Page 27 - Nutrition Counseling and Education Skills: A Guide for Professionals

CASE ANALYSIS 7

Write a potential nutrition care process “chain” plan for your work with Karen? How would you evaluate
your effectiveness of treatment and document the cost-effectiveness of your professional time for future
reimbursement?

Evolving Scope of Practice in Nutrition

New areas of practice are continually evolving in the field of nutrition. A few will be highlighted here, but
these examples only illustrate a small portion of the new and exciting areas of practice that are yet to be
defined. The Subjective Global Assessment tool and nutrition physical examination examines patients for
changes in oral mucosa, skin integrity, and nutrient deficiencies to formulate nutrition diagnoses and
corresponding nutrition interventions.27,28 Some practitioners are exploring advanced clinical skills
examination principles that may one day be tested using standardized patients such as is currently done in
medicine, osteopathic medicine, and podiatry.29 An advanced practice audit conducted in 2013 funded by the
CDR provided initial practice patterns that could eventually be used to develop an advanced practice
credential examination.30

The concept of nutrition assessment using narrative medicine is also being explored. This technique builds
upon motivational interviewing skills. It provides the ability to include subjective and detailed narrative prose
in addition to the NCP. An example of narrative medicine documentation:

The patient sat in the room with a lifeless expression, not wanting to make eye contact. He had just learned that his kidneys were failing
and dialysis would soon be required. What to eat or not to eat was the last thing on his mind. Mr. Smith was instead focused on how he
could continue to work and support his family.31

Finally, new practice settings are being explored. The area of emerging nutrition practice within integrated
healthcare teams is evolving in patient-centered “whole-person” philosophy medical “homes” and accountable
care organizations. These systems are shifting from a traditional fee-for-service model to a more
comprehensive “total” care viewpoint. These integrated systems are rewarded for financially for improving
health and wellness outcomes. The RDN has an integral basis in determining nutrition diagnosis, delivering
appropriate nutrition interventions, and taking credit for client change in health risk reduction.32

Support sustainable farming practices and ecologic agriculture innovation
Encourage international food security and public policy collaboration
Promote farm-to-fork and fork-to-table global education initiatives
Advocate for safe and nutrition-conscious food processing
Partner with retailers to market healthy food options and programs
Educate consumers on evidence-based food preparation and storage methods
Raise awareness for comprehensive reduction of food waste/wasted food

Table 1-3 ■ Professional Initiatives to Link Agriculture, Nutrition, and Health

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