A model of the multidimensional nature of experienced dietitian clinical decision‐making in the acute care setting

Abstract

Background: Clinical decision-making (CDM) is an essential component of dietetic practice that can significantly affect the quality of patient care. Research around CDM in clinical dietetics is scarce, with research in other healthcare professions offering limited insight into dietitian CDM in the specific setting of the acute care hospitals. The aim of this qualitative research was to deepen our understanding of the nature of the CDM of experienced dietitians in the acute care setting. Methods: The present study employed philosophical hermeneutics to guide methods situated within the interpretative paradigm. This study invited dietitians currently practising in adult acute care hospitals with at least 3 years of experience to be involved two in-depth semi-structured interviews using the principles of hermeneutics. A reference focus group session was then used to provide rigour and further interpretation of the findings. Results: Ten dietitians participated in the interviews and five of these same participants in the reference focus group. The findings have informed the development of A Model of the Multidimensional Nature of Dietitian CDM in the Acute Care Setting, which reflects the nature of making decisions for patient care through the synergistic relationship between five key dimensions: (i) tasks; (ii) interactions; (iii) reasoning; (iv) practitioner factors; and (v) context, all of which are managed and monitored by the higherorder reasoning process of the dietitian's clinical judgement. Conclusions: Because there is scarcity of research on the CDM of dietitians in acute care settings, the present study can provide training and professional development insights to managers, educators and supervisors.

Power, autonomy and interprofessional practice in dietitian clinical decision making: An interpretive study in acute hospitals

“…The capabilities needed for navigating the power relations revealed in the present study can be understood in light of research on interpersonal influence and power 49 facilitated through emotional intelligence capabilities 50 . Our research on the multidimensional nature of dietitian CDM 3 and the nature of clinical judgement have described the role of metacognition, empathy and intuition in practice 6 . These overlap with descriptions of emotional intelligence capabilities in the literature, suggesting that emotional intelligence is related to reasoning dimensions in dietitian CDM 51‐54 .…”

“…In acute hospital settings, dietitian CDM facilitates the prioritisation, identification and management of both acute and chronic nutritional issues. Dietitian CDM in acute care settings has been revealed as a multidimensional phenomenon, where interactions between health professionals and patients are vital to delivering quality patient care 3 . However, knowledge of the interactions and how they relate to the dietitian's autonomy in CDM has received very little research attention.…”

“…The present study reports findings relating to the interprofessional aspects of dietitian CDM in a study that aimed to gain a deeper understanding of the nature of CDM of experienced dietitians practising in acute care settings. This study is part of the lead author's doctoral research that explored the multidimensional nature of dietitian CDM of which interprofessional interactions are a key domain 3 and in which clinical judgement helps guide such interactions 6 …”

The role of dietitian clinical judgement in the nutrition care process within the acute care setting: a qualitative study

“…A more in‐depth account of the methods employed in the present study has previously been published ( 25 ) . A brief overview is provided below.…”

Digital disruption of dietetics: are we ready?

“…Hypothetically, variations in nutrition interventions used in standard clinical practice could be evaluated in real time, with the potential for algorithms to inform recommendations for the most appropriate nutrition intervention for each clinical case. This is an example of a move towards precision nutrition, which can further personalise recommendations ( 44 ) , at the same time as supporting dietitians in complex clinical decision making via electronic decision pathways ( 77 ) .…”