A study to investigate perceptions of the role of the dietetic support worker by dietitians and dietetic support workers in the NHS.

摘要

Background: The role of the dietetic support worker (DSW) was first established in the late 1990s as a cost effective way to tackle the increasing incidence of malnutrition in hospitals (British Dietetic Association, 1999). Many dietetic departments now employ DSWs in diverse roles with varying degrees of responsibility (British Dietetic Association, 2007). The introduction of Agenda for Change (Department of Health, 2004) has had implications for the organisation and provision of cost-effective dietetic services and patient care. The aim of this study was to explore attitudes and opinions of both dietetic support workers and dietitians towards the present and future role of dietetic support workers within the NHS. Methods: A postal questionnaire survey was conducted with 18 dietetic support workers (75% response rate) and 62 dietitians (63% response rate) who worked with DSWs, from 10 trusts within the East of England Strategic Health Authority. The survey collected demographic data, information aboutthe current role of the dietetic support worker and training provision and uptake. Descriptive statistics were obtained for the quantitative data. Free text data were thematically coded and the resulting themes were further explored by means of semi-structured telephone interviews conducted with six dietetic support workers and six dietitians. Qualitative data were analysed using content analysis methods using NVivo computer software. Approval was obtained from the Norfolk Research Ethics Committee. Results: The majority (59%) of the work of the dietetic support worker involved direct patient/client contact, particularly delivering follow up care to patients initially assessed by a dietitian. However, both dietitians and DSWs highly valued the contribution DSWs made to 'supporting the dietitian' with tasks such as, providing administrative support, conducting audit surveys and liaising with other healthcare staff and patients. This aspect of the role enabled dietitians to manage their workload and further develop the dietetic service. A main theme that emerged from both groups was the lack of provision for training for DSWs. More than half of dietetic support workers (nine of 17; 53%) and dietitians (39/61; 64%) supported the development of a recognised mandatory qualification for DSWs (P = 0.416). Most dietitians (47/62; 76%) and dietetic support workers (11/18; 61%) anticipated the role of the dietetic support worker developing in the future. Discussion: The role of the dietetic support worker was highly valued. However, there was difficulty in defining the role of a 'typical' DSW as this depended on a range of factors including their qualifications and past experience, their desire to develop their role, the amount of training they received and the support they had from dietitians within their department. Dietetic support workers were keen to participate in training as a way to professionally develop and enhance their career prospects. However, many dietitians acknowledged that current opportunities for training were limited and were not tailored specifically for DSWs. Few dietetic support workers wanted to train as dietitians but most would welcome a clear career pathway to be available. Conclusions: The role of the dietetic support worker can only develop alongside dietetic service developments within the NHS. Currently, there is no evidence for the best skill mix for the cost-effective provision of dietetic services in the NHS (British Dietetic Association, 2006). The definition and clarification of tasks suitable for DSWs and dietitians requires further discussion and research. A national evaluation should be conducted to explore more fully the findings from this study and inform future strategic planning of dietetic services within the NHS. This work was supported by the BDA General Education Trust. References British Dietetic Association. (1999) Dietetic Assistants. Professional Development Committee. Briefing Paper No.