Wednesday, September 3, 2014

Is the NCP a Process or a Model....or both??

Both!!  as the formal name implies...NUTRITION CARE PROCESS AND MODEL (NCPM)

The 2003 and 2008 revision of the NCPM diagram published by the Academy was intended to reflect both the Nutrition Care Process as well as provide a model that described the context in which the Nutrition Care Process occurred.  Both articles published elaborated on the thinking that was behind each of the components of the Model. (1,2)

Strictly interpreting things.... NCP refers only to the four steps represented in the diagram:  Nutrition Assessment/Re-assessment, Nutrition Diagnosis, Nutrition Intervention, and Nutrition Monitoring and Evaluating.  And there are times when you are focusing just on these steps and it may be appropriate to use a diagram that only represents these activities.

Having said this, it should be recognized by anyone who has truly studied "processes" that this diagram is NOT a typical process flow is a stylized representation of four large groups of processes...usually referred to as a "block diagram".  The traditional symbols of a process flow chart are not used and it does NOT reflect the actual sequence in which these activities occur when performed.

However when you refer to the NCPM this refers to all the other components of the Model as well.

Two definitions of a model hold true for the larger diagram.  Webster's dictionary includes these definitions:    a) a set of ideas and numbers that describe the past, present, or future state of something (such as an economy or a business)  and b) an example for imitation or emulation.  Both of these represent what the larger diagram was intended to convey to the public and to the dietetics profession as a whole.

The Model includes two key activities that are often accomplished by persons other than dietitians....the 1) screening, that occurs before the NCP steps where the individuals or populations that would benefit from dietitian intervention are identified, and 2) the outcomes management where data is aggregated and the dietitian's or department's overall performance is evaluated.

The Model also includes other factors that affect the outcomes of the NCP represented by the core and two outer circles encircling the  four NCP steps:

1-core (relationship between dietitian and patient/client/population)  which is the basis of all counseling relationships and critical to any interaction where the dietitian is facilitating change in nutrition-related behavior or making decisions about nutrition care

2- outer circle representing the environmental factors that affected the outcome::  Healthcare systems, Practice settings, Economics, and Social Systems

3- innermost of the two outer circles representing the strengths and abilities that the dietitian him/herself brings to the process: Code of ethics, Dietetics knowledge, Skills and competencies, Critical Thinking, Collaboration, Communication, and Evidence-based practice.

Periodically the Academy engages in a process to update and revise the Nutrition Care Process and Model based on questions that have arisen or new information.  Each time this has involved publication of a formal paper that explains the rationale behind the changes/revisions to the NCP and Model.  We look forward to future revisions to the NCPM and understanding the logic behind the proposed changes.

1.            Lacey K, Pritchett E. Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management. J Am Diet Assoc. Aug 2003;103(8):1061-1072.

2.            Nutrition care process and model part I: the 2008 update. J Am Diet Assoc. Jul 2008;108(7):1113-1117.

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