How dietitians turn experience into knowledge about practice in community-based prenatal nutrition

As a practicing dietitian, I am reminded by the dietetics and education literatures of just how important it is for nic, and for the profession, to develop skills to continue to learn and improve practice.Although retlection is an integral step of professional development strategies in dietetics, little is known about it in our context.The study's purpose is to assist dietitians in their quest for continuous learning and improved practice by documenting experiences of dietitians and exploring the reflection process embedded in this data.Research questions guiding this exploration focused on 1) the process through which dietitians reflect on their practice, 2) the outcomes of dietitians' reflection on practice and, 3) conditions influencing dietitians' reflection.Reflection is defined as a process of turning experience into knowledge about practice and improving it.The s t ~t d y was designed based on grounded theory to allow for detailed exploration of dietitians' reflection and theory generation.Data collection consisted of a) a pilot study to determine effectiveness of instruments and procedures, b) formal interviews to document participant oxpericmcc:s and thinking during and following it, and, c) follow u p interviews to verify interprctation of data and to pursue themes arising from analysis.Interview questions invited participants to recall and relate a time when they experienced something uncertain, puzzling, surprising or satisfying, an experience in which learning about prenatal nuh-ition occurred or one that had an impact on their thinking or approach.Participants were six dietitians practicing in prenatal projects sponsored by comniunity organizations or in prenatal initiatives of governmental department., both of which targeted pregnant wonien facing challenging social, economic o r cultural situations.Data analysis centered on identification of concepts and constant comparisons within and between participants.Study findings suggest participants' reflection was more often than not a slow, steady process of knowledge construction bascd on routine, day-to-day cxpcriences.These results imply that, as practicing dietitians, we need to be more intentional about learning from our experiences by putting in place formal and informal strategies that will favour reflection.Implications of results for dietetics education include the pursuit of specialized and advanced degrees in nutrition.R e s u m 6 Lcs literatures en di6tbtique et en 6ducation nous rapellcnt, qu'en tant quc dietetiste, nous nous devons d e d6veloppcr irs 1iabilett.spour continuer a apprendre ct pour ameliorer notre pratique.Bien que la reflexion soit une 6tape integrale des strategies de d6veloppement profcssionnel en dietktique, nous en savvns peu sur ce processus dans notre domaine.Le but de cette 6tude est d e faciliter I'apprentissap?continu des dietetistes et le d6vcloppement d e lcur conipktence.Dans ce but, des experiences d e dietetistcs sont recueillies et le processus d e reflexion contenu dans ces donn6es est examin6.Les questions guidant cette exploration portent sur 1) le processus utilise par des dietetistes pour reflechir A lcur pratique, 2) le r6sultat des reflexions sur leur pratique et, 3) les conditions lavorisant I w r reflexion.La reflexion se dklinit commc: un processus d e transformation d'experiences en connaissances sur la pratique et d'amdioration.L'etude a 6tk conc;u selon la theorie ancrce puisque cette approche permet un examen d6taill6 des reflexions d e dict6tistes et le d6veloppcment d'une theone.La collecte de donn6es comprenaient a) une etude pilote pour determiner I'cllicacit6 des instruments ainsi clue des procedures, b) des entrevues permettant de recueillir des experiences do participantes et l(?urs pensees pendant, et apres une experience, et, c) des suivis pour verifier I'interpretation des donnees et explorer dcs themes ayant surgit lors de I'analyse.L'entrevue invitait les participantes a se rememorer et 2 detailler une situation inccrtaine, enigmatique, surprenante ou satisfaisante, une exp6rience ayant influence le developpment d e leur savoir, leur conception ou leur approche en nutrition prenatale.Six diktetistes, pratiquant en nutrition prenatale dans le cadre d e projets d'organismes communautaires ou de programmes gouvernernentaux ciblant des fcmmes affrontant des situations sociales, culturelles ou economiques difficilcs, ont participees 5 1'6tude.L'analyse d c donnees comprenait I'identification d e concepts et unc coniparaison continuelle par participantes et entre participantes.Les r6sultats de I'6tudr.suggPrent que la reflexion des participantes 6tait souvent un processus lent et r6gulicr de I'6volution du savoir b a d sur des expbriences joumali&res et routiniPres.Ccs rtsultats sugghent que, comme diet6tistes, nous dcvons adopter ilne approche plus intentionnelle en mettant en place des strat6gies d'apprentissage formelles et informelles qui favoriseront notre rtflexion.Pour nos universitks, une des cons6quences de ces r6sultats est I'exploration et la creation de dipl6rnes professionnels sp6cialis6s et sup6ricurs en nutrition.A c k n o w l e d g e m e n t s Many people deserve my gratefulness for their support throughout the long process that resulted in this thesis.A special thank you to my advisor, Cynthia Weston, for her unwavering support and wise guidance.Cynthia is my role model for her caring, advising and teaching.My thanks to my doctoral committee for so generously sharing their time, expertise and advice.In particular, my gratitude to Franco Camevale for guiding me through the grounded theory approach and for answering my clcctronic messages so early in the morning; to Irene Strychar for imparting her vast knowledge of dietetics

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