Page 115 - Nutrition Counseling and Education Skills: A Guide for Professionals

Nutrition Monitoring and Evaluation

Nutrition monitoring and evaluation together comprise the fourth step in the nutrition care process (NCP).22
Monitoring is the follow-up step and evaluation is the comparison step, whether it is comparison with the
previous client visit or with a standard or goal. The purpose of monitoring and evaluation is to ascertain
progress and modify recommendations as needed to promote progress toward goals. The determination of
what the intervention should be and the evaluation mechanisms are individualized.

An outcome is the measured result of the counseling process. Outcome data identify the benefits of medical
nutrition therapy in patient and client care. In using these systems of quality control, nutrition and dietetics
counselors may wish to evaluate several things: (1) the success of the client in following the goals set and in
implementing new eating behaviors; (2) the degree of success of the nutrition intervention, including its
strengths and weaknesses; and (3) their own personal skills as counselors.

The counselor should keep records of the client’s issues and goals, the factors influencing them, and the
intervention for future measurement of client change. Some examples of outcomes are changes in weight,
glycemic control, blood pressure, lipid, and other laboratory values; patient acceptance and progress at self-
care and self-management; improvements in knowledge and dietary changes; and lifestyle changes. These
indicate the impact of the intervention and can be used to evaluate the effectiveness of the treatment. The
counselor and client should engage in evaluation together.

Some measures of success are obvious, such as an overweight person who is now eating differently. Other
outcome measures may be indicators of quality of care. Some tools or data sources for monitoring and
evaluation are questionnaires, interviews, anthropometric assessments, biochemical and medical tests, and
food and nutrition intake records. The blood pressure and lipid levels of cardiovascular patients can be
monitored, for example, although they are more difficult to evaluate because they may depend on factors
beyond dietary adherence. Despite the client’s commitment to dietary change, results may not reflect
adherence to the regimen. These outcomes can be used by the health care team working together to adjust the
treatment to achieve or maintain treatment goals.

Frequent follow-up for reassessment, further intervention, coaching, and support is essential until the client
is self-sufficient. Discussion at subsequent sessions should focus first on what went well, that is, the successful
experiences and short-term goals reached, no matter how small. Such a positive focus helps clients feel that
they can have some control over their eating, health, and life, and builds a sense of personal mastery and
coping ability.

Self-monitoring records kept by the client should be examined jointly, discussed, and difficulties identified
and resolved. Overlooking the records indicates to clients that they were not considered important. If progress
is made, new short-term goals for change may be established jointly for the appropriate SOC. Support and
reinforcement to strengthen desirable habits along with gradual, planned changes should continue as long as
necessary until the client is successful at self-management.

Enthusiasm for change may decline during the first week and even more during the second week, as
obstacles develop. Therefore, frequent follow-up appointments should be scheduled if possible. Counselors in
acute care settings who do not have the opportunity for follow-up may need to refer patients to nutrition and
dietetics counselors in outpatient settings or in private practice, because one session with a client is insufficient

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