Nutrition Care Process Tutorial 2020

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Module 4: Nutrition Intervention - Overview, Terms and Use

Slide Number Title Script

1 Module 4: Nutrition Intervention - Welcome to the Nutrition Care Process Tutorial. This is module 4, Nutrition
Overview, Terms and Use Intervention – Overview, Terms and Use. This module is based on the
eNCPT 2019 edition, available on www.ncpro.org.

2 NCP Tutorial: Module 4 Objectives The objective of module 4 is to understand the purpose and components of
Nutrition Intervention, including:
○ The two phases of Nutrition Intervention: Planning and
Implementing
○ The organization of domains and classes of Nutrition Intervention
terminology

3 NCP Step 3: Nutrition Intervention Nutrition Intervention is the third of four steps in the Nutrition Care
Process. The purpose of Nutrition Intervention is to plan and implement
purposeful actions intended to positively change or improve a nutrition
related problem.

The nutrition intervention should be directed at the etiology or root cause

of the nutrition problem previously identified in the PES statement.

In some cases, the nutrition intervention may be directed towards

alleviating the signs and symptoms when the RDN cannot impact the
etiology.

4 Nutrition Intervention relation to The nutrition intervention has a relationship to the nutrition diagnosis.
Nutrition Diagnosis Selection of the nutrition intervention:
➢ Is driven by the etiology, or the ‘E’ portion of the PES statement
➢ It is also aimed at resolving the underlying cause of the nutrition
problem
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Module 4: Nutrition Intervention - Overview, Terms and Use

➢ Is targeted at minimizing the signs and symptoms associated with

the nutrition diagnosis

This flowchart illustrates the interrelation between the first three steps of
the Nutrition Care Process. Data collected during nutrition assessment is
used as evidence in the signs and symptoms portion of the PES statement.
The etiology drives the selection of the nutrition intervention, and the
nutrition intervention is aimed at resolving or alleviating the etiology.

5 Two Phases of Nutrition Intervention There are two phases in the Nutrition Intervention step: The planning
phase, and the implementing phase. These phases are interrelated and
work to resolve the nutrition problem through altering or eliminating the
nutrition etiology.

6 Planning the Nutrition Intervention During the planning phase of the nutrition intervention, Registered Dietitian
Nutritionists:
➢ Collaborate with clients to identify goals of the intervention and
expected outcomes
➢ Prioritize the nutrition interventions based on client preference,
urgency, impact potential and available resources
➢ Write a Nutrition Prescription
➢ Determine a specific, science-based nutrition intervention strategy
➢ Define time and frequency of care, including intensity, duration,
and follow-up.

7 Implementing the Nutrition During the implementation phase of the nutrition intervention, Registered
Intervention Dietitian Nutritionists:
➢ Collaborate with the client to carry out the plan of care
➢ Individualize the plan
➢ Communicate the plan of nutrition care
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Module 4: Nutrition Intervention - Overview, Terms and Use

➢ Modify the plan of care as needed

➢ Continue data collection
➢ Follow-up and verify that the plan is being implemented
➢ Revise strategies based on changes in condition or response to
intervention

8 Nutrition Intervention Terminology Nutrition Intervention Terminology is categorized into 5 Domains:

Food And/Or Nutrient Delivery (ND)

Nutrition Education (E)
Nutrition Counseling (C)
Coordination of Nutrition Care By A Nutrition Care Professional (RC)
Population Based Nutrition Action (P)

Also included in the Nutrition Intervention terms is the Nutrition

Prescription (NP). This is the client’s tailored recommended dietary intake
of energy and/or selected foods or nutrients.

9 Food And/Or Nutrient Delivery (ND) The first domain- Food And/Or Nutrient Delivery (ND) includes nutrition
intervention terms that describe the customized food and/or nutrient
approach for a client.

This slide shows an example of the hierarchy and organization for the Meals
and Snacks (ND-1) class of terms. The nutrition intervention listed,
Increased Protein Diet, is an example of a nutrition intervention from this
domain. Other classes of nutrition intervention terms within the food
and/or nutrient delivery domain include:

➢ Enteral and Parenteral Nutrition (ND-2)

➢ Nutrition Supplement Therapy (ND-3)
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Module 4: Nutrition Intervention - Overview, Terms and Use

➢ Feeding Assistance Management (ND-4)

➢ Manage Feeding Environment (ND-5)

10 Nutrition Education (E) The next domain in Nutrition Intervention is Nutrition Education (E).
Nutrition Education interventions are used to address a new knowledge
requirement or knowledge deficit.

The intervention used here, Nutrition related skill education, is defined as

an instruction or training leading to nutrition-related skill development,
such as enteral nutrition feeding tube and feeding pump training.

The other class of intervention terms in the Nutrition Education domain is

Nutrition Education Content.

11 Nutrition Counseling (C) Nutrition Counseling (C) is the third nutrition intervention domain. Nutrition
Counseling interventions are used to create priorities, goals, and
individualized action plans through a collaborative counselor–client
relationship. During Nutrition Counseling interventions, RDNs utilize
theories and strategies to treat existing conditions and promote health.

The intervention used here, Nutrition Counseling Based on Motivational

Interviewing Strategy, is a directive, client-centered counseling style for
eliciting behavior change by helping clients to explore and resolve
ambivalence.

The other class of nutrition intervention terms in the Nutrition Counseling

domain is Theoretical Basis/Approach.

12 Coordination Of Nutrition Care By A Coordination Of Nutrition Care By A Nutrition Care Professional (RC) is a
Nutrition Care Professional (RC) nutrition intervention domain related to referral or coordination of
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Module 4: Nutrition Intervention - Overview, Terms and Use

nutrition care with other healthcare providers, institutions, or agencies that

can assist in treating or managing nutrition-related problems.

The intervention shown on this slide, Referral by nutrition professional to

community agencies and programs is a term used to capture the nutrition
intervention when the RDN refers a client to agency or program, such as
WIC or SNAP – both agencies are government led supplemental nutrition
programs available in the United States.

The other Coordination Of Nutrition Care By A Nutrition Care Professional

domain is Discharge and transfer of Nutrition Care to a New Setting or
Provider.

13 Population Based Nutrition Action (P) The last domain in Nutrition Intervention is the Population Based Nutrition
Action (P) domain. This domain contains interventions designed to improve
the nutritional well-being of a population.

The intervention on this slide is Environmental Change (P-2.1). This

intervention is defined as ‘actions designed to alter the environment where
people live, work, learn and play to promote and support healthful
behaviors, prevent disease and disability, and reduce inequities.’ An example
of this intervention could be an RDN who works for a school system and works
with vending machine companies to improve the nutritional quality of food
choices offered.

Other classes of terms in the Population Based Nutrition Action (P) domain
include Population Theoretical Frameworks, Population Settings, and
Population Sectors.

14 Nutrition Intervention Example

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Module 4: Nutrition Intervention - Overview, Terms and Use

Now that all nutrition intervention domains have been reviewed, let’s
review an example. In this nutrition intervention example, the client goal is
to consume 1 oral nutrition supplement 6 out of 7 days per week.
Remember that the goal is part of the planning phase, and that goals should
be specific, measurable, achievable, realistic, time-based (SMART).

The nutrition prescription listed provides specific calorie, protein, and fluid
recommendations to be obtained through a general, healthful diet.

Remember that the nutrition prescription should be customized to meet

the client’s needs and intake recommendations should be based on current
reference standards and dietary guidelines.

The Implementation Phase contains the nutrition intervention, which in this

case was content related nutrition education. This is the action portion of
the nutrition intervention, where the RDN collaborates with the client to
carry out the plan and also communicates the plan of nutrition care to all
relevant health professionals and caretakers.

15 Nutrition Intervention Documentation When documenting the nutrition intervention, ask yourself the following
questions:
✓ Are the goals identified and SMART (specific, measurable,
achievable, relevant, and time defined)?
✓ Do the goals consider client needs and values?
✓ Is the nutrition prescription written to help achieve client goals?
✓ Is the nutrition intervention directed at changing the etiology of the
PES statement?

16 Nutrition Intervention Summary In summary, Nutrition Intervention is customized to meet the unique needs
of the client.
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Module 4: Nutrition Intervention - Overview, Terms and Use

The Nutrition Intervention is driven by the Nutrition Assessment and

Diagnosis steps, and it is used to resolve a problem by altering or
eliminating the root cause of the nutrition diagnosis, also known as the
etiology.

Lastly, Nutrition Intervention requires planning and implementation

(action), both phases use defined nutrition intervention terminology.

17 Proceed to Module 5 This concludes module 4, Nutrition Intervention – Overview, Terms and
Use. Please proceed to module 5.