Page 60 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT MAKES NEW IDEAS DIFFICULT?
team should participate in and contribute to decisions that affect the well-being of clients by drawing on the perspectives, values, and experiences of the social work profession...social works for whom a team decision raises ethical concerns should attempt to resolve the disagreement through appropriate channels. If the disagreement cannot be resolved, social workers should pursue other avenues to address their concerns consistent with client wellbeing.” (NASW Delegate Assembly, 2008)
Dietetics Accountability Is Evolving in Somewhat Competing Directions
The Code of Ethics for the Profession of Dietetics and Process for Consideration of Ethics Issues
was adopted by the American Dietetic Association (ADA) and its credentialing agency, the Commission on Dietetic Registration (CDR) in 2009. It cites as one responsibility to the public, “The dietetics practitioner provides professional services with objectivity and with respect for the unique needs and values of individuals. “ (ADA, 2009)
The American Dietetic Association Revised 2008 Standards of Practice for Registered Dietitians in Nutrition Care... (which together with the Code of Ethics is intended to guide the practice and performance of RDs and DTRs in all settings), addresses in Indicators for Standard 1: Nutrition Assessment, the expectation that the RD will document and communicate “1.7D Changes in clients’ perceptions, values and motivation related to presenting problems.” Indicators for Standard 3: Nutrition Intervention, notes that “each RD Plans the Nutrition Intervention – Determines patient/client-focused goals and expected outcomes.” Examples of Outcomes for Standard 4: Nutrition Monitoring and Evaluation, include “the client/community outcome directly relate to the nutrition diagnosis and the goals established in the intervention plan including but not limited to client-centered outcomes (eg. quality of life, satisfaction, self- efficacy, self-management, and functional ability).” (ADA, 2008)
Standards of Professional Performance do address the responsibility of the RD to provide quality service based on customer expectations and needs, but very generally. These documents do not form a firm foundation for dietitian advocacy for resident choice and resident rights, or for quality of life in long-term care. While these priorities are touched upon in several places, and certainly consistent within those infrequent mentions of patient choice and satisfaction, they are far from a focus of the standards, leaving a void for best practice regardless of the place of practice. Standards of practice for the dietetic practitioner in long-term care are currently being developed, presenting the opportunity to address the standard of resident self-determination with much needed emphasis. Hopefully they will do so.
A review of the mission, vision, values and goals of ADA Practice Groups did not identify a priority commitment to resident rights and resident choice. The mission and vision of the Dietetics in Health Care Communities (DHCC) practice group, formerly Consultant Dietitians in Health Care Facilities, focus on empowering members to be the nation’s food and nutrition leaders and to optimize the nation’s health through food and nutrition. (DHCC, 2009)
The CDM, CFPP Scope of Practice is silent on the subject of resident rights, as is the Code of Ethics and the Practice Standards. (DMA, 2009)
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