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Chapter 1 Advanced Medical Nutrition Therapy Practice: An Introduction and Rationale ................................... 1 Trends Affecting the Need for Advanced Practice Dietitians ..................... ..................... Continued Growth in Knowledge .........................................4 Continued Growth in Jobs ...............................5 Increasing Regulation ...................... ............. Scientific and Economic Accountability ................................ Changes in Skills and Settings ............................................. 7 Changes in Roles....................................................7 Increasing Educational Requirements ....................................8 The Rationale for Advanced Medical Nutrition Therapy Practice ............................ ..... .........8 Value of Advanced Practice to Patients .................................. Value of Advanced Practice to Dietitians ...............................9 Value of Advanced Practice to Employers ......................... 10 Value of Advanced Practice to the Profession .................... 10 Value of Advanced Practice to the Healthcare System.......... 11 Sum m ary........................................................11 K ey Points ............................................... ......... 11 References ............................................... ......... 12 Chapter 2 A Historical and Contextual Perspective on Advanced Medical Nutrition Therapy ......................................15 Advanced Practice Models ........................................ 17 The Naturalistic or Unschooled Genius Model ................17 The Longevity M odel ........................................................ 18 The Expertise Continuum Model................................ 18 The Practitioner Characteristics Model ............................19 The Task Hierarchy Model .................... ...20 The M arketable Skills M odel................................ ....21 Institution-Specific M odels .......................................... 23 Advanced Practice Models: A Summary ...........................23 The Healthcare Context .................... .....24 Routes to Expertise...................... .......24 Credentials .................................. ........... ...........27 Practice Autonomy ..................... ........27 The Healthcare Context: A Summary ..............................29 A Brief History of Advanced Practice in Dietetics.............29 Levels of Dietetics Practice: A Three-Tier System .............31 The Difference Between Specialty and Advanced Practice .......................... ........35 Summary.....................................36 Key Points ...................... ..................................37 Suggested Reading...................... .. .... .......37 Experiences to Try ..................... .........37 R eferences .......................................... ...........38 Chapter 3 A Model for Advanced Medical Nutrition Therapy Practice .......................................... ........ 43 An Advanced Practice Model................................ ...44 Initiative and A utonom y ..................... .... .......................45 Advanced and Specialty Practice ...................................... 50 Application to Practice ............................................ ......52 Sum m ary................................................... ....... .......... 57 Key Points ...................... ...................................57 Suggested Reading.............................. .....................57 Experiences to Try ....................... ......57 R eferences ........................................ ..................... 58 Chapter 4 Aptitude ..................................... ............. 59 Brief Review of Entry-Level Preparation ..........................60 Entry-Level Education ..................... .....60 Entry-Level Credentials ..................... ....62 Review of Advanced Practice Education ...........................62 Educational Systems in Other Health Professions..............63 Dietetics Education Compared to Education for Other Professions ................................. . .......... .........64 A Description of a Medical Nutrition Therapy Practice Degree................................ ................... 66 Existing Educational Programs ....................................... 67 Education: A Sum m ary ...................... ...................... 68 Review of Advanced Practice Experience ..........................69 Learning by Experience ............ ............................69 Acquiring Expertise ........................................ ......70 Experience: A Summary ............................................71 Advanced Dietetics Practice Credentials ...........................71 Summary..........................................73 Key Points ..................................... ..................... 73 Suggested Reading. ............ .................... 74 Experiences to Try ........ ............ .................... 74 References ...................................... .............. 77 Chapter 5 Attitude .......................................... .........81 Scientific Inquiry.............................. .. ................... 82 Techniques of Scientific Inquiry .......................................83 Scientific Inquiry: A Summary .........................................87 C reativity ................................ .... .................... 88 Creativity: A Summary ....................... .......... 89 Breadth and Balance of Perspective.....................90 Breadth and Balance: A Summary ....................................92 Sum m ary..........................................................................93 Key Points ........................................93 Suggested Reading...... .......... ......................93 Experiences to Try ..................................................... ... 95 References ............................. ................... ............... 97 Chapter 6 Context .........................................................................99 C ollaboration .................................... ...................... 101 Collaboration in Advanced Practice Dietetics..................102 Collaboration in Health Care ........................................ 102 Collaboration: A Summary..................... ....... 106 Networking ................................................. 106 Networking in Advanced Practice Dietetics .................... 106 Networking: A Summary ..........................107 C onsultation ................................................................. 108 Consultation versus Referral ..................................... 109 The Consultation-Referral Process: A Summary ...............112 Leadership............................................. 113 The Study of Leadership ......................... .. ................... 114 Leadership: A Summary .............................. ........116 Aw areness ........................................ 116 Self-Awareness .................... ............. ............117 Organizational Awareness....................... ....................... 17 Situational Awareness ...................... ........ .............118 Awareness: A Summary ........................................ 119 Sum m ary........................... ......... .................120 Key Points ................................... .................... 120 Suggested Reading.............................. ............. 120 Experiences to Try ........................ ................... 122 References ..................... .. ..................... 124 Chapter 7 Advanced Practice Expertise...............................127 Nutrition Pharmacology........................... ........130 Nutrition Pathophysiology ........................................ 133 Intake.. .................................................... 135 A bsorption ........................................... 135 Metabolism ................................................................ 136 Excretion ........................................ 136 Nutrition Pathophysiology: A Summary..........................137 Advanced Medical Nutrition Therapy ............................ 138 Nutrition Counseling ............................. .......... 142 Cognitive-Behavioral Therapy ..................................... 145 Health Belief Model .................................. ......... 145 Social Learning Theory ..................................... 146 Transtheoretical Model ..................................... 146 Nutrition Counseling: A Summary .................................146 Nutrition Outcomes Research ........................................ 148 Summary........................................... 152 Key Points ........................................ 153 Suggested Reading.................... .............154 Experiences to Try .................. ................... 155 R eferen ces ................................................................... 158 Chapter 8 The Advanced Practice Approach............................. 63 Comprehensive Approach ........................ 164 Discerning Approach...................... ....... ............ 166 Integrated Approach..................................... 168 Simplified Approach....................... ................... 170 Summary............................................170 K ey Points .......................................... 171 Suggested Reading................................ ..........172 Experiences to Try ............................ ............. 172 References ........................................................ 173 Chapter 9 Influencing Patients, Practice, and the Environment ........................................ ......175 Patients .............................. ... ............................. 176 Autonomy ....................... ..................... 177 Expert Intervention ........................................ 177 Treatment of Complex Nutritional Problems .................... 179 Additional Patient-Related Roles ....................................... 179 Practice ....................................... ..............182 Environment ........................................ 184 Summary........................................187 Key Points .................... ...... .................... 187 Suggested Reading.................... .............188 Experiences to Try ........................................ 188 References ........................ .................................. 189 Chapter 10 Application of the Advanced Practice Model ................191 Putting the Advanced Practice Model to Work ............... 191 Experiences to Try ......... ......... ......................206 Reference ....................................... .............207