Zechariah Sunitha, Lehman Leigh, Waller Jennifer L, De Leo Gianluca, Stallings Judith, Gess Ashley J
Applied Health Sciences Program, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA.
Morrison Healthcare, Sandy Springs, GA 30350, USA.
Healthcare (Basel). 2021 May 13;9(5):576. doi: 10.3390/healthcare9050576.
An alarming 30% to 50% prevalence rate of disease-related malnutrition among hospitalized patients compels the need for early diagnosis and treatment of malnutrition. Registered Dietitian Nutritionists (RDNs) can utilize the nutrition-focused physical examination (NFPE) as one of the nutrition assessment criteria to accurately diagnose malnutrition. Although RDNs are striving to employ NFPE in practice, a lack of experience and adequate training impedes full utilization of this technique. This results in wide skill variations requiring continuous evaluation of RDNs' NFPE competency. However, a standardized, validated competency tool is not widely available and hence this study aims to develop a standardized, interactive nutrition-specific physical exam competency tool (INSPECT). As a first step in the development of INSPECT, a qualitative, technology-based focus group approach with 7 content and practice experts was utilized to generate appropriate tool items. A total of 70 NFPE items under 9 areas including 12 items for muscle loss, 4 items for subcutaneous fat loss, 31 items for micronutrient deficiencies, 1 item for fluid status, 2 items for handgrip strength, 5 items for initial preparation, 4 items for bedside manner, 8 items for swallowing, and 3 items for abdominal evaluation were generated. This study successfully utilized technology-based focus groups to generate appropriate NFPE items for the competency tool development. Using the items, an initial version of INSPECT has been developed, which is presently being investigated for content and face validity. The final version will undergo field tests and will be examined for reliability, validity, and item-level psychometric properties.
住院患者中与疾病相关的营养不良患病率高达30%至50%，令人担忧，这使得有必要对营养不良进行早期诊断和治疗。注册营养师（RDN）可将以营养为重点的体格检查（NFPE）作为营养评估标准之一，以准确诊断营养不良。尽管RDN努力在实践中运用NFPE，但经验不足和培训不够阻碍了这项技术的充分利用。这导致技能差异很大，需要持续评估RDN的NFPE能力。然而，一种标准化、经过验证的能力工具尚未广泛可用，因此本研究旨在开发一种标准化、交互式的特定营养体格检查能力工具（INSPECT）。作为开发INSPECT的第一步，采用了基于技术的定性焦点小组方法，与7位内容和实践专家一起生成合适的工具项目。在9个领域共生成了70项NFPE项目，包括肌肉量减少12项、皮下脂肪减少4项、微量营养素缺乏31项、液体状态1项、握力2项、初始准备5项、床边态度4项、吞咽8项和腹部评估3项。本研究成功利用基于技术的焦点小组为能力工具开发生成了合适的NFPE项目。利用这些项目，已开发出INSPECT的初始版本，目前正在对其内容和表面效度进行研究。最终版本将进行现场测试，并将对其信度、效度和项目层面的心理测量特性进行检验。
