Submitted by: Jean Bouche, RD CD
I remember from my undergraduate years in dietetics, learning about malnutrition by reading and looking at some children in Africa with Kwashiorkor and Marasmus.
I don't recall from either my undergrad nor in my internship ever "touching" a patient to do a physical assessment - only perhaps a visual assessment of sort. We did watch an underwater weighing, Bioelectric Impedance was done at the Health and Wellness Fair at our university campus. I remember having (cheap plastic) skin fold calipers, but as I have always been told, this measurement is not very reliable if not practiced on a regular basis. Our class was taught by a public health staff member how to check blood pressure.
I hadn't found any of this particularly useful in my clinical nutrition day to day work. But I always have tried to keep the effects of malnutrition at the front of my mind. My first few years as a Registered Dietitian, I kept a two page picture from a magazine showing an African child on his knees in a near fetal position that was obviously malnourished with dry skin, wounds, bones protruding. Yes, kind of a morbid picture, but a daily reminder; and a reminder to discuss this with the interns going through my pediatric rotation with me. Fast forward many years... The International Dietetic and Nutrition Terminology has been developed with nutrition diagnostic language; The Malnutrition Screening Tool is developed and has the highest sensitivity and specificity based on the evidence analysis library review. The Academy & ASPEN have developed a Consensus Statement on Malnutrition, and there is now a one-stop site for information on malnutrition.
I am more aware of reimbursement issues related to nutrition and hear that hospitals are receiving less reimbursement from Medicare, but the reimbursement is greater for those identified with severe malnutrition.
I was asked recently how I identified malnourished patients in the past. During much of my training, I felt I was discouraged from using the term malnutrition, as only a doctor can provide that kind of medical diagnosis (pre- IDNT). I might have used the word phrase that a patient had a poor diet / was poorly nourished.
The past 4 years or so, I've taken a more proactive approach to learning more about malnutrition and how I can further assess a patient’s nutritional status using the Nutrition Focused Physical Assessment (NFPA). There are many great resources available. I found out right before FNCE last year, that Abbott Nutrition had a NFPA Virtual reality training tool at their booth!! Unfortunately, I was not able to attend FNCE and felt I missed out on this. I contacted Abbott and Nancy Collins right away about seeing if this training tool could be used at our State conference 6 months later, but unfortunately, this was not available at the time.
NOW Abbott Nutrition Health Institute has brought this tool to all of us through their website!! Free of charge CEU in the comfort of your own office or home! I took this self-study course and was impressed with the excellent tactile description and suggestions using everyday objects of how the temporal muscle, clavicle and shoulder feel in a patient is nourished vs malnourished. I am encouraging all other RD's who want to learn more about NFPA to take this self-study course. What a great learning tool-- using Nutrition Informatics to bring training right to you!