In 2009, we published an issue, Advanced Practice Perspectives, that highlighted the growth and need for specialists and advanced practitioners in health care, especially in nutrition and dietetics. As a practice-based journal that questions the status quo and informs our readers, this issue examines the practice of dietetics as it is today and major issues for future consideration. Several articles provide viewpoints and projects that exemplify varying solutions to practice dilemmas.
Professor Riva Touger-Decker opens this issue with a commentary on global approaches for health professions education, with an emphasis on dietetics. She stresses the value of distance education for building multicultural understanding and enhancing global networks at all levels of dietetics education.
The examination of trends affecting the nutrition and dietetics profession is elucidated in 6 practice sectors. The sectors are based on the existing literature within the profession, dietetic practice group resources, and the recommendations of a task force report on practice and education; they provide a framework for the evolution of nutrition and dietetics practice.
Brody and her colleagues initiated a reexamination of advanced nutrition and dietetics practice. The authors looked at past recommendations about advanced practice and speculated on future practice, including the development of continuing professional education, graduate and certificate programs, and other potential routes in dietetics compared with allied health in general. Resources exist for dietitians to advance their own practice base using the Dietetics Career Development Guide and other materials from dietetic practice groups and the committee on practice.
Trostler and her colleagues adapted the evidence-based nutrition practice guidelines of the Academy of Nutrition and Dietetics (Academy) for an international diabetes outcomes study. They explored implementation of the guidelines in Turkey and Israel by registered dietitians. By comparing selected clinical parameters and behavioral changes of patients, they concluded that the Academy's evidence-based guidelines could be used internationally with resources for training, translation, and adaptations.
Stamp and Davis examined an age-old dilemma in the clinical dietetics realm. Specifically, they conducted an observational study to determine how physicians implemented the recommendations of dietitians in patient-centered care. They identified some of the barriers to implementing nutrition recommendations and suggested the development and adoption of protocols. More research is needed to provide a clearer view of success in the implementation of recommendations by dietitians.
Erlandson et al investigated whether there is an association between the admissions criteria for coordinated programs (CP) in dietetics and achievement on the registration examination for dietitians. They surveyed CP graduates, CP directors, and registered dietitians and found some differences between the 3 samples. In parti-cular, the findings revealed associations between science grades, GPA (grade point average), and examination success among CP graduates and practicing registered dietitians.
A possible association was measured between risk and resources management of nutrition support and whether salaries of nutrition support dietitians differed on the basis of selected parameters. Dietitians replied to a survey by Roosevelt et al that included a rubric to quantify risk. Salaries were significantly different on the basis of several factors: demographic characteristics, risk of decision making, and budgetary and supervisory responsibilities.
The evolution of evidence-based practice (EBP) has affected dietitians as it has other health and medical personnel. This study by Vogt et al, derived from an earlier survey by Byham-Gray, elicited the perceptions, attitudes, and knowledge of practicing dietitians who use EBP in clinical care. They found that the participants used EBP resources fewer than once per month and conclu-ded that more targeted education is required to increase usage.
Ravn et al conducted a study to examine the attitudes, perceptions, and knowledge among hospital staff concerning postdischarge nutritional follow-up. They found staff members were able to improve the care process, but there was some variation among physicians and other staff members. More education and communication efforts need to be done.
Public policy is a continuing interest in the nutrition and dietetics profession. An attempt to assess knowledge of dietitians on public policy initiatives of the Academy was measured by an online survey. The survey posed 10 knowledge questions for the sample of members who responded. Four questions were answered correctly by 80% of the respondents.
The editorial board appreciates the many authors and contributors to this issue. We encourage more articles that measure practice and provide innovative approaches to investigating the outcomes of dietetics education and practice.
-Judith A. Gilbride, PhD, RD, FADA
Editor