M. Rosita Schiller

Patients Report Positive Nutrition Counseling Outcomes

OBJECTIVE Assess outcomes of patient nutrition counseling. DESIGN A descriptive study based on the results of a telephone interview performed 2 to 8 weeks after counseling. SUBJECTS/SETTING Subjects were 400 adult patients referred for nutrition counseling at 2 academic health centers. Of these, 274 patients received nutrition counseling during hospitalization and 126 as outpatients. STATISTICAL ANALYSIS Descriptive statistics were used to summarize data and the Mann-Whitney U statistic and logistic regressions were used to test significant differences (P < .05) between inpatient and outpatient counseling outcomes. RESULTS Most patients (83%) gave a partial or full description of their diet modifications and 79% had a moderate or good understanding of their diet. Most patients reported that the dietitians advice was suited to their special needs (88%) and that they knew what to eat (83%). A majority (62%) had made dietary changes, but 17% said they had had trouble changing their diets as suggested. After talking with a dietitian, 57% felt better emotionally, 37% felt better physically, 64% felt in control of their condition, and 43% noticed improved health indicators. Initial analysis indicated that outpatients reported better outcomes than inpatients; further analysis showed that these differences could be attributed to younger ages among the outpatient sample. APPLICATIONS/CONCLUSIONS Patient nutrition counseling has positive outcomes. Therefore, key counseling points should be introduced or reinforced in inpatient settings, in conjunction with multiple-session protocols during the pre- and/or posthospitalization continuum of care. Dietitians, managers, administrators, and credentialing agencies should work together to secure and promote the necessary physical, personnel, and financial resources to make this happen.

Nutrition screening and assessment: current practices and dietitians' leadership roles.

OBJECTIVE To ascertain hospital nutrition screening and assessment practices and the need for additional resources to facilitate these processes. DESIGN A survey questionnaire was developed to ascertain screening protocols, assessment procedures and tools, relevant training and research needs, and respondent characteristics. SAMPLE The survey was sent to 988 members of Dietitians in Nutrition Support, a dietetic practice group of The American Dietetic Association; 388 (39.3%) responses were used for analysis. STATISTICAL ANALYSIS Descriptive statistics were used to calculate response frequency. chi 2 Statistics were used to test associations between nutrition assessment practices and association membership, nutrition support team activity, patient load, time allocations, and type and size of hospital. RESULTS Most institutions had policies for screening (90.2%); 68.7% of dietitians were involved in screening either alone or with others. Assessment practices within hospitals varied widely: 45.9% used a standard form; 66.8% assessed patients at risk; and 10.6% assessed all patients. Typical assessments included height and weight, diagnosis, weight history, albumin, food intolerance, and allergies. Social histories and sophisticated methods such as indirect calorimetry were used infrequently. Most assessments (54.5%) took 31 to 59 minutes; 35.0% of the dietitians spent more than half their time doing assessments. A large percentage (48.7%) of respondents viewed the dietitian as having greatest influence on assessment policies; others thought physicians (23.2%), administrators (15.7%), nurses (6.2%), or pharmacists (6.5%) had the greatest influence. APPLICATIONS/CONCLUSIONS Recommended improvements include improved standards of practice, development of written protocols and practice guidelines, better use of human resources, standardization of assessment procedures throughout the profession, and empowerment of dietitians to assume a stronger leadership role in this dimension of dietetics practice.

Transformational leadership of clinical nutrition managers

OBJECTIVE To identify leadership qualities of clinical nutrition managers and associate these leadership qualities with selected demographic variables (eg, training/degree, length of time in management, number of people supervised, income, and participation in advanced practice activities). DESIGN The theory of transformational leadership, that is, leadership that incorporates specific interpersonal behaviors of the leader and his or her actions within the organization, provided the framework for the study. Specific transformational leadership qualities--leader behavior, leader personal characteristics, and the effect of the leader on organizational functioning and culture--were measured using the Leadership Behavior Questionnaire (LBQ). The reliability and validity of the LBQ have been reported previously. Other data were obtained using two demographic surveys. SAMPLE Demographic surveys were mailed to 1,599 members of the Clinical Nutrition Management dietetic practice group. From the 951 (59.8%) respondents, a study sample of 150 clinical nutrition managers and their subordinates was selected to receive the LBQ; 116 (77.3%) instrument sets were used for analysis. STATISTICAL ANALYSIS Descriptive statistics were used to analyze the demographic surveys. A specified mixed linear model repeated measures Statistical Analysis System procedure was used to compare the clinical manager and subordinate LBQ scores. Association of the selected demographic variables with leadership qualities was measured by lambda, a predictive value measure, using the BMDP 4F program. RESULTS Clinical nutrition managers exhibited transformational leadership qualities as rated by the LBQ, rating lowest on the communication leadership score and highest on the respectful leadership score. Most of the clinical nutrition manager self LBQ scores were significantly higher than the clinical nutrition manager LBQ scores rated by subordinates. The selected demographic variables appeared to have the strongest predictive effect for the visionary culture building subscore of the LBQ. The visionary culture building subscore is a measure of how well the leader interacts with and affects the functioning of an organization. APPLICATIONS/CONCLUSIONS More research is needed to define leadership in dietetics: this study can serve as a possible model. One way clinical nutrition managers may be able to enhance their leadership behaviors is to strengthen their skills in communicating their vision. Programs are needed to help clinical nutrition managers shape their organizations to foster leadership development in their subordinates.

Clinical Nutrition Managers have Access to Sources of Empowerment

OBJECTIVE To ascertain perceived access of dietitians to power in the workplace. DESIGN The conceptual framework was Kanters theory of organizational power. The Conditions for Work Effectiveness Questionnaire was used to measure perceived access to sources of power: information, support, resources, and opportunities. Demographic data were collected to identify factors that may enhance empowerment. SUBJECTS/SETTINGS The questionnaire was sent to a random sample of 348 dietitians chosen from members of the Clinical Nutrition Management dietetic practice group of the American Dietetic Association. Blank questionnaires were returned by 99 (28.4%) people not working as clinical nutrition managers, which left 249 in the sample. STATISTICAL ANALYSES Descriptive statistics were used to organize and summarize data. One-way analysis of variance and t tests were performed to identify differences in responses based on levels of education, work setting, and information technology skills. RESULTS Usable questionnaires were received from 178 people (71.5%). On a 5-point scale, scores for access to information (mean +/- standard deviation [SD] = 3.8 +/- 0.7), opportunity (mean +/- SD = 3.6 +/- 0.7), support (mean +/- SD = 3.2 +/- 0.9), and resources (mean +/- SD = 3.1 +/- 0.8) demonstrated that clinical nutrition managers perceived themselves as having substantial access to sources of empowerment. Those having higher levels of education, working in larger hospitals, having better-developed information technology skills, and using information technology more frequently had statistically significant higher empowerment scores (P = < or = .05) than contrasting groups in each category. APPLICATIONS/CONCLUSION Clinical nutrition managers are empowered and able to assume leadership roles in todays health care settings. Their power may be enhanced by asserting more pressure to gain greater access to sources of power: support, information, resources, and opportunities.

Dietitians' self-perceptions : implications for leadership

This article reports usual modes of thinking and behavior as measured by the Life Styles Inventory--Level 1, Self-Description (LSI--Level 1), which was completed by 893 dietitians who attended at least one invitational leadership seminar during 1986 through 1989. The LSI--Level 1 measures 12 lifestyles, both positive and negative, and there is a score for each style. On a scale of 1 to 40, mean scores of the study sample were highest for Affiliative (32.0), Humanistic-Helpful (31.6), Achievement (31.1), and Self Actualize (28.8) styles. These are positive styles that characterize creative thinkers who have been described as good leaders: confident and energetic with balanced concern for both tasks and people. When mean scores of the study sample were plotted on a scaled circumplex to give a visual profile of the scores, the Dependent and Self Actualize styles were dominant; the study sample means were above the 75th percentile of the general population sample. Dependency is described as a self-defeating style characterized by insecurity, indecision, meekness, and acquiescence. chi 2 Analysis showed that study respondents who had high scores in positive styles were significantly more likely to hold graduate degrees, publish articles, conduct research, hold offices, initiate projects, and serve as mentors. High scores in self-defeating styles were associated with the bachelors degree level and less involvement in research and continuing education programs. These results indicate that many dietitians possess attributes associated with strong leadership skills; nevertheless, a substantial number reported self-defeating, dependent behaviors.(ABSTRACT TRUNCATED AT 250 WORDS)

Dietitians in Home Care: A Survey of Current Practice

OBJECTIVE To determine current practice patterns of dietitians who work in home health care. DESIGN A mail survey was sent and a reminder postcard was mailed 2 weeks later. SUBJECTS Registered dietitians (1,305) who returned a postcard indicating employment in home care. A total of 660 questionnaires (50.6%) were returned; of these, 252 were usable for data analysis. STATISTICAL ANALYSES PERFORMED Descriptive statistics for summary data and a paired t test to compare level of importance and level of expertise needed for nutrition care skills. RESULTS The typical respondent was a consultant, relatively new to home care, working fewer than 10 hours a week, and paid an hourly wage (mean=

Dietetics and Foodservice Personnel are Ready for Team Problem Solving

61.45/hour). Most agencies did not bill separately for nutrition services but 28.2% received third-party payment for services. Primary diagnoses of home care patients were diabetes and cancer. Many dietitians worked with patients receiving enteral tube feedings (55%), total parenteral nutrition (29%), or both (17%), but most made fewer than two visits per week to these patients. Areas of skill rated highest in level of importance for dietitians working in home care were patient counseling, caregiver education, documentation, and dietary history. These plus the ability to develop a care plan received highest expertise ratings. Disparity between skill importance and personal expertise was greatest for activities in the clinical and administrative categories. Most respondents expected growth and role expansion for dietitians in home care, but lack of reimbursement was the greatest deterrent. APPLICATIONS To expand their role in the home care field, dietitians need to develop additional skills, improve outcome documentation, diversify roles, and create new relationships with home care providers and case managers.

Administrators' perceptions of nutrition services in home health care agencies

OBJECTIVE To determine the readiness of dietetics and foodservice personnel for contributing to team problem solving. DESIGN A descriptive, correlation study in which a five-part questionnaire was designed to collect data. SUBJECTS Dietetics and foodservice personnel (n = 632) in eight hospital settings; 321 subjects (51%) volunteered to participate. STATISTICAL ANALYSES PERFORMED Statistical data to summarize demographic information and two-way analysis of variance with a Scheffe post hoc analysis was used to investigate differences between dietetics and foodservice personnel on each of the subscales. RESULTS In general, all respondents were somewhat oriented toward group problem solving and were confident in their problem-solving skills. Problem-solving expertise within the organization decreased for the respondents as the problem moved from their direct work areas to the organization level. Dietitians displayed higher self-efficacy in contributing to problem-solving teams than did foodservice personnel, indicating a 75% chance that they would contribute whereas all other respondents indicated a 50% chance of contributing. APPLICATIONS The results of this study generate optimism for involving all dietetics and foodservice personnel in team problem solving. However, training activities are needed for both foodservice personnel and dietetics professionals.

Functional health literacy and smoking cessation outcomes

OBJECTIVE Ascertain views of home care administrators regarding the need for nutrition services in home care, current status and gaps in dietitian services, and obstacles toward expansion. DESIGN Mailed survey. SUBJECTS Members of the National Association for Home Care residing in California, New York, Pennsylvania, Ohio, and Texas. Of the 1,992 questionnaires sent, 402 (20.1%) were completed and used for data analysis. STATISTICAL ANALYSES PERFORMED Descriptive statistics. RESULTS Respondents gave high importance to nutrition (6.2 on a 7-point scale), and 39.6% estimated that more than half of their patients were malnourished. Most respondents reported using dietitian services, either as consultants (45.5%) or full-time (5.8%) or part-time (11.9%) employees. Nurses (85.5%) were listed most often as providers of nutrition services; also listed were dietitians (70.6%), pharmacists (17.2%), and physicians (11.2%). More than half of the respondents did not have, but would like to have, a dietitian serve as a nutrition consultant, prepare nutrition care plans, and provide nutrition counseling for patients and caregivers. Primary deterrents noted were lack of reimbursement by third-party payers and lack of physician request. Dietitian services ranked as having the highest value were patient education and counseling, medical nutrition therapy for specific conditions, development of nutrition care plans, staff in-service training, and nutrition assessments. Most home care administrators expected dietitian hours, services, and staff to increase during the next 5 years. APPLICATIONS The growing home health care market is fertile ground for dietitians. To expand their role in home care, dietitians can position nutrition services as being vital to cost-effective, high-quality care; augment their skills in consultation, training, nutrition support, and outcomes research; strengthen collaborative ties with key home health care professionals; and advocate for Medicare coverage of medical nutrition therapy.

Nutrition in the Prevention and Treatment of Disease

Purpose – This paper aims to describe the relationship between functional health literacy level and smoking cessation outcomes.Design/methodology/approach – Participants in an inpatient smoking cessation program in a mid‐western city in the USA were enrolled and the Short Test of Functional Health Literacy in Adults was administered while the participant was still admitted. A follow‐up telephone call was made three months after the intervention in order to assess self‐reported smoking cessation.Findings – A total of 30 participants were enrolled. At the three‐month follow‐up, 22 patients were currently smoking and eight had quit smoking. Chi‐square analysis indicated that there was no difference in the incidence of successful smoking cessation based on level of functional health literacy. The results of a stepwise logistic regression analysis suggest that predicting whether a study participant will quit smoking or not appears to be a function of the participants environment, since the only variable that ...