Topical Area: Methods and Protocols
The purpose of this work was to conduct content analysis of college-level clinical nutrition textbooks, specifically text coverage of client history, one of five standard domains in nutrition assessment protocols.
Ten clinical nutrition textbooks were identified in Books-in-Print electronic database (Bowker LLC) using nutrition (title keyword) and medical nutrition therapy (subject keyword) with refinements, e.g., range: 01-01-2013 to 06-01-2018, and exclusion criteria, e.g., study guides. The evidence base for client history was determined from the Academy of Nutrition and Dietetics’ (AND) International Dietetics & Nutrition Terminology (IDNT) Reference Manual: Standardized Language for the Nutrition Care Process, 4th ed. (2013), subsequently published as AND’s Nutrition Care Process Terminology (e-NCPT), which organizes client history into three categories: personal history; patient/client/family medical/health history; and social history.
Only seven of the ten clinical nutrition textbooks had chapters/sections devoted to nutrition assessment; these seven textbooks mentioned all three categories of client history delineated in the AND evidence base albeit at significantly varying depth of coverage. Only two of the textbooks, however, acknowledged client history as one of five domains of nutrition assessment whereas others infused aspects of client history into the chapters/sections thus fracturing the presentation of client history material. Only four textbooks mentioned using physical examination data provided by the physician or nurse as a resource in determining client history. And only one textbook included “client history” in the index of the textbook.
Content analysis of clinical nutrition textbooks revealed fractured coverage of client history which detracts from developing clinical skills for implementing this domain of nutrition assessment protocols. Furthermore, the prevailing reference standard perhaps short changes clinical nutrition practice by not aligning client history with the standard format associated with medical history plus physical examination. These systematic limitations in current textbook coverage may inhibit optimal evidence-based education and subsequent clinical nutrition practice.
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