Every patient in the healthcare system is part of a team, whether they know it or not. Behind the scenes of every appointment or clinic visit is a world
of conversation and collaboration intended to support better health outcomes. Dietitians and nurses serve as critical components of many such interdisciplinary teams (IDT).
In dialysis, effective collaboration with the team dietitian supports better patient outcomes. Dietitians are experts in dietary sodium and phosphate management, glycemic health, screening for and treatment of malnutrition, and so much more. If the dietitian voice is missing from the IDT collaboration,
it means more patient hospitalizations, worsening comorbid conditions, and potentially increased mortality risk.
While collaboration often runs smoothly, there are situations when it can be difficult for a member or members of the IDT to have a voice in the conversation. At these times, it can be easier to let things go unsaid for the sake of moving a meeting along or avoiding an uncomfortable situation. However,
when this occurs and important details are overlooked or omitted, it can mean worse outcomes for patients and diminished professional fulfillment.
When approaching a potentially difficult conversation or learning to find our voice within the IDT, it can be helpful to come back to 3 basic principles:
- Shared values
Understanding what each IDT member values and matching our points to those values can increase interest and engagement. One commonly shared value is the value of patient-centered care.Patient-centered care prioritizes placing the patient as the decision-maker in their healthcare journey.
To be a good decision maker, patients need to know their options. For example, when managing protein-energy malnutrition patients need to be aware of their treatment choices which can include dietary changes, oral nutrition supplements, dialysis-specific parenteral nutrition – IDPN for HD
or IPN for PD; appetite stimulants, etc.When it comes to nutrition care, the dietitian is the authority on the nutrition options available and thus to honor the value of patient-centered care,
the dietitian must speak up within the IDT to make sure all options are on the table.
- Mutually developed perspectives
Even when values are shared, it does not mean the IDT always understands the perspective being shared. This can be due to inadequate baseline information, conflicting opinions, or not seeing a clear connection between your message and the circumstances at hand.To be effective
in communication and allow someone the opportunity to fully understand your perspective, it helps to be prepared with a succinct explanation.
This explanation should be based on scientific evidence as that will provide additional credibility to your message. Evidence for a nutrition-related conversation can include:- Research articles on interventions
- Clinical guidelines
- Tools and scores for nutrition assessment like the 7-point SGA or Malnutrition Inflammation Score
- Prior clinical experience
Sometimes, you may need to repeat your idea or suggestion before members of the IDT fully understand the value of what is being shared.
- Valuing collaborative decision making by each team member
Other IDT members’ clinical experience and knowledge is equally important to your own. When sharing your message and perspective, remember
to welcome input and acknowledge that expertise. By being truly open to collaboration we build better rapport with our team members and set the stage for more positive collaboration in the future.
If you are looking for tools and evidence to support your conversation regarding nutrition support for malnourished patients on dialysis, check out
our resources at pcacorp.com.
We thank our guest blogger Maiya Slusser, MS, RDN, CD, CNSC, for sharing her knowledge and writing this blog post!
