Nutrition is not meant to replace the treatment of disease but rather complement the normal use of drug therapies prescribed by physicians and other licensed healthcare providers.
- The following advantages come with medical nutrition:
- Medical nutrition can benefit people with various medical conditions such as cancers, Chronic obstructive pulmonary disease (COPD), Diabetes mellitus, Eating disorders, food allergies, Gastrointestinal disorders, immune system disorders; such as HIV/AIDS, inherited disorders affecting metabolism, involuntary weight loss, Kidney disease,Sarcopenia, surgery recovery, Pregnancy, Osteoporosis, Ulcer and so on.
- It is often very effective in treating type 1 or type 2 diabetes.
- It can help one to live better at any age.
- A patient may need to follow a strict diet to see benefits while using a medical nutrition plan.
- Some forms of medical nutrition can be very expensive. A poor patient may not afford such.
- So it should always be the aim of the concerned dietitian to give as simplified food as possible according to the socio economic status of the patient.
Importance of patient care and dietary counseling
There has baeen an increased emphasison setting standards of practice to ensue the delivery of quality patient care. An increased focus has been there on cost control in health care settings, for effectively evaluating patient care programmed based on two factors- cost effectiveness and provision of nutritional services.
Further, counseling is one of the most useful method for assisting in individual to arrive at a solution of his/her problems. Let us get started to learn about patient care.
The healthcare team in this process involves a physician, dietitian, nurse and other health care professionals.
How do we define quality of care?
On the basis of several definitions in the literature, the WHO definition of quality of care is “the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people-centred.”
Safe. Delivering health care that minimizes risks and harm to service users, including avoiding preventable injuries and reducing medical errors.
Effective. Providing services based on scientific knowledge and evidence-based guidelines.
Timely. Reducing delays in providing and receiving health care.
Efficient. Delivering health care in a manner that maximizes resource use and avoids waste.
Equitable. Delivering health care that does not differ in quality according to personal characteristics such as gender, race, ethnicity, geographical location or socioeconomic status.
People-centred. Providing care that takes into account the preferences and aspirations of individual service users and the culture of their community.
A process by which a health professional with special training in nutrition helps people make healthy food choices and form healthy eating habits.
Other factors that may be assessed during dietary counseling include:
- medical history, including assessment of any nutrition-related illnesses, and biochemical and anthropometric measures
- dietary assessment (dietary analyses)
- psychosocial evaluation, including food-related attitudes and behaviors
- sociological evaluation, including cultural practices, housing, cooking facilities, financial resources, and support of family and friends
- nutrition knowledge
- readiness to learn or change; as well as learning style analyses
- current exercise and activity level
Some of the most common dietary assessment tools that assist in providing dietary counseling include food records, dietary recalls, food frequency questionnaires, diet histories, and several other methods, including biochemical indices. A scientific assessment of nutritional status may be made by using a combination of the information collected from clinical evaluations, biochemical tests, and dietary information.
Factors that play a major role in contributing towards motivation
- Psychological factors: Depression, anxiety or phobia induced by the illness, lifestyle changes or medication effects may comply to hinder the desired health behavioral changes.
- Psychosocialfactors: these may prevent patients from expressing concern for their health. They may lack confidence in the health professional or simply be unable to cope with the dietary changes at that particular point of time because of the degree of illness or personal problems.
- Physical factors:the drugs or illness may induce pain, fatigue or depression which might block desire or ability to follow health professional.
- Personal factors: there may be a language barrier or a lack of transportation, or money for clinic visits.
- Counselorrelated factors: A personality conflict may exist between the patient and counselor.
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