RESUMEN
Nutrition support is a therapy that crosses all ages, diseases, and conditions as health care practitioners strive to meet the nutrition requirements of individuals who are unable to meet nutrition and/or hydration needs with oral intake alone. Registered dietitian nutritionists (RDNs), as integral members of the nutrition support team provide needed information, such as identification of malnutrition risk, macro- and micronutrient requirements, and type of nutrition support therapy (eg, enteral or parenteral), including the route (eg, nasogastric vs nasojejunal or tunneled catheter vs port). The Dietitians in Nutrition Support Dietetic Practice Group, American Society for Parenteral and Enteral Nutrition, along with the Academy of Nutrition and Dietetics Quality Management Committee, have updated the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs working in nutrition support. The SOP and SOPP for RDNs in Nutrition Support provide indicators that describe the following 3 levels of practice: competent, proficient, and expert. The SOP uses the Nutrition Care Process and clinical workflow elements for delivering patient/client care. The SOPP describes the 6 domains that focus on professional performance. Specific indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs and are intended to be used as a self-evaluation tool for assuring competent practice in nutrition support and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.
Asunto(s)
Dietética , Nutricionistas , Academias e Institutos , Competencia Clínica , Nutrición Enteral , Humanos , Estados UnidosRESUMEN
Nutrition support is a therapy that crosses all ages, diseases, and conditions as health care practitioners strive to meet the nutritional requirements of individuals who are unable to meet nutritional and/or hydration needs with oral intake alone. Registered dietitian nutritionists (RDNs), as integral members of the nutrition support team provide needed information, such as identification of malnutrition risk, macro- and micronutrient requirements, and type of nutrition support therapy (eg, enteral or parenteral), including the route (eg, nasogastric vs nasojejunal or tunneled catheter vs port). The Dietitians in Nutrition Support Dietetic Practice Group, American Society for Parenteral and Enteral Nutrition, along with the Academy of Nutrition and Dietetics Quality Management Committee, have updated the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs working in nutrition support. The SOP and SOPP for RDNs in Nutrition Support provide indicators that describe the following 3 levels of practice: competent, proficient, and expert. The SOP uses the Nutrition Care Process and clinical workflow elements for delivering patient/client care. The SOPP describes the 6 domains that focus on professional performance. Specific indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs and are intended to be used as a self-evaluation tool for assuring competent practice in nutrition support and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.
Asunto(s)
Competencia Clínica/normas , Dietética/normas , Apoyo Nutricional/normas , Nutricionistas/normas , Academias e Institutos , Humanos , Sociedades Médicas , Estados UnidosRESUMEN
Clinical simulation training provides a realistic environment for students and healthcare professionals to strengthen and broaden skills and abilities. This type of learning experience creates a controlled environment in which learners may attain new skills or further develop skills that positively impact patient outcomes. Although few studies exist regarding the use of clinical simulation training and nutrition support practitioners, preliminary data following a small-bowel feeding tube (SBFT) insertion workshop for intensive care unit registered nurses and registered dietitian nutritionists showed potential use in this realm. The purpose of this paper is to provide a basic overview of clinical simulation learning, review literature related to clinical simulation in healthcare, and discuss the recent implementation of a SBFT insertion workshop incorporating clinical simulation learning.
Asunto(s)
Nutrición Enteral/instrumentación , Intubación Gastrointestinal/métodos , Entrenamiento Simulado , Nutrición Enteral/enfermería , Nutrición Enteral/tendencias , Humanos , Unidades de Cuidados Intensivos/tendencias , Intestino Delgado , Intubación Gastrointestinal/enfermería , Intubación Gastrointestinal/tendencias , Nutricionistas/educación , Entrenamiento Simulado/tendencias , Terminología como Asunto , Factores de Tiempo , Recursos HumanosRESUMEN
This article provides a clinician's guide to nutritional support of the burn patient. The authors review the assessment and management of the needs of the thermally injured patient and provide recommendations on replacement and supplementation with calories, protein, carbohydrates, lipids, fluids, and minerals. Furthermore, the authors compare and contrast enteral versus parenteral delivery of nutrition.
Asunto(s)
Quemaduras/terapia , Nutrición Enteral , Nutrición Parenteral , Quemaduras/metabolismo , Quemaduras/fisiopatología , Ingestión de Energía , Metabolismo Energético , HumanosRESUMEN
BACKGROUND: The purpose of this study was to evaluate the success rate, outcomes, and cost-effectiveness of blind bedside placement of postpyloric feeding tubes by registered dietitians. Feeding tubes placed by a physician using fluoroscopy were used to benchmark certain study parameters. MATERIALS AND METHODS: Patients who underwent postpyloric feeding tube insertion between June 1, 2007, and May 31, 2011, were included in the study. Medical charts were reviewed for the time span between physician order and procedure documentation, bedside feeding tube tip location, number of radiographic images to confirm placement of tubes placed at the bedside, physician clearance to use the feeding tube when applicable, and reported complications. Patient charges for each procedure were also compared. RESULTS: Data were collected on 729 patient encounters, with 285 encounters per study group and 159 encounters excluded for incomplete documentation. The average time span to bedside procedure completion was 3.7 hours compared with an average of 4.2 hours for insertion using fluoroscopy. Dietitians achieved postpyloric access 73% of the time, and an additional 16.8% of bedside tubes were deemed appropriate for use for gastric feeding. The majority of bedside insertion encounters required 1 abdominal radiograph to confirm placement, and no reported complications were associated with either technique. A 66% reduction in patient charges was associated with bedside tube insertion. CONCLUSION: Based on this sample, blind bedside postpyloric feeding tube insertion by registered dietitians may be a safe, cost-effective method for achieving short-term feeding tube access in the hospitalized patient.