The role of dietitian clinical judgement in the nutrition care process within the acute care setting: a qualitative study

Abstract

Background Dietitian clinical decision making in the acute care setting likely incorporates a practitioner’s clinical judgement to effectively support patient care. The term ‘dietitian clinical judgement’ is well used in clinical practice, yet is poorly defined and often used interchangeably with other concepts. The aim of this research was to describe the nature of dietitians’ clinical judgement in the acute care setting. Methods A qualitative design within the interpretative paradigm was used guided by principles of philosophical hermeneutics. Dietitians with at least 3 years experience were invited to participate in two 60‐min in‐depth semi‐structured interviews which were recorded, transcribed and interpreted using hermeneutic principles. A reference group was used to increase rigour and further interpretation of the findings. Results Ten dietitians participated in the interviews and five of these same participants in the reference focus group. The findings revealed clinical judgement to be a sophisticated practitioner dependent meta‐reasoning process that helps the dietitian manage complexity, guide interpersonal interactions and individualise patient care. It is characterised by tacit and efficient use of various reasoning strategies reliant on the dietitian’s clinical experience, used to synthesise and weigh up various types of information and knowledge with respect to delivering context‐relevant care. Conclusions Dietitian clinical judgement is a necessary part of clinical decision making that extends beyond logical or critical thinking. It facilitates a person‐centredness to patient care and professional relationships that are key dimensions to dietitian clinical decision making. These findings provide training and professional development insights to managers, educators and supervisors.

Power, autonomy and interprofessional practice in dietitian clinical decision making: An interpretive study in acute hospitals

“…The capabilities needed for navigating the power relations revealed in the present study can be understood in light of research on interpersonal influence and power 49 facilitated through emotional intelligence capabilities 50 . Our research on the multidimensional nature of dietitian CDM 3 and the nature of clinical judgement have described the role of metacognition, empathy and intuition in practice 6 . These overlap with descriptions of emotional intelligence capabilities in the literature, suggesting that emotional intelligence is related to reasoning dimensions in dietitian CDM 51‐54 .…”

“…Clinical judgment is a context-dependent meta-reasoning process within CDM that cannot be used interchangeably with the term critical thinking. 6 Empirical research on the nature of dietitian CDM in any context or setting is very limited. Instead, dietetics research about critical thinking, reasoning and decision-making has been focused on gaining consensus on a standardised and assessable process that dietitians should use to help validate intervention decisions and subsequent patient outcomes.…”

“…This study is part of the lead author's doctoral research that explored the multidimensional nature of dietitian CDM of which interprofessional interactions are a key domain 3 and in which clinical judgement helps guide such interactions. 6…”

“…However, interactions necessary for CDM are guided by dietitians’ clinical judgment. Clinical judgment is a context‐dependent meta‐reasoning process within CDM that cannot be used interchangeably with the term critical thinking 6 . Empirical research on the nature of dietitian CDM in any context or setting is very limited.…”

“…The present study reports findings relating to the interprofessional aspects of dietitian CDM in a study that aimed to gain a deeper understanding of the nature of CDM of experienced dietitians practising in acute care settings. This study is part of the lead author's doctoral research that explored the multidimensional nature of dietitian CDM of which interprofessional interactions are a key domain 3 and in which clinical judgement helps guide such interactions 6 …”