The document discusses the role of registered dietitians in the healthcare system. It describes dietitians as working in clinical settings like hospitals and long-term care facilities using the nutrition care process of assessment, diagnosis, intervention, and monitoring. Dietitians are part of interdisciplinary teams along with doctors, nurses, and other professionals. The document also outlines how dietitians must develop critical thinking skills through education, experience, and continuing education to provide medical nutrition therapy and work in the evolving U.S. healthcare system.

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Nutrition Therapy and Pathophysiology | 3e
Nelms | Sucher | Lacey | Roth
Kathryn Sucher, ScD, RD
San Jose State University
Role of the Dietitian in the Health
Care System
Chapter 1

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The Registered Dietitian in Clinical
Practice
• What is the role of the clinical dietitian?
– Nutrition therapy
• Nutrition care process (NCP)
– Nutrition assessment
– Nutrition diagnosis
– Nutrition intervention
– Nutrition monitoring and evaluation

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Scope of Practice Framework
• Defines roles, functions, responsibilities
and activities of practitioners
– Practice Management and Advancement
– Practice Standards
– Practice Resources
• Supported by:
– Education
– Credentials
• See Figure 1.1

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Clinical Nutrition Team
• Settings
– Acute care facilities
– Longer-care facilities
• Inpatient and outpatient
• General and specialized units
• Organization varies across settings
• See Tables 1.1 and 1.2

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Other Health Professionals –
Interdisciplinary Teams
• Members of the health care team
– Medical doctor
– Nurse
– Pharmacist
– Occupational therapist (OT)
– Speech-language pathologist
– Social worker
– See Table 1.4

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Health Care Services and
Reimbursement for (MNT)
• Where does medical nutrition therapy
(MNT) fit within our current health care
picture?
• In 2012, among the U.S. population:
– 84.6% insured
– 15.4 % not insured

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Health Insurance
• Private – 64% of insured population under
65
– Alliance Healthcare Initiative
– Group contract- RDs can obtain
reimbursement
• Public – 33% of insured population under
65
– Medicare – Part B reimbursement for R.D.’s
– Medicaid – varies among states

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2014 Affordable Care Act
• Allows purchase of insurance by
individuals and small companies
• Expanded Medicaid in some states
• Requires preventive services
– Nutrition services are likely to expand

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Critical Thinking Skills and
Professional Performance
• To become an educated and trained
member of the health care team
– Didactic program in dietetics
– Supervised practice
• Apply education in clinical setting
– Learn to become a critical thinker
– Become a RD (registered dietitian)
– Participate in continuing education, practice,
critical thinking

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Definition of Critical Thinking
• What is critical thinking?
– Specific knowledge base
– Experience
– Competencies
– Attitude
– Standards

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Components of Critical Thinking –
Specific Knowledge Base
• Knowledge of nutrition and its role in
health and disease
– Minimum level based on Standards of
Education of the ADA set by CADE
– Continually changing and expanding
knowledge and skills
– Continuing Education as professionals

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Components of Critical Thinking –
Experience
• Experience
– Supervised practice
• Dietetic internship or coordinated program
– Continued application and practice as a
professional

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Components of Critical Thinking –
Competencies
• Competencies
– Cognitive process to make clinical judgments
– Medical problem solving
• Scientific method: critically reviewed research
• Evidence-based dietetics practice
• Problem solving
• Decision making
• Diagnostic reasoning

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Components of Critical Thinking –
Attitudes and Standards
• Attitudes
– Reflection of values
– Consider fairness and responsibility
– See Table 1.7
• Standards
– Professional standards
• Code of Ethics
• Standards of Professional Performance
• Outcomes research

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Levels of Clinical Reasoning
• Entry-level practice—basic
• More experienced—able to examine
alternatives independently, systematically,
disconnecting from authority
• Highest level—analysis of the entire
situation, accountability for decisions, and
continuous quality of care