Toward development of a theory of the structures underlying the roles of two specialization categories of dietitians: the hospital administrative dietitian and the hospital clinical dietitian

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1977

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Abstract

The purpose of this study was to investigate the structures underlying the roles of two categories of dietitians—the hospital administrative dietitian and the hospital clinical dietitian. The rationale for the study rests on the proposition that the identification and description of the structures underlying the roles of dietitians, as perceived by practitioners of the dietetic profession, are essential precursors to the development of competencies. These explanatory structures form the basis within the profession for development of a theory of the specialties. The survey instrument encompassed an array of both administrative and clinical dietitian responsibilities, so as to permit the respondents to specify their perceived specialist role from a full range of dietitian duties. The degree of proficiency perceived to be required at two levels of experience —entry level and three-year experience level— also was an integral part of this instrument. The survey was mailed to a random sample of 1600 administrative dietitian specialists and to a random sample of 1600 clinical dietitian specialists. The response rates were approximately 33% and 31% respectively. The focus of data analysis was on dimensions delineated through factor analysis. The individual performance statements of the survey instrument were treated only in terms of their interrelatedness in constituting the factors. The scree test was applied in an attempt to determine the optimal number of factors to extract. Five distinct and unique dimensions were identified for each of the two specialties at entry level. Seven distinct and unique dimensions were delineated for each of these specialties at the three-year experience level. The strategy for analysis of data was based on a unique application of factor analytic procedure in which data from one group were mapped on to the perspective of another group, and vice versa. This method characterizes succinctly perspectives of two competing, yet equally valued groups. Initially, two-group discriminant analysis was employed to attempt the test of significant differences between the following: (a) the perspective of the administrative dietitian respondents and the perceptions of the clinical dietitian respondents mapped on to the administrative dietitian respondents' perspective; and conversely, (b) the perspective of the clinical dietitian respondents and the perceptions of the administrative dietitian respondents mapped on to the clinical dietitian respondents' perspective. Results indicated that the assumption of homogeneity of variance-covariance matrices did not exist in the groups tested, and thus it was not possible for the significance of differences in perceptions of the two groups to be computed through discriminant analysis. As an alternative, significant differences in perceptions of the two groups were identified through application of the t test to the correlation coefficients constituting the matrices of within-group intercorrelations of estimated factor scores in that aspect of the data analysis design where perceptions of one group were mapped on to the perspective of the opposite group. The specific conclusions of this study were as follows: 1. The tenets of the dietetic profession relative to specialization, as reflected in publications of The American Dietetic Association and in writings of leaders in the profession, are not in harmony with the perspectives of practitioners, or vice versa. 2. When the survey instrument is not delimited to a specific specialty orientation, both groups of dietitians in administrative and clinical specialty roles respectively define the roles of these specialties as generalists. 3. Within this generalist context, there are both similarities and differences in the perspectives of the two groups which are statistically significant. 4. The clinical dietitian practitioner perceived no future in that specialty role at the three-year experience level. The report closes with implications of the research and recommended next steps for theory building in the profession.

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