What are students learning from evaluating their nutrition progress notes?
This fall we introduced a new activity for students who were advanced and were ready to write progress notes summarizing nutrition care. The evaluation tool was adapted from the tool developed by Dee Pratt, Dietitian Associates, Inc that she used as a consultant when she evaluated progress notes.
This fall so far, 70 students have used the evaluation tool to evaluate their own or their classmates nutrition progress notes, sometimes as a group activity and sometimes as an individual assignment.
The following are the five questions that are most often rated as needing improvements:
Selected Questions from the Evaluation Tool
(most often rated as needing improvement)
9. Signs/Symptoms included in the PES statements provide evidence that the nutrition diagnosis in that PES statement exists AND the signs and symptoms are specific, measurable, and conducive to monitoring and evaluation. For example ask - are the signs and symptoms quantified in the PES statement? That is, have I indicated # servings or grams rather than described intake as "high" or "excessive"?
11. Goals/Aims are identified and SMART (specific, measurable, achievable, relevant, and time-defined) and consider client needs and values, that is goals are specific for example lose 1/2 lb (1/4 kg) per week until reach goal of xxx lbs (xx kg) in 6 months or normalize serum lipid levels in 3 months.
19. Time frame for nutrition monitoring and evaluation is noted for each parameter identified. For example, it indicates whether the serum value should be evaluated daily, weekly or in months or whether BMI should be re-evaluated in 6 months, 9 months, or 12 months based on the likelihood of meaningful changes in the parameter.
22. If the monitoring and evaluation indicators do not indicate progress, the reason for lack of progress is noted. Re-assessment should explore and document potential reasons (e.g. non-compliance, lack of social support, extenuating personal situations, lack of availability to food or supplies etc.)
23. The status of the previous nutrition diagnosis(es) are noted. Whether resolved, continuing or no longer appropriate. If they are continuing indicate whether progress had been made.
Among the student responses, these were concepts indicating what they had learned or needed to improve after this activity:
- Need to be more specific and detailed in signs and symptoms, description of interventions, SMART goals, and monitoring and evaluation time frames and indicators
- Need for better connection between the PES statements and interventions
- Need to link previous nutrition consultations to current consultation, either by evaluating progress made and reasons for success or lack of success and annotating the need to continue or discontinue previous nutrition diagnoses.
- Some student indicated that the activity validated that their progress notes were on the right track.
- Need to focus on what the patient needs right now
- Details were important for others reading the note so they can have a full understanding of the case and show how nutrition fits into overall patient care
- Need to be more practical and better combine all information into a more cohesive progress note
- In some cases students found that they needed to add a PES statement or ensure that their interventions matched their existing PES statements.
- Templates for progress notes vary, but the information included is the same
A copy of the questions included in the tool is included in the activity which is the same in each case. This way the student can see all the questions prior to starting to use the evaluation tool (on-line form). When the student completes the on-line form they receive a copy of their responses in an email that they provide to instructor as their assignment. See EXAMPLE ACTIVITY FOR FOLLOW-UP NUTRITION PROGRESS NOTE