Follow-up Session Standards of Care

Below are expectations for Nourish RDs for follow-up sessions. Care should follow the ADIME standard — Assessment, Diagnosis, Intervention, and Monitoring / Evaluation.

These expectations are meant to be guidelines rather than a comprehensive script or checklist — dietitians should develop their own style, maintain flexibility, and tailor their approach to the patient and what agenda feels right in each session.

Welcome them back and continue to build rapport with the patient. This is very important — be sure to invest in the relationship!

• 💡 Tips

  • Don’t rush into the session! Take the time needed to feel like you are starting the session at a natural point.

Give an agenda for the session and set expectations. Use your judgment — this will depend on how many sessions you’ve had with the patient and your rapport.

• 🔊 Examples

  • “As a reminder, in follow-up sessions like today, we will work together to fine-tune and implement the plan of care we had discussed. We will monitor your progress toward your goals and set new goals, and I will continue providing recommendations and resources to help support you as I get to know you better. Is there anything on the top of your mind that you wanted to make sure we cover today?”

Review last session’s action items and discuss progress since last session, including successes and obstacles. Review any new documents, labs, or data from the Nourish app / third party apps, as relevant.

• 💡 Tips

  • Discuss their past week and any short-term goals that you had set together, focusing on what went well, what didn’t go well, and if there were any questions that came up over the course of the week(s). Be sure to create a safe space where patients can feel comfortable sharing any concerns or failures they may have had.

  • Celebrate the small wins, ensuring the patient feels accomplished when they were able to hit a tangible goal.

  • Discussion of the past week and their goals should take up a considerable portion of the session, so make sure you are using this time to educate them on the roadblocks and discuss any potential improvement areas.

  • Use Patient Notes to remember any plans they may have between sessions, and use those plans as a forum for discussing nutrition progress where possible.

• 🔊 Examples

  • “How are you feeling about your progress so far? Are there any areas that you’d like to focus on today?"

  • “Last week, we set the action item to have breakfast 2 times. We had discussed having oatmeal and yogurt at home and also trying to stop at Starbucks to pick up a turkey breakfast sandwich. How did it go?”

  • “I remember you said it was your nephew’s birthday party this weekend and that you’d be with your family celebrating. How was it? Were you able to work on any of the goals we set in practice there?”

Gather information to fine-tune your nutrition assessment as needed. Have the patient speak through any updates / diet recall and gather any new health metric and outcomes data as laid out in the chart note template.

• 💡 Tips

  • Be sure to maintain a conversational tone to build rapport with the patient — no one likes to feel like they’re being asked a list of questions. Focus on the patient rather than solely relying on chart notes. Make sure to understand the patient’s unique situation.

  • Use motivational interviewing to encourage active participation from the patient, and tailor it to what’s most important to them. Don’t stop at what the patient first says — stay curious and ask for specifics!

• 🔊 Examples

  • “We didn’t talk about grocery shopping in our first session; tell me more. Do you go grocery shopping typically? When do you go? Do you make a list?”

Based on their progress, your care plan, and the information you’ve gathered, guide the intervention and provide nutrition education that is pertinent to the patient. Address the nutrition diagnosis root cause (etiology) and work to reduce signs/symptoms.

• 💡 Tips

  • Before making intervention recommendations, ensure they are realistic and achievable. Consider the following:

    • Would you be able to implement the recommendations in your own life?

    • How will these recommendations fit into the patient's life? Can you educate them on how to adhere to the intervention without causing a major disruption to their routine?

  • Invite the patient into the education. Avoid “Lets talk about XYZ today” — instead, try “You mentioned one of your goals was lowering your cholesterol. A great place to start with this would be discussing saturated and unsaturated fats, how does that sound to you?”

  • When providing education, try to use the patient's language and vocabulary. Using words that the patient is unfamiliar with can confuse them and hinder the efficacy of your intervention.

    • Additionally, be sure to assess education first before providing education. This way, you can avoid making assumptions about the patient’s nutrition knowledge and be sure to share new information with them. This can be as simple as asking “Are you familiar with foods are high in carbohydrates?” or “What have you heard about blood sugar management?”

  • Constantly check in with them on their reaction to the recommendation. Work together to come up with an approach they feel works for them.

  • An effective question to ask patients:

    • What is a positive thing you could do in one area of your health (movement, food, sleep, stress reduction, self-care & mental health) that you could realistically maintain for the rest of your life?

Communicate any updates to the personalized plan of care and goals. Set new action items and goals for the patient to work on until the next session — make sure they don’t leave the session without next steps.

• 💡 Tips

  • If a patient doesn’t meet a goal, remind them that it’s okay and that is often when they most need to meet with the dietitian so that they can discuss barriers and work through them.

Set expectation for what will occur the until next appointment (including action items) and in the upcoming appointment. Let them know that they can expect a follow up email summarizing key points of the appointment, including any action items, recommendations, and resources.

Make sure next session is scheduled and on the calendar and works for the patient. It is always better to schedule recurring sessions for the entirety of the 12 week program. Summarize progress so far during the program and motivate the patient. If relevant, discuss reduction in frequency of sessions or graduation from care.