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Report of the Committee on the Dietetic Profession N.Z. Board Hith. Rep. Ser., 1973 19 BOARD OF HEALTH REPORT SERIES No 19 REPORT OF THE COMMITTEE ON THE DIETETIC PROFESSION MOH Library WB 400 NEW 1973 110133 \ WELLINGTON 1073- STACK BOARD OF HEALTH Chairman Hon. R. J. TIZARD, Minister of Health; ex officio. Deputy Chairman Dr H. J. H. HIDDLESTONE, M.D., CII.B., F.R.C.P., F.R.A.c.p.; ex officio. Members Dr C. N. D. TAYLOR, MB., CII.B., D.P.IL, M.P.H.; nominated by Minister of Health. Prof. A. CROWTDER, M.A., PH.D. (CAMB.), F.B.PS.S., nominated by Minister of Health. Sir EDWIN BATE, O.B.E., LL.M.; nominated by Hospital Boards Associa- tion. Prof. PATRICIA D. COLEMAN, M.S., DIPJLSC.; nominated by Minister of Health. Mr J. B. THOMAS, M.B.E., nrninated by Counties Association. Mr E. M. H. KEMP, M.B.E., A.C.A.; nominated by Municipal Associa- tion. Prof. C. W. DIXON, M.D., F.P.A.C.P., D.P.H., M.R.C.S., L.R.C.P., D.C.IL, D.L.o.; nominated by University of Otago. Mr G. W. HOLLAND, M.B., CH.B., F.R.C.S.(ENG), F.R.A.C.S.; nominated by Medical Research Council. Dr W. C. R. NORTH, B.SC., M.B., CH.B., M.R.c.G.P.; nominated by Medical Association of New Zealand. Secretary Mr W. 0. D. FINCH, Department of Health. FUNCTIONS OF THE BOARD The principal function of the board shall be to make recommendations to the Minister in respect of such matters relating to public health as may he referred to it by the Minister, and in particular, any matters which may be so referred to it relating to: (a) The adoption of a general health policy for the promotion of health, the prevention of disease and disability, and the proportion of the available resources that should be allocated for each of the foregoing purposes. (b) The relationship of the control and management of hospitals to the general health policy. (c) The operation of medical, pharmaceutical, hospital, maternity, and other related benefits underPart II of the Social Security Act 1964 and their relationship to the general health policy. (d) The co-ordination of the activities of local authorities under this Act, and of the activities of voluntary associations in respect of public health, with the activities of the Department of Health.. DIETETIC PROFESSION BOARD OF HEALTH (Under Health Act 1956) 3 nd Departm f ,AR Opinions expressed in this report are those of the committee responsible and do not necessarily represent the views of the Board of Health REPORT SERIES: No. 19 Published 1973 LIBRARY DEPARTMENT OF HEALTH WELLINGTON "Since nutrition so completely affects the well-being of each individual, every man has a right to be informed concerning the current knowledge of nutrition, or at least to have nutrition knowledge translated for him into practical terms of food and meals." E. Neige Todhunter, M.H.sc.(N.z.), PH.D.(coLuMBIA). "The Evolution of Nutrition Concepts—Perspectives and New Horizons". Journal of the American Dietetic Association, Vol. 46, No. 2. "The duties of the dietitian in a hospital can be divided into three groups, namely: administrative, scientific, and teaching. Her status must be well established, with clear-cut understanding in regard to her functions, duties and relations. Her services are absolutely essential, and no hospital can get along properly without her from the standpoints of economy and efficiency. "It is recognised today that each hospital should have one qualified dietitian for every one hundred patients." Malcolm T. MacEachern, M.D., c.M., D.sc., Chicago. Report on the Hospital System of the Dominion of New Zealand to the New Zealand Branch of the British Medical Association, 1926. MEMBERS OF THE COMMITTEE Chairman Professor P. D. Coleman, M.S.(TEXAS), DIP.H.sC.(N.Z.), Dean of Faculty of Home Science, University of Otago. Members Professor D. W. Beaven, M.B., CH.B.(N.z.), F.R.C.P., F.R.c.P.(EDIN.), FR.A.C.P., Professor and Head of Department of Medicine, the Christchurch Clinical School of the University of Otago. Miss J. M. Benedict, M.s.(I0WA), B.SC.(HOME ECON.) (MANIT.), R.P.DT. (0NT.), New Zealand Registered Dietitian, Senior Lecturer, Foods Department, University of Otago. Miss E. A. Boyd, N.z.DIP.N., REG.N., REG.M., Assistant Director, Division of Nursing, Department of Health. Miss P. F. M. Donnelly, DIP.H.SC.(N.Z.), New Zealand Registered Dietitian, Senior Dietitian, Wellington Hospital Board. Miss B. E. Kelly, M.s.(KANsAs), DIP.H.sc.(N.z.), New Zealand Registered Dietitian, Advisory Dietitian, Department of Health. Dr W. Murphy, M.D., CH.B., D.P.H., DIP.NUT., Director, Division of Public Health, Department of Health. Dr G. I. Nicholson, M.B., CR.B., DIP.OBST., M.R.C.P., F.R.A.C.P., Gastro- enterologist, Auckland Hospital Board. Professor P. E. Rossell, M.A.(sHEFF.), Professor of Management, University of Otago. Mrs H. W. P. Williamson, B.H.SC.(N.Z.), New Zealand Registered Dietitian, formerly Advisory Dietitian, Department of Health. 2 CONTENTS PAGE 9 INTRODUCTION 1. DIETITIANS 9 1.1 Title of Dietitian 9 1.2 Definitions 10 1.2.1 Nutrition 10 1.2.2 Dietetics 10 1.2.3 Dietitian 10 1.2.4 Further Definitions 10 1.3 Registration of Dietitians 10 2. THE NEED FOR DIETITIANS .. .. .. .. 11 2.1 Confirming the Need for Dietitians .. .. .. 11 2.1.1 Responses from Hospitals Employing Dietitians 11 2.1.2 Responses from Hospitals Not Employing Dietitians 12 2.2 General Evidence Concerning Need for Dietitians .. 12 2.3 Summary .. .. .. .. .. 13 3. BACKGROUND TO DIETETICS IN NEW ZEALAND .. .. 13 3.1 Development of Training .. .. .. .. 13 3.2 Legislation for Dietitians . .. 15 3.3 Number Trained .. .. .. .. .. 15 3.4 Summary .. .. .. •. .. 16 4,. THE PRESENT PRACTICE OF DIETETICS: INFORMATION RELATING TO QUALIFICATIONS AND EMPLOYMENT OF DIETITIANS 17 4.1 Sources of Information .. .. 17 4.2 Qualifications of Dietitians .. 17 4.3 Present Employment Status of Dietitians 17 4.4 Reasons for Leaving or Changing Employment as a Dietitian . 20 4.5 Number of Dietitians Employed by Hospitals.. 20 4.6 Execution of Dietetic Functions in Hospitals 20 4.6.1 Hospitals Employing Dietitians 21 4.6.2 Hospitals Without Dietitians .. 21 4.7 Employment of Ancillary Staff for Dietetic Functions 21 4.8 Summary .. .. .. 22 5. THE PRESENT ROLE OF THE DIETITIAN .. , .. .. 22 5.1 The Hospital Dietitian .,. .. .. .. 22 5.1.1 Administrative Role.. .. .. .. 22 5.1.2 Therapeutic Role • .. .. .. .. 23 5.1.3 Teaching Role .. .. .. .. 24 5.1.4 Research Role ... .. .. .. 25 5.1.5 Division of Time as Reported by Dietitians .. 25 .3 1 PAGE 5.2 Problems Identified in the Present Role of the Hospital Dietitian . 27 5.2.1 Responsibility for Total Food Services 27 5.2.2 Food Supervisors .. 28 5.2.3 Other Ancillary Staff 28 5.2.4 Food Service in the Hospital Ward 29 5.3 The Public Health Dietitian 30 5.4 The Dietitian in University Education 30 5.5 The Dietitian in Private Practice 31 5.6 Assessment of Fulfilment of Dietetic Functions 31 5.6.1 Shortcomings in Hospital Dietetic Services 32 5.6.2 Shortage of Dietitians 33 5.6.3 Public Health Dietitians 34 5.6.4 Morale of Dietitians.. 34 5.7 Summary .. .. 35 6. THE FUTURE ROLE OF THE DIETETIC PROFESSION 36 6.1 Greater Recognition of Nutritional Factors in Maintaining Good Health .. .. 36 6.2 Disease Prevention .. 37 6.3 Organisation of Health Services 37 6.3.1 Hospital Services .. 38 6.3.2 Psychiatric Hospitals .. .. 39 6.3.3 Medical Practice .. .. 39 6.3.4 Group Practices and Health Centres 40 6.3.5 Regional Health Services .. 40 6.4 The Dietitian in the Future .. 40 6.4.1 Specialisation .. .. 41 6.4.2 The General Dietetic Practitioner. 41 6.4.3 The Administrator of Dietetic Services 41 6.4.4 The Clinical Dietitian .. 42 6.4.5 Educational Role of Dietitians 43 6.4.6 The Public Health Dietitian .. 43 6.4.7 Advisory Role in Institutions Not Employing Dietitians .. 44 6.4.8 Dietetic Research .. .. 44 6.4.9 Liaison with Related Fields of Work 45 6.4.10 Food Tables .. .. -45 6.5 Achievement of Future Role .. 45 6.5.1 Availability of Trained Food Service Staff 45 6.5.2 Recognition of the Dietitian .. 46 6.6 Summary .. .. .. 46 PRESENT TRAINING OF DIETITIANS .. .. .. 48 7.1 Training Programme .. .. .. .. 48 4 PAGE 7.1.1 Observations by the Committee on Prerequisite• University Training 48 7.1.2 Observations by the Committee on Aspects of Present Hospital Training .. 49 7.1.3 Library Resources .. 49 7.2 Opinions Expressed to the Committee on Present Training 50 7.2.1 General Comments 50 7.2.2 Comments on the School of Home Science Courses 50 7.2.3 Comments on Dietetic Training 51 7.3 Summary .. .. 52 8. FUTURE TRAINING OF DIETITIANS 53 8.1 Problems Affecting the Future of the Dietetic Profession 53 8.2 Outline of Recommendations for Training 54 8.2.1 Training for Registration 54 8.2.2 Post-registration and Post-graduate Training 54 8.2.3 Educational Basis of Training 55 8.2.4 Aims of Training .. .. 55 8.2.5 Assessment of General Aims in Relation to Future Needs .. .. .. 55 8.2.6 Educational Requirements in Relation to Goals.. 55 8.2.7 Consideration of Specialisation at Undergraduate Level .. .. .. 56 8.3 Introduction of a Degree in Dietetics 56 8.3.1 Location of Course .
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