German Nutrition Care Process
The German Nutrition Care Process (G-NCP) is a process model in dietetics that consists of five sub-steps (nutrition assessment, nutrition diagnosis, planning of the nutritional intervention, implementation of the nutritional intervention, monitoring and evaluation). It is primarily used by dietitians as a structured guide for holistic, science-based and result-oriented nutritional support for users and user groups. This model enables the comparability of actions in dietetics both nationally and internationally. Like the development of the nursing process in the nursing professions, the G-NCP must also be viewed against the background of the professionalization of the professional group of dieticians.
Depending on the legal situation and the process content, this process model can also be used by other professional groups, e.g. B. nutritionists or dietitians are used.
Definition and purpose
The German Nutrition Care Process (G- NCP) is a method of systematic problem solving that is used by dietitians in order to be able to make reflective decisions that enable nutrition-related interventions to be carried out effectively, in a user-oriented, quality-controlled manner.
Standardized procedures and uniformly defined terminology (e.g. the coding of diagnostic criteria) are intended to achieve a high level of quality and comparability in all areas of activity of dietitians in Germany.
background
Due to process models already established worldwide in the field of activity of dietitians (Nutrition Care Process (USA), Nutrition and Dietetic Care Process (UK), Methodisch Handelen (NL), Diaetologischer Prozess (AT)), it came about in Germany in 2009 and then on a pan-European level Discussions about process-guided work by dietitians. These prompted the European Federation of Associations of Dietitians (EFAD) to issue a recommendation to its member states in 2014 to establish a process model. The Association of German Dieticians e. V. (VDD) has been developing a version of the Nutrition Care Process (NCPs) modified for Germany - the G-NCP - since 2012. The reason for the modification was the limited transferability of the American NCP to Germany. The G-NCP manual was published in 2015. The G-NCP has already been taken up by several authors, such as the "White Paper on Obesity", which is a standard work for the care of obese people in Germany, and in the "Framework agreement on quality assurance in nutritional advice and nutrition education in Germany."
The G-NCP model
The G-NCP model is a visualization of the process.
At the center of the G-NCP model is the relationship between the dietician and the user. The term “user” s comes from English (“user”) and neutrally subsumes the terms patient, client, customer or group.
The middle ring describes the dietetic competence of dietitians. In principle, action competence is made up of several dimensions and relates to the concept of competence by John Erpenbeck from 2007. According to this, competencies such as behavioral dispositions and the ability to act lead to self-organized action and self-reflection at work.
Dietary action competence includes:
- Evidence Based Dietetics Practice
- Professional ethics and professional guidelines
- Clinical reasoning
- Intra- and interprofessional collaboration
Evidence Based Dietetics Practice (compare Evidence-based medicine , evidence-based medicine ) means that the measures carried out are based on the best available scientific evidence, but also on the experience of the dietitian and the values and circumstances of the user and are based on basic ethical principles. Professional ethics and professional guidelines: Professional ethics include professional guidelines and the professional code. The professional guidelines form the basis of action in dietetics and are to be understood as principles of professional self-image. The professional code (International Code of Professional Ethics and Code of Good Practice), on the other hand, formulates basic ethical principles.
Clinical reasoning means that clinical argumentation, conclusion, evidence and the associated thought and decision-making processes guide and influence action in dietetics. Clinical Reasoning includes various abilities (skills), which also includes critical thinking, the Critical Thinking , is subsumed. Critical thinking here means “the regulated and intellectual process of actively and skillfully conceptualizing, applying, analyzing, synthesizing and / or evaluating information collected through observation, experience, reflection, clinical judgment (reasoning) or communication, and the professional Acting as well as guiding convictions ”, understood.
Intra- and interprofessional collaboration means that collaboration within the professional group and with other professional groups, such as B. doctors, nursing staff and / or other health professions as well as nutritionists and nutritionists, is a prerequisite for optimal care of the user.
The outer ring shows the environmental factors that influence the nutrition-related measures: economy , setting , social system and health system .
The process steps of the G-NCP are listed in a clockwise direction between the center and the rings.
The process steps of the G-NCP
The G-NCP consists of five successive process steps
- Nutritional assessment
- Nutritional diagnosis (PESR statement)
- Planning the nutritional intervention
- Implementation of the nutritional intervention
- Monitoring and Evaluation
The process starts with a referral (e.g. medical certificate of necessity or psychological report) or the user's own request. Likewise, positive screening carried out by caregivers, e.g. B. on malnutrition, at the start of the G-NCP.
Nutritional assessment
Definition: “The nutritional assessment is an ongoing, non-linear, dynamic process that includes an initial assessment, but also a continuous re-assessment. It also forms the basis for the continuous status analysis of the user in relation to specifically defined criteria. ”The aim is to record the user holistically and not just in relation to his food intake.
In contrast to the nutritional history, the nutritional assessment is broader. The nutritional assessment is a spiral, non-linear process in which several work steps take place in constant interrelation. In the data check, the collected data of the user are checked with regard to their influence on the nutritional and health status. When clustering, the data obtained is sorted and systematized. Orientation is provided by the bio-psycho-social model of the [WHO International Classification of Functioning, Disability and Health (ICF)] , which provides categories through which all aspects, on the one hand the overall biophysical situation and on the other hand the living environment of the user, are taken into account Find. The comparison of the user's data with standard or target values leads to the identification of the nutritional problem. The principles of Evidenced Based Dietetic Practice are applied; the best available scientific evidence is used for the comparison, taking into account the frame of reference. During the assessment [see also nursing assessment ], a variety of assessment instruments are used depending on the situation. These include various screening tools , nutrition logs (see also consumption log method ), anthropometric measurements, measurements of body composition and, if necessary, hand strength, as well as measurements of the resting energy requirement .
Only through the interaction of the data can the nutritional problem be comprehensively recorded and the correct nutritional diagnosis made based on this.
Nutritional diagnosis
| Medical diagnosis | Nutritional diagnosis |
| falls within the legal competence of the doctor; this results in decisions for medical diagnosis and therapy. | falls under the legal responsibility of the dietitian (§3 DietAssG 1994); from this arises the responsibility for the selection of the goals and measures of the nutritional intervention. |
| refers to a disease or organ disorder | describes a nutritional problem that can be solved independently by dietitians, |
| most of them have no relation to the family or the everyday life of the patient, | takes family / community and everyday life into account (activity, participation, personal and environmental factors), |
| remains the same until the disease or organ disorder is cured. | can change continuously. |
Source: Comparison of medical and nutritional diagnosis based on EVESLAGE 2006: 7 and VDD 2015: 44
The PESR statement
The nutritional diagnosis is summarized in a standardized form using the PESR statement. A PESR statement is formulated for each nutritional problem identified.
It consists of four components:
P = stands for problem and forms the core message of the nutritional diagnosis. The problem does not describe the illness, but rather the resulting nutritional consequences or the nutritional risks that could lead to an illness.
E = stands for Etiology (etiology / cause) and describes the causes that trigger the nutritional problem.
S = stands for symptoms and describes the signs that prove the nutritional problem. A distinction is made between objective (measurable by parameters) and subjective (described by the patient) symptoms that are specific to the nutritional problem.
R = stands for resources, properties or forces that are available to the user (e.g. through his environment such as family, friends, other actors in the health system ) in order to master the nutritional problem.
Example 1 for a PESR statement in nutritional advice for the medical diagnosis of lactase deficiency (ICD E73.1):
P (problem) = too little calcium intake
E (Etiology) = fear of intolerance when consuming dairy products
S (symptoms) = calcium deficit of approx. 500 mg / d
R (resources) = high motivation and curiosity, user likes to cook
Example 2 for a PESR statement in clinical nutrition for the medical diagnosis of bronchial carcinoma (ICD C34.8):
P (problem) = insufficient protein and energy intake
E (Etiology) = treatment- related , effects of chemotherapy on food intake
S (symptoms) = hardly possible to eat orally, vomiting episodes 3 times a day, weight loss of 3 kg in 2 weeks, decrease in the phase angle according to BIA measurement from 6.2 to 5.8 ° within 2 weeks
R (resources) = support with the provision of food by family members, accompanying support by caregivers or the mobile care service
Planning the nutritional intervention
Definition: “A nutritional intervention comprises a set of activities and related materials that are used to solve the nutritional problem. It is used with the intention of changing nutritional behavior, risk factors, conditions / factors of the environment / the surrounding area, health or nutritional status of individuals, groups or a community. "
On the basis of this, the results from the nutritional assessment and nutrition diagnosis are essential for the planning process step. The nutritional intervention is primarily aimed at eliminating the cause of the nutritional problem and uses the resources identified by the user. If the cause of the nutritional problem cannot be eliminated, an improvement in the symptoms is sought.
If there are several nutritional problems, prioritization is necessary in order to weigh up the importance and urgency of dealing with the nutritional problems. Criteria such as the severity of the nutritional problem, security, the likelihood of solving the nutritional problem through the intervention and - whenever possible - the needs, expectations, ideas and resources of the user are taken into account.
Planning includes the following components:
- Define goals
- Select appropriate form (s) of intervention
- Determine the frequency and duration of the contacts
- Define monitoring parameters and time of review
The following types of intervention can be distinguished:
- Ensuring nutrition (oral, enteral, parenteral)
- Nutritional management
- Nutritional communication: nutritional information, nutrition education, nutrition training (instruction / education), nutritional advice
Implementation of the nutritional intervention
Definition: “When performing the nutritional intervention, a dietitian performs a complex of activities in order to solve the nutritional problem of the user. The first basis for this is the action plan fixed in writing in the previous process step (planning the nutritional intervention). "
If other actors are involved in the implementation, coordination and supervision must be carried out by the dietitian .
Monitoring and Evaluation
Definition of monitoring:
Under Monitoring refers to the previously scheduled observation and measurement of selected parameters, the statements of changes in the status of the user allow at different times in the course of the G-NCP.
Definition of evaluation:
Evaluation is the systematic review of the user's progress with regard to the nutritional diagnosis, the intervention goals and the anticipated result, as well as the effectiveness of the measures taken by the dietitians at the end of the process.
The monitoring and evaluation in the G-NCP serve not only to determine the user's progress in solving his nutritional problem, but also for the systematic review of the intervention goals and the assessment of the professional behavior of dietitians. The following questions are of essential importance:
- Has the user's nutritional problem been resolved?
- Have the user's intervention goals been achieved?
- Has there been any improvement in symptoms in the user?
- If goals and improvements were not (fully) achieved, why not?
Components of monitoring and evaluation
Monitoring and evaluation include the assessment of all measures that have been agreed with and implemented by the user. In order to ensure professional action during monitoring and evaluation, the following points should be included:
- Checking whether the user has understood the goals of the intervention.
- Adherence ( adherence ) in the diet intervention.
- Transfer and Persistence.
- Checking that the nutritional intervention was implemented as planned.
- Collection of monitoring parameters or evaluation indicators that prove that the nutritional intervention was successful or that prove whether the behavior / nutritional congestion of the user has changed or not.
- Collecting reasons that explain a lack of / only slow progress.
- Justification of results based on data.
In particular, the verification of the transfer must be emphasized in this process step and represents a special requirement. This means whether the user can integrate and implement what he has learned from the nutritional intervention in his everyday life.
Outcome Management System
The task of the outcome management system is to externally evaluate the effectiveness and efficiency of the entire process. The outcome management system thus assesses the effectiveness and efficiency of the work of dietitians .
documentation
All process steps must be documented. The aspects of the Patient Rights Act must be taken into account.
literature
- Association of Dieticians - Deutscher Bundesverband e. V. (VDD) (Hrsg.): Manual for the German Nutrition Care Process (G-NCP). 1st edition. Pabst Science Publishers, Lengerich 2015, ISBN 978-3-95853-119-2 .
Web links
- Website: German Nutrition Society
- Website: European Federation of Association of Dietitians
- World Health Organization
- Nederlandse Vereniging van Dietisten
- The British Dietetic Association
- The Academy of Nutrition and Dietetics (USA)
- Association of Dietologists in Austria
Individual evidence
- ↑ a b c d Association of Dieters - German Federal Association e. V. (VDD) (Hrsg.): Manual for the German Nutrition Care Process (G-NCP). 1st edition. Pabst Science Publishers, Lengerich 2015, p. 33.
- ↑ a b Association of Dieticians - German Federal Association e. V. (VDD) (Hrsg.): Manual for the German Nutrition Care Process (G-NCP). 1st edition. Pabst Science Publishers, Lengerich 2015.
- ^ Academy for Dietetics and Nutrition: The Nutrition Care Process (NCP). cited June 23, 2016.
- ↑ The Association for UK dietitians: The Nutrition and Dietetic Care Process. cited June 23, 2016.
- ↑ Nederlandse Vereniging van Dietisten: Methodically trading. cited June 23, 2016.
- ^ Association of Dieticians Austria: The Diaetological Process. cited June 23, 2016.
- ↑ EFAD- European Federation of Association of Dietitians Professional Practice Committee (PCC) (2014): Vision paper: The Implementation of a Nutrition Care Process and Standardized Language (SL) among dietitians in Europe.
- ↑ D. Buchholz et al: The Nutrition Care Process and a standardized language in dietetics - Status Quo, Implications & Perspectives. In: Nutrition review. 10, 2012, pp. 586-593.
- ↑ A. Weimann, T. Schütz, M. Fedders, G. Grünewald, S. Ohlrich (Eds.): Nutritional medicine, nutritional management, nutritional therapy. Interdisciplinary practical guide. Verlag ecomed Medizin, Landsberg, pp. 246-257.
- ↑ D. Buchholz, S. Ohlrich-Hahn, N. Erickson: Process -guided action in nutritional therapy for oncological diseases. Diet in Oncology. Prevention and therapy. Association for nutrition and dietetics (VFED), 2016, pp. 32–39.
- ↑ S. Klein, S. Krupka, S. Behrendt, A. Pulst, H.-H. Bleß: White Paper on Obesity. Supply situation in Germany. Medical Scientific Publishing Company, Berlin 2016, p. 77.
- ↑ Framework agreement for quality assurance in nutritional advice and nutrition education in Germany. (PDF) Retrieved July 31, 2016 .
- ^ Association of Dieticians - German Federal Association e. V. (VDD) (Hrsg.): Manual for the German Nutrition Care Process (G-NCP). 1st edition. Pabst Science Publishers, Lengerich 2015, pp. 14, 33.
- ^ J. Erpenbeck, V. Heyse: The competence biography. Paths of competence development. Waxmann, Münster 2007.
- ↑ ICDA- International Confederation of Dietetic Associations the (ICDA) (2010): true for evidence based practice dietetics. (15/01/2013)
- ↑ ICDA- International Confederation of Dietetic Associations the (ICDA): International Code of Ethics and Code of Good Practice. translated from English, 2008.
- ^ Paul Scriven (2004): 1, cit. in Smith et al. 2008: 106.
- ↑ ICDA- International Confederation of Dietetic Associations the (ICDA): true for evidence based practice dietetics. 2010.
- ^ Association of Dieticians - German Federal Association e. V. (VDD) (Hrsg.): Manual for the German Nutrition Care Process (G-NCP). 1st edition. Pabst Science Publishers, Lengerich 2015, p. 46.
- ^ AND - Academy of Nutrition and Dietetics: International Dietetics and Nutrition Terminology (IDNT) Reference Manual. 4th edition. Academy of Nutrition and Dietetics, Chicago, Illinois 2013, p. 49.
- ^ Association of Dieticians - German Federal Association e. V. (VDD) (Hrsg.): Manual for the German Nutrition Care Process (G-NCP). 1st edition. Pabst Science Publishers, Lengerich 2015, p. 52.
- ^ AND - Academy of Nutrition and Dietetics: International Dietetics and Nutrition Terminology (IDNT) Reference Manual. 4th edition. Academy of Nutrition and Dietetics, Chicago, Illinois 2013, p. 67.
- ^ AND - Academy of Nutrition and Dietetics: International Dietetics and Nutrition Terminology (IDNT) Reference Manual. 4th edition. Academy of Nutrition and Dietetics, Chicago, Illinois 2013, p. 70.
- ↑ K. Lacey, E. Pritchett: Nutrition Care Process and Model: ADA adopts road map to quality care and outcome management. In: J Am Diet Assoc. 103, 2003, pp. 1069f.