Nutrition diagnosis according to the German-Nutrition Care Process (G-NCP) model

Peer-reviewed | Manuscript received: 16.11.2017 | Revision accepted: 06.07.2018

Challenges for implementation – a case study

Introduction

The “Framework Agreement on Quality Assurance in Nutrition Counselling and Nutrition Education” (Rahmenvereinbarung zur Qualitätssicherung in der Ernährungsberatung und Ernährungsbildung) of the German Nutrition Society (DGE) states in particular that in nutrition counselling scientific standards, counselling methodology standards, and process-oriented standards must be observed, and that the counselling process must be documented and evaluated [1]. This is where the models for nutrition counselling come in [2, 3].

For Germany, the German-Nutrition Care Process (G-NCP) (• Figure 1) was developed to provide quality assurance and greater transparency in the nutrition counselling and therapy process. The manual [4] published by the German Association of Dietitians (VDD) provides a “guideline for the professional conduct of dietitians”. This laid a foundation for establishing standard elements of quality assurance in nutrition counselling¹ – the G-NCP – with the five following process steps:

• nutrition assessment
• nutrition diagnosis
• planning and
• implementation of an intervention
• monitoring and evaluation

The G-NCP follows the four-step NCP from the US [5], but it has five process steps instead of four because the German-Nutrition Care Process describes the planning and implementation of the intervention as two separate process steps [4]. There have already been some relevant publications: a case study from the context of oncology practice [6], and possible nutrition diagnoses for patients with bronchial carcinoma, type 2 diabetes mellitus [7], Crohn’s disease [8] and insulinoma [9].

¹ For the sake of better readability, this article is limited to the term “nutrition counselling”. Process-driven action and G-NCP are of course relevant to both nutrition counselling and nutrition therapy.

Abstract

Nutrition diagnosis is the second step in the G-NCP model and it is based on the information collected in the assessment. It is carried out systematically in the form of PESR statements that state the nutrition problem (P), etiology (E), signs and symptoms (S) and resources (R). The aim of this study was to investigate and discuss the practical implementation of the guidelines for diagnosis on the basis of a case study. Some challenges arose in formulating the PESR statements: Several aspects of the process of assigning nutrition assessment data using the G-NCP system require a rethink.

Nutrition diagnosis forms the interface between nutrition assessment and intervention, and this requires an awareness of how each of the process steps are woven together. It was found that when implementing process-driven actions according to the G-NCP model, there is some variance in terms of the interpretation of the guidelines of the Manual of the German Association of Dietitians (VDD), and that there is a need for specific training for the users.

Keywords: Nutrition diagnosis, PESR statements, German-Nutrition Care Process (G-NCP), quality assurance in nutrition counselling, behavioral/environmental

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