Barriers and Enablers to Delegating Malnutrition Care Activities to Dietitian Assistants

Abstract

Delegation of malnutrition care to dietitian assistants can positively influence patient, healthcare, and workforce outcomes. However, nutrition care for hospital inpatients with or at risk of malnutrition remains primarily individually delivered by dietitians—an approach that is not considered sustainable. This study aimed to identify barriers and enablers to delegating malnutrition care activities to dietitian assistants. This qualitative descriptive study was nested within a broader quality assurance activity to scale and spread systematised and interdisciplinary malnutrition models of care. Twenty-three individual semi-structured interviews were completed with nutrition and dietetic team members across seven hospitals. Inductive thematic analysis was undertaken, and barriers and enablers to delegation of malnutrition care to dietitian assistants were grouped into four themes: working with the human factors; balancing value and risk of delegation; creating competence, capability, and capacity; and recognizing contextual factors. This study highlights novel insights into barriers and enablers to delegating malnutrition care to dietitian assistants. Successful delegation to dietitian assistants requires the unique perspectives of humans as individuals and in their collective healthcare roles, moving from words to actions that value delegation; engaging in processes to improve competency, capability, and capacity of all; and being responsive to climate and contextual factors.

The Deployment and Utilization of the Allied Health Professions Support Workforce: A Scoping Review

“…In Australia, some SWAPs work alongside a defined profession, with varying levels of responsibility ranging from a largely administrative role 22 to making clinical decisions and monitoring patients alongside their registered counterparts. 23 Many were employed in broad roles covering care and therapist-specific functions but aligned with many different registered professionals. This was similar for rehabilitation assistants in the UK 24 who mostly work alongside physiotherapy and occupational therapy colleagues.…”

“… 55 , 56 Six articles reported SWAPs working across more than one discipline, as a transdisciplinary assistant, 24 , 42 , 46 , 51 , 54 , 59 with physiotherapy and occupational therapy as the most common combination. Three Australian articles described different levels of the SWAP roles, 23 , 50 , 57 with two of those three also describing the scope of practice associated with each, 23 , 50 with one article defining the levels as being trainee, full scope, and advanced scope. 57 There was some contradiction in the scope of practice, with four studies describing a broader scope.…”

“…One article 41 suggested that role definition, defined scope of practice, and effective delegation are factors that contribute to the optimal utilization of the SWAP workforce. Key drivers for successful delegation and deployment were identified to be effective communication, 23 , 59 sufficient training, appropriate clinical governance, 23 and effective supervision. 49 One article 23 reported that challenging workloads and increasing demands are both barriers to, and enablers of, delegation.…”

Use and safety of enteral nutrition protocols in acute care: A scoping review of literature and retrospective audit of practice

“…The reasonably high proportion of patients on the general EN protocol at the facility who were reviewed by the dietitian within a day of commencing enteral feeds suggests that medical and/or nursing staff may still be relying on dietitians to review EN feeding rates. This could reflect sub‐optimal implementation of the protocol or poor acceptability of the protocol among non‐dietetics (and even dietetics 33 ) staff locally and warrants further qualitative investigation. It also implies that estimates applied in clinical practice by dietitians are accurate, however these typically represent only a crude estimate of patient requirements 34,35 .…”

Are Malnourished Inpatients Treated by Dietitians Active Participants in Their Nutrition Care? Findings of an Exploratory Study of Patient-Reported Measures across Nine Australian Hospitals

“…The Systematised Interdisciplinary Malnutrition Program for impLementation and Evaluation (SIMPLE) Phase II implementation program was a knowledge translation, quality assurance program aiming to scale and spread the initial SIMPLE program across hospitals in Queensland, Australia [ 16 , 17 , 30 , 31 , 32 , 33 , 34 , 35 ]. Led by an interdisciplinary knowledge translation team, the program engaged local dietetics and interdisciplinary ward/unit teams, the SIMPLE Champions Network and subgroups, and key site influencers to translate SIMPLE into new wards/units and hospitals.…”