nutr 486 exam 1

What the 5 influences on people's food habits or behaviors?

- Cultural (sociocultural)
- Social
- Economic
- Environmental
- Other factors (physical, geographical, cognitive)

Cognition

all the mental activities associated with thinking, knowing, remembering, and communicating (may be influenced by attitudes, perceptions, and feelings

The National Health & Nutrition Evaluation Survey (NHANES)

an ongoing federally funded longitudinal program that provides data on a randomized set of children and adults of varying ages by collecting data on dietary intake and anthropometrics. The dataset is used by investigators to conduct research on health trends over time correlated to behavior changes.

Choose MyPlate

Fruits and vegetables should make-up half the diet with more vegetables than fruit. Grains and protein should make-up the other half of the diet with more grains than protein

Dietary Guidelines for Americans

The US Department of Health & Human Services (HHS) sponsors the dietary guidelines, the most recent edition is 2015-2020. It summarizes a consensus of scientific evidence-based nutrition recommendations for a healthy diet and are revised every 5 years

Healthy People 2020

a set of national goals and objectives designed to guide health promotion and disease prevention efforts to improve people's health over a 10- year period

7 out 10 deaths among Americans annually are caused by what diseases?

Heart disease, Cancer, and Diabetes mellitus

Food and Agriculture Organization (FAO) of the United Nations

monitors food-focused guidelines

World Health Organization (WHO)

maintains a global focus as well as an individualized focus by countries and regional areas of health and nutrition interests

What are the top 3 drivers for food purchases in the US?

Taste, price, and healthfulness

What does the scope of practice framework include?

NCP, SOP's , and SOPP's

NCP

a tool created to advance the profession of dietetics and to achieve "strategic goals of promoting the demand for professionals and to help them be more competitive in the marketplace."

What are the 5 categories of data collection for the NCP?

- Food/nutrition-related history obtained by interviews
- Anthropometric measurements (height,weight, and BMI)
- Results of biochemical data, medical tests, and medical procedures
- Nutrition- focused physical findings (appetite and physical appearance)
- Client personal history (compared to standards)

What format does the NCP follow?

ADIME

Nutrition Assessment

- Gather diet history
- Family history
- Medical history
- Occupation
- Socioeconomic status
- Educational level
- Cultural
- Religious beliefs
- Physical activity
- Functional status
- Cognitive abilities and
- Housing situation

Nutrition Diagnosis

Intake, Clinical, Behavioral-Environment

Intake (NI):

Amount of nutrients consumed compared to needs

Clinical (NC):

Problems related to medical or physical conditions

Behavioral-Environmental (NB):

Attitudes, beliefs, and the person's physical environment

How are nutrition diagnosis written?

As PES statements

Nutrition Intervention

Defined as "purposefully planned actions intended to positively change a nutrition-related behavior, environmental condition, or aspect of health status for an individual, target group, or the community at large"

Four general categories of nutrition intervention:

1. Food and/or nutrient delivery
2. Nutrition education
3. Nutrition counseling
4. Coordinated Nutrition Care

Food/nutrition-related history outcomes:

changes in dietary intake, physical activity, or knowledge and behaviors

Anthropometric measurement outcomes:

Height, weight, body mass index (BMI)

Biochemical data, medical tests, and procedure outcomes:

Lab data and tests

Nutrition-focused physical finding outcomes:

Physical appearance and appetite

What is level 2 of the Scope of practice framework?

Self-evaluation tools used to determine knowledge and
education between a generalists and a specialist (Includes the Academy Code of Ethics)

Standards of Practice (SOPs)

based on the NCP (assessment, diagnosis, intervention, and monitoring/evaluation)

What are the 6 dimensions of professional performance/ Standards of Professional Performance (SOPPs)

- Provision of services
- Application of research
- Communication and application of knowledge
- Utilization and management of resources
- Quality in practice
- Competency and accountability

NCP Chains

document RDN interventions through electronic medical records. Adding to the evidence that RDN services are cost-effective and patients should be reimbursed

The purpose of the nutrition diagnosis

"to identify and describe a specific nutrition problem that can be resolved or improved through treatment/nutrition intervention by a nutrition professional"

ACEND recognizes "\---- \----" as core competencies for communicating effectively with patients, clients, customers, and other professionals

"expertise in verbal communication"

Communication

is the process of acting on information and about transmitting verbal and nonverbal messages in which "meaning is co-created simultaneously among people"

Sources of misunderstanding

culture, gender, age, education, background, and other factors

Health literacy

a constellation of skills that contribute to the ability to perform basic reading and numerical tasks for functioning in the healthcare environment and acting on health care information

Interpersonal communication model

a graphic illustration to aid one's understanding

Sender

Senders of the message originate the thought or emotion, encode it into words, and speak first

Receiver

listens and attempts to decode or make sense of the message and usually interpret and transmit simultaneously. (even if the receiver doesn't respond verbally there is usually non-verbal communication to the sender of the message)

Message

the information that is communicated to another. The receiver interprets 2 messages the actual verbal message and non-verbal message inferred from the sender and the environment

Feedback

Both verbal and non-verbal responses to messages

Barriers

AKA noise, or interference, can distort the understanding of the message

The Verbal Guidelines for creating a supportive communication climate

1. To be aware of one's choice of words and discuss problems descriptively rather than evaluatively
2. Describe situations with a problem orientation in interpreting messages rather than in a manipulative way
3. Offer alternatives provisionally rather than dogmatically
4. Treat people as equals listening thoughtfully
5. Be empathic rather than neutral or self-centered responding sensitively

Empathy

is an emotional reaction that is similar to the reaction being experienced by another person (We feel what the other person feels)

Paraphrasing

is restating in your own words what the other person has said (it is often done with empathy)

Two Points need to be emphasized regarding paraphrasing

- Not everything the other person says needs paraphrasing
- Paraphrasing often leads to additional disclosure and therefore provides further information

Paraphrasing is only necessary when...

the discussion is centered on critical information that must be understood

Nonverbal communication

communication that creates meaning for people, but is not verbal or written

What is usually the first nonverbal trait that's noticed?

Facial expression

What is the most ancient healthcare skill?

Listening to someone

Listening

is the process of receiving, constructing meaning from, and responding to verbal and nonverbal messages

The five common issues and barrier related to poor listening

- Most people have a limited and undeveloped attention span
- People tend to stop listening when they have decided that the material is uninteresting and tend to pay attention only to material they "like or see an immediate benefit in knowing"
- Listeners tend to trust their intuition regarding the speaker's credibility, basing their judgements more on the speaker's nonverbal behavior than on the content of the message
- Listeners tend to attach too much credibility to messages heard on electronic media, such as the internet, television, movies, and so forth
- Communication is inhibited by judging, bias, prejudice, giving advice, providing solutions, and ignoring the concerns of the person

Interviewing

is a guided communication process between two people with the predetermined purpose of sharing, obtaining, and verifying specific information by the asking and answering of questions

Food and nutrition interview

AKA diet history, is an account of a person's food habits, preferences, eating behaviors, and other factors influencing food choices

What are the 3 most common types of nutrition interviews?

24-hour recall, usual daily food intake, and food frequency questionnaire

Closed questions

give interviewers more control over length of response

Portion distortion

the perception that large portions are appropriate to eat

MEDFICTS

-Meats
-Eggs
-Dairy
-Fried foods,
-In baked goods
-Convenience foods
-Table fats
-Snacks

What are the 3 stages of interviewing?

- Introducing the process
- Questioning by the interviewer as well as the interviewee
- With a closing including information on next steps and a timeline for each step

Introducing the process

-Rapport building
-Introduction and overview
-Discuss purpose

Questioning by the interviewer as well as the interviewee

- Gather information with questions
- Explore problems
- Explore both thoughts and feelings
- Continue building rapport

With a closing including information on next steps and a timeline for each step

- Express appreciation
- Review purpose; ask for questions or comments. Plan future contacts

How can attentiveness be shown?

by appropriate nonverbal behaviors, friendly eye contact, interested facial expression, good posture, smiling, and nodding

Rapport

is the personal relationship established between the interviewer and the respondent

Open questions

allow people to tell their story

Primary questions

introduce new topics

Secondary questions or "Follow-up"

Elicits further information

Probing questions

ask clients to clarify partial responses or to continue talking

Are probing questions considered primary on secondary questions?

Secondary

Leading questions

Directs person's answer, and reveals bias of the interviewer

Neutral questions

More accurate answers and are more preferred than leading questions

What are 3 ways to sequence questions?

Funnel, Inverted Funnel, Tunnel

Funnel

begins with broad, open questions each covering a different topic and proceeds to more restrictive or closed ones

What are the 6 types of responses?

- Understanding responses
- Probing responses
- Confrontational responses
- Evaluative responses
- Hostile responses
- Reassuring responses

Confrontational responses

authority-laden response in which the interviewer tactfully and tentatively calls to the person's attention some inconsistency or discrepancy in the client's story, words, or actions by pointing out the discrepancy to the client (i.e claiming to follow the diet, but has not lost weight)

Evaluative responses

interviewer makes a judgement about the person's behavior or responses or implies how the person ought to feel

Hostile responses

the professional's anger or frustration is uncontrolled, and the response may lead to antagonism or humiliation of the client

Reassuring responses

the client is prevented from working through her feelings because the interviewer suggests that there is nothing to worry about

Transtheoretical Model (TTM) or Stages of Change (SOC)

the purpose is to guide the timing and content on interventions for better health

What are the 4 categories of the Transtheorectical Model (TTM)?

- Stages of Change
- Processes of change or how people change
- Decisional balance
- Situational Self-efficacy

What are the stages of change?

1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Termination

Precontemplation

Not intending to make changes within the next 6 months

Contemplation

intends to make a change. Small changes are made, intending to change in 30 days

Action

Changes are made in food choices regularly

Maintenance

Behavior changes maintained for 6 months

Termination

Occurs only if changes are maintained for a year or more

Stage 1: Precontemplation

a person is unaware or underaware that a health problem exists, denies that there is a problem, or has no intention to take action to change

Stage 2: Contemplation

a person is aware that the health problem exists and intends to do better eventually, such as eating differently or exercising more. He or she has no serious thought of or commitment to making a change, however, and keeps putting it off

Stage 3: Preparation

a person is more determined to make a change and intends to take initial action soon, perhaps in about 30 days. He or she reports small changes in addressing the problem behavior, such as reading a few food labels or buying low-fat foods.

Stage 4: Action

a person takes action to implement a plan and overcome the health problem by actively modifying food choices, behaviors, environments, and experiences

Stage 5: Maintenance

a person consolidates and integrates new health behaviors into his or her lifestyle made over several months. With time the new behavior will become automatic

Stage 6: Termination

happens when clients reacts automatically and is no longer tempted by former behavior, and is no longer lapsing or relapsing

What are the 10 processes of change?

- Consciousness raising
- Dramatic relief
- Self-reevaluation
- Environmental reevaluation
- Self-liberation
- Social- liberation
- Counterconditioning
- Stimulates control
- Reinforcement management
- Helping relationships

Consciousness raising

increases the client's awareness of the health risks and insight into the consequences of the problem health behavior

Dramatic relief

increases emotional awareness and feelings about the unhealthy behavior that may be relieved if appropriate action is taken

Self-reevaluation

includes both cognitive (thoughts) and affective (feelings) reassessment of client's self-image either with or without the unhealthy eating, such as one's image as an obese person or a thinner person

Environmental reevaluation

includes both cognitive (thoughts) and affective (feelings) assessment of how the personal behavior or health problem affects the client's social environment, especially family members

Self-liberation

is the belief that one can change and the commitment to act on that belief. Examples include New Year's resolutions and Public testimonies

Social- liberation

increases social alternatives and opportunities that support healthy behaviors for those who lack them.

Counterconditioning

entails changing the behavior in response to activities, such as substituting healthier coping strategies for unhealthy ones. "I can do it"

Stimulates control

Removes environmental cues for unhealthy eating behavior and adds healthy ones instead