Exploring the Dimensions and Nature of Clinical Decision Making Among Doctorally Prepared Dietitians Practicing in the Acute Care and Ambulatory Setting: A Rapid Ethnography Study.

BACKGROUND: Clinical decision making (CDM) driven by evidence-based practice promotes positive outcomes in health care. Little is known about CDM among doctorally prepared dietitians (i.e., those clinicians who practice at an advanced level), and a better understanding may lead to improvements in patient care and dietetics education. OBJECTIVE: To explore the key dimensions and the nature of doctorally prepared dietitians' clinical decision making. DESIGN: To capture the complexities of CDM throughout 10 workdays, a rapid ethnographic study was conducted using multiple data collection methods, including the critical incident technique and two validated questionnaires, the Health Sciences Reasoning Test (HSRT) and the California Critical Thinking Disposition Inventory (CCTDI). Participant Setting PARTICIPANTS: (N=10) were recruited through purposeful sampling of dietitians from a doctoral nutrition program database. They were required to have completed all components of a Doctor of Clinical Nutrition degree and work in either an acute-care or ambulatory setting for at least 20 hours per week. ANALYSIS: Performed The critical incidents reflecting on a memorable patient care experience were analyzed using thematic analysis. Two questionnaires (HSRT and CCTDI) assessed distributions of critical thinking skills (analysis, interpretation, inference, evaluation, explanation, induction, deduction, numeracy) and dispositions (truth-seeking, open-mindedness, analyticity, systematically, confidence in reasoning, inquisitiveness, maturity of judgement). RESULTS: Forty critical incidents were collected. Dietitians worked an average of 31.8 hours weekly with equal representation from acute-care and ambulatory care settings and have been in practice an average of 13.9 years. The critical incidents yielded four themes characterizing doctorally prepared dietitians' decision making in practice, and they included: (1) adaptive learning, (2) delivery of patient-centered care, (3) display of situational leadership, and (4) upholding of ethical practice. HSRT and CCTDI data reported positive or strong average classifications among critical thinking and disposition skills; however, there is a potential opportunity for growth in interpretation, deduction, and numeracy skills. CONCLUSION: Doctorally prepared dietitians develop advanced level skills and leverage evidence-based research to drive CDM in practice. Understanding the nature of dietitian decision making may help better support dietitian retention, professional development, and the necessary professional training and education required to provide effective patient care.