Nutrition Care Process: Elements for its implementation and use by Nutrition and Dietetics Professionals

Authors

  • Ángeles Carbajal Departamento de Nutricion y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid. Madrid, Spain.
  • José Luis Sierra Departamento de Nutricion y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid. Madrid, Spain.
  • Lorena López-Lora Departamento de Nutricion y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid. Madrid, Spain.
  • Mar Ruperto Departamento de Ciencias Farmaceuticas y de la Salud, Facultad de Farmacia, Universidad CEU San Pablo. Madrid, Spain.

DOI:

https://doi.org/10.14306/renhyd.24.2.961

Keywords:

Nutritionists, Nutrition Therapy, Standard of Care, Reference Standards, Process Assessment, Health Care, Clinical Decision-Making, Terminology as Topic, dietitians, nutrition care process, dietetic care process.

Abstract

Introduction: The Nutrition Care Process (NCP) and NCP Terminology (NCPT) provides a performance protocol that allows encouraging critical thinking, promoting evidence-based professional practice, documenting it, measuring outcomes and evaluating the quality of nutritional care. Objective: To increase awareness of using NCP and NCPT, its basic elements, application in nutritional care in professionals of Nutrition and Dietetics and evaluating its international implementation.
Material and methods: A review of the published works about NCP and NCPT in English and Spanish. Search terms: Nutrition Care Process, Dietetic Care Process, Standardized Terminology, Proceso/Plan de Atención/Cuidado Nutricional/Dietético and TE. It was not limited by date of publication and those articles with low scientific evidence or with changes from the original model were excluded.
Results: The NCP provides a holistic approach and contributes to improving the quality of nutritional care, the exchange information and nutritional follow-up. The implementation of the NCP improves the productivity of those professionals, who are using it, and furthermore, promotes and strengthens the functions of the Nutrition professional in clinical-community healthcare settings.
Conclusions: NCP and NCPT are internationally recognized tools to promote the professional practice in the clinical-community setting and nutritional research, emphasizing the requirement to include it in the academic curriculum and the professional practice of Nutrition and Dietetics.

References

(1) Velasco G, Cuerda C, Alonso A, Frías L, Camblor M, Bretón I, et al. Implantación de un sistema de gestión de calidad en una unidad de nutrición según la norma UNE-EN-ISO 9001:2008. Nutr Hosp. 2015;32(3):1386-92. DOI: http://dx.doi.org/10.3305/nh.2015.32.3.9403

(2) European Federation of the Associations of Dietitians (EFAD). Dietitians in Europe. Definition. Profession and Education. 2016. Último acceso en septiembre 2019. Disponible en: http://www.efad.org/media/1128/revised-definition-of-a-dietitian.pdf

(3) International Confederation of Dietetic Associations (ICDA). International Competence Standards for Dietitian-Nutritionists. 2016. Último acceso en septiembre 2019. Disponible en: https://www.internationaldietetics.org/International-Standards.aspx

(4) World Health Organization (WHO). Diet, nutrition and the prevention of chronic diseases. Report of a join WHO/FAO expert consultation. WHO Technical Report Series, 916. Ginebra: WHO; 2003.

(5) Todhunter EN. Some aspects of the history of dietetics. World Rev Nutr Diet. 1973;18:1-46.

(6) British Dietetic Association (BDA). Model and process for nutrition and dietetic practice. 2016. Último acceso en septiembre 2019. Disponible en: https://www.bda.uk.com/publications/professional/model_and_process_for_nutrition_and_dietetic_practice

(7) Hammond MI, Myers EF, Trostler N. Nutrition care process and model: an academic and practice odyssey. J Acad Nutr Diet. 2014;114(12):1879-94. DOI: 10.1016/j.jand.2014.07.032

(8) Lacey K, Pritchett E. Nutrition care process and model: ADA adopts a road map to quality care and outcomes management. J Am Diet Assoc. 2003;103(8):1061-72. DOI: 10.1053/jada.2003.50564

(9) European Federation of the Associations of Dietitians (EFAD). Nutrition Care Process and Standardised Language report, 2012. Último acceso en septiembre 2019. Disponible en: http://www.efad.org/en-us/professional-practice/nutrition-care-process-and-standardised-language/

(10) Papoutsakis C, Orrevall Y. The use of a standardized language among dietitians in Europe: results and conclusions from a questionnaire by EFAD’s Professional Practice Committee. DietistAktuellt. 2012;21(1):34-6.

(11) Donabedian A. Evaluating the quality of medical are. Milbank Mem Fund Q. 1966;44(3):166-203.

(12) Farris KB, Kirking DM. Assessing the quality of pharmaceutical care. II. Application of concepts of quality assessment from medical care. Ann Pharmacother. 1993;27(2):215-23.

(13) Buchholz D, Kolm A, Vanherle K, Adam M, Kohlenberg-Müller K, Roemeling-Walters ME et al. Process models in dietetic care. A comparison between models in Europe. Ernahrungs Umschau. 2018;65(9):154–63. DOI: 10.4455/eu.2018.034

(14) Bueche J, Charney P, Pavlinac J, Skipper A, Thompson E, Myers E. Nutrition Care Process and Model part I: The 2008 update. J Am Diet Assoc. 2008;108(7):1113-7. DOI: 10.1016/j.jada.2008.04.027

(15) Bueche J, Charney P, Pavlinac J, Skipper A, Thompson E, Myers E. Nutrition Care Process part II: Using the International Dietetics and Nutrition Terminology to document the Nutrition Care Process. J Am Diet Assoc. 2008;108(8):1287-93. DOI: 10.1016/j.jada.2008.06.368

(16) Morris SF y Wylie-Rosett J. Medical Nutrition Therapy: A Key to Diabetes Management and Prevention. Clinical Diabetes. 2010;28(1):12-8. DOI: https://doi.org/10.2337/diaclin.28.1.12

(17) Franz MJ, MacLeod J, Evert A, Brown C, Gradwell E, Handu D, et al. Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Systematic Review of Evidence for Medical Nutrition Therapy Effectiveness and Recommendations for Integration into the Nutrition Care Process. J Acad Nutr Diet. 2017;117(10):1659-79. DOI: 10.1016/j.jand.2017.03.022

(18) Gäbler GJ, Coenen M, Bolleurs C, Visser WK, Runia S, Heerkens YF, et al. Toward Harmonization of the Nutrition Care Process Terminology and the International Classification of Functioning, Disability and Health−Dietetics: Results of a Mapping Exercise and Implications for Nutrition and Dietetics Practice and Research. J Acad Nutr Diet. 2018;118(1):13-20. DOI: 10.1016/j.jand.2016.12.002

(19) Gäbler G, Coenen M, Lycett D, Stamm T. Towards a standardized nutrition and dietetics terminology for clinical practice: An Austrian multicenter clinical documentation analysis based on the International Classification of Functioning, Disability and Health (ICF)-Dietetics. Clin Nutr. 2018;Mar 3. pii: S0261-5614(18)30110-9. DOI: 10.1016/j.clnu.2018.02.031

(20) Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36(1):49-64. DOI: 10.1016/j.clnu.2016.09.004

(21) Hakel-Smith N, Lewis NM. A standardized nutrition care process and language are essential components of a conceptual model to guide and document nutrition care and patient outcomes. J Am Diet Assoc. 2004;104(12):1878-84. DOI: 10.1016/j.jada.2004.10.015

(22) Charney P, Peterson SJ. Practice Paper of the Academy of Nutrition and Dietetics: Critical Thinking Skills in Nutrition Assessment and Diagnosis. J Acad Nutr Diet. 2013;113(11):1545-58. DOI: http://dx.doi.org/10.1016/j.jand.2013.09.006

(23) Academy of Nutrition and Dietetics (AND). eNCPT, Electronic Nutrition Care Process Terminology. 2018. Último acceso en septiembre de 2019. Disponible en: https://www.ncpro.org/the-ncpt-and-electronic-health-records

(24) Academy of Nutrition and Dietetics (AND). Nutrition terminology reference manual (eNCPT): Dietetics language for nutrition care. 2014. Último acceso en septiembre de 2019. Disponible en: https://ncpt.webauthor.com/

(25) Swan WI, Pertel DG, Hotson B, Lloyd L, Orrevall Y, Trostler N, et al. Nutrition Care Process (NCP) Update Part 2: Developing and Using the NCP Terminology to Demonstrate Efficacy of Nutrition Care and Related Outcomes. J Acad Nutr Diet. 2019;119(5):840-55. DOI: 10.1016/j.jand.2018.10.025

(26) Murphy WJ, Yadrick MM, Steiber AL, Mohan V, Papoutsakis C. Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII): A Pilot Study on the Documentation of the Nutrition Care Process and the Usability of ANDHII by Registered Dietitian Nutritionists. J Acad Nutr Diet. 2018;118(10):1966-74. DOI: 10.1016/j.jand.2018.03.013

(27) Swan WI, Vivanti A, Hakel-Smith NA, Hotson B, Orrevall Y, Trostler N, Beck Howarter K, Papoutsakis C. Nutrition Care Process and Model Update: Toward Realizing People-Centered Care and Outcomes Management. J Acad Nutr Diet. 2017;117(12):2003-14. DOI: 10.1016/j.jand.2017.07.015

(28) Lövestam E, Boström AM, Orrevall Y. Nutrition Care Process Implementation: Experiences in Various Dietetics Environments in Sweden. J Acad Nutr Diet. 2017;117(11):1738-48. DOI: https://doi.org/10.1016/j.jand.2017.02.001

(29) Ichimasa A. Review of the Effectiveness of the Nutrition Care Process. J Nutr Sci Vitaminol (Tokyo). 2015;61:S41-3. DOI: https://doi.org/10.3177/jnsv.61.S41

(30) International Confederation of Dietetic Associations (ICDA). ICDA Strategic Plan 2017-2020. 2018. Último acceso en septiembre de 2019. Disponible en: www.internationaldietetics.org/Downloads/ICDA-STRATEGIC-PLAN-2012-TO-2016.aspx

(31) European Federation of the Associations Dietitians (EFAD). Professional Practice Committee (PPC): Vision Paper 2020: The implementation of the Nutrition Care Process (NCP) and Standardized Language (SL) among dietitians in Europe 2014. Último acceso en septiembre de 2019. Disponible en: www.efad.org/media/1186/ncp-sl_vision_paper_final_mar_2014.pdf

(32) NCP Website. Último acceso en septiembre de 2019. Disponible en: www.eatright.org/ncp - https://www.ncpro.org/nutrition-care-process

(33) Carbajal A. Dietética: Diseño y planificación de dietas. En: Gil A, editor. Tratado de Nutrición. Tomo IV. Nutrición Humana en el Estado de Salud. Madrid: Editorial Médica Panamericana, 2017. p. 591-617.

(34) Sladdin I, Ball L, Bull C, Chaboyer W. Patient-centred care to improve dietetic practice: An integrative review. J Hum Nutr Diet. 2017;30(4):453-470. DOI: 10.1111/jhn.12444

(35) Álvarez-Hernández J. Cribado nutricional en aras de la eficiencia. Nutr Hosp. 2018;35(2):249-51. DOI: http://dx.doi.org/10.20960/nh.1927

(36) Castro-Vega I, Veses Martín S, Cantero Llorca J, Salom Vendrell C, Bañuls C, Hernández Mijares A. Validation of nutritional screening Malnutrition Screening Tool compared to other screening tools and the nutritional assessment in different social and health areas. Nutr Hosp. 2018;35(2):351-8. DOI: 10.20960/nh.1619

(37) Sherry CL, Sauer AC, Thrush KE. Assessment of the Nutrition Care Process in US Hospitals Using a Web-Based Tool Demonstrates the Need for Quality Improvement in Malnutrition Diagnosis and Discharge Care. Curr Dev Nutr. 2017;16;1(11):e001297. DOI: 10.3945/cdn.117.001297

(38) Papoutsakis C, Moloney L, Sinley RC, Acosta A, Handu D, Steiber AL. Academy of Nutrition and Dietetics methodology for developing evidence-based nutrition practice guidelines. J Acad Nutr Diet. 2017;117(5):794-804. DOI: 10.1016/j.jand.2016.07.011

(39) International Confederation of Dietetic Associations (ICDA). Final Report of the ICDA Evidence-based Practice Working Group. Último acceso en septiembre de 2019. Disponible en: https://www.internationaldietetics.org/Downloads/ICDA-Report-Evidence-based-Dietetics-Practice-2010.aspx.

(40) Academy of Nutrition and Dietetics. About the Evidence Analysis Library. Último acceso en septiembre de 2019. Disponible en: http://www.andeal.org/about.

(41) Dietitians of Canada. PEN® Toolkits. En: PEN: Practice Based Evidence in Nutrition®. Último acceso en septiembre de 2019. Disponible en: http://www.pennutrition.com

(42) Thompson KL, Davidson P, Swan WI, Hand RK, Rising C, Dunn AV, Lewis N, Murphy WJ. Nutrition Care Process Chains: The “Missing Link” between Research and Evidence-Based Practice. J Acad Nutr Diet. 2015;115(9):1491-8. DOI: 10.1016/j.jand.2015.04.014

(43) Marqués ME, Herrero A, Baladia E, Martínez-Rodríguez R, Cervera A, Buhring K, et al. Hacia la investigación basada en la evidencia. Rev Esp Nutr Hum Diet. 2018;22(1):92-100.

(44) Baladia E, Martínez-Rodríguez R, Martínez-Sanz JM, Norte Navarro A, Ortiz-Moncada R. Formulación de Políticas Nutricionales informadas por la Evidencia. Rev Esp Nutr Hum Diet. 2015;19(2):56-7.

(45) Red NuBE. Red de Nutrición Basada en la Evidencia. Último acceso en septiembre de 2019. Disponible en: https://www.rednube.net/

(46) World Health Organization (WHO). Worldwide prevalence of anaemia 1993-2005. Ginebra: WHO; 2008.

(47) Sabater D, Silva MM, Faus MJ. Método Dáder: Guía de Seguimiento Farmacoterapéutico. 3ª Ed. Granada: Ed. Universidad de Granada; 2007.

(48) SNOMED International. SNOMED-CT: The global language of healthcare. Último acceso en septiembre de 2019. Disponible en: http://www.ihtsdo.org/snomed-ct/

(49) Lövestam E, Steiber A, Vivanti A, Boström AM, Devine A, Haughey O, et al. Use of the Nutrition Care Process and Nutrition Care Process Terminology in an International Cohort Reported by an Online Survey Tool. J Acad Nutr Diet. 2019;119(2):225-41. DOI: 10.1016/j.jand.2018.09.002

(50) Lövestam E, Vivanti A, Steiber A, Boström AM, Devine A, Haughey O, et al. The International Nutrition Care Process and Terminology Implementation Survey: Towards a Global Evaluation Tool to Assess Individual Practitioner Implementation in Multiple Countries and Languages. J Acad Nutr Diet. 2019;119(2):242-60. DOI: 10.1016/j.jand.2018.09.004

(51) Lövestam E, Orrevall Y, Koochek A, Karlstrom B, Andersson A. Evaluation of a Nutrition Care Process in electronic patient records: Need of improvement. Nutr Diet. 2015;72(1):74-80. DOI: 10.1111/1747-0080.12128

(52) Lorentzen SS, Papoutsakis C, Myers EF, Thoresen L. Adopting Nutrition Care Process Terminology at the National Level: The Norwegian Experience in Evaluating Compatibility with International Statistical Classification of Diseases and Related Health Problems, 10th Revision, and the Existing Norwegian Coding System. J Acad Nutr Diet. 2019;119(3):375-93. DOI: 10.1016/j.jand.2018.02.006

(53) Vanherle K, Werkman AM, Baete E, Barkmeijer A, Kolm A, Gast C, et al. Proposed standard model and consistent terminology for monitoring and outcome evaluation in different dietetic care settings: Results from the EU-sponsored IMPECD project. Clin Nutr. 2018;37(6A):2206-16. DOI: 10.1016/j.clnu.2018.08.040

(54) Vivanti A, Lewis J, O'Sullivan TA. The Nutrition Care Process Terminology: Changes in perceptions, attitudes, knowledge and implementation amongst Australian dietitians after three years. Nutr Diet. 2018;75(1):87-97. DOI: 10.1111/1747-0080.12347

(55) McGreevy J, Orrevall Y. Translating Terminology for the Nutrition Care Process: The Swedish Experience (2010-2016). J Acad Nutr Diet. 2017;117(3):469-76. DOI: 10.1016/j.jand.2016.06.366

(56) Atkins M, Basualdo-Hammond C, Hotson B. Canadian perspectives on the nutrition care process and international dietetics and nutrition terminology. Can J Diet Pract Res. 2010;71(2): e18-e20. DOI: https://doi.org/10.3148/71.2.2010.e18

(57) Herrera M. Guía de la asociación americana de dietética para el cuidado y manejo nutricional en países en transición nutricional. Ann Venez Nutr. 2010;23:108–20.

(58) Ruperto M. Desnutrición en los adultos mayores: importancia preventiva-terapéutica de la evaluación integral y la intervención nutricional. Rev Esp Nutr Hum Diet. 2017;21(Supl.1):69–70.

(59) Ruperto M. Enfoque clínico-nutricional en pacientes en hemodiálisis. Rev Esp Nutr Hum Diet. 2014;18(Supl.1):20-1.

(60) Ruperto M, Sánchez-Muniz FJ, Barril G. A clinical approach to the nutritional care process in protein-energy wasting hemodialysis patients. Nutr Hosp. 2014;29(4):735-50. DOI: 10.3305/nh.2014.29.4.7222

(61) Lövestam E. NCP around the world: experiences from USA and other countries. Example questions from the International Nutrition Care Process and Terminology Implementation Survey (INIS). 2017. Último acceso en septiembre de 2019. Disponible en: https://www.ncpro.org/international-ncpncpt-survey-inis

(62) Vivanti A, O'Sullivan TA, Porter J, Hogg M. Successful long-term maintenance following Nutrition Care Process Terminology implementation across a state-wide health-care system. Nutr Diet. 2017;74(4):372-80. DOI: 10.1111/1747-0080.12346

(63) Lövestam E, Vivanti A, Steiber A, Boström AM, Devine A, Haughey O, et al. Barriers and enablers in the implementation of a standardised process for nutrition care: findings from a multinational survey of dietetic professionals in 10 countries. J Hum Nutr Diet. 2020 Jan 7. DOI: 10.1111/jhn.12700

(64) Carpenter A, Mann J, Yanchis D, Campbell A, Bannister L, Vresk L. Implementing a Clinical Practice Change: Adopting the Nutrition Care Process. Can J Diet Pract Res. 2019;80:127-30, DOI: 10.3148/cjdpr-2019-003

(65) O'Sullivan TA, Lo J, Vivanti A. Predictors of nutrition care process and terminology use, applicability and importance within Asia-Pacific dietitians. Nutr Diet. 2019;76(4):455-61. DOI: 10.1111/1747-0080.12467

(66) Kim J, Kim Y, Jang H, Lee H, Park S, Park K, Lim H. Evidence-based Nutritional Intervention Protocol for Korean Moderate-Severe Obese Children and Adolescents. Clin Nutr Res. 2019;8(3):184-95. DOI: 10.7762/cnr.2019.8.3.184

(67) O'Sullivan TA, Lo J, Vivanti A. Predictors of nutrition care process and terminology use, applicability and importance within Asia-Pacific dietitians. Nutr Diet. 2019;76(4)455-461. DOI: 10.1111/1747-0080.12467

(68) Murphy WJ, Hand RK, Steiber AL. Practicalities of Using the Nutrition Care Process in Research. J Ren Nutr. 2015;25(4):393-4. DOI: 10.1053/j.jrn.2014.12.009

(69) Vivanti A, Ferguson M, Porter J, O’Sullivan T, Hulcombe J. Increased familiarity, knowledge and confidence with Nutrition Care Process Terminology following implementation across a statewide health-care system. Nutr Diet. 2015;72:222–31. DOI: https://doi.org/10.1111/1747-0080.12199

(70) European Federation of the Associations of Dietitians (EFAD). EFAD Academic Standards, 2018. Último acceso en septiembre de 2019. Disponible en: www.efad.org/media/1633/efad-academic-standards-revised-june-2018.pdf

(71) Macedo G, Altamirano MB, Márquez YF, Vizmanos B. Manual de prácticas de evaluación del estado nutricional. Madrid: McGraw-Hill Interamericana de España, 2015.

Published

2020-07-16

How to Cite

Carbajal, Ángeles, Sierra, J. L., López-Lora, L., & Ruperto, M. (2020). Nutrition Care Process: Elements for its implementation and use by Nutrition and Dietetics Professionals. Spanish Journal of Human Nutrition and Dietetics, 24(2), 172–186. https://doi.org/10.14306/renhyd.24.2.961