Peer Assisted Learning
Resource Pack
A guide for Practice Educators
London Cluster Placements Team
January 2012
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Welcome to the London Cluster Peer Assisted Learning Resource Pack
This resource pack has been developed by the London Cluster Placements Team to support
Practice Educators to incorporate peer assisted learning activities into clinical placements
offered to dietetic students.
It is anticipated that Practice Educators will select the most relevant activities to support the
stage of the student’s placement, the student’s key areas for skill development and the
resources available in their clinical setting. It is also anticipated that activities will be adapted
to meet specific student or service requirements.
If you are accessing this pack electronically, you can navigate to a specific section from the
contents page by hovering over the page number with your mouse, pressing Ctrl and then
pressing the left click on your mouse.
If you have any queries about the resources in this pack, please contact a member of the
London Cluster Placements Team on either: dietetics@londonmet.ac.uk or
dietetics@kcl.ac.uk
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Contents
Contents ............................................................................................................................... 2
1. Introduction ...................................................................................................................... 4
1.1.
Introduction to Peer Assisted learning (PAL) ....................................................... 4
1.2.
Using PAL for dietetic placements learning activities .......................................... 4
1.3.
Essential components to a successful PAL activity ............................................. 5
1.3.1.
Planning.............................................................................................................. 5
1.3.2.
Facilitated debrief sessions ................................................................................. 6
1.3.3.
Feedback ............................................................................................................ 7
Peer feedback ................................................................................................................... 7
Supervisor feedback ......................................................................................................... 7
1.3.4.
Using PAL activities as evidence towards assessment ....................................... 8
1.4.
Frequently asked questions ................................................................................ 8
1.4.1.
Supporting students who are not getting on with each other ............................... 8
1.4.2.
Supporting students who are progressing at different rates................................. 9
2. Induction......................................................................................................................... 10
2.1.
Expectations and Orientation ............................................................................ 10
2.2.
Policies and procedures .................................................................................... 11
2.3.
Role of the Dietitian/ Dietetic Assistant.............................................................. 11
2.4.
Meal Production Activity .................................................................................... 12
2.5.
Meal Service Activity ......................................................................................... 13
2.6.
Ward Orientation............................................................................................... 13
2.7.
Dietetic Shadowing ........................................................................................... 15
2.8.
Doctor and Nurse Observation activity .............................................................. 17
3. Assessment - Anthropometry ......................................................................................... 18
3.1.
Commonly used anthropometric variables ........................................................ 19
3.2.
Estimating anthropometric measurements ........................................................ 19
3.3.
Choosing appropriate anthropometric variables to use ..................................... 20
3.4.
Gathering anthropometric data ......................................................................... 20
4. Assessment - Biochemistry ............................................................................................ 21
4.1.
Identifying relevant biochemical parameters ..................................................... 22
4.2.
Identifying abnormal biochemistry ..................................................................... 22
4.3.
Biochemistry and dietetic interventions ............................................................. 23
4.4.
Assessing biochemistry .................................................................................... 23
2
5. Assessment - Clinical ..................................................................................................... 24
5.1
Medical notes familiarisation activity – part 1 of 2 ............................................. 24
5.2.
Medical notes familiarisation activity – Part 2 of 2 ............................................. 25
5.3.
Medication familiarisation activity ...................................................................... 26
5.4.
Familiarisation with unfamiliar clinical conditions ............................................... 28
6. Assessment - Dietary ..................................................................................................... 29
6.1.
Compilation of oral nutrition support and enteral feed ready reckoner ............... 29
6.2.
Differing approaches to gathering dietary information ....................................... 29
6.3.
Qualitative and quantitative assessments of dietary intake ............................... 30
6.4.
Food record charts/food diaries ........................................................................ 30
7. Assessment - Environmental .......................................................................................... 32
7.1.
Individuals ......................................................................................................... 32
7.2.
Groups .............................................................................................................. 33
7.3.
Populations ....................................................................................................... 33
8. Nutrition and dietetic diagnosis ....................................................................................... 34
8.1.
Identifying nutritional priorities ........................................................................... 34
8.2.
Identifying dietetic diagnosis statements ........................................................... 34
9. Intervention, planning and implementation ..................................................................... 35
9.1.
Identifying dietetic management goals .............................................................. 35
9.2.
Implementing dietetic management goals ......................................................... 36
9.2.1.
Devising implementation plans ......................................................................... 36
9.2.2.
Implementing the dietetic care process ............................................................. 36
10.Monitoring and evaluation .............................................................................................. 37
10.1.
Identifying appropriate follow-up arrangements................................................. 37
10.2.
Identifying appropriate outcome measures ....................................................... 37
10.3.
Reviewing dietetic interventions ........................................................................ 38
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1. Introduction
1.1.
Introduction to Peer Assisted learning (PAL)
Peer Assisted Learning has been defined by a number of different people:
“To get knowledge through study, experience, observation or teaching of an equal” (Lincoln
et al, 1993)
“Peers helping each other to learn” (Crouch et al, 2001)
“Individuals with equal status actively help and support each other in learning tasks”
(Ladyshewsky 2006)
The Oxford dictionary defines a peer as “an equal in civil standing or rank or equal in any
respect”
Ladyshewsky (2006) states that PAL is “a natural way of learning or completing tasks if the
same task has been set for more than one person” and that it is a “way of pooling resources
and reducing duplication of effort”. In essence PAL is a way of increasing knowledge and
skills by working in partnership with someone else.
There is a substantial amount of medical and allied health professional research in using
PAL to enhance student learning (Cate & Durning 2007, Field et al 2007, Roberts et al
2009a & b) but little in the way of practical guidance.
1.2.
Using PAL for dietetic placements learning activities
Students are usually allocated to placements in even numbers so as they are able to work in
pairs. PAL activities can be used to facilitate induction into a new clinical area and support
the development of key skills in assessment, identifying nutrition and dietetic diagnoses,
planning and implementing interventions and reviewing, monitoring and evaluating dietetic
interventions. PAL activities can also support the development of key professional skills
such as communication skills, team working and reflective practice skills. Sections 2 – 10 of
this resource pack include suggestions for PAL activities to support skill development in a
range of areas.
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1.3.
Essential components to a successful PAL activity
1.3.1. Planning
Pairing students
We suggest that you either pair students randomly or if appropriate take transport
arrangements into account. If you are basing students at sites that are some distance from
each other than it would make sense to pair students according to who lives nearest the site
at which they will be based. If the students will be required to make frequent visits to
community clinics then it may be sensible to pair drivers or car owners with non-drivers. It is
not advisable to allow students to select their own pairings as there may be one person in
the group that everyone would prefer not to work with. Randomly allocating partners avoids
making this obvious.
Although it can be useful to take learning styles into account when planning activities for
students and might therefore seem sensible to put students with similar learning styles
together, often students with complementary learning styles make good pairs. The activists’
tendency to jump in and have a go can be tempered by the reflector who might prefer to
watch someone else before performing the activity themselves. The problem with this type
of complementary pairing is that it can then be difficult to move the students beyond their
comfort zone and encourage them to develop a more rounded learning style. It is important
that the students are encouraged to be explicit with their peer about their individual learning
style to support their effective peer working.
Planning for activities
It is essential to plan a PAL activity to ensure that the exercise meets its aims and objectives
and facilitates a valuable learning experience. Core components of a PAL activity will
include:

An opportunity to brief the students in relation to the expectations of the activity

Time for the students to complete the activity, including designated time for peer
discussion and reflection

Opportunity for a facilitated debrief with a supervisor and individualised feedback (see
section 1.3.2 for further information)
Sections 2 – 10 of this resource pack include a series of briefing sheets for Practice
Educators for a range of PAL activities. These briefing sheets have been designed to
support you in planning PAL activities and include details of the aims and objectives of the
activity and the resources required for the students to successfully complete the activity. It is
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envisaged that activities may need to be modified to suit individual learning environments
and so this resource pack is meant to support practice educators to develop tailored PAL
activities rather than be a definitive list of activities that can be used.
1.3.2. Facilitated debrief sessions
Debrief sessions can take two formats, debriefs following individual PAL activities and
student led facilitated group discussions.
Debriefs following individual PAL activities
It is important that students have the opportunity to debrief from a PAL activity to consolidate
learning and identify specific learning needs. Debrief sessions should be arranged as part of
the planning of a PAL activity and should happen as near to the activity as possible. It may
be helpful to prepare specific questions to direct the debrief session or you may want to ask
the students to lead the direction of the session. It is particularly important that all students
have the opportunity to participate in the debrief session. Students should be encouraged to
be prepared to speak about the entire activity and not just the section they complete to
promote a more holistic learning experience.
Student led facilitated group sessions
Student led facilitated group sessions also provide an important opportunity for students to
meet and share their learning experiences. If you are only working with two students, it may
be most appropriate to timetable these sessions at times when they are working more
independently of each other to facilitate ongoing peer support and shared learning. In cases
where there are only two students attached to one placement site other members (e.g. Band
5 Dietitians) could also be encouraged to attend these sessions and present a case they
have seen in order to facilitate a greater breadth and depth of learning. Although student led,
a facilitator (usually a member of the placement team) should also be present to support the
students get the most out of these sessions.
Although the format of the sessions can vary, and should be directed by the students, it
would be common for each student to prepare a case presentation of a patient that they
have seen during the previous week. In the early stages of their training, students can
present a case that they saw whilst shadowing a dietitian but as they progress they can
report on cases in which they took a more active part in the consultation. Once a case has
been presented the other members in the group are encouraged to ask questions, in early
sessions the facilitator may need to lead the questioning but the students should actively
participate and take on the leading of these group sessions. It may also be appropriate for
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students to present a reflection on a learning experience during the previous week. Student
participation in these sessions can also be recorded by the facilitating dietitian using the
proforma “observation of student in tutorials” (Appendix 1). This sheet can be used as a
basis for giving the student feedback, or used by the student as evidence of meeting
learning outcomes in the portfolio.
1.3.3. Feedback
Constructive feedback is crucial to student learning. When completing PAL activities,
feedback is specifically important to ensure that each student is aware of their own progress
and individual learning objectives. This helps to remove feelings of competition between
paired students, and helps students to understand what they were expected to learn from a
particular activity.
Peer feedback
Students on a PAL placement have the opportunity to learn from feedback given by their
peer. The clinical observation form (Appendix 2) can be used by both practice educators
and peers to provide structured feedback following a consultation. Peers may also find it
helpful to use this form as a reminder of the skills they should be looking out for and of the
things that it is useful to have feedback on. Peers may initially find it difficult to give
constructive feedback, using the form provides a structured way of facilitating this. It is worth
spending some time during the induction period to ensure that peers understand the
importance of giving each other constructive feedback and feel comfortable doing this. If
they are unable to give each other useful feedback then many of the learning opportunities
will be lost. All of the students have also had opportunities to give each other feedback at
University. Feedback should be given as near to the event that it refers to as possible as
this is when it is most constructive and helpful.
Supervisor feedback
Although there are many benefits of peer feedback, supervisor feedback is vital to support
skill development and the development of competence against the placement learning
outcomes.
Individualised feedback
Individualised, supervisor feedback can be given as part of a debrief session but should also
be based on episodes of direct observation of the students practice in a range of settings.
Students should be observed completing tasks at a minimum frequency of 2 – 3
times/week. There may be more periods of direct observation at the start of the placement
but it is important that the level of observation does not drop as the placement progresses as
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feedback based on direct observation remains crucial throughout the placement to support
the development of key skills.
Daily feedback & reflection
A half hour facilitated feedback session should also be timetabled into the programme at the
end of every day, to encourage students to reflect on the days learning. This session can be
done with both students as a pair. A record of this feedback can be kept in a student held
log book to ensure that the content of this feedback and subsequent action plans are not
forgotten about.
Weekly review meeting
A student led weekly review meeting should also be timetabled into each students
programme. This session is designed to review the week’s progress and discuss objectives
for the coming week. This session presents an opportunity to see students individually and
can be used to hand over to a new supervisor if appropriate.
1.3.4. Using PAL activities as evidence towards assessment
Collaborative pieces of work can be used as pieces of formative assessment to facilitate
feedback and action planning however they should not be used towards an individual
student’s summative assessment. However, individual pieces of work that have been
collated to form a larger project (e.g. a clinical audit or a health promotion project) can be
used as evidence. Documentation of reflective discussion and the facilitator-completed
review of a student’s contribution towards a feedback session can also be used as evidence
to support summative assessment.
1.4.
Frequently asked questions
1.4.1. Supporting students who are not getting on with each other
Students should behave in a professional manner just like everyone else in the department.
We are not able to choose our work colleagues or members of the MDT, students should be
reminded that they need to “get on” with everyone and form professional working
relationships. It may be helpful to arrange a mediation process to allow each member of the
pair to express their difficulties in a safe environment. Each student should have an equal
time to speak and also a right to reply. It is also important that a practice educator is present
to facilitate discussion between the students. Questions such as “What would you like to
see happen?” “What would help you to work together?” and “Is there anything that you
could do differently in future?” may be helpful. Often discussing issues openly rather than
allowing things to fester can promote understanding between a pair and allow them to
overcome their differences and work together more easily.
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1.4.2. Supporting students who are progressing at different rates
It is important to ensure that each student has equal time with the dietitian available to them.
Each student should have his or her own supervisor to ensure that weekly feedback and
goal setting is done individually. It is also important to avoid any comparison of students’
performance. Build confidence by asking questions that you know the less confident student
can answer. It is important to stretch both students, individual team members may be able
to provide opportunities for students individually.
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2.
Induction
2.1.
Expectations and Orientation
Aim: The aim of this activity is to ensure that students are aware of the basic arrangements
for the functioning of the department and what is expected of them.
Objectives: By the end of this activity, students should be able to:

Identify key staff members

Obtain refreshment and locate the toilets,

Understand their programme and what is expected of them.

Find key locations in the base building(s)
Activity
Cover the following induction information with both students:
1. Introduction to the department
2. Who’s who, who sits where, hours of work, breaks, refreshments, toilets, fire exits
3. Student programme
4. Expectations – give students half an hour in their peer pair to come up with their
expectations of placement.
Discuss with Practice Educator and talk through department’s expectations of the
student. Both sign expectations agreement
5. Arrange security passes, computer log-ins etc.
6. Orientation activity – give the students a questionnaire that they can only find the
answers to by visiting key locations in the Trust/ Building/ Area – send them to complete
this together then debrief afterwards. Were there any surprises? Any places they
couldn’t find?
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2.2.
Policies and procedures
Aim: To familiarise students with the key policies and procedures that are relevant to dietetic
practice within the organisation where their placement is taking place.
Objectives: By the end of this activity, the students will be able to:

Identify key policies that are relevant to dietitians working in your area

Give a summary of the key points which affect dietitians.

Describe how those points influence the day-to-day practice of dietitians.
Activity
Give the students access to the policies and procedures that affect dietitians working in your
area.
The students need to divide the policies between them and read the ones that they have
been allocated, taking notes of key points that are relevant to dietitians as they do so.
Each student will then present a summary of the key points of the policies they have
covered, and how they affect the day-to-day work of a dietitian, to their partner and
supervisor
2.3.
Role of the Dietitian/ Dietetic Assistant
Aim: To introduce the students to the different roles of the dietetic assistant and dietitian and
to the differences in their communication styles.
Objectives: By the end of this activity the students should be able to:

Identify 3 key differences between the role of the dietitian and that of the dietetic
assistant.

Identify 3 similarities or areas of overlap between the 2 roles

Identify 3 differences in the communication styles used.
Activity
Both students should observe the Dietitian/Dietetic Assistant undertaking a consultation and
take notes on it, using the clinical observation checklist. The students should compare notes
on the different aspects they observed and discuss any queries with the Dietitian/ Dietetic
Assistant. As well as thinking about the different styles they have observed, the students
should think about the differences between the two in terms of their professional roles and
boundaries.
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2.4.
Meal Production Activity
Aim: The aim of this activity is for the students to become familiar with the meal production
system in use in your area along with its strengths and limitations.
Objectives: By the end of this activity the students will be able to:

Describe the meal production system used in your area.

Describe how portion control is managed in your area.

Describe the nutritional guidelines used in the development of the menu for your area.

Know how to order a “Special diet” and describe the range of meals and snacks
available for patients.

List the strengths and weaknesses of this type of meal production system.
Activity:
Both students should go to the catering department and have a briefing from the catering
manager about the catering system in use, including costs, restrictions, benefits of this
system etc.
One student should then spend time with a designated member of staff in the main meal
production unit, taking note of how the meals are prepared to be sent to each ward or area
and any strengths or weaknesses that they can identify.
The second student should spend time with the “diet cook” or equivalent, learning how
special meals are ordered, prepared and sent to the correct patient, again noting any
strengths and weaknesses of the system.
The students will then debrief with a facilitator, each sharing what they have found with the
other.
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2.5.
Meal Service Activity
Aim: The aim of this activity is for the students to begin to understand how meals are served
to patients and the strengths and limitations of the system in use in your area.
Objectives: By the end of this activity, the students should be able to:

Describe the meal service systems in use in your area

Describe the differences between the meals provided to two different areas

List key strengths and limitations of each of the systems.
Activity:
The students should each observe/ help with meal service in one area, each having different
systems in use e.g. an adult ward and a paediatric ward or a general ward and a dialysis
unit, or a nursing home and a school. The students should take note of how the food is
served, how the portions are controlled and how the correct food reaches the correct person.
They should note the strengths and limitations of the system.
The two students should then meet up to compare notes and determine the advantages and
disadvantages of the systems they observed in the places in which they were observed.
The students should then debrief with a facilitator.
2.6.
Ward Orientation
Aim: to provide an introduction to the dietitian practice educator as a professional role
model for students, and to give students some insight into the skills and knowledge they will
develop over the placement.
Objectives: By the end of this activity the student will be able to:

Describe the type of ward and the patients most frequently referred to the dietitian

Describe the referral process

Describe the discharge process and how dietitians are informed about discharges

Locate key areas in the ward

Locate key sources of information
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Activity:
The students will need to be taken to different wards and make brief notes on the following:

Key ward staff – note their names and titles

The ward name and what types of patients are admitted to this ward?

Which patients are likely to be seen by the dietitian and why?

Is there a referral process for dietetic input?

The average patient length of stay

The discharge process? How is the dietitian informed of discharges?

Location of:

o
Bed list
o
Nursing handover list (if available)
o
Medical Records
o
Equipment for measuring anthropometry
o
Enteral feeding pumps and giving sets
o
Reference books eg BNF
o
End of bed charts
o
Ward pantry/ kitchen
o
Computers
o
Meeting rooms or areas
Brief training from dietitian in EPR and CRS
The students will need to be prepared to discuss their findings with each other and a
facilitator
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2.7. Dietetic Shadowing
Aim: The aim of this activity is to observe how the dietitian interacts with the different people
they come into contact with in their work area.
Objectives: By the end of this activity, the student will be able to:

Describe the dietitian’s main aims in the consultation

Describe the patient’s main aims for the consultation

Describe the people the dietitian liaised with before and after the consultation

Identify the differences in the dietitian’s communication style, depending on whom
he/she is communicating with.

Describe any professionalism issues that arose in connection with this consultation.
Activity:
The students should observe a dietitian undertaking a consultation and should take notes on
the following:

Did the dietitian talk to anyone else before seeing the patient? Was it helpful? Why/
Why not?

How did the dietitian greet the patient?

What were the dietitian’s main aims for the consultation?

What did the patient want to get out of the consultation? How do you know this?

What information did the dietitian collect?

What strategies did they use to collect the information?

What information would have been useful, but was unavailable?

What decision did the dietitian make in managing this patient? Propose a rationale for
the decision.

Look at the medical notes/ dietetic record card after the dietitian has made the entry for
the patient. Did the dietitian use any abbreviations? Are all of these in line with
department guidelines?

Did the dietitian liaise with anyone after the consultation? Do you feel this communication
was helpful to: the other person, the patient, yourself and how do you know this?

How did the dietitian’s communication with the patient differ from that with the
nurse/doctor/consultant, other dietitian?

How would you describe the dietitian’s manner i.e. formal, informal, chatty, or serious?
Was this appropriate? How do you know?
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
Are you aware of any issues relating to:
o
Anti-discriminatory practice.
o
Practice in line with the Statement of Conduct.
o
Professionalism.
o
Team working.

Did you learn anything from this consultation? Why?

Did anything trouble you about this consultation? Why?
The students should then meet up to discuss their findings with each other, having the
opportunity to raise any queries or concerns with a facilitator.
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2.8.
Doctor and Nurse Observation activity
Aim: The aim of this activity is for the students to observe how a doctor/ nurse
communicate with each other, both within their own profession and between the different
professions.
Objectives: By the end of this activity, the students should be able to:

Identify the key information handed over between nurses at handover.

Identify the key information communicated between doctors and nurses with regard to
patient care

Identify the format which doctors use to describe patients to each other

Describe key differences between the way doctors and nurses communicate about
patients, compared to the way dietitians communicate
Activity:
Students should attend the ward at nursing handover time and gain permission to listen in as
nurses give each other handover about the patients. They should note the format used, the
information shared and any information that was omitted that the student thinks might have
been important.
Students should attend the ward when the junior doctor visits the ward and gain permission
to listen in as nurses give doctors handover about the patients. They should note the format
used, the information shared/ requested and any information that was omitted that the
student thinks might have been important.
Students should attend the ward when a consultant ward round is in progress and gain
permission to listen in as the junior doctors give their senior colleagues handover about the
patients. They should note the format used, the information shared/ requested and any
information that was omitted that the student thinks might have been important.
The students should reflect on what they have learned in the 3 sessions and identify the
differences between the way that doctors and nurses’ communication with each other and
the way that dietitians communicate. They should share their reflections with their peer/
facilitator.
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3. Assessment - Anthropometry
Aim: The aim of these activities are to develop the student’s understanding of and ability to
gather and interpret anthropometric measurements when assessing individual patients.
Objectives: By the end of these activities the student will be able to:

Identify how anthropometric variables are collected and recorded in dietetic notes.

Outline the possible problems in obtaining anthropometric data and seek solutions or
alternatives.

Carry out measurements of anthropometric variables with patients

Interpret anthropometric measurements within the context of a clinical condition.

Explain how a patient’s anthropometric data may affect the dietetic intervention.
Overview of the activity
Students should ideally work in pairs.
These tasks can be worked through sequentially to build on assessment skills, or depending
on learning focus, parts could be carried out in isolation.
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3.1.

Commonly used anthropometric variables
Students should list the most commonly used anthropometric variables and take half
the list each.


For each variable students should identify:
o
How it is measured (along with any reference tables used etc.)
o
Equipment available for measurement
o
Normal range of results and standard units
Students should come together along with a supervising dietitian and present their
findings to each other, adding to their notes as they bring together their knowledge.
Discussion should include:

3.2.

o
Possible causes of abnormal results
o
Possible practical problems with measuring each variable
o
Possible solutions or alternatives
o
Possible limitations of variable and how it may affect interpretation
Findings should be discussed with their supervisor.
Estimating anthropometric measurements
Students are given the same list of 5 – 10 patients who are currently being seen by
the Dietitian

Students should (separately) estimate the weight and height of each patient.

Students should come back together at an agreed time with a supervising dietitian to
compare estimates with each other, and actual measurements. Discussion should
also focus on when it is appropriate to estimate anthropometric measurements and
strategies to develop skills in this area
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3.3.

Choosing appropriate anthropometric variables to use
Students are each allocated a patient who is currently under the care of a dietitian.
Students should ideally be allocated patients with different clinical conditions.

Each student should identify which anthropometric variables were used within the
assessment and note how they were recorded and interpreted by the dietitian.

Students should come back together at an agreed time with a supervising dietitian
and discuss:

3.4.

o
Which anthropometric variables were and were not used and why?
o
How the variables were recorded.
o
How the measurements were interpreted by the dietitian.
Findings should be discussed with their supervisor.
Gathering anthropometric data
In pairs, autonomously if possible, students should practice performing some or all of
the following anthropometric measurements:

o
Height
o
Weight
o
Waist Circumference
o
Mid upper arm circumference (MUAC)
o
Hand grip strength
o
Skinfolds
Students can either:
o
Both take measurements from the same patient and compare, or;
o
Take it in turns to measure while the other student observes, encourages,
supports and feeds back afterwards.

Students should gather a basic clinical background (e.g. reason for admission, past
medical history, age) to aid interpretation of findings during discussion.

Students should come back together at an agreed time with a supervising dietitian
and discuss:
o
In each case, how the patient’s anthropometric data can be interpreted in the
context of their clinical background.
o
Problems encountered in performing measurements.
o
How difficulties can be overcome in the clinical setting.
o
If and why measurements taken by each student from the same patient
varied.

Findings should be discussed with their supervisor.
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4. Assessment - Biochemistry
Aim: The aim of these activities is to develop the student’s understanding of and ability to
interpret biochemical parameters when assessing individual patients.
Objectives: By the end of these activities the student will be able to:

Identify how biochemical parameters are collected and recorded in dietetic notes.

Outline the possible causes for abnormal measurements of dietetically relevant
biochemical parameters.

Interpret a set of blood results in the context of a clinical condition.

Explain how key dietetically relevant biochemical parameters are important as part of a
patient assessment.

Explain how a patient’s biochemistry results may affect the dietetic intervention.
Overview of the activity
Students should ideally work in pairs.
This task can be worked through sequentially to build on assessment skills, or depending on
learning focus, parts could be carried out in isolation.
21
4.1.

Identifying relevant biochemical parameters
Students should obtain a list of biochemical markers commonly used by the dietitian
and take half the list each.


For each parameter students should identify:
o
Reference range and standard units used within the trust
o
Possible causes of high or low results
o
Possible consequences of high or low results
Students should come together along with a supervising dietitian and present their
findings to each other, adding to their notes as they share their knowledge.

Any questions raised should be noted down and researched further.

Students should then use this information along with other resources available to
together construct a table summarising the above information as a biochemistry
‘ready reckoner’ for their folders.
4.2.

Identifying abnormal biochemistry
Students are given a patient’s blood results (one each) to look at individually and
identify parameters outside of the reference range.

Students go to the ward together and for their own patients, gather a brief clinical
history using medical notes, bed end observation charts and any other relevant
sources of information.

Students should come back together at an agreed time with a supervising dietitian
and present their patient to each other, then discuss:
o
Which biochemical parameters were outside the normal reference range?
o
What are the possible causes of this given the patient’s clinical condition?
o
Any clinical signs that would point to a particular cause? (e.g. vomiting,
diarrhoea)
22
4.3.

Biochemistry and dietetic interventions
Students are each allocated a patient who is currently under the care of a dietitian.
Students should ideally be allocated patients with different clinical conditions. (Better
patients for this task might include those whose dietetic treatment is more directly
related to specific biochemical parameters, for example renal patients, enterally or
parenterally fed patients, lipid-lowering).

Each student should gather a brief clinical history using medical notes, bed end
observation notes and any other relevant sources of information, and make a note of
the dietetic interventions.

Each student should note how the dietetic interventions made by the dietitian relate
to the biochemistry results for that patient.

Students should come back together at an agreed time with a supervising dietitian
and present their patient to each other, then discuss:
o
How the dietetic intervention relates to the patient’s biochemistry.
o
How the biochemical information was recorded by the dietitian in both the
medical notes and/or dietetic notes as appropriate.
o
Which parameters were recorded and which were omitted?
o
4.4.
Assessing biochemistry

Students are allocated a patient each.

The patient can be either a new referral or a patient currently under the dietitian’s
care but the students should not have access to the actual dietetic intervention plan.

Students gather a brief clinical history using medical notes, bed end observation
notes and any other relevant sources of information.

Students collect and record relevant biochemical results, noting whether they are
inside or outside the reference range.

Students should come back together at an agreed time with a supervising dietitian
and present their patient to each other, then discuss:
o
Which biochemical parameters were important/ relevant to note?
o
What are the possible causes of any abnormalities?
o
How might these findings affect your dietetic intervention plan?
o
What additional biochemical parameters would be useful to consider?
23
5. Assessment - Clinical
5.1
Medical notes familiarisation activity – part 1 of 2
Aim: The aim of this activity is to introduce students to the format and content of medical
records as well as the variation that may occur between different health care providers.
Objectives: By the end of this activity the students will be able to:

Understand the different ways that entries are recorded within and between professions
(including the use of different formats such as SOAP or BDAP)

Become familiar with abbreviations used (often contextual e.g. Ca could mean cancer or
calcium depending on the context),

Begin to develop skills in identifying and collecting relevant information for dietetic
assessments.
Activity:
Students should ideally work in pairs
Each student should have an opportunity to explore a set of patient notes for patients that
have been seen by the dietitian, individually, and gain experience trying to gather dietetically
useful information on the patient (based on written records only). This can take some time
for students at the start of their training, as they are not familiar with language, abbreviations
and organisation of medical notes (which may differ from ward to ward, and trust to trust). It
may be useful to use structured headings to guide the information gathering, for example the
‘ABCDE’ (Anthropometry, Biochemistry, Clinical, Dietary, Ethnic/Social/ Economic)
assessment model. If the students are at a later stage to their placement then it may be
useful to give a specific time-frame in which to carry out this activity to develop their time
management skills
After the specific time period, the students will swap patient notes and review the second set
of notes. The students should then compare the information they each gleaned individually
to highlight any discrepancies/ differences. The students should note down any terms or
abbreviations they don’t understand and look them up later. The information that has been
gathered will be used in the next activity so keep it in an accessible place.
24
Specific notes for Practice Educator
Identify appropriate patients’ medical records for students to review on the ward or in the
clinic. Appropriate patients may have had some dietetic input in the past, but should not be
overly complicated (e.g. patients on ITU may not be appropriate).
Ensure the activity is scheduled for a time when the medical records for the identified
patients are available (e.g. not at a time when ward rounds are scheduled). The record does
not have to be a patient currently admitted. It may be more practical to request the record of
a known patient not currently admitted.
Students can undertake this activity on a ward, in a clinic environment or in the dietetic office
(depending on where the records are)
5.2.
Medical notes familiarisation activity – Part 2 of 2
Aim: This activity aims to provide students with an introduction to the dietetic records used
by dietitians, and will help them to reflect on the usefulness of the information they gathered
in Part 1.
Objectives: On completion of this activity, the students should be able to:

Identify a ‘good’ dietetic record as compared to a ‘not so good’ record

Discuss issues of confidentiality and the need to ensure information is not easily
identifiable

Begin to develop a framework for gathering useful information for dietetic assessment.
Activity:
Students should continue to work in pairs
Using the information they have gathered from the Part 1 medical notes activity, the students
will each complete a dietetic record card for each patient.
At the end of the activity, make the actual dietetic records available to the students so they
can compare what they have done to an actual dietetic record. Ideally, if you have time, look
over their completed record cards and provide direct feedback, but note that this is not
essential.
25
Each student will prepare a brief (max 5 minutes) presentation on each patient; they must
both be able to present on either of the cases. They should prepare the presentations
together.
Ensure they have de-identified any notes they have made on patients before leaving the
hospital.
Specific notes for Practice Educators
Provide the students with blank dietetic record cards.
Pull the actual dietetic records for the two patients that students have used for Part 1, and
give these to the students towards the end of the activity.
Allocate some time in your diary, if possible, to provide direct feedback to the students on
the record cards they have completed.
The activity should have a formal debrief session for all students to discuss Parts 1 and 2.
The students can also each present one of their cases in the group session, which will begin
to develop their skills in case presentation and handover.
5.3.
Medication familiarisation activity
Aim: This activity aims to provide students with a working knowledge of commonly
prescribed medications and their potential relevance to dietetic assessment and intervention.
Objectives: On completion of this activity, the students should be able to:

List commonly prescribed medications under the following categories:
o
Painkillers
o
Antibiotics
o
Laxatives
o
Cholesterol lowering medications
o
Diabetes medications
o
Antiemetics

Identify specific medications that directly impact on dietetic therapy

Identify medication plans from drug charts

Understand how the pharmacist liaises with the dietitian
26
Activities:

Working in pairs, students should divide the following list of commonly prescribed
medications between them. Students should then independently look up common
medications under each of these categories and identify any side effects that might
impact on dietetic intervention:

o
Painkillers
o
Antibiotics
o
Laxatives
o
Cholesterol lowering medications
o
Diabetes medications
o
Antiemetics
Students should then meet and feedback their findings to each other. Their findings
should then be collated to form a ‘crib sheet’ to be used by both students for future
reference. This crib sheet should be shown to the dietetic supervisor to ensure that the
information collected is complete and accurate.

The students should be allocated two separate wards covered by separate pharmacists.
The student should be encouraged to introduce themselves to the pharmacist and
ascertain their role and how they work with the dietitian. During this conversation, the
student should ask the pharmacist to identify specific medications with an impact on diet
therapy. Students should then be encouraged to find out when these medications would
be prescribed, relevant side effects and specific impact on diet therapy. Students should
then meet and compare their findings with the support of a facilitator.

In pairs, students should have the opportunity to review a number of drug charts,
identifying the layout, how to ascertain regular and one-off medications and clarifying
commonly used abbreviations (e.g. od, bd, tds, qds, po).

Students should then be given two drug charts to review, in addition to the patients’
medical notes to identify key background information (e.g. diagnosis, previous medical
history). After a set time they should present a summary of the patients including the
rationale for their current medication plan to their peer and supervising dietitian.
27
5.4.
Familiarisation with unfamiliar clinical conditions
Aim: This activity aims to support students to develop their knowledge of unfamiliar clinical
conditions
Objectives: On completion of this activity, the students should be able to:

Provide a brief description of the physiological and biochemical abnormalities associated
with the condition

Understand the key treatment strategies associated with the condition

Identify how the condition might impact on the patients’ nutritional status

Identify any specific diet therapy associated with the condition
Activity:
In anticipation for the weekly facilitation session, students should be encouraged to take
responsibility to explore specific conditions that they have come across during the week,
considering the following points:

Description of the physiological and biochemical abnormalities associated with the
condition

Key treatment strategies associated with the condition

How the condition might impact on the patients’ nutritional status

Any specific diet therapy associated with the condition

Students should work together to design a format to present this information in a clear
and concise manner

Students should present their findings verbally at the weekly facilitation session in the
presence of a supervising dietitian.
28
6. Assessment - Dietary
6.1.
Compilation of oral nutrition support and enteral feed ready
reckoner
Aim: To familiarise the students with the range of oral nutrition support options and enteral
feeding products available in your area and their macronutrient contents.
Objectives: By the end of this activity, students will have a ready reckoner that enables
them to quickly assess the energy, protein and fluid provided by a given volume of product.
Activity:
The students should be given access to the nutritional composition of the menu, diet bay
items, feed store as well as data sheets for the products they will be using most frequently.
They should share the task between them, e.g one take ONS and one take Enteral Feeds.
The students will need to agree on a format for the ready reckoner and then each will
prepare their part and then share it with their partner. If there are many more products in
one area than the other, they may need to help each other out.
They should share their ready reckoner with their supervising dietitian to ensure that the
information they have collected is relevant and accurate.
6.2.
Differing approaches to gathering dietary information
Aim: To familiarise the students with two commonly used methods for gathering dietary
information from patients.
Objectives: By the end of this activity, students will be able to:

Gather dietary assessment data using the 24 hour recall and typical day approaches

Identify the benefits and limitations of each of these approaches in a variety of settings
Activity
Each student to be assigned two patients (these do not necessarily need to be patients who
have been referred to a dietitian – they just need to be happy to talk to the students about
29
their eating habits). Each student should complete one 24 hour recall and one typical day
diet history while being observed by their peer. The observing student should then provide
specific feedback to their peer in respect to their questioning style, body language and
quality of information collected considering two positive aspects of their practice and two
areas for development. The students should present the summary of their feedback to the
supervising dietitian with suggestions as to how they could work to improve their skills.
6.3.
Qualitative and quantitative assessments of dietary intake
Aim: To develop the student’s skills in completing qualitative and quantitative assessments
of dietary intake
Objectives: By the end of this activity, students will be able to:

Complete qualitative and quantitative assessments of dietary intake

Identify strategies to ensure that accurate assessments are completed
Activity
Using all four of the dietary assessments completed in activity 6.2, both students should
independently complete both qualitative and quantitative dietary assessments of the
information collected. The students should then compare their assessments and identify any
errors in their assessments. The students should then collate their findings and present their
assessments to their supervising dietitian.
6.4.
Food record charts/food diaries
Aim: To familiarise the students with the dietary recording tools used by the department
Objectives: By the end of this activity, students will be able to:

Know the tools used by the department to collect written dietary intake data in a variety
of settings

Understand the limitations of using these tools
Activity
The students should be given access to the tools used by the department to collect written
dietary intake data and should complete these tools independently over a 48 hour period.
The students should then meet to discuss suitable changes that could be made to the tools
to support the collection of more accurate dietary information in as user friendly a way as
possible.
The students should then present their recommendations to their supervising
dietitian
30
31
7. Assessment - Environmental
Aim: The aim of these activities is to develop the skills of the student in collecting and
assessing information to support this section of the dietetic care process in individuals,
groups and populations.
Objectives: By the end of these activities the student will be able to:

Identify sources of information regarding the Environmental/ Emotional aspects of the
assessment process.

Collect relevant information from the range of sources available.

Use the information collected to assist in the formulation of a dietetic diagnosis and
treatment plan for individuals, groups and populations.
Overview of the activity
Students should ideally work in pairs
Parts of this activity may happen at different times e.g. the information gathering regarding
the group or population are likely to happen prior to the actual delivery of the project/ group
session, so careful notes should be taken and kept in a safe place for comparison.
After the activity:

The students should compare the information that they gathered to identify any
similarities or differences and reflect on why the discrepancies arose.

They should discuss with their partner any information that you feel was a) omitted
but should have been gathered, b) gathered but was not relevant c) you can’t agree
on.

They should discuss their findings with their supervisor.

7.1.

Individuals
One student should gather all of the relevant Environmental information from the
medical notes/ nursing notes/ referral letter/ care staff.

The second student should interview the patient, with their partner observing, using
an appropriate communication style, to elicit information regarding the environmental
aspects of the patient’s history.
32
e.g. For ward patients: the students should gather relevant information on who the
patient lives with, what kind of accommodation they have, cooking facilities, financial
status, what social support, whether they are a smoker, any concerns about their
mental health/ emotional state, previous dietary interventions, physical activity level,
readiness to change, barriers to change, language skills.
7.2.

Groups
In the planning stage of a group education session, the first student should gather all
of the relevant Environmental information from appropriate sources e.g. referral
letters, staff who usually run the sessions, care staff etc.

The second student should gather the relevant environmental information from the
group participants in an appropriate style, during the group session. This can only
happen once the students are confident enough to reflect in action as they may need
to modify some aspects of the session, depending on what they discover.
e.g.
For a group, the students should gather relevant information on the socio-
economic status of the group, previous health/ dietary education, physical activity
levels, social support networks, language skills, readiness to change, barriers to
change.
7.3.

Populations
In the planning stage of a health promotion activity, the first student should gather all
of the relevant environmental information from appropriate sources e.g. request
letters, staff who usually run the sessions, care staff etc.

The second student should gather the relevant Environmental/ Emotional information
from the target population in an appropriate style, during the project. This can only
happen once the students are confident enough to reflect in action as they may need
to modify some aspects of the project depending on what they discover.
e.g. For a population, the students should gather relevant information on the socioeconomic status of the group, previous health/ dietary education, physical activity
levels, social support networks, language skills, readiness to change, barriers to
change.
33
8. Nutrition and dietetic diagnosis
8.1.
Identifying nutritional priorities
Aim: The aim of this activity is to support students to use the assessment information
collected to identify key clinical priorities considering both the medical and patient
perspective
Objectives: By the end of this activity, students will be able to:

Identify the key clinical ‘problem’ justifying their decision with appropriate rationale

Identify possible key patient priorities
Activity
Each student should complete a thorough assessment on two patients. Using these four
assessments, students should work independently initially to identify the key nutritional
problem and possible patient priorities based on the information they collected. Students
should then share there suggested and agree the key nutritional problem for each case.
Students should then work together to provide a rationale for their decision. The students
should then present their conclusions and rationale to their supervising dietitian. The focus
of this feedback will be on the students’ ability to justify their decisions. Discussion should
also take place as to how nutritional priorities and patient priorities can be managed
simultaneously.
8.2.
Identifying dietetic diagnosis statements
Aim: The aim of this activity is to support students to use the assessment information
collected to identify a nutrition and dietetic diagnosis comprising of the key clinical problem,
the aetiology of this problem and how this problem is manifesting itself
Objectives: By the end of this activity, students will be able to:

Devise nutrition and dietetic diagnosis statements

Justify their decisions to a peer and their supervisor
Activity
Each student should complete a thorough assessment on at least two patients. Having
undertaken this assessment, the students should work independently to devise a nutrition
and dietetic diagnosis statement under the headings ‘problem’, ‘aetiology’ and ‘signs and
34
symptoms’. The students should then meet and present their assessments and nutrition and
dietetic diagnosis statements to each other. The student who is not presenting should be
encouraged to probe the other student with regards to their justification for the statements
they make. The students will then be asked to present two of the four cases that have been
considered – each student should be equipped to present any of the cases that they have
discussed with their peer.
9. Intervention, planning and implementation
9.1.
Identifying dietetic management goals
Aim: The aim of this activity is to support students to use the assessment information
collected and nutrition and dietetic diagnosis to identify possible dietetic management goals
Objectives: By the end of this activity, students will be able to:

Identify appropriate dietetic management goals

Identify possible barriers to patients implementing these goals
9.1.1. Identifying dietetic management goals – stage 1
Students should observe a dietitian complete an assessment on a patient. The students
should make notes during the assessment. Once the assessment is completed, the
students should leave the consultation and work together to formulate a nutrition and dietetic
diagnosis and possible dietetic management goals. The students should also be
encouraged to list the possible barriers that might exist to achieving these goals. Once the
consultation is complete, the students should present their suggestions to the supervising
dietitian who can also explain what goals were agreed in the consultation and why these
were agreed.
9.1.2. Identifying dietetic management goals – stage 2
Each student should complete an assessment for a new and follow up patient. The students
should then work independently to devise appropriate dietetic management goals for the 4
patients. The students should then compare their suggestions to agree what they are going
to feedback to their supervising dietitian (including the rationale for their decisions). The
students should then have the opportunity to feedback to their supervising dietitian.
35
9.2.
Implementing dietetic management goals
Aim: The aim of this activity is to support students to identify appropriate implementation
plans to enable patients to meet their dietetic management goals
Objectives: By the end of this activity, students will be able to:

Recognise that there may be more than one way to meet dietetic management goals

Suggest suitable actions plans for achieving dietetic management goals

Identify factors that would need to be taken into consideration to ensure the
implementation of specific action plans
9.2.1. Devising implementation plans
Having identified suitable dietetic management goals for 4 patients, students should work
independently to develop a possible action plan for achieving these goals. Students should
then meet together with their supervisor to discuss their recommendations including the
steps that would need to be taken to implement their action plan.
9.2.2. Implementing the dietetic care process
Each student should be given one new and one follow up patient to assess, plan and
implement dietetic care. The students should complete these consultations while being
observed by their peer. At the end of the consultation, the peer should provide specific
feedback on the following aspects of the consultation:

Has the student considered the knowledge, beliefs and attitudes of the client/carer?

Has the student negotiated SMART goals with the client/family?

Has the student selected appropriate resources to support implementation of the
dietetic management goals?

How has the student assisted the client to overcome barriers to change?

Has the student responded to the clients questions appropriately and correctly?

How has the student responded to verbal and non-verbal cues?
The student who completed the consultation may want to reflect on their own performance
using the above prompt questions, prior to the feedback session with their peer. The
students should then work together to identify 1 strength of each others practice, one area
for development and devise an action plan to support this development. This summary
should be fed back to the supervising dietitian.
36
10.
Monitoring and evaluation
Aim: The aim of this activity is to support students develop their skills in reviewing,
monitoring and evaluating dietetic interventions
Objectives: By the end of this activity, students will be able to:

Gather reassessment data and evaluate this against previously documented goals

Negotiate and agree changes to the dietetic care plan based on accurate
interpretation of information collected

Evaluate clients/carer’s understanding of the agreed changes/nutritional care plan
and answers questions appropriately

Provide relevant written information

Arrange appropriate follow-up
10.1. Identifying appropriate follow-up arrangements
The students should work together to review dietetic records from patients that have been
seen by their supervising dietitian. If possible, the follow up arrangements should be
removed from these records. The students should agree an appropriate follow up plan for
each patient including a justification for why this plan has been suggested. The students
should then feedback their conclusions to their supervising dietitian and compare their
proposed follow up plans with the actual follow up arrangements.
10.2. Identifying appropriate outcome measures
Each student should take two patients who they have identified dietetic management goals
for and consider relevant outcome measures under the following categories:

Symptom change/Patient Reported Measures

Physical

Biochemical

Psychological

Behaviour Change

Patient Focused
The students should feedback their conclusions to their peer and then work together to
identify how these outcomes will be measured/assessed. The students should feedback
their findings to their supervising dietitian
37
10.3. Reviewing dietetic interventions
Each student should be given two follow up patients to review, monitor and evaluate dietetic
interventions. The students should complete these consultations while being observed by
their peer. At the end of the consultation, the peer should provide specific feedback on the
following aspects of the consultation:

Has the student gathered reassessment data and evaluated this against previously
documented goals?

Has the student appropriately negotiated and agreed changes to the dietetic care
plan based on accurate interpretation of information collected?

How has the student evaluated the clients/carer’s understanding of the agreed
changes/nutritional care plan and have they answered questions appropriately?

Has relevant written information been provided?

Has an appropriate follow up plan been arranged?
The student who completed the consultation may want to reflect on their own performance
using the above prompt questions, prior to the feedback session with their peer. The
students should then work together to identify 1 strength of each others practice, one area
for development and devise an action plan to support this development. This summary
should be fed back to the supervising dietitian.
38
11.
Appendix 1 – Observation of students in tutorials
Assessment of Participation of Tutorials
This form is to be completed by the group facilitator for each student for each of the tutorials.
A copy is to be given to the portfolio manager and lead assessor.
Student Name:
Tutorial:
Date:
Tick the most appropriate comment in each section
Attendance
Attended session on time
Attended but late
Missed session, tutor notified
Missed session, tutor not notified
Preparation
Evidence of extensive reading and preparation
Evidence of adequate preparation
Evidence of some preparation
No evidence of preparation
Participation
Provided regular questions/comments/new information
Provided some questions/comments/new information
Sporadic questions/comment/new information
No meaningful participation
Communication Skills
Consistently communicated effectively
Generally communicated effectively
Did not communicate effectively
Presentation skills
Demonstrated developed presentation skills
Demonstrated developing presentation skills
Demonstrated poor presentation skills
Interpersonal Skills (GROUP)
Supported participation of others and demonstrated respect for others
opinions
Allowed others to participate and demonstrates respect for others opinions
Provided minimal interaction or support to other participants
Learning skills
Demonstrated self-directed learning
39
Demonstrated some self-directed learning
Did not demonstrate self-directed learning
Critical thinking
Regularly offered critical analysis/interpretation of ideas
Sometimes offered critical analysis/interpretation of ideas
Little evidence of agreement or disagreement with ideas
No evidence of agreement or disagreement with ideas
Other
Demonstrated reflection on discussion and own learning and/or introduction
of innovative ideas and/or relating discussion to broader themes or context
Facilitated the group process, actively encouraged others to participate
Additional comments/evidence
Dietitian
Signature
40
12.
Appendix 2 – Clinical Observation Form
Date:
Week No:
Type of Patient:
New/Follow-up
In/out Patient
Adult/Child
Other information (e.g. working through interpreter)
Summary:
Current Strengths:
Key areas to focus on to develop skills:
This has been discussed with my supervising dietitian
Signed student: ________________________________
Signed Dietitian: ________________________________
Date:____________
41
STAGE OF CONSULTATION
COMMENTS e.g. areas that went well, areas that
didn’t go well, aspects I need to improve on.
1. Opening
Welcomes client, introduces self,
ensures patient comfortable, and
establishes rapport.
Clarifies patient expectations and
format of consultation.
2. Data collection - communication
Demonstrates good communication
skills.
Communicates at an appropriate
level, eye contact, volume of speech,
appropriate language.
Listens attentively.
Recognises and responds to nonverbal cues.
Collects, records and interprets
relevant information from client, other
health care professionals and carers/
relatives e.g..
 Diet history
 Weight
 Height
 Fluid balance
Uses appropriate questioning style to
elicit relevant information.
Recognises and notes factors that will
affect clients compliance eg:
 Motivation to change
 Lifestyle
 Finance
Provides information and responds to
client’s concerns.
Maintains the direction of the
interview.
42
Ensures suitable room layout and
privacy.
3. Data collection – documentation
Collects, records and interprets
relevant quantitative information (from
referral letter, medical notes, nursing
notes, computer databases) including:
 Medical
 Biochemical
 Pharmacological
 Nutritional
 Social
 Psychological
 Cultural
 Financial
 Personal information
4. Formulates and justifies dietetic
diagnosis
Correctly identifies the dietetic
problems, their causes and
presenting symptoms. Can
prioritise the problems and justify
this prioritisation.
5. Develops dietetic management
goals.
Uses information from assessment to
devise dietetic management goals
that are:


Acceptable and practical for
the client/carer
Evidence based
6. Designs and implements action
plan to achieve dietetic goals
Develops goals which are SMART
Negotiates goals with client/ carers/
staff
Formulates plan for monitoring and
review
Communicates the plan using
effective strategies
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7. Review, monitoring and evaluation
of dietary intervention
Gathers reassessment data and
evaluates against previously
documented goals
Negotiates and agrees changes to
dietetic care plan based on accurate
interpretation of information collected.
Evaluates client’s/carer’s understanding
of the agreed changes/nutritional care
plan and answers questions.
Provides relevant written information.
Arranges appropriate follow-up.
8. Closing
Summarises and closes consultation.
9. Documentation and feedback
Informs dietetic supervisor of actions
taken.
Writes concise, legible notes in
appropriate documents.
10. Reflections
Keeps to appointment time.
Monitors and reviews client at suitable
time intervals without prompting (if
applicable).
Practices within the Standards of
Performance, Conduct and Ethics:
 Maintains confidentiality
 Complies with departmental
referral procedures.
 Uses generic names for products
or mentions several brand
names.
 Words and actions
(spoken/written) do not
discriminate against clients with
respect to: race, religion, age,
sexual orientation, learning
disability or physical disability.
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



Acknowledges own limitations
within consultation and seeks
advice when appropriate.
Identifies any critical incidents in
consultation and reflects
appropriately.
Evaluates own practice and
identifies areas for improvement.
Demonstrates reflection ‘in
action’ and uses this to change
plan during consultation when
appropriate.
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