Thursday, November 13, 2014

Value of "THINK ALONG" Nutrition Care Process cases

As dietitians throughout the world increasingly use a common nutrition care process and standardized  language to describe and document their care, the value of   THINK ALONG  cases becomes apparent.  I first recall hearing about "think along"  from the late Dr Mary Ann Kight, in the late 1990's.  Dr Kight is the person who first developed the thinking behind the concept of a "Nutrition Diagnosis" in the United States.  She was describing her method for teaching others the logic behind the process of making a nutrition diagnosis.

 If you search the concept of  THINK ALONG, you find that it usually involves reading with another person (many times childhood education) and involves the following things:

  • Expressing how you are thinking so another can "follow along" in their own thinking process (and perhaps add to the thinking as you go)
  • Allows you to talk about related topics, e.g. other similar experiences, other patients, or research
  • Allows you to explain how you are arriving at a given conclusion or interpretation of the material, e.g. how you decided that xxx was the primary nutrition diagnoses needing to be addressed during this patient encounter
  • Allows you to engage the other by asking questions that stimulate creative and critical thinking 
    • Why does this occur? (explanation)
    • What do you think will happen next? (prediction of future)
  • Allows both parties engaged to tell about other things they know on the topic e.g. related medical conditions where this also might be true, current research on topic, or historic context of case
So what would THINK ALONGs look like with Nutrition Care Process (NCP) cases?  

Well, the cases might be structured in such a way that some information is presented and then there is a discussion about what this means, then some additional information is provided and another discussion of how it would be interpreted now that there is additional information.  

Or it might be that an entire case is presented with a series of questions afterward to allow the reader to "follow along" with the logic that has been described and either contribute to agreeing or posing alternative interpretation of the data or alternative interventions that might be successful.  

After doing many NCP workshops throughout the world, I have come to the conclusion that I agree with Dr Kight.  The best way to "teach"  the concepts of the NCP and the choice of the standardized terms to describe our dietetics care is a "think along".  

Ideally there is a two way process of presenting a case, engaging in a dialogue about what this "means" and a dialogue about what would be the "best course of action", and finally a dialogue about "how it might be documented".  

The dialogue process among peers is the best way to bring our assumptions to light and allow us to have a truly productive conversation about how we can continually improve our dietetics/nutrition care.  

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