Barriers and Enablers to Delegating Malnutrition Care Activities to Dietitian Assistants

Barriers and Enablers to Delegating Malnutrition Care Activities to Dietitian Assistants

Alita Rushton^1,2, Adrienne Young^4,5, Heather Keller⁶, Jack Bell^2,7, Judith Bauer<sup>3

1</sup>Department of Nutrition and Dietetics, The Prince Charles Hospital, Chermside, QLD, Australia
²School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
³Department of Nutrition, Dietetics & Food, School of Clinical Sciences, Monash University, Notting Hill, VIC, Australia
⁴Department of Nutrition and Dietetics, Royal Brisbane Women’s Hospital, Herston, QLD, Australia
⁵Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
⁶Schlegel-UW Research Institue for Aging, Waterloo, ON, Canada
⁷Allied Health, The Prince Charles Hospital, Chermside, QLD, Australia

Abstract

Delegation of malnutrition care to dietitian assistants can positively influence patient, healthcare, and workforce outcomes. However, nutrition care for hospital inpatients with or at risk of malnutrition remains primarily individually delivered by dietitians—an approach that is not considered sustainable. This study aimed to identify barriers and enablers to delegating malnutrition care activities to dietitian assistants. This qualitative descriptive study was nested within a broader quality assurance activity to scale and spread systematised and interdisciplinary malnutrition models of care. Twenty-three individual semi-structured interviews were completed with nutrition and dietetic team members across seven hospitals. Inductive thematic analysis was undertaken, and barriers and enablers to delegation of malnutrition care to dietitian assistants were grouped into four themes: working with the human factors; balancing value and risk of delegation; creating competence, capability, and capacity; and recognizing contextual factors. This study highlights novel insights into barriers and enablers to delegating malnutrition care to dietitian assistants. Successful delegation to dietitian assistants requires the unique perspectives of humans as individuals and in their collective healthcare roles, moving from words to actions that value delegation; engaging in processes to improve competency, capability, and capacity of all; and being responsive to climate and contextual factors.

Biography

Alita Rushton, MPhil, BHlthSc(Nutr) combines clinical nutrition assistant experience and research skills to explore opportunities for delegation, with a focus in improving malnutrition care for patients.