Exploring extended scope of practice in dietetics: A systems approach

Abstract

Extended scope of practice in dietetics may provide positive outcomes for various stakeholders. However, further development of extended scope roles for dietitians requires increased advocacy and support from governments, professional bodies, training institutions and dietitians. We have developed an implementation framework which can be utilised by health professionals interested in embracing an extended scope model of care.

Post‐pyloric feeding tube placement in critically ill patients: Extending the scope of practice for Australian dietitians

“…3,13,18,21 In their recent work Ryan et al 22 cite a distinct scarcity in evidence relating to local dietetic experience around ESP roles and subsequently propose a comprehensive model that integrates work systems, processes and outcomes around ESP for dietitians. 22 Despite, or perhaps because of, this lack of evidence, there is increasing acknowledgement by the Australian dietetic community that undertaking ESP work and developing ESP roles is important to the growth of the local dietetic profession and individual practitioners. In her editorial on dietitians as leaders, Capra 23 suggests that protecting the scope of practice for dietitians in the face of the modernisation of and technical advances within the health care system may prove challenging.…”

“…Elsewhere, internationally, dietitians routinely place enteral feeding tubes and have within their professional standards a process that enables the development of ESP roles . In their recent work Ryan et al cite a distinct scarcity in evidence relating to local dietetic experience around ESP roles and subsequently propose a comprehensive model that integrates work systems, processes and outcomes around ESP for dietitians . Despite, or perhaps because of, this lack of evidence, there is increasing acknowledgement by the Australian dietetic community that undertaking ESP work and developing ESP roles is important to the growth of the local dietetic profession and individual practitioners.…”

Introducing novel advanced practice roles into the health workforce: Dietitians leading in gastrostomy management

“…There has been continued growth in the number of children and adults with g‐tubes living in the community because of advancements in medical care and feeding tube technology, the aging population, and patient choice . This cohort represents a diverse and complex group of patients requiring a significant level of resources for their ongoing clinical and care coordination needs …”

“…Traditionally, care tasks related to g‐tube management such as appropriate tube selection, scheduling and performing g‐tube procedures, stoma site skin care, prescribing formula type and regimen, troubleshooting complications, and ordering formula and consumables are provided in numerous community and hospital care settings by multiple health professionals including dietitians, nurses and doctors . International studies demonstrate that this situation results in fragmented and delayed patient care, poorer patient experience and suboptimal health system productivity .…”

Creating the dietitians of the future

“…While specialists or ‘experts’ may have high‐level expertise and significant experience in a particular area, without leadership, this will not translate to the necessary change required to impact the contexts and systems in which we operate. Emerging evidence suggest that dietitians working in extended‐scope roles may improve outcomes for patients, other health professionals and the health system . Achieving nutrition outcomes for the population requires leadership at all levels…”