This study was conducted to investigate attitudes of dietitians regarding ethical dilemmas surrounding nutritional support for terminally ill patients. In addition, the methods and adequacy of ethics training received in dietetics education and in supervised experience programs, such as the Approved Preprofessional Practice Program (AP4), Coordinated Program in Dietetics (CPD), dietetic internship (DI), or any other experience approved by the American Dietetic Association (ADA), was researched. A mailed questionnaire was sent to 147 dietitians living in Virginia with one to three years of clinical experience. Of the 144 deliverable questionnaires, 104 (72.2%) were returned, and results were tabulated. Data analysis included descriptive analyses, Pearson's correlation coefficient tests and analysis of variance (ANOVA) of selected variables. Results indicated that the majority of the dietitians surveyed were women younger than 40 years old who reasoned contextually in decisions regarding termination of nutritional support, had little or no formal ethics education, and held either bachelor's or master's degrees. Dietitians who felt more confident with making ethical decisions were significantly more contextually influenced in nutritional support decisions than those who were somewhat, or not at all, confident. Those who said they brought spiritual beliefs to bear to a great extent in ethical decision making used more absolute principles in their decision-making. There were no differences in attitudes or ethics training relative to which supervised experience was completed, or to the highest degree attained. Most dietitians have not had formal ethics training, and they are not confident in ethical decision-making. Therefore, dietetics education may need to focus on ethics training to enable future dietitians to effectively deal with ethical dilemmas they will face in their professional lives. / Master of Science

Introduction: The aim of this research was to establish the attitudes, knowledge, job satisfaction and professional development of community service dietitians because negative attitudes, poor knowledge, low levels of job satisfaction and poor professional development would be detrimental to the process of community service and ultimately to the provision of health services. Methodology: Three distinct annual intakes of qualified dietitians completing compulsory community service were the subjects of an analytical cross sectional survey conducted biannually for the period 2003-2005. Data collection methods included telephone interviews, mail, emailed questionnaires and focus group discussions. Individual factors: sex, population group, language, university attended; institutional factors: organisation of community service, mentorship rating, hospital manager support type of facility, rural allowance, hospital location, access to resources, working and living conditions and personal safety and other factors: attitude, community nutrition knowledge, job satisfaction and professional development were included in the data set. Management of data: Data were divided into 2003 cohort (n=20) and 2004-2005 cohorts (n=26). Analysis of the demographic details for 2003 and 2004-2005 cohorts were, respectively: mean ages 23.6 (±0.99) and 24.05(±4.96) years, 60 percent and 73 percent white, 90 percent and 96 percent female, 35 percent and 73 percent University of KwaZulu-Natal graduates and 65 percent of both cohorts were placed in rural facilities. Results: Community nutrition knowledge of the 2003 cohort was unacceptable but improved in the 2004-2005 cohort. Subjects had a generally positive attitude towards community service. Community nutrition levels of knowledge of the 2003 ranged between 60 percent at entry and 67 percent at exit and for the 2004-2005 between 72.8 percent and 78.42 percent. The job satisfaction level of the 2003 cohort at exit was 13.65 (±3.573). In the 2004-2005 cohort job satisfaction was 15.75(±3.360) at entry and 15.75 (±3.360) at exit. 85 percent of the 2003 cohort rated their professional development positively whereas 65 percent of the 2004-2005 cohort rated theirs' positively. This decline and associated problems were to some extent shown in the interview responses. The 2004-2005 cohort did however show a tendency for improvement in the professional practitioner ranking (p=0.088). The majority (95%) of the 2004-2005 cohort rated the dietetic services positively. Focus group discussions highlighted problems that the community service dietitian (CSD) encountered such as lack of supervision and support, lack of basic facilities, poor hospital administration, problems with transport, work overload and problem with their professional role in the community and health facility. A model showing the results of the research indicated that the objectives of the Department of Health for improved service in rural areas were obtained but the retention of health professionals and capacity was lost due to annual rotation of subjects. Community service as a strategy to overcome service delivery has merit provided identified problems are addressed. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Background A global shift towards sustainable food habits is imperative to mitigate climate change. Registered Dietitians (RDs)s work in positions where they have the opportunity to influence decisions affecting food consumption. Objective To survey Swedish RDs’ attitudes and interest towards integrating a sustainability perspective into practice, and elucidate what determinants affect their choice and possibilities to promote sustainable food habits. Methods A mixed methods approach was taken consisting of a digital questionnaire including question of qualitative and quantitative character, namely: 1) an initial section regarding the respondents’ background 2) Likert scale questions to measure level of agreement in various statements 3) open-ended questions where the respondents were asked to describe their experiences, opinions and thoughts regarding the subject. Results The RDs (n=102) were interested in learning more about sustainable food habits, but unsure regarding whether RDs should have a leading role in promoting sustainable food habits. The integration of a sustainability perspective in nutrition practice was a matter of prioritizations. Dietitians were concerned that sustainable food habits would stand in conflict with other aspects of nutrition therapy. Organizational policies and work descriptions were reported to rarely mention sustainable food habits and this affected the RDs work. The dietetic programs at the Swedish Universities were described to lack a sustainability perspective. The RDs were unsure about how to approach sustainability in their practice. Conclusion Policies and work descriptions need to comprise a sustainability perspective to enable RDs to use and develop their knowledge and skills in sustainable food habits. Educational departments need to consider sustainability in their educational plans to meet the RDs’ need for more education and training in this area. The profession should come together to discuss the its’ role in promoting sustainable food habits / Bakgrund En utveckling mot hållbara matvanor är av största vikt för att dämpa klimatförändringarna. Dietister är experter på kost och nutrition och arbetar på positioner där de har möjlighet att påverka beslut som rör matkonsumtion. Syfte Att kartlägga svenska dietisters attityder och intresse för att integrera ett hållbarhetsperspektiv i sitt arbetssätt och utröna vilka faktorer som påverkar deras val och möjlighet att främja hållbara matvanor. Metod Undersökningen omfattade både kvalitativ och kvantitativ metod i en digital enkät. Enkätens första sektion innehöll frågor rörande deltagarens bakgrund. Övriga delar av enkäten bestod i huvudsak av frågor av typen Likertskalor, samt öppna frågor där deltagarna fick beskriva sina upplevelser, åsikter och tankar kring olika delar av forskningsämnet. Resultat Dietisterna (n=102) var intresserade av att lära sig mer om hållbara matvanor, men det rådde delade meningar huruvida dietister borde ha en ledande roll i arbetet för att främja hållbara matvanor. Integration av ett hållbarhetsperspektiv i dietistens arbetssätt var en fråga om prioriteringar. Dietisterna var oroliga att hållbara matvanor skulle stå i konflikt med andra viktiga aspekter av nutritionsbehandlingen. Policydokument och arbetsbeskrivningar nämnde sällan hållbara matvanor och detta verkade försvåra för dietisterna. Deltagarna uttryckte att dietistprogrammen vid universiteten saknar ett hållbarhetsperspektiv. Dietisterna kände sig osäkra på hur de skulle förhålla sig till hållbarhet i deras arbete. Slutsats Policydokument och arbetsbeskrivningar behöver innefatta ett hållbarhetsperspektiv för att möjliggöra för dietister att använda och utveckla deras kunskap och färdighet gällande hållbara matvanor. Utbildningsinstitutionerna behöver ta hänsyn till hållbarhet i sina utbildningsplaner för att möta dietisternas behov och önskemål om utökad utbildning och praktik i detta område. Professionen behöver komma samman för att diskutera vilken roll dietisten bör ha I arbetet för att främja hållbara matvanor.

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Thesis (MNutr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Objectives: Children with autism spectrum disorder (ASD) are known to have feeding difficulties. This study gathered information from parents/caregivers with children diagnosed with ASD. The following aspects were investigated: early feeding history, food preferences, sensory issues, current dietary practices and the use of nutritional supplements and special diets. The study also gathered information regarding these families’ experience with dietitians in supporting them with advice related to dietary problems. Methodology: An online questionnaire was used and the link to the study was placed on the National Autistic Society (NAS) of the United Kingdom’s website to recruit participants. Parents/ caregivers of children aged between 3-16 years and diagnosed with ASD, who resided in England, could take part in the study. Results: Three hundred and twenty five parents/ caregivers participated in the study. The mean age of children was 9.5 years. The majority of children were male (85%). The most common feeding problem was the transition from stage 1 weaning foods to more textured food (55.6%). Sensory problems played a large role in food acceptance. Clear preferences were made for crunchy (81.5%) or dry foods (79%), followed by food with a smooth consistency (69.8%) such as yogurt. Food appearance and presentation (64%) was the main determinant of food acceptance and specific brands and packaging played a major role. Habitual food intake and continually choosing the same foods for meals were present in the majority of children (75.6%). Specific preference was given to the following foods: starchy vegetables (62.6%), refined carbohydrates (81%), processed meat products (69.2%) and dairy products (68.6%). The use of ‘special’ and exclusion diets were not popular. However, where specifically gluten and/ or casein were excluded (19%, n=55), it was generally excluded for more than one year. Reported observations with these exclusions were: improvement in bowel habits, sleep, concentration, behaviour and social communication. The use of nutritional supplements were significantly higher (p<0.5) where exclusion diets were used. A large number of children (43.4%, n=23) on exclusion diets, have not been consulted by a dietitian. Most parents /caregivers (58.1%) had the perception that dietitians were lacking knowledge of ASD and had inadequate knowledge of current dietary interventions for children with ASD (61.7%). However, parents felt that it was reassuring to consult a dietitian, that practical advice was given to improve dietary intake and that generally it reduced their concern regarding their child’s dietary intake. Conclusion: The study highlights the complexity of ASD and the variable effect it has on eating, behaviour and dietary intake. The use of the gluten and casein free (GFCF) diet may improve general wellbeing in some children with ASD when used appropriately and warrants further investigation. It is concerning that only a minority of children on exclusion diets are consulted by dietitians to ensure nutritional adequacy. Due to the complexity of ASD and in the absence of clear guidance for dietary interventions, dietitians who work with children with ASD need to be supported by continued training opportunities in order to enhance their competencies and optimise their service delivery. / AFRIKAANSE OPSOMMING: Doelwitte: Kinders wat aan Outismespektrum-steuring (OSS) lei is geneig om voedingsprobleme te hê. Die studie het inligting ingesamel van ouers en versorgers met kinders wat met OSS gediagnoseer is. Die volgende aspekte is ondersoek: vroeë voedingsgeskiedenis, voedsel voorkeure, sensoriese probleme, huidige eetgewoontes en die gebruik van nutriëntaanvullings en spesiale diëte. Die studie het ook inligting ingesamel aangaande gesinne se ondervinding met dieetkundiges en ondersteuning met dieetprobleme. Metodologie: ‘n Elektroniese vraellys is gebruik en die skakel na die studie was op die webwerf van die National Autistic Society (NAS) van die Verenigde Koninkryk geplaas om deelnemers te werf. Ouers/ versorgers van kinders tussen die ouderdomme van 3-16 jaar, met ‘n diagnose van OSS en woonagtig in Engeland, kon deelneem aan die studie. Resultate: Drie honderd vyf en twintig ouers/ versorgers het deelgeneem aan die studie. Die gemiddelde ouderdom van die kinders was 9.5 jaar en 85% was manlik. Die mees algemene voedingsprobleem vir kinders met OSS was die oorgangsfase van gladde speningsvoedsel na growwer voedsel (55.6%). Sensoriese probleme het ‘n groot rol gespeel in voedselaanvaarding. Daar was duidelike voorkeure vir bros (81.5%) en droë voedsel (79%), gevolg deur voedsel met ‘n gladde tekstuur soos jogurt (69.8%). Die voorkoms en aanbieding van voedsel het grootliks bepaal of voedsel aanvaarbaar (64%) is. Spesifieke handelsmerke of verpakkings het ‘n groot rol gespeel (64.7%). Die meeste van die kinders (75.6%) het vaste eetgewoontes gehad en dieselfde kos tydens maaltye gekies. Die volgende voedselsoorte was verkies: styselryke groente (62.6%), verfynde koolhidrate (81%), geprosesseerde vleis produkte (69.2%) en suiwel produkte (68.6%). Die gebruik van spesiale en uitsluitingsdiëte was ongewild. Waar gluten- en kaseïen-uitsluitingsdiëte (19%, n=55) gebruik is, is dit meestal vir langer as een jaar gebruik. Met die gebruik van uitsluitingsdiëte is verbeteringe waargeneem in stoelgang gewoontes, slaap, konsentrasie, gedrag en sosiale kommunikasie. Die gebruik van nutriëntsupplemente was beduidend hoër (p<0.5) in die groep waar uitsluitingsdiëte gebruik is. ‘n Hoë persentasie kinders (43.4%, n=23) wat op uitsluitingsdiëte was, is nie deur dieetkundiges gekonsulteer nie. Die meeste ouers /versorgers (58.1%) het gevoel dat dieetkundiges gebrekkige kennis oor OSS en dieetverwante probleme het, asook onvoldoende kennis van huidige dieet intervensies vir kinders met OSS (61.7%). Ouers het wel gevoel dat dit gerusstellend was om dieetkundiges te gaan spreek vir praktiese raad om dieet inname te verbeter. Dit het ook hul kommer veminder aangaande kinders se diëte. Gevolgtrekking: Die studie benadruk die kompleksiteit van OSS en die wisselende effek wat dit op eetgewoontes, gedrag en voedsel inname het. Die gebruik van die gluten- en kaseïenvrye diëte kan moontlik die gesondheid en welsyn van sommige kinders met outisme verbeter mits dit reg gebruik word, maar vereis verdere navorsing. Dit was kommerwekkend dat ‘n minderheid van die kinders op uitsluitingsdiëte deur dieetkundiges gekonsulteer word om voldoende nutriëntinname te verseker. Aangesien OSS ‘n komplekse toestand is en daar ‘n gebrek is aan duidelike riglyne vir dieet intervensies, word dit aanbeveel dat dieetkundiges wat met kinders met OSS werk ondersteun word deur opleidingsgeleenthede om hul vaardighede te verbeter en dienslewering te optimaliseer.

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