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.

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