Process models in dietetic care: A comparison between models in Europe

Daniel Buchholz, Alexandra Kolm, Koen Vanherle, Marleen Adam, Kathrin Kohlenberg-Müller, Maaike E. Roemeling-Walters, Daniela Wewerka-Kreimel, Christina Gast, Karoline Lange, Sabine Ohlrich-Hahn, Shelly Rachman-Elbaum, Eline Baete, Renate Heine-Bröring, Elisabeth Höld, Andrea Werkman

Peer-reviewed | Manuscript received: May 28, 2018 | Revision accepted: July 17, 2018

Introduction

Healthcare is evolving and with this comes a demand for an increased evidence of treatment effectiveness and efficiency from everyone involved in health care. Standardized processes are seen as necessary to generate predictable outcomes and transparency in health care [1] including dietetic care. Using a Dietetic Care Process (DCP) for dietetic practice, research and education can lead to the improved application of evidence-based guidelines and critical thinking, a more-focused documentation of dietetic care, and an increased acknowledgment of the value of dietetic care by other health care professionals [2].

For the purpose of this paper, the extensive term dietetics includes the term nutrition. For dietitians, using a DCP is recommended by several professional associations such as the International Confederation of Dietetic Associations (ICDA) [3], the European Federation of the Associations of Dietitians (EFAD) [4] and the Academy of Nutrition and Dietetics (AND) from the USA [2, 5]. However, DCPs are not only used and recommended for dietetic care in practical settings, they are also used as a didactic tool for students. In fact, the Nutrition Care Process (NCP) developed by the AND has its origin as a didactic tool in dietetic education long before it was implemented and used as a quality instrument in applied dietetics [6, 7].

In Europe, several DCPs are being used [1, 8]. In 2012 EFAD reported the use of DCPs in eleven EFAD member states [9]. Currently, with an increase in cross-border mobility of dietetic professionals and patients in Europe, updated information on DCPs is needed. In 2015 five Universities of Applied Sciences from four European countries (Austria, Belgium, Germany and the Netherlands) started the Erasmus+ funded project Improvement of Education and Competences in Dietetics (IMPECD; www.impecd.eu). One central aim of IMPECD is to provide an international online collaboration platform to improve competences in solving clinical cases applying a unified European process model in education. Therefore, we needed a description and comparison on e.g. the content, structure, number of steps and graphical representation of DCPs used in Europe. To our knowledge the existence and usage of process models in dietetics in Europe has never been reported in a scientific publication.

Abstract

Using a Dietetic Care Process (DCP) can lead to improved application of evidence-based guidelines and critical thinking in dietetics. One aim of the project Improvement of Education and Competences in Dietetics (IMPECD) is to develop a unified DCP for international educational purposes. Therefore, a comparison of European DCPs was needed.A concise literature search and semi-structured interviews with experts representing the full EFAD (European Federation of the Associations of Dietitians) member states were conducted from June to October 2017.16 out of 23 EFAD member states responded (70%) from which 13 indicated to use a DCP. Eight different DCPs were found, with four to six core steps and three graphical representations. In one country the use of a dietetic process is indicated by law. The DCPs have more similarities than differences as they follow the same principles. Differences in language or form may not limit the improvement in collaboration and international exchange in dietetic practice. These results provide a good basis for the development of a unified DCP for educational purposes.

Keywords: process model, dietetic care, nutrition, dietetics, Europe, IMPECD

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