The Nutrition Care Process and You

By Marycela Barron, RD, LD

The month of October has been an exciting month here at Meals on Wheels San Antonio (MOWSA). In addition of having the privilege of serving our clients delicious and nutritious meals, MOWSA is now providing nutrition screening and assessments by a registered dietitian (RD). This new service helps us help our clients who are at malnutrition risk.

Nutrition screens and assessments are part of the Nutrition Care Process (NCP). The purpose of the NCP was to standardize care and to enable practioners to provide high-quality care that is individualize with measurable outcomes. There are four steps to the NCP:

  1. Nutrition Assessment
  2. Nutrition Diagnosis
  3. Nutrition Intervention
  4. Nutrition Monitoring and Evaluation

To begin the NCP dietitians rely on the nutrition screening and referrals system. This starts with our case managers when they visit our clients and ask a series questions used to determine their Nutritional Health Score (NHS). This questionnaire is the DETERMINE checklist created by Nutrition Screening Initiative (NSI) to assess the nutrition risk of the client and is mandated by the state of Texas to be administered to new and existing clients during each of their program eligibility assessments. At MOWSA, any client who receives a score of six or more is referred to the in house RD.

Next, the RD will call the clients with an NHS score of six or more and administer the Mini-Nutritional Assessment (MNA). The MNA is a set of six validated questions and the aggregate score determines the nutritional status of the client.  A score of 0-7 indicates that the client is malnourished; a score of 8-11 indicates that the client is at risk of malnutrition, and a score of 12-14 indicates that the client is at the normal nutritional status. During this phone call, we also obtain feedback about the meals and provides a personalized nutritional education.

For clients with a score of 11 or less on their MNA the RD sets up an appointment for an in-home visit to conduct a nutrition assessment. The nutrition assessment is the method an RD uses to obtain, verify, and interpret the cause of the nutrition problem(s). The RD uses their investigative skills to gather information to determine the nutrition diagnosis.

The nutrition diagnosis comes on from one of three domains. There can be more than one nutrition diagnosis and each diagnosis should be able to be resolved or improved through the interventions of the RD. The nutrition diagnosis domains are:

  • Intake: how much or how little a client is eating compared to their estimated energy needs.
  • Clinical: nutritional problems related to their medical or physical conditions.
  • Behavioral/Environment: the knowledge, attitude, belief, physical environment, and access to safe food.

The nutrition intervention is the action taken to resolve or improve the problem. The client should agree to the nutritional intervention in order for it to be effective. There are four domains of Nutrition Intervention:

  • Food and/or Nutrient Delivery: the individualized plan for changes or additions to the clients’ meals, snacks, and nutrients. This also includes enteral and parenteral feeding and supplements which is not applicable to the Meals on Wheels clients.
  • Nutrition Education: the individualized training and instruction provided to the client to improve their knowledge and enable them to manage or modify their food choices and behavior to resolve or improve their nutritional problem(s).
  • Nutrition Counseling: the client-led process to set priorities, establish goals, and create an action plan to treat or improve their nutrition problem.
  • Coordination of Nutrition Care: consulting with or referring the client to other sources which would assist in resolving and improving the nutrition problem.

Nutrition monitoring and evaluation enables the RD to determine if nutritional problems have been resolved or improved and if there are any new nutrition problems. If the nutrition problems have been resolved then the client is discharged from nutrition services care.

This is an exciting time to be a part of the MOWSA family. Adding the nutrition assessment service enables us to help those who need the most help. If you are interested in helping us help others, please call 210.735.5115 to make a donation. Together, we can deliver more than a meal!