Nutritional support refers to methods other than eating for providing necessary nutrients. This may involve tube feedings.
Nutrition support professionals include dietitians, nurses, pharmacists, physicians, advanced practice providers and other healthcare practitioners. They work in various healthcare environments such as hospitals, home care agencies and long-term care facilities.
Dietitians
Dietitians are licensed health professionals who assess, diagnose and treat individual and public dietary and nutrition problems. Their role involves translating the latest scientific findings regarding food’s effect on health into practical guidance to assist individuals in making healthy lifestyle choices.
Food service dieticians may be responsible for both clinical dietetics (patient nutrition therapy) and food service dietetics, the latter of which involves providing meals and snacks to patients, staff, visitors and volunteers as well as reviewing supplier ingredient specifications and catering menus to meet nutrition and allergen requirements.
Nutrition Support Professionals (NSPs) are registered nurses, nurse practitioners, physician assistants or physicians who specialize in enteral and parenteral nutrition therapy for individuals who require special feeding due to gastrointestinal impairment or other conditions. NSPs work directly with these patients by screening and assessing individual nutritional needs before developing a personalized feeding plan, monitoring response to therapy as well as transitional care planning based on established standards and guidelines for enteral and parenteral nutrition delivery.
Nutrition Support Professionals
Nutrition support professionals provide direct care and education for patients undergoing nutritional therapy, helping identify any nutrient deficiencies as well as prepare and administer enteral or parenteral nutrition formulations.
Dietitians provide assistance in developing nutrition policies, patient and family education and quality assurance monitoring. Dietitians may be part of multidisciplinary teams comprised of nurses, dietitians and physicians.
Nearly 78% of healthcare providers reported written policies concerning the provision of nutrition support therapy (PN) existed at their institutions, with physicians, dietitians and pharmacists all playing roles in writing them. All reported being familiar with published ASPEN/ESPEN guidelines but some respondents did not use them in practice – suggesting more should be done to make health care providers aware of them – perhaps through continuing education courses for healthcare professionals as well as curriculum changes at schools providing nutrition support therapy classes.
Physician Assistants
Nutritional support may be needed if illness or injury prevents someone from eating and digesting food normally, and can come in the form of tube feedings (enteral) or parenteral nutrition which dispenses essential vitamins directly into their bloodstream via an intravenous catheter.
Nutrition support teams provide an essential service and save costs for hospitalized patients, through reduced length of stay, staffing costs and nutrition use as a result of multidisciplinary team approaches.
Physician assistants (PAs) can add value to nutritional support teams by integrating nutrition assessments into healthcare assessments and providing patient education about nutrition. PAs may prescribe medications, treatments and diagnostic tests; participate in care planning for home parenteral nutrition patients; help place central venous catheters; care for pediatric patients needing specialized parenteral nutrition treatments; or perform tasks normally undertaken by dietitians and nutrition support pharmacists such as formula preparation.
Other Healthcare Practitioners
People who are critically ill or cannot consume adequate nutrition require additional nourishment in the form of artificial feeding. This may include enteral nutrition via tube feeding directly into the gastrointestinal tract or parenteral nutrition via central and peripheral venous access routes, both of which may increase muscle mass, improve wound-healing rates, strengthen host defense capabilities and provide essential nutrition after surgery or illness.
EN/PN practice requires a multidisciplinary team. While roles of members vary by facility, most hospitals have nutrition support teams (NST) comprised of dietitians and physicians to reduce inappropriate resource utilization, complications due to PN use, mortality risks associated with it and hospital costs (12).
Physicians play an essential role in identifying when nutritional support is required. This involves assessing each patient’s condition and need for nutrition support, monitoring tolerance to EN and PN, prescribing necessary medication and suggesting appropriate therapies. They may also be responsible for identifying potential indications and obtaining informed consent of patients.
