Aim of the Case Study

CASE STUDY GUIDANCE AND ASSESSMENT TOOL

During each of your B and C placements you will be required to complete a written case study.

Aim of the case study

The case study aims to develop your ability to obtain, assess, evaluate and present relevant information. Following the BDA Nutrition and Dietetic Process (2016), it should increase your understanding of medical terminology, disease states, prescribed treatments and the evidence base behind these. You should also focus on the patient’s response to their condition and treatment. Throughout your case study you should demonstrate an understanding of the importance of a patient’s medical, cultural, social and economic circumstances in relation to clinical conditions and any dietary treatment given. It should allow you to demonstrate your ability to show clinical reasoning as part of evidence based decision-making as part of patient centered care.

No grade or mark will be given to the case study. However, it may demonstrate your competency in relation to many of the placement learning outcomes and contribute to the evidence towards any of the following learning outcomes:

BPlacement: K1, C3, P1, P2, P3, P4, P5, P6, P7, P8, P9, P10, P11, P12, P13

C Placement: K1, C3, P1, P2, P3, P4, P5, P6, P7, P8, P9, P10,P12, P13, P14

Choosing your case study

You should begin looking for a case study early on in your placement (ideally deciding on a case between weeks 2-5 as guided by your placement supervisor).

The initial dietetic assessment may be carried out by a dietitian only or by a dietitian and yourself. If it was carried out by a dietitian only prior to the patient becoming your case study, ensure you understand the assessment undertaken and the decisions made so that you are able to justify them.Your supervising dietitian will be able to help you decide if a particular case is suitable. Your supervising dietitian will also be able to guide you about which reviews to include in your case study if the patient has been seen many times, this may particularly apply if the type of dietetic input has changed.

Consent

Consent is required from the patient and lead clinician. When the patient is not able to give consent, this needs to be obtained from the patient’s next of kin and the lead clinician.

Confidentiality

All information concerning the patient is confidential. The patient’s name, hospital number, date of birth, ward or clinic, name of the consultant and dietitian should not be stated in your case study. If your case study is discussed on return to university it is very important that this confidentiality is maintained.

Timing and length of case study

When you have decided on a case study you must arrange with your supervising dietitian an agreed time period to complete the case study. This will normally be 3-6 weeks during which the information will be collected and will usually include an initial dietetic assessment (which may have been undertaken by a dietitian already) and 1 or 2 reviews after the case has been identified. At some stage during your placement you will be required to present your case study to the dietetic department. You will be allocated 15 minutes for the presentation and 5 minutes for questions.

The written work and your presentation should include relevant information assembled in an informative and understandable way.

Presentation of written work

Typed, font size (Arial 11), single spaced
Correct use of English, terminology and abbreviations
Bullet points are appropriate to use however, the discussion and reflection should be written in prose. These 2 sections have a maximum word count.
Boxes should be expanded as required.

References

All references should be listed in the Harvard style and should be presented on an additional page.

CASE STUDY PROFORMA

Case Study Summary: Provide one or two sentences to provide a very brief overview of the casee.g.A 57 year old man was referred to the dietetic service for oral nutritional support because he had a poor appetite. He subsequently had a stroke and was nil by mouth and required NGT feeding.
Identification of need for dietetic input
The stated reason for dietetic referral:
Gender, ethnicity and age of the person referred:
Date(s) dietetic referral was made and received:
Date of hospital admission (if applicable):
What was the method(s) used which identified the nutritional need (e.g. nutritional screening/ reported symptoms):
Date and location when first seen by a Dietitian, for this episode of care (e.g. inpatient/ outpatient setting):
Date and location when first seen by you if different (e.g. inpatient/ outpatient setting):

Initial Dietetic Assessment

Was the initial dietetic assessment carried out by a dietitian only / by a dietitian and yourself (delete as appropriate)

This follows the BDA Model and Process for Dietetic Practice (2016).

Anthropometry: Include weight (state whether estimated or actual,if actual state date recorded) and height (state whether estimated or actual, if actual state date recorded), BMI (including interpretation), weight history, percentage weight loss / weight gain (including interpretation), include MUST score (if appropriate). State if data is unavailable.
Biochemistry: include relevant biochemistry (expand or reduce table as required), indicate whether or not they are within range.
Date
Biochemistry / Reference range
Provide aninterpretation of the results:
Clinical Details:
Past Medical History (including duration and effect on quality of life) :
Presenting complaint: (include reason for admission to hospital for inpatients) :
Medical diagnosis and relevant medical and/or surgical treatment. Please consider how they may influence or be influenced by nutritional status/ intervention:
Relevant drug treatment (expand or reduce table as required):
Drug / Date commenced / Reason for prescription / Relevance to nutrition?
Any other clinical observations (e.g. bowels, skin integrity, fluid balance):
Has there been any relevant previous dietetic treatment prior to this episode of care? If so briefly state what
Dietary assessment: State the rationale for the method of assessment (e.g. dietary recall, or food record chart or food diary).
Record the person’s dietary and fluid intake in the table below. Decide the two most relevant components to quantify (e.g. energy and protein). Quantify these and state how these values were obtained.
State type of diet:
If NBM, state why:
If receiving a tube feed or oral nutritional supplements, include the nutritional composition
Dietary assessment / Energy (kcal) or other / Protein or Fat or CHO (g) or other / Fluid (ml)
Breakfast
Mid-morning
Lunch
Mid afternoon
Evening
Bedtime
If being tube fed, state feeding regimen

Total

Previous nutritional intake and eating pattern (e.g. pre-hospital admission or pre-diagnosis if relevant. State if you have been unable to obtain this information with reasoning):
Estimation of nutritional requirements:Calculate the person’s requirements for all relevant nutrients, showing your methodology and explaining your rationale.
Family and other social history: Record appropriate information e.g. marital, cultural, financial, personal, occupation, shopping and cooking facilities. Consider psychological aspects of this diagnosis and/or dietary advice as relevant.
Identification of the Nutrition and Dietetic Diagnosis
This should take the form of the nutritional problem (excess or deficit for example), in relation to the disease process (biochemistry or physical health may be useful) and then its link to the signs you have identified in your assessment. The relationship between the medical and dietetic treatment needs to be acknowledged. Consider diagnosis, aetiology, signs and symptoms.
Plan of Nutrition and Dietetic Intervention
List the aim and SMART objectives and include a brief rationale.
Implementation of Nutrition and Dietetic Intervention
State the plan of dietetic treatment and the rationale. Explain how the plan was discussed with the person (if applicable) and communicated with others involved (e.g. family, carers, nursing staff, medical team).
Monitoring Plan
What were the monitoring plans? Include a timeframe and the relevant parameters with rationale.

Review – Please note: If your case includes more than one review, copy, paste and complete the sections from ‘Anthropometry’ through to ‘Monitoring Plan’

Date of review:

Anthropometry: Include an updated weight (state whether estimated or actual, if actual state date recorded) & height (state whether estimated or actual, if actual state date recorded), BMI (including interpretation), percentage weight loss / weight gain (including interpretation), include updated MUST score (if appropriate). State if data is unavailable.
Biochemistry: include relevant biochemistry (expand or reduce table as required), indicate whether or not they are within range.
Date
Biochemistry / Reference range
Provide aninterpretation of the results:
Clinical: Comment on any relevant changes in medical diagnosis, medical and/or surgical treatment. Please consider how they may influence or be influenced by nutritional status/ intervention
Update the drug treatment: (expand or reduce table as required):
Drug / Date commenced / Reason for prescription / Relevance to nutrition?
Any other clinical observations (e.g. bowels, skin integrity, fluid balance):
Dietary assessment: State the rationale for the method of assessment (e.g. dietary recall, or food record chart or food diary).
Record the person’s dietary and fluid intake in the table below. Decide the two most relevant components to quantify (e.g. energy and protein). Quantify these and state how these values were obtained.
State type of diet:
If NBM, state why:
If receiving a tube feed or oral nutritional supplements, include the nutritional composition
Dietary assessment / Energy (kcal) or other / Protein or Fat or CHO (g) or other / Fluid (ml)
Breakfast
Mid morning
Lunch
Mid afternoon
Evening
Bedtime
If being tube fed, state feeding regimen

Total

Estimation of nutritional requirements: If appropriate re-calculate the person’s requirements for all relevant nutrients, showing your methodology and explaining your rationale.
Family and other social history: Update if required
Plan of Nutrition and Dietetic Intervention Review the aim and SMART objectives and include a brief rationale.
Implementation of Nutrition and Dietetic Intervention
State the plan of dietetic treatment and the rationale. Explain how the plan was discussed with the person (if applicable) and communicated with others involved (e.g. family, carers, nursing staff, medical team).
Monitoring PlanWhat were the monitoring plans? Include a timeframe and the relevant parameters with rationale.
DiscussionInclude a discussion of the aims and objectives, rationale and were they met and how?Alsocritically analyse your case study; justify dietetic intervention, discuss limitations by referring to current relevant literature regarding treatment of the patient. This should be written in prose no longer than 1000 words, excluding references.
Reflection and learning pointDescribe what went well, not so well and what would be done differently next time to improve nutritional treatment of the patientand state your main learning point from the case. This should be written in prose no longer than 250 words.

CASE STUDY ASSESSMENT FORM

Student’s Name:- …………………………………………………………………………...

Placement: B / C (Pleasedelete as appropriate)

Comments
CASE STUDYSUMMARY
IDENTIFICATION OF NEED FOR DIETETIC INPUT
INITIAL DIETETIC ASSESSMENT (K1, C3, P1, P2)
-Anthropometry
-Biochemistry
-Clinical details including past medical history, presenting complaint, diagnosis, medical and /or surgical treatments, drugs, other clinical observations
-Dietary assessment, intake and history
-Estimate of requirements
-Family and other social history
Identification of Nutrition and Dietetic Diagnosis (C3, P3)
Plan of Nutrition and Dietetic Intervention
- Aims and objectives of dietetic treatment
Implementation of Nutrition and Dietetic intervention (K1, C3, P3, P5, P6, P7, P8)
-Dietetic treatment plan and rationale
Monitoring Plan (K1, C3, P3, P4, P5, P6, P7, P8, P9)
REVIEW(S) (K1, P4)
-Anthropometry
-Biochemistry
-Clinical details including any changes in medical diagnosis and medical and /or surgical treatments, drugs and other clinical observations
-Dietary assessment - intake
-Estimate of requirements – recalculate if appropriate
-Family and other social information update
Plan of Nutrition and Dietetic Intervention
- Review aims and objectives of dietetic treatment if appropriate
Implementation of Nutrition and Dietetic intervention (K1, C3, P4, P5, P6, P7, P8, P9)
-Dietetic treatment plan and rationale
Monitoring Plan (K1, C3, P4, P5, P6, P7, P8, P9)
DISCUSSION (K1, C3, P10,
B:P11, P12, P13or C:P12, P13, P14)
There should be an evidenced-based discussion of the aims and objectives, including a rationale and, where they met and how
There should be a critical analysis of the case, interventions should be justified and limitations should be discussed with reference to current literature
(1000 words maximum)
REFLECTION AND LEARNING POINT
(P10)
What went well, not so well, what could be improved next time and main learning point
(250 words maximum)
REFERENCES
PRESENTATION OF WRITTEN WORK
ADDITIONAL COMMENTS:

This piece of work can / cannot be used as evidence of competency. (Please delete as appropriate)

If it can be used as evidence please circle the learning outcomes that have been achieved:

B Placement: K1, C3, P1, P2, P3, P4, P5, P6, P7, P8, P9, P10, P11, P12, P13

C Placement: K1, C3, P1, P2, P3, P4, P5, P6, P7, P8, P9, P10, P12, P13, P14

Assessing Dietitians: / Signed: / Date: