Interprofessional Care: Dieticians and Nutritionists

On Interprofessional Care

Interprofessional care is perhaps the single most crucial aspect of healthcare. Interprofessionalism is defined as “health professionals working as equals, contributing their knowledge and specific expertise to collectively achieve patient care goals” (as cited in Tsang Cheung, and Sakakibara, 2016, p. 1). Physical therapists and physical therapist assistants work closely with a wide variety of professionals from different disciplines when treating patients, which has a direct impact on the efficacy of the treatment of said patients. Dieticians and nutritionists are absolutely critical in the collaborative process of interprofessional care as it pertains to physical therapy. In order to better understand the impact dieticians and nutritionists can have in interprofessional care, it is important to be aware of some of the goals, associated elements, and core values related to interprofessionalism.

Interprofessionalism in Patient-Centered Care and Education

Interprofessionalism is integral to patient-centered care and education due to the fact that a multidisciplinary healthcare team collaborating to meet goals can only have a beneficial effect on their patients. As stated by Jakubowski and Perron (2018), interprofessional team leaders and members “must understand each member’s education, scope of practice, and areas of expertise. Learning the language, norms, and special foci of other disciplines fosters more effective use of resources and knowledge”. Each medical discipline has their own scope of practice, a select series of procedures for which they are specifically trained to handle. When a particular discipline attempts to operate outside their scope of practice is when errors are more likely to be made. In order to facilitate proper interprofessional care, it is important for prospective medical professionals to be trained in the ways of interprofessionalism as they complete their education. A community service intitiative performed by students from different medical disciplines at the University of British Columbia had thirty-eight students collaborate in the interest of promoting cardiovascular risk reduction in Vancouver’s Downtown Eastside. A survey conducted before and after the study assessed the student’s attitudes toward interprofessionalism using the Interdisciplinary Education Perception Scale (IEPS). The post-initiative survey completed by only twenty-one of the thirty-eight participants showed considerable improvement in competency, autonomy, and perception of actual cooperation, which proved that community service initiatives can be an efficient way to educate future medical professionals in the significance of interprofessional care (Tsang et al, 2016). In the medical field, one may work interprofessionally with individuals from many different disciplines, but one of the most vital disciplines that can affect a patient’s prognosis would be the field of dietetics.

Dietitians and Nutritionists

Many individuals don’t know how to identify the differences between a dietitian and a nutritionist. Even though they both perform similar professional duties, their differences lie in what they actually do on a daily basis and the places where they are usually employed. According to nutritionED.org (2019), “all dietitians can be nutritionists, but not all nutritionists can be dietitians”. Dietitians must have a bachelor’s degree and hours of practice, but the same is not required of nutritionists. The dietitians also earn more income than nutritionists because of their job settings. Finally, dietitians must have legal status to complete their requirements to obtain their license while nutritionists do not.

Dietitians

A Registered Dietitian (RD) is a trained nutrition professional and expert in dietetics. They also design healthy food programs according to people’s needs. This profession specializes in the creation of individualized plans with healthy eating habits, physical activity, and past medical history. To become an RD, one must earn a bachelor’s degree and perform 1,200 hours of supervised practice. After earning their title, they must pass the Registration Examination for Dietitians and apply for a license through their state dietetics board. In addition, to maintain their license, every 5 years they must create a learning plan, maintain a log on how they complete their plan, and conduct a professional development evaluation (PDE). The workplace settings for these professionals are mainly in healthcare facilities such as hospitals, long-term care facilities, clinics, and private practice.

Nutritionists

Nutritionists are those who advise others on how different types of food and nutrition can change their lifestyles. As stated by Cooper (2019), “there are many areas where they can specialize such as sports, animals, schools, etc. They also work in private clinics on weight loss, hormonal balance, digestion, and food allergies”. In many states they do not need a license to become a nutritionist. However, it is highly recommended to have as much knowledge as possible about the profession in order to provide the best service to the population. Dietetics can play a pivotal role in the health of any patient’s wellbeing, but when professionals from other disciplines begin to collaborate with professionals from the dietetics field is when the patient can truly benefit.

Goals, Associated Elements, and Core Values in Interprofessional Care

The goal of nutritionists and dietitians working in an interprofessional healthcare setting is to have the best communication and collaboration with the rest of the team in order to provide an exceptional quality of care for patients on a daily basis. Dietitians and nutritionists play an important role in today’s healthcare field due to the importance of collaboration with multiple health care professionals such as physical therapists, occupational therapists, dentists, physicians, physician assistants and many others.(DiMaria-Ghalili, R.A., 2014). This type of collaboration can only be carried out due to the level of professionalism, trust, communication, and respect that exist between each one of the healthcare professionals. Providing the team with these important fundamentals is when anything can be made possible. As the saying in Spanish goes “in union there is strength”. As in many other healthcare professions, a code of ethics is needed for those specializing in dietetics. As professionals, registered and/or licensed dietitians have to follow their code of ethics or core values that can be experienced in this particular profession as stated by the Academy of Nutrition and Dietetics. Some of the core values held by those in the dietetics profession include integrity, beneficence, social responsibility, and non-maleficence (Academy of Nutrition and Dietetics, 2018). In order to promote more efficient interprofessional care, medical professionals must be taught how to collaborate with those in other disciplines from early on in their education and the educational activity detailed within the following section was designed to do just that.

Interprofessional Care Educational Activity

Having learned about the interprofessional relationships pertaining to dietitians and nutritionists, this information will be put to use in an educational activity designed to foster interprofessional relationships between students of dietetics and physical therapy. We will begin with a question that intends to challenge a student physical therapist assistant’s knowledge on what is permitted in the physical therapy scope of practice in Florida.  We would dedicate three to four minutes to propose and discuss the activity. The proposed question is: “May a PT and/or PTA provide individualized nutrition counseling to a patient?” 

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To answer in depth, our research showed that in the state of Florida, it is illegal for a PT or PTA to provide individualized or group counseling for nutrition. Only a licensed dietician or nutritionist may offer services of goal setting, assessments, and counseling of nutrition care. Under the legislation of FS 486, in order to treat any individual issue with a dietary plan alone, you must have earned an Registered Dietitian or Nutritionist license. This short exercise can be iterated on in any number of ways with different questions being posed to the students. This would be an effective way to test students on their knowledge of Interprofessionalism in the healthcare field.

Conclusion

Dieticians and nutritionists are absolutely critical in the collaborative process of interprofessional care as it pertains to physical therapy. A patient cannot complete the interventions detailed in their individual plan of care if they do not have the energy, the vitamins, or the nutrients present in their body to complete their healthcare goals. Interprofessionalism is essential in the medical field and it can only lead to positive and beneficial outcomes for the patients. Proper interprofessional collaboration begins in the classroom; when students of medicine are taught the value of interprofessional care, they are much more likely to engage in it once they have a license to practice. Interprofessionalism is the most crucial aspect of healthcare and its value cannot be understated. As medical professionals, we should all endeavor to advocate for more prevalent and more effective interprofessional care.

References

S. Tsang, E., C. Cheung, C., & Sakakibara, T. (2016). Perceptions of interprofessionalism in health professional students participating in a novel community service initiative. Journal of Interprofessional Care, 30(1), 132–134. Retrieved from http://search.ebscohost.com/login.aspx?

Jakubowski, T. L., & Perron, T. J. (2018). Interprofessional collaboration improves healthcare. Retrieved from https://www.reflectionsonnursingleadership.org/features/more-features/interprofessional-collaboration-improves-healthcare

Cooper, C. C. (2019). Focus on nutrition generates demand for registered dieticians, nutritionists. Westchester County Business Journal, 55(2), 19. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=bwh&AN=134193840&site=ehost-live

Registered Dietician Career Overview (n.d.). Retrieved September 22, 2019, from https://www.nutritioned.org/registered-dietitian.html

DiMaria-Ghalili, R. A., Mirtallo, J. M., Tobin, B. W., Hark, L., Van Horn, L., & Palmer, C. A. (2014). Challenges and opportunities for nutrition education and training in the health care professions: intraprofessional and interprofessional call to action. The American journal of clinical nutrition, 99(5 Suppl), Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3985220/

Academy of Nutrition and Dietetics (June 1, 2018). Code of Ethics.

Retrieved from https://www.eatrightpro.org/-/media/eatrightpro-files/career/code-of-ethics/coeforthenutritionanddieteticsprofession.pdf?la=en&hash=0C9D1622C51782F12A0D6004A28CDAC0CE99A032