Monday, July 30, 2018

Is the NCP Patient/Client Centered?

Is the Nutrition Care Process Patient/Client Centered??
While the steps featured in the pictorial NCP model focus on dietitian activities, the center of the model reflects the importance of the interaction between the dietitian and the client.  Positioning this in the center indicates that this is the “core” of everything that surrounds it. 

If you look back as the very beginning of the model as originally depicted by Hammond, et al, you will see that this core was originally named patient and dietitian and progressed through subsequent iterations as follows:

When the Academy published their first model in 2003, the diagram drew heavily on Hammond’s work, and the core was labeled as “Relationship between patient/client/group & dietetics professional”.   In the subsequent 2008 revision, Marian Hammond was invited to participate with the Academy committee and expressed her belief that the relationship was the important part of the model.  

In the 2017 Nutrition Care Process update the center was relabeled as “Individual/Population Interacts with Nutrition Professional”.  However the title of the article presenting the 2017 update of the Academy’s model indicated a realizing people centered care was one of the focuses of the update. 

The the rationale for replacing the previous core label was that "interaction" was a broader and more inclusive term than relationship.  The example given was that the change would allow for surveys where there was no “relationship” between the client/population and the nutrition professional.  The same would be true for other steps in the NCP, e.g. population focused interventions such as price adjustments, or interventions to increase store offerings of healthy food products. 

While these two words, Relationship and Interaction, both reflect the focus on the individual or group and the nutrition professional they have slightly different definitions. 

A key part of identifying the true need and selection of an optimal intervention for an individual or population depends on input from both the individual/population and the dietetics professional.

Regardless of the varying definitions and word choice, the core of the model depicts the concept that  for the nutrition care process to be effective it must be focused on engaging and meeting the needs of the individual or population group.