Identifying Components of Advanced-Level Clinical Nutrition Practice: A Delphi Study

• Published in: Journal of the Academy of Nutrition and Dietetics Vol. 112; no. 6; pp. 859 - 869
• Main Authors: Brody, Rebecca A., PhD, RD, LD, Byham-Gray, Laura, PhD, RD, Touger-Decker, Riva, PhD, RD, FADA, Passannante, Marian R., PhD, O'Sullivan Maillet, Julie, PhD, RD, FADA
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2012; Elsevier
• Subjects: Adult; adult education; Aged; Aged, 80 and over; Biological and medical sciences; Clinical Competence; clinical nutrition; communications technology; Consensus; counseling; Data Collection; Delphi Technique; dietetics; Dietetics - standards; dietitians; Educational Status; experts; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Health Knowledge, Attitudes, Practice; Humans; Internal Medicine; leadership; Male; Middle Aged; nutrition knowledge; occupations; patient care; patients; Professional Role; Professional-Patient Relations; surveys; United States; Vertebrates: anatomy and physiology, studies on body, several organs or systems; United States; Delphi; Clinical nutrition practice; Advanced-level practice; Symptomatology; Metabolic diseases; Advanced stage; Nutrition; Professional practice; Feeding
• ISSN: 2212-2672; 2212-2680
• DOI: 10.1016/j.jand.2012.02.022

Abstract The dietetics profession lacks a comprehensive definition of advanced-level practice. Using a three-round Delphi study with mailed surveys, expert consensus on four dimensions of advanced-level practice that define advanced practice registered dietitians (RDs) in clinical nutrition was explored. Purposive sampling identified 117 RDs who met advanced-level practice criteria. In round 1, experts rated the essentiality of statements on a 7-point ordinal scale and generated open-ended practice activity statements regarding the following four dimensions of advanced-level practice: professional knowledge, abilities and skills, approaches to practice, roles and relationships, and practice behaviors. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 was neutral, and 5.0 to 7.0 were nonessential. In rounds 2 and 3, experts re-rated statements not reaching consensus by evaluating their previous responses, group median rating, and comments. Consensus was reached when the interquartile range of responses to a statement was ≤2.0. Eighty-five experts enrolled (72.6%); 76 (89.4%) completed all rounds. In total, 233 statements were rated, with 100% achieving consensus; 211 (90.6%) were essential to advanced practice RD clinical practice. Having a master's degree; completing an advanced practice residency; research coursework; and advanced continuing education were essential, as were having 8 years of experience; clinical nutrition knowledge/expertise; specialization; participation in research activities; and skills in technology and communication. Highly essential approaches to practice were systematic yet adaptable and used critical thinking and intuition and highly essential values encompassed professional growth and service to patients. Roles emphasized patient care and leadership. Essential practice activities within the nutrition care process included provision of complex patient-centered nutrition care using application of advanced knowledge/expertise and interviewing and counseling strategies approached in a comprehensive yet discriminating manner. Communication with patients and the health care team is a priority. An advanced-level practice model in clinical nutrition was proposed depicting the requisite attributes and activities within four dimensions of professional practice.