Monday, December 15, 2014

Inquiring minds want to know...How many countries are using NCP and IDNT?

Participants in the MEDNA pilot survey asked how many countries other than the US are using the NCP and IDNT (Nutrition Care Process Terminology)?  While we don't have a complete answer for exactly how many countries are currently using it or the extent of the use, here are some links to what has been posted on a number of websites relative to the Nutrition Care Process and standardized language in countries other than the US.

The International Confederation of Dietetic Associations (ICDA) has posted their support for the concept of having a global process that describes how dietitians approach nutrition care.  They have a tab on the ICDA home page for the NCPT and states “The Nutrition Care Process being promoted by the International Confederation of Dietetic Associations provides a framework for nutrition and dietetic practice”. 

The European Federation of Associations for Dietitians (EFAD) has also posted a document summarizing their thoughts called the Vision paper: The implementation of a Nutrition Care Process (NCP) and Standardized Language (SL) among dietitians in Europe.  The Professional Practice Committee recommends that all national dietetic associations "support the access and use of a chosen Nutrition Care Process/Dietetic Process (NCP) model and a SL developed for dietitians."  

The DietitiansAssociation of Australia website includes a document, Health Informatics and e-health, outlining their support for the standarized language saying that A working party has now been formed to facilitate the the implementation of Nutrition Care Process Terminology (NCPT, formerly IDNT) in Australia" 

British Dietetic Association includes the statement that "The BDA has approved the adoption, with adaptations, of the international Nutrition Care Process Terminology (NCPT) as the preferred standardised language (terminology) for use in electronic records" in their document Nutrition and Dietetic Process Terminology.  Another document Model Process for Nutrition and Dietetic Practice states "The BDA believes that the implementation of the Process for Nutrition and Dietetic Practice is important as it enables you to show how you deliver effective and quality nutrition and dietetic services".

Dietitians of Canada discusses the need for NCP and Standardized language in a public policy statement called Canadian Perspectives on the Nutrition Care Process and International Dietetics and Nutrition Terminology .  They state  " The Nutrition Care Process (NCP) and International Dietetics and Nutrition Terminology (IDNT) are recommended by the International Confederation of Dietetic Associations for international adoption as a framework for dietetic practice" 

The Swedish Dietetic Association has fully supported the NCP and IDNT/NCPT and has issued a position statement, POSITION STATEMENT - NCP and IDNT,  that  "recommends the implementation of NCP and IDNT" and included a translation of key parts of the model description and terminology in Swedish on the ENCPT. 

According to a website from Fukuoka Womens University, Professor Yoshinori Katagiri reported being at 2014 member of a Working Group of the Japan Dietetic Association for reviewing Nutrition Care Processes.  

Two documents summarize published research on use of NCP in other countries (Korea and Venezuela). A summary of research evaluating the use of the NCP use in Korea, A Survey on the status of Nutrition Care Process Implementation in Korean Hospitals by Kim and Baek was published in Jul 2013
A description of research conducted in Venezuela for childhood obesity prevention,  Going International:  Using Kids Eat Right to Address Childhood Obesity and Under nutrition Part II   by Marianella Herrera shows how to use INDT in describing their intervention. 

The Academy International Nutrition Care Process website includes a place for countries to share documents.  This tab includes a Venezuela implementation plan (under Documents, Implementation) 

While this list certainly is not inclusive, it gives a glimpse into what other countries are doing relative to the NCP and standardized language. 
List of Links Embedded in Message:

Wednesday, December 10, 2014

If I'm new to the Nutrition Care Process (NCP) and IDNT, where do I start?

A recent survey in Middle Eastern countries asked dietitians and nutritionists about their awareness, knowledge and use of the Nutrition Care Process and the standardized terminology.  They also identified questions they would like answered.  One of the questions was:  "If I am new to the Nutrition Care Process (NCP) and IDNT, where do I start?"  

There are a lot of resources available to you at no charge.  Some of these are located on the Academy of Nutrition and Dietetics and are available to you even if you are not a member of the Academy of Nutrition and Dietetics.

One of the first things you may want to do is to check out the Academy's website for Nutrition Care Process information for Health Professionals   It is located at:  health professionals information on the website. (  

Another source of information is to the International NCP page, which is free to all and allows for discussion of international implementation issues at .  Although the website asks you to "register" there is no fee associated with registration and use of the site at this time.

When you access these sites, a way to get started might be the following:
1) read the article , Nutrition Care Process, Update Part 1, that describes the current model and the content of each of the steps.  This is a comprehensive description of the entire model as well as the steps in the nutrition care process.

2) Then read each of the snapshots as a review of the article's high points.  These are intended to be quick and easy references for each of the steps.  This document downloads 4 pages, a one page summary for each of the four steps in the nutrition care process:  Nutrition Assessment, Nutrition Diagnosis, Nutrition Intervention, and Nutrition Monitoring and Evaluation.

3) After getting an overview of the Nutrition Care Process, then you may want to read the article about the standardized language,  Part 2 of the Nutrition Care Process Update.  This article summarizes the way the terminology was created, organized and the basics on how to use it.

4) At this point you may want to find someone who is using it that you can discuss with them, or you may want to start looking at cases to see what it looks like in practice and will likely want to attend a workshop where you use cases to work with applying the NCP and terminology.  You could also read older blog issues on specific topics that you find challenging.

 If this was your question, please let me know if this was helpful.

Friday, December 5, 2014

If a picture is worth a thousand words...what is a "model" worth?

Lets examine the various components of the Nutrition Care Process and model...starting with the CORE of the model...the patient-dietitian relationship.  
Open access has been provided to an article that traces the history of one line of thinking that clearly influenced the formal development of the Academy of Nutrition and Dietetics' Nutrition Care Process and Model.  The article lays out the historical evolution of the dietetics teaching models that occurred at Pennsylvania State University starting in the 1970's and identifies the body of knowledge that was used to articulate some of the key concepts.

For example, this article traces the evolution of the core (center) of the model...the relationship between the dietitian and the client.

In the original hand drawn model the core/center of the model was just the words "dietitian" and "patient" with arrows indicating a two way interaction.   In the 1977 Hammond model the core depicted "The Helping Relationship, Rapport, empathy listening, objectivity, etc" and the concept reflected drew heavily on Dr Steven Danish's work at Pennsylvania State University from the Psychology department.

 In the 1984 Hammond model the core was depicted as a "Partnership" between the clinical dietitian and the patient/client with the two way interaction arrows.  In the 1986 model core was depicted as a "Partnership of Individuals" again listing the clinical dietitian and patient/client as those involved. As Marian Hammond described the thinking at the time, this notation reflected the belief that "each member’s individuality affected the partnership dynamics, process, and, most likely, quality of outcomes."

Later, both the original 2003 and the updated 2008 Academy of Nutrition and Dietetics (then called the American Dietetic Association)  models have the core of the model designated as the "Relationship between the patient/client/group and the dietetic professional".

Occasionally people ask whether the Nutrition Care Process is really patient-centered or client-centered. While it certainly it takes more that one component in a model to truly fulfill the concept of "patient centered-ness",  this evolution clearly shows the intent for the model to recognize the importance of putting the patient/client at the very "core" of the whole process.  

Hammond, M, Myers, E, Trostler, N. Nutrition Care Process and Model:  An Academic and Practice Odessey.  J Academy of Nutr and Diet, 2014.  FREE FULL TEXT LINK

Danish SJ. Developing helping relationships in dietetic counseling. J Am Diet Assoc. 1975;67(2):107-110.

Danish SJ, Ginsberg MR, Terrell A, Hammond MI, Adams SO. The anatomy of a dietetic counseling interview. J Am Diet Assoc. 1979;75(6):626-630.

LaQuatra I, Danish SJ. Effect of a helping skills transfer program on dietitians’ helping behavior. J Am Diet Assoc. 1981; 78(1):22-27.