C.

NUTRITION INTERVENTION
“Nutrition Intervention” is the third step of the Nutrition Care Process.
An intervention is a specific set of activities and associated materials used to address the problem.
Nutrition interventions are purposefully planned actions designed with the intent of changing a nutrition-
related behavior, risk factor, environmental condition, or aspect of health status for an individual, target group,
or the community at large.
The purpose of a nutrition intervention is to resolve or improve the nutrition diagnosis or nutrition problem by
provision of advice, education, or delivery of the food component of a specific diet or meal plan tailored to the
patient/client’s needs.
The selection of nutrition interventions is driven by the nutrition diagnosis and provides the basis upon which
outcomes are measured and evaluated.
Dietetics professionals may actually do the interventions, or may include delegating or coordinating the
nutrition care that others provide. All interventions must be based on scientific principles and rationale and,
when available, grounded in a high level of quality research (evidence-based interventions).
Dietetics professionals work collaboratively with the patient/client/group, family, or caregiver to create a
realistic plan that has a good probability of positively influencing the diagnosis/problem.
This client- driven process is a key element in the success of this step, distinguishing it from previous planning
steps that may or may not have involved the patient/client/group to this degree of participation
Determining a nutrition intervention: The nutrition diagnosis and its etiology drive the selection of a nutrition
intervention. Nutrition intervention strategies are selected to change nutritional intake, nutrition-related
knowledge or behavior, environmental conditions, or access to supportive care and services.
The first step in planning nutrition intervention is the nutrition prescription. The prescription is based on best
available evidence and the clinical judgment of the dietician.
Terminology for nutrition intervention is organized in 4 domains (categories):
Food and/or Nutrient Delivery: Individualized approach for food/nutrient provision It is the individualized plan
for changes or additions to the clients' meals, snacks, and nutrients. This also includes enteral and
parenteral feeding and supplements
Nutrition education: A formal process to instruct or train a patient/client in a skill or to impart knowledge to
help patients/clients voluntarily manage or modify food, nutrition and physical activity choices and behavior to
maintain or improve health
Nutrition counseling: A supportive process, characterized by a collaborative counselor- patient relationship, to
establish food, nutrition and physical activity priorities, goals, and individualized action plans that
acknowledge and foster responsibility for self-care to treat an existing condition and promote health
Coordination of Nutrition Care: Consultation with, referral to, or coordination of nutrition care with other
health care providers, institutions, or agencies that can assist in treating or managing nutrition-related problems
Use of nutrition intervention terminology:
Nutrition intervention is accomplished in two distinct and interrelated steps: planning and implementing.
Planning the nutrition intervention involves:
 Prioritize the nutrition diagnoses based on severity of problem; safety; patient/client/group’s need; likelihood
that nutrition intervention will impact problem and patient/client/groups’ perception of importance.
  Consult practice guides. These resources can assist dietetics professionals in identifying science-based ideal
goals and selecting appropriate interventions. They list appropriate value(s) for control or improvement of the
disease or conditions as defined and supported in the literature.
 Determine patient-focused expected outcomes for each nutrition diagnosis. The expected outcomes are the
desired change(s) to be achieved over time as a result of nutrition intervention. They are based on nutrition
diagnosis; for example, increasing or decreasing laboratory values, decreasing blood pressure, decreasing
weight, or increasing fiber.
Expected outcomes should be written in observable and measurable terms that are clear and concise. They
should be patient/client/group-centered and need to be tailored to what is reasonable to the patient’s
circumstances and appropriate expectations for treatments and components.
 Confer with patient/client/group, other caregivers or policies and program standards throughout planning
step.
 Define intervention plan (for example write a nutrition prescription, provide an education plan or community
program, and create policies that influence nutrition programs and standards).
 Select specific intervention strategies that are focused on the etiology of the problem and that are known to
be effective based on best current knowledge and evidence.
 Define time and frequency of care including intensity, duration, and follow-up.
The following types of critical thinking skills are especially needed in the intervention step:
 Setting goals and prioritizing;
 Transferring knowledge from one situation to another;
 Defining the nutrition prescription or basic plan;
 Making interdisciplinary connections;
 Initiating behavioral and other interventions;
 Matching intervention strategies with client needs, diagnoses, and values;
 Choosing from among alternatives to determine a course of action; and
 Specifying the time and frequency of care
Data sources /tools  evidence-based nutrition guides for practice and protocols  current research literature 
current consensus guidelines and recommendations from other professionals organization  current patient
education materials at appropriate reading level and language  behavior change theories
Documentation of intervention  date and time  specific treatment goals and expected outcomes 
recommended interventions, individualized for patient  patient receptivity  referrals made and resources used
 rationale for discharge if appropriate  plans for follow-up and frequency of care
Determination of continuation of care If the patient has met intervention goals or is not at this time able/ready
to make needed changes, the health services professional may include discharging the client from this episode
of care as part of the planned intervention
D. NUTRITION MONITORING AND EVALUATION
The purpose of nutrition monitoring and evaluation is to determine and measure the amount of progress made
for the nutrition intervention and whether the nutrition related goals/expected outcomes are being met. The aim
is to promote more uniformity within the dietetics profession in assessing the effectiveness of nutrition
intervention.
 The monitoring and evaluation step of the NCP is defined as the review and measurement of the
patient/client’s status at a scheduled or preplanned follow-up point with regard to the nutrition diagnosis,
intervention/plans goals, and outcomes. Evaluation is the systematic comparison of current findings with
previous status, interventions, goals, or a reference standard.
Effectiveness of the intervention is monitored by changes in the signs and symptoms listed in the PES
statement. The monitoring and evaluation step incorporates changes from baseline in biochemical and medical
tests, anthropometric data, intake and output, and other familiar nutrition support monitoring parameters.
Determining what to measure for nutrition monitoring and evaluation: Dieticians should select nutrition care
indicators that will reflect a change as a result of nutrition care. The monitoring and evaluation phase should be
considered during the assessment phase, while determining the Nutrition Diagnosis and the Nutrition
Intervention. Additional factors to consider are the medical diagnosis, health care outcome goals, nutrition
quality management goals, practice setting, patient/client population, and disease state and/or severity.
Terminology for nutrition monitoring and evaluation is organized in 4 domains (categories)
Food/Nutrition-Related History Outcomes: Food and nutrient intake, food and nutrient administration,
medication, complementary/alternative medicine use, knowledge/beliefs, food and supplies availability,
physical activity, nutrition quality of life.
Anthropometric Measurement Outcomes: Height, weight, body mass index (BMI), growth pattern
indices/percentile ranks, and weight history.
Biochemical Data, Medical Tests, and Procedure Outcomes: Lab data (e., electrolytes, glucose) and tests (e.,
gastric emptying time, resting metabolic rate)
Nutrition-Focused Physical Finding Outcomes: Physical appearance, muscle and fat wasting, swallow
function, appetite, and affect.
Collection and use of nutrition monitoring and evaluation outcome data: This step consists of three
components: monitoring, measuring, and evaluating the changes in nutrition care indicators.
Dieticians monitor by providing evidence that the nutrition intervention is or is not changing the
patient/client’s behavior or status.
They measure outcomes by collecting data on the appropriate nutrition outcome indicator(s). They compare the
current findings with previous status, nutrition intervention goals, and/or reference standards and evaluate the
overall impact of the nutrition intervention on the
Select outcome indicators that are relevant to the nutrition diagnosis or signs or symptoms, nutrition goals,
medical diagnosis, and outcomes and quality management goals.
Use standardized indicators to:
 Increase the validity and reliability of measurements of change; and  Facilitate electronic charting, coding,
and outcomes measurement.
3. Evaluate outcomes
Compare current findings with previous status, intervention goals, and/or reference standards
Critical thinking
The following types of critical thinking skills are especially needed in the monitoring and evaluation step
 Selecting appropriate indicators/measures  Using appropriate reference standard for comparison;  Defining
where patient/client/group is now in terms of expected outcomes;  Explaining variance from expected
outcomes;  Determining factors that help or hinder progress; and  Deciding between discharge or
continuation of nutrition care
 Documentation of monitoring and evaluation
Documentation is an on-going process that supports all of the steps in the Nutrition Care Process and is an
integral part of monitoring and evaluation activities. Quality documentation of the monitoring and evaluation
step should be relevant, accurate, and timely. It includes a statement of where the patient is now in terms of
expected outcomes. Standardized documentation enables pooling of data for outcomes measurement and
quality improvement purposes. Quality documentation should also include:
 Date and time;  Specific indicators measured and results;  Progress toward goals (incremental small change
can be significant therefore use of a Likert type scale may be more descriptive than a“ met” or “not met” goal
evaluation tool);  Factors facilitating or hampering progress;  Other positive or negative outcomes; and 
Future plans for nutrition care, monitoring, and follow up or discharge
Documenting ‘progress made in resolving a nutrition diagnosis’
 “Resolved”– nutrition diagnosis no longer exists because it has been addressed
 “Improvement shown/ unresolved”– nutrition diagnosis still exists but signs/symptoms
showing improvement. Patient/ client making progress.
 “No improvement/unresolved” – nutrition diagnosis still exists, little to no improvement
shown, still appropriate for patient/client’s condition
 “No longer appropriate” – nutrition diagnosis is no longer exists because patient/client’s
condition or situation has changed. The focus of nutrition interventions no longer supports the nutrition
diagnosis.
Determination for Continuation of Care
 Based on the findings, a decision to actively continue care or discharge the patient from nutrition care (when
necessary and appropriate nutrition care is completed or no further change is expected at this time).
 If nutrition care is to be continued, the nutrition care process cycles back as necessary to assessment, diagnosis,
and/or intervention for additional assessment, refinement of the diagnosis and adjustment and/or reinforcement
of the plan.
 If care does not continue, the patient may still be monitored for a change in status and reentry to nutrition care
at a later date.