- Email: [email protected]
A nutrition counseling workshop: Integrating counseling psychology into nutrition practice
MEMO M H
D
M·M R·
Anutrition counseling workshop: Integrating counseling psychology into nutrition practice Sr M. CARROLL ISSELMANN, EdD, RD; LINDA S. DEUBNER, MA, RD; MARYANNE HARTMAN, MA, RD
ietetics practitioners often find them-
selves in the role of counselor. Often, however, they lack knowledge oftheories of counseling psychology as well as the ability to translate theory into practice. Historically, counseling skills have not been an academic or professional experience requirement for dietitians. In the past two decades, authors have described the need for nutrition counseling skills in the dietetics practitioner (1-4). Severalhow-to books about nutrition counseling were published during the early 1980s (5-8). In spite of the acknowledged need, many dietetics professionals completed their academic programs and professional experience without developing specific skills in nutrition counseling. Danish et al (9) highlight the need to educate practitioners who are not trained in nutrition counseling; they believe that the mechanism for developing competency is continuing education. Dietitians have identified a need for additional training to improve their interviewing and counseling skills (10). Because nutrition counseling has come to be regarded as an entry-level competency, and because many students and practitioners lack that skill, we developed a continuing education workshop in nutrition counseling. WORKSHOP DESIGN, OBJECTIVES, AND CONTENT Integration of the disciplines of nutrition and counseling psychology was the primary objective of the workshop design. L. S. Deubner (correspondingauthor) is in private practice at 5249 CambrianRd, Toledo, OH43623. Sr M. C. Isselmann is chairpersonof Nutrition Education, Graduate Division, Immaculata College, Immaculata, PA 19345-0732. M. Hartman is a nutrition consultant at 1514 Vista Club Cir, Santa Clara, CA 95054. L. S. Deubner and M. Hartmanformerly were graduate students at Immaculata College. 324 / MARCH 1993 VOLUME 93 NUMBER 3
Achieving integration was also planned through the selection of teaching methods. The anticipated outcome was the development of nutrition counseling skills. Other authors have surveyed the counseling strategies used by the registered dietitian (11), provided a model for developing discrete counseling skills (12), provided a schematic model for the counseling session (13), and studied the effect of the counseling environment (14). Our graduate-level workshop was comprehensive. It included all four areas addressed previously in the literature. The workshop's educational methods and objectives reflected the desire to integrate the cognitive and affective domains oflearning. The objectives were (a) to develop an awareness of one's personal counseling style, attitudes, and values related to counseling; (b) to develop an introductory knowledge of counseling theories and techniques; (c) to apply knowledge of counseling theories and techniques to the practice of nutrition counseling; and (d) to identify the impact of the nutrition counseling environment on nutrition counseling.
.............................................. Workshop participants (n = 40) came from a variety of nutrition counseling settings. Most of the participants had not previously taken a nutrition counseling course or workshop. All of the participants indicated a belief that counseling skills were important in nutrition practice. Participants had the opportunity not only to acquire knowledge but also to internalize values about the importance of counseling theory and technique and applications to dietetics practice. The workshop was didactic and experiential. The content of the workshop is outlined in the Figure. Teaching methods included lecture, role-playing, self-assessment, small-group discussion, videotaped demonstrations, and videotaped practice witheritique. Videotapes of nutritioncounseling scenarios were developed to illustrate the application of each counseling theory to dietetics practice; the tapes were shown immediately after each theory was presented to provide a link between theory and practice. WORKSHOP EVALUATIONS At the conclusion of the workshop, each participant responded to a questionnaire presented on a Likert scale to evaluate learning and skill acquisition. Thirty-eight of the 40 participants reported that as a result of the workshop their knowledge of counseling theories increased. Thirty-nine of the participants reported an increased appreciation for the integration of counseling theories into nutrition practice. Most participants (n = 37) agreed or strongly agreed that they could realistically use counseling skills in their work settings. Increased confidence in nutrition counseling skills and the ability to apply these skills
WORKSHOP OUTLINE IV. Basic counseling techniques and skills I. Self-inventory of counseling attitudes and values A. Attending skills 1. Open and closed questions II. Theoretical orientations inpsychology 2. Paraphrasing A. Reality theory B. Influencing skills 1. Key figures 1. Interpretation 2. Major focus 2. Feedback 3. Philosophy 3. Directives 4. Basic assumptions 5. Key concepts V. Effects of the counseling environ6. Therapeutic goals ment on counseling 7. Client-counselor relationships A. Hospital-based vs private 8. Videotaped or live role-play ilpractice lustrations of theories in practice B. Environmental problem B. Behavior theory (1-8 above) identification C. Rational-emotive theory C. Problem solving (1-8 above) D. Client-centered theory (1-8 above) VI. Videotaped role-plays with critique III. Comparison of self-inventory with theoretical orientations Workshop content outline.
VII. Workshop evaluations
Table Follow-up evaluation 6 months after workshop a uetlion
Response Strongly agree
Agree
No
%
No.
17
19
comfortable and effective.
5
patient.
Neutral
Disagree
Strongly disagree
Not applicable
%
No.
%
No
%
No.
%
No.
%
20
56
5
14
0
0
0
0
4
11
14
21
58
7
19
0
0
0
0
3
8
6
17
21
58
4
11
2
6
0
0
3
8
10
28
16
44
5
14
0
0
0
0
5
14
listening during the counseling process.
9
25
17
47
5
14
1
3
0
0
4
11
counseling process.
6
17
18
50
8
22
0
0
0
0
4
11
the counseling process.
6
17
22
61
4
11
0
0
0
0
4
11
6
17
20
56
6
17
0
0
0
0
4
11
counseling session.
6
17
17
47
7
19
1
3
0
0
5
14
counseling session.
5
14
15
42
7
19
4
11
0
0
5
14
2
6
9
25
4
11
10
27
2
6
9
25
11
31
15
42
2
6
4
11
1
3
3
8
1. My confidence inmy counseling skills has increased over the past 6 months.
2. I have identified the counseling style inwhich I am most 3. 1am able to adapt my counseling style to meet the needs of the 4. 1am now using more attending and listening skills in my nutrition counseling sessions.
5. I am now able to recognize when a patient is not attending or 6. I am better able to acknowledge my feelings that arise during the 7. Iam better able to acknowledge the feelings of my patients during 8. I have altered the way Iconduct the counseling session based on the recognition of my own or my patient's feelings. 9. Ievaluate the counseling environment before beginning the 10. I take steps to correct the environment before beginning the 11. I have requested that management make changes inmy work site counseling environment that will enhance the counseling process.
12. I need further instruction, encouragement, and/or evaluation to enhance my counseling skills.
aThirty-six workshop participants were interviewed by telephone.
was reported by 34 of the participants, but the number who strongly agreed (n = 16) was somewhatlowerthanthosewho agreed (n = 21). Most participants (n = 31) thought they had begun to recognize their personal style of counseling as suggested by the course objectives. Role-playing and learning counseling theory promoted the recognition that in the nutrition counseling process, the counselor could apply skills and techniques taken from psychological models. This recognition enhanced the value of the patient-counselor relationship. A 6-month follow-up survey was conducted to determine whether the workshop participants had opportunities to practice and apply the skills acquired in the nutrition counseling workshop (Table). A standardized telephoneinterviewwas conducted using a 12-question survey on a Likert scale; a 90% response rate was achieved. Participants who were not working were scored as not applicable. Results of the telephone surveyrevealed favorable long-term outcomes. Twentyseven of the 36 respondents agreed that their confidence in their counseling skills had increased. Participants had identified a counseling style in which they were comfortable and were able to adapt their style to meet the needs of clients. Almost two thirds of the participants began to evaluate
the counseling environment before beginningacounseling session, and slightlymore than half took steps to correct the environment. Fewer participants (n = 11) requested that management make changes to enhance the counseling environment. APPLICATIONS As the body of knowledge and practice nowcallednutritioncounselinghas evolved, it has become evident that more effective nutrition counseling occurs if the disciplines of counseling psychology and nutrition are integrated. Many practicing dietetics professionals have not been adequately prepared in nutrition counseling and need to fill this void in their education. The variety of educational methods selected for the workshop described in this article produced an immediate positive effect on the participant's appreciation of the importance of developingandintegrating counseling skills within nutrition practice. More important, a 6-month follow-up survey verified increased confidence in the development anduse ofnutrition counseling skills as well as recognition of personal counseling styles. In the initial evaluation, participants indicated an awareness of the importance of the nutrition counseling environment. Nevertheless, the 6-month follow-up survey indicated that a significant percentage of
participants did not take active steps toward improving their counseling environment. This behavioral aspect of nutrition counseling deserves increased emphasis in future workshops. Activities could include the development of assertiveness and negotiation skills to help practitioners secure from management provision of an appropriate nutrition counseling environment. The following recommendations are based on the results of our workshop experience: * Nutritionprofessionals should recognize that nutrition counseling is more effective if theories and techniques of counseling psychology are integrated into nutrition practice. * Future workshops should provide a means for empowering the professional with the assertiveness needed to secure an appropriate space and environment for effective counseling. * Academic institutions, internships, and approved preprofessional practice programs should include practice-oriented experiences in teaching nutrition counseling skills. * Future research should address the question of the most effective time for this learning to occur in the education of the nutrition professional.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / 325
.....................................................
References 1. Ohlson M. The philosophy of dietary counseling. JAm Diet Assoc. 1973; 63:13-14. 2. Ling L,Spragg D, Stein P, Myers ML. Guidelines for diet counseling. J Am Diet Assoc. 1975; 66:571-575. 3. Mason M, Wenberg B, Welsh P. The Dynamics of ClinicalDietetics. New York, NY: John Wiley &Sons; 1977. 4. Danish SJ, Ginsberg MR, Terrell A, Hammond MI, Adams SO. The anatomy of a dietetic counseling interview. JAmDietAssoc. 1979; 75:626-630. 5. Danish S, D'Augelli A. Helping Skills II: Life Development Intervention. New York, NY: Human Sciences; 1983. 6. Laquatra I, D'Augelli A,Danish S. Helping Skills II: Life Development Intervention, Leader'sManual. New York, NY: Human Sciences; 1983. 7. BuildingNutritionCounselingSkills. vol 1.Bethesda, Md: US Dept of Health and Human Services, National Institutes of Health; 1984. DHHS publication (NIH) 84-2661.
EERHMD
US
.....................................................
8. BuildingNutritionCounselingSkills. vol 2.Bethesda, Md: US Dept of Health and Human Services, National Institutes of Health; 1984. DHHS publication (NIH) 84-2662. 9. Danish S, Lang D, Smiciklas-Wright H, Laquatra I. Nutrition counseling skills: continuing education for the dietitian. Top Clin Nutr. 1986; 1:25-32. 10. CassellJ. TopClinNutr.1986; 1:1. Editor's note. 11. Glanz K. Strategies for nutritional counseling. JAm DietAssoc. 1979; 74:431-437. 12. Snetselaar LG, Schrott HG, Albanese M, lasiello-Vailas L, Smith K, Anthony S. Model workshop on nutrition counseling for dietitians. JAm Diet Assoc. 1981; 79:678-682. 13. VickeryCE,HodgesPAM. Counselingstrategies for dietary management: expanded possibilities for effecting behavior change. JAm Diet Assoc. 1986; 86:924-928. 14. Picus SS. Evaluation of the nutrition counseling environment of hospitalized patients. J Am Diet Assoc. 1989; 89:403-405.
fe Attitudes of Ing-teare staff toward okler workers
iee
CHRISTINE D. ARCHETTI, MA; JENENE G. GAREY, PhD, RD; NEAL F. BERMAS, PhD
The foodservice industry is facing serious labor shortages. The industry has relied heavily on 16- to 24-year-olds (1) to meet its work force needs. Today less traditional work groups such as disabled persons, retirees, and older workers are being recruited (2). Research has shown that older workers are subject to more stereotyping; hence, they are viewed and evaluated less positively than youngerworkers (1,3-9). Negative stereotypes of older workers can influence managerial decisions, such as selection (6) and promotion (1,3,6), and affect the career progression of older workers C. D. Archetti (correspondingauthor) is thefoodservice managerat the Kings HarborCare Center, Bronx, NY 10469. At the time of this study, she was a graduatestudent in the Department of Nutrition, Food and Hotel Management, New York University. J. G. Garey is an associate professor and N F. Bermas is an adjunct associateprofessor in the Department of Nutrition, Food and Hotel Management, New York University, New York, NY 10003. 326 / MARCH 1993 VOLUME 93 NUMBER 3
(1,3,4,6). But researchers have found that older workers possess many favorable qualities, such as stability (7), dependability (1,3,7,10), loyaltyto the company (10), and reliability (7) and have better attendance records than do younger workers (11). Generally, older workers have fewer on-the-job accidents than younger workers (11,12), but conflicting results have been reported (7,10). This study examined the attitudes of foodservice personnel in long-term-care facilities toward workers 55 years of age and older. METHODOLOGY Ten nursing homes in the New York City area, employing a total of 448 foodservice workers, were selected on the basis of willingness to participate. The nursing homes were of varying size (200 to 720 beds). All had a self-operated foodservice department headed by a registered dietitian and all prepared food on the premises. Eight ofthe 10 nursing homes offered trayline and dining room service; two offered only tray-line service. The survey instrument measured attitudes of hourly and management food-
service personnel toward older workers using a 15-item Likert-type questionnaire = 0.83) (1,3), which had (Cronbach's been modified from 24 items (r = .90) (5). The questionnaire also included demographic questions (eg, number of years with the facility and opinions on mandatory retirement). The foodservice directors agreed during an introductory telephone call that employees would self-admirister the questionnaire and return it individually. The questionnaires included an envelope to ensure confidentiality. The instructions given were similar to those used by DeMicco (1). The New York University Human Subjects Committee approved the study. RESULTS Of the 300 surveys distributed, 160 (53%) were completed and 143 (48%) were usable-from 112 hourly and 31 management employees equally divided by gender. All age groups were represented. The largest groups were 18- to 29-year-olds for hourly employees (n = 36) and 30- to 49year-olds for management employees (n = 22). Sixty-one percent of hourlyworkers had no more than a high school diploma; 50% of management workers had a college degree. The mean number of years working at the facility was 8.5 and the mean number of years working in the foodservice industry was 11.2. According to an unpaired t test (t = .396, P = .05), the scores for mean attitude toward older workers were similar for hourly personnel (49.82, standard deviation [SD] = 7.865) and management personnel (50.45, SD = 7.762) (Table 1). A two-factor analysis of variance of employees (hourly or management) showed a significant difference in mean attitude score by age (F = 2.804, P = .05) but not by type of employee. On the basis of findings from previous studies (1,3,5,13,14), we expected a parallel increase in mean attitude score as the age of the respondents increased. We found that there were slight increases in mean attitude score (with one exception) as the age of respondents increased to age 60 (Table 1). Regrouping our respondents into general age categories-younger than 40, 40 to 49, and 50 and older-yielded results similar to those of Bird and Fisher (14) (Table 1). Seventy percent of the total sample believed that people should retire at a certain age; the most frequent responses were 65 years (27%) and 60 years (26%) (mean = 61.37). The respondents said "old" was 70 years (21%) and 65 years (20%) (mean = 64.64). Table 2 shows the 10 positive and 5 negative statements expressing attitudes
D
M·M R·
Anutrition counseling workshop: Integrating counseling psychology into nutrition practice Sr M. CARROLL ISSELMANN, EdD, RD; LINDA S. DEUBNER, MA, RD; MARYANNE HARTMAN, MA, RD
ietetics practitioners often find them-
selves in the role of counselor. Often, however, they lack knowledge oftheories of counseling psychology as well as the ability to translate theory into practice. Historically, counseling skills have not been an academic or professional experience requirement for dietitians. In the past two decades, authors have described the need for nutrition counseling skills in the dietetics practitioner (1-4). Severalhow-to books about nutrition counseling were published during the early 1980s (5-8). In spite of the acknowledged need, many dietetics professionals completed their academic programs and professional experience without developing specific skills in nutrition counseling. Danish et al (9) highlight the need to educate practitioners who are not trained in nutrition counseling; they believe that the mechanism for developing competency is continuing education. Dietitians have identified a need for additional training to improve their interviewing and counseling skills (10). Because nutrition counseling has come to be regarded as an entry-level competency, and because many students and practitioners lack that skill, we developed a continuing education workshop in nutrition counseling. WORKSHOP DESIGN, OBJECTIVES, AND CONTENT Integration of the disciplines of nutrition and counseling psychology was the primary objective of the workshop design. L. S. Deubner (correspondingauthor) is in private practice at 5249 CambrianRd, Toledo, OH43623. Sr M. C. Isselmann is chairpersonof Nutrition Education, Graduate Division, Immaculata College, Immaculata, PA 19345-0732. M. Hartman is a nutrition consultant at 1514 Vista Club Cir, Santa Clara, CA 95054. L. S. Deubner and M. Hartmanformerly were graduate students at Immaculata College. 324 / MARCH 1993 VOLUME 93 NUMBER 3
Achieving integration was also planned through the selection of teaching methods. The anticipated outcome was the development of nutrition counseling skills. Other authors have surveyed the counseling strategies used by the registered dietitian (11), provided a model for developing discrete counseling skills (12), provided a schematic model for the counseling session (13), and studied the effect of the counseling environment (14). Our graduate-level workshop was comprehensive. It included all four areas addressed previously in the literature. The workshop's educational methods and objectives reflected the desire to integrate the cognitive and affective domains oflearning. The objectives were (a) to develop an awareness of one's personal counseling style, attitudes, and values related to counseling; (b) to develop an introductory knowledge of counseling theories and techniques; (c) to apply knowledge of counseling theories and techniques to the practice of nutrition counseling; and (d) to identify the impact of the nutrition counseling environment on nutrition counseling.
.............................................. Workshop participants (n = 40) came from a variety of nutrition counseling settings. Most of the participants had not previously taken a nutrition counseling course or workshop. All of the participants indicated a belief that counseling skills were important in nutrition practice. Participants had the opportunity not only to acquire knowledge but also to internalize values about the importance of counseling theory and technique and applications to dietetics practice. The workshop was didactic and experiential. The content of the workshop is outlined in the Figure. Teaching methods included lecture, role-playing, self-assessment, small-group discussion, videotaped demonstrations, and videotaped practice witheritique. Videotapes of nutritioncounseling scenarios were developed to illustrate the application of each counseling theory to dietetics practice; the tapes were shown immediately after each theory was presented to provide a link between theory and practice. WORKSHOP EVALUATIONS At the conclusion of the workshop, each participant responded to a questionnaire presented on a Likert scale to evaluate learning and skill acquisition. Thirty-eight of the 40 participants reported that as a result of the workshop their knowledge of counseling theories increased. Thirty-nine of the participants reported an increased appreciation for the integration of counseling theories into nutrition practice. Most participants (n = 37) agreed or strongly agreed that they could realistically use counseling skills in their work settings. Increased confidence in nutrition counseling skills and the ability to apply these skills
WORKSHOP OUTLINE IV. Basic counseling techniques and skills I. Self-inventory of counseling attitudes and values A. Attending skills 1. Open and closed questions II. Theoretical orientations inpsychology 2. Paraphrasing A. Reality theory B. Influencing skills 1. Key figures 1. Interpretation 2. Major focus 2. Feedback 3. Philosophy 3. Directives 4. Basic assumptions 5. Key concepts V. Effects of the counseling environ6. Therapeutic goals ment on counseling 7. Client-counselor relationships A. Hospital-based vs private 8. Videotaped or live role-play ilpractice lustrations of theories in practice B. Environmental problem B. Behavior theory (1-8 above) identification C. Rational-emotive theory C. Problem solving (1-8 above) D. Client-centered theory (1-8 above) VI. Videotaped role-plays with critique III. Comparison of self-inventory with theoretical orientations Workshop content outline.
VII. Workshop evaluations
Table Follow-up evaluation 6 months after workshop a uetlion
Response Strongly agree
Agree
No
%
No.
17
19
comfortable and effective.
5
patient.
Neutral
Disagree
Strongly disagree
Not applicable
%
No.
%
No
%
No.
%
No.
%
20
56
5
14
0
0
0
0
4
11
14
21
58
7
19
0
0
0
0
3
8
6
17
21
58
4
11
2
6
0
0
3
8
10
28
16
44
5
14
0
0
0
0
5
14
listening during the counseling process.
9
25
17
47
5
14
1
3
0
0
4
11
counseling process.
6
17
18
50
8
22
0
0
0
0
4
11
the counseling process.
6
17
22
61
4
11
0
0
0
0
4
11
6
17
20
56
6
17
0
0
0
0
4
11
counseling session.
6
17
17
47
7
19
1
3
0
0
5
14
counseling session.
5
14
15
42
7
19
4
11
0
0
5
14
2
6
9
25
4
11
10
27
2
6
9
25
11
31
15
42
2
6
4
11
1
3
3
8
1. My confidence inmy counseling skills has increased over the past 6 months.
2. I have identified the counseling style inwhich I am most 3. 1am able to adapt my counseling style to meet the needs of the 4. 1am now using more attending and listening skills in my nutrition counseling sessions.
5. I am now able to recognize when a patient is not attending or 6. I am better able to acknowledge my feelings that arise during the 7. Iam better able to acknowledge the feelings of my patients during 8. I have altered the way Iconduct the counseling session based on the recognition of my own or my patient's feelings. 9. Ievaluate the counseling environment before beginning the 10. I take steps to correct the environment before beginning the 11. I have requested that management make changes inmy work site counseling environment that will enhance the counseling process.
12. I need further instruction, encouragement, and/or evaluation to enhance my counseling skills.
aThirty-six workshop participants were interviewed by telephone.
was reported by 34 of the participants, but the number who strongly agreed (n = 16) was somewhatlowerthanthosewho agreed (n = 21). Most participants (n = 31) thought they had begun to recognize their personal style of counseling as suggested by the course objectives. Role-playing and learning counseling theory promoted the recognition that in the nutrition counseling process, the counselor could apply skills and techniques taken from psychological models. This recognition enhanced the value of the patient-counselor relationship. A 6-month follow-up survey was conducted to determine whether the workshop participants had opportunities to practice and apply the skills acquired in the nutrition counseling workshop (Table). A standardized telephoneinterviewwas conducted using a 12-question survey on a Likert scale; a 90% response rate was achieved. Participants who were not working were scored as not applicable. Results of the telephone surveyrevealed favorable long-term outcomes. Twentyseven of the 36 respondents agreed that their confidence in their counseling skills had increased. Participants had identified a counseling style in which they were comfortable and were able to adapt their style to meet the needs of clients. Almost two thirds of the participants began to evaluate
the counseling environment before beginningacounseling session, and slightlymore than half took steps to correct the environment. Fewer participants (n = 11) requested that management make changes to enhance the counseling environment. APPLICATIONS As the body of knowledge and practice nowcallednutritioncounselinghas evolved, it has become evident that more effective nutrition counseling occurs if the disciplines of counseling psychology and nutrition are integrated. Many practicing dietetics professionals have not been adequately prepared in nutrition counseling and need to fill this void in their education. The variety of educational methods selected for the workshop described in this article produced an immediate positive effect on the participant's appreciation of the importance of developingandintegrating counseling skills within nutrition practice. More important, a 6-month follow-up survey verified increased confidence in the development anduse ofnutrition counseling skills as well as recognition of personal counseling styles. In the initial evaluation, participants indicated an awareness of the importance of the nutrition counseling environment. Nevertheless, the 6-month follow-up survey indicated that a significant percentage of
participants did not take active steps toward improving their counseling environment. This behavioral aspect of nutrition counseling deserves increased emphasis in future workshops. Activities could include the development of assertiveness and negotiation skills to help practitioners secure from management provision of an appropriate nutrition counseling environment. The following recommendations are based on the results of our workshop experience: * Nutritionprofessionals should recognize that nutrition counseling is more effective if theories and techniques of counseling psychology are integrated into nutrition practice. * Future workshops should provide a means for empowering the professional with the assertiveness needed to secure an appropriate space and environment for effective counseling. * Academic institutions, internships, and approved preprofessional practice programs should include practice-oriented experiences in teaching nutrition counseling skills. * Future research should address the question of the most effective time for this learning to occur in the education of the nutrition professional.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / 325
.....................................................
References 1. Ohlson M. The philosophy of dietary counseling. JAm Diet Assoc. 1973; 63:13-14. 2. Ling L,Spragg D, Stein P, Myers ML. Guidelines for diet counseling. J Am Diet Assoc. 1975; 66:571-575. 3. Mason M, Wenberg B, Welsh P. The Dynamics of ClinicalDietetics. New York, NY: John Wiley &Sons; 1977. 4. Danish SJ, Ginsberg MR, Terrell A, Hammond MI, Adams SO. The anatomy of a dietetic counseling interview. JAmDietAssoc. 1979; 75:626-630. 5. Danish S, D'Augelli A. Helping Skills II: Life Development Intervention. New York, NY: Human Sciences; 1983. 6. Laquatra I, D'Augelli A,Danish S. Helping Skills II: Life Development Intervention, Leader'sManual. New York, NY: Human Sciences; 1983. 7. BuildingNutritionCounselingSkills. vol 1.Bethesda, Md: US Dept of Health and Human Services, National Institutes of Health; 1984. DHHS publication (NIH) 84-2661.
EERHMD
US
.....................................................
8. BuildingNutritionCounselingSkills. vol 2.Bethesda, Md: US Dept of Health and Human Services, National Institutes of Health; 1984. DHHS publication (NIH) 84-2662. 9. Danish S, Lang D, Smiciklas-Wright H, Laquatra I. Nutrition counseling skills: continuing education for the dietitian. Top Clin Nutr. 1986; 1:25-32. 10. CassellJ. TopClinNutr.1986; 1:1. Editor's note. 11. Glanz K. Strategies for nutritional counseling. JAm DietAssoc. 1979; 74:431-437. 12. Snetselaar LG, Schrott HG, Albanese M, lasiello-Vailas L, Smith K, Anthony S. Model workshop on nutrition counseling for dietitians. JAm Diet Assoc. 1981; 79:678-682. 13. VickeryCE,HodgesPAM. Counselingstrategies for dietary management: expanded possibilities for effecting behavior change. JAm Diet Assoc. 1986; 86:924-928. 14. Picus SS. Evaluation of the nutrition counseling environment of hospitalized patients. J Am Diet Assoc. 1989; 89:403-405.
fe Attitudes of Ing-teare staff toward okler workers
iee
CHRISTINE D. ARCHETTI, MA; JENENE G. GAREY, PhD, RD; NEAL F. BERMAS, PhD
The foodservice industry is facing serious labor shortages. The industry has relied heavily on 16- to 24-year-olds (1) to meet its work force needs. Today less traditional work groups such as disabled persons, retirees, and older workers are being recruited (2). Research has shown that older workers are subject to more stereotyping; hence, they are viewed and evaluated less positively than youngerworkers (1,3-9). Negative stereotypes of older workers can influence managerial decisions, such as selection (6) and promotion (1,3,6), and affect the career progression of older workers C. D. Archetti (correspondingauthor) is thefoodservice managerat the Kings HarborCare Center, Bronx, NY 10469. At the time of this study, she was a graduatestudent in the Department of Nutrition, Food and Hotel Management, New York University. J. G. Garey is an associate professor and N F. Bermas is an adjunct associateprofessor in the Department of Nutrition, Food and Hotel Management, New York University, New York, NY 10003. 326 / MARCH 1993 VOLUME 93 NUMBER 3
(1,3,4,6). But researchers have found that older workers possess many favorable qualities, such as stability (7), dependability (1,3,7,10), loyaltyto the company (10), and reliability (7) and have better attendance records than do younger workers (11). Generally, older workers have fewer on-the-job accidents than younger workers (11,12), but conflicting results have been reported (7,10). This study examined the attitudes of foodservice personnel in long-term-care facilities toward workers 55 years of age and older. METHODOLOGY Ten nursing homes in the New York City area, employing a total of 448 foodservice workers, were selected on the basis of willingness to participate. The nursing homes were of varying size (200 to 720 beds). All had a self-operated foodservice department headed by a registered dietitian and all prepared food on the premises. Eight ofthe 10 nursing homes offered trayline and dining room service; two offered only tray-line service. The survey instrument measured attitudes of hourly and management food-
service personnel toward older workers using a 15-item Likert-type questionnaire = 0.83) (1,3), which had (Cronbach's been modified from 24 items (r = .90) (5). The questionnaire also included demographic questions (eg, number of years with the facility and opinions on mandatory retirement). The foodservice directors agreed during an introductory telephone call that employees would self-admirister the questionnaire and return it individually. The questionnaires included an envelope to ensure confidentiality. The instructions given were similar to those used by DeMicco (1). The New York University Human Subjects Committee approved the study. RESULTS Of the 300 surveys distributed, 160 (53%) were completed and 143 (48%) were usable-from 112 hourly and 31 management employees equally divided by gender. All age groups were represented. The largest groups were 18- to 29-year-olds for hourly employees (n = 36) and 30- to 49year-olds for management employees (n = 22). Sixty-one percent of hourlyworkers had no more than a high school diploma; 50% of management workers had a college degree. The mean number of years working at the facility was 8.5 and the mean number of years working in the foodservice industry was 11.2. According to an unpaired t test (t = .396, P = .05), the scores for mean attitude toward older workers were similar for hourly personnel (49.82, standard deviation [SD] = 7.865) and management personnel (50.45, SD = 7.762) (Table 1). A two-factor analysis of variance of employees (hourly or management) showed a significant difference in mean attitude score by age (F = 2.804, P = .05) but not by type of employee. On the basis of findings from previous studies (1,3,5,13,14), we expected a parallel increase in mean attitude score as the age of the respondents increased. We found that there were slight increases in mean attitude score (with one exception) as the age of respondents increased to age 60 (Table 1). Regrouping our respondents into general age categories-younger than 40, 40 to 49, and 50 and older-yielded results similar to those of Bird and Fisher (14) (Table 1). Seventy percent of the total sample believed that people should retire at a certain age; the most frequent responses were 65 years (27%) and 60 years (26%) (mean = 61.37). The respondents said "old" was 70 years (21%) and 65 years (20%) (mean = 64.64). Table 2 shows the 10 positive and 5 negative statements expressing attitudes