Question 2
Parenteral nutrition has long been implemented as a form of nutrition support to prevent protein-energy malnutrition. However, given that there are philosophical differences related to feeding between dietitians and other hospital staff, how might one deal with assessing patient needs and trying to implement nutrition recommendations which may not be in line with the recommendations of the nurses or doctors?
posted by Vanessa @ 12:39 PM
12 comments
12 Comments:
I would begin by bringing scientific support to the other health professionals and stating my case. I would explain why I think the research has validity and why the patient would benefit from an alternative approach to feeding. You could even point out specific biochemical indicators to be checked while the patient was on an “experimental” period with the new feeding. If you could collaborate with other health professionals and come to agreements with where you wanted to see certain lab values, maybe other health professionals would agree to keep the patient on a certain regimen. At the end, the MD has the final say, so I would obviously respect his decisions; however, I would continue to do research and bring studies and results to his attention if I really believed that the hospital or clinic’s nutrition support approaches needed to be altered.
A dietitian making a recommendation that may be against or in conflict with an MD or nurses recommendations needs to present significant evidence as to why their recommendations are correct and warranted for that particular patient. Extensively explain how your particular recommendations would improve the patient’s health by including the disease state, lab value indicators and other chart information to help your cause. By continuously providing research-based evidence to the other professionals, they will realize that you provide a valid point and will hopefully consider your form of treatment.
First, you would have to gather a knowledgeable base. You do not want to argue a point with strictly your opinions to support your claims. You need to show the Doctors/Nurses who do not see things the same way as you, how you, yourself, have come to the conclusion that this, indeed, is the better form of care for this particular patient. If you walk in prepared you will have a better chance of altering one's views on something. Even though you believe this is the best form of treatment you must also come into the situation with an open mind. You should be willing to hear the explanation of why the Doctor/Nurses think their form of treatment is the best for the patient. You may be surprised and end up revoking your initial plan of treatment.
If there are differences between RD's and other medical staff, there are a few things that the RD can do to ensure that the patient receives the best possible nutrition therapy. Finding supporting research can be beneficial, although even with supporting evidence staff members may still not agree. I think an important component of MNT is TEAM work. The RN's, RD's and Dr's need to work together and bounce ideas off of each other. It may even be beneficial to set up procedures for certain situations, which may prevent any differences when the time comes. The most important item to consider is the patient, if a therapy would be more beneficial over another the RD needs to fight for the patient and present the facts of why the situation should be handled a certain way. Hopefully over time RD's will become more respected and thus Dr's will listen to us when the situation arises!
I believe it is the RD's position to use their knowledge of nutrition combined with their assessment of the patient including lab values, health conditions, etc to make the best recommendation to the doctor. I agree with Stephanie that often times the best situations are a process of teamwork between the doctor, RD, and nurse. So I do believe that sometimes the most the RD can do is make their recommendation and then allow the doctor to make their decision. It is the RD's job to try and provide the best possible treatment for the patient and a poor relationship between the nurses and doctors will not help facilitate good care.
Shanell- I completely agree, research-based evidence is the way to go!! If you think about it, new research is being conducted every day to make health care (and many other) processes more effective. We aren’t doing our job as dietitians if we’re not reviewing pertinent articles and bringing the significant ones to the attention of other healthcare professionals.
If you, the RD, is suggesting a different treatment than what the MD or RN is suggesting, I would first find evidence that will help you support your case. If you can find the backbone as to why you think another option would be better than the one that the MD or RN is recommending, then you better have a strong case to support it. After you have found the evidence that would support your recommendation, I would present this information to the MD and other staff workin in the facility in a way that is not overpowering their tx beliefs. During this conversation, I would give the other professionals a chance to state why they believe the tx is a better option, and I would also present my case. I would hope to have present other "neutral" staff professionals so that they could hear both sides proposed. If they still decide that my tx recommendation is not currently what the pt needs, I would continue to find evidence that supports my case, but I would not interfere with the tx that they have decided upon because at least the pt is getting some form of nourishment!
Nutrition recommendations might be different between the MNT team; however, this is why there usually is a team when dealing with TPN. (however, not always the case)Everyone works together to come up with the best solution for the pt. Personally, I am not working with a team in the clinical setting; however, from discussing some of these issues with other clinical RD’s, it seems that RD’s are given more “responsibility” and “control” over the nutrition support depending on their setting. RD’s still have to keep current with research and be able to decipher which is best according to data found today and be able to support their decision/opinion with sound data.
I agree with you, Lauren. Even though we may research all of this data on the topic in order to plead our case, we may end up revoking our plan and go with what the physician or nurse suggests. It may make more sense after researching the specific topic.
I love the fact that Stephanie stressed the fact of TEAMwork. If each dividing organization in the hospital setting does not work together then the ultimate goal of the patient's wellness will never be achieved. This TEAMwork should be developed before the patient even steps into the hospital. Intiating a good communication throughout the many channels of the establishment is the first step in gaining TEAMwork.
I believe that Lauren brings up a great point that even though we may believe our answer/solution is the best, we should go into the situation with an open mind. Just because you think that your correct, they may have been an aspect that you may have overlooked. So in order to fully prepare yourself, it is important to do the research to be able to present you reasoning behind the treatment that you are wanting to choose, but also to be able to see the viewpoints of others in order to consider the full aspect of the situation!
Lauren and Shanell
I agree with both of you, as an RD we have our recommendations but whether the Docs or RN even read what we recommend is one point and if they would follow our recommendations is another point. It would be different if we specialized in this particular area and had a repore with docs and RN where they trusted and respected us enough to take our recommendations.
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