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Contents
Foreword.........................................................................................................4
Introduction.....................................................................................................5
Purpose..........................................................................................................6
Section One................................................................................................... 8
Service Users Autonomy and Welfare............................................................ 8
Respecting the autonomy of the service user.....................................................8
Service User Well-being..................................................................................9
Duty of Care to the Service User....................................................................10
Section Two................................................................................................. 11
Services to Service Users............................................................................ 11
Referral of Service Users..............................................................................11
Equity of service provision............................................................................13
Provision of services to service users..............................................................13
Recording of information..............................................................................13
Confidentiality.............................................................................................14
Section Three.............................................................................................. 15
Personal / Professional Integrity................................................................ 15
Personal integrity........................................................................................15
Personal relationships with patients/clients/users............................................. 15
Professional integrity...................................................................................15
Whistle-blowing...........................................................................................15
Professional demeanour...............................................................................16
Personal health and substance misuse............................................................16
Personal profit / gain...................................................................................16
Advertising.................................................................................................17
Representation of information.......................................................................17
Sustainability..............................................................................................17
Section Four................................................................................................ 18
Professional Competence and Standards..................................................... 18
Professional competence..............................................................................18
Delegation..................................................................................................18
Collaborative practice...................................................................................19
Continuing Professional Development.............................................................19
Dietetic student education............................................................................20
Development of the profession......................................................................20
Acknowledgements.........................................................................................21
References & Further Reading..........................................................................22
Foreword
In the assessment, diagnosis and treatment of diet and nutrition problems, dietitians have a
responsibility to act in a professional and ethical manner. The Code of Professional Conduct
provides a governance framework to ensure the accountability of dietitians who work in the
interest of public safety at all times.
In addition to this, the code provides a set of professional principles that apply to the wider
dietetic workforce, which will provide support and help to make informed choices when faced
with ethical and professional dilemmas.
The Code of Conduct forms part of the Associations governance framework and links closely
with the BDAs Professional Standards for Dietitians and other professional practice guidance
papers, e.g. Records and Record Keeping. Together, these documents are complementary to
and underpin the Health Professions Councils Standards of Conduct, Performance and Ethics
and the Standards of Proficiency: Dietitians.
I am pleased to present to you the Code of Professional Conduct and trust that it will help to
ensure a consistent and high level of best practice by the dietetic workforce across the UK.
I would like to extend my thanks and congratulations to all those involved with its production.
Pauline Douglas
Honorary Chairman
Introduction
The Health Act 19991 bestows the status of a profession on dietetics, which
automatically carries the statutory requirement to regulate professional conduct
for the protection of the service user. The title Dietitian is protected by law and
can only be used by persons who are registered with the Health Professions Council
(HPC).
This means that as registered practitioners, dietitians must:
Purpose
The purpose of the BDA Code of Professional Conduct is to provide a set of principles
that applies to all dietitians. It requires the dietetic workforce to discharge their duties and
responsibilities in a professional, ethical and moral manner.
Producing and promoting a code cannot alter the behaviour of an individual who is
determined to act unethically. However, a major function of this code of conduct is to enable
professionals to make an informed choice when faced with an ethical dilemma so that they do
not behave unethically by error rather than by design.
There are five guiding principles which underpin professional conduct. These are:
Note
In this document the following terms are used:
You must is used as an overriding principle or duty.
You should is used where the principle or duty may not apply in all circumstances or where
there are factors outside your control affecting your ability to comply.
This document replaces Code of Professional Conduct which was issued by The British Dietetic
Association in January 2004.
Section One
Service Users Autonomy and Welfare
Respecting the autonomy of the service user
1.1
You will at all times recognise, respect and uphold the autonomy of service
users: i.e. their right to make choices and to work in partnership with dietetic
practitioners. You will promote the dignity, privacy and safety of all service
users.
1.1.1 You will respect the decisions of service users concerning their own health and
independence, even when such decisions conflict with professional opinion.
1.1.2 Service users should be given sufficient information and time to enable them to
make informed decisions, about their health and social care.
1.1.3 You will take care to present information in a way that service users can
understand3,6.
1.1.4 Reasonable steps should be taken to ensure that the service user understands the
nature, purpose and likely effect of the proposed intervention5,7.
1.1.5 Service users have a right to refuse intervention, and should be offered the
opportunity to refuse it. Any such refusal should be respected and recorded in
writing.
1.1.6 Discussions with, or about, service users should be confidential and be
conducted in such a place and manner as to protect their privacy.
NOTE: Exceptional circumstances may, however, prevail, for example where the service user is
deemed to lack competence in relation to consent to treatment (mental health legislation and
current case law)8,9,10,11,12,13.
Mental Capacity Act (2005) England and Wales8 governs decision-making on behalf of adults,
where they lose mental capacity at some point in their lives or where the incapacitating condition
has been present since birth. The Act received Royal Assent on 7 April 2005 and came into force
during 2007.
The Adults with Incapacity Act (2000) Scotland sets out in law a range of options to help people
aged 16 or over who lack the capacity to make some or all decisions for themselves. It allows
other people to make decisions on their behalf.
There is currently no equivalent law on mental capacity in Northern Ireland. The Bamford
Review of Mental Health and Learning Disability is looking athowcurrent law affects people
with mental health needs or a learning disability in Northern Ireland.
You must not engage in or condone behaviour that causes mental distress or
physical harm. Such behaviour includes neglect, intentional acts, indifference
to the pain or misery of others and other malpractice.
1.2.1 Any intervention that may cause pain or distress should first be explained to the
service user, who should also understand its nature, purpose and likely outcome,
before it begins.
1.2.2 You should make every reasonable effort to avoid leaving a service user in pain
or distress after any intervention. If distress continues, relevant parties should
be informed as soon as is reasonably practical.
1.2.3 If you witness, or have evidence of, behaviour which appears to cause
unnecessary or avoidable pain or distress (including unreasonable restraint),
you have a duty to make this known confidentially to your line manager or other
appropriate agency12,13.
1.2.4 You should act to prevent such action from continuing, providing this action is
within your professional competence and does not conflict with local policies and
procedures. If you are unable to intervene you should withdraw from the action.
1.2.5 You should take all reasonable steps to prevent service users following action or
advice which you know to be harmful to their health.
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Section Two
Services to Service Users
Referral of service users
2.1
Dietitians shall only accept referrals which they deem to be appropriate and
for which they have the resources14.
2.1.1 It is the duty of the dietitian to determine whether the referral is appropriate.
The referral may be made verbally or in writing by a medical practitioner,
another health professional, or by individual service users.
2.1.2 If the dietitian decides that dietetic advice is not appropriate, the referrer should
be informed so as to increase awareness of the role and limitations of dietetic
practice.
2.1.3 It is not a requirement of dietetic practice for dietitians to accept only medical
referrals. Dietitians are autonomous professionals and the responsibility for
assessment and subsequent intervention remains with the individual dietitian.
2.1.4 Dietitians are legally liable for their intervention, teaching and advice carried
out following assessment. This applies regardless of whether the intervention
requested by the referrer is found to be appropriate or not.
2.1.5 Responsibility lies with the dietitian to identify whether or not dietetic
intervention is indicated. Criteria must be established to ensure that clear
objectives are agreed, with both the service user and the referrer, for any
intervention.
Dietitians have a threefold responsibility to ensure that the intervention is
necessary and appropriate to:
a. the service user; to make sure that expectations are not raised that
cannot be fulfilled, and to not waste time and resources treating service
users for whom the treatment will not be or has ceased to be beneficial.
b. themselves as dietitians; by treating a service user who does not require
such treatment. It is morally wrong to give treatment when it is not
required, or when referral to another agency is necessary, or more
appropriate.
c. their employer; whether self employed or employed through a health
trust, private hospital or industrial concern, it is ethically wrong to waste
time and money by treating service users unnecessarily.
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2.1.6
Prescriptive referrals
Actively harmful
Unnecessary treatment
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Recording of information
2.4
2.4.2 Records should be accurate, legible, factual, in sequence, made promptly, and
signed by the person who made them.
2.4.3 If you are delegating care activities to another member of staff appropriately
(e.g. students, support workers) there must be a system in place to ensure
the accuracy of the record, i.e. that what has been done has been accurately
recorded. This may, but not necessarily, include countersigning their entries.
Until there is UK-wide national guidance on the countersigning of records by
support workers and students the decision is one for individual departmental
interpretation. Further information and guidance on this can be found in the BDA
Guidance on Records and Record Keeping Document 200816.
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2.4.4 Subjective opinion should always be identified as such and should be clinical and
relevant.
2.4.5 Records should be stored securely so as to be confidential16,27.
Confidentiality
2.5
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Section Three
Personal/Professional Integrity
Personal integrity
3.1
3.1.1 You have a duty to refrain from bullying and other forms of harassment, and to
be aware of how your behaviour affects others32.
3.1.2 You have a duty to behave safely, responsibly and legally online, particularly in
relation to the use of social networking sites. You must not:
breach confidentiality and data protection laws;
engage in potentially libellous gossip;
bring your profession into disrepute.
Personal relationships with service users
3.2
You will not enter into relationships that exploit or abuse service users
sexually, physically, emotionally, financially, socially or in any other manner.
3.2.1 It is considered unethical for you to enter into relationships which may
impair your professional judgment and objectivity and/or may give rise to
advantageous/disadvantageous treatment of the service user.
Professional integrity
3.3
Whistle-blowing
3.4
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You must not work whilst under the influence of any substance which is likely
to impair the performance of your duties.
3.6.1 You must not misuse, nor encourage others to misuse, alcohol, drugs or other
substances.
3.6.2 You must seek advice and take action if you become aware that your physical
and/or mental health could affect your fitness to practise.
3.6.3 You must inform the HPC about any significant changes to your health, especially
if you have changed your practice as a result of medical advice2.
Personal profit/gain
3.7
You must not accept favours, gifts, or hospitality from service users, their
families or commercial organisations when the offer might be construed as an
attempt to gain preferential treatment36,37.
3.7.1 Your prime duty is to the service user and you should not let this duty be
influenced by any commercial or other interest that conflicts with it.
3.7.2 A bequest in a will to you by a service user should be declared to your employer,
where appropriate.
3.7.3 Local policies concerning gifts should be observed.
NOTE: In certain cases, the property and affairs of a service user may be subject to the
authority of the Court of Protection.
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Advertising
3.8
You may make direct contact with potential referring agencies in order to
promote your services.
3.8.1 Dietitians should be guided by the HPC Standards of Conduct, Performance and
Ethics2 and the Standards of Proficiency: Dietitians3.
3.8.2 You must take care not to make or support unjustifiable statements relating to
particular products.
3.8.3 If you are involved in advertising or promoting any product or service, you must
make sure that you use your scientific knowledge, clinical skills and experience
in an accurate and professionally responsible way. You must not make or support
unjustifiable statements relating to particular products. Any potential financial
rewards to you should play no part at all in your advice or recommendations of
products and services that you give to patients, clients and users.
Representation of information
3.9
Sustainability
3.10 Public accountability and respect for the environment
3.10.1 You have a responsibility to The Association, to tax payers, to the wider
community and to the environment not to waste resources. You should
demonstrate due regard for the sustainable management of resources at your
disposal and should use resources responsibly and efficiently as is practicable.
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Section Four
Professional Competence and Standards
Professional competence
4.1
4.1.2 You must only provide services for which you are qualified by education, training
and/or experience, and which are within your professional competence and
scope of practice2,4,38.
4.1.3 If you are asked to act up or cover for an absent colleague you must identify and
decline to undertake any aspect of work which you know or believe to be outside
the scope of your clinical competence. Such duties should not be undertaken in
the absence of adequate supervision and training2,4.
4.1.4 Dietitians seeking work for which their training or experience is insufficient or
out of date have a responsibility to ensure that adequate self-directed learning,
training and supervision takes place38.
Delegation
4.2
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Collaborative practice
4.3
You will respect the needs, working practices, skills and responsibilities of
others with whom you work.
4.3.1 You should acknowledge the need for multi-professional collaboration to ensure
the provision of well-coordinated services delivered in the most effective way. In
so doing the unique contribution of each profession should be acknowledged.
4.3.2 Dietitians must refer service users to, or consult with, other service providers
when additional knowledge and expertise is required.
4.3.3 With the exception of seeking a second opinion, it is in the interests of good
service user care and best practice that there should be one dietitian taking
overall responsibility for the assessment and treatment of a service user for any
one episode of care.
4.3.4 When more than one dietitian is involved in the treatment of the same service
user, they must liaise with each other and agree explicit areas of responsibility.
It is your responsibility to develop your knowledge and skills and keep yourself
up to date2,3,39.
4.4.1 You must continue to develop and maintain your professional knowledge and
skills.
4.4.2 You should keep a record of your professional development25,39.
4.4.3 You should set annual objectives in partnership with your line manager or
appropriate professional peer as part of the appraisal process.
4.4.4 You must engage in a range of CPD activities of which a key component is
practice supervision2,25,26. A minimum recommendation is at least one session
every two months. Further guidance on practice supervision can be found in the
BDA Practice Supervision Guidelines September 200842.
4.4.5 It is your duty to ensure that your practice is evidence based, wherever possible.
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Acknowledgements
This document has been based on the Code of Ethics and Professional Conduct for
Occupational Therapists 2000, the Chartered Society of Physiotherapy Rules of Professional
Conduct 2002 and the Nursing and Midwifery Council Code of Professional Conduct 2002 and
the Society of Radiographers Code of Conduct and Ethics 2007.
The Code of Professional Conduct was revised by Najia Qureshi, Professional Development
Officer on behalf of the Professional Development Committee of The British Dietetic
Association.
Please direct any enquiries on this document to the Education and Professional Development
Section of the Association.
September 2008
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