Getting Comfortable with Being Physical: Tips for Utilizing the Nutrition Focused Physical Exam

I have gotten to see first hand some of the growth in the field of dietetics. I graduated from my undergrad dietetic program in 2014. While I feel that my education still prepared me well for the internship, there have been changes in the responsibilities of dietitians since 2014.

The Nutrition Focused Physical Exam (NFPE) is a standardized practice that is being encouraged and promoted in dietetics. This was a new skill for me to learn during my clinical rotation and in our didactic class.

The Academy’s NFPE Pocket Guide is a great resource with visuals. Most likely, your clinical rotation site will have a copy of this or something similar .

This doesn’t mean that the NFPE is a new creation. Based on some brief research, I saw mention of the NFPE in dietetic practice from 2009 . I also learned that the Academy of Nutrition and Dietetics (the Academy) and the American Society for Parenteral and Enteral Nutrition (ASPEN) published a statement in 2012 that defined the diagnostic criteria for malnutrition. The NFPE is an especially valuable tool for assessing two of these criteria: muscle and fat loss.

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Also, in the hospital setting, malnutrition is now a reimbursable diagnosis through Medicare and Medicaid. This move to reimbursement further validates the importance of diagnosing and treating malnutrition. It also means that hospitals are encouraging the practice of the NFPE.

This I saw firsthand during my clinical rotation. My preceptor encouraged me to use the NFPE whenever it was appropriate. She told me how the hospital was encouraging NFPE training and competency for dietitians. We also recently had a didactic class hosted by Abbot Nutrition about the NFPE. I felt that now would be a relevant time to talk about a hands-on skill that dietitians use in practice.

Now, I am not going to write about the detailed steps of a NFPE. Instead, I want to focus on how to feel comfortable practicing the NFPE. I hope that these tips will make you feel a little less nervous about the process!

Tip 1: Be an investigator

This is a helpful mindset throughout clinical dietetics. Remember that you are an information gather. The NFPE is just another form of information you can obtain and use to assess your patients. At first, I thought that it was unnecessary for dietitians to physically touch patients. However, as I practiced the NFPE more, I learned that it is a very effective way of learning more about a patient’s nutrition status.

Tip 2: Look for opportunities

I really appreciated that my clinical preceptor encouraged NFPEs from the very beginning. She asked me to perform one in my second week! While I was nervous at first, practicing this skill in the beginning made it less intimidating. I pushed myself to look for opportunities to perform NFPEs. The more exposure and practice you have with it, the more comfortable you will feel. It also helps when you can practice on a variety of patients and see different degrees of nutrition status.

Tip 3: Find and Respect Comfort Levels

(That means yours and the patient’s)

While I looked for NFPE opportunities, I never attempted one when it was inappropriate. This is standard patient care but NEVER perform any physical exam on a patient who is sleeping or otherwise altered. In other situations, you may be able to tell right away that a patient would be uncomfortable with a physical exam.

You should ALWAYS ask permission and explain the NFPE procedure before performing one. It is important that a patient feels comfortable and empowered during the entire process. In our didactic class, one of the dietitians recommended shaking the patient’s hand to initiate physical contact in a comfortable way.

In addition, be aware of your own comfort levels with touch. There are a range of body parts that can be assessed during a NFPE. It is completely all right if you are not comfortable performing some of the assessments! I first focused on areas that were relatively easy to access such as the temple or under the eyes. As I got more practice, I became more comfortable with the process and incorporated more areas of assessment.

Practicing the NFPE on my fellow intern, Kacee. In this picture, I am looking for any wasting of the temporalis muscle.

I hope this makes the NFPE a little less intimidating! Remember to be inquisitive, look for opportunities to practice NFPE and respect comfort levels of yourself and the patient. Keeping these tips in mind helped me become more confident and comfortable performing this skill and I hope it will do the same for you!