Rushton Alita, Young Adrienne, Keller Heather, Bauer Judith, Bell Jack
Department of Nutrition and Dietetics, The Prince Charles Hospital, Chermside, QLD 4032, Australia.
School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia.
Healthcare (Basel). 2021 Apr 10;9(4):446. doi: 10.3390/healthcare9040446.
Approximately one-third of adult inpatients are malnourished with substantial associated healthcare burden. Delegation frameworks facilitate improved nutrition care delivery and high-value healthcare. This study aimed to explore knowledge, attitudes, and practices of dietitians and dietitian assistants regarding delegation of malnutrition care activities. This multi-site study was nested within a nutrition care implementation program, conducted across Queensland (Australia) hospitals. A quantitative questionnaire was conducted across eight sites; 87 dietitians and 37 dietitian assistants responded and descriptive analyses completed. Dietitians felt guidelines to support delegation were inadequate (agreement: <50% for assessment/diagnosis, care coordination, education, and monitoring and evaluation); dietitian assistants perceived knowledge and guidelines to undertake delegated tasks were adequate (agreement: >50% food and nutrient delivery, education, and monitoring and evaluation). Dietitians and dietitian assistants reported confidence to delegate/receive delegation (dietitian agreement: >50% across all care components; dietitian assistant agreement: >50% for assessment/diagnosis, food and nutrient delivery, education, monitoring and evaluation). Practice of select nutrition care activities were routinely performed by dietitians, rather than assistants ( < 0.001 across all nutrition care components). The process for care delegation needs to be improved. Clarity around barriers and enablers to delegation of care prior to implementing reforms to the current models of care is key.
大约三分之一的成年住院患者存在营养不良问题，并伴有巨大的相关医疗负担。授权框架有助于改善营养护理服务和高价值医疗服务。本研究旨在探讨营养师和营养师助理在营养不良护理活动授权方面的知识、态度和实践。这项多地点研究嵌套在一项营养护理实施计划中，该计划在澳大利亚昆士兰州的多家医院开展。在八个地点进行了定量问卷调查；87名营养师和37名营养师助理做出了回应，并完成了描述性分析。营养师认为支持授权的指南不充分（评估/诊断、护理协调、教育以及监测与评估方面的认同率均低于50%）；营养师助理认为承担授权任务的知识和指南是充分的（食物和营养供应、教育以及监测与评估方面的认同率超过50%）。营养师和营养师助理报告称对授权/接受授权有信心（营养师在所有护理环节的认同率均超过50%；营养师助理在评估/诊断、食物和营养供应、教育以及监测与评估方面的认同率超过50%）。特定营养护理活动通常由营养师而非助理执行（在所有营养护理环节中P<0.001）。护理授权流程需要改进。在对当前护理模式进行改革之前，明确护理授权的障碍和促进因素是关键。
