passages, all of which communicate the writer's ideas, the con-

tent of the writing. These items-rhetorical norms, ideas,

organization, and grammar (the sentence structures,
punctuation, word choice, and spelling)-are generally referred to
as the lev els of discourse. Decisions regarding the rhetorical
norms at the highest level that is, decisions about the
purpose,audience, subject matter, and writer's ethos-will
determine decisions at these other, lower levels of discourse.
During the process of writing, successful writers will move-
sometimes effortlessly, it that is, decisions about the purpose,
audience, n seems-between and through these levels of
discourse. As they write, successful writers focus on different
levels of discourse at different times, as needed. They may be
generating ideas at one moment, then reorganizing sections at
another. They may consider their choice of particular words and
then move on to generating and then revising sentences, and
determine the cor- rect punctuation all the way through.

While texts appear linear, moving from a beginning to a middle to

an end, the actual process of writing is virtually never that linear.
Successful writers are always stopping and returning to already
produced sentences and ideas in order to reorient themselves so
that they can go forward again. They may pause to make sure
that what they have written will lead the reader logically from
one thought to the next. They may pause to reestablish their own
connection to the logical flow of their writing, to give them-
selves direction. A better metaphor for writing than the straight
line is the spiral, because writing tends to be "recursive"-that is,
writing moves backward in order to then move forward again.
Composition scholars have identified the following major steps in
the process of writing:

Prewriting or invention, whatever it is that the writer does before

actually writing. For longer pieces of writing, success- ful writers
tend to spend time planning a text before beginning to write it.
They develop their ideas about the subject matter. For example,
in planning a new patient education resource, RDs may read the
most current literature supporting nutrition therapy for a
particular diagnosis. They identify their purpose and audience.
They produce a rough plan (sometimes in writ- ing, sometimes
just in their heads) for how the text is to be organized. From that
point, an outline may be developed that organizes the most
important issues for the patient. Drafting or actual sentence
generation. As mentioned above, his is not a linear process. It
involves setting goals and sub- goals and recalibrating one's
thinking as more and more text is produced. Successful writers
tend to do some revising during drafting, too. Revision. In
addition to revising while drafting, successful writ- ers virtually
always make revisions to their text after it has beern completely
drafted Editing. After the text has been drafted and revised,
successful writers also spend time making minor corrections at
the low- est, sentence and subsentence levels of discourse. This
is when proofreading takes place, and these writers make their
changes based on errors they identify during that proofing of
their manuscripts. Typically, successful writers wait to make
editing changes to a text until revision is complete, to avoid
wasting time proofing sentences that may later be revised or
even elimi- nated from the text.

25
As indicated, all writing involves subject matter, a purpose, an
audience, and the writer's ethos. But as writers move from be-
ing outsiders to being insiders within their communities, they
adopt the discourse conventions of their communities-that is the
purposes, audiences, ethos, subject matter, writing pro- cesses,
textual organizations, and writing styles specific to their
communities. These differences in the writing of different
communities-different disciplines, different workplaces- coalesce
into what are referred to as "genres:" As you have seen
throughout this chapter, registered dietitians typically write into
charts, but they also write memos, brochures, handouts, and
other health information texts as well as research reports. These
are all different genres adopted by the dietetics profession.
Reporting Your Own Research When you become a clinical
dietitian, you automatically become a member of the professional
community of clinical dietitians and other health professionals.
You are expected to keep up with the research in your field and to
go to confer- ences and participate in other forms of continuing
education You may also want to contribute to the ongoing
deliberations in your field. You may want to do original research
and report the findings of that research either in professional
journals and books or at professional conferences. Discussion of
how to do such research and how to write professional articles,
book chapters, and conference papers is beyond the scope of this
text. Nevertheless, you need to be aware that this research and
professional writing is possible for you. It is considerably more
formal than writing instructions for patients, in the sense that
there are certain organizational and stylistic con- ventions that
you must adopt when reporting your research. The Web links at
the end of the chapter provide information about doing research
in dietetics and reporting that research professionally.

Documentation of the Nutrition Care Process Introduction: Mr. J,

a 52-year-old man, is referred by his physician to the nutrition
outpatient clinic for counseling on a weight- reduction diet. You
discuss his goals with him and find out that he does want to lose
weight because of his family history of diabetes Nutrition
Assessment: Food/Nutrition-Related History: While talking with
Mr. J, you obtain a quick diet history, which you feel is reasonably
accurate. You calculate that his diet contains approximately 2800
kcal per day. Mr. J tells you that he dislikes sweets and fats,
rarely eats vegetables, and drinks about 8 cups of fruit juice daily
in addition to cof- fee and tea (which have added sugar)
throughout the day. and that he is fairly inactive, eats two large
meals a day, and never eats breakfast. Anthropometrics: You
measure Mr. J and find that he is 5'7" tall and weighs 195 pounds
Biochemical Data: None available.

Conclusions: Your Ethos- Establishing Expertise When you write

professionally, you establish your professional ethos by making
wise recommendations and orders and, most importantly, by
establishing your expertise both in your actions and in your
writing. The 2009 Code of Ethics outlines your professional
obligation to convey accurate information for all audiences.17.
Fulfilling this obligation means continuing your professional
education throughout your career, and drawing on that ongoing
knowledge when you chart and when you create and update
informational and educational material. This is a crucial
component that helps to define a profession and is the
foundation for maintaining competence. Nutrition Diagnosis: As
Dlagnosis Related Dlagnosis to Etiology Symptoms Consumption
of approximately 720 kcal from juice daily documented in 24-hour
recall. by AEB EXAMPLE: Excessive energy intake
PLEEtiologyvidenced RT Excessive fruit juice consumption
Nutrition Monitoring/Evaluation: One goal that is determined is to
reduce fruit juice to 1 cup per day and change to artificial
sweetener for coffee and tea. He will keep a food record for one
week and then return for a follow-up appointment. Questions: 1.
Outline the subjective information that should be in- cluded in a
chart note for this session 2. List all the objective information. 3.
Write a PES statement for one other nutrition problem. 4. Write
your assessment. 5. Determine appropriate interventions for the
nutrition problem you identified. 6. Design your
evaluation/outcome measures for this problem.