THE ROLE OF NUTRITION SUPPORT DIETITIANS AS VIEWED BY CHIEF CLINICAL AND NUTRITION SUPPORT DIETITIANS - IMPLICATIONS FOR TRAINING

Objectives To determine current and ideal frequencies with which nutri tion support dietitians perform each item on a List of 15 tasks and ev aluate dietitian preparation for the practice of nutrition support. De sign Data were collected using two questionnaires, one completed by th e chief clinical dietitian and the other completed by the nutrition su pport dietitian at each hospital surveyed. Both versions of the questi onnaires contained a list of 15 tasks that had been validated as being related to advanced nutrition support by a panel of 20 nutrition supp ort experts using a modified Delphi method. Follow-up telephone calls were made to increase the number of responses.Sample Questionnaires we re mailed to the chief clinical dietitian at 300 randomly selected, ge neral medical/surgical hospitals with 300 or more beds in the United S tates and Puerto Rico. A total of 134 chief clinical dietitians (45%) and 129 nutrition support dietitians (43%) responded to the surveys; 1 24 (41%) and 120 (40%) questionnaires, respectively, were usable for s tatistical analyses. Statistical analyses The Wilcoxon matched-pairs s igned-ranks test was used to determine differences between nutrition s upport dietitian actual and ideal frequencies and between chief clinic al dietitian actual and ideal frequencies for each of the 15 tasks. Th e Mann-Whitney U-Wilcoxon rank sum W test was used to determine differ ences between nutrition support dietitian and chief clinical dietitian actual frequencies and between nutrition support dietitian and chief clinical dietitian ideal frequencies for each of the 15 tasks. Descrip tive statistics were used to analyze the questions regarding education al preparation for nutrition support practice and demographic data. Re sults The ideal frequency for each of the 15 tasks was significantly g l eater (P<.0001) than the actual frequency reported by nutrition supp ort dietitians and chief clinical dietitians. Whereas chief clinical d ietitians and nutrition support, dietitians agreed on the ideal freque ncy for most tasks, the nutrition support dietitian ideal frequency in dicated for the tasks ''determines macronutrient composition of parent eral nutrition'' and ''performs physical examinations related to nutri tional status, fluid status, and gastrointestinal function'' was signi ficantly greater (P<.001, P<.05), respectively) than the ideal frequen cy indicated by chief clinical dietitians. Of the nutrition support di etitians, 79% agreed and 16% somewhat agreed that experiences beyond t hose required for becoming a registered dietitian are needed to provid e nutrition support dietitians with specialized clinical skills. Appli cations/conclusions Nutrition support dietitians desire increased resp onsibility for delivering nutrition support to their patients and this desire is largely supported by chief clinical dietitians. Nutrition s upport dietitians appear to have a strong interest in postregistration qualifying experiences that would provide a foundation for expanding their roles. According to the results of this study, programs designed to provide practical, clinical experience in nutrition support are ne eded.