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fromtheacademy standards of practice professional performance academy of nutrition and dietetics revised 2014 standards of practice and standards of professional performance for registered dietitian nutritionists competent procient and expert in ...

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                                                                                                                           FROMTHEACADEMY
                                                                        Standards of Practice & Professional Performance
                Academy of Nutrition and Dietetics: Revised 2014
                Standards of Practice and Standards of Professional
                Performance for Registered Dietitian Nutritionists
                (Competent, Proficient, and Expert) in Sports
                Nutrition and Dietetics
                Patricia L. Steinmuller, MS, RDN, CSSD, LN; Laura J. Kruskall, PhD, RDN, CSSD, LD, FACSM; Christine A. Karpinski, PhD, RD, CSSD, LDN;
                Melinda M. Manore, PhD, RDN, CSSD, FACSM; Michele A. Macedonio, MS, RDN, CSSD, LD; Nanna L. Meyer, PhD, RDN, CSSD, FACSM
                ABSTRACT
                Sports nutrition and dietetics addresses relationships of nutrition with physical activity, including weight management, exercise, and
                physical performance. Nutrition plays a key role in the prevention and treatment of obesity and chronic disease and for maintenance of
                health, and the ability to engage in physical activity, sports, and other aspects of physical performance. Thus, the Sports, Cardiovascular,
                and Wellness Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management
                Committee, has developed the Revised 2014 Standards of Practice and Standards of Professional Performance as a resource for Regis-
                tered Dietitian Nutritionists working in sports nutrition and dietetics to assess their current skill levels and to identify areas for further
                professional development in this emerging practice area. The revised document reflects advances in sports nutrition and dietetics
                practice since the original standards were published in 2009 and replaces those standards. The Standards of Practice represents the four
                steps in the Nutrition Care Process as applied to the care of patients/clients. The Standards of Professional Performance covers six
                standards of professional performance: quality in practice, competence and accountability, provision of services, application of research,
                communication and application of knowledge, and utilization and management of resources. Within each standard, specific indicators
                provide measurable action statements that illustrate how the standards can be applied to practice. The indicators describe three skill
                levels (competent, proficient, and expert) for Registered Dietitian Nutritionists working in sports nutrition and dietetics. The Standards
                of Practice and Standards of Professional Performance are complementary resources for Registered Dietitian Nutritionists in sports
                nutrition and dietetics practice.
                J Acad Nutr Diet. 2014;114:631-641.
                   Editor’snote:Figures1,2,and5that                   Dietetics: Revised 2014 Standards of                 past 5 years and replace the 2009 Stan-
                   accompany this article are avail-                  Practice and Standards of Professional               dards. These documents build on the
                   able online at www.andjrnl.org                     Performance for Registered Dietitian                 Academy of Nutrition and Dietetics
                         HESPORTS, CARDIOVASCULAR,                    Nutritionists (Competent, Proficient,                 Revised 2012 SOP in Nutrition Care
                         and Wellness Nutrition (SCAN)                and Expert) in Sports Nutrition and Di-
                         Dietetic Practice Group (DPG)                etetics, reflect advances in sport nutri-
                Tofthe Academy of Nutrition                           tion and dietetics practice during the
                and Dietetics (Academy), under the                                                                           Approved December 2013 by the Quality
                guidance of the Academy Quality                                                                              Management Committee of the Academy
                Management Committee, has revised                                                                            of Nutrition and Dietetics (Academy) and
                the Standards of Practice (SOP) and                    All registered dietitians are nutritionists—          the Executive Committee of the Sports,
                                                                       but not all nutritionists are registered di-          Cardiovascular, and Wellness Nutrition Di-
                Standards of Professional Performance                  etitians. The Academy’s Board of Directors            etetic  Practice Group of the Academy.
                (SOPP) for Registered Dietitians (RDs)                 and Commission on Dietetic Registration               Scheduled review date: April 2018.
                in Sports Dietetics originally published               have determined that those who hold                   Questions regarding the Standards of
                                     1                                 the credential Registered Dietitian (RD)              Practice and Standards of Professional
                in March 2009. The revised docu-                       may optionally use “Registered Dietitian              Performance for Registered Dietitian Nutri-
                ments, Academy of Nutrition and                        Nutritionist” (RDN) instead. The two cre-             tionists in Sports Nutrition and Dietetics
                                                                       dentials have identical meanings. In this             may be addressed to Academy quality-
                                                                       document, the expert working group has                management staff: Sharon McCauley, MS,
                                                                       chosen to use the term RDN to refer to                MBA, RD, LDN, FADA, FAND, director,
                  2212-2672/$36.00                                     both registered dietitians and registered             Quality Management at quality@eatright.
                  http://dx.doi.org/10.1016/j.jand.2013.12.021         dietitian nutritionists.                              org.
                ª2014 by the Academy of Nutrition and Dietetics.                                JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS                      631
          FROMTHEACADEMY
                             2                              6
          andSOPPforRDs. TheAcademyof                clients. The SOPP consist of standards    practice after having obtained RDN
          Nutrition and Dietetics/Commission on      representing six domains of profes-       registration by CDR or an experienced
          Dietetic Registration’s (CDR) Code of      sionalism. The SOP and SOPP are de-       RDN who has recently assumed re-
          Ethics3 along with the Academy of          signedtopromotetheprovisionofsafe,        sponsibility to provide nutrition ser-
          Nutrition and Dietetics Revised 2012       effective, and efficient food and nutri-   vices in a new focus area. A focus area
          SOPinNutrition Care and SOPP for           tion services; facilitate evidence-based  is defined as an area of nutrition and
          RDs2aretoolswithintheScopeofPrac-          practice; and serve as a professional     dietetics practice that requires focused
          tice in Nutrition and Dietetics4 and       evaluation resource.                      knowledge, skills, and experience.8 A
          ScopeofPractice for the RD5 that guide       These focus area standards for RDNs     competent practitioner who has ob-
          the practice and performance of regis-     in sports nutrition and dietetics pro-    tained RDN status and is starting in
          tered dietitian nutritionists (RDNs) in    vide a guide for self-evaluation and      professional   employment     acquires
          all settings.                              expanding practice, a means of identi-    additional on-the-job skills and en-
            Thescopeofpracticeinnutritionand         fying areas for professional develop-     gages in tailored continuing education
          dietetics is composed of statutory and     ment, and a tool for demonstrating        to further enhance knowledge and
          individual components; includes the        competence in the delivery of sports      skills obtained in formal education. An
          Code of Ethics; and encompasses the        nutrition and dietetics care and ser-     RDN starts with technical training and
          range of roles, activities, and regula-    vices. RDNs use these standards to        professional interaction for advance-
          tions  within which nutrition and          assess their current level of practice    ment and expanding breadth of
          dietetics practitioners  perform. For      and to determine the education and        competence. A general practice RDN
          credentialed practitioners, scope of       training required to maintain currency    may include responsibilities across
          practice is typically established within   in their focus area and advancement to    several areas of practice, including, but
          the practice act and interpreted and       a higher level of practice. In addition,  not limited to community, clinical,
          controlled by the agency or board that     the standards may be used to assist       consultation and business, research,
          regulates the practice of the profession   RDNs in transitioning their knowledge     education, and food and nutrition
                           4                         and skills to a new focus area of prac-                 8
          in a given state.  An RDN’s statutory                                                management.
          scope of practice may delineate the        tice. Like the SOP in Nutrition Care and
          services  an RDN is authorized to          SOPP for RDs,2 the indicators (ie,        Proficient Practitioner
          perform in a state where a practice act    measureable action statements that        Aproficientpractitioner is an RDN who
          or certification exists.                    illustrate how each standard can be       is generally 3 or more years beyond
            The RDN’s individual scope of prac-      applied inpractice) (see Figures 1 and 2  entry into the profession, has obtained
          tice  is  determined   by education,       available online at www.andjrnl.org,      operational job performance skills, and
          training, credentialing, and demon-        and Figure 3) for the SOP and SOPP        is successful in the RDN’s chosen focus
          strated and documented competence          for RDNs in Sports Nutrition and Di-                      8
          to practice. Individual scope of practice  etetics were developed with input         area of practice. The proficient practi-
          in nutrition and dietetics has flexible     and consensus of content experts          tioner demonstrates additional knowl-
          boundaries to capture the breadth of       representing   diverse  practice  and     edge, skills, and experience in a focus
          the individual’s professional practice.    geographic perspectives. The SOP and      area of dietetics practice. An RDN may
          The Scope of Practice Decision Tool, an    SOPP for RDNs in Sports Nutrition and     acquire specialist credentials, if avail-
          online, interactive tool, permits an RDN   Dietetics were reviewed and approved      able, to demonstrate proficiency in a
          to answer a series of questions to         by the Executive Committee of the         focus area of practice.
          determinewhetheraparticularactivity        SCAN DPG and the Academy Quality
          is within his or her scope of practice.    Management Committee.                     Expert Practitioner
          The tool is designed to assist an RDN                                                AnexpertpractitionerisanRDNwhois
          in   critically  evaluating   personal                                               recognized within the profession and
          knowledge, skill, and demonstrated         THREE LEVELS OF PRACTICE                  has mastered the highest degree of
          competence with criteria resources         The Dreyfus model7 identifies levels       skill in or knowledge of a certain focus
          (access tool in the Academy Shop,          of proficiency (novice, advanced be-       or generalized area of dietetics through
          www.eatright.org/shop/product.aspx?        ginner,  competent,   proficient,  and     additional knowledge,formalacademic
          id=6442474794).                                                                                                            8
                                                     expert) (refer to Figure 3) during the    preparation, experience, or training.
            The Academy’s Revised 2012 SOP in        acquisition and development of knowl-     An expert practitioner exhibits a set of
          Nutrition Care and SOPP for RDs2                                                     characteristics that include leadership
          reflect the minimum competent level         edgeandskills. This model is helpful in   and vision and demonstrates effec-
          of nutrition and dietetics practice and    understanding the levels of practice      tiveness in planning, achieving, evalu-
          professional performance for RDNs.         describedintheSOPandSOPPforRDNs           ating,  and communicating targeted
          These standards serve as blueprints for    in Sports Nutrition and Dietetics. In     outcomes. An expert practitioner may
          the development of focus area SOP and      Academy focus areas, the levels are       have an expanded or specialist role, or
          SOPP for RDNs in competent, profi-          represented as competent, proficient,      both, and may possess an advanced
          cient, and expert levels of practice. The  andexpertpracticelevels.                  credential, if available, in a focus area of
          SOP in Nutrition Care is composed of                                                 practice. Generally, the practice is more
          four standards representing the four       Competent Practitioner                    complex and the practitioner has a
          steps of the Nutrition Care Process        In dietetics, a competent practitioner is high degree of professional autonomy
          (NCP)asappliedtothecareofpatients/         an RDN who is either just starting        and responsibility.
          632    JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS                                        April 2014 Volume 114 Number 4
                                                                                                                    FROMTHEACADEMY
                 These Standards, along with the                 importance of regular PA and adequate              Board Certification as a Specialist
               Academy and CDR’s Code of Ethics,3                nutrition for attaining optimal weight             in Sports Dietetics
               answer the questions: Why is an RDN               and overall health has also been high-             In 2006, CDR launched the Board Cer-
               uniquely qualified to provide sports               lighted in a number of recent US                   tification as a Specialist in Sports Di-
               nutrition and dietetics care and ser-             Department of Health and Human                     etetics (CSSD). An RDN who has earned
               vices? What knowledge, skills, and                Services and US Department of Agri-                the CSSD has met minimum practice
               competencies does an RDN need to                  culture documents. These include the               experience requirements and has suc-
               demonstrate for the provision of safe,            2010 Dietary Guidelines for Ameri-                 cessfully completed the CSSD exami-
                                                                       18                          19
               effective, and quality sports nutrition           cans,    Healthy People 2020,        and the       nation. An RDN who has earned the
               and dietetics care and services at                2008 PA Guidelines Advisory Commit-                CSSDcertification has demonstrated, at
                                                                              11
               the competent, proficient, and expert              tee Report.      The 2008 PA Guidelines            minimum, proficient-level skills pre-
               levels?                                           Advisory Committee Report11 is the                 sented in this document. Increasingly,
                                                                 first report issued by the US Govern-               job descriptions for sports RDNs are
               OVERVIEW                                          ment specifically for the American                  writtentorequiresuccessfulcandidates
               Public interest in the relationships of           public with regard to the health bene-             toholdtheCSSDcertification.Eligibility
               nutrition with physical activity (PA)             fits of PA and includes a summary of                criteria for the credential and other
               andexercisehasdramaticallyincreased               the science supporting its recommen-               information are available from CDR
               during the last 25 years, fueled in part          dations. In 2013, the US Department of             (www.cdrnet.org). To enhance delivery
               by the rising incidence of obesity and            Health and Human Services released                 and consistency of sports nutrition
               chronic disease. In addition, interest            the    PA Guidelines for Americans                 services to Olympic-caliber athletes,
               in relationships between nutrition and            Midcourse Report, Strategies to In-                The US Olympic Committee sport nu-
               sport and physical performance has                crease PA Among Youth.20 This report               trition team has initiated a US Olympic
               greatly expanded due to an increase in            further emphasizes the importance of               Committee Sport Dietitian Registry to
               the general population’s participation            PA for health in children and youth                maintain a roster of prescreened CSSDs
               in competitive exercise/training pro-             andoutlines methods for achieving the              as resources for National Governing
               grams and events (eg, CrossFit, Tough             recommended 60 minutes of PA per                   Bodies of Olympic, Paralympic, and Pan
                                           9,10                  day. In addition, the Institute of Medi-                               23
               Mudder, P90X routine).           The focus                                                           American Sports.
               area of sports nutrition and dietetics            cine issued Dietary Reference Intakes
               addresses all aspects of relationships            for energy intake in 2005, which, for              Scope of Practice for the RDN in
               of nutrition with PA. Although often              the first time, specifically included                Sports Nutrition and Dietetics
               used interchangeably, PA is any bodily            recommendations for the level of PA
               movement produced by the contrac-                 required for weight maintenance and                The Scope of Practice for the RD5 de-
               tion of skeletal muscle, while exercise           weight loss.21 Finally, the US Depart-             scribes the sports nutrition practice
               is a subcategory of PA that is planned,           ment of Agriculture, American College              area of nutrition and dietetics per-
                                                          11     of Sports Medicine, and the Academy                formed by RDNs who apply evidence-
               structured, and repetitive in nature.
               The term exercise refers to PA that               have also jointly emphasized the syn-              based knowledge in PA and exercise/
               contributes to health, fitness, and                ergismofnutritionandPAforachieving                 training to address the diverse nutri-
                                               11                energy balance.22 Thus, RDNs whose                 tional needs of physically active in-
               chronic disease prevention.       The term
               training and conditioning refers to PA            skills include weight management and               dividuals. Sports RDNs provide medical
               that contributes to task-specific phys-            nutrition for PA are well positioned to            nutrition therapy (MNT) in direct care
               ical performance. The term task-specific           assist individuals and organizations in            and design, implement, and manage
               physical performance encompasses PA               integrating nutrition with PA to pro-              safe and effective nutrition strategies
               related to sport, military training and           mote overall health, wellness, and                 that enhance lifelong health, fitness,
               military operations, and training and             optimal physical performance.                      and optimal physical performance.
               performance of law enforcement offi-                                                                  Theyassess,educate,andcounselwhat,
               cers, firefighters, professional emer-              SCAN DPG                                           howmuch,andwhentoconsumefoods
               gency responders, and others whose                In 1982 the SCAN DPG was established               and fluids to maintain health, appro-
               occupations require physical labor and/           to bring together nutrition practi-                priate body weight and composition,
               or maintenance of specified levels of              tioners with expertise in sports and PA,           and how to properly fuel the body for
               physical conditioning or body weight              cardiovascular health, wellness, and               PA and exercise, training and condi-
               and body composition.                             disordered eating and eating disorders.            tioning,   and physical performance.
                 Poor dietary habits and low levels of           In 2004, Sports Dietetics-USA, a sub-              Valued for their ability to positively
               PA are strongly linked to overweight/             unit    within    SCAN, was launched               impact behavior and promote behavior
               obesity and some chronic diseases (eg,            to promote nutrition practices that                change, sports RDNs assist individuals
               cardiovascular disease, hypertension,             enhance lifelong health, fitness, and               in implementing nutrition plans that
                                                12                                                                  achieve their goals. In addition, sports
               diabetes, and some cancers).        It is not     sports performance, and advance the
               surprising that interest in the syner-            vocation of sports nutrition and di-               RDNs generate and analyze data to
               gistic roles of nutrition and PA has              etetics.   The SCAN website (www.                  monitor and evaluate the effectiveness
                            13-16                                scandpg.org) offers sports nutrition               of their interventions.
               heightened.         The role PA plays in
               promoting weight loss and preventing              fact sheets, webinars, and other re-                 Sports RDNs use the SOP SOPP for
               weight gain subsequent to weight                  sources targeted to practitioners and              RDNs in Sports Nutrition and Dietetics
                                                  11,17          physically active individuals.                     to assess their knowledge, skills, and
               loss is also well documented.            The
               April 2014 Volume 114 Number 4                                             JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS                  633
         FROMTHEACADEMY
          Standards of Practice are authoritative statements that describe practice demonstrated through nutrition assessment, nutrition
          diagnosis(problemidentification),nutritionintervention(planning,implementation),andoutcomesmonitoringandevaluation(four
          separate standards) and the responsibilities for which registered dietitian nutritionists (RDNs) are accountable. The Standards of
          Practice for RDNs in Sports Nutrition and Dietetics presuppose that the RDN uses critical thinking skills, analytical abilities, theories,
          best available research findings, current accepted dietetics and medical knowledge, and the systematic holistic approach of the
          Nutrition Care Process as they relate to the application of the standards. Standards of Professional Performance for RDNs in Sports
          Nutrition and Dietetics are authoritative statements that describe behavior in the professional role, including activities related to
          quality in practice; competence and professional accountability; provision of services; application of research; communication and
          application of knowledge; and utilization and management of resources (six separate standards).
          Standards of Practice and Standards of Professional Performance are evaluation resources with complementary sets of
          standards—both serve to describe the practice and professional performance of RDNs. All indicators may not be applicable to
          all RDNs’ practice or to all practice settings and situations. RDNs operate within the directives of applicable federal and state
          laws and regulations as well as policies and procedures established by the organization in which they are employed. To
          determine whether an activity is within the scope of practice of the RDN, the practitioner compares his or her knowledge, skill,
          and competence with the criteria necessary to perform the activity safely, ethically, legally, and appropriately. The Academy’s
          Scope of Practice Decision Tool, an online, interactive tool, is specifically designed to assist practitioners with this process.
          The term patient/client is used in the Standards of Practice as a universal term as these Standards relate to direct provision of
          nutrition care and services. Patient/client could also mean client/patient, resident, customer, participant, consumer, or any individual
          or group who receives sports nutrition and dietetics care. Customer is used in the Standards of Professional Performance as a
          universal term. Customer could also mean client/patient, client/patient/customer, participant, consumer, or any individual, group, or
          organization the RDN provides services. These services are provided to individuals of all ages. These Standards of Practice and
          Standards of Professional Performance are not limited to the clinical setting. In addition, it is recognized that the family and
          caregiver(s) of patients/clients of all ages, including individuals with special health care needs, play critical roles in overall health and
          are important members of the team throughout the assessment and intervention process. The term appropriate is used in the
          standards to mean: Selecting from a range of best practice or evidence-based possibilities, one or more of which would give an
          acceptable result in the circumstances. The term exercise refers to physical activity that contributes to health, fitness, and chronic
          disease prevention. The term training and conditioning refers to physical activity that contributes to task-specific physical
          performance. The term task-specific physical performance encompasses physical activity related to sport, military training and
          military operations, and training and performance of law enforcement officers, firefighters, professional emergency responders, and
          others whose occupations require physical labor and/or maintenance of specified levels of physical conditioning or body weight and
          body composition. Sports nutrition and dietetics practice is performed by RDNs who apply evidence-based nutrition and dietetics
          knowledge in exercise and sports. They assess, educate, and counsel athletes and physically active individuals. They design,
          implement, and manage safe and effective nutrition strategies that enhance lifelong health, fitness, and optimal performance.
          Each standard is equal in relevance and importance and includes a definition, a rationale statement, indicators, and examples
          of desired outcomes. A standard is a collection of specific outcome-focused statements against which a practitioner’s performance
          can be assessed. The rationale statement describes the intent of the standard and defines its purpose and importance in greater
          detail. Indicators are measurable action statements that illustrate how each specific standard can be applied in practice. Indicators
          serve to identify the level of performance of competent practitioners and to encourage and recognize professional growth.
          Standard definitions, rationale statements, core indicators, and examples of outcomes found in the Academy of Nutrition and
          Dietetics Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for RDNs have been
          adapted to reflect three levels of practice (competent, proficient and expert) for RDNs in sports nutrition and dietetics (see
          figure on page 635). In addition, the core indicators have been expanded to reflect the unique competence expectations for the
          RDN providing sports nutrition and dietetics care.
          Standards described as proficient level of practice in this document are not equivalent to the Commission on Dietetic
          Registration certification, Board Certification as a Specialist in Sports Dietetics (CSSD). Rather, the CSSD designation recognizes
          the skill level of an RDN who has developed and demonstrated, through successful completion of the certification examination,
          sports nutrition and dietetics knowledge and application beyond the competent practitioner and demonstrates, at a minimum,
          proficient level skills. An RDN with a CSSD designation is an example of an RDN who has demonstrated additional knowledge,
          skills, and experience in sports dietetics by the attainment of a specialist credential.
                                                                                               (continued on next page)
         Figure 3. Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent,
         Proficient, and Expert) in Sports Nutrition and Dietetics.
         634   JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS                             April 2014 Volume 114 Number 4
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...Fromtheacademy standards of practice professional performance academy nutrition and dietetics revised for registered dietitian nutritionists competent procient expert in sports patricia l steinmuller ms rdn cssd ln laura j kruskall phd ld facsm christine a karpinski rd ldn melinda m manore michele macedonio nanna meyer abstract addresses relationships with physical activity including weight management exercise plays key role the prevention treatment obesity chronic disease maintenance health ability to engage other aspects thus cardiovascular wellness dietetic group guidance from quality committee has developed as resource regis tered working assess their current skill levels identify areas further development this emerging area document reects advances since original were published replaces those represents four steps care process applied patients clients covers six competence accountability provision services application research communication knowledge utilization resources within e...

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