No 2
The Tools of Nutrition Assessment
What is an assessment tool?
• A tool is“ any device used for doing or facilitating work”
• A tool is “A mean to an end ,as an instrument or implement used to
accomplish a purpose”
• Tools are generally adapted or individualized to take and give only those
data of interest in a specific situation.
• Generally ,a series of tools will be selected to strengthen the validity of
data collection and implementation of nutrition intervention
Data collection instruments as assessment tools or forms
• Nutrition assessment tools include many forms or instruments for
gathering data to assess the nutritional status of the patient .Examples are
1- Screening forms
“Nutrition screening is the process of discovering
characteristics or risk factors Known to be associated with dietary nutritional
problems ”.Its main purpose is to identify individuals who are potentially at
high risk ,that is ,who have complex and involved problems that touch upon
nutrition .
• Screening forms are used to assess the kinds of care or level of care needed
in order to provide health care interventions to individuals or groups and to
identify those at greatest risk.
• A screening may be simple or complex depending on its intended use ,the
data may be collected by one practitioner or by a number of health care
professionals.
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2-Dietary intake forms
“Dietary intake forms are tools used to collect
information about an individual’s food intake”
These include
1-24- hour recall forms
2-Food frequency checklists.
3- Food records.
4-Dietary history questionnaires.
3-The nutrition profile forms
“The nutrition profile is a broad needs assessment form
(or set of forms ) that can be used to collect or organize information about the
population served and available resources”.
• The primary purpose is to help identify the nutrition related problems of a
population.
• As a diagnostic tool it provides a systematic method of descriptive
information that can be used to meet the nutrition or health related needs
and to expand resources within a demographic area .
• It can serve as a basis for planning nutrition intervention programs
Objective Data as Assessment Tools
• Objective data can be quantified and can serve as assessment tools .These
tools provide specific, quantifiable data to assess individual patients or
group and to monitor nutrition intervention outcomes.
• If correct techniques and reliable instruments are used to provide these
data ,they are generally accurate ,comparable measures.
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• Laboratory data and anthropometric measurements
Laboratory values
• Laboratory data offer a large number of measurements to select for
nutrition assessment.
• Selection of number of measurements is based on the complexity of the
assessment .
• Laboratory data provide baseline information that can be sequentially
compared and interpreted .Because laboratory values include a“normal
range” assessments can be made that are very specific.
Anthropometric measures
• Anthropometric measurements can be simple ,such as height and weight
,or more complex , such as measurement of body density and body fat.
• These techniques are inexpensive in terms of time and equipment required
and can be repeated and compared.
• Recording of height and weight can be inaccurate and misleading if the
equipment is poor or if improper techniques are used.
Subjective Data AS Assessment Tools
• Subjective data require the collection of information that is then evaluated
by sets of standards that are qualitative and less specific than those for
quantitative data.
• These tools are extremely important in the nutrition assessment process.
• Clinical judgment and experience are important factors in evaluating
subjective data.
Physical signs
• Physical or clinical signs provide important assessment data .
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• Visual examination of hair ,face, eyes skin ,lips ,nails ,cardiovascular , and
gastrointestinal status can be revealing in identifying the presence of
malnutrition.
• Examination of gums , teeth , and tongue should not be overlooked and can
reveal abnormal nutritional status especially in children.
• Sensory perception is important because inability to smell can lead to
decreased food intake.
• Descriptive standards have been set for normal appearance and lists
,charts, and photographs of signs of malnutrition have been developed to
assist in this assessment.
Food intake information
• Food intake and diet patterns collected on any of the assessment tools are
also qualitative.
• These data are compared with a set of standards such as the DRI , food
groups ,dietary guidelines, or the USDA pyramid.
• Errors can be made in reporting and collecting these data .
• Environmental and functional information
Environmental and functional information are other tools that play an
important role in assessing nutritional status .
• Is the client physically able to purchase adequate food?
• Are finances sufficient to buy food?
• Who shops for food?
• Is there adequate and safe storage for food products?
• Is someone able to prepare meals?
• Is he or she eating alone?
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• Can clients feed themselves?
• These questions are important in determining who is at risk for inadequate
food intake.
Subjective global assessment (SGA)
• This is an alternative method of nutrition assessment that collects and
evaluates subjective data for identification of patients at nutritional risk .
• It includes only data from a physical examination and medical history .
• Anthropometric measurements and laboratory data are not included.
• The medical history focuses on weight change, dietary intake changes,
gastrointestinal symptoms (nausea , vomiting, diarrhea , anorexia)
functional capacity
•
(walking ),and metabolic (stress) demands of disease.
• The physical examination focuses on subcutaneous fat ,muscle wasting,
and presence of edema in the ankles .
• Data by SGA system that ranks the patients as well nourished ,moderately
or possibly malnutrition or severely malnutrition.
How Assessment Tools Are Used
• The tools of nutrition assessment provide information for a number of
different purposes.
• First and foremost they document baseline data about the nutritional
status of an individual or group .
• These data are then referred to at sequential intervals when follow–up
assessments are completed to monitor nutritional progress of patients or
group.
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• Monitoring provide documentation of the effectiveness of nutrition
intervention and an opportunity to evaluate
the change of the intervention when needed.
How Screening Tools Are Used
• A screening tools is not used for nutrition assessment per se.
• It provides a small amount of nutritional information to divide groups of
people quickly into categories and make decisions about appropriate
nutrition interventions and levels of care.
• Screening is the first step of the outline levels of care with an appropriate
monitoring system.
How Dietary Assessment Tools Are Used
• Dietary assessment is usually the first step in nutrition assessment ,and is
used to evaluate the food intake in greater depth than a screening process
can.
• Generally ,screening will have indicated that the client needs a more
extensive dietary evaluation.
• The tool or combination of tools selected depends on the depth necessary
and should be appropriate for appraising each situation.
How laboratory assessment tools are used
• Laboratory data are usually collected in hospitals.
• Physicians order those tests for diagnosis.
• Laboratory data are valuable for the dietary assessment for the patient.
How Physical Assessment Tools are used
• Physical signs observed during the clinical examination of the patient
provide an overall impression of nutritional status.
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• Examination of the body observing obvious obesity will provide important
information about general nutritional status of the patient.
• Physical assessment is more evident and of greater value in children.
• Physical s of disease are not always evident in early stage.
• Physical assessment provides a general impression and this information will
usually be followed by the use of other tools to complete the nutrition
assessment.
How Anthropometric Assessment Tools Are Used
• The most common anthropometric tool is documentation of height and
weight.
• Patient reporting about height and weight should not be substituted for a
actual measurements since the validity of patient reports is questionable
.Depending on the goals and need ,other forms of anthropometric
assessment may be employed such as measuring tapes for measuring
skinfold and body circumference.
How the nutrition profile is used
• The nutrition profile is a written document or set of forms that provides a
total picture of the nutritional problems and resources of a defined
population.
• The process of collecting demographic and nutritional data acts as a guide
to evaluate the population and to plan nutrition support systems
Nutrition profile allows
• 1- Identify those who may be in need of nutritional care.
• 2-Review the availability and utilization of existing supportive health
personnel.
• 3- indicate where to upgrade nutrition support services.
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• 4- Expand opportunities for nutrition intervention strategies.
• 5-Plan procedures for evaluation and monitoring.
• The most important consideration in the process of data collection involves
the development of a group profile as the basis for identifying groups at
nutritional risk and planning intervention.
• Thus data collection must be systematic giving a description of nutrition
problems for the community served.
• Since institution and community organizational structure vary ,the
collection of data base is based on vailability of staff or organizational
requirement.
• The key to effective utilization of the profile may be to adept the tool to
meet the needs and individual characteristics of a specific health care
setting.
• If a tool is “any device used for doing or facilitating work” then the nutrition
profile is a tool because it facilitates and identifies background information
about clients, institutions, and the community.
• Descriptive indicators identified by the profile include a description of the
population served, demographic, socioeconomic factors, and the presence
of nutrition related disease.
How information is organized in the profile
• Nutrition profile is organized in three sections
•
1- The first section include the entire community serving the people in a
defined area, such as a city ,township , or country.
•
A" community assessment paints a picture of the health of the
community, its ecology , and the factors influencing the way its people
live.”
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• Subgroups in that community receive health care from a variety of
facilitates such as hospitals, nursing homes, and neighborhood clinics.
• 2-Secound the profile then focuses on the characteristics of the specific
population subgroups that receive services from each identified facility.
• 3-Third One use of the profile is the sharing of information across facilities
within the community ,since some clients might be served at the same time
or at different time by more than one facility.
• At the end the content for the nutrition profile in each of the three sections
community, facility and client .Data can be collected by an individual or a
team.
• A team is more efficient because they pool information, shorten time , and
provide greater awarness.
Advantage of using the profile
• Increase communication among the team member involved in the process.
• A free flow of communications cuts across both horizontal and vertical
structure of management.
• Lower ,middle , and executive staff are directly or indirectly a part of the
profile process.
• The purpose of the profile pinpoints the challenge to professional dietitians
and nutritionist to provide dynamic leadership in the nutrition assessment
process.
• The profile provide the practitioner with database for describing the state
of the art for dietary/nutritional services
• It can enable quality nutrition services to be planned around stated goals
and objectives.
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• The early formulation of short and long term goals based on the profiles
which should include ways of measuring performance and outcomes.
• Because cost effectiveness is of great concern all or part of the profile can
be used to determine costs of providing minimal, medium level or maximal
care based on staffing resources and patterns
Importance of Nutrition Assessment Tools
• Nutrition assessment tools are used to determine base line data in order to
identify who needs nutritional care and to plan nutrition intervention.
• Nutrition assessment tools provide data for planning nutrition instruction
for individuals or groups .For example , laboratory data will reflect the
biochemical levels of nutrients in the blood ,urine, and tissues .Dietary
histories provide information about individual eating habits ,lifestyle, and
nutritional problems .Clinical assessment reveal physical signs that can help
detect nutritional deficiencies or excesses .Information such as height and
weight data is most useful for routine application in an assessment
protocol.
•
The major objective of the plan is to improve the nutritional status of the
individuals or group ,as well as to improve the nutritional status of the
entire population .The plan should consider the levels of care needed and
the most effective way to provide the care. Specific objectives should be set
within a time frame. It is recommended that the plan be written and stored
in a central place for the health care team to review and revise.
•
Nutrition assessment tools provide data to monitor patient or program
progress .Monitoring is the checking of progress over a period of time to
ensure continuation of quality care and to identify the new nutritional
needs.
• Nutrition assessment tools provide data to evaluate outcomes of nutrition
assessments in individuals or groups .Positive outcomes are needed to
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determine the effectiveness of the plan or program .Ongoing evaluation is
needed to measure the progress and success of the program.
The following questions is used to evaluate the intervention program:
• Has the nutritional status of the clients changed?
• Were the procedures and standards appropriate to the population ?
• Were the goals of the program met within the time frame?
• Did members of the health care team fulfill their responsibilities in carrying
out the program?
• Would a different intervention program produce greater improvement ,be
more cost-effective ,be less time consuming ,or affect a larger group of
individuals?
• If the answers are not appropriate ,the program goals and resources must
be reevaluated and perhaps redesigned toward more realistic results
1-Identify need for specific data units
Formation plan for data collection
Determine responsibility of team member/groups in collection.
2-Collect data from internal source
• Medical /dietary
• Business and other records
3-Collect data from external source
4-Analyze record data
5-Identify population at risk
• Describe population at risk ,gaps in service
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6-Determine program priorities
7-Implement revised plans and programs
8-The last step is to evaluate programs and review programs
• Conclusion
• A wide variety of tools are available that are essential in the comprehensive
nutrition assessment of individuals and group .Usually no one tool can be
used as a definitive indicator of nutritional status, rather it must be
combined with data obtained through other assessment tools .In practice
,the tools will need to be selected and adapted to the need of each facility
,community ,or agency.
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