Needs for clinical dietitian in hospital settings: Importance of doctor's awareness regarding clinical nutrition service as mediating variable

Mi Hyang Um; Yoo Kyoung Park; Yoon Mi Song; Song Mi Lee; Eun Soon Lyu

doi:10.4163/jnh.2017.50.5.519

Journal List > J Nutr Health > v.50(5) > 1081527

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Um, Park, Song, Lee, and Lyu: Needs for clinical dietitian in hospital settings: Importance of doctor's awareness regarding clinical nutrition service as mediating variable

Research Article

Journal of Nutrition and Health 2017; 50(5): 519-529.

Published online: 31 October 2017

DOI: https://doi.org/10.4163/jnh.2017.50.5.519

Needs for clinical dietitian in hospital settings: Importance of doctor's awareness regarding clinical nutrition service as mediating variable

Mi Hyang Um^1,^*, Yoo Kyoung Park^1,^*, Yoon Mi Song², Song Mi Lee³, Eun Soon Lyu²

¹Department of Medical Nutrition, Graduate school of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea.

²Department of Food Science & Nutrition, Pukyong National University, Busan 48513, Korea.

³Department of Nutrition and Dietetics Service, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.

To whom correspondence should be addressed. tel: +82-51-629-5848, eslyu@pknu.ac.kr

Equal contributor:

*Co-first author

Received 12 July 2017 Revised 6 August 2017 Accepted 25 September 2017

The Korean Nutrition Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to explore whether or not there is a relationship between doctor's awareness of clinical nutrition service and needs for a clinical dietitian.

Methods

A cross-sectional survey design was used. The research was carried out by using questionnaires that had been specifically designed for the study. The research was conducted from September to October, 2013 for 311 doctors at 43 hospitals (with over 400 beds). Frequency analysis, factor analysis, reliability analysis, confirmatory factor analysis, and bootstrapping analysis were conducted using SPSS 21.0.

Results

‘Implementation of clinical nutritional service’ (p < 0.001) and ‘usefulness on clinical nutrition service’ (p < 0.001) were found to be correlated with ‘importance of clinical nutrition service’ as an independent variable. The correlation between ‘importance of clinical nutrition service’ as a mediating variable and ‘needs for clinical dietitian’ as a dependent variable was also confirmed (p < 0.001). The results of the bootstrapping test showed that the mediating effect of ‘importance of clinical nutrition service’ was significant. The indirect effect value between ‘implementation of clinical nutrition service’ and ‘needs for clinical dietitian’ was 0.040, indirect effect value between ‘usefulness on clinical nutrition service’ and ‘needs for clinical dietitian’ was 0.095.

Conclusion

The frequency of providing clinical nutritional services, the quality of clinical nutritional services, and the degree of implementation of clinical nutritional services were found to be important for positive perception of clinical nutrition services by doctors. Therefore, proper provision of clinical nutrition services and effective therapeutic effects will be continuously highlighted, which will increase the awareness of the physician and ultimately increase the demand for clinical nutrition service.

Keywords: clinical nutrition service, clinical dietitian, doctor's awareness, mediation

Figures and Tables

Fig. 1

Complete mediation model

Fig. 2

Partial mediation model

Table 1

General characteristics of the medical staffs

1) Medicus gratus, neurology 2) General surgery, orthopedic surgery, neurosurgery, cardiovascular surgery 3) Anesthesiology, pediatrics, urology, radiotherapy oncology, rehabilitation medicine, family medicine, nuclear medicine, occupational and environmental medicine

Table 2

Result of factor analysis for single factor test

1) EN: enteral nutrition 2) PN: parenteral nutrition

Table 3

Means, standard deviations, and correlations between variables

Scale score: 1 (never important) ~ 5 (very important)

1) Male = 0, Female = 1 2) Bachelor = 0, Master = 1, Doctor = 2 3) Intern = 0, Resident = 1, Medical specialist = 2 4) Yes = 0, No = 1, CDC: clinical dietitian certificate 5) Participation = 0, Absence = 1, N = 267, ^*p < 0.05, ^**p < 0.01, ^*** p < 0.001 6) CNS: clinical nutrition service 7) CD: clinical dietitian

Table 4

Results of regression analyse of the mediating of importance on clinical nutrition service between implementation of clinical nutrition service, usefulness on clinical nutrition service and needs for clinical dietitian

1) CDC: clinical dietitian certificate 2) CNS: clinical nutrition service 3) CD: clinical dietitian N = 267, ^*p < 0.05, ^**p < 0.01, ^***p < 0.001

Table 5

Results of Indirect Effect of Importance on clinical nutrition service

N = 267, Bootstrap, N = 5,000, BCaL 95: 95% lower limit of confidence interval, BCaU 95: 95% upper limit of confidence interval, bias correlated and accelerated (BCa)

References

1. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003; 22(4):415–421.

2. Robinson G, Goldstein M, Levine GM. Impact of nutritional status on DRG length of stay. JPEN J Parenter Enteral Nutr. 1987; 11(1):49–51.

3. So HS, Joung KA, No YH. A study on the nutritional status, and quality of life of cancer patients completing radiotherapy. Chonnam J Nurs Sci. 1997; 2(1):41–56.

4. Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC. Fruit and vegetable intakes, C-reactive protein, and the metabolic syndrome. Am J Clin Nutr. 2006; 84(6):1489–1497.

5. Rajgopal R, Cox RH, Lambur M, Lewis EC. Cost-benefit analysis indicates the positive economic benefits of the Expanded Food and Nutrition Education Program related to chronic disease prevention. J Nutr Educ Behav. 2002; 34(1):26–37.

6. Lee JE. The time series analysis of standards and results of nutritional domain in hospital evaluation program. J Korean Diet Assoc. 2013; 19(4):317–342.

7. Ministry of Health and Welfare (KR). The nation nutrition control law [Internet]. Seoul: Korea Ministry of Government Legislation;2013. cited 2017 Jul 3. Available from: http://www.law.go.kr/lsInfoP.do?lsiSeq=139303&efYd=20130417#0000.

8. Kieselhorst KJ, Skates J, Pritchett E. American Dietetic Association: standards of practice in nutrition care and updated standards of professional performance. J Am Diet Assoc. 2005; 105(4):641–645.

9. Lee GJ. Nutrition care process and diabetes: focus on nutrition diagnosis. J Korean Diabetes. 2012; 13(1):48–51.

10. Um MH, Park YK, Lee SM, Lee SM, Lee E, Cha JA, Park MS, Lee HS, Rha MY, Lyu ES. Clinical nutrition service in Korean tertiary hospitals and general hospitals: result of nationwide cross-sectional survey. J Korean Diet Assoc. 2014; 20(3):183–198.

11. Han MH, Lee SM, Lyu ES. Doctors' perception and needs on clinical nutrition services in hospitals. J Korean Diet Assoc. 2012; 18(3):266–275.

12. Choi J, Park E. Different perceptions of clinical nutrition services between doctors and dietitians in the Busan-Gyeongnam area. J Korean Diet Assoc. 2013; 19(1):69–81.

13. Jeong HS, Teong CH, Choi YJ, Kim WJ, Lee AR. Attitudes of medical staff and factors related to nutritional support for patient care in a university hospital. J Clin Nutr. 2014; 6(1):37–41.

14. Um MH, Park YK, Lee SM, Cha JA, Lee E, Lyu ES. Time measurement study of certified clinical dietitians from tertiary hospital in Seoul and Gyeonggi-do. J Korean Diet Assoc. 2015; 21(2):123–139.

15. Lyu ES, Eum YR, Lee SM. The medical staffs' perception about nutrition care. J Korean Diet Assoc. 1998; 4(1):40–52.

16. Choi KB, Lee SM, Lyu ES. Patient perceptions of clinical nutrition service. J Korean Diet Assoc. 2012; 18(1):59–71.

17. Choi YY, Yoon HS. A study on nurses' perception for nutrition education working in Kyungnam area. J Korean Diet Assoc. 2003; 9(4):278–287.

18. Lee SM. Basics of factor analysis. Seoul: Kyoyookbook;2000.

19. Lee HY. Research methodology. 2nd edition. Seoul: Cheongram;2012.

20. Han GS. Social psychology. 4th edition. Seoul: Hakjisa;2017.

21. Olson JM, Zanna MP. Attitudes and attitude change. Annu Rev Psychol. 1993; 44(1):117–154.

22. Boyhtari ME, Cardinal BJ. The role of clinical dietitians as perceived by dietitians and physicians. J Am Diet Assoc. 1997; 97(8):851–855.

23. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008; 40(3):879–891.

24. Sobel ME. Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol. 1982; 13:290–312.

25. Zhao X, Lynch JG Jr, Chen Q. Reconsidering Baron and Kenny: myths and truths about mediation analysis. J Consum Res. 2010; 37(2):197–206.

26. Jang HS, Kwon CS. Evaluation of necessity of clinical nutrition education in the medical school curriculum. J Korean Soc Food Nutr. 1996; 25(3):415–422.

27. Ryan AS, Foltz MB, Finn SC. The role of the clinical dietitian: II. Staffing patterns and job functions. J Am Diet Assoc. 1988; 88(6):679–683.

28. Thoresen L, Rothenberg E, Beck AM, Irtun Ø. Scandinavian Nutrition Group (SNG). Doctors and nurses on wards with greater access to clinical dietitians have better focus on clinical nutrition. J Hum Nutr Diet. 2008; 21(3):239–247.

29. Kennedy JF, Nightingale JM. Cost savings of an adult hospital nutrition support team. Nutrition. 2005; 21(11-12):1127–1133.

30. Kang JH, Baek HW, Shin DW, Shin DH, Son HJ, Chang SH, Seo YS, Min JH, Lee YA, Mo YH, Kim MY. The outcomes of critically ill patients after following the recommendations of the nutritional support team. J Korean Soc Parenter Enter Nutr. 2010; 3(1):40–44.

31. Sriram K, Cyriac T, Fogg LF. Effect of nutritional support team restructuring on the use of parenteral nutrition. Nutrition. 2010; 26(7-8):735–739.

TOOLS

Similar articles