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Dietitians’ experience of clinical practice in Long Term Care Wassink, Heather Louise


The purpose of this research was to gain insight into the experience of dietitians as they practice clinical dietetics in the Long Term Care (LTC) setting, with a particular interest in identifying and understanding elements of LTC that help or hinder clinical dietetic practice to the benefit of LTC clients. Eleven dietitians were recruited for this qualitative study using purposive sampling. The sample included participants with varying lengths of practice since internship; different lengths of time working in LTC; both those working under contract (individual and corporate) and those working as employees; and both those with and without administrative responsibility. Effort was also made to include participants from a variety of sizes of LTC facilities and both government funded and private facilities. Semi-structured interviews were tape-recorded and transcribed verbatim. Transcripts were initially coded using a content analysis method. This was followed by thematic analysis during which three major themes emerged: teams and teamwork, philosophy of nutritional care for LTC, and dietitians' roles in the LTC setting. Teams were identified as a significant feature of the culture of LTC. The measure of effective teamwork was the extent to which teams provided individualized nutritional care to LTC residents. Participants identified several features of a philosophy of care for the LTC setting. These included the obvious, but sometimes neglected fact that residents need to eat real food, that nutritional care be resident focused and that it addresses quality of life issues as identified by residents. Dietitians identified several tasks that they completed in the course of their work. However, they spoke in greater detail about self-assigned roles that promoted effective teamwork. A model was developed as a result of this research that describes the relationship between a philosophy of nutritional care for LTC and teamwork. A philosophy of nutritional care directs teamwork and effective teamwork is essential for applying a philosophy of care in practice. While there is a great deal of literature to inform the theory of each of these elements, this research highlights the importance of the relationship between them.

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