The dietitian: role, ethics, types and the nutrition care process
A dietitian applies the science of nutrition to feed people in health and disease. She assesses, plans, counsels and follows up, using the ADIME nutrition care process.
Who is a dietitian?
Dietetics is the science and art of applying the principles of nutrition to feeding people in health and disease. A dietitian is a professionally trained person, usually a nutrition graduate who has done a hospital internship, who plans, prepares, supervises and explains diets for individuals and groups. A clinical (therapeutic) dietitian works with the doctor, nurse and pharmacist as part of the health-care team. The word nutritionist is wider and is often used for people working in community and public health. In India the Indian Dietetic Association (IDA) conducts the Registered Dietitian (RD) examination.
Classification of dietitians
| Type | Main work | Where you find her |
|---|---|---|
| Clinical or therapeutic dietitian | Assesses patients, plans therapeutic diets, counsels patients and families, plans discharge diets | Hospital wards, ICU, dialysis and diabetes clinics |
| Administrative (food service) dietitian | Manages the diet kitchen: menu planning, purchase, storage, staff, hygiene, budget | Hospital kitchens, industrial and college canteens, hostels |
| Community or public health nutritionist | Nutrition education, surveys, running feeding programmes | ICDS anganwadis, PM POSHAN (school meals), NGOs, health departments |
| Research dietitian | Plans and serves exact diets for studies, collects and analyses data | Research institutes, medical colleges |
| Teaching dietitian | Teaches nutrition and dietetics to students, nurses and interns | Colleges, nursing schools, teaching hospitals |
| Consultant dietitian | Private practice: counsels clients, advises hospitals, gyms or food companies | Own clinic, online practice, wellness centres |
Role of the dietitian in patient care
- Nutritional assessment: height, weight, BMI, laboratory reports, clinical signs and a diet history of every patient.
- Planning the diet: turns the doctor's diet order into a day's menu that suits the disease, the patient's food habits and the budget.
- Supervising preparation and service of therapeutic diets so that the right tray reaches the right bed.
- Counselling the patient and family in simple words, using local foods and household measures.
- Monitoring intake, weight and laboratory values, and changing the diet as the patient improves.
- Discharge planning and follow-up, so the diet continues at home.
- Team work with doctors, nurses and pharmacists; record keeping; training kitchen staff; research.
Code of ethics (main points)
- Practise with honesty, integrity and fairness; put the patient's welfare first.
- Base advice on scientific evidence, not fads.
- Keep patient information confidential.
- Treat every patient with respect, without discrimination by caste, religion, sex or income.
- Work within your competence and refer to other professionals when needed.
- Keep knowledge up to date through continuing education.
- Avoid conflict of interest: do not promote a product for personal gain or make false claims.
- Get the patient's informed consent and respect the right to refuse.
Draw it: the nutrition care process (ADIME)
- back to Assessment
Example PES statement: excessive energy intake (P) related to frequent fried snacks (E) as shown by BMI 28 and a diet recall of about 2,600 kcal a day (S).
On a ward round the dietitian reads the case sheet, weighs the patient and takes a 24-hour recall before writing the diet. A clear PES statement in the file tells the whole team why a diet was changed.
2 marks: “Define dietitian.” A professionally trained person who applies the science of nutrition to plan, supervise and explain diets for people in health and disease.
5 marks: “Classify dietitians and explain their functions.” List six types (clinical, administrative, community, research, teaching, consultant) with one line of work and one workplace for each.
10 marks: “Discuss the role of a dietitian in the hospital and her code of ethics.” Define, list roles (assessment, planning, supervision, counselling, monitoring, discharge, team work), draw ADIME, then 6-8 points of the code of ethics.
ADIME = Assess, Diagnose, Intervene, Monitor and Evaluate. Assessment is ABCD: Anthropometry, Biochemical, Clinical, Dietary.