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Evaluating the Needs of Registered Dietitians and Managers when Implementing and

Performing Nutrition Focused Physical Assessments

Sarah Genton, BS, Brooke Pfest, BS, Ausrine Paulauskaite,BS, Amy DeMage, MS, RDN, LDN
Aramark Healthcare Distance Learning Dietetic Internship



Many studies have concluded that malnutrition, which is often misdiagnosed and
goes untreated in hospitalized patients, can be identified and diagnosed through Nutrition
Focused Physical Assessments (NFPA). Registered Dietitians play an important role in
the performance and interpretation of the findings exposed in a NFPA due to their
nutritional significance. This study aimed to better understand the current needs of
Aramark Registered Dietitians and the Managers overseeing Registered Dietitians
concerning the implementation efforts of Nutrition Focused Physical Assessments. A
needs assessment survey was developed and administered to Aramark Registered
Dietitians and the Managers overseeing Registered Dietitians participating in the Aramark
Dietetic Internship 2015-2016 site locations. SurveyMonkey Pro was used to develop,
administer, and organize the data responses of the needs assessment. A total of fourteen
Registered Dietitians and twenty-three Registered Dietitian Managers completed the
survey via SurveyMonkey Pro. Implementation efforts for NFPA have been made by 77%
of the managers at their locations. The two main barriers that RDs face in receiving more
training include time away from work (78%) and program costs (71%). Following the
survey, it seems as if Registered Dietitians and managers understand the importance, the
knowledge behind, and are motivated to learn more about NFPA. However, most of the
managers responded that more budget friendly hands-on training, pocket guides,
malnutrition documentation education, and resources/guidance provided by Aramark were
needed for successful implementation. The limitations and recommendations for future
research are discussed.

A cross-sectional study was conducted to evaluate the current needs of Registered Dietitians and the managers overseeing the Registered Dietitians within Aramark
regarding the implementation and performance of Nutrition Focused Physical Assessment in clinical practice.

Research findings support the need for extensive instructor guided hands-on
training with NFPA.
Barriers include financial implication, time away from work, and travel
requirements. Consistent with what hands-on training workshops would require.
Registered Dietitians and managers understand the importance, the knowledge
behind, and are motivated to learn more about NFPA.
Actually performing the invasive NFPA and interpreting that information into the
appropriate criteria is a problem area, which is consistent with majority of trainings
delivered through webinars, self-study, and written materials since application
would not be involved.
One struggle of NFPA is on obese/overweight patients and on critical patients in
the intensive care units. This is consistent with other studies findings that
performing NFPA on patients in the ICU presents a complex situation due to the
nature of the setting and their fragile condition 5
Self-Reported Data
Pilot Study with a small convenience sample
Strength is the ability to quickly assess the needs of Aramark Registered Dietitians
and Managers about NFPA.

Inclusion Criteria:
Clinical Registered Dietitian or a manager overseeing Registered Dietitians employed or managed by Aramark
Providing inpatient services
Located at sites participating in the 2015-2016 Aramark Dietetic Internship.
The survey was developed using SurveyMonkey Pro.
The survey was distributed using Electronic Mail.
An Initial question divided out the Managers overseeing the Registered Dietitians to a specific Manager survey.
SurveyMonkey Pro compiled percent (%) responses for each question.
Descriptive Statistics were used to evaluate the data
Microsoft Excel-201l was used to compile the findings and to calculate mean percentages for questions regarding years credentialed, worked for or managed by
Aramark, and Aramark contract length at the facilities.



Malnutrition impacts 30%-50% of hospitalized adult patients, but only 3.2% of these
patients are diagnosed upon discharge1.
When a Registered Dietitian was exposed to a malnourished patient, only 29% of the
45% were accurately documented2.
There is a developing need for Registered Dietitians to perform and apply the
outcomes from Nutrition Focused Physical Assessments (NFPA) to recognize and
diagnose malnutrition3,4,5.
Among Registered Dietitians there is a lack of training, resistance to touch patients,
and little knowledge of findings causing it to not commonly be included among
Registered Dietitian's nutrition assessments6.
At this time, it is unclear what resources practicing Registered Dietitians and their
respective Managers need to support the implementation efforts of NFPA.
The intent of this research is to better understand the current needs of Aramark
Registered Dietitians and Managers overseeing Registered Dietitians with the
implementation of Nutrition Focused Physical Assessments at their accounts.

What are the current needs of Aramark Registered Dietitians and Registered Dietitian
Managers with the implementation of Nutrition Focused Physical Assessments into clinical

All received some form of training or
resources in NFPA
Over half (53%) of respondents are very
motivated to receive more training in
The two main barriers that RDs face in
receiving more training include time away
from work (78%) and program costs (71%).

Facility Support
No RD felt their other interdisciplinary roles
were not encouraging, supportive, or
57% of the the RDs noted it is important to
have support from other interdisciplinary
No RD selected the physicians at their
facility are diagnosing malnutrition via the
ASPEN and Academy guidelines.

Implementation efforts NFPA have been
made by 77% of the managers at their
81% have received training in Nutrition
Focused Physical Assessment through
webinars, and 51% through written
Some reported their training was solely selfstudy or self-taught

Facility Support
Only 31% of the Managers feel they have
access to resources to successfully
implement NFPA at their facility.
22% of the managers noted their physicians
are using the appropriate guidelines for
malnutrition diagnostic criteria.
Only 9% have made efforts to educate other
disciplines within their facilities, while 47%
have not made any efforts.

Results from the needs assessment surveys provide important information about
the current performance and implementation efforts of NFPA.
Barriers exist that are hindering these Registered Dietitians and Managers from
performing, receiving additional training, and to further implement NFPA at their
Inconsistencies exist across the Aramark accounts surveyed.
The survey will need to be sent out to the rest of Aramarks registered dietitians
and their respective managers to fully understand what resources or guidance is
needed. Further more, the development of a training program that addresses the
needs for further education, hands-on instruction, and guidance from Aramark.


Dietitians Survey
Clinical Deparment Support
38% are attempting the performance
75-100% of the time, and 38% are less than
25% of the time.
Only 28% feel they are in full compliance
with Aramark's Policy with NFPA.
Barriers: difficulty to perform on certain
patients, non-clinical practicing manager,
more assistance from Aramark to receive
the necessary training, more staff, and more

Personal Performance
None of the selected they were very
comfortable performing NFPA.
No RD selected they were very
comfortable in performing NFPA, but 38%
were only somewhat comfortable.
53% of the RDs understood the malnutrition
diagnosis criteria guidelines written by
A.S.P.E.N and the Academy.

Managers Overseeing
Registered Dietitians Survey

NFPA is being included into departmental
meetings an even 50-50 split between
talking about it every meeting or every other
Only 36% of the managers selected their
Clinical Department was greater than 75%
in compliance with Aramarks policy for
40% were very comfortable in providing
constructive feedback to the Dietitians with
regards to NFPA performance.

Personal Performance
61% are only somewhat confident with
interpreting findings from NFPA.
38% were only somewhat comfortable
performing NFPA.
47% have a very high understanding of
diagnosing malnutrition based on ASPEN
and Academy guidelines.
Barriers: 59% limited time away from work,
59% financial reasons, and 36% travel



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2014-2015 term.

Sarah Genton
Brooke Pfest

Ausrine Paulauskaite
provided by: