Roles and Responsibilities of Registered Dietitians and Dietetic Technicians, Exams of Nutrition

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Essentials in Dietetics Exam 1

Roles of CDR - Commission on Dietetic Registration The purpose of the Commission, as the credentialing agency and organization unit of the Academy, is to serve the public by establishing and enforcing standards for certification, recertification and the Code of Ethics and by issuing credentials to individuals who meet these standards. Roles of ACEND - The Accreditation Council for Education in Nutrition and Dietetics is the accrediting agency for education programs preparing students for careers as registered dietitian nutritionists or nutrition and dietetics technicians, registered. Continuing education requirements for the RDs - Completes 75 hours/5 years continuing education to maintain registration Things you need to take the national exam from the Commission on Dietetic Registration (CDR) -

• verification statement from a DPD or CP
• dietetic internship -DPD or CP
• 1200 hours of supervised practice
• B.S. Credentialing requirements to become an RD -
• Food & Nutrition expert
• Completed a minimum of a BS degree -- Masters Degree by 2024
• Completed an ACEND-accredited supervised practice program (1200 hrs)
• Passed a national exam from the Commission on Dietetic Registration (CDR)

Medical Nutrition Therapy - Nutritional diagnostic, therapy, & counseling services for the purpose of disease management that are furnished by a registered dietitian or nutrition professional Clinical Nutrition Team -

• Clinical Nutrition Manager or Chief Clinical Manager
• RD/RDN
• Registered Dietetic Technicians (DTR) or Nutrition and Dietetic Technician, Registered (NDTR) -- DTR has a 2 year degree program Advanced Practice certifications - Things you can get to be a specialist after you are an RD most of the teams will have to be taken every five years to maintain your specialist standing CDR oversees who gets the specialist certification Members of the Health Care Team - Medical Doctors Physician Assistant Nurses Nurse practitioners Pharmacists Occupational therapists Physical therapists Speech-language pathologists Social Workers Health Educators roles of an RD: Critical Thinking components - Specific knowledge base Experience Competencies

• Evidence-based dietetics practice
• Problem Solving
• Diagnostic Reasoning Attitudes Standards What is the professional development portfolio (PDP)? - This is a way that you can track your hours for your area of practice. It gives you lists of what things can give your hours. You have to make a plan of what area of things you will be attending to get your 75 hours of continuing education that you need to get every 5 years. After you make your plan you have to submit it and get it approved by the CDR before you can start your hours. PDP Guide Purpose -
  1. Completing the Professional Development Portfolio process,

2. maintaining your own records and documentation,
3. submitting all required information to CDR by the specified deadlines, either online or as documented by postmark. CPEU - continuing professional education units Steps of the PDP -
   1. Professional Self-Reflection
4. Learning needs assessment
5. Learning Plan
6. Activity Log
7. Professional Development Evaluation Professional Self-Reflection -

In this step consider what external factors or trends are affecting your professional practice. Self-reflection will clarify where you are now and where you want to go. You can then position yourself to achieve your desired level of proficiency through establishing short-term (1-3 years) and long-term (3-5 years) goals. Learning needs assessment - In this step, identify knowledge and skills you need to develop or strengthen to reach your goals. Learning Plan - our Learning Plan may focus on specific content or a specific area of practice and or on broad- based areas as determined by your individual needs and goals. All CPE activities must be dietetics- related. Activity log - This step provides a means to record, evaluate and document the CPE activities that directly relate to your identified learning needs. Reviewing your evaluations of your learning activities can help you in making future decisions about learning opportunities. Professional Development Evaluation - The purpose of this step is to evaluate what you have learned and how you have applied this learning. The outcome is the completed evaluation of the effectiveness of your Learning Plan and CPE activities. Ethics -

1. The study of standards of conduct and moral judgment.
2. The study of the general nature of morals and of the specific moral choices to be made by a person.
3. The rules or standards governing the conduct of a person or the members of a profession. Types of Codes - Aspirational Educational

Regulatory Aspirational (def and example) - ideals or broad principles to strive for (Ex: Hippocratic Oath) Educational (def and example) - principles with guidelines to make informed choices (Ex: Student Honor Code) Regulatory (def and example) - Govern professional conduct Ex: Police Office Code of Conduct How many categories does the code consist of? - five categories The Code Consists of Five Categories -

1. Fundamental Principles
2. Responsibilities to the Public
3. Responsibilities to Clients
4. Responsibilities to the Profession
5. Responsibilities to Colleagues and Other Professionals how many principles does the code have? - 19 principles Functions of the Code of Ethics -

• Protect the profession and the credential
• Influence public and private policy
• Improve professional practice
• Educate dietetics practitioners about ethical decision making
• Meet the guidelines of the accrediting agency for the Commission on Dietetic Registration The Code is not intended to: -
• Identify and reprimand all unqualified dietitians and dietetic technicians
• Be a punitive force to take away credentials how complaints work - Anyone can make a complaint. Complaints are not anonymous but are confidential. If a complaint is made, it is forwarded to the member for a response. The Ethics Committee then reviews the complaint and discusses the response in executive session. Ethics Case Management Procedure - The enforcement procedures are intended to permit a fair resolution of disputes on ethical practices in a manner that protects the rights of individuals while promoting understanding of ethical practice. Ethics Comity dealing with a dispute - The Ethics Committee has the authority and the flexibility to determine the best way to resolve a dispute, including educational means where appropriate. What happens after a complaint is submitted - Case may be dismissed Further information may be requested Person may be contacted with specific actions for educational intervention What happens after a complaint is submitted and it is serious -

Membership in the Academy of Nutrition and Dietetics may be censured, placed on probation, suspended, or revoked RDN or NDTR credential or specialist credential may be suspended or revoked Ethics Committee uses a defined policy and procedure handbook to guide its decisions. Legal Issue: - Many state and federal laws apply to our profession. If a state or federal law has been violated, the issue could result in action by the Ethics Committee. Business Issue: - An issue may be a business issue, but not an ethical issue, if it arises from a business dispute or breach of a contractual obligation, or a failure to provide products or services of an expected quality. Employment Issue: - Employment issues can be addressed by an employer's policy or policies or can be resolved in the workplace via the appropriate structure to provide oversight (i.e., Human Resources) or through federal and state laws that protect employees. scope of practice - Encompasses the range of roles, activities, and regulations within which nutrition and dietetics practitioners perform. regulates the practice of the profession in a given state WHAT a Scope of Practice is Not - Not a prescriptive list of tasks that an RD or DTR is or is not allowed to perform WHY is it important to have a scope of practice? - Defines key characteristics Presents authority to practice Guides profession into the future

Examines and expands practice

• Provides guidance in making practice changes
• Acts as a key to unlock a door to new opportunities Competence - Competence is "a principle of professional practice, identifying the ability of the provider to administer safe and reliable services on a consistent basis." when can RD's and DTR's practice - "RDs and DTRs can ONLY practice in areas in which they are qualified and have demonstrated competence in delivery of food and nutrition services that achieve safe, ethical and quality outcomes." Principles of competence -
  1. Level of experience, skills and proficiency to perform designated activities varies among individuals;

2. Individual practitioners might not be competent in all aspects of the field;
3. Practitioners are expected to practice in the areas in which they are competent;
4. Practitioners pursue additional education and experience to expand their individual scope of practice. Decision Tree - The decision-tree is an algorithm matched to critical questions that help you decide if you can and should move forward or if there is a limiting factor in your desire to changing your practice. activities RD/RDNs can do to earn continuing education according to the PDP? - Academic Coursework Recorded, Online Non-Credit Academic Lectures/Seminars Case Presentations Certificate Programs Exhibits Experiential Skill Development

Interactive Workshops Journal Clubs Lectures/Seminars Webinars/Teleseminars Recorded Pre-Approved CPE Posters Professional Leadership Professional Reading research Residency and Fellowship Programs Sponsored Independent Learning Study Groups Pre-approved Self-Study Materials Who uses the Scope of Practice? - EVERYONE in the dietetics profession Throughout their professional careers How do Members and Credentialed Dietetics Practitioners use the Scope of practice? - To evaluate practice; to seek expanded privileges; those seeking to carve out new roles for dietetics practice How do Administrators use the scope of practice - To reduce institutional risks and improve patient safety How do human resources departments use the scope of practice - To make employment decisions; to evaluate compensation practices How do educators use the scope of practice? - To teach professional accountability

How do Students use the scope of practice? - To guide career development How do managers use the scope of practice? - To make hiring decisions; to expand department's scope of care; to assure care is provided by sanctioned professionals How do legislators and regulators use the scope of practice? - as a basis for initiating regulatory reform Standards of Practice (SOP) and Standards of Professional Performance (SOPP) - Describes a MINIMUM level of competence for RDs and DTRs who provide direct patient, client, or resident care This is a guide to practice. These are standards -- NOT regulations SOP - Standards of Practice in Nutrition Care Standards of Practice in Nutrition Care - Incorporate the Nutrition Care Process as a method to manage nutrition care activities; Applies to RDs with direct patient/client interaction and contact Formatted according to four parts of NCP Reflect the training, responsibility and accountability of the RD SOPP - Standards of Professional Performance Standards of Professional Performance -

Address behaviors related to professional role Outside the realm of direct patient/client care Apply in all practice settings Six domains of professional behavior Reflect RD training, responsibilities and accountabilities SOP: Follows the? - NCP SOP steps - Assessment Diagnosis Intervention Monitoring & Evaluation SOPP: Relates to? - Professional Behaviors SOPP Six domains of professional behavior - Quality in Practice Competence & Accountability Provision of Services Application of Research Communication & Application of Knowledge Utilization & Management of Resources Practice-Specific Standards of Practice and Standards of Professional Performance levels? -

Each indicator within each standard is categorized by level of practice: Generalist, Specialty or Advanced Scope of Practice Decision Tool - Online interactive tool that permits an RDN or DTR to answer a series of questions to determine if a particular activity is within his or her scope of practice Purposes of the Nutrition Care Process - Systematic problem solving method developed by the Academy that dietetic professionals use to think critically, make decision addressing nutrition-related problems, & provide safe, effective, high quality nutrition care advantages of the NCP - Clear communication & documentation of care Facilitates productivity Improve outcomes based research Ensure quality and safe care Enhance visibility of RD as nutrition expert NCP steps -

1. Nutrition Assessment
2. Nutrition Diagnosis
3. Nutrition Intervention
4. Nutrition Monitoring/Evaluation Step 1: Nutrition Assessment - Most familiar to Nutrition professionals Method for obtaining, verifying, & interpreting data in order to make decisions about the cause & significance of nutrition-related problems Gather information to identify nutrition problems Needed to correctly identify nutrition diagnosis.

Assessment Categories - Food/Nutrition Related History Anthropometric measurements Biochemical Data, Medical Tests, & Procedures Nutrition-focused physical findings Client history Step 2: Nutrition Diagnosis - Identifies & describes a specific nutrition problem that a dietetics professional is responsible for treating NOT a medical dx 3 domains three domains of nutrition diagnosis - Intake clinical behavioral-environmental intake - Too much or too little of a food or nutrient compared to actual or estimated needs Clinical - Nutrition problems that related to medical or physical conditions Behavioral-Environmental - Knowledge, attitudes, beliefs, physical environment, access to food, or food safety what does the Nutrition diagnosis result in? - Resulting in Nutrition Diagnosis Statements or PES statement

PES statement parts - Problem Etiology Sign & symptoms PES: problem - Diagnostic label describes alterations in patient's/client's nutrition status PES: Etiology - Cause or contributing factor PES: Sign and symptoms - Defining characteristics; data used to determine that the patient/client has the nutrition diagnosis specified. Step 3: Nutrition Intervention - resolve or improve the nutrition problem by planning & implementing appropriate nutrition interventions that are tailored to the patient/client's needs. Strategies are organized into 4 categories Nutrition intervention strategies categories - Food &/or nutrient delivery Nutrition Education Nutrition Counseling Coordination of Nutrition Care by a Nutrition Professional Planning a nutrition intervention - Prioritize nutrition Dx Consult evidence based practice guidelines Establish goals/expected outcomes; confer with client/pt or caregiver Define intervention plan & strategies Define time & frequency of care

Identify resources needed Implementation of a nutrition intervention - action phase Communicate plan of care Carry out the plan Step 4: Nutrition Monitoring/Evaluation - Purpose: determine degree of progress is being made toward goals or desired outcomes.

• In lecture: "similar to assessment except it determines why there was a change in the 1st place, and does NOT include patient history".
• --- Identifies outcomes relevant to nutrition dx & intervention plans/goals Determine factors helping or hindering progress Outcomes are organized into 4 categories 4 outcome categories of nutrition monitoring/evaluation - Food/Nutrition-Related History Outcomes Anthropometric Measurement Outcomes Biochemical Data, Medical Tests, Procedure Outcomes Nutrition-Focused Physical Finding Outcomes Monitor - Provide evidence that the nutrition intervention is/not changing the pt/client behavior or status Measure - Collect data on the nutrition outcome indicator(s) Evaluation - Systematic comparison with previous status, intervention, goals & reference standard

What are the grades on the EAL and what do they mean? (good/strong) - grades: good, fair, limited, expert opinion, not assignable Grade I: Good - has studies of strong design/evidence pertaining to question. results are clinically important and consistent with few minor exceptions Grade II: Fair - has studies of strong design for question with minor concerns or only studies of weaker design Grade III: Limited - evidence consists of results from a limited number of studies of weak design for question. or strong evidence/studies included are unavailable or inconsistent Grade IV: Expert Opinion Only - no studies available, the support of conclusion is based only on expert consensus, clinical experience, opinion, or extrapolation from basic research Grade V: Not assignable - no evidence that pertains to question being addressed How are the grades for the EAL determined? - grades are assigned based on the strength of evidence through systematic reviews What are the requirements for telehealth for practicing RDNs re: licensure and requirements in various states? - RDNs providing telehealth services where the practitioner and patient are located in different states, the practitioner must be licensed and/or meet the other applicable standards that are required by state of both the practitioner and the patient locations Acute healthcare facilities -

Acute - short term care Examples - hospitals)

• private for profit - usually physician owned/small - facilities
• public not for profit - owned by country or state
• private not for profit - managed by community ( clinics)
• Outpatient - no overnight stay
• Urgentcare - primary care Post-acute health care facilities - Long term care
• patient has been treated but are not able to take care of themselves Ex: residential/assisted living, retirement community continuing care, long term acute care, skilled nursing facilities, hospice care (aka - death bed care). medical Vs Nutrition diagnosis - Medical Diagnosis - is a disease or pathology of organs or body systems & does not change as long as the condition exists. Nutrition diagnosis - is often temporary & with nutrition intervention the diagnosis ideally resolves Example's: Medical - diabetes melluitis Nutrition - carbohydrate intake, fluid retention chronic healthcare facilities - Chronic - long term care
• same care as post-acute facilities Nutrition Prescription -

concisely states the client's customized recommended dietary intake of energy and/or selected foods or nutrients based on current reference standards and dietary guidelines and a client's health condition and nutrition diagnosis.