Etiology Intervention Link Predicts Resolution of Nutrition Diagnosis

The Nutrition Care Process (NCP) is a systematic problem-solving method that nutrition and dietetics professionals use to critically think and make decisions to address nutrition-related problems and provide safe and effective quality nutrition care.

The NCP is also a process with linkages between steps that can influence the success of the implementation process. It requires a significant amount of critical thinking and documenting each step demonstrates adequate clinical reasoning. The NCP parallels the Nursing Clinical Reasoning Model - Etiology is the basis for the Clinical Reasoning Model.

According to research studies, if the etiology is addressed effectively and the goals are met, then, in theory, the problem will be resolved. However, if the etiology step is left out, the care process is an uneducated guess lacking evidence. To date, there have been very few outcomes reported as a result of nutrition interventions. An explanation would be the lack of patient outcomes, often due to the rushed aspect of bedside care and the lack of documented linking components. Limited outcomes measurement is a barrier to the advancement of the dietetics profession.

Lewis et al., (2020), evaluated the relationship between the Nutrition Care Process (NCP) chain links and improvement or resolution of the nutrition diagnosis. They conducted a retrospective record review for 12 months in a single Veterans Health Administration health care system using the Veterans Health Administration specific monitoring and evaluation terms, NCP terminology, and its etiology categories to evaluate outcomes. This study included veterans who had a nutrition diagnosis documented from January 10, 2018, through February 10, 2018, in settings that included acute inpatient, outpatient primary care, outpatient specialty clinic, long-term care, subacute rehabilitation, and home-based primary care.

A total of 84 patients, 24 to 97 years of age – the majority, white [65 white; 74 male] were evaluated in the study. Mean body mass index of 27.2 indicated that the evaluated population was overweight. Some patients had more than 1 nutrition diagnosis, etiology, or intervention; therefore, the data were labeled according to NCP encounter and not patient. In addition, each NCP encounter was evaluated using the NCP audit score to assess the quality of the documentation. Documentation of interventions, goals, and problem status were all >90%, and the mean NCP audit score was 19.9. This mean score indicates high-quality documentation by the clinicians at this facility.

The 9 predictors significantly related to diagnosis status in the univariate analysis were as follows: the number of visits by an RDN; interventions implemented; positive goal status (goals progressing in the desired direction); evidence - diagnosis link present; diagnosis - etiology link present; etiology- intervention link present; intervention - goal link present; diagnosis - outcome link present; and NCP audit score.

All 9 predictors were entered in the multivariate model and, after 4 steps, the strongest predictor for diagnosis improvement was the presence of the etiology - intervention link The odds of improving the nutrition diagnosis were 51.43 times higher when the etiology-intervention link and the odds of improving the nutrition diagnosis were 19.74 times higher when the evidence - diagnosis link was present (P¼0.049) and 9.46 times higher when the intervention- goal link was present (P¼0.070). It is important to note that there was a significant relationship between the etiology – intervention link and nutrition diagnosis improvement was supported.

This supports the theory of the NCP Model that etiology drives the intervention. Determining the etiology is considered to be the most likely influence on the development or maintenance of a nutrition problem. When the appropriate etiology is selected and relates to the intervention, there’s no doubt that the goals of that intervention would be met, and if goals are met then problems or outcomes would improve. RDNs are encouraged to critically evaluate links of the NCP chain, assess NCP documentation for quality, and pursue follow-up visits to improve the resolution of nutrition problems.

Interested in reading more about the Nutrition Care Process? Here's where https://jandonline.org/article/S2212-2672(20)30378-6/fulltext