Abstract
The dietetics profession lacks a comprehensive definition of advanced-level practice.
Using a three-round Delphi study with mailed surveys, expert consensus on four dimensions
of advanced-level practice that define advanced practice registered dietitians (RDs)
in clinical nutrition was explored. Purposive sampling identified 117 RDs who met
advanced-level practice criteria. In round 1, experts rated the essentiality of statements
on a 7-point ordinal scale and generated open-ended practice activity statements regarding
the following four dimensions of advanced-level practice: professional knowledge,
abilities and skills, approaches to practice, roles and relationships, and practice
behaviors. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 was neutral,
and 5.0 to 7.0 were nonessential. In rounds 2 and 3, experts re-rated statements not
reaching consensus by evaluating their previous responses, group median rating, and
comments. Consensus was reached when the interquartile range of responses to a statement
was ≤2.0. Eighty-five experts enrolled (72.6%); 76 (89.4%) completed all rounds. In
total, 233 statements were rated, with 100% achieving consensus; 211 (90.6%) were
essential to advanced practice RD clinical practice. Having a master's degree; completing
an advanced practice residency; research coursework; and advanced continuing education
were essential, as were having 8 years of experience; clinical nutrition knowledge/expertise;
specialization; participation in research activities; and skills in technology and
communication. Highly essential approaches to practice were systematic yet adaptable
and used critical thinking and intuition and highly essential values encompassed professional
growth and service to patients. Roles emphasized patient care and leadership. Essential
practice activities within the nutrition care process included provision of complex
patient-centered nutrition care using application of advanced knowledge/expertise
and interviewing and counseling strategies approached in a comprehensive yet discriminating
manner. Communication with patients and the health care team is a priority. An advanced-level
practice model in clinical nutrition was proposed depicting the requisite attributes
and activities within four dimensions of professional practice.
Keywords
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Biography
R. A. Brody is an assistant professor, Graduate Programs in Clinical Nutrition, Department of Nutritional Sciences, School of Health Related Professions, University of Medicine and Dentistry of New Jersey, Newark
Biography
J. O'Sullivan Maillet is interim dean, School of Health Related Professions, University of Medicine and Dentistry of New Jersey, Newark
Biography
R. Touger-Decker is professor and chair of the Department of Nutritional Sciences, School of Health Related Professions, University of Medicine and Dentistry of New Jersey, Newark
Biography
L. Byham-Gray is an associate professor and director of the Master of Science in Clinical Nutrition Program, Graduate Programs in Clinical Nutrition, Department of Nutritional Sciences, School of Health Related Professions, University of Medicine and Dentistry of New Jersey, Stratford
Biography
M. R. Passannante is an associate professor, New Jersey Medical School and School of Public Health, University of Medicine and Dentistry of New Jersey, Newark
Article info
Publication history
Published online: May 23, 2012
Accepted:
February 22,
2012
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
Identification
Copyright
© 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
