Why Cox College?

Nutritional diagnosing (Kight) is evidence-based ruling out and ruling in of nutritional health-related problems that RDs are uniquely qualified to identify and process.

Nutritional Diagnosing

• allows the study of nutritional problems and their causes
• allows us to diagnose nutritional health problems, utilizing nutrition/dietetic-specific human condition codes (a scientifically standardized language and classification system) that give direction for classifying treatments provided – i.e. describe nutritional diagnosis(es) and etiology(ies)
• provides a framework for use of a Nutrition-focused Physical Exam (NPE) to identify physical signs and symptoms of nutrient deficiencies (or excesses)

The Nutrition Diagnostic concentration is designed to meet the following competencies:

• Consider the interrelationships of nutrition with biochemical, physiological and anatomical changes associated with acute, chronic, and terminal illness to determine nutrition diagnoses & etiologies, macro/micronutrient needs and formulate appropriate medical nutrition therapy plans utilizing Kight’s Nutrition Care Process (NCP), the 5 axes of evidence & Nutriokinetic/Nutriodynamic modeling.
• Utilize assessment techniques (including Nutrition-focused Physical Exam (NPE), body composition/ changes, Activities of Daily Living (ADL) as appropriate) to evaluate physiologic, pathophysiologic, and functional status to determine the nutritional status of patients across a myriad of settings.
  Perform Nutrition-focused Physical Exam (NPE) to assess nutritional status and identify:
  • protein-calorie malnutrition
  • micronutrient based lesions

Dr. Mary Ann Kight, Ph.D., is the visionary behind the Nine-Step Nutritional Care Process utilized at Cox College and within CoxHealth systems. We believe the best description of her legacy comes from her obituary:

Memoriam

Dr. Mary Ann Kight Ph.D., Biochemist and Biomedical Nutritionist, Creator and Leader of the Diagnostic Nutrition Movement

Visionary Theorist Scholar. Linguist. Consummate Scientist. Internationally Recognized Creator of The Quality Improvement Cube Guided Nine-Step Nutritional Care Process. Dedicated Educator of Clinical Nutritionists Throughout the United States and Canada for the past 35 years. A supporter of Young Clinical Nutrition Investigators. Unwavering Mentor to Those With Passion for Improving the Human Condition. All descriptors of an uncommon woman who in so many ways broke through the ceiling. Her work has always and continues to remain years beyond that of conventional thought.

Dr. Kight was awarded her doctorate in Biochemistry and Nutrition from The University Of Arizona in 1967 due in part to her research study “Serum Fatty Acid Patterns Of Clinically Healthy Women Living in the Southeast Section Of Arizona” in which she demonstrated the effects of a warmer climate on serum lipids. Prior to completion of her doctorate, University of Arizona President Dr. Richard Harvill and major professor Dr. Ethel Thompson became keenly aware of her unique intellectual potential for scientific discovery and strongly supported her in the completion of a lipid lab sabbatical at the University of California, Berkley. After completion, Dr. Kight returned to The University of Arizona where she designed and built her department’s lipid laboratories. Within five years of receiving her Ph.D., she attained the level of full professor with continued research, administrative (chairperson of both undergraduate and graduate dietetic programs), and undergraduate/graduate teaching responsibilities including the creation of the Master of Science degree in dietetics. She pioneered the Nutrition Physical Examination which was taught both undergraduate and graduate clinical nutrition students. Dr. Kight served as the appointed University of Arizona Representative to USDA Western Regional Project W-116 for five years and was elected the project’s founding chairperson. This large Nutritional Status Assessment Project served as a primary stepping stone toward establishing her research program in the area of nutritional health science; in the area of effectiveness/clinical outcomes research. Her interpretation of data from the Western Regional project W-116 helped to transition the concept of Nutritional Status Assessment from a dietological to a nutrituristic context. Having also served as an invited expert witness in the court (1977-1979) on matters associated with Nutritional Status Assessment, her work became endowed with Maude E. Fairchild funds which served as a complementary stepping stone toward a) translating all other nutritional status assessment principles and methodologies into clinical nutrition, and b) transforming all of her translations into units, classes, and systems relevant to fostering “effectiveness research” and “new health science” – namely nutrition-specific clinical epidemiology. Her work added preventive, diagnostic, and intervention value to the rapidly changing healthcare environment.

With the Fairchild funds and Agricultural Administration’s recognition and approval in 1980, Dr. Kight began stretching the boundaries of “tradition-prescribed” research toward the health sciences and “effectiveness/clinical outcomes” research. After donating her traditional chemistry laboratories and experiment station funds to other faculty, Dr. Kight initiated the use of “clinical settings” as her research laboratories, a transition she stated she felt privileged to have made. This included the development of The University of Arizona Clinical Nutrition Client Care Laboratories, the first clinical nutrition clinic located in The University Of Arizona Campus Health Center, and off-campus clinical sites at El Dorado Medical Center, Tucson. In addition to the clinical settings, Dr. Kight created and became the original director of The University of Arizona Dietetic Internship. Peer recognition of her first translations and transformations began to appear in 1984. After an initial conference with Dr. Kight’s expert clinician group, three International Conferences were held (Winnipeg, Canada; Nashville, Tennessee; Scottsdale, Arizona) specifically on her assessment-diagnostic-etiologic-goal setting-intervention-effectiveness/outcomes classification work. This was the beginning of the development of the first Nutrition-Specific Diagnostic Set which nutrition clinicians and researchers use in the diagnosis of nutritional problems, in defining research theories/studies and documenting the unique practice of the clinical nutritionist. From then on, thousands of dietetic clinicians and educators attended her many national presentations. Several major health-medical care facilities participated in the testing and validation of her principles, methodologies, translations, and transformations. U.S. Army and Air Force Administrators of Nutrition Services also tested the use of her classification of 102 nutritional problems as a human condition coding system for reimbursement. Her faculty-based Diagnostic Nutrition Work Group (N-43) fostered publication of a new peer-reviewed periodical Diagnostic Nutrition Network/DNN which was based upon Dr. Kight’s s work.

Collaborative research projects with Ms. Mary Pat Kelly at UCSF were funded by the National Kidney Foundation (NKF). One particular project (Prognostic Nutrition Index/PNI in Hemodialysis Patients) was reviewed and approved as the 1995-1996 Council on Renal Nutrition National Research Question. This Multi-centered National Study validated Kelly and Kight’s original findings. The PNI project as a stepping stone toward secondary studies and NKF funding for nutritional replacement therapy and effectiveness/outcomes research projects. Further research defined the concept of Nutritional Injury in the landmark study “The nutritional cost of hospitalization and time needed to achieve nutritional resiliency for hemodialysis patients” (1994).

From 1999-2001, Dr. Kight served as Co-Creator and Principal Instructor of Diagnostic Nutrition Continuing Education Courses at the University of Nebraska, Lincoln. Between 2001-2005, Dr. Right co-created and also served as Co-Principal Instructor of the Carl T. Hayden V A Medical Center Diagnostic Nutrition Residency, Phoenix, Arizona. Her methods were taught at both facilities.

In all, Dr. Kight was an invited lecturer at over 200 states, regional, national, or international programs on various aspects of advanced nutrition practice. She sustained a thirty-five-year career of advancing diagnostic nutrition knowledge and linguistics among some 100 Master of Science degree dietetic students, 6 Ph.D. level students, 3 postdoctoral scholars, and over 16 residents. She was a woman of great intellect, amazing strength, character, dedication, perseverance, and determination. The world of advanced nutrition has certainly lost its original champion.

The article “Is nutrition diagnosing a critical step in the Nutrition Care Process?” (Journal of the American Dietetic Association, 2002) compares Kight’s Nine-Step Nutritional Care Process to Splett & Myer’s Five-Step Nutrition Care Process and contains an interview with Dr. Kight.

A unique and significant component of nutrition diagnosing is the addition of the Nutrition-focused Physical Exam (NPE). Acquiring the skill set necessary to perform this exam takes learning the proper exam technique, the practice of the technique along with knowledge of anatomy, pathology, pharmacology, and nutritional biochemistry. Experience gained in practice leads to the development of critical reasoning skills and a growing ability to identify nutrient-based lesions and make reliable nutrition diagnoses. The Nutrition Diagnostics programs utilize the college simulation lab to learn and practice the exam. Below are examples of our students practicing the NPE.

Cox College students receive a wide range of supervised practice experiences throughout the Southwest Missouri area. We believe in fostering relationships with our preceptors and personnel at supervised practice facilities that promote open feedback as a way to continuously improve the rotation experiences. Many of our preceptors are former Cox College students giving them a unique understanding of our program. Examples of rotation experiences are described below.

Clinical Experiences

Cox College’s relationship with CoxHealth Systems creates a unique opportunity for collaboration with clinical preceptors, which is foundational in our program. Inpatient clinical experiences may be completed at Cox South Hospital, Meyer Orthopedic and Rehabilitation Hospital, or Cox Branson in Branson, MO. The outpatient clinical rotations may include experiences at outpatient clinics within the CoxHealth system as well as Veteran’s Affairs clinics in Branson and Springfield, a dialysis clinic, or long-term care & rehab facilities.

Community Experiences

Community supervised practice rotations include a wide variety of facilities throughout the southwest Missouri area. Rotations may include experiences in retail nutrition, WIC nutrition, local community health centers, wellness counseling, private practice nutrition counseling, behavioral health, public school nutrition, community gardens, or senior nutrition programs.

In addition to regular community rotations, additional community experiences will be provided which may include cooking school food demos; KGBX Women’s Show food demo; National Nutrition Month recipe preparation and booth collaboration, and CoxHealth Nutrition blog postings.

Clinical Management Experiences

CoxHealth, Mercy Springfield, and Mercy Joplin provide the foodservice and clinical management supervised practice experiences.