UNIT -2

Definition of NCPM
The Nutrition Care Process and Model (NCPM) is a systematic, problem-solving method
developed by the Academy of Nutrition and Dietetics to guide nutrition and dietetics practitioners
in providing high-quality, individualized care. It offers a standardized framework for critical
thinking and decision-making in nutrition-related practice.

The NCPM consists of four interrelated steps:

● Nutrition Assessment and Reassessment

● Nutrition Diagnosis
● Nutrition Intervention
● Nutrition Monitoring and Evaluation
Definition of NCPM
The Nutrition Care Process (NCP) is a systematic approach to providing high quality nutrition
care. The NCP consists of four distinct, interrelated steps:
● Nutrition Assessment: The RDN collects and documents information such as food or
nutrition-related history; biochemical data, medical tests and procedures;
anthropometric measurements, nutrition-focused physical findings and client history.
● Nutrition Diagnosis: Data collected during the nutrition assessment guides the RDN in
selection of the appropriate nutrition diagnosis (i.e., naming the specific problem).
● Nutrition Intervention: The RDN then selects the nutrition intervention that will be directed
to the root cause (or etiology) of the nutrition problem and aimed at alleviating the signs and
symptoms of the diagnosis.
● Nutrition Monitoring/Evaluation: The final step of the process is monitoring and
evaluation, which the RDN uses to determine if the client has achieved, or is making
progress toward, the planned goals.
 ADIME
FOUR STEPS
● Nutrition Assessment
● Nutrition Diagnosis
● Nutrition Intervention
● Nutrition Monitoring and Evaluation.
Nutrition Assessment.
Definition:
Nutrition assessment is the first step in the Nutrition Care Process (NCP). It involves collecting, verifying,
and interpreting data related to a patient’s nutritional status to identify nutrition-related problems and guide
intervention strategies.
Nutrition Assessment has 5 Domain Category:
● Food/Nutrition-Related History
● Anthropometric Measurements
● Biochemical Data, Medical Tests, and Procedures
● Nutrition-Focused Physical Findings
● Client History
 1) Food/Nutrition-Related History 2) Anthropometric Measurements

● Dietary intake (24-hour recall, food frequency ● Height and weight

questionnaire, food diary) ● Body Mass Index (BMI)
● Eating behaviors and patterns ● Growth charts (for children)
● Access to food and food security ● Waist circumference and body composition
● Use of dietary supplements ● Mid upper arm Circumference
● Knowledge/belief/Attitudes ● SGA- Subjective Global Assessment
● Physical activity and function.

3)Biochemical Data, Medical Tests, and Procedures 4) Nutrition-Focused Physical Findings

● Blood tests (e.g., glucose, lipid profile, electrolytes, ● Skin, hair, and nail condition
hemoglobin) ● Muscle and fat wasting
● Urinary analysis (e.g., nitrogen balance, ketones) ● Oral Health
● Other lab markers relevant to nutrition ● Presence of edema or dehydration
● Signs of micronutrient deficiencies
 Client History

● Medical history (chronic diseases, medications)

● Family history
● Socioeconomic factors (income, education, cultural influences)
● Psychological factors (stress, mental health conditions affecting nutrition)

Nutrition Diagnosis:
The Purpose of Nutrition Diagnosis is to identify and describe a specific nutrition problem that
can be resolved or improved through treatment/nutrition intervention by a food and nutrition
professional.
Definition
Nutrition diagnosis is the second step in the Nutrition Care Process (NCP). It involves identifying
and labeling a specific nutrition-related problem that a dietitian or healthcare professional can
address through nutrition intervention.
Nutrition Diagnosis has three Domains (categories):
1)Intake-related diagnoses 2) Clinical-related diagnoses 3)Behavioral-environmental
diagnoses
Intake Clinical Behavioral-environmental

Intake:Too much or too little Clinical: Nutrition Behavioral-environmental:

of a food or nutrient compared Problems that related to Knowledge, attitudes, beliefs,
to actual or estimated Needs. medical or physical Physical environment, access to
Ex: condition. food or safety.
● Inadequate energy intake Ex: Ex:
● Excessive carbohydrate ● Swallowing difficulty ● Food and nutrition-related
intake (dysphagia) knowledge deficit
● Inadequate protein intake ● Unintended weight loss ● Limited access to food
● Malnutrition ● Disordered eating patterns
A nutrition diagnosis includes three main elements, often written in a PES (Problem, Etiology,
Signs/Symptoms) Statement format:
Problem (P) – The specific nutrition-related issue identified/ Name of nutrition problem
Etiology (E) – Identifies its cause (or etiology)
Signs/Symptoms (S) – List the assessment data (signs and symptoms)
Example of a PES Statement:
"Inadequate energy intake (P) related to decreased appetite due to chemotherapy (E) as evidenced
by a 5 kg weight loss in one month and reduced food intake of 50% of estimated needs (S)
Nutrition Intervention
In the Nutrition Care Process (NCP), Nutrition Intervention is the third step,
Definition:
Nutrition Intervention involves planned actions designed to address the identified nutrition
problem (nutrition diagnosis) and improve or maintain a person's nutritional health. These actions
are based on scientific evidence and tailored to the individual's needs.
Purpose:
The intervention is the purposeful action of the RD aimed at improving the condition of the
patient’s nutrition diagnosis.
Components:
● Goal Setting – Setting measurable and achievable nutrition goals.
● Implementation – Putting the intervention into action.
● Education & Counseling – Providing knowledge, motivation, and support.
● Coordination of Care – Working with healthcare professionals or support systems.
 Nutrition Monitoring and Evaluation
Purpose: To determine and measure the amount of progress made for the nutrition intervention
and whether the nutrition related goals/expected outcomes are being met.
Nutrition Monitoring: Preplanned review and measurement of selected nutrition care indicators
of patients/Client status.
Nutrition Evaluation: The Systematic comparison of current findings with the previous.
Three (3) Components:
● Monitoring
● Measuring
● Evaluating
Monitoring: Provide evidence that the nutrition intervention is changing/not changing patients
behaviour or status.
Measuring: Measure outcomes by collecting data on nutrition outcomes indicators.
Evaluating: Compare current findings to intervention goals /reference standard and evaluate
overall impact.
Monitoring:
● Ensure patients understand goals and their importance.
● Discuss problems, questions, and concerns with patients regarding goals.
● Adhering,continue on path or needs to change
● Continue to document, update data to patient’s file and continue to measure in order to
assess progress.
Evaluating
● Compare new data to old & Compare the obtained results to the desired goals.
● Assess whether goals are being obtained, and if they are truly helping to improve the health
of the patient.
● If not discuss alternatives.
Nutrition Monitoring and Evaluation
● Monitor progress
● Monitor Outcome
● Evaluate outcome
● Document
 Role of Evidence-Based Practice in Nutrition Care Process Model (NCPM)
Evidence-based practice (EBP) plays a crucial role in improving healthcare outcomes by integrating the
best available research evidence with clinical expertise and patient preferences. In the field of dietetics
and nutrition, EBP ensures that interventions and recommendations are backed by scientific research,
leading to more effective and standardized care.
Role of Evidence-Based Practice in NCPM:
The Nutrition Care Process Model (NCPM) is a systematic approach used by dietitians to provide
high-quality nutrition care. EBP strengthens this model in the following way.
1) Enhancing Decision-Making
2) Improving Patient Outcomes
3) Strengthening Nutrition Diagnosis and Interventions
4) Developing Evidence-Based Guidelines and Toolkits
5) Promoting Standardization in Nutrition Care
6) Encouraging Continuous Professional Development
1) Enhancing Decision-Making
● EBP helps dietitians make informed decisions by critically evaluating research findings.
● It ensures that interventions are based on well-established scientific evidence rather than
personal opinions or outdated practices.
Example: Managing Diabetes through Medical Nutrition Therapy (MNT)
● Without EBP: The dietitian may suggest a generalized low-carb diet based on personal
experience.
● With EBP: The dietitian refers to ADA’s Evidence-Based Guidelines that recommend a balanced
approach with carbohydrate counting, the Mediterranean diet, and low-glycemic foods.
● Impact: The patient receives a scientifically backed dietary plan that effectively controls blood
sugar and prevents complications.
2) Improving Patient Outcomes
● Using EBP within NCPM allows for individualized nutrition care, tailored to patient needs.
● It supports best practices in managing conditions like obesity, diabetes, cardiovascular diseases, and
malnutrition.
Example: Nutrition Support in Critical Care
A patient in the ICU requires enteral (tube feeding) nutrition. The decision about the type of formula and
feeding method is crucial.
● Without EBP: A dietitian might use a high-protein standard formula without assessing the latest
research on critically ill patients.
● With EBP: The dietitian consults evidence-based guidelines on enteral feeding, which suggest early
enteral nutrition and specific formulations (e.g., immune-enhancing formulas with omega-3 fatty acids
for ventilated patients).
3) Strengthening Nutrition Diagnosis and Interventions
● EBP provides validated nutrition diagnosis terms and evidence-based interventions, ensuring
consistency in practice.
● The Dietetics Practice-Based Research Network plays a role in validating these diagnoses to improve
accuracy and relevance.
Example: Managing Pediatric Malnutrition
● Without EBP: The dietitian might rely only on weight-for-age measurements, which can be
misleading.
● With EBP: The dietitian follows guidelines from the World Health Organization (WHO) and
ASPEN (American Society for Parenteral and Enteral Nutrition), using Weight-for-Height
Z-scores, Mid-Upper Arm Circumference (MUAC), and dietary intake records.
● Impact: The dietitian accurately diagnoses malnutrition and implements a ready-to-use therapeutic
food (RUTF) intervention, improving recovery rates.
4) Developing Evidence-Based Guidelines and Toolkits
● Organizations like the American Dietetic Association (ADA) compile research into Evidence-Based
Guidelines and Toolkits to assist dietitians in making clinical decisions.
● These resources offer structured recommendations for weight management, critical care, lipid
metabolism disorders, and more.
Example: Managing Hyperlipidemia (High Cholesterol)
A patient with high LDL cholesterol seeks dietary advice.
● Without EBP: The dietitian may recommend reducing fat intake in general, without specifying the
types of fats.
● With EBP: Using evidence from the American Heart Association (AHA), the dietitian advises the
patient to:
○ Increase unsaturated fats (olive oil, nuts, fatty fish).
○ Reduce trans fats and limit saturated fats.
○ Include soluble fiber (oats, beans, flaxseeds) to lower LDL cholesterol.
● Impact: The patient achieves improved lipid levels and reduced cardiovascular risk.
5) Promoting Standardization in Nutrition Care
● By incorporating EBP, NCPM provides a standardized framework that improves the reliability of
dietary assessments, interventions, and monitoring strategies.
● This ensures consistency in nutrition care across different settings, including hospitals, community
programs, and outpatient services.
Example: Hospital Malnutrition Screening
Hospitals use Malnutrition Universal Screening Tool (MUST) or Nutrition Risk Screening (NRS-2002)
for hospitalized patients.
● Without EBP: Screening may be done inconsistently, missing at-risk patients.
● With EBP: Every admitted patient is screened using a validated malnutrition screening tool,
ensuring early detection and intervention.
● Impact: The standardization improves hospital-wide patient nutrition management, reducing
complications and healthcare costs.
6)Encouraging Continuous Professional Development
● EBP encourages dietitians to stay updated with new research and emerging trends in nutrition
science.
● It fosters a culture of lifelong learning and professional growth
Example: Dietitians Updating Knowledge on Plant-Based Diets
● Without EBP: The dietitian may hold outdated beliefs that plant-based diets lack sufficient
protein.
● With EBP: The dietitian studies new research from journals like the Academy of Nutrition and
Dietetics and The American Journal of Clinical Nutrition, learning that a well-planned
plant-based diet provides adequate protein, iron, and vitamin B12 with proper supplementation.
● Impact: The dietitian provides accurate, science-backed dietary advice to plant-based eaters,
preventing nutrient deficiencies.
 Benefits of Using the NCP Model in Nutrition Care
1) Standardization and Improved Quality of Care
2) Enhanced Documentation and Communication
3) Individualized and Evidence-Based Care
4) Efficient Monitoring and Outcome Evaluation
5) Increased Recognition of Dietitians’ Role in Healthcare
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