Strategies for Dietetic Communication

Strategies for Dietetic Communication Abstract This report contains information about the academic discourse, history, resources used, and communication skills, which make up an important arena for a professional in the dietetic profession. A brief explanation of the AMA style manual used in the dietetic profession is also outlined and compared to the APA style manual. There is a shared understanding of language and terminology that must exist in the dietetic profession, along with knowledge of the ever-changing nutrition world that a professional works in. It is important to know the history of the profession that a person works in to fully appreciate how it evolved to what it is today and who the people are that deserve credit for their hard work and determination. Many resources are involved in gaining knowledge and producing materials that will teach others as well. From journals to magazines, there are many sources that provide up to date, valuable information that can enhance the professional career of a dietetic profession al. Communication skills are the most important characteristic of a dietetic professional. The many ways a dietetic communicates is reviewed in this report. There are many areas to explore in the dietetic profession and that is what is being presented here. Dietetic Profession DISCOURSE A certain language and style of communication that is common among groups of people can be described as discourse. Ideas and rules are shared within a profession community to effectively communicate and comprehend the intended message. A functional structure is learned and becomes common language for those who are involved a certain profession. The discourse of dietetics involves many areas of study of which one must become familiar with in order to communicate effectively with other professionals in the field. A certain vocabulary and terminology must be researched, studied, understood, and communicated between members of this educated community. It is necessary to engage in the values, vocabulary, forms, and manners of the language to be able to effective communicate with those involved in Dietetic profession (1). Learning the discourse of Dietetics begins with the desire to become a professional in the field. One has to be open to learning the required material and master it. There is no end to the learning; it is a constant demand to keep oneself up to speed with what is going on in the current time. There are always more sources, advancements, and newer interests being sparked amongst professionals who desire to make a difference. A person who desires to work in the Dietetic field may have an interest in working with the community in a public health setting, in a clinic or hospital, long-term care, or possibly in food service management. The required curriculum is relative for all of the mentioned and provides a base for a good understanding of nutrition, interpersonal communication, and the health of those that seek Dietetic services. While the classroom sets the stage for what a student seeking a Dietetic degree needs, there is so much that is also learned while performing on-the job training and internship requirements. An important aspect of Dietetic coursework is having an understanding of multiple sciences. It is a challenging biological field and demands attention in the areas of nutritional and food sciences (2). Chemistry is important to study and understand how the human body breakdowns and uses energy. The food that goes into a persons body has chemical properties that are used as energy. It is necessary to complete human anatomy and physiology courses with a firm understanding of the bodys systems and how they work. Without a clear understanding of how the body works, there would be great mystery as to how the body receives, uses, and disposes of nutrients that are consumed. Communication skills are as important as any other skill when working with other professionals in dietetics, clients, and customers. It is necessary that dietetic workers have open communication with other professionals in different fields to ensure that proper treatment and education will be delivered to the client. A common language and terminology is necessary between members of the medical and nutritional field. It is necessary to have access to Merck manuals and medical terminology manuals as a desk reference. There is a difference in presentation when considering whom the audience will be. If a Dietetic professional is presenting to others in the field, it would be appropriate to use tables and graphs that display research finding on the new diabetes medication and its effects on certain ethnic groups. In this case, medical terms and treatment plans can be discussed using words and descriptions that might not be easily recognized by a client or someone unfamiliar with medical terms. It is very important to consider any communication barriers that may be present when counseling and discussing treatment plans with clients. Therefore, it is necessary to be flexible, have, and recognize the different levels of understanding of all different kinds of people. Mathematics is actively part of the day-to-day routine of dietetic personnel. Whether it is tallying up a clients caloric intake for the day or calculating how many kilocalories a certain patient might need in accordance to their body mass index, basic math and algebra come into play each day. If a dietetic professional takes the position of food service manager, that professional has the responsibility of budget preparation, employee hours, wages, training hours, and many other areas that require the use and implementation of mathematics. Most facilities use designated computer applications and programs to keep everyone involved organized and up to date with the care plan and treatment of patients. Altru Health Systems uses Carex and Affinity computer programs to aid in assessment, charting, implementing diet orders, tracking dietary intake, room service and meal management, and for the convenience of shared information between all disciplines that have access to the programs. This is a very useful and accurate way for everyone involved to stay on the same page and therefore be able to deliver better service to the patient. Problem solving skills are tested everyday as new health conditions and medical treatments are constantly changing. Each person who walks through the door requiring dietetic services is unique and needs assessment and screening to determine the best method for treatment and care. What works for one person, may not work for the other. Each care plan is tailored to the individual for any specific needs that may be present. There may be a point when a physician refers someone to nutrition health services for treatment and while assessing the patient, something does not quite match up or a new diagnosis may be necessary. In cases like these, all health professionals need to be up to date with testing and treatment procedures. Keeping up-to-date with the advancements and knowledge of the field through joining the American Dietetic Association can offer a variety of resources and opportunities to stay involved with the profession (3). There are quarterly meetings and continuing professional education (CPE) credits that professionals can take to keep up with the latest research. Health Magazines and newspapers are also great ways to keep up with what is going on in the profession. Someone who is working in a food service management position may not know what kinds of new medications are being used in combination with nutrition therapies and vice a versa. Experimentation is happening all of the time, especially if working as a clinical dietician. Finding the right diet fit for each individual takes trial, error and patience. With the obesity epidemic, Celiac disease, and other dietary related health highlights, it is necessary for the dietetic professional to be open to new ideas and trials of treatment. Research on how the body uses certain macronutrients, vitamins, and minerals can help professionals understand why certain things affect different people, while others may not be affected at all. Sanitation and food safety is key in providing healthful food to all people, especially those who already in a compromised state. September is National Food Safety Education Month, which was created to heighten the awareness of the importance of food safety (4). Proper hand washing, sanitation of workspaces, avoiding cross-contamination, proper cooling methods, and ensuring food is cooked and held for service at the appropriate temperatures must be implemented. A Serve Safe certification is necessary to obtain prior to completion of the outlined curriculum for the dietetic program. This certification is good for five years and needs to be renewed before expiration; otherwise, the course must be repeated to obtain a new certification. The Food Guide Pyramid was developed by the US Department of Agriculture to be used as a visual tool to help people make healthy food choices (5). This is a helpful guide for Dietetic professionals to use when counseling patients and designing meal plans. There is also a specific Food Guide Pyramid for patients with diabetes. The exchange system, in regards to carbohydrates, needs to be considered when preparing a healthy meal plan for this community of people. There are many sources, which can be accessed to aid members of this community in learning and developing a professional and working knowledge of the required technical language and methods used for effective communication. Reading academic journals, attending ADA meetings, joining committees, networking within, attending conferences and workshops, and reading health and nutritional magazines can all be great sources to discover the language used and the format in which the message is delivered. Dietetic Practice Groups (DPG) provides opportunities to increase knowledge through newsletters, publications and continuing professional education credits (6). People who have a shared interest in a more specific area of the profession set up these groups. The goals and interests of the ADA are upheld as new issues are explored and focused on. These groups can help members network and be part of a smaller group within a larger group, of which they become the expert on a specific topic or issue. The AMA style manual is used in the Dietetic profession and provides the appropriate format for citation and professional writing. The manual provides a guide for abbreviating and referencing materials that are commonly used in the writings of professional works. The ADA website, www.eatright.org, is a great place to find important communication information, ranging from sample letters to forms, to application assistance. The discourse of Dietetics is complex and takes time and interest to become the expert in. HISTORY The history of food and nutrition dates back as far as the beginning of recorded history. In the era of hunters and gathers, people knew that they had to eat in order to survive. The teachings and techniques that were used to obtain food at that time came from trial and error. It was up to the people to figure out which foods were suitable and which could possibly cause illness or even death. The importance of food, specific dietary patterns and disease prevention were observed in the Indian Ayurvedic tradition, dating back to 2500 BCE (7). Looking beyond the medieval era, western science and medicine developed ways of thinking about food and health between 600 BCE and 300 CE (7). Societies throughout each era have looked at diet and nutrition as a means of healthy living and survival. Through the Renaissance and up to the eighteenth century, reports have noted that diet and nutrition were an integral part of having a fulfilled life (7). Many documents from ancient and historical times have evidence that inventions for food processing were becoming common knowledge and new foods were being discovered. In this time, food was mostly produced and consumed entirely within the local area. A familys nourishment was provided by the food that was grown and prepared within the family and exchanged with nearby neighbors. Cooking and preservation techniques at this time were not necessarily safe but were evolving towards more advanced processes. During the Industrial Revolution, the introduction of railroads and wagon roads made the transfer of goods possible at greater distances. This shift began to affect the foods that people had access to and what they ate (8). The science of nutrition began to emerge in the early to mid nineteenth century. During this time, both Europe and the United States were influenced by their governments to increase the yield of food from plant crops and animal herds (7). Food production held a very important role in nourishing the soldiers who were fighting in the war. Safe food was soon found to be the key for survival of troops, especially those who had been wounded and needed proper nourishment to fight illness and infection. Dietetics as a profession can be linked back to the evolution of home economics (9). The early evolution of food and nutrition science was explored to feed soldiers in battle and to also to provide necessary nutrition to those who were preparing to become young soldiers. Nutrition and appropriate food choices were demonstrated to young families to ensure healthy individuals. World War I brought food shortages. Those who were knowledgeable in dietetics encouraged others to plant gardens and learn how to develop recipes for home and hospital use. Both world wars experienced the creation of dietetics as a profession (9). Many important people deserve credit in the history of Dietetics. Far more than five people contributed to its development. Dietetics is largely applied by the use of chemistry. It is necessary to recognize Antoine Lavoisier, who is known as the Father of Chemistry. Lavoisier was born into an upper class, Paris family in 1743. He was able to obtain a law degree at the College Mazarin, though he never practiced law. He had more interest in mathematics and science and gained membership into the Academy of Sciences at 25 years old. (10). Lavoisier had many contributions, which include the assistance in establishing the metric system, to naming 33 elements of periodic table. He died at 51 from literally losing his head. He was found guilty of conspiracy against the people of France. Wilbur Olin Atwater, an American chemist, was born May 3, 1844 in Johnsburg, New York. Atwater is known for his studies in human nutrition and metabolism. He pursued an undergraduate degree at Wesleyan University in Connecticut and later went on to obtain his PhD from Yale Universitys Sheffield Scientific School in agricultural chemistry (11). Atwater invented a device called the respiration calorimeter that measured human metabolism balance by analyzing the heat produced and metabolic rate by a person performing certain activities. This new invention aided many new studies in dietary evolution and food analysis (7, 8, 11). Energy and protein sources were studied and measured to determine that certain foods provide different amounts of nutrients and energy than others. The fat, protein, and carbohydrates of all different kinds of foods were observed and soon there was an awareness of the food calorie. Atwater continued to lead research teams on the discovery of nutrient requirements, food composition and consumption, and consumer economics (12). Throughout his discoveries, Atwater determined that Americans eat more unhealthful foods than desired and do not exercise enough. Florence Nightingale, born 1820 in Tuscany into an upper class family, needs to be mentioned as a contributor to Dietetics as she was the one who acknowledged the need for safe and nutritious food for soldiers during the Crimean War (13). She was actually a pioneer nurse in her time and was determined to improve the living conditions at the camp hospitals and made an effort to clean and organize facilities where patients were cared for. Her contributions helped spread awareness of the necessity for clean, safe, and nutritious foods. There is a long history of health and nutrition and the involvement and contribution of many people and their discoveries has made great progress. Most of the progress has been made in the last 100 years, as new technologies have been a great asset to nutritional health and implementation. Scientific advances, social and economic factors, and military conflicts are contributors to the advancement of the dietetic profession as well. The most important contribution would have to be the determination and dedication by early dietitians who knew that there was a difference to be made and that they were the ones who would be able to make that difference. The understanding and importance of good eating habits was not common, not known, or perhaps just not understood by most of society. Scientific experiments were documented and scholarly journals written about nutrients, but they were almost impossible to understand by anyone who was not in the dietetic profession. Alice Blood was the one who would be able to put all of the difficult works into something that could be understood by large public audience. She translated science-based nutrition information into easy-to-read pamphlets in an effort to educate people on good nutrition. Alice Blood obtained a bachelors degree from Massachusetts Institute of Technology and a PhD in biochemistry from Yale. She also held the title of director at the School of Household Economics at Simmons College in Massachusetts (14). Many changes came about in 1917 for the dietetics profession and many women contributed to these changes. A new organization, the American Dietetic Association [ADA], was born in the fall of 1917 when more than 100 women organized a meeting in Cleveland to discuss multiple issues within dietetics. Lulu Graves, a dietician in Cleveland, held a strong position that dietitians play an important role of the medical team and that when nutrition services are offered to patients, money is saved (14). This is a time when dietitians had the primary role of feeding the wounded and sick in hospitals. The doctors were the ones who could prescribe special diets for treatments and dietitians were like the physicians assistants. At this point, doctors were primarily male and all dietitians were female. Graves stressed the importance of scientific training for dietitians and knew that the future of dietetics would be assured. Lulu Graves was elected the first president of the ADA (15). At the first meeting, many issues were discussed especially concerning food conservation and global food needs. This was an important time for the Association to come together, as World War I was still in full. The annual meeting to follow had greater attendance and included more states involvement. By the sixth annual meeting, which was held in Indianapolis in 1923, insulin was presented as the new treatment for diabetes (15). Insulin was discovered and isolated at the University of Toronto in 1921-1922 by Dr. Frederick Banting (16). Insulin is a hormone that is produced in the pancreas and is necessary to keep glucose levels in the blood at a safe and functional level. This was a major event in dietetic history, as the diagnosis and treatment of type 1 and type 2 diabetes continues to be largely addressed. Food technology was on the rise going into the 1930s. Refrigerators, toasters, canned goods, frozen vegetables, sliced bread and many other developments were introduced. These new preparation and storage methods provided more convenience for keeping food on hand. Obesity became a health concern, which was the topic of discussion towards the end of the 30s. Soon to follow would be the opening of the first McDonalds and Dairy Queen in the early 1940s (15). If what was known then about the negative health affects Americans would experience from frequenting fast food chains, one has to wonder if there would be any earlier changes in the way food is processed and produced for these places. Martha Lewis Nelson was a pioneer in exploring total education of dietitians (14). The original dietetic program was a four-year course at a University with a major in food and nutrition with a six-month dietetic internship. In 1942, Lewis was the director of Medical Dietetics at Ohio State University and she redesigned the internship program, making it possible to earn a Master of Science degree along with the internship (14). Many institutions today use this curriculum to develop education programs for dietetics. In 1966, nutrition and diet therapy services were included in comprehensive medical care programs. Clare Forbes, a Massachusetts delegate to the ADAs House of Delegates, was the force behind this movement (14). Forbes is credited for developing future state legislative programs and guiding the development of the ADAs mission statement (14). Twenty-six years ago, in 1982, the ADAs capacity to reach the public on food nutrition, and health concerns was forever changed. A new resource center, National Canter for Nutrition and Dietetics, was funded through a capital fund program (15). National Nutrition Month is one of the outreach programs that are very active today. The purpose of National Nutrition Month is to help make people aware of necessity of a healthy lifestyle and diet. Many more factors go into health other than just what a person eats. Diet and exercise go hand in hand. If it were not for the good old girls Blood, Graves, Lewis Nelson, and Forbes, the American Dietetic Association may not exist today. It is up to those in the profession to get the message out to the public about good health and nutrition so that money and lives can be saved in the end. Over the past 20 years, many new diet fads have been introduced. Some of these diets have proven to be effective and safe while others are affective and unsafe. Most often the results are temporary, as the people get bored with the same food or routine and then end up failing. Reading nutrition labels and ingredient lists on foods has become more popular in the past couple of years as people now have a better idea of what they are looking for. There are multiple commercials, newspaper articles, and health magazines that give health alerts to new findings in the food that people eat. With all of the sources in which nutrition facts and health information can be found, Americans are far more educated now than they ever have been before. The image is to get into shape and live healthier lifestyles. The advancements in medical technology have expanded the role of the dietetic professional on so many levels. Special diets, mechanically altered foods, and diagnosis of new disease conditions have forced nutritional professionals to test and experiment with new ways of feeding patients and ensuring that they are receiving appropriate nutrition. RESOURCES From academic journals to informational web sites, dietetic professionals look to many sources each day for updated health information and new discoveries. As a dietetic technician, registered dietician, nutritionist, or educator of dietetics, it is necessary to have many resources readily available. Educating and keeping up to date with the latest and greatest is the responsibility of each individual to ensure that they are providing the best possible care to patients. Since there are different focus areas in the dietetic profession, it is necessary to identify the best possible resources in which to keep each self informed and to continue learning day to day. The first major reference that is read and referred to regularly is the Journal of the American Dietetic Association. This journal covers practice applications, research that has been conducted, a calendar of events, new products and services, and a list of periodicals abstracted. Any area of study in the dietetic profession will be able to find useful information is in the journal. There is also a listing of job opportunities and advertisement for education at the back of the journal. Contact information is provided for non-dietetic professional to contact those who are in the profession (17). Elsevier Inc. in New York, NY publishes the Journal of the American Dietetic Association monthly. The copyright belongs to the American Dietetic Association with all rights reserved (17). Journals can be ordered from the publisher, found in public and school libraries and accessed online. There are certain journals that will most often be on the desks or bookshelves of those in the dietetic profession. The American Journal of Clinical Nutrition is a publication of the American Society for Nutrition (18). The major focus of this journal is to provide information from clinical studies that have been conducted on basic human nutrition. This is a wonderful source to keep professionals up to date with the newest results from experiments and findings that have been performed by researchers and scientists. Using this journal as a reference is important, as all research is relevant to those in the profession. This journal is published monthly with two volumes per year in Bethesda, MD (18). Print and online subscriptions are available to both members and non-members of the dietetic profession. This journal can also be found in libraries. The Journal of Nutrition provides professionals with information on experiment nutrition, controversial issues in nutrition and critical reviews of nutrition scientists. This journal began circulation in 1928 as the official publication of the American Society for Nutrition. The journal publishes manuscripts that advance the understanding of nutritional mechanisms in the human population (19). This journal is also published monthly in Bethesda, MD. Anyone who has a membership in the American Society for Nutrition has access to the online version of the Journal of Nutrition. The journal can be found in the library and subscribed to through the publisher. Another journal, Nutrition, is designed as both an open access online journal and as a hardcopy version published by Elsevier. The interest of the journal is to publish results from clinical trials performed by physicians and scientists of all fields that aim to find better ways of determining treatment and diagnosis. Research articles, case studies, and peer reviews are all included in this journal. BioMed Central is the independent publisher of Nutrition journal online. Once articles are accepted and published by BioMed Central, they are also accessible at PubMed Central and MEDLINE (20). Access to BioMed Central can be achieved by using the URL: http://www.biomedcentral.com. Nutrition Research journal is An International Publication to Advance Food and Life Science Research (21). The journal is another one of many publications that is from Elsevier. Dietetic professionals refer to this journal for the latest articles and reviews of basic and applied nutrition, global communication of nutrition, and research on food and health. The purpose of the journal is to provide an advanced understanding of nutrients and how dietary components improve health conditions in humans. The publication of Nutrition Research began in 1981 (21). There is a Nutrition Package that can be purchased which includes the fore mentioned Nutrition Journal and the Nutrition Research journal, which is available through Elsevier. The American Journal of Health Behavior is the official publication of the American Academy of Health Behavior. PNG Publications in Star City, WV publish this journal bimonthly. Members of the American Academy of Health Behavior receive the journal as part of their membership. Online access to the journal is included in the membership (22). The journal provides valuable information on maintenance, restoration, and improving health using multiple methods. Information on how behavior causes health affects and how health care programs can and have been implemented can be found in this journal as well. This journal is a valuable tool for dietetic professionals, as the studies included give information that can be used when educating patients and designing diet plans and healthy lifestyle outlines. A professional in dietetics who wishes to become an educator would find it a good idea to become part of the Society for Nutrition Education [SNE]. With a membership to SNE, professionals have access to the Journal of Nutrition Education and Behavior. Elsevier in New York, NY publishes the journal bimonthly (23). Journal articles and abstracts are accessible online at MEDLINE and www.jneb.org. Information that is found in the journal and online is beneficial for all levels of education. From school-aged children learning about the food groups to parents learning about appropriate feeding patterns, this resource will help educators with all levels of cliental. Four major magazines most often appear on the desks or end tables in the offices of dietitians and other nutrition professionals. Todays Dietitian is the most popular magazine subscription, which includes a wide range of health topics such as diabetes management, food allergies, research updates, and long-term care information. Great Valley Publishing Co., Inc. in Spring City, PA publishes this magazine (24). This magazine is very informational and easy to navigate to find exactly what a person is looking for. Todays Diet Nutrition offers expert information on issues such as eating right, exercising and getting results. Like the Todays Dietitian magazine, Great Valley Publishing Co. Inc. publishes Todays Diet Nutrition in Spring City, PA (25). Food, fitness, knowledge, and balance are all important aspects in living a healthy life and this magazine has valuable information to help the health-conscious person achieve what they are looking for and working toward. This magazine is published bimonthly. Most libraries carry this subscription and it can be purchased at Barnes Noble and many other retail outlets. A magazine that offers the newest information on fad diets and newly discovered functions of nutrients is Nutrition Today, published by Lippincott Williams Wilkins in Philadelphia, PA (26). The magazine covers topics of nutrition science, obesity and behavior, nutritional guidelines, and the business of nutrition and roles of the nutritional professional. Information found in this magazine is from credible sources, which includes scientists and nutritionists who back their reports and findings with evidence. This is a very good source to reference when seeking information about the latest diets and up-to-date controversial issues in dietetics. Continuing education and keeping oneself up to date is extremely important in the dietetic profession. Registered dietitians and technicians can complete Continuing Professional Education (CPE) credits in a number of ways. One great resource for this is the Topics in Clinical Nutrition magazine, published in Philadelphia, PA by Lippincott Williams Wilkins (27). New and updated issues are addressed and current research results are provided to keep professionals up to speed with the ever-changing world of nutrition. Members of the American Dietetic Association can become part of Dietetic Practice Groups (DPG), which focus on certain areas of nutrition and health. Newsletters are printed monthly or quarterly, depending which group the member is involved in. These newsletters are available online as well as hard copy. Copyright belongs to the American Dietetic Association and is published by Elsevier Inc (28). The Nutrition Research Newsletter is a monthly newsletter published by Technical Insights/Frost Sullivan in San Antonio, TX (29). The latest developmen