Characteristics of an Effective Preceptor: Dietetics Education as a Paradigm.

PURPOSE: To examine the characteristics of effective preceptors, using the perceptions of students who are enrolled in a Dietetic Internship (DI), and to evaluate the influence of the following factors on preceptor behavior: a preceptors' area of practice, credentials, and type of DI program where the student is enrolled. METHODS: Three hundred fifty-one students from 129 randomly selected DI programs completed an online survey to evaluate their preceptors, using a 40-item Preceptor Behavior Scale that included four categories: knowledge and professional competence, interpersonal skills, personality characteristics, and teaching ability. RESULTS: The students ranked knowledge and professional competence as the most important category for effective preceptors. Teaching ability had the largest difference in mean scores between an effective and ineffective preceptor. Preceptors who were considered more effective included: a) preceptors in clinical and "other" practice areas such as community and private practice vs those in food service; b) preceptors who were registered dietitians (RD) vs non-RD; and c) preceptors in hospital-based DI programs vs university-based DI programs. CONCLUSIONS: Preceptor training should emphasize skills in all of the categories from the Preceptor Behavior Scale so that preceptors can effectively help students meet the competencies required for entry-level practice. A web-based preceptor training module that can reach offsite preceptors should be developed that includes scenarios for all areas of practice, teaching skills based on the principles of adult learning, and a credential and/or a professional incentive.

Intradialytic parenteral nutrition: a practical approach.

Intradialytic parenteral nutrition (IDPN) therapy is becoming more prevalent in the malnourished patient undergoing maintenance hemodialysis. This is of particular concern to the nephrology nurse in that additional time is required to administer the solution, monitor the patient, and document the process. The IDPN monitoring flowsheet described in this article was developed to promote continuity of care from treatment to treatment, especially during initiation of IDPN, and to assist the nephrology nurse in administering and monitoring the therapy.

The effects of moderate doses of megestrol acetate on nutritional status and body composition in a hemodialysis patient.

OBJECTIVE: To determine the safety and efficacy of moderate doses of megestrol acetate (>/=320 mg/day) in a patient on hemodialysis. DESIGN: Case study. SETTING: Chronic hemodialysis facility and body composition unit in New York City. MAIN OUTCOME MEASURES: Body weight, body composition, dietary energy and protein intake, appetite assessment, serum albumin, prealbumin, serum transferrin, and quality of life. RESULTS: The patient received megestrol acetate for 24 weeks and gained little body weight. However, his fat mass increased by 7.5 kg (163%), and fat-free mass decreased by 6.8 kg (10.6%) from baseline measurements. The proportional content of total body water, extracellular water, intracellular water, body cell mass in fat-free mass, and average cell K+ concentration were maintained within normal ranges. Serum albumin was maintained, serum transferrin increased, prealbumin decreased, dietary energy and protein intakes increased, and reported appetite improved. CONCLUSIONS: Moderate doses of megestrol acetate may be an effective therapeutic agent in reversing poor appetite, increasing dietary energy and protein intakes, and improving nutritional status in some patients receiving maintenance hemodialysis. However, these changes were at the expense of altering body composition components. Further research that includes measures of body composition, nutritional status, appetite assessment, and quality of life are needed to determine the safety and effectiveness of moderate or high doses of megestrol acetate in a large number of hemodialysis patients.

The hemodialysis pilot study: nutrition program and participant characteristics at baseline. The HEMO Study Group.

OBJECTIVE: Describe the nutrition program (assessments and interventions) and the participants' baseline nutritional characteristics in the Hemodialysis Pilot Study. DESIGN: Cross sectional survey in which hemodialysis patients were examined during 10 weeks of baseline (BL), before randomization study interventions (dose and flux). SETTING: Four hemodialysis centers (eight dialysis units in total). PATIENTS: Twenty-nine male (mean age, 63 years; range, 34 to 75) and 20 female (mean age, 61 years; range, 29 to 73) hemodialysis patients. INTERVENTIONS: None during BL. MAIN OUTCOME MEASURES: Feasibility of implementing the proposed nutrition program before conducting the full-scale trial, and description of baseline characteristics related to nutrition. RESULTS: A nutrition program was developed to assess nutritional status during BL and follow-up periods and to intervene in patients with weight loss or decreasing serum albumin. Methods for collecting biochemical, dietary and anthropometric data were implemented at four clinical centers. At baseline, mean protein intake estimated by single pool normalized protein catabolic rate was 0.95 +/- 0.21 gm/kg adjusted body weight (ABW) (n = 42) and by diet record assisted recalls (n = 47) 0.94 +/- 0.36 gm/kg ABW/d, respectively. Mean energy intake was 22.8 +/- 8 kcal/kg ABW/day (n = 39). Mean serum albumin concentration using the bromcresol green method was 3.8 +/- 0.4 gm/dL (n = 40). Mean body mass index was within the normal limits of 19-27 kg/m2. Mean skinfold thicknesses in females, but not males, were shifted toward the lower end of usual distributions for healthy individuals. CONCLUSIONS: The goal of designing, developing, and implementing the diet and nutrition component, and related data collection for the HEMO pilot study was accomplished at four separate clinical centers. Baseline mean protein and energy intake were low, suggesting that continuing dietary surveillance is needed. The ongoing full-scale HEMO study will provide the first prospective analysis of dietary intake, nutritional status, and outcome in maintenance hemodialysis patients as a function of dialysis dose and membrane flux.