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.

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.