Evaluating the performance of clinical dietitians.

The purposes of this study were to describe how clinical managers evaluate the performance of clinical dietitians and to examine managers' opinions about performance appraisal. Managers from 55 acute-care hospitals in seven midwestern states responded to a telephone survey about their appraisal of the performance of clinical dietitians. Most of the clinical managers had developed criteria with written standards for evaluating performance. Respondents evaluated the dietitians once a year and relied primarily on chart audits, other work samples, and critical incidents to judge performance. Managers in 32 of the hospitals asked their subordinates to complete a self-appraisal, and almost all of the managers negotiated with the dietitians to identify goals for professional improvement. Respondents' reasons for conducting performance appraisals were indicative of a participative management style. During the interviews, many clinical managers requested help in improving their performance appraisal systems, which suggests a need for additional training in conducting performance appraisals. The findings indicate that most clinical managers were following recommended guidelines for conducting performance appraisals.

Nutrition care planning: comparison of the skills of dietitians, interns, and students.

A written case study--or patient management problem--was used to examine how the nutrition care planning process is influenced by increasing clinical experience. The sample consisted of 45 students in diet therapy courses, 46 dietetic interns, and 44 experienced clinical or generalist dietitians. The patient management problem tested data gathering, with sections containing information needed to assess nutritional status, and nutrition care planning, in which subjects identified and evaluated problems and selected short- and long-term goals. Performance was scored by comparing subjects' answers with those of five dietetic experts. Dietitians scored highest and students scored lowest on efficiency of data gathering. Dietitians and interns scored higher than students on proficiency of data gathering and nutrition care planning. Overall, dietitians and interns performed better than students. Only in tasks requiring the highest levels of information processing and/or confidence in clinical judgment were differences between dietitians and interns consistently found. These findings demonstrate that basic nutrition care planning skills are acquired during dietetic internships, but advanced skills are added with clinical experience.

Dietetics professionals have a positive perception of professional development.

This study summarizes the perceptions towards the Professional Development Portfolio method of recertification and attitude towards professional development of dietetic professionals as measured in the national pilot study of the Portfolio. Portfolio compared to control respondents had greater awareness, and better understanding and knowledge of the Portfolio process after using the Portfolio guide. The perception that the Portfolio process will aid in maintaining competence did not differ between groups. The perception that self-reflection aided in determining career goals and confidence to conduct a learning needs assessment differed slightly between groups. Both groups had a positive attitude towards professional development and that continuing professional education (CPE) improved competence. All perceptions and attitudes were positive. The focus of CPE in foods, business, management, education, and research did affect the ability of dietetics professionals to find appropriate CPE. Rural and unemployed respondents had more difficulty finding appropriate CPE. The findings indicate that the Portfolio guide aides the dietetics professional using the Portfolio process and that the perception towards the Portfolio process is positive. Some dietetics professionals with different CPE focus had difficulty finding appropriate CPE, and this did not differ by control and Portfolio group. More innovative methods of CPE delivery may need to be considered for these practitioners.

Evaluation and comparison of the nutrition care process for persons with diabetes among inpatient and outpatient dietitians.

The purpose of this study was to compare the problem-solving skills used by dietitians when planning care for inpatient and outpatient persons with type II diabetes. Telephone interviews were conducted with 44 inpatient dietitians and 45 outpatient dietitians. Inpatient dietitians used more information from the medical record to make clinical judgments than outpatient dietitians. Inpatient dietitians reported condensing their assessment more frequently due to time pressure than outpatient dietitians. Inpatient dietitians were more likely to identify nutrition-related problems via information from the medical record while outpatient dietitians reported using diet history information. Outpatient dietitians more frequently identified specific behavioral goals whereas inpatient dietitians recommended general goals. The increased availability of objective, detailed information necessary for a thorough nutritional assessment is an advantage of inpatient care planning. However, outpatient diabetes education may be a preferred setting because of more time available for education and better learning effectiveness.

Acquisition of American Sign Language versus Amerind signs in a mentally handicapped sample.

The differential acquisition of American Sign Language versus Amerind signs was investigated in a moderately to severely mentally handicapped sample. The subjects (n = 10) were selected from a residential training facility and each had a mental age within the range 3;0-5;0 years. Twenty signs were taught to each subject, 10 American Sign Language signs and 10 Amerind signs. An Alternating Treatments Design was selected to facilitate comparison of the relative efficacy of the two sign systems across single subjects. Five signs were presented per week (2 weeks) in each sign system. Results showed that a significantly greater (p less than .001) number of Amerind as compared to American Sign Language signs were acquired during Week 1, Week 2, and across both weeks. Retention results, after 1- and 2-week delays, showed that subjects continued to reproduce significantly more Amerind than American Sign Language signs. The results were thought to be due to the more concrete and less complex nature of the Amerind system. Implications of these results for this and similar samples are discussed.

Nutritional care of ambulatory residents in special care units for Alzheimer's patients.

The availability and an assessment of the nutritionally-relevant information from 100 medical records of ambulatory residents in ten special care units (SCU) for Alzheimer's patients was determined. Eight facilities had estimated calorie and fluid needs and four estimated protein needs of residents. Over 40% of the residents were underweight and significant weight loss was reported for 20%. Values for hemoglobin, hematocrit, albumin and cholesterol were available on 61, 60, 36, and 25% of the patients, respectively. Hemoglobin, hematocrit and albumin were 8% lower and cholesterol was 24% higher than the levels associated with high death rates among institutionalized elderly. Many factors existed placing patients at high risk for malnutrition. Staff at all the facilities monitor the nutritional status of Alzheimer's patients to a variable extent.