Dietitian Blog, MNT Guidelines, Professional Development | Jun 7 2020

How to write a perfect PES statement

Woman typing on an Apple laptop on a clean desk with yellow sticky notes and a calculator and a pencil cup with 3 pencils

A PES statement (or Nutrition Diagnosis Statement) is a structured sentence that describes the specific nutrition problem that you (the dietitian) is responsible for treating and working toward resolving, the cause/s of the problem and the evidence that this problem exists. A PES statement is needed for all nutrition assessments except those with “no nutrition diagnosis.”

Three components make up the PES statement :

The Problem (P)– the Nutrition Diagnosis

The Etiology (E)– the cause/s of the nutrition problem (Nutrition Diagnosis)

The Signs and Symptoms (S)– the evidence that the nutrition problem (Nutrition Diagnosis) exists.

The PES statement is a structured sentence, hence has a specific format to follow. Here’s a sample of how to structure your statement:

Nutrition Diagnosis term (the nutrition Problem)

related to

The Etiology (the cause/s of the problem or Nutrition Diagnosis)

as evidenced by

The Signs and Symptoms (the evidence that the nutrition problem or Nutrition Diagnosis exists).

The Problem (P) – the Nutrition Diagnosis

The Nutrition Diagnosis, identifies the specific nutrition problem that the dietitian is responsible for treating and works towards resolving. The nutrition diagnosis uses specific terminology from the eNCP. There are 3 classifications of the nutrition diagnosis: Intake, clinical, and behavioral.

  • Intake: These relate to nutrition and intake related problems
  • Clinical: These diagnosis include medical or physical conditions that have a nutritional impact.
  • Behavioral: this category covers the nutritional problems associated with nutrition knowledge and belief (including attitude), physical activity and function (e.g. ability to self care) and food access and safety).

The nutrition diagnosis should be specific to the role dietitian. The Nutrition Diagnosis is something that you as a dietitian can resolve (ideally) or improve.

The Etiology (E) – the cause/s of the nutrition problem/Nutrition Diagnosis

The ‘E’ in the PES Statement stands for Etiology. The definition of etiology is “the cause, set of causes, or manner of causation of a disease or condition.” (Oxford Dictionary). The etiology describes the cause of the nutrition diagnosis in the PES statement. The Nutrition Intervention should be aimed at resolving the Etiology (underlying cause of the nutrition problem). The etiology statement is free text. Etiologies are grouped in categories according to cause of the diagnosis. There is no incorrect etiology statement, but it should include these general points:

  1. The Etiology is the “root cause” of the Nutrition Diagnosis.
  2. The Nutrition Intervention, should aim to resolve or at least attempt to improve the Etiology.
  3. The Etiology is supported by the nutrition assessment data.

Signs and Symptoms (S) – evidence that the Nutrition Diagnosis exists

  • Signs are objective data obtained through direct physical examination, observation, lab values and test results.
  • Symptoms are subjective data reported by the client’s or their family’s rather than actual results.

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Like Etiology, Signs and Symptoms in the PES Statement are free text. It is an important skill for a dietitian to identify the Signs and Symptoms that demonstrate that a Nutrition Diagnosis exists. The signs and symptoms statement should support the Nutrition Diagnosis. It should be specific, so it can be monitored and measured, to be able to evaluate changes.

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Sara Glanz, registered dietitian

About Sara Glanz

Sara Glanz, MS, RD, LD, CNSC worked as a traveling dietitian for Dietitians On Demand for two years before joining the corporate team. In her current role as Director of Clinical Education, she has championed the continuing education program to empower dietitians everywhere to achieve their professional goals.

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