Dietitian

Assignment

The Dietician will be based in Amel Association’s Woman and Child Center, located in Douris-Baalbek. The Dietician will help our patients achieve their nutrition and health goals. S/He will work with patients of different ages and health levels, so s/he must be able to create nutritional programs based on their specific medical needs. To reinforce the proposed plan, the Dietician will educate the patients and their families on how to follow the diet guidelines closely, follow-up on patients' nutritional progress, and make adjustments to the diet plan when necessary.

S/He works as part of a multidisciplinary team alongside other health professionals, and will often liaise with family and caregivers when developing treatment plans.

Scope of work: Screen for malnutrition, perform a comprehensive nutritional assessment, provide therapeutic diets (for patients with diabetes, hypertension, obesity, dyslipidemia, and gastrointestinal diseases), provide weight management plans, and counsel breastfeeding mothers on the benefits of breastfeeding, pregnancy-related diet plans.

The dietitian is not allowed to prescribe any medication

Duration of the First consultation: 30-45 min

Duration of Follow-up consultation after 2-3 weeks: 20-30 min

Duration of Visit: 8:00 am- 2:00 pm

Standards of Practice for Licensed Clinical Dietitian Nutritionists

Standard 1: Nutrition Assessment

The dietitian nutritionist uses accurate and relevant data and information to identify nutrition-related problems.

1. Nutrition assessment
   1. Patient/client history: Assesses current and past information related to personal, medical, family, and psychosocial/social history
   2. Anthropometric assessment: Assesses anthropometric indicators (eg, height, weight, body mass index [BMI], waist circumference, arm circumference), comparison to reference data (eg, percentile ranks/z-scores), and individual patterns and history
   3. Biochemical data, medical tests, and procedure assessment: Assesses laboratory profiles (eg, acid-base balance, renal function, endocrine function, inflammatory response, vitamin/mineral profile, lipid profile), and medical tests and procedures (eg, gastrointestinal study, metabolic rate)
   4. Nutrition-focused physical examination (NFPE) may include visual and physical examination: Obtains and assesses findings from NFPE (eg, indicators of vitamin/mineral deficiency/toxicity, edema, muscle wasting, subcutaneous fat loss, altered body composition, oral health, feeding ability [suck/swallow/breathe], appetite, and affect)
   5. Food and nutrition-related history assessment (ie, dietary assessment): Evaluates:
      1. Food and nutrient intake, including composition and adequacy, meal and snack patterns, and appropriateness related to food allergies and intolerances
      2. Food and nutrient administration, including current and previous diets and diet prescriptions and food modifications, eating environment, and enteral and parenteral nutrition administration
      3. Medication and dietary supplement use, including prescription and over-the-counter medications, and integrative and functional medicine products
      4. Knowledge, beliefs, and attitudes (eg, understanding of nutrition-related concepts, emotions about food/nutrition/health, body image, preoccupation with food and/or weight, readiness to change nutrition- or health-related behaviors, and activities and actions influencing achievement of nutrition-related goals)
      5. Food security defined as factors affecting access to a sufficient quantity of safe, healthful food and water, as well as food/nutrition-related supplies.
      6. Physical activity, cognitive and physical ability to engage in developmentally appropriate nutrition-related tasks (eg, self-feeding and other activities of daily living), instrumental activities of daily living (eg, shopping, food preparation), and breastfeeding.
      7. Other factors affecting intake and nutrition and health status (eg, cultural, ethnic, religious, lifestyle influencers, psychosocial,  and social determinants of health).
   6. Comparative standards: Uses reference data and standards to estimate nutrient needs and recommended body weight, body mass index, and desired growth patterns
   7. Physical activity habits and restrictions: Assesses physical activity, history of physical activity, and physical activity training
   8. Uses collected data to identify possible problem areas for determining nutrition diagnoses
   9. Documents and communicates:
      1. Date and time of assessment
      2. Pertinent data (eg, medical, social, behavioral)
      3. Comparison to appropriate standards
      4. Patient/client/population perceptions, values, and motivation related to presenting problems
      5. Changes in patient/client/population perceptions, values, and motivation related to presenting problems
      6. Reason for discharge/discontinuation or referral, if appropriate

Standard 2: Nutrition Diagnosis

The dietitian nutritionist identifies and labels specific nutrition problem(s)/diagnosis(es) that the RDN is responsible for treating.

2. Nutrition diagnosis:
   1. Diagnoses nutrition problems based on evaluation of assessment data and identifies supporting concepts (ie, etiology, signs, and symptoms)
   2. Prioritizes the nutrition problem(s)/diagnosis(es) based on severity, safety, patient/client needs and preferences, ethical considerations, likelihood that nutrition intervention/plan of care will influence the problem, discharge/transitions of care needs, and patient/client/advocate perception of importance
   3. Communicates the nutrition diagnosis(es) to patients/clients/advocates, community, family members or other health care professionals when possible and appropriate
   4. Documents the nutrition diagnosis(es) using standardized terminology and clear, concise written statement(s) (eg, using Problem [P], Etiology [E], and Signs and Symptoms [S] [PES statement(s)] or Assessment [A], Diagnosis [D], Intervention [I], Monitoring [M], and Evaluation [E] [ADIME statement(s)])
   5. Re-evaluates and revises nutrition diagnosis(es) when additional assessment data become available

Standard 3: Nutrition Intervention/Plan of Care

The dietitian nutritionist identifies and implements appropriate, person-centered interventions designed to address nutrition-related problems, behaviors, risk factors, environmental conditions, or aspects of health status for an individual, target group, or the community at large.

3. Nutrition Intervention/Plan of Care:

Plans the Nutrition Intervention/Plan of Care:

1. 1. Addresses the nutrition diagnosis(es) by determining and prioritizing appropriate interventions for the plan of care
   2. Bases intervention/plan of care on best available research/evidence and information, evidence-based guidelines, and best practices
   3. Refers to policies and procedures, protocols and program standards
   4. Collaborates with patient/client/advocate/population, caregivers, interprofessional team, and other health care professionals
   5. Works with patient/client/advocate/population and caregivers to identify goals, preferences, discharge/transitions of care needs, plan of care and expected outcomes
   6. Develops the nutrition prescription and establishes measurable patient-/client-focused goals to be accomplished
   7. Defines time and frequency of care including intensity, duration, and follow-up
   8. Uses standardized terminology for describing interventions
   9. Identifies resources and referrals needed

Implements the Nutrition Intervention/Plan of Care:

1. 10. Collaborates with colleagues, interprofessional team, and other health care professionals
   11. Communicates and coordinates the nutrition intervention/plan of care
   12. Initiates the nutrition intervention/plan of care (Therapeutic diet, education, counseling)
   13. Documents:
       1. Date and time
       2. Specific and measurable treatment goals and expected outcomes
       3. Recommended interventions
       4. Patient/client/advocate/caregiver/community receptiveness
       5. Referrals made and resources used
       6. Patient/client/advocate/caregiver/community comprehension
       7. Barriers to change
       8. Other information relevant to providing care and monitoring progress over time
       9. Plans for follow-up and frequency of care
       10. Rationale for discharge or referral if applicable

Standard 4: Nutrition Monitoring and Evaluation

The dietitian nutritionist monitors and evaluates indicators and outcomes data directly related to the nutrition diagnosis, goals, preferences, and intervention strategies to determine the progress made in achieving desired results of nutrition care and whether planned interventions should be continued or revised.

4. Nutrition Monitoring and Evaluation
   1. Monitors progress:
      1. Assesses patient/client/advocate/population understanding and compliance with nutrition intervention/plan of care
      2. Determines whether the nutrition intervention/plan of care is being implemented as prescribed
   2. Measures outcomes:
      1. Selects the standardized nutrition care measurable outcome indicator(s)
      2. Identifies positive or negative outcomes, including impact on potential needs for discharge/transitions of care
   3. Evaluates outcomes:
      1. Compares monitoring data with nutrition prescription and established goals or reference standard
      2. Evaluates impact of the sum of all interventions on overall patient/client/population health outcomes and goals
      3. Evaluates progress or reasons for lack of progress related to problems and interventions
      4. Evaluates evidence that the nutrition intervention/plan of care is maintaining or influencing a desirable change in the patient/client/population behavior or status
      5. Supports conclusions with evidence
   4. Adjusts nutrition intervention/plan of care strategies, if needed, in collaboration with patient/client/population/ advocate/caregiver and interprofessional team
      1. Improves or adjusts intervention/plan of care strategies based upon outcomes data, trends, best practices, and comparative standards
   5. Documents:
      1. Date and time
      2. Indicators measured, results, and the method for obtaining measurement
      3. Criteria to which the indicator is compared (eg, nutrition prescription/goal or a reference standard)
      4. Factors facilitating or hampering progress
      5. Other positive or negative outcomes
      6. Adjustments to the nutrition intervention/plan of care, if indicated

Future plans for nutrition care, nutrition monitoring and evaluation, follow-up, referral, or discharge