This issue provides a collection of articles related to registered dietitian (RD) practice. Many components of RD practice remain undescribed, and dietitians often rely on nursing literature to provide background information related to health care practice. In this issue, we examine how RDs react to a change in practice, explore RD views on leadership, evaluate how physicians perceive the role of the RD, identify the role of personality characteristics on RD job satisfaction, and describe how attire impacts the perceived professionalism of the RD. In addition, the Home Enteral Nutrition Caregiver Task Checklist is evaluated for validity and reliability in the Turkish population and a systematic review examines serum vitamin D levels and pneumonia risk in children.

Hilel et al of Haifa University in Israel interviewed 18 dietitians in a qualitative study to assess how they coped with change in practice related to implementation of the nutrition-focused physical examination. Inductive theme analysis identified that dietitians viewed the change as a threat or a challenge stemming from within or outside of the profession. Dietitians coped on the basis of their own experiences. Leaders can facilitate coaching opportunities during times of change to improve skills and to help highlight the change as a challenge.

Patten et al conducted a qualitative study by surveying 561 RDs to explore perspectives and barriers to clinical leadership. Two thematic analyses revealed that RDs believed clinical dietetics leadership involved strong technical skills, interpersonal interactions, and personal attributes. Barriers were described to involve work environment, limited resources, and individual factors. Managers may consider adjustments to staffing and productivity to incorporate leader development.

Pojednic et al surveyed 109 physicians associated with a large pediatric hospital network regarding their perceptions of the RD, particularly related to order writing privileges (OWPs). Physicians associated RDs mostly with nutrition education and counseling and least with food service. Although there was a lack of physician consensus on RD OWPs without prior physician approval, overall perceptions of the RD were positive and RDs were identified as valued members of the health care team.

Moore et al surveyed 380 RDs from North Carolina practicing in various areas with 2 validated survey tools to assess personality characteristics and job satisfaction. Agreeableness was found to be positively associated with job satisfaction, while neuroticism was negatively associated. These findings shed light on potential ways to enhance job satisfaction and possibly reduce attrition. Future research may seek to evaluate the relationship within various specific practice areas.

Tadros et al from the University of Florida investigated whether perceived professionalism of RDs was influenced by attire. Participants were randomized to view one of 4 identically scripted videos of an RD providing diet education wearing one of 4 combinations of attire and professionalism was then rated. Attire, including the presence or absence of a white coat, did not influence perceived professionalism of the RD. Although dress is only one determination of professionalism, these findings help clarify which attributes may impact perception of RD professionalism.

Sezer et al sought to establish validity and reliability of the Home Enteral Nutrition Caregiver Task Checklist for the Turkish population. They studied a sample of 70 caregivers of adults with a percutaneous endoscopic gastrostomy (PEG) to determine training needs and found that the Turkish version of the checklist had satisfactory language validity, content validity, and reliability. The checklist can be used to improve PEG tube home care by identifying training needs and tailoring education prior to discharge home.

Tang et al of Shandong Maternal and Child Health Hospital in China conducted a systematic review and meta-analysis to assess the association between serum vitamin D concentrations and risk of pneumonia in children. Their evaluation of 10 studies revealed that serum vitamin D levels were slightly lower in children with pneumonia than in healthy controls. Although there was no control for confounding factors, the relationship of vitamin D deficiency in pneumonia pathophysiology requires further study.

Thank you for your support of Topics in Clinical Nutrition. We welcome author contributions as well as suggestions for topics to highlight in future editions.

-Kelly Kane, MS, RD, CNSC

Editor, Topics in Clinical Nutrition