Date of Award

2014

Degree Type

Thesis

Degree Name

Master of Public Health

School

School of Exercise and Health Sciences

Faculty

Health, Engineering and Science

First Advisor

Dr Amanda Devine

Second Advisor

Dr Therese O'Sullivan

Abstract

The Nutrition Care Process (NCP) and accompanying International Dietetic and Nutrition Terminology (IDNT) has been endorsed internationally as the standard model for nutrition care. However, there is limited published Australian literature on the implementation of the NCP and IDNT including the attitudes, knowledge and support requirements of dietitians to facilitate this. This study aimed to develop and test a survey to assess attitudes, support and knowledge of NCP and use the findings in conjunction with literature to design and implement a NCP package and evaluate the package.

The research was conducted in two phases: (1) formative research to inform development of the implementation package, and (2) implementation and evaluation. Phase One involved dietitians from two hospitals who had undergone informal NCP implementation in Queensland (termed “postimplementers”) and three hospitals in Western Australia who were yet to implement the NCP (termed “pre-implementers”) completing an online questionnaire, Attitudes Support Knowledge NCP survey (ASK NCP). This questionnaire surveyed demographics, knowledge, familiarity, confidence, support, value, barriers and training requirements for NCP. From this a NCP implementation package and resources were developed for the implementation of step two of the NCP specifically, in conjunction with literature and a change management framework. In Phase Two, the NCP implementation package was implemented over a 5-month period at two test hospitals that were yet to undergo implementation, whilst a control hospital did not receive the package. Evaluation occurred by re-administering the ASK NCP survey to the test and control sites and by conducting focus groups at the test sites.

The fist phase of the study demonstrated that post-implementers had higher knowledge scores, were more familiar with NCP and more confident to implement then pre-implementers. Time required to implement was a concern for all participants. Lack of knowledge, training/support and resources were barriers to implementation for the pre-implementers. Post implementers identified that dedicated time to practice and regular tutorials; support and leadership from management; and professional growth through understanding how change could benefit practice were keys to successful implementation. Phase Two showed that the resulting NCP implementation package led to significantly higher NCP knowledge scores and confidence to use step two in practice within the test group. Emerging themes from focus groups included the usefulness of the package to build confidence, the value of education and resources, peer support and leadership team establishment.

This research has resulted in the development of a structured NCP implementation package focusing on step two of the NCP, for hospital dietitians that utilises a change management framework to support NCP in practice. The evaluation of the package provides support for future implementation of NCP in clinical dietetic practice

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