The Nutrition Care Process

Nutrition Care Process (NCP)

A systematic approach dietitians use to provide consistent, patient-centered, individualized nutrition care and improve patient outcomes and safety.

Purpose of the Nutrition Care Process

To provide consistent but individualized care, improve patient outcomes, promote patient safety, and allow dietitians to work with other healthcare providers and multidisciplinary team members.

ADIME

The acronym for the four steps of the Nutrition Care Process

Four Steps of the Nutrition Care Process

Nutrition Assessment, Nutrition Diagnosis, Nutrition Intervention, and Nutrition Monitoring and Evaluation.

Nutrition Assessment

The process of obtaining, verifying, and interpreting subjective and objective data to identify nutrition problems.

Subjective Data

Information reported by the patient, such as eating habits, symptoms, or what the patient says about their nutrition.

Objective Data

Measurable or observable information, such as weight, laboratory values, food intake, or physical findings.

Nutrition Assessment Data

Information gathered and compared to standards to identify a nutrition problem; can include psychosocial, functional, and behavioral factors.

Purpose of Nutrition Assessment

To gather and interpret information that can be used to identify a nutrition problem.

Nutrition Diagnosis

Identification of a specific nutrition problem that a dietitian is responsible for treating, monitoring, and determining whether it has been resolved.

Nutrition Diagnosis vs. Medical Diagnosis

A nutrition diagnosis identifies a nutrition-related problem that can be addressed by the dietitian; it is not a medical diagnosis.

Nutrition Diagnosis Domains

The three categories of nutrition diagnoses

Intake (NI) Domain

Nutrition diagnoses related to the intake of food, nutrients, fluids, or bioactive substances.

Clinical (NC) Domain

Nutrition diagnoses related to medical or physical conditions that affect nutrition.

Behavioral-Environmental (NB) Domain

Nutrition diagnoses related to knowledge, attitudes, behaviors, environmental factors, and access to food or nutrition resources.

PES Statement

A standardized way to write a nutrition diagnosis using Problem, Etiology, and Signs/Symptoms.

PES

Problem + Etiology + Signs/Symptoms.

Problem (PES)

The specific nutrition diagnosis or nutrition-related problem.

Etiology (PES)

The underlying cause or root cause of the nutrition problem that can be addressed through nutrition intervention.

Signs/Symptoms (PES)

Measurable evidence that supports the nutrition diagnosis and can be monitored to determine whether the problem is improving or resolved.

PES Format

“Problem related to Etiology as evidenced by Signs/Symptoms.”

Root Cause

The underlying cause of a nutrition problem that should be targeted by the nutrition intervention.

Actionable Nutrition Diagnosis

A nutrition diagnosis for which the RD can develop an intervention to address the etiology or reduce the signs and symptoms.

Evaluating a PES Statement

Determine whether the RD can address the diagnosis, whether assessment data support the diagnosis and etiology, whether the etiology is the root cause, and whether the signs and symptoms are measurable and specific.

Nutrition Intervention

The step where the RD addresses the nutrition-related problem or improves nutrition-related signs and symptoms.

Purpose of Nutrition Intervention

To address the etiology of the nutrition diagnosis and/or reduce its signs and symptoms.

Food and Nutrient Delivery

A nutrition intervention domain involving changes to the foods, nutrients, meals, or supplements provided to the patient.

Protein-Modified Diet

A diet intervention that changes the amount of protein provided to meet the patient's nutrition needs.

Increased Protein Diet

A nutrition intervention that increases protein intake to help meet needs, such as for wound healing.

Nutrition Supplement Therapy

Providing a nutrition supplement or medical food to help meet a patient's nutrition needs.

Commercial Beverage Medical Food Supplement Therapy

Use of a commercial nutrition beverage as part of nutrition supplement therapy.

Coordination of Care by Nutrition Professional

An intervention involving collaboration with other healthcare providers or referral to community resources and programs.

Collaboration by Nutrition Professional

Working with other healthcare providers to coordinate nutrition care.

Referral by Nutrition Professional

Connecting a patient with community agencies, programs, or other resources that can help address nutrition-related needs.

Nutrition Monitoring and Evaluation

The step where the RD determines whether the nutrition diagnosis is improving and whether nutrition goals are being met.

Purpose of Monitoring and Evaluation

To determine whether the nutrition intervention is working, whether goals are being met, and whether the nutrition problem has been resolved.

Nutrition Goal

A measurable outcome that the patient is expected to achieve through nutrition intervention.

Monitoring

Collecting follow-up information about the patient's nutrition status, intake, signs, symptoms, or other relevant outcomes.

Evaluation

Determining whether the collected information shows that the nutrition diagnosis and goals are improving or have been resolved.