Reclaiming the Healing Art: What Caring Theory Offers to Dietetics: Part 1

Although nutrition and dietetics were referenced in ancient medical texts by Homer, Plato, and Hippocrates around 2500 BC[1], the field of dietetics is a relatively young discipline within healthcare, officially established with the founding of the American Dietetic Association in 1917. The Nutrition Care Process has developed as a step-by-step framework that sets “global standards for the provision of nutrition care by dietetics practitioners.[2]” The focus of dietetics care has shifted from being primarily an activity performed by dietitians as hospital-based educators on healthy eating or medical nutrition to a patient-centered approach to nutrition counseling. Practitioners are encouraged to build a dynamic helping relationship with their patients to facilitate the assessment, diagnosis, intervention, monitoring, and evaluation of patients’ nutritional and lifestyle health needs.

 A significant gap still exists regarding how to consider a patient’s personal needs that a practitioner becomes aware of during the interaction while delivering evidence-based care. Similar to nursing in the early 1970s, before the development of Caring Theory by Jean Watson, RN, or Kristen Swanson’s work, dietetics remains mainly focused on the scientific evidence and technology of nutritional care rather than being whole-person-centered. Dietitians appear to be unaware of the need to develop skills within the Nutrition Care Process to assess and address emotional, relational, and spiritual needs that foster trust and genuine healing. What if expanding our understanding of care could strengthen both our patients’ outcomes and our own sense of meaning?

What has been missing is the core of caring—how to engage people with an open attitude toward their situation, learning to relinquish control over the interaction so that one’s knowledge, technical skills, and interpersonal abilities become part of a healing encounter where the patient ultimately experiences healing and motivation for self-care. Practitioners need to develop a caregiving identity that encompasses a personal caregiver style beyond being merely social, diagnostic, tolerant, or technologically competent.

Dr. Jean Watson’s Human Caring Theory describes a paradigm shift within nursing from a focus primarily on disease and technology to a more comprehensive, personal approach of caring. She explains that “Persons are unique beings who are in the midst of becoming and whose wholeness is made manifest in thoughts, feelings, and behaviors.”[3]  She illustrates that when a provider demonstrates concern for the patient, this is even more essential than providing clinical care. She encourages personalized education where providers of care become aware of their own emotions & needs that impact their interactions with patients. She encourages nurses to learn to act more selflessly in their care of others.

Dr. Kristen Swanson, RN, Ph.D., who studied under Dr. Jean Watson, describes five essential skills or processes that dietitians should consider when caring for others through the nutrition care process and building their caregiving identity: maintaining belief, knowing, being with, doing for, and enabling.[4] Maintaining belief in individuals encourages the provider to listen and help the patient identify what is most meaningful to them as they navigate a health condition or pursue deeper wellness. In being with, dietitians become able to know those they care for, showing that they matter to them so they can provide essential technical knowledge and support that ultimately enables them to care for themselves.

Consider the following example as an illustration of integrating Caring Theory into Dietetics:

Celeste, a motivated 50-year-old patient experiencing insulin resistance, obesity, and gallbladder issues, shares with her dietitian that she is grieving the death of her dog, which she had to put down this week. The dietitian listens to her experiences and feelings of guilt, sadness, and heartbreak over putting her dog to sleep, as well as her loneliness at home this week. She encourages her to set simple goals related to her eating and self-care. She also refers her to a short pamphlet on grieving the loss of a pet. She relinquishes control of the session to be with her patient, aiming to understand her struggle and identify goals and strategies that fit her life this week. Her client shares that she truly feels valued by the RD and confident she can follow through with their discussion. The RD leaves the session feeling empowered herself that she made a difference for this person.

In Part 2, we will continue to explore why incorporating Caring Theory into Dietetics matters for nutrition and dietetics professionals. Stay tuned for the next article.

[1] Hwalla N, Koleilat M, Dietetic Practice: The Past, Present, and Future, La Revue de Sante de la Méditerranée Orientale, 2004, 10, 6

[2] Lacey K, Pritchett E, Nutrition Care Process and Model: ADA Adopts road Map to Quality Care and Outcomes Mangement, J Am Diet Assoc, 2003, 103, 8, 1061-1072

[3] Swanson K, Nursing as Informed Caring for the Well-Being of Others, Journal of Nursing Scholarship, Winter 1993 25, 4, 352-357

[4] ibid