Revision of previous Work
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AN EDUCATIONAL TRAINING PROGRAM FOR NURSES IN AN OUTPATIENT SETTING REGARDING THE IMPORTANCE OF A HEALTHY DIET FOR PATIENTS WITH OBESITY
By
Ayoola Aker
A Project
Submitted to the Faculty of D’Youville
Division of Academic Affairs
In partial fulfillment of the requirements for the degree of
Master of Science in
Family Nurse Practitioner
Buffalo, NY
[Month Day, Year]
Copyright © 2023 by Ayoola aker. All rights reserved. No part of this project may be copied or reproduced in any form or by any means without the written permission of Funmilola A, Akerele.
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PROJECT APPROVAL
Project Committee Chairperson
Name:
__ ____________________________
Signature: ___________________________________________
Discipline:
________________Nursing________________
Project Defended
On
[Month Day, Year]
Abstract
Obesity has become a significant concern in the healthcare system, and diet is the key contributing factor to obesity. Therefore, a healthy diet should be the primary requirement for reducing weight and improving overall health. The health life knowledge gap among patients and limited nursing education programs contribute to this condition. Nurses should collaborate closely with patients to provide healthcare education that will assist patients in improving their nutritional habits and identify the challenges they face in maintaining a healthy diet. An educational training program for nurses regarding obesity and diet will allow nurses to advance their knowledge of the risk factors of obesity, the health conditions associated with obesity, and how to manage obesity (Seger, 2019). Peplau Interpersonal Relations in Nursing Theory was utilized as the theoretical framework for this project. Five content experts reviewed the educational training program for content validity.
Acknowledgment
Table of Contents
Chapter
I. PROJECT INTRODUCTION …………………………………………………………… 8
Statement of Purpose ……………………………………………………………………….. 9
Theoretical Framework ……………………………………………………………………. 9
Initial Review of the Literature ………………………………………………………….13
Significance and Justification ……………………………………………………………21
Project Objectives ……………………………………………………………………………21
Definition of Terms ……………………………………………………………………….. 22
Project Limitations ………………………………………………………………………… 22
Project Development Plan ………………………………………………………………. 22
Plan for Protection of Human Subjects …………………………………………….. 24
Plan for Project Evaluation……………………………………………………………… 24
Summary ……………………………………………………………………………………… 25
II. REVIEW OF LITERATURE …………………………………………………………..
Summary ………………………………………………………………………………………
III. PROJECT DEVELOPMENT PLAN. ……………………………………………….
Project Setting and Population… ……………………………………………………..
Content Expert Participants …………………………………………………………….. Data Collection Methods …………………………………………………………………
Project Tools …………………………………………………………………………………
The Protection of Human Subjects ………………………………………………………
Summary ………………………………………………………………………………………
IV. PROJECT EVALUATION, IMPLICATIONS, AND FUTURE RECOMMENDATIONS
……………………………………………..
Project Evaluation ………………………………………………………………………….
Implications for Future Practice ……………………………………………………….
Future Recommendations ………………………………………………………………..
Summary ………………………………………………………………………………………
References ……………………………………………………………………………………. 27
Appendices …………………………………………………………………………………… 32
List of Appendices
Appendix
A D’Youville
Patricia H. Garman School of Nursing
Full Approval Letter
…………………….….
B Letter of Intent …………………………………………………………………………………….
C Evaluation Tool …………………………………………………………………………………..
D
Educational Training Program
…………………………………………………………
E Survey tool results in graph……………………………………………….
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Chapter I
The age of fast food and instant gratification brought about by the growth of technology has affected the general population in many ways. In America, obesity is becoming problematic, with a prevalence estimate of 41% leading to risk in the severity of diseases (Kalligeros et al., 2020). As a result, there is a need for nursing practice to take accountability in developing a relationship with collaborative patient care. Obesity can be a lifestyle disease. Therefore, all stakeholder participation must be considered a need to look at the four-metaparadigm perspectives in caregiving using a foundational basis in a theoretical framework. First, a nurse needs expertise in addressing health issues, especially those reversible through natural means, for example, obesity. Obesity is reversible through natural means, including dietary modification and practicing fasting.
The factors that make a successful program include proper planning. Proper planning allows for allocating adequate time and resources toward the project, resulting in the successful implementation of the program (Shi, 2017). Another factor is incorporating experienced project managers with knowledge about the program. For example, specialists such as nutritionists and experts in physical activity and breastfeeding are essential when developing a program to improve nutrition in children and adults and minimize obesity. Finally, it is essential to practice monitoring and control for a program to succeed. Regular evaluation of the progress and the program results allows for modification and alignment in case of an error or a potential error—effective communication results in a program’s success (Ross et al., 2019).
The success of any implementable nursing program should have ways to effect cultural change. As such, education plays a significant role in making people adopt healthy habits. Education is well achievable after evaluating the clients through wellness programs and other community programs that involve health checkups and screening. However, personal barriers such as individual change resistance may negatively impact the success of the social change (Allan, 2020). Some people are susceptible to changes they perceive as threats to their social environment, including the workplace. Individuals may develop resistance to change when they feel uncertain about the intervention or when the change comes as a surprise without the time to prepare mentally. The questions about the competency of the intervention concerning the new environment—the resistance results in difficulty in implementing the intervention to achieve social change (Ross et al., 2019). This study will assess interpersonal relations in nursing theory to draw mechanisms for developing effective strategies for an educational plan for nurses taking care of patients with obesity in an outpatient department. The program will major in how nurses can effectively pass educative information to the clients on dietary intervention as a critical mechanism for reversing obesity. The idea considers all the possible challenges nurse educators may experience while trying to enhance social changes among patients.
Statement of Purpose
The purpose of this project is to develop an educational training program for nurses in an outpatient setting regarding the importance of a healthy diet for patients with obesity.
Theoretical Framework
Hildegard Peplau’s (1991)
Interpersonal Relations in Nursing Theory is utilized as the theoretical framework for developing this project. A brief overview of the theory is presented as well as a discussion regarding how the theory was utilized to guide the project’s development. In addition, Peplau’s (1991) theoretical definitions for nursing’s interpersonal relationships and concepts together with the Project Author’s operational definitions for nursing’s four metaparadigm concepts will be presented.
Interpersonal Relations in Nursing’s Theory
Hildegard E. Peplau’s impact on nursing and patient care is reflected in her development and establishment of the Interpersonal Relations Theory. Her theory development began with questions of the philosophical underpinning of psychology as fundamental in-patient care especially when it came to nursing and patient relationships (Peplau, 1991). According to Peplau (1991), the development of patient care begins by understanding the foundational elements as concepts of nursing care. namely, the
orientation, identification, exploitation, and
resolution defined. In her book,
Interpersonal Relations in Nursing, the theory emphasizes the importance of crosscutting issues and their effect on nursing care and patient wellness, such as nursing education on dietary interventions for patients with obesity.
Orientation refers to the reaction of the patient and the difference from one to another with consideration to resolve in treatment difficulty.
Exploitation on the other hand is the ability of the patient to recognize interpersonal relationships and use the services offered effectively. Lastly, there is a resolution that refers to the relinquishing of ties in the relationship as the patient utilizes the lesson learned to better manage their health (Peplau, 1991).
Interpersonal Relations Theory
As a mother of nursing psychiatry, Peplau (1991) describes interpersonal relations as a conditional aspect that includes first the interaction of the nurse and patient. She points out that this is attained when understanding each patient’s condition is an experience that allows for improving nursing care (Peplau, 1991). Therefore, the focus in the definition of the theory begins with grasping the nurse and patient metaparadigm concepts as the interaction between patient and nurse makes the relationship personal. Similarly, considerable insights thus point out that the patient care process is personalized in a way that responsibility is both technical and emotional. Peplau (1991) explains that effective patient outcome delivery comes from trust in diagnostics and thus acceptance of health as an essential metaparadigm aspect. The theory focuses on developing the relationship between a nurse and a patient to emphasize trust and collaboration.
Based on Peplau (1991), the experience of establishing a connection between a nurse and a patient is an indicator of progress reporting and is the only source of data for patient experience information. Perception of the phenomena of patient information as instrumental to positive is highlighted as a primary measure of the direction of health. Based on the fact that health is described to be only a success when it moves in the positive direction, by looking at the patient with obesity this means loss of weight. At the same time, with the insistence on the sustainability of better health as the result being sought, there is direct evidence that the management of health, in the long run, is the better outcome for the patient in this project.
Peplau (1991) is supported by her in-depth analysis of the achievability of better health through utilitarian task alignment. Using communication as the necessary tool for the nurse to ensure that a patient attains a favorable outcome, as a theory, Interpersonal Relations theory emphasizes the built-in interaction as a psychodynamic need. This need is important as it is directionally focused on relieving the patient’s anxiety and improving their confidence regardless of external and self-perceived variables. There is thus centralization of goal setting for a patient with obesity that is linked directly to the strengthening of the nurse-patient relationship as the best approach to attaining better health outcomes.
This theory is a perfect fit for the proposed educational training program for nurses in an outpatient setting to provide education regarding the importance of a healthy diet for patients with obesity. The relationship between the outpatient and the nurse must be founded on trust so that information can be shared comfortably and with trusted support from nurses. A support system must be developed because obesity and the issues surrounding obesity can often bleed into self-esteem and mental health. This theorist ideology will assist in identifying and orienting nurses to the causes of obesity, introducing a perfectly balanced diet with regular exercise, and finally producing solutions for diabetic prevention, a foundation that this theoretical framework supports.
Interpersonal Relations Theory and Nursing’s Metaparadigm
Concerning the four metaparadigms, in her
Interpersonal Relations in Nursing Theory, Peplau (1991) defines it as input for developing positive outcomes and relinquishing the relationship with a support system that enhances positive outcomes. It is the promotion of health through appropriate methods and illness prevention by recognizing triggers for all patients. Therefore, the nurse can only facilitate treatment and not make a diagnosis; hence, the critical aspect is ensuring that the environment is conducive and that communication in the relationship with patients is constant. This means the nurse favors patients’ understanding of their issues by explaining the problem and the treatment plan. This includes a preventive measure to ensure informed decision-making is enhanced and thus a partnership that, in essence, is therapeutic.
Theoretically, Branch et al. (2016) defines a person as the receiver of care whose needs should be assessed all-round. On the other hand, Peplau (1991) theoretically defines environment as the surroundings of the patient which influences their bearing of health and wellness. At the same time, both Branch et al. (2016) and Peplau (1991) theoretically define health as the multidimensional extent to which a person attains wellness for a qualitative life. As such, they complete the definition of the four metaparadigms by pointing out that theoretically, nursing is the creation of a trust and mutual understanding between person and care giver to ensure that health outcomes are optimal (Branch et al., 2016 & Peplau, 1991).
For this project, the nurse is a supporter who ensures that patient needs are unique and met adequately and suitably to their circumstance. This recognizes that a different relationship develops between nurse and patient from one. In the same stance, a person is operationally defined as an entity with individual preconceptions and a mutual understanding of the nature of a medical issue. Within this understanding, they can collaborate with informed decision-making toward a productive solution.
Health is operationally defined as contextualized patient conditions that allow for human processes that facilitate tendencies supportive of positive development to attain health (Peplau, 1991). For this project, health is defined as a symbolic future positive goal that is attained after effective healthcare hence instrumental for the person moving in the forward direction of wellbeing
A patient is operationally defined by Peplau (1991) as a person in need who develops a relationship with a nurse to seek adequate support suitable for the promotion of better health. For this project, the patient is referred to as the outpatient navigating the interpersonal relationships with a medical service provider seeking the implementation of need-based healthcare delivery through the respectable promotion of perception and prevention of escalation of obesity (Peplau, 1991).
Peplau (1991) operationally defines environment as the unique position of the patient leading to the development of a different relationship with the nurse and health-related delivery in a way that affects the success rate of their health promotion. For this project, the environment will be operationally defined as conditions that allow for human processes that facilitate tendencies supportive of positive development to attain health. It is contextualized as the symbolic future positive goal that is attained after effective healthcare hence instrumental for the person moving in the forward direction of well-being (Peplau, 1991). As such, following Peplau’s underpinning of outpatient care for obese patients is ensuring that patient that individual preconceptions and mutual understanding of the nature of a medical issue allow for better collaboration toward a productive solution.
Initial Review of the Literature
The review of the literature will be conducted to explore studies that are associated with nursing education for obesity and a healthy diet. Using the following words both singularly and in multiple combinations: nursing training, obesity, outpatient care, nursing psychiatry, overweight, diet, obesity facts, obesity prevention, body weight, and care management planning. Databases searched, limited to the years 2018 and 2023, will include AMED, Alt Health Watch, CINAHL Plus with Full Text, EBSCO, Medical Journal sites for nursing care, nursing training, PubMed, Scopus, Science Direct, Directory of Open Access Journals, Google Scholar, JSTOR and the D’Youville library to loan articles through interlibrary loan. The search is limited to the years 2018 to 2023 to ensure that current evidence-based literature is reviewed and summarized for the purpose this project. A summary of the review of the literature is presented.
Dynamics of Outpatient Care
According to Balani et al., (2019) The epidemic of obesity is a significant health crisis that continues to increase globally, it is reported that in the United States, more than two-thirds of adults are considered either overweight or obese. A lifestyle disease is critical to the discussion on nursing care for outpatient obesity. As such, care focuses on management and fostering better and healthy weight maintenance (Kalligeros et al., 2020). Thus, it does not necessarily focus on age but understands that eagerness is also a risk factor for comorbidities associated with being overweight. Furthermore, Kalligeros et al. (2020) study points out that the exploration of the association between obesity and chronic diseases is something that should be understood. This is because there is a direct relation between the severity of the outcomes seen in intensive care units and admission rates. For example, research that analyzes a retrospective cohort with 103 patients found that the patients admitted to the hospital history of heart disease is a direct result of obesity. Therefore, a recommendation is that vigilance should be given to treating patients with obesity starting from the outpatient setting, alluding to necessitated prevention of escalation when faced with other conditions (Kalligeros et al., 2020).
Role of Nursing
The role of nursing is to provide integrated care and enhance patient comfort by providing interventions to alleviate symptoms of obesity. Findings from Rezaei et al. (2022) study point out that high morbidity rates are caused by poor health maintenance, which aligns with the results in studies by Smith et al. 2020; Sutaria et al., 2020. Furthermore, Gadde et al. (2018) study findings indicate a significant reduction in morbidity and mortality rates among patients in weight maintenance trials. The high number of obesity cases creates a risk factor in the population; this points to the need to emphasize training for this. Recognizing physician efforts in collaboration with outpatients by sensitization on environmental awareness is essential (Walia et al., 2022). This includes considering that proper evaluation starts by recognizing the appropriateness of the environment for supporting weight management. Achieving and maintaining weight loss or gain requires physician-patient collaboration in a way that can be facilitated by nurses providing pertinent information. Again, support and motivation are also determined by letting a carefully defined plan be identified with the patient to understand the expected health outcomes. This is the nurse’s work as it allows for the recognition of a strategy of control for each patient (Stonerock & Blumenthal, 2017: p.1457).
According to Rezaei et al. (2022), the combination of aspects such as the cost of health, care expenditures, and hospitalization risks are some of the reasons that can be used in motivating outpatients to adhere to their plan of losing weight. This study aligns with the findings of Piché et al. (2020) study findings. The findings indicate that advanced heart diseases are often caused by obesity and lack of maintenance, and the determinant of failure lies in the early handling of the issue. Therefore, health literacy is an integral part of the nursing fraternity to impart to the patients as it allows for the opportunity to understand the implication of obesity in the long run. Consequently, the narrative is applicable because by the time medication is involved, the progression will be higher risk associated and thus significant mortality risk, however, creating a provider-patient relationship with a healthy diet, diabetes and obesity teaching without having a judgmental response, whereby both parties agrees on goals, share a vision of improvement in general metabolic health status, the patient and provider will be able to create a personalized and participatory lifestyle changes plan as described by Foley et al. (2019) study. Furthermore, Alexander et al. (2021) study findings indicate that health literacy as part of outpatient training will provide the necessary support for proper weight loss and maintain it while allowing room for recognition of mental health too. This caters to the grasping of the incorporation of strategies that align outcomes centered on the totality of patient care within the six sigma of quality improvement in healthcare delivery.
Alexander et al. (2021) research focuses on promoting healthcare delivery as a focal point in preventive care and is supported by Levine et al. (2019), which look at a similar issue but with a different approach. Levine et al. (2019) surveyed to find out why the use of preventive healthcare is still low in the modern healthcare system. The findings from the survey linked modernization and the advancement in technology as one the contributors to the limited use of preventive medicine. Nevertheless, Harris et al. (2017) point out how using preventive healthcare would enhance the efficiency of care and result in better outcomes. Therefore, Alexander et al., 2021; Levine et al., 2019; Harris et al., 2017 studies collectively look at transitioning patients from outpatient to inpatient and provide insight into what to avoid and what is necessary to promote better care. From the start, the studies allow room for relativity in practices that promote and optimize safety, and within those points to the relevance of individual patient circumstances. While the project gives valuable information on the standard procedure, it contributes to the general discussion on the improvement of health by nurses. It thus applies that, for all patients, recognition of the value in situation background assessment facilitates the improvement of health outcomes. The improvement starts with a reduction in risks hence understanding beneficial outcomes accurately first (Alexander et al., 2021).
Recognition of Potential Barriers
There is also a need to recognize the impact of cultural competency in nursing care (Chae & Park, 2019). With outpatients, there is a risk of exposure to external biases and pressure that may result in declining health whenever they leave a session. Therefore, the value must be provided in educating the patient on the potential risks they face within their environment. This can only be achieved through collaboration which aligns with the results of Seger’s (2019) and Ogbolu et al. (2018) studies. Furthermore, it is essential for the perspective of the community and support system of the patient to be observed by the patient (Bloor & McIntosh, 2019). Therefore, sharing with the nurse is a natural step of goal setting that allows an informed understanding of the underlying implication of the stereotypes and norms of expectation (Halvorson et al., 2019). This will help focus on reducing the risk of “temptation” of hindrances to improving patient health in a way that respects them and their communities. Similarly, (Balani, et al., 2019) study examined factors affecting healthy weight in the community, the study explained that obesity is not a lifestyle crisis, but rather a complicated, chronic disease affecting areas of behavioral, psychosocial, biological, and environmental factors. For this reason, there is a need for a collaborative and comprehensive approach to obesity management. Therefore, foundational planning is essential for the nurse and the patient to recognize early on.
According to Hee Soon, et al. (2019) opted to conduct a study on this subject focusing on the younger populations. They point out that one thing that tends to be overlooked is the fact that children tend to learn from what they see happening in their surroundings. Thus, even if a child is prone to eating healthy when they are in their respective homes, they are also prone to be influenced by what they see in schools or other surroundings. This research study aimed to answering the question, “What are the barriers at home and school to healthy eating?” It also aimed at answering this through the perspectives of parents and children who had or were suffering from obesity, therefore, parents, teachers, and community healthcare providers should alleviate the issues of obesity through adequate healthy diet teaching and implementation.
It is imperative that when it comes to the management of unvoiced expectations of a patient in a way that recognizes their efforts and input towards change. According to Ma et al. (2019) study findings, obesity management requires self-discipline at a higher level than average and recognizing a gradual result, supported by Reas’s (2017) study. These studies describe how lack of self-discipline results in binge eating disorder; at the same time, public and healthcare professionals’ knowledge, and attitudes toward the relationship between self-awareness results in binge eating disorder and, consequently, weight gain (obesity). The fact that it cannot be cured by medication and results are not immediate is a cause of concern that both nurse and patient should understand (Boersema et al., 2021: p.11). It requires patience and a lens where small milestones can only weigh competent management. Furthermore, obesity practitioners must have complete comprehension and apply evidence-based knowledge while administering care to patients with obesity (Srivastava et al., 2019: p.196).
When management optimization is needed in the treatment strategy for a patient with obesity, especially outpatients, there is a need for longitudinal consideration of the comprehensiveness of management aspects. According to Seger (2019), a complication of obesity as a chronic illness is as sophisticated as any other issue, which aligns with Godfrey et al. (2017) study. Godfrey et al. (2017) describe the complications primarily associated with maternal obesity, including coronary artery disease, obesity in the offspring, asthma, and allergies. In addition, Wharton et al. (2020), tackles nursing and obesity pointing it to be one of the current health concerns affecting a large proportion of the world’s population as it interferes with health outcomes As such, an intensity level should be employed with preventive controls in line with the responsibility set. This allows for desired treatment to be the main goal rather than the desired end product, such as specific weight. It removes the tension without negating the implication of the process and thus optimizes input by the small measures that can be seen regularly. Therefore, a pathophysiological approach is necessary for an all-hands-on methodology hence simplicity that is specific to the patient in question rather than a generalization as in Block et al. (2020) study findings.
Nurses’ Knowledge of The Management of Obesity
Inadequacy of skills and knowledge among healthcare professionals is one of the significant challenges facing the fight against metabolic conditions such as obesity. Bucher Della Torre et al. (2018) describe one of the challenges in one of the university hospitals as the presentation of poor knowledge, skills, and attitude about obesity among nurses and physicians, which aligns with the findings of Turner et al.’s (2018) study. Turner et al.’s study revealed inadequate knowledge concerning managing obesity effectively. The results imply that provider perception of optimal healthcare services for obesity is at odds with research-based guidelines. Healthcare practitioners must be aware of the best ways to use pharmacotherapy and behavioral counseling, such as adopting a healthy diet; these interventions are widely applied in improving the health of obese patients (Turner et al., 2018).
Reinforcing Positive Environment in Nurse-Patient Relationship
When looking at the studies, it is evident that nurse and patient relationships are integral to both the definition of health and the understanding of treatment planning. These are essential to the pathways to positive outcome expectation and hence accurate to the operational definitions. Given that outpatient care for obesity is almost therapeutic, there is a sense of delivery requiring that verbal and non-verbal communication be read. As such, the nurse must have the core conditioning of genuine concerns, which sometimes could be perceived as going above and beyond the baseline required (Okdie & Ewoldsen, 2018). The relationship between the two is skill-based, examining the level of trust in both directions with absolute truths. The points of conflict should thus be handled with care and isolated from the goals by accepting attitudes as progression hence the removal of fear (Walia et al., 2022). This also removes the anxiety of either side as the nurse can trust that discipline will be employed within the period they have not met. Similarly, the patient will trust that information will not be withheld, anger will not be enforced, and the environment of care will be positively reinforced with empathy rather than pity.
Significance and Justification
Findings from the initial literature review revealed that a lack of knowledge exists in nursing and patient care practice regarding obesity and diet management. In their study, Bucher et al. (2018) revealed a significant inadequacy of knowledge and skill among nurses and physicians working in a university hospital concerning the management of obesity (Bucher et al., 2018). This gap exists, yet healthcare professionals ought to be at the forefront of executing various interventions in managing obesity and healthy diet. It is an implication that patients suffering from obesity and related complications will find it challenging to get adequate and effective nursing education concerning diet to manage and treat their condition. In addition, there is inconsistency in provider understanding of appropriate clinical care for obesity. The study recommends that there is a need for healthcare professionals to develop an understanding of how to effectively leverage health interventions to promote outcomes for patients with obesity. This article is a good choice for supporting the proposed project because it points out the limitations of proper management of obesity, one of which is the low knowledge level among health professionals and the need to address them towards achieving the goal of healthcare. Therefore, this project will enable nurses to have a training program where they will obtain more knowledge and skills concerning the management of obesity through dietary interventions.
Project Objectives
The objectives of this project are to:
1. Conduct an extensive review of the literature exploring a healthy diet for patients with obesity using the following keywords both singularly and in multiple combinations: nursing training, obesity, obesity prevention, outpatient care, overweight, diet, and healthy diet. Databases searched, limited to the years 2017 to 2022, will include, AMED, Alt Health Watch, CINAHL Plus with Full Text, EBSCO, Medical Journal sites for nursing care, nursing training, PubMed, Scopus, Science Direct, Directory of Open Access Journals, Google Scholar, JSTOR and the D’Youville library to loan articles through interlibrary loan;
2. Develop an Educational Training Program; and
3.
Have a panel of five content experts with extensive knowledge and expertise in a healthy diet for patients with obesity evaluate and critique the project for clarity, readability, applicability, quality, organization, and evidence-based clinical relevance.
Definition of Terms
The following concepts are defined both theoretically and operationally for the purpose of this project:
Health Promotion
Theoretical Definition: Facilitation of motivational behavior to recognize a positive outcome as an approach to better health management (Peplau, 1991).
Operational Definition: conducting and directing the implementation of weight management strategies that enhance forward-focused change for a better quality of life for outpatients that are diagnosed with obesity.
Healthcare Support
Theoretical and Operational Definition: integrative healthcare service delivery that facilitates the provision of effective and efficient aid to the patient in a way that is essential to their safety, improved quality of life, and development of better coping tools (Boersema et al., 2021). Operational Definition: A nursing duty that recognizes the provision of the totality of care for outpatients with obesity through readiness in resource and information availability that allows sustainable improvement of patient’s health.
Healthy diet
Theoretical definition: Refers to both a health-promoting and disease-preventing diet. It delivers adequate nutrients and other health-promoting ingredients from wholesome foods while avoiding ingesting harmful substances (Chaudhary et al., 2018). Operational Definition: A diet composed of macronutrients, micronutrients, and vitamins necessary for maintaining the body’s normal functioning and promoting health through enhancing healthy weight loss in obese and overweight patients.
Limitations
The Project Author recognizes the following project limitations:
1. The implementation of the educational training program is not within the context of this project;
2. The educational training program is developed in the English language only and may benefit a more culturally diverse population if written in additional languages.
Project Development Plan
A detailed topical outline of the educational training program content is created based on the extensive review of evidence-based literature and the theoretical framework used to support and guide the development of an educational training program. After permission is granted from the D’Youville Patricia H. Garman School of Nursing, graduate faculty designee (Appendix A), five professionals with knowledge and expertise in a healthy diet for patients with obesity will be asked if they are interested in voluntarily participating as expert content reviewers for an educational training program. The content expert panel will consist of two registered nurses working in an outpatient healthcare service delivery, one nutritionist working in a public health system that educates about healthy diets, and two clinical dieticians working in an outpatient clinic. If interested, the Project Author will mail a packet containing a Letter of Intent (Appendix B), a copy of the
Content Expert Project Evaluation Tool
created by the Project Author specifically for the project (
Appendix C
), a copy of the educational training program (
Appendix D
), and a self-addressed stamped envelope. The Letter of Intent will explain the project purpose and instructions for completing and returning the Content Expert Project Evaluation Tool to the Project Author. The Content Expert Project Evaluation Tool contains six evaluative items with space for narrative comments and suggestions. Approximately 20 minutes will be required to review the educational training program and to complete the Content Expert Project Evaluation Tool. Content experts will be provided a self-addressed envelope to return the Content Expert Project Evaluation Tool to the Project Author. Once all evaluation tools are returned to the Project Author, data will be analyzed and reported narratively and in bar graph format. A summary of the evaluation results, including the findings of the six evaluative items in the content expert project evaluation tool, will be provided to the content expert reviewers by postal mail.
Plan for the Protection of Human Subjects
Following approval from D’Youville Patricia H. Garman School of Nursing, the graduate faculty designee (Appendix A) five professionals with knowledge and expertise in the field of a healthy diet particularly for patients with obesity will be personally approached and asked to voluntarily participate as a content expert in the review and evaluation of an educational training program (Appendix D). Content experts will be advised that participation or non-participation as an expert reviewer will have no effect on their employment status. The Project Author has a collegial, professional, and nonsupervisory relationship with the content expert reviewers thereby protecting the participants from any risk of coercion. Content experts will be guaranteed confidentiality because identifying characteristics will not be collected on the Content Expert Project Evaluation Tool and because their names will not be revealed anywhere in the project manuscript or in required project presentations. Only the Project Author will know the names of the content expert reviewers. Return of the completed content expert Project Evaluation Tool (Appendix C) will indicate implied voluntary consent to participate as a content expert reviewer. Content experts will be advised that they will not be able to withdraw from project participation once the project evaluation tool is returned to the Project Author because the evaluation tool will be returned without identifying information. Returned Content Expert Project Evaluation Tools will be stored according to the D’Youville Patricia H. Garman School of Nursing protocol in a locked drawer located in the Project Author’s home for a period of three years and then destroyed.
Plan for Project Evaluation
After obtaining full approval from the D’Youville Patricia H. Garman School of Nursing (Appendix A), the Project Author will mail a packet to each content expert reviewer containing one Letter of Intent (Appendix B), one copy of the Content Expert Project Evaluation Tool (Appendix C), one copy of the educational training program (Appendix D), and one self-addressed stamped envelope. The Letter of Intent will explain the project purpose and instructions for completing and returning the Content Expert Project Evaluation Tool to the Project Author.
The Content Expert Project Evaluation Tool will consist of six evaluative items scored on a four-point Likert Scale that ranges from (1) Strongly Disagree, (2) Disagree, (3) Agree, and (4) Strongly Agree. Space will be provided for narrative comments and suggestions following each evaluative item. Evaluative items will ask reviewers to rate the resource guide on clarity, readability, applicability, quality, organization, and evidence-based clinical relevance. Approximately 20 minutes will be required to review the resource guide and to complete the Content Expert Project Evaluation Tool. Content experts will be given seven days to complete and return the Content Expert Project Evaluation Tool to the Project Author via postal mail using the self-addressed stamped envelope included in the original packet. Likert scale responses will be presented narratively and displayed in bar graph format. Content expert suggestions and comments will be analyzed for common themes and presented narratively. A summary of the evaluation results including the findings of the six evaluative items in the content expert project evaluation tool will be provided to the content expert reviewers by postal mail.
Summary
Chapter I presented the project introduction, statement of purpose, an overview of the theoretical framework guiding project development, an initial review of the literature focusing on
the development of an educational training program for nurses in an outpatient setting exploring healthy diets for patients with obesity, the project significance and justification, project objectives, definition of terms, project limitations, the project development plan, the protection of human subjects, the plan for project evaluation, and a chapter summary. Chapter II will provide an extensive review of the literature focusing on an educational training program for nurses regarding the importance of a healthy diet for patients with obesity and a chapter summary. Chapter III will discuss the intended project setting and population, the content expert participants, data collection methods, project tools, the protection of human subjects, and a chapter summary. Chapter IV will discuss the evaluation of the project, implications for future advanced nursing practice, recommendations for future projects and research, and a chapter summary.
References
Alexander, C. C., Tschannen, D., Hays, D., Clouse, M., Zellefrow, C., Amer, K. S., … & Milner, K. A. (2022). An integrative review of the barriers and facilitators to nursing engagement in quality improvement in the clinical practice setting.
Journal of Nursing Care Quality,
37(1), 94-100.
Alexander, C., Rovinski-Wagner, C., Wagner, S., & Oliver, B. J. (2021). Building a Reliable Health Care System: A Lean Six Sigma Quality Improvement Initiative on Patient Handoff.
Journal of Nursing Care Quality,
36(3), 195-201.
Allan, J. (2020). Theorizing new developments in critical social work. In
Critical social work, 30–44. Routledge.
Balani, R., Herrington, H., Bryant, E., Lucas, C., & Kim, S. C. (2019). Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity.
Journal of the American Association of Nurse Practitioners,
31(9), 502-510.
Block, B. L., Smith, A. K., & Sudore, R. L. (2020). During COVID‐19, outpatient advance care planning is imperative: We need all hands on deck.
Journal of the American Geriatrics Society.
Bloor, M., & McIntosh, J. (2019). Surveillance and concealment: a comparison of techniques of client resistance in therapeutic communities and health visiting. In
Selected Writings in Medical Sociological Research, 93–116. Routledge.
Boersema, G. C., Smart, H., Giaquinto-Cilliers, M., Mulder, M., Weir, G. R., Bruwer, F. A., … & Van der Merwe, Z. (2021). Management of non-healable and maintenance wounds: a systematic integrative review and referral pathway.
Wound Healing Southern Africa,
14(1), 8-17.
Branch, C., Deak, H., Hiner, C., & Holzwart, T. (2016). Four nursing metaparadigms.
IU South Bend Undergraduate Research Journal, 16, 123-132.
Bucher, D. T. S., Courvoisier, D. S., Saldarriaga, A., Martin, X. E., & Farpour‐Lambert, N. J. (2018). Training is essential in nurses’ and physicians’ knowledge, attitudes, representations, and declared practices about obesity in a university hospital.
Clinical obesity,
8(2), 122-130.
Chae, D., & Park, Y. (2019). Organizational cultural competence needed to care for foreign patients: A focus on nursing management.
Journal of Nursing Management,
27(1), 197–206.
Chaudhary, A., Gustafson, D., & Mathys, A. (2018). Multi-indicator sustainability assessment of global food systems.
Nature communications, 9(1), 1-13. Retrieved from
https://doi.org/10.1038/s41467-018-03308-7
Foley, P. J., Gunson, J. T., & Baumann, S. L. (2019). Two Stories about Diet and Diabetes in Europe.
Nursing Science Quarterly,
33(1), 85-90.
Gadde, K. M., Martin, C. K., Berthoud, H. R., & Heymsfield, S. B. (2018). Obesity: pathophysiology and management.
Journal of the American College of Cardiology,
71(1), 69–84.
Godfrey, K. M., Reynolds, R. M., Prescott, S. L., Nyirenda, M., Jaddoe, V. W., Eriksson, J. G., & Broekman, B. F. (2017). Influence of maternal obesity on the long-term health of offspring.
The lancet Diabetes & endocrinology,
5(1), 53-64.
Halvorson, E. E., Curley, T., Wright, M., & Skelton, J. A. (2019). Weight bias in pediatric inpatient care.
Academic Pediatrics,
19(7), 780-786.
Hee Soon, K. I. M., Jiyoung, P. A. R. K., Yumi, M. A., & Mihae, I. M. (2019). What are the barriers at home and school to healthy eating? Overweight/obese child and parent perspectives.
The Journal of Nursing Research,
27(5), e48. Retrieved from
https://doi.org/10.1177/0894318419881797
Kalligeros, M., Shehadeh, F., Mylona, E. K., Benitez, G., Beckwith, C. G., Chan, P. A., & Mylonakis, E. (2020). Association of obesity with disease severity among patients with coronavirus disease 2019.
Obesity,
28(7), 1200-1204.
Levine, S., Malone, E., Lekiachvili, A., & Briss, P. (2019). Health care industry insights: why the use of preventive services is still low.
Preventing chronic disease,
16.
Ogbolu, Y., Scrandis, D. A., & Fitzpatrick, G. (2018). Barriers and facilitators of care for diverse patients: Nurse leader perspectives and nurse manager implications.
Journal of nursing management,
26(1), 3-10.
Oleck, L. (2022). Psychiatric-Mental Health Nurses: Spread the Word.
Journal of the American Psychiatric Nurses Association, 28(5), 413–415. Retrieved from
https://doi.org/10.1177/10783903221117555
Peplau, H. (1991).
Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. Springer Publishing.
Phillips, K. E., & LoGiudice, J. A. (2020). Practices and Attitudes of Nursing Students Toward Patients with Disordered Eating Behaviors.
Nursing education perspectives, 41(1), 49-51.
Piché, M. E., Tchernof, A., & Després, J. P. (2020). Obesity phenotypes, diabetes, and cardiovascular diseases.
Circulation Research,
126(11), 1477-1500.
Rezaei, S., Vaezi, F., Afzal, G., Naderi, N., & Mehralian, G. (2022). Medication Adherence and Health Literacy in Patients with Heart Failure: A Cross-Sectional Survey in Iran.
HLRP: Health Literacy Research and Practice,
6(3), e191-e199.
Ross, A., Yang, L., Wehrlen, L., Perez, A., Farmer, N., & Bevans, M. (2019). Nurses and health‐promoting self‐care: Do we practice what we preach?
Journal of nursing management,
27(3), 599-608.
Seger, J. C. (2019). Optimizing Outcomes in Outpatient Obesity Management. In
Quality in Obesity Treatment, 221–234. Springer, Cham.
Shi, H. (2017). Planning Effective Educational Programs for Adult Learners.
World Journal of Education,
7(3), 79–83.
Smith, J. D., Fu, E., & Kobayashi, M. A. (2020). Prevention and management of childhood obesity and its psychological and health comorbidities.
Annual review of clinical psychology,
16, 351-378.
Srivastava, G., Fox, C. K., Kelly, A. S., Jastreboff, A. M., Browne, A. F., Browne, N. T., … & Apovian, C. M. (2019). Clinical considerations regarding the use of obesity pharmacotherapy in adolescents with obesity.
Obesity,
27(2), 190–204.
Stonerock, G. L., & Blumenthal, J. A. (2017). Role of counseling to promote adherence in healthy lifestyle medicine: strategies to improve exercise adherence and enhance physical activity.
Progress in cardiovascular diseases,
59(5), 455-462.
Sutaria, S., Devakumar, D., Yasuda, S. S., Das, S., & Saxena, S. (2019). Is obesity associated with depression in children? Systematic review and meta-analysis.
Archives of disease in childhood,
104(1), 64-74.
Tartavoulle, T., & Landry, J. (2021). Educating Nursing Students About Delivering Culturally Sensitive Care to Lesbian, Gay, Bisexual, Transgender, Questioning/Queer, Intersex, Plus Patients: The Impact of an Advocacy Program on Knowledge and Attitudes.
Nursing education perspectives, 42(4), E15-E19.
Turner, M., Jannah, N., Kahan, S., Gallagher, C., & Dietz, W. (2018). Current knowledge of obesity treatment guidelines by health care professionals.
Obesity,
26(4), 665–671.
Walia, I., Krainovich-Miller, B., & Djukic, M. (2022). Nurses’ Lived Experience with Nurse–Physician Collaboration.
The Journal of Continuing Education in Nursing,
53(9), 397–403.
Wharton, S., Lau, D. C., Vallis, M., Sharma, A. M., Biertho, L., Campbell-Scherer, D., … & Wicklum, S. (2020). Obesity in adults: a clinical practice guideline.
Canadian Medical Association Journal, 192(31), E875-E891. Retrieved from
https://www.cmaj.ca/content/cmaj/192/31/E875.full
CMAJ 2020 August 4;192:E875-91. doi: 10.1503/cmaj.191707
Whitehouse, C. R., Sharts-Hopko, N. C., Smeltzer, S. C., & Horowitz, D. A. (2018). Supporting transitions in care for older adults with type 2 diabetes mellitus and obesity.
Research in gerontological nursing,
11(2), 71–81.
Appendix A
Patricia H. Garman School of Nursing
Full Approval Letter
Appendix B
Letter of Intent
Content Expert Letter of Intent
Dear Content Expert,
Hello, my name is ayoola aaaa, I am a graduate student completing a Master of Science in Nursing/Family Nurse Practitioner degree at D’Youville College in Buffalo, New York. Currently, I am developing an Educational Training Program for nurses on healthy diet and obesity in an outpatient setting.
I am submitting the Educational Training Program for your expert review and evaluation. Recommendations and critiques of this work in progress will be taken into serious consideration during the final revisions of this work. You are being asked to review and evaluate the resource guide for clarity, readability, applicability, quality, organization, and evidence-based relevance. Your review of the Educational Training Program should take approximately 20 minutes of your time. The evaluation process is completely voluntary and your refusal to participate will involve no penalty or loss to you. Your responses will be kept confidential and will be available only to me. If you choose to participate, please return the evaluation tool within the next seven (7) days using the enclosed self-addressed stamped envelope. Consent to participate in the evaluation is implied upon the completion and return of the evaluation tool. Once you return the evaluation tool, there is no way to withdraw your responses, as there are no identifying markers included on the tool. Returned evaluation tools will be stored in my home for a period of three years and then destroyed. There are no direct benefits to you as a content expert participant. A copy of the results including the findings of the six evaluative items in the content expert project evaluation tool will be mailed to you at the conclusion of this project.
If you have any questions regarding my project or the evaluation process, please contact me via email at ddddddd@dyc.edu. Any specific questions may be directed to Dr. Sharon Mang, my Project Chair, at (716) ——0000 or via email at ppppp@dyc.edu. Thank you for your assistance and participation as a content expert. I look forward to receiving your evaluation of my project.
Best Regards,
Ayoola mmmmm
Appendix C
Content Expert Project Evaluation Tool
Instructions:
The purpose of this tool is to provide you with a guideline for evaluating the clarity, readability, applicability, quality, organization, and relevance of the current evidence-based practice of the proposed an Educational Training Program. The purpose of the project is to develop an Educational Training Program to provide nurses with information on the importance of a healthy diet for obese patients in an outpatient setting. Using the four-point Likert Scale, please circle one choice that best reflects your opinion. Space is provided after each of the six evaluative items for further feedback and direction regarding the Educational Training Program. To maintain your confidentiality, please do not make any identifying marks on the evaluation tool.
1.
Clarity
The information presented in the Educational Training Program is clearly understood and easy to follow
Strongly disagree
Disagree
Agree
Strongly agree
1
2
3
4
Comments and Suggestions:
2. Readability
The information in the Educational Training Program is presented at an appropriate and comprehensive level of reading for pediatric healthcare providers.
Strongly disagree
Disagree
Agree
Strongly agree
1
2
3
4
Comments and Suggestions:
3. Applicability
The information presented in the Educational Training Program is relevant and fits the project’s purpose.
Strongly disagree
Disagree
Agree
Strongly agree
1
2
3
4
Comments and Suggestions:
4. Consistency
The Educational Training Program is well-designed and with a consistent flow.
Strongly disagree
Disagree
Agree
Strongly agree
1
2
3
4
Comments and Suggestions:
5. Organization
The Educational Training Program is in order and well organized
Strongly disagree
Disagree
Agree
Strongly agree
1
2
3
4
Comments and Suggestions:
6. Evidence-Based Clinical Relevance
The Educational Training Program addresses a current and clinically relevant problem in nursing and patient care practice and utilizes current clinical evidence.
Strongly disagree
Disagree
Agree
Strongly agree
1
2
3
4
Comments and Suggestions:
Thank you for taking the time to evaluate the Educational Training Program. Your feedback is deeply appreciated and will strengthen the development of the Educational Training Program for nurses in an outpatient setting.
Appendix D
Educational Training Program
Appendix E
Survey Tool Results
1
AN EDUCATIONAL TRAINING PROGRAM FOR NURSES IN AN OUTPATIENT
SETTING REGARDING THE
IMPORTANCE OF A HEALTHY DIET FOR PATIENTS WITH OBESITY
By
Funmilola A Akerele
A Project
Submitted to the Faculty of D’Youville
Division of Academic Affairs
In partial fulfillment of the
requirements for the degree of
Master of
Science in
Family Nurse Practitioner
Buffalo, NY
[Month Day, Year]
Sharon Mang
4501000000000172
5
Do not center the title
wwwwwwwwwwwww
2
Copyright © 2023 by Funmilola A, Akerele. All rights reserved. No part of this project
may be copied or reproduced in any form or by any means without the written permission
of Funmilola A, Akerele.
wweeeeetyuioyyyyyy
3
PROJECT APPROVAL
Project Committee Chairperson
Name: __ ________Dr. Sharon Mang_____________________
Signature: ___________________________________________
Discipline: ________________Nursing________________
Project Defended
On
[Month Day, Year]
sdddddddddddd
4
Abstract
Obesity has become a significant concern in the healthcare system, and diet is the key
contributing factor to obesity. Therefore, a healthy diet should be the primary requirement for
reducing weight and improving overall health. The health life knowledge gap among patients and
limited nursing education programs contribute to this condition. Nurses should collaborate
closely with patients to provide healthcare education that will assist patients in improving their
nutritional habits and identify the challenges they face in maintaining a healthy diet. An
educational training program for nurses regarding obesity and diet will allow nurses to advance
their knowledge of the risk factors of obesity, the health conditions associated with obesity, and
how to manage obesity (Seger, 2019). Peplau Interpersonal relations in Nursing Theory is
utilized as the theoretical framework for this project. Five content experts will review the
educational training program for content validity.
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was
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reviewed
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Relations
5
Acknowledgment
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fill in or take out
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Table of Contents
Chapter
I. PROJECT INTRODUCTION …………………………………………………………… 8
Statement of Purpose ……………………………………………………………………….. 9
Theoretical Framework ……………………………………………………………………. 9
Initial Review of the Literature ………………………………………………………….13
Significance and Justification ……………………………………………………………21
Project Objectives ……………………………………………………………………………
21
Definition of Terms ………………………………………………………………………..
22
Project Limitations ………………………………………………………………………… 22
Project Development Plan
………………………………………………………………. 22
Plan for Protection of Human Subjects ……………………………………………..
24
Plan for Project Evaluation……………………………………………………………… 24
Summary ……………………………………………………………………………………… 25
II. REVIEW OF LITERATURE …………………………………………………………..
Summary ………………………………………………………………………………………
III. PROJECT DEVELOPMENT PLAN. ……………………………………………….
Project Setting and Population… ……………………………………………………..
Content Expert Participants
…………………………………………………………….. Data
Collection Methods
…………………………………………………………………
Project Tools …………………………………………………………………………………
The Protection of Human Subjects ………………………………………………………
Summary ………………………………………………………………………………………
IV. PROJECT EVALUATION, IMPLICATIONS, AND FUTURE
RECOMMENDATIONS
……………………………………………..
Project Evaluation ………………………………………………………………………….
Implications for Future Practice ……………………………………………………….
Future Recommendations ………………………………………………………………..
Summary ………………………………………………………………………………………
References ……………………………………………………………………………………. 2
7
Appendices …………………………………………………………………………………… 32
7
List of Appendices
Appendix
A D’Youville Patricia H. Garman School of Nursing
Full Approval Letter
…………………….….
B Letter of Intent …………………………………………………………………………………….
C Evaluation Tool …………………………………………………………………………………..
D An Educational Training Program …………………………………………………………
E Survey tool results in graph……………………………………………….
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take out An
8
Chapter I
The age of fast food and instant gratification brought about by the growth of technology
has affected the general population in many ways. In America, obesity is becoming problematic,
with a prevalence estimate of 41% leading to risk in the severity of diseases (Kalligeros et al.,
2020). As a result, there is a need for nursing practice to take accountability in developing a
relationship with collaborative patient care. Obesity can be a lifestyle disease. Therefore, all
stakeholder participation must be considered a need to look at the four-metaparadigm perspectives
in caregiving using a foundational basis in a theoretical framework. First, a nurse needs expertise
in addressing health issues, especially those reversible through natural means, for example,
obesity. Obesity is reversible through natural means, including dietary modification and practicing
fasting.
The factors that make a successful program include proper planning. Proper planning
allows for allocating adequate time and resources toward the project, resulting in the successful
implementation of the program (Shi, 2017). Another factor is incorporating experienced project
managers with knowledge about the program. For example, specialists such as nutritionists and
experts in physical activity and breastfeeding are essential when developing a program to
improve nutrition in children and adults and minimize obesity. Finally, it is essential to practice
monitoring and control for a program to succeed. Regular evaluation of the progress and the
program results allows for modification and alignment in case of an error or a potential error—
effective communication results in a program’s success (Ross et al., 2019).
The success of any implementable nursing program should have ways to effect cultural
change. As such, education plays a significant role in making people adopt healthy habits.
Education is well achievable after evaluating the clients through wellness programs and other
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you are not implementing the educational training program
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are you referring to the educational training program?
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is this supported in the literature?
9
community programs that involve health checkups and screening. However, personal barriers such
as individual change resistance may negatively impact the success of the social change (Allan,
2020). Some people are susceptible to changes they perceive as threats to their social environment,
including the workplace. Individuals may develop resistance to change when they feel uncertain
about the intervention or when the change comes as a surprise without the time to prepare mentally.
The questions about the competency of the intervention concerning the new environment—the
resistance results in difficulty in implementing the intervention to achieve social change (Ross et
al., 2019). This study will assess interpersonal relations in nursing theory to draw mechanisms for
developing effective strategies for an educational plan for nurses taking care of patients with
obesity in an outpatient department. The program will major in how nurses can effectively pass
educative information to the clients on dietary intervention as a critical mechanism for reversing
obesity. The idea considers all the possible challenges nurse educators may experience while trying
to enhance social changes among patients.
Statement of Purpose
The purpose of this project is to develop an educational training program for nurses in an
outpatient setting regarding the importance of a healthy diet for patients with obesity.
Theoretical Framework
Hildegard Peplau’s (1991) Interpersonal Relations in Nursing Theory is utilized as the
theoretical framework for developing this project. A brief overview of the theory is presented as
well as a discussion regarding how the theory was utilized to guide the project’s development. In
addition, Peplau’s (1991) theoretical definitions for nursing’s interpersonal relationships and
concepts together with the Project Author’s operational definitions for nursing’s four metaparadigm
concepts will be presented.
Sharon Mang
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Take out the remaining sentences and add a sentence to follow up on the previous sentences on how the literature supports the need for education on a healthy diet for patients with obesity.
10
Interpersonal Relations Theory
Hildegard E. Peplau’s impact on nursing and patient care is reflected in her development
and establishment of the Interpersonal Relations Theory. Her theory development began with
questions of the philosophical underpinning of psychology as fundamental in-patient care
especially when it came to nursing and patient relationships (Peplau, 1991). According to Peplau
(1991), the development of patient care begins by understanding the foundational elements as
concepts of nursing care. namely, the orientation, identification, exploitation, and resolution
defined. In her book, Interpersonal Relations in Nursing, the theory emphasizes the importance of
crosscutting issues and their effect on nursing care and patient wellness, such as nursing education
on dietary interventions for patients with obesity. Orientation refers to the reaction of the patient
and the difference from one to another with consideration to resolve in treatment difficulty.
Exploitation on the other hand is the ability of the patient to recognize interpersonal relationships
and use the services offered effectively. Lastly, there is a resolution that refers to the relinquishing
of ties in the relationship as the patient utilizes the lesson learned to better manage their health
(Peplau, 1991).
Interpersonal Relations Theory
As a mother of nursing psychiatry, Peplau (1991) describes interpersonal relations as a
conditional aspect that includes first the interaction of the nurse and patient. She points out that
this is attained when understanding each patient’s condition is an experience that allows for
improving nursing care (Peplau, 1991). Therefore, the focus in the definition of the theory begins
with grasping the nurse and patient metaparadigm concepts as the interaction between patient and
nurse makes the relationship personal. Similarly, considerable insights thus point out that the
patient care process is personalized in a way that responsibility is both technical and emotional.
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in Nursing Theory
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take out this subheading
11
Peplau (1991) explains that effective patient outcome delivery comes from trust in diagnostics and
thus acceptance of health as an essential metaparadigm aspect. The theory focuses on developing
the relationship between a nurse and a patient to emphasize trust and collaboration.
Based on Peplau (1991), the experience of establishing a connection between a nurse and
a patient is an indicator of progress reporting and is the only source of data for patient experience
information. Perception of the phenomena of patient information as instrumental to positive is
highlighted as a primary measure of the direction of health. Based on the fact that health is
described to be only a success when it moves in the positive direction, by looking at the patient
with obesity this means loss of weight. At the same time, with the insistence on the sustainability
of better health as the result being sought, there is direct evidence that the management of health,
in the long run, is the better outcome for the patient in this project.
Peplau (1991) is supported by her in-depth analysis of the achievability of better health
through utilitarian task alignment. Using communication as the necessary tool for the nurse to
ensure that a patient attains a favorable outcome, as a theory, Interpersonal Relations theory
emphasizes the built-in interaction as a psychodynamic need. This need is important as it is
directionally focused on relieving the patient’s anxiety and improving their confidence regardless
of external and self-perceived variables. There is thus centralization of goal setting for a patient
with obesity that is linked directly to the strengthening of the nurse-patient relationship as the best
approach to attaining better health outcomes.
This theory is a perfect fit for the proposed educational training program for nurses in an
outpatient setting to provide education regarding the importance of a healthy diet for patients with
obesity. The relationship between the outpatient and the nurse must be founded on trust so that
information can be shared comfortably and with trusted support from nurses. A support system
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take out thus
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for this project as the relationship between the nurse and patient must be founded on trust. A support system…
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in Nursing Theory
12
must be developed because obesity and the issues surrounding obesity can often bleed into self-
esteem and mental health. This theorist ideology will assist in identifying and orienting nurses to
the causes of obesity, introducing a perfectly balanced diet with regular exercise, and finally
producing solutions for diabetic prevention, a foundation that this theoretical framework supports.
Interpersonal Relations Theory and Nursing’s Metaparadigm
Concerning the four metaparadigms, in her Interpersonal Relations in Nursing Theory,
Peplau (1991) defines it as input for developing positive outcomes and relinquishing the
relationship with a support system that enhances positive outcomes. It is the promotion of health
through appropriate methods and illness prevention by recognizing triggers for all patients.
Therefore, the nurse can only facilitate treatment and not make a diagnosis; hence, the critical
aspect is ensuring that the environment is conducive and that communication in the relationship
with patients is constant. This means the nurse favors patients’ understanding of their issues by
explaining the problem and the treatment plan. This includes a preventive measure to ensure
informed decision-making is enhanced and thus a partnership that, in essence, is therapeutic.
Theoretically, Branch et al. (2016) defines a person as the receiver of care whose needs
should be assessed all-round. On the other hand, Peplau (1991) theoretically defines environment
as the surroundings of the patient which influences their bearing of health and wellness. At the
same time, both Branch et al. (2016) and Peplau (1991) theoretically define health as the
multidimensional extent to which a person attains wellness for a qualitative life. As such, they
complete the definition of the four metaparadigms by pointing out that theoretically, nursing is the
creation of a trust and mutual understanding between person and care giver to ensure that health
outcomes are optimal (Branch et al., 2016 & Peplau, 1991).
Sharon Mang
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may lead to decreased self-esteem and mental health issues.
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not a primary theorist source
Sharon Mang
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Suggest you follow the template in the Graduate Project Handbook. For each concept, start with the theoretical definition and include the primary theorist source citation, followed by the operational definition. Each definition should be one sentence in length and each concept should be italicized.
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take out the remaining sentence
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in Nursing Theory
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not a primary theorist source
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not a primary theorist source
13
For this project, the nurse is a supporter who ensures that patient needs are unique and met
adequately and suitably to their circumstance. This recognizes that a different relationship
develops between nurse and patient from one. In the same stance, a person is operationally defined
as an entity with individual preconceptions and a mutual understanding of the nature of a medical
issue. Within this understanding, they can collaborate with informed decision-making toward a
productive solution.
Health is operationally defined as contextualized patient conditions that allow for human
processes that facilitate tendencies supportive of positive development to attain health (Peplau,
1991). For this project, health is defined as a symbolic future positive goal that is attained after
effective healthcare hence instrumental for the person moving in the forward direction of wellbeing
A patient is operationally defined by Peplau (1991) as a person in need who develops a
relationship with a nurse to seek adequate support suitable for the promotion of better health. For
this project, the patient is referred to as the outpatient navigating the interpersonal relationships
with a medical service provider seeking the implementation of need-based healthcare delivery
through the respectable promotion of perception and prevention of escalation of obesity (Peplau,
1991).
Peplau (1991) operationally defines environment as the unique position of the patient
leading to the development of a different relationship with the nurse and health-related delivery in
a way that affects the success rate of their health promotion. For this project, the environment will
be operationally defined as conditions that allow for human processes that facilitate tendencies
supportive of positive development to attain health. It is contextualized as the symbolic future
positive goal that is attained after effective healthcare hence instrumental for the person moving
in the forward direction of well-being (Peplau, 1991). As such, following Peplau’s underpinning
14
of outpatient care for obese patients is ensuring that patient that individual preconceptions and
mutual understanding of the nature of a medical issue allow for better collaboration toward a
productive solution.
Initial Review of the Literature
The review of the literature will be conducted to explore studies that are associated with
nursing education for obesity and a healthy diet. Using the following words both singularly and in
multiple combinations: nursing training, obesity, outpatient care, nursing psychiatry, overweight,
diet, obesity facts, obesity prevention, body weight, and care management planning. Databases
searched, limited to the years 2018 and 2023, will include AMED, Alt Health Watch, CINAHL
Plus with Full Text, EBSCO, Medical Journal sites for nursing care, nursing training, PubMed,
Scopus, Science Direct, Directory of Open Access Journals, Google Scholar, JSTOR and the
D’Youville library to loan articles through interlibrary loan. The search is limited to the years 2018
to 2023 to ensure that current evidence-based literature is reviewed and summarized for the
purpose this project. A summary of the review of the literature is presented.
Dynamics of Outpatient Care
According to Balani et al., (2019) The epidemic of obesity is a significant health crisis that
continues to increase globally, it is reported that in the United States, more than two-thirds of
adults are considered either overweight or obese. A lifestyle disease is critical to the discussion on
nursing care for outpatient obesity. As such, care focuses on management and fostering better and
healthy weight maintenance (Kalligeros et al., 2020). Thus, it does not necessarily focus on age
but understands that eagerness is also a risk factor for comorbidities associated with being
overweight. Furthermore, Kalligeros et al. (2020) study points out that the exploration of the
association between obesity and chronic diseases is something that should be understood. This is
15
because there is a direct relation between the severity of the outcomes seen in intensive care units
and admission rates. For example, research that analyzes a retrospective cohort with 103 patients
found that the patients admitted to the hospital history of heart disease is a direct result of obesity.
Therefore, a recommendation is that vigilance should be given to treating patients with obesity
starting from the outpatient setting, alluding to necessitated prevention of escalation when faced
with other conditions (Kalligeros et al., 2020).
Role of Nursing
The role of nursing is to provide integrated care and enhance patient comfort by providing
interventions to alleviate symptoms of obesity. Findings from Rezaei et al. (2022) study point out
that high morbidity rates are caused by poor health maintenance, which aligns with the results in
studies by Smith et al. 2020; Sutaria et al., 2020. Furthermore, Gadde et al. (2018) study findings
indicate a significant reduction in morbidity and mortality rates among patients in weight
maintenance trials. The high number of obesity cases creates a risk factor in the population; this
points to the need to emphasize training for this. Recognizing physician efforts in collaboration
with outpatients by sensitization on environmental awareness is essential (Walia et al., 2022). This
includes considering that proper evaluation starts by recognizing the appropriateness of the
environment for supporting weight management. Achieving and maintaining weight loss or gain
requires physician-patient collaboration in a way that can be facilitated by nurses providing
pertinent information. Again, support and motivation are also determined by letting a carefully
defined plan be identified with the patient to understand the expected health outcomes. This is the
nurse’s work as it allows for the recognition of a strategy of control for each patient (Stonerock &
Blumenthal, 2017: p.1457).
16
According to Rezaei et al. (2022), the combination of aspects such as the cost of health,
care expenditures, and hospitalization risks are some of the reasons that can be used in motivating
outpatients to adhere to their plan of losing weight. This study aligns with the findings of Piché et
al. (2020) study findings. The findings indicate that advanced heart diseases are often caused by
obesity and lack of maintenance, and the determinant of failure lies in the early handling of the
issue. Therefore, health literacy is an integral part of the nursing fraternity to impart to the patients
as it allows for the opportunity to understand the implication of obesity in the long run.
Consequently, the narrative is applicable because by the time medication is involved, the
progression will be higher risk associated and thus significant mortality risk, however, creating a
provider-patient relationship with a healthy diet, diabetes and obesity teaching without having a
judgmental response, whereby both parties agrees on goals, share a vision of improvement in
general metabolic health status, the patient and provider will be able to create a personalized and
participatory lifestyle changes plan as described by Foley et al. (2019) study. Furthermore,
Alexander et al. (2021) study findings indicate that health literacy as part of outpatient training
will provide the necessary support for proper weight loss and maintain it while allowing room for
recognition of mental health too. This caters to the grasping of the incorporation of strategies that
align outcomes centered on the totality of patient care within the six sigma of quality improvement
in healthcare delivery.
Alexander et al. (2021) research focuses on promoting healthcare delivery as a focal point
in preventive care and is supported by Levine et al. (2019), which look at a similar issue but with
a different approach. Levine et al. (2019) surveyed to find out why the use of preventive healthcare
is still low in the modern healthcare system. The findings from the survey linked modernization
and the advancement in technology as one the contributors to the limited use of preventive
17
medicine. Nevertheless, Harris et al. (2017) point out how using preventive healthcare would
enhance the efficiency of care and result in better outcomes. Therefore, Alexander et al., 2021;
Levine et al., 2019; Harris et al., 2017 studies collectively look at transitioning patients from
outpatient to inpatient and provide insight into what to avoid and what is necessary to promote
better care. From the start, the studies allow room for relativity in practices that promote and
optimize safety, and within those points to the relevance of individual patient circumstances. While
the project gives valuable information on the standard procedure, it contributes to the general
discussion on the improvement of health by nurses. It thus applies that, for all patients, recognition
of the value in situation background assessment facilitates the improvement of health outcomes.
The improvement starts with a reduction in risks hence understanding beneficial outcomes
accurately first (Alexander et al., 2021).
Recognition of Potential Barriers
There is also a need to recognize the impact of cultural competency in nursing care (Chae
& Park, 2019). With outpatients, there is a risk of exposure to external biases and pressure that
may result in declining health whenever they leave a session. Therefore, the value must be
provided in educating the patient on the potential risks they face within their environment. This
can only be achieved through collaboration which aligns with the results of Seger’s (2019) and
Ogbolu et al. (2018) studies. Furthermore, it is essential for the perspective of the community and
support system of the patient to be observed by the patient (Bloor & McIntosh, 2019). Therefore,
sharing with the nurse is a natural step of goal setting that allows an informed understanding of
the underlying implication of the stereotypes and norms of expectation (Halvorson et al., 2019).
This will help focus on reducing the risk of “temptation” of hindrances to improving patient health
in a way that respects them and their communities. Similarly, (Balani, et al., 2019) study examined
18
factors affecting healthy weight in the community, the study explained that obesity is not a lifestyle
crisis, but rather a complicated, chronic disease affecting areas of behavioral, psychosocial,
biological, and environmental factors. For this reason, there is a need for a collaborative and
comprehensive approach to obesity management. Therefore, foundational planning is essential for
the nurse and the patient to recognize early on.
According to Hee Soon, et al. (2019) opted to conduct a study on this subject focusing on
the younger populations. They point out that one thing that tends to be overlooked is the fact that
children tend to learn from what they see happening in their surroundings. Thus, even if a child is
prone to eating healthy when they are in their respective homes, they are also prone to be
influenced by what they see in schools or other surroundings. This research study aimed to
answering the question, “What are the barriers at home and school to healthy eating?” It also aimed
at answering this through the perspectives of parents and children who had or were suffering from
obesity, therefore, parents, teachers, and community healthcare providers should alleviate the
issues of obesity through adequate healthy diet teaching and implementation.
It is imperative that when it comes to the management of unvoiced expectations of a patient
in a way that recognizes their efforts and input towards change. According to Ma et al. (2019)
study findings, obesity management requires self-discipline at a higher level than average and
recognizing a gradual result, supported by Reas’s (2017) study. These studies describe how lack
of self-discipline results in binge eating disorder; at the same time, public and healthcare
professionals’ knowledge, and attitudes toward the relationship between self-awareness results in
binge eating disorder and, consequently, weight gain (obesity). The fact that it cannot be cured by
medication and results are not immediate is a cause of concern that both nurse and patient should
understand (Boersema et al., 2021: p.11). It requires patience and a lens where small milestones
19
can only weigh competent management. Furthermore, obesity practitioners must have complete
comprehension and apply evidence-based knowledge while administering care to patients with
obesity (Srivastava et al., 2019: p.196).
When management optimization is needed in the treatment strategy for a patient with
obesity, especially outpatients, there is a need for longitudinal consideration of the
comprehensiveness of management aspects. According to Seger (2019), a complication of obesity
as a chronic illness is as sophisticated as any other issue, which aligns with Godfrey et al. (2017)
study. Godfrey et al. (2017) describe the complications primarily associated with maternal obesity,
including coronary artery disease, obesity in the offspring, asthma, and allergies. In addition,
Wharton et al. (2020), tackles nursing and obesity pointing it to be one of the current health
concerns affecting a large proportion of the world’s population as it interferes with health outcomes
As such, an intensity level should be employed with preventive controls in line with the
responsibility set. This allows for desired treatment to be the main goal rather than the desired end
product, such as specific weight. It removes the tension without negating the implication of the
process and thus optimizes input by the small measures that can be seen regularly. Therefore, a
pathophysiological approach is necessary for an all-hands-on methodology hence simplicity that
is specific to the patient in question rather than a generalization as in Block et al. (2020) study
findings.
Nurses’ Knowledge of The Management of Obesity
Inadequacy of skills and knowledge among healthcare professionals is one of the
significant challenges facing the fight against metabolic conditions such as obesity. Bucher Della
Torre et al. (2018) describe one of the challenges in one of the university hospitals as the
presentation of poor knowledge, skills, and attitude about obesity among nurses and physicians,
20
which aligns with the findings of Turner et al.’s (2018) study. Turner et al.’s study revealed
inadequate knowledge concerning managing obesity effectively. The results imply that provider
perception of optimal healthcare services for obesity is at odds with research-based guidelines.
Healthcare practitioners must be aware of the best ways to use pharmacotherapy and behavioral
counseling, such as adopting a healthy diet; these interventions are widely applied in improving
the health of obese patients (Turner et al., 2018).
Reinforcing Positive Environment in Nurse-Patient Relationship
When looking at the studies, it is evident that nurse and patient relationships are integral to
both the definition of health and the understanding of treatment planning. These are essential to
the pathways to positive outcome expectation and hence accurate to the operational definitions.
Given that outpatient care for obesity is almost therapeutic, there is a sense of delivery requiring
that verbal and non-verbal communication be read. As such, the nurse must have the core
conditioning of genuine concerns, which sometimes could be perceived as going above and beyond
the baseline required (Okdie & Ewoldsen, 2018). The relationship between the two is skill-based,
examining the level of trust in both directions with absolute truths. The points of conflict should
thus be handled with care and isolated from the goals by accepting attitudes as progression hence
the removal of fear (Walia et al., 2022). This also removes the anxiety of either side as the nurse
can trust that discipline will be employed within the period they have not met. Similarly, the patient
will trust that information will not be withheld, anger will not be enforced, and the environment
of care will be positively reinforced with empathy rather than pity.
Significance and Justification
Findings from the initial literature review revealed that a lack of knowledge exists in
nursing and patient care practice regarding obesity and diet management. In their study, Bucher et
21
al. (2018) revealed a significant inadequacy of knowledge and skill among nurses and physicians
working in a university hospital concerning the management of obesity (Bucher et al., 2018). This
gap exists, yet healthcare professionals ought to be at the forefront of executing various
interventions in managing obesity and healthy diet. It is an implication that patients suffering from
obesity and related complications will find it challenging to get adequate and effective nursing
education concerning diet to manage and treat their condition. In addition, there is inconsistency
in provider understanding of appropriate clinical care for obesity. The study recommends that there
is a need for healthcare professionals to develop an understanding of how to effectively leverage
health interventions to promote outcomes for patients with obesity. This article is a good choice
for supporting the proposed project because it points out the limitations of proper management of
obesity, one of which is the low knowledge level among health professionals and the need to
address them towards achieving the goal of healthcare. Therefore, this project will enable nurses
to have a training program where they will obtain more knowledge and skills concerning the
management of obesity through dietary interventions.
Project Objectives
The objectives of this project are to:
1. Conduct an extensive review of the literature exploring a healthy diet for patients with
obesity using the following keywords both singularly and in multiple combinations:
nursing training, obesity, obesity prevention, outpatient care, overweight, diet, and healthy
diet. Databases searched, limited to the years 2017 to 2022, will include, AMED, Alt
Health Watch, CINAHL Plus with Full Text, EBSCO, Medical Journal sites for nursing
care, nursing training, PubMed, Scopus, Science Direct, Directory of Open Access
Journals, Google Scholar, JSTOR and the D’Youville library to loan articles through
interlibrary loan;
2. Develop an Educational Training Program; and
3. Have a panel of five content experts with extensive knowledge and expertise in a healthy
diet for patients with obesity evaluate and critique the project for clarity, readability,
applicability, quality, organization, and evidence-based clinical relevance.
Sharon Mang
45010000000001725
2018 to 20
23
22
Definition of Terms
The following concepts are defined both theoretically and operationally for the purpose of this
project:
Health Promotion
Theoretical Definition: Facilitation of motivational behavior to recognize a positive
outcome as an approach to better health management (Peplau, 1991).
Operational Definition: conducting and directing the implementation of weight
management strategies that enhance forward-focused change for a better quality of life for
outpatients that are diagnosed with obesity.
Healthcare Support
Theoretical and Operational Definition: integrative healthcare service delivery that
facilitates the provision of effective and efficient aid to the patient in a way that is essential to
their safety, improved quality of life, and development of better coping tools (Boersema et al.,
2021).
Operational Definition: A nursing duty that recognizes the provision of the totality of
care for outpatients with obesity through readiness in resource and information availability that
allows sustainable improvement of patient’s health.
Healthy diet
Theoretical definition: Refers to both a health-promoting and disease-preventing diet. It
delivers adequate nutrients and other health-promoting ingredients from wholesome foods while
avoiding ingesting harmful substances (Chaudhary et al., 2018).
Operational Definition: A diet composed of macronutrients, micronutrients, and
vitamins necessary for maintaining the body’s normal functioning and promoting health through
enhancing healthy weight loss in obese and overweight patients.
Limitations
The Project Author recognizes the following project limitations:
1. The implementation of the educational training program is not within the context of
this project;
2. The educational training program is developed in the English language only and may
benefit a more culturally diverse population if written in additional languages.
Project Development Plan
23
A detailed topical outline of the educational training program content is created based on
the extensive review of evidence-based literature and the theoretical framework used to support
and guide the development of an educational training program. After permission is granted from
the D’Youville Patricia H. Garman School of Nursing, graduate faculty designee (Appendix A),
five professionals with knowledge and expertise in a healthy diet for patients with obesity will be
asked if they are interested in voluntarily participating as expert content reviewers for an
educational training program. The content expert panel will consist of two registered nurses
working in an outpatient healthcare service delivery, one nutritionist working in a public health
system that educates about healthy diets, and two clinical dieticians working in an outpatient clinic.
If interested, the Project Author will mail a packet containing a Letter of Intent (Appendix B), a
copy of the
Content Expert Project Evaluation Tool
created by the Project Author specifically for
the project (Appendix C), a copy of the educational training program (Appendix D), and a self-
addressed stamped envelope. The Letter of Intent will explain the project purpose and instructions
for
completing and returning the Content Expert Project Evaluation Tool to the Project Author.
The Content Expert Project Evaluation Tool contains six evaluative items with space for narrative
comments and suggestions. Approximately 20 minutes will be required to review the educational
training program and to complete the Content Expert Project Evaluation Tool. Content experts will
be provided a self-addressed envelope to return the Content Expert Project Evaluation Tool to the
Project Author. Once all evaluation tools are returned to the Project Author, data will be analyzed
and reported narratively and in bar graph format. A summary of the evaluation results, including
the findings of the six evaluative items in the content expert project evaluation tool, will be
provided to the content expert reviewers by postal mail.
Plan for the Protection of Human Subjects
24
Following approval from D’Youville Patricia H. Garman School of Nursing, the graduate
faculty designee (Appendix A) five professionals with knowledge and expertise in the field of a
healthy diet particularly for patients with obesity will be personally approached and asked to
voluntarily participate as a content expert in the review and evaluation of an educational training
program (Appendix D). Content experts will be advised that participation or non-participation as
an expert reviewer will have no effect on their employment status. The Project Author has a
collegial, professional, and nonsupervisory relationship with the content expert reviewers thereby
protecting the participants from any risk of coercion. Content experts will be guaranteed
confidentiality because identifying characteristics will not be collected on the Content Expert
Project Evaluation Tool and because their names will not be revealed anywhere in the project
manuscript or in required project presentations. Only the Project Author will know the names of
the content expert reviewers. Return of the completed content expert Project Evaluation Tool
(Appendix C) will indicate implied voluntary consent to participate as a content expert reviewer.
Content experts will be advised that they will not be able to withdraw from project participation
once the project evaluation tool is returned to the Project Author because the evaluation tool will
be returned without identifying information. Returned Content Expert Project Evaluation Tools
will be stored according to the D’Youville Patricia H. Garman School of Nursing protocol in a
locked drawer located in the Project Author’s home for a period of three years and then destroyed.
Plan for Project Evaluation
After obtaining full approval from the D’Youville
Patricia H. Garman School of Nursing
(Appendix A), the Project Author will mail a packet to each content expert reviewer containing
one Letter of Intent (Appendix B), one copy of the Content Expert Project Evaluation Tool
(Appendix C), one copy of the educational training program (Appendix D), and one self-addressed
Sharon Mang
45010000000001725
use same description as in Project Objective #3
25
stamped envelope. The Letter of Intent will explain the project purpose and instructions for
completing and returning the Content Expert Project Evaluation Tool to the Project Author.
The Content Expert Project Evaluation Tool will consist of six evaluative items scored on a
four-point Likert Scale that ranges from (1) Strongly Disagree, (2) Disagree, (3) Agree, and (4)
Strongly Agree. Space will be provided for narrative comments and suggestions following each
evaluative item. Evaluative items will ask reviewers to rate the resource guide on clarity,
readability, applicability, quality, organization, and evidence-based clinical relevance.
Approximately 20 minutes will be required to review the resource guide and to complete the
Content Expert Project Evaluation Tool. Content experts will be given seven days to complete and
return the Content Expert Project Evaluation Tool to the Project Author via postal mail using the
self-addressed stamped envelope included in the original packet. Likert scale responses will be
presented narratively and displayed in bar graph format. Content expert suggestions and comments
will be analyzed for common themes and presented narratively. A summary of the evaluation results
including the findings of the six evaluative items in the content expert project evaluation tool will
be provided to the content expert reviewers by postal mail.
Summary
Chapter I presented the project introduction, statement of purpose, an overview of the
theoretical framework guiding project development, an initial review of the literature focusing on
the development of an educational training program for nurses in an outpatient setting exploring
healthy diets for patients with obesity, the project significance and justification, project objectives,
definition of terms, project limitations, the project development plan, the protection of human
subjects, the plan for project evaluation, and a chapter summary. Chapter II will provide an
extensive review of the literature focusing on an educational training program for nurses regarding
Sharon Mang
45010000000001725
educational training program
26
the importance of a healthy diet for patients with obesity and a chapter summary. Chapter III will
discuss the intended project setting and population, the content expert participants, data collection
methods, project tools, the protection of human subjects, and a chapter summary. Chapter IV will
discuss the evaluation of the project, implications for future advanced nursing practice,
recommendations for future projects and research, and a chapter summary.
27
References
Alexander, C. C., Tschannen, D., Hays, D., Clouse, M., Zellefrow, C., Amer, K. S., … & Milner,
K. A. (2022). An integrative review of the barriers and facilitators to nursing engagement
in quality improvement in the clinical practice setting. Journal of Nursing Care
Quality, 37(1), 94-100.
Alexander, C., Rovinski-Wagner, C., Wagner, S., & Oliver, B. J. (2021). Building a Reliable
Health Care System: A Lean Six Sigma Quality Improvement Initiative on Patient
Handoff. Journal of Nursing Care Quality, 36(3), 195-201.
Allan, J. (2020). Theorizing new developments in critical social work. In Critical social work,
30–44. Routledge.
Balani, R., Herrington, H., Bryant, E., Lucas, C., & Kim, S. C. (2019). Nutrition knowledge,
attitudes, and self-regulation as predictors of overweight and obesity. Journal of the
American Association of Nurse Practitioners, 31(9), 502-510.
Block, B. L., Smith, A. K., & Sudore, R. L. (2020). During COVID‐19, outpatient advance care
planning is imperative: We need all hands on deck. Journal of the American Geriatrics
Society.
Bloor, M., & McIntosh, J. (2019). Surveillance and concealment: a comparison of techniques of
client resistance in therapeutic communities and health visiting. In Selected Writings in
Medical Sociological Research, 93–116. Routledge.
Boersema, G. C., Smart, H., Giaquinto-Cilliers, M., Mulder, M., Weir, G. R., Bruwer, F. A., … &
Van der Merwe, Z. (2021). Management of non-healable and maintenance wounds: a
systematic integrative review and referral pathway. Wound Healing Southern
Africa, 14(1), 8-17.
28
Branch, C., Deak, H., Hiner, C., & Holzwart, T. (2016). Four nursing metaparadigms. IU South
Bend Undergraduate Research Journal, 16, 123-132.
Bucher, D. T. S., Courvoisier, D. S., Saldarriaga, A., Martin, X. E., & Farpour‐Lambert, N. J.
(2018). Training is essential in nurses’ and physicians’ knowledge, attitudes,
representations, and declared practices about obesity in a university hospital. Clinical
obesity, 8(2), 122-130.
Chae, D., & Park, Y. (2019). Organizational cultural competence needed to care for foreign
patients: A focus on nursing management. Journal of Nursing Management, 27(1), 197–
206.
Chaudhary, A., Gustafson, D., & Mathys, A. (2018). Multi-indicator sustainability assessment of
global food systems. Nature communications, 9(1), 1-13. Retrieved from
https://doi.org/10.1038/s41467-018-03308-7
Foley, P. J., Gunson, J. T., & Baumann, S. L. (2019). Two Stories about Diet and Diabetes in
Europe. Nursing Science Quarterly, 33(1), 85-90.
Gadde, K. M., Martin, C. K., Berthoud, H. R., & Heymsfield, S. B. (2018). Obesity:
pathophysiology and management. Journal of the American College of
Cardiology, 71(1), 69–84.
Godfrey, K. M., Reynolds, R. M., Prescott, S. L., Nyirenda, M., Jaddoe, V. W., Eriksson, J. G.,
& Broekman, B. F. (2017). Influence of maternal obesity on the long-term health of
offspring. The lancet Diabetes & endocrinology, 5(1), 53-64.
Halvorson, E. E., Curley, T., Wright, M., & Skelton, J. A. (2019). Weight bias in pediatric
inpatient care. Academic Pediatrics, 19(7), 780-786.
https://doi.org/10.1038/s41467-018-03308-7
29
Hee Soon, K. I. M., Jiyoung, P. A. R. K., Yumi, M. A., & Mihae, I. M. (2019). What are the
barriers at home and school to healthy eating? Overweight/obese child and parent
perspectives. The Journal of Nursing Research, 27(5), e48. Retrieved from
https://doi.org/10.1177/0894318419881797
Kalligeros, M., Shehadeh, F., Mylona, E. K., Benitez, G., Beckwith, C. G., Chan, P. A., &
Mylonakis, E. (2020). Association of obesity with disease severity among patients with
coronavirus disease 2019. Obesity, 28(7), 1200-1204.
Levine, S., Malone, E., Lekiachvili, A., & Briss, P. (2019). Health care industry insights: why
the use of preventive services is still low. Preventing chronic disease, 16.
Ogbolu, Y., Scrandis, D. A., & Fitzpatrick, G. (2018). Barriers and facilitators of care for diverse
patients: Nurse leader perspectives and nurse manager implications. Journal of nursing
management, 26(1), 3-10.
Oleck, L. (2022). Psychiatric-Mental Health Nurses: Spread the Word. Journal of the American
Psychiatric Nurses Association, 28(5), 413–415. Retrieved from
https://doi.org/10.1177/10783903221117555
Peplau, H. (1991). Interpersonal Relations in Nursing: A Conceptual Frame of Reference for
Psychodynamic Nursing. Springer Publishing.
Phillips, K. E., & LoGiudice, J. A. (2020). Practices and Attitudes of Nursing Students Toward
Patients with Disordered Eating Behaviors. Nursing education perspectives, 41(1), 49-51.
Piché, M. E., Tchernof, A., & Després, J. P. (2020). Obesity phenotypes, diabetes, and
cardiovascular diseases. Circulation Research, 126(11), 1477-1500.
https://doi.org/10.1177/0894318419881797
https://doi.org/10.1177/10783903221117555
30
Rezaei, S., Vaezi, F., Afzal, G., Naderi, N., & Mehralian, G. (2022). Medication Adherence and
Health Literacy in Patients with Heart Failure: A Cross-Sectional Survey in Iran. HLRP:
Health Literacy Research and Practice, 6(3), e191-e199.
Ross, A., Yang, L., Wehrlen, L., Perez, A., Farmer, N., & Bevans, M. (2019). Nurses and
health‐promoting self‐care: Do we practice what we preach? Journal of nursing
management, 27(3), 599-608.
Seger, J. C. (2019). Optimizing Outcomes in Outpatient Obesity Management. In Quality in
Obesity Treatment, 221–234. Springer, Cham.
Shi, H. (2017). Planning Effective Educational Programs for Adult Learners. World Journal of
Education, 7(3), 79–83.
Smith, J. D., Fu, E., & Kobayashi, M. A. (2020). Prevention and management of childhood
obesity and its psychological and health comorbidities. Annual review of clinical
psychology, 16, 351-378.
Srivastava, G., Fox, C. K., Kelly, A. S., Jastreboff, A. M., Browne, A. F., Browne, N. T., … &
Apovian, C. M. (2019). Clinical considerations regarding the use of obesity
pharmacotherapy in adolescents with obesity. Obesity, 27(2), 190–204.
Stonerock, G. L., & Blumenthal, J. A. (2017). Role of counseling to promote adherence in
healthy lifestyle medicine: strategies to improve exercise adherence and enhance physical
activity. Progress in cardiovascular diseases, 59(5), 455-462.
Sutaria, S., Devakumar, D., Yasuda, S. S., Das, S., & Saxena, S. (2019). Is obesity associated
with depression in children? Systematic review and meta-analysis. Archives of disease in
childhood, 104(1), 64-74.
31
Tartavoulle, T., & Landry, J. (2021). Educating Nursing Students About Delivering Culturally
Sensitive Care to Lesbian, Gay, Bisexual, Transgender, Questioning/Queer, Intersex, Plus
Patients: The Impact of an Advocacy Program on Knowledge and Attitudes. Nursing
education perspectives, 42(4), E15-E19.
Turner, M., Jannah, N., Kahan, S., Gallagher, C., & Dietz, W. (2018). Current knowledge of
obesity treatment guidelines by health care professionals. Obesity, 26(4), 665–671.
Walia, I., Krainovich-Miller, B., & Djukic, M. (2022). Nurses’ Lived Experience with Nurse–
Physician Collaboration. The Journal of Continuing Education in Nursing, 53(9), 397–
403.
Wharton, S., Lau, D. C., Vallis, M., Sharma, A. M., Biertho, L., Campbell-Scherer, D., … &
Wicklum, S. (2020). Obesity in adults: a clinical practice guideline. Canadian Medical
Association Journal, 192(31), E875-E891. Retrieved from
https://www.cmaj.ca/content/cmaj/192/31/E875.full
CMAJ 2020 August 4;192:E875-91. doi: 10.1503/cmaj.191707
Whitehouse, C. R., Sharts-Hopko, N. C., Smeltzer, S. C., & Horowitz, D. A. (2018). Supporting
transitions in care for older adults with type 2 diabetes mellitus and obesity. Research in
gerontological nursing, 11(2), 71–81.
https://www.cmaj.ca/content/cmaj/192/31/E875.full
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Appendix A
Patricia H. Garman School of Nursing
Full Approval Letter
33
Appendix B
Letter of Intent
34
Content Expert Letter of Intent
Dear Content Expert,
Hello, my name is Funmilola A. Akerele, I am a graduate student completing a Master of
Science in Nursing/Family Nurse Practitioner degree at D’Youville College in Buffalo, New York.
Currently, I am developing an Educational Training Program for nurses on healthy diet and obesity
in an outpatient setting.
I am submitting the Educational Training Program for your expert review and evaluation.
Recommendations and critiques of this work in progress will be taken into serious consideration
during the final revisions of this work. You are being asked to review and evaluate the resource
guide for clarity, readability, applicability, quality, organization, and evidence-based relevance.
Your review of the Educational Training Program should take approximately 20 minutes of your
time. The evaluation process is completely voluntary and your refusal to participate will involve
no penalty or loss to you. Your responses will be kept confidential and will be available only to
me. If you choose to participate, please return the evaluation tool within the next seven (7) days
using the enclosed self-addressed stamped envelope. Consent to participate in the evaluation is
implied upon the completion and return of the evaluation tool. Once you return the evaluation tool,
there is no way to withdraw your responses, as there are no identifying markers included on the
tool. Returned evaluation tools will be stored in my home for a period of three years and then
destroyed. There are no direct benefits to you as a content expert participant. A copy of the results
including the findings of the six evaluative items in the content expert project evaluation tool will
be mailed to you at the conclusion of this project.
If you have any questions regarding my project or the evaluation process, please contact
me via email at akeref24@dyc.edu. Any specific questions may be directed to Dr Sharon Mang,
my Project Chair, at (716) 829-8376 or via email at mangs@dyc.edu. Thank you for your
assistance and participation as a content expert. I look forward to receiving your evaluation of my
project.
Best Regards,
Funmilola A Akerele
Sharon Mang
45010000000001725
University
Sharon Mang
45010000000001725
in a locked drawer
Sharon Mang
45010000000001725
Dr.
erttyyyyyyyyyyyyyyy
dddfffffffgggggggggg
dfffgggggggggggg
ggggggggggg
33444445555ggggggggg22
dddddd
35
Appendix C
Content Expert Project Evaluation Tool
36
Instructions:
The purpose of this tool is to provide you with a guideline for evaluating the clarity, readability,
applicability, quality, organization, and relevance of the current evidence-based practice of the
proposed an Educational Training Program. The purpose of the project is to develop an
Educational Training Program to provide nurses with information on the importance of a healthy
diet for obese patients in an outpatient setting. Using the four-point Likert Scale, please circle one
choice that best reflects your opinion. Space is provided after each of the six evaluative items for
further feedback and direction regarding the Educational Training Program. To maintain your
confidentiality, please do not make any identifying marks on the evaluation tool.
1. Clarity
The information presented in the Educational Training Program is clearly understood and easy to
follow
Strongly disagree Disagree Agree Strongly agree
1 2 3 4
Comments and Suggestions:
2. Readability
The information in the Educational Training Program is presented at an appropriate and
comprehensive level of reading for pediatric healthcare providers.
Strongly disagree Disagree Agree Strongly agree
1 2 3 4
Comments and Suggestions:
3. Applicability
The information presented in the Educational Training Program is relevant and fits the project’s
purpose.
Strongly disagree Disagree Agree Strongly agree
37
1 2 3 4
Comments and Suggestions:
4. Consistency
The Educational Training Program is well-designed and with a consistent flow.
Strongly disagree Disagree Agree Strongly agree
1 2 3 4
Comments and Suggestions:
5. Organization
The Educational Training Program is in order and well organized
Strongly disagree Disagree Agree Strongly agree
1 2 3 4
Comments and Suggestions:
6. Evidence-Based Clinical Relevance
The Educational Training Program addresses a current and clinically relevant problem in nursing
and patient care practice and utilizes current clinical evidence.
Strongly disagree Disagree Agree Strongly agree
1 2 3 4
Comments and Suggestions:
Thank you for taking the time to evaluate the Educational Training Program. Your feedback is
deeply appreciated and will strengthen the development of the Educational Training Program for
nurses in an outpatient setting.
38
Appendix D
Educational Training Program
39
Appendix E
Survey Tool Results
1
AN EDUCATIONAL TRAINING PROGRAM FOR NURSES IN AN OUTPATIENT
SETTING REGARDING THE
IMPORTANCE OF A HEALTHY DIET FOR PATIENTS WITH OBESITY
By
Funmilola A Akerele
A Project
Submitted to the Faculty of D’Youville
Division of Academic Affairs
In partial fulfillment of the
requirements for the degree of
Master of
Science in
Family Nurse Practitioner
Buffalo, NY
[Month Day, Year]
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5
Do not center the title
2
Copyright © 2023 by Funmilola A, Akerele. All rights reserved. No part of this project
may be copied or reproduced in any form or by any means without the written permission
of Funmilola A, Akerele.
3
PROJECT APPROVAL
Project Committee Chairperson
Name: __ ________Dr. Sharon Mang_____________________
Signature: ___________________________________________
Discipline: ________________Nursing________________
Project Defended
On
[Month Day, Year]
4
Abstract
Obesity has become a significant concern in the healthcare system, and diet is the key
contributing factor to obesity. Therefore, a healthy diet should be the primary requirement for
reducing weight and improving overall health. The health life knowledge gap among patients and
limited nursing education programs contribute to this condition. Nurses should collaborate
closely with patients to provide healthcare education that will assist patients in improving their
nutritional habits and identify the challenges they face in maintaining a healthy diet. An
educational training program for nurses regarding obesity and diet will allow nurses to advance
their knowledge of the risk factors of obesity, the health conditions associated with obesity, and
how to manage obesity (Seger, 2019). Peplau Interpersonal relations in Nursing Theory is
utilized as the theoretical framework for this project. Five content experts will review the
educational training program for content validity.
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was
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reviewed
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Relations
5
Acknowledgment
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Table of Contents
Chapter
I. PROJECT INTRODUCTION …………………………………………………………… 8
Statement of Purpose ……………………………………………………………………….. 9
Theoretical Framework ……………………………………………………………………. 9
Initial Review of the Literature ………………………………………………………….13
Significance and Justification ……………………………………………………………21
Project Objectives ……………………………………………………………………………
21
Definition of Terms ………………………………………………………………………..
22
Project Limitations ………………………………………………………………………… 22
Project Development Plan
………………………………………………………………. 22
Plan for Protection of Human Subjects ……………………………………………..
24
Plan for Project Evaluation……………………………………………………………… 24
Summary ……………………………………………………………………………………… 25
II. REVIEW OF LITERATURE …………………………………………………………..
Summary ………………………………………………………………………………………
III. PROJECT DEVELOPMENT PLAN. ……………………………………………….
Project Setting and Population… ……………………………………………………..
Content Expert Participants
…………………………………………………………….. Data
Collection Methods
…………………………………………………………………
Project Tools …………………………………………………………………………………
The Protection of Human Subjects ………………………………………………………
Summary ………………………………………………………………………………………
IV. PROJECT EVALUATION, IMPLICATIONS, AND FUTURE
RECOMMENDATIONS
……………………………………………..
Project Evaluation ………………………………………………………………………….
Implications for Future Practice ……………………………………………………….
Future Recommendations ………………………………………………………………..
Summary ………………………………………………………………………………………
References ……………………………………………………………………………………. 2
7
Appendices …………………………………………………………………………………… 32
7
List of Appendices
Appendix
A D’Youville Patricia H. Garman School of Nursing
Full Approval Letter
…………………….….
B Letter of Intent …………………………………………………………………………………….
C Evaluation Tool …………………………………………………………………………………..
D An Educational Training Program …………………………………………………………
E Survey tool results in graph……………………………………………….
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Chapter I
The age of fast food and instant gratification brought about by the growth of technology
has affected the general population in many ways. In America, obesity is becoming problematic,
with a prevalence estimate of 41% leading to risk in the severity of diseases (Kalligeros et al.,
2020). As a result, there is a need for nursing practice to take accountability in developing a
relationship with collaborative patient care. Obesity can be a lifestyle disease. Therefore, all
stakeholder participation must be considered a need to look at the four-metaparadigm perspectives
in caregiving using a foundational basis in a theoretical framework. First, a nurse needs expertise
in addressing health issues, especially those reversible through natural means, for example,
obesity. Obesity is reversible through natural means, including dietary modification and practicing
fasting.
The factors that make a successful program include proper planning. Proper planning
allows for allocating adequate time and resources toward the project, resulting in the successful
implementation of the program (Shi, 2017). Another factor is incorporating experienced project
managers with knowledge about the program. For example, specialists such as nutritionists and
experts in physical activity and breastfeeding are essential when developing a program to
improve nutrition in children and adults and minimize obesity. Finally, it is essential to practice
monitoring and control for a program to succeed. Regular evaluation of the progress and the
program results allows for modification and alignment in case of an error or a potential error—
effective communication results in a program’s success (Ross et al., 2019).
The success of any implementable nursing program should have ways to effect cultural
change. As such, education plays a significant role in making people adopt healthy habits.
Education is well achievable after evaluating the clients through wellness programs and other
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you are not implementing the educational training program
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are you referring to the educational training program?
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is this supported in the literature?
9
community programs that involve health checkups and screening. However, personal barriers such
as individual change resistance may negatively impact the success of the social change (Allan,
2020). Some people are susceptible to changes they perceive as threats to their social environment,
including the workplace. Individuals may develop resistance to change when they feel uncertain
about the intervention or when the change comes as a surprise without the time to prepare mentally.
The questions about the competency of the intervention concerning the new environment—the
resistance results in difficulty in implementing the intervention to achieve social change (Ross et
al., 2019). This study will assess interpersonal relations in nursing theory to draw mechanisms for
developing effective strategies for an educational plan for nurses taking care of patients with
obesity in an outpatient department. The program will major in how nurses can effectively pass
educative information to the clients on dietary intervention as a critical mechanism for reversing
obesity. The idea considers all the possible challenges nurse educators may experience while trying
to enhance social changes among patients.
Statement of Purpose
The purpose of this project is to develop an educational training program for nurses in an
outpatient setting regarding the importance of a healthy diet for patients with obesity.
Theoretical Framework
Hildegard Peplau’s (1991) Interpersonal Relations in Nursing Theory is utilized as the
theoretical framework for developing this project. A brief overview of the theory is presented as
well as a discussion regarding how the theory was utilized to guide the project’s development. In
addition, Peplau’s (1991) theoretical definitions for nursing’s interpersonal relationships and
concepts together with the Project Author’s operational definitions for nursing’s four metaparadigm
concepts will be presented.
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Take out the remaining sentences and add a sentence to follow up on the previous sentences on how the literature supports the need for education on a healthy diet for patients with obesity.
10
Interpersonal Relations Theory
Hildegard E. Peplau’s impact on nursing and patient care is reflected in her development
and establishment of the Interpersonal Relations Theory. Her theory development began with
questions of the philosophical underpinning of psychology as fundamental in-patient care
especially when it came to nursing and patient relationships (Peplau, 1991). According to Peplau
(1991), the development of patient care begins by understanding the foundational elements as
concepts of nursing care. namely, the orientation, identification, exploitation, and resolution
defined. In her book, Interpersonal Relations in Nursing, the theory emphasizes the importance of
crosscutting issues and their effect on nursing care and patient wellness, such as nursing education
on dietary interventions for patients with obesity. Orientation refers to the reaction of the patient
and the difference from one to another with consideration to resolve in treatment difficulty.
Exploitation on the other hand is the ability of the patient to recognize interpersonal relationships
and use the services offered effectively. Lastly, there is a resolution that refers to the relinquishing
of ties in the relationship as the patient utilizes the lesson learned to better manage their health
(Peplau, 1991).
Interpersonal Relations Theory
As a mother of nursing psychiatry, Peplau (1991) describes interpersonal relations as a
conditional aspect that includes first the interaction of the nurse and patient. She points out that
this is attained when understanding each patient’s condition is an experience that allows for
improving nursing care (Peplau, 1991). Therefore, the focus in the definition of the theory begins
with grasping the nurse and patient metaparadigm concepts as the interaction between patient and
nurse makes the relationship personal. Similarly, considerable insights thus point out that the
patient care process is personalized in a way that responsibility is both technical and emotional.
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in Nursing Theory
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Peplau (1991) explains that effective patient outcome delivery comes from trust in diagnostics and
thus acceptance of health as an essential metaparadigm aspect. The theory focuses on developing
the relationship between a nurse and a patient to emphasize trust and collaboration.
Based on Peplau (1991), the experience of establishing a connection between a nurse and
a patient is an indicator of progress reporting and is the only source of data for patient experience
information. Perception of the phenomena of patient information as instrumental to positive is
highlighted as a primary measure of the direction of health. Based on the fact that health is
described to be only a success when it moves in the positive direction, by looking at the patient
with obesity this means loss of weight. At the same time, with the insistence on the sustainability
of better health as the result being sought, there is direct evidence that the management of health,
in the long run, is the better outcome for the patient in this project.
Peplau (1991) is supported by her in-depth analysis of the achievability of better health
through utilitarian task alignment. Using communication as the necessary tool for the nurse to
ensure that a patient attains a favorable outcome, as a theory, Interpersonal Relations theory
emphasizes the built-in interaction as a psychodynamic need. This need is important as it is
directionally focused on relieving the patient’s anxiety and improving their confidence regardless
of external and self-perceived variables. There is thus centralization of goal setting for a patient
with obesity that is linked directly to the strengthening of the nurse-patient relationship as the best
approach to attaining better health outcomes.
This theory is a perfect fit for the proposed educational training program for nurses in an
outpatient setting to provide education regarding the importance of a healthy diet for patients with
obesity. The relationship between the outpatient and the nurse must be founded on trust so that
information can be shared comfortably and with trusted support from nurses. A support system
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take out thus
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for this project as the relationship between the nurse and patient must be founded on trust. A support system…
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in Nursing Theory
12
must be developed because obesity and the issues surrounding obesity can often bleed into self-
esteem and mental health. This theorist ideology will assist in identifying and orienting nurses to
the causes of obesity, introducing a perfectly balanced diet with regular exercise, and finally
producing solutions for diabetic prevention, a foundation that this theoretical framework supports.
Interpersonal Relations Theory and Nursing’s Metaparadigm
Concerning the four metaparadigms, in her Interpersonal Relations in Nursing Theory,
Peplau (1991) defines it as input for developing positive outcomes and relinquishing the
relationship with a support system that enhances positive outcomes. It is the promotion of health
through appropriate methods and illness prevention by recognizing triggers for all patients.
Therefore, the nurse can only facilitate treatment and not make a diagnosis; hence, the critical
aspect is ensuring that the environment is conducive and that communication in the relationship
with patients is constant. This means the nurse favors patients’ understanding of their issues by
explaining the problem and the treatment plan. This includes a preventive measure to ensure
informed decision-making is enhanced and thus a partnership that, in essence, is therapeutic.
Theoretically, Branch et al. (2016) defines a person as the receiver of care whose needs
should be assessed all-round. On the other hand, Peplau (1991) theoretically defines environment
as the surroundings of the patient which influences their bearing of health and wellness. At the
same time, both Branch et al. (2016) and Peplau (1991) theoretically define health as the
multidimensional extent to which a person attains wellness for a qualitative life. As such, they
complete the definition of the four metaparadigms by pointing out that theoretically, nursing is the
creation of a trust and mutual understanding between person and care giver to ensure that health
outcomes are optimal (Branch et al., 2016 & Peplau, 1991).
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may lead to decreased self-esteem and mental health issues.
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not a primary theorist source
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Suggest you follow the template in the Graduate Project Handbook. For each concept, start with the theoretical definition and include the primary theorist source citation, followed by the operational definition. Each definition should be one sentence in length and each concept should be italicized.
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take out the remaining sentence
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in Nursing Theory
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not a primary theorist source
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not a primary theorist source
13
For this project, the nurse is a supporter who ensures that patient needs are unique and met
adequately and suitably to their circumstance. This recognizes that a different relationship
develops between nurse and patient from one. In the same stance, a person is operationally defined
as an entity with individual preconceptions and a mutual understanding of the nature of a medical
issue. Within this understanding, they can collaborate with informed decision-making toward a
productive solution.
Health is operationally defined as contextualized patient conditions that allow for human
processes that facilitate tendencies supportive of positive development to attain health (Peplau,
1991). For this project, health is defined as a symbolic future positive goal that is attained after
effective healthcare hence instrumental for the person moving in the forward direction of wellbeing
A patient is operationally defined by Peplau (1991) as a person in need who develops a
relationship with a nurse to seek adequate support suitable for the promotion of better health. For
this project, the patient is referred to as the outpatient navigating the interpersonal relationships
with a medical service provider seeking the implementation of need-based healthcare delivery
through the respectable promotion of perception and prevention of escalation of obesity (Peplau,
1991).
Peplau (1991) operationally defines environment as the unique position of the patient
leading to the development of a different relationship with the nurse and health-related delivery in
a way that affects the success rate of their health promotion. For this project, the environment will
be operationally defined as conditions that allow for human processes that facilitate tendencies
supportive of positive development to attain health. It is contextualized as the symbolic future
positive goal that is attained after effective healthcare hence instrumental for the person moving
in the forward direction of well-being (Peplau, 1991). As such, following Peplau’s underpinning
14
of outpatient care for obese patients is ensuring that patient that individual preconceptions and
mutual understanding of the nature of a medical issue allow for better collaboration toward a
productive solution.
Initial Review of the Literature
The review of the literature will be conducted to explore studies that are associated with
nursing education for obesity and a healthy diet. Using the following words both singularly and in
multiple combinations: nursing training, obesity, outpatient care, nursing psychiatry, overweight,
diet, obesity facts, obesity prevention, body weight, and care management planning. Databases
searched, limited to the years 2018 and 2023, will include AMED, Alt Health Watch, CINAHL
Plus with Full Text, EBSCO, Medical Journal sites for nursing care, nursing training, PubMed,
Scopus, Science Direct, Directory of Open Access Journals, Google Scholar, JSTOR and the
D’Youville library to loan articles through interlibrary loan. The search is limited to the years 2018
to 2023 to ensure that current evidence-based literature is reviewed and summarized for the
purpose this project. A summary of the review of the literature is presented.
Dynamics of Outpatient Care
According to Balani et al., (2019) The epidemic of obesity is a significant health crisis that
continues to increase globally, it is reported that in the United States, more than two-thirds of
adults are considered either overweight or obese. A lifestyle disease is critical to the discussion on
nursing care for outpatient obesity. As such, care focuses on management and fostering better and
healthy weight maintenance (Kalligeros et al., 2020). Thus, it does not necessarily focus on age
but understands that eagerness is also a risk factor for comorbidities associated with being
overweight. Furthermore, Kalligeros et al. (2020) study points out that the exploration of the
association between obesity and chronic diseases is something that should be understood. This is
15
because there is a direct relation between the severity of the outcomes seen in intensive care units
and admission rates. For example, research that analyzes a retrospective cohort with 103 patients
found that the patients admitted to the hospital history of heart disease is a direct result of obesity.
Therefore, a recommendation is that vigilance should be given to treating patients with obesity
starting from the outpatient setting, alluding to necessitated prevention of escalation when faced
with other conditions (Kalligeros et al., 2020).
Role of Nursing
The role of nursing is to provide integrated care and enhance patient comfort by providing
interventions to alleviate symptoms of obesity. Findings from Rezaei et al. (2022) study point out
that high morbidity rates are caused by poor health maintenance, which aligns with the results in
studies by Smith et al. 2020; Sutaria et al., 2020. Furthermore, Gadde et al. (2018) study findings
indicate a significant reduction in morbidity and mortality rates among patients in weight
maintenance trials. The high number of obesity cases creates a risk factor in the population; this
points to the need to emphasize training for this. Recognizing physician efforts in collaboration
with outpatients by sensitization on environmental awareness is essential (Walia et al., 2022). This
includes considering that proper evaluation starts by recognizing the appropriateness of the
environment for supporting weight management. Achieving and maintaining weight loss or gain
requires physician-patient collaboration in a way that can be facilitated by nurses providing
pertinent information. Again, support and motivation are also determined by letting a carefully
defined plan be identified with the patient to understand the expected health outcomes. This is the
nurse’s work as it allows for the recognition of a strategy of control for each patient (Stonerock &
Blumenthal, 2017: p.1457).
16
According to Rezaei et al. (2022), the combination of aspects such as the cost of health,
care expenditures, and hospitalization risks are some of the reasons that can be used in motivating
outpatients to adhere to their plan of losing weight. This study aligns with the findings of Piché et
al. (2020) study findings. The findings indicate that advanced heart diseases are often caused by
obesity and lack of maintenance, and the determinant of failure lies in the early handling of the
issue. Therefore, health literacy is an integral part of the nursing fraternity to impart to the patients
as it allows for the opportunity to understand the implication of obesity in the long run.
Consequently, the narrative is applicable because by the time medication is involved, the
progression will be higher risk associated and thus significant mortality risk, however, creating a
provider-patient relationship with a healthy diet, diabetes and obesity teaching without having a
judgmental response, whereby both parties agrees on goals, share a vision of improvement in
general metabolic health status, the patient and provider will be able to create a personalized and
participatory lifestyle changes plan as described by Foley et al. (2019) study. Furthermore,
Alexander et al. (2021) study findings indicate that health literacy as part of outpatient training
will provide the necessary support for proper weight loss and maintain it while allowing room for
recognition of mental health too. This caters to the grasping of the incorporation of strategies that
align outcomes centered on the totality of patient care within the six sigma of quality improvement
in healthcare delivery.
Alexander et al. (2021) research focuses on promoting healthcare delivery as a focal point
in preventive care and is supported by Levine et al. (2019), which look at a similar issue but with
a different approach. Levine et al. (2019) surveyed to find out why the use of preventive healthcare
is still low in the modern healthcare system. The findings from the survey linked modernization
and the advancement in technology as one the contributors to the limited use of preventive
17
medicine. Nevertheless, Harris et al. (2017) point out how using preventive healthcare would
enhance the efficiency of care and result in better outcomes. Therefore, Alexander et al., 2021;
Levine et al., 2019; Harris et al., 2017 studies collectively look at transitioning patients from
outpatient to inpatient and provide insight into what to avoid and what is necessary to promote
better care. From the start, the studies allow room for relativity in practices that promote and
optimize safety, and within those points to the relevance of individual patient circumstances. While
the project gives valuable information on the standard procedure, it contributes to the general
discussion on the improvement of health by nurses. It thus applies that, for all patients, recognition
of the value in situation background assessment facilitates the improvement of health outcomes.
The improvement starts with a reduction in risks hence understanding beneficial outcomes
accurately first (Alexander et al., 2021).
Recognition of Potential Barriers
There is also a need to recognize the impact of cultural competency in nursing care (Chae
& Park, 2019). With outpatients, there is a risk of exposure to external biases and pressure that
may result in declining health whenever they leave a session. Therefore, the value must be
provided in educating the patient on the potential risks they face within their environment. This
can only be achieved through collaboration which aligns with the results of Seger’s (2019) and
Ogbolu et al. (2018) studies. Furthermore, it is essential for the perspective of the community and
support system of the patient to be observed by the patient (Bloor & McIntosh, 2019). Therefore,
sharing with the nurse is a natural step of goal setting that allows an informed understanding of
the underlying implication of the stereotypes and norms of expectation (Halvorson et al., 2019).
This will help focus on reducing the risk of “temptation” of hindrances to improving patient health
in a way that respects them and their communities. Similarly, (Balani, et al., 2019) study examined
18
factors affecting healthy weight in the community, the study explained that obesity is not a lifestyle
crisis, but rather a complicated, chronic disease affecting areas of behavioral, psychosocial,
biological, and environmental factors. For this reason, there is a need for a collaborative and
comprehensive approach to obesity management. Therefore, foundational planning is essential for
the nurse and the patient to recognize early on.
According to Hee Soon, et al. (2019) opted to conduct a study on this subject focusing on
the younger populations. They point out that one thing that tends to be overlooked is the fact that
children tend to learn from what they see happening in their surroundings. Thus, even if a child is
prone to eating healthy when they are in their respective homes, they are also prone to be
influenced by what they see in schools or other surroundings. This research study aimed to
answering the question, “What are the barriers at home and school to healthy eating?” It also aimed
at answering this through the perspectives of parents and children who had or were suffering from
obesity, therefore, parents, teachers, and community healthcare providers should alleviate the
issues of obesity through adequate healthy diet teaching and implementation.
It is imperative that when it comes to the management of unvoiced expectations of a patient
in a way that recognizes their efforts and input towards change. According to Ma et al. (2019)
study findings, obesity management requires self-discipline at a higher level than average and
recognizing a gradual result, supported by Reas’s (2017) study. These studies describe how lack
of self-discipline results in binge eating disorder; at the same time, public and healthcare
professionals’ knowledge, and attitudes toward the relationship between self-awareness results in
binge eating disorder and, consequently, weight gain (obesity). The fact that it cannot be cured by
medication and results are not immediate is a cause of concern that both nurse and patient should
understand (Boersema et al., 2021: p.11). It requires patience and a lens where small milestones
19
can only weigh competent management. Furthermore, obesity practitioners must have complete
comprehension and apply evidence-based knowledge while administering care to patients with
obesity (Srivastava et al., 2019: p.196).
When management optimization is needed in the treatment strategy for a patient with
obesity, especially outpatients, there is a need for longitudinal consideration of the
comprehensiveness of management aspects. According to Seger (2019), a complication of obesity
as a chronic illness is as sophisticated as any other issue, which aligns with Godfrey et al. (2017)
study. Godfrey et al. (2017) describe the complications primarily associated with maternal obesity,
including coronary artery disease, obesity in the offspring, asthma, and allergies. In addition,
Wharton et al. (2020), tackles nursing and obesity pointing it to be one of the current health
concerns affecting a large proportion of the world’s population as it interferes with health outcomes
As such, an intensity level should be employed with preventive controls in line with the
responsibility set. This allows for desired treatment to be the main goal rather than the desired end
product, such as specific weight. It removes the tension without negating the implication of the
process and thus optimizes input by the small measures that can be seen regularly. Therefore, a
pathophysiological approach is necessary for an all-hands-on methodology hence simplicity that
is specific to the patient in question rather than a generalization as in Block et al. (2020) study
findings.
Nurses’ Knowledge of The Management of Obesity
Inadequacy of skills and knowledge among healthcare professionals is one of the
significant challenges facing the fight against metabolic conditions such as obesity. Bucher Della
Torre et al. (2018) describe one of the challenges in one of the university hospitals as the
presentation of poor knowledge, skills, and attitude about obesity among nurses and physicians,
20
which aligns with the findings of Turner et al.’s (2018) study. Turner et al.’s study revealed
inadequate knowledge concerning managing obesity effectively. The results imply that provider
perception of optimal healthcare services for obesity is at odds with research-based guidelines.
Healthcare practitioners must be aware of the best ways to use pharmacotherapy and behavioral
counseling, such as adopting a healthy diet; these interventions are widely applied in improving
the health of obese patients (Turner et al., 2018).
Reinforcing Positive Environment in Nurse-Patient Relationship
When looking at the studies, it is evident that nurse and patient relationships are integral to
both the definition of health and the understanding of treatment planning. These are essential to
the pathways to positive outcome expectation and hence accurate to the operational definitions.
Given that outpatient care for obesity is almost therapeutic, there is a sense of delivery requiring
that verbal and non-verbal communication be read. As such, the nurse must have the core
conditioning of genuine concerns, which sometimes could be perceived as going above and beyond
the baseline required (Okdie & Ewoldsen, 2018). The relationship between the two is skill-based,
examining the level of trust in both directions with absolute truths. The points of conflict should
thus be handled with care and isolated from the goals by accepting attitudes as progression hence
the removal of fear (Walia et al., 2022). This also removes the anxiety of either side as the nurse
can trust that discipline will be employed within the period they have not met. Similarly, the patient
will trust that information will not be withheld, anger will not be enforced, and the environment
of care will be positively reinforced with empathy rather than pity.
Significance and Justification
Findings from the initial literature review revealed that a lack of knowledge exists in
nursing and patient care practice regarding obesity and diet management. In their study, Bucher et
21
al. (2018) revealed a significant inadequacy of knowledge and skill among nurses and physicians
working in a university hospital concerning the management of obesity (Bucher et al., 2018). This
gap exists, yet healthcare professionals ought to be at the forefront of executing various
interventions in managing obesity and healthy diet. It is an implication that patients suffering from
obesity and related complications will find it challenging to get adequate and effective nursing
education concerning diet to manage and treat their condition. In addition, there is inconsistency
in provider understanding of appropriate clinical care for obesity. The study recommends that there
is a need for healthcare professionals to develop an understanding of how to effectively leverage
health interventions to promote outcomes for patients with obesity. This article is a good choice
for supporting the proposed project because it points out the limitations of proper management of
obesity, one of which is the low knowledge level among health professionals and the need to
address them towards achieving the goal of healthcare. Therefore, this project will enable nurses
to have a training program where they will obtain more knowledge and skills concerning the
management of obesity through dietary interventions.
Project Objectives
The objectives of this project are to:
1. Conduct an extensive review of the literature exploring a healthy diet for patients with
obesity using the following keywords both singularly and in multiple combinations:
nursing training, obesity, obesity prevention, outpatient care, overweight, diet, and healthy
diet. Databases searched, limited to the years 2017 to 2022, will include, AMED, Alt
Health Watch, CINAHL Plus with Full Text, EBSCO, Medical Journal sites for nursing
care, nursing training, PubMed, Scopus, Science Direct, Directory of Open Access
Journals, Google Scholar, JSTOR and the D’Youville library to loan articles through
interlibrary loan;
2. Develop an Educational Training Program; and
3. Have a panel of five content experts with extensive knowledge and expertise in a healthy
diet for patients with obesity evaluate and critique the project for clarity, readability,
applicability, quality, organization, and evidence-based clinical relevance.
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2018 to 20
23
22
Definition of Terms
The following concepts are defined both theoretically and operationally for the purpose of this
project:
Health Promotion
Theoretical Definition: Facilitation of motivational behavior to recognize a positive
outcome as an approach to better health management (Peplau, 1991).
Operational Definition: conducting and directing the implementation of weight
management strategies that enhance forward-focused change for a better quality of life for
outpatients that are diagnosed with obesity.
Healthcare Support
Theoretical and Operational Definition: integrative healthcare service delivery that
facilitates the provision of effective and efficient aid to the patient in a way that is essential to
their safety, improved quality of life, and development of better coping tools (Boersema et al.,
2021).
Operational Definition: A nursing duty that recognizes the provision of the totality of
care for outpatients with obesity through readiness in resource and information availability that
allows sustainable improvement of patient’s health.
Healthy diet
Theoretical definition: Refers to both a health-promoting and disease-preventing diet. It
delivers adequate nutrients and other health-promoting ingredients from wholesome foods while
avoiding ingesting harmful substances (Chaudhary et al., 2018).
Operational Definition: A diet composed of macronutrients, micronutrients, and
vitamins necessary for maintaining the body’s normal functioning and promoting health through
enhancing healthy weight loss in obese and overweight patients.
Limitations
The Project Author recognizes the following project limitations:
1. The implementation of the educational training program is not within the context of
this project;
2. The educational training program is developed in the English language only and may
benefit a more culturally diverse population if written in additional languages.
Project Development Plan
23
A detailed topical outline of the educational training program content is created based on
the extensive review of evidence-based literature and the theoretical framework used to support
and guide the development of an educational training program. After permission is granted from
the D’Youville Patricia H. Garman School of Nursing, graduate faculty designee (Appendix A),
five professionals with knowledge and expertise in a healthy diet for patients with obesity will be
asked if they are interested in voluntarily participating as expert content reviewers for an
educational training program. The content expert panel will consist of two registered nurses
working in an outpatient healthcare service delivery, one nutritionist working in a public health
system that educates about healthy diets, and two clinical dieticians working in an outpatient clinic.
If interested, the Project Author will mail a packet containing a Letter of Intent (Appendix B), a
copy of the
Content Expert Project Evaluation Tool
created by the Project Author specifically for
the project (Appendix C), a copy of the educational training program (Appendix D), and a self-
addressed stamped envelope. The Letter of Intent will explain the project purpose and instructions
for
completing and returning the Content Expert Project Evaluation Tool to the Project Author.
The Content Expert Project Evaluation Tool contains six evaluative items with space for narrative
comments and suggestions. Approximately 20 minutes will be required to review the educational
training program and to complete the Content Expert Project Evaluation Tool. Content experts will
be provided a self-addressed envelope to return the Content Expert Project Evaluation Tool to the
Project Author. Once all evaluation tools are returned to the Project Author, data will be analyzed
and reported narratively and in bar graph format. A summary of the evaluation results, including
the findings of the six evaluative items in the content expert project evaluation tool, will be
provided to the content expert reviewers by postal mail.
Plan for the Protection of Human Subjects
24
Following approval from D’Youville Patricia H. Garman School of Nursing, the graduate
faculty designee (Appendix A) five professionals with knowledge and expertise in the field of a
healthy diet particularly for patients with obesity will be personally approached and asked to
voluntarily participate as a content expert in the review and evaluation of an educational training
program (Appendix D). Content experts will be advised that participation or non-participation as
an expert reviewer will have no effect on their employment status. The Project Author has a
collegial, professional, and nonsupervisory relationship with the content expert reviewers thereby
protecting the participants from any risk of coercion. Content experts will be guaranteed
confidentiality because identifying characteristics will not be collected on the Content Expert
Project Evaluation Tool and because their names will not be revealed anywhere in the project
manuscript or in required project presentations. Only the Project Author will know the names of
the content expert reviewers. Return of the completed content expert Project Evaluation Tool
(Appendix C) will indicate implied voluntary consent to participate as a content expert reviewer.
Content experts will be advised that they will not be able to withdraw from project participation
once the project evaluation tool is returned to the Project Author because the evaluation tool will
be returned without identifying information. Returned Content Expert Project Evaluation Tools
will be stored according to the D’Youville Patricia H. Garman School of Nursing protocol in a
locked drawer located in the Project Author’s home for a period of three years and then destroyed.
Plan for Project Evaluation
After obtaining full approval from the D’Youville
Patricia H. Garman School of Nursing
(Appendix A), the Project Author will mail a packet to each content expert reviewer containing
one Letter of Intent (Appendix B), one copy of the Content Expert Project Evaluation Tool
(Appendix C), one copy of the educational training program (Appendix D), and one self-addressed
Sharon Mang
45010000000001725
use same description as in Project Objective #3
25
stamped envelope. The Letter of Intent will explain the project purpose and instructions for
completing and returning the Content Expert Project Evaluation Tool to the Project Author.
The Content Expert Project Evaluation Tool will consist of six evaluative items scored on a
four-point Likert Scale that ranges from (1) Strongly Disagree, (2) Disagree, (3) Agree, and (4)
Strongly Agree. Space will be provided for narrative comments and suggestions following each
evaluative item. Evaluative items will ask reviewers to rate the resource guide on clarity,
readability, applicability, quality, organization, and evidence-based clinical relevance.
Approximately 20 minutes will be required to review the resource guide and to complete the
Content Expert Project Evaluation Tool. Content experts will be given seven days to complete and
return the Content Expert Project Evaluation Tool to the Project Author via postal mail using the
self-addressed stamped envelope included in the original packet. Likert scale responses will be
presented narratively and displayed in bar graph format. Content expert suggestions and comments
will be analyzed for common themes and presented narratively. A summary of the evaluation results
including the findings of the six evaluative items in the content expert project evaluation tool will
be provided to the content expert reviewers by postal mail.
Summary
Chapter I presented the project introduction, statement of purpose, an overview of the
theoretical framework guiding project development, an initial review of the literature focusing on
the development of an educational training program for nurses in an outpatient setting exploring
healthy diets for patients with obesity, the project significance and justification, project objectives,
definition of terms, project limitations, the project development plan, the protection of human
subjects, the plan for project evaluation, and a chapter summary. Chapter II will provide an
extensive review of the literature focusing on an educational training program for nurses regarding
Sharon Mang
45010000000001725
educational training program
26
the importance of a healthy diet for patients with obesity and a chapter summary. Chapter III will
discuss the intended project setting and population, the content expert participants, data collection
methods, project tools, the protection of human subjects, and a chapter summary. Chapter IV will
discuss the evaluation of the project, implications for future advanced nursing practice,
recommendations for future projects and research, and a chapter summary.
27
References
Alexander, C. C., Tschannen, D., Hays, D., Clouse, M., Zellefrow, C., Amer, K. S., … & Milner,
K. A. (2022). An integrative review of the barriers and facilitators to nursing engagement
in quality improvement in the clinical practice setting. Journal of Nursing Care
Quality, 37(1), 94-100.
Alexander, C., Rovinski-Wagner, C., Wagner, S., & Oliver, B. J. (2021). Building a Reliable
Health Care System: A Lean Six Sigma Quality Improvement Initiative on Patient
Handoff. Journal of Nursing Care Quality, 36(3), 195-201.
Allan, J. (2020). Theorizing new developments in critical social work. In Critical social work,
30–44. Routledge.
Balani, R., Herrington, H., Bryant, E., Lucas, C., & Kim, S. C. (2019). Nutrition knowledge,
attitudes, and self-regulation as predictors of overweight and obesity. Journal of the
American Association of Nurse Practitioners, 31(9), 502-510.
Block, B. L., Smith, A. K., & Sudore, R. L. (2020). During COVID‐19, outpatient advance care
planning is imperative: We need all hands on deck. Journal of the American Geriatrics
Society.
Bloor, M., & McIntosh, J. (2019). Surveillance and concealment: a comparison of techniques of
client resistance in therapeutic communities and health visiting. In Selected Writings in
Medical Sociological Research, 93–116. Routledge.
Boersema, G. C., Smart, H., Giaquinto-Cilliers, M., Mulder, M., Weir, G. R., Bruwer, F. A., … &
Van der Merwe, Z. (2021). Management of non-healable and maintenance wounds: a
systematic integrative review and referral pathway. Wound Healing Southern
Africa, 14(1), 8-17.
28
Branch, C., Deak, H., Hiner, C., & Holzwart, T. (2016). Four nursing metaparadigms. IU South
Bend Undergraduate Research Journal, 16, 123-132.
Bucher, D. T. S., Courvoisier, D. S., Saldarriaga, A., Martin, X. E., & Farpour‐Lambert, N. J.
(2018). Training is essential in nurses’ and physicians’ knowledge, attitudes,
representations, and declared practices about obesity in a university hospital. Clinical
obesity, 8(2), 122-130.
Chae, D., & Park, Y. (2019). Organizational cultural competence needed to care for foreign
patients: A focus on nursing management. Journal of Nursing Management, 27(1), 197–
206.
Chaudhary, A., Gustafson, D., & Mathys, A. (2018). Multi-indicator sustainability assessment of
global food systems. Nature communications, 9(1), 1-13. Retrieved from
https://doi.org/10.1038/s41467-018-03308-7
Foley, P. J., Gunson, J. T., & Baumann, S. L. (2019). Two Stories about Diet and Diabetes in
Europe. Nursing Science Quarterly, 33(1), 85-90.
Gadde, K. M., Martin, C. K., Berthoud, H. R., & Heymsfield, S. B. (2018). Obesity:
pathophysiology and management. Journal of the American College of
Cardiology, 71(1), 69–84.
Godfrey, K. M., Reynolds, R. M., Prescott, S. L., Nyirenda, M., Jaddoe, V. W., Eriksson, J. G.,
& Broekman, B. F. (2017). Influence of maternal obesity on the long-term health of
offspring. The lancet Diabetes & endocrinology, 5(1), 53-64.
Halvorson, E. E., Curley, T., Wright, M., & Skelton, J. A. (2019). Weight bias in pediatric
inpatient care. Academic Pediatrics, 19(7), 780-786.
https://doi.org/10.1038/s41467-018-03308-7
29
Hee Soon, K. I. M., Jiyoung, P. A. R. K., Yumi, M. A., & Mihae, I. M. (2019). What are the
barriers at home and school to healthy eating? Overweight/obese child and parent
perspectives. The Journal of Nursing Research, 27(5), e48. Retrieved from
https://doi.org/10.1177/0894318419881797
Kalligeros, M., Shehadeh, F., Mylona, E. K., Benitez, G., Beckwith, C. G., Chan, P. A., &
Mylonakis, E. (2020). Association of obesity with disease severity among patients with
coronavirus disease 2019. Obesity, 28(7), 1200-1204.
Levine, S., Malone, E., Lekiachvili, A., & Briss, P. (2019). Health care industry insights: why
the use of preventive services is still low. Preventing chronic disease, 16.
Ogbolu, Y., Scrandis, D. A., & Fitzpatrick, G. (2018). Barriers and facilitators of care for diverse
patients: Nurse leader perspectives and nurse manager implications. Journal of nursing
management, 26(1), 3-10.
Oleck, L. (2022). Psychiatric-Mental Health Nurses: Spread the Word. Journal of the American
Psychiatric Nurses Association, 28(5), 413–415. Retrieved from
https://doi.org/10.1177/10783903221117555
Peplau, H. (1991). Interpersonal Relations in Nursing: A Conceptual Frame of Reference for
Psychodynamic Nursing. Springer Publishing.
Phillips, K. E., & LoGiudice, J. A. (2020). Practices and Attitudes of Nursing Students Toward
Patients with Disordered Eating Behaviors. Nursing education perspectives, 41(1), 49-51.
Piché, M. E., Tchernof, A., & Després, J. P. (2020). Obesity phenotypes, diabetes, and
cardiovascular diseases. Circulation Research, 126(11), 1477-1500.
https://doi.org/10.1177/0894318419881797
https://doi.org/10.1177/10783903221117555
30
Rezaei, S., Vaezi, F., Afzal, G., Naderi, N., & Mehralian, G. (2022). Medication Adherence and
Health Literacy in Patients with Heart Failure: A Cross-Sectional Survey in Iran. HLRP:
Health Literacy Research and Practice, 6(3), e191-e199.
Ross, A., Yang, L., Wehrlen, L., Perez, A., Farmer, N., & Bevans, M. (2019). Nurses and
health‐promoting self‐care: Do we practice what we preach? Journal of nursing
management, 27(3), 599-608.
Seger, J. C. (2019). Optimizing Outcomes in Outpatient Obesity Management. In Quality in
Obesity Treatment, 221–234. Springer, Cham.
Shi, H. (2017). Planning Effective Educational Programs for Adult Learners. World Journal of
Education, 7(3), 79–83.
Smith, J. D., Fu, E., & Kobayashi, M. A. (2020). Prevention and management of childhood
obesity and its psychological and health comorbidities. Annual review of clinical
psychology, 16, 351-378.
Srivastava, G., Fox, C. K., Kelly, A. S., Jastreboff, A. M., Browne, A. F., Browne, N. T., … &
Apovian, C. M. (2019). Clinical considerations regarding the use of obesity
pharmacotherapy in adolescents with obesity. Obesity, 27(2), 190–204.
Stonerock, G. L., & Blumenthal, J. A. (2017). Role of counseling to promote adherence in
healthy lifestyle medicine: strategies to improve exercise adherence and enhance physical
activity. Progress in cardiovascular diseases, 59(5), 455-462.
Sutaria, S., Devakumar, D., Yasuda, S. S., Das, S., & Saxena, S. (2019). Is obesity associated
with depression in children? Systematic review and meta-analysis. Archives of disease in
childhood, 104(1), 64-74.
31
Tartavoulle, T., & Landry, J. (2021). Educating Nursing Students About Delivering Culturally
Sensitive Care to Lesbian, Gay, Bisexual, Transgender, Questioning/Queer, Intersex, Plus
Patients: The Impact of an Advocacy Program on Knowledge and Attitudes. Nursing
education perspectives, 42(4), E15-E19.
Turner, M., Jannah, N., Kahan, S., Gallagher, C., & Dietz, W. (2018). Current knowledge of
obesity treatment guidelines by health care professionals. Obesity, 26(4), 665–671.
Walia, I., Krainovich-Miller, B., & Djukic, M. (2022). Nurses’ Lived Experience with Nurse–
Physician Collaboration. The Journal of Continuing Education in Nursing, 53(9), 397–
403.
Wharton, S., Lau, D. C., Vallis, M., Sharma, A. M., Biertho, L., Campbell-Scherer, D., … &
Wicklum, S. (2020). Obesity in adults: a clinical practice guideline. Canadian Medical
Association Journal, 192(31), E875-E891. Retrieved from
https://www.cmaj.ca/content/cmaj/192/31/E875.full
CMAJ 2020 August 4;192:E875-91. doi: 10.1503/cmaj.191707
Whitehouse, C. R., Sharts-Hopko, N. C., Smeltzer, S. C., & Horowitz, D. A. (2018). Supporting
transitions in care for older adults with type 2 diabetes mellitus and obesity. Research in
gerontological nursing, 11(2), 71–81.
https://www.cmaj.ca/content/cmaj/192/31/E875.full
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Appendix A
Patricia H. Garman School of Nursing
Full Approval Letter
33
Appendix B
Letter of Intent
34
Content Expert Letter of Intent
Dear Content Expert,
Hello, my name is Funmilola A. Akerele, I am a graduate student completing a Master of
Science in Nursing/Family Nurse Practitioner degree at D’Youville College in Buffalo, New York.
Currently, I am developing an Educational Training Program for nurses on healthy diet and obesity
in an outpatient setting.
I am submitting the Educational Training Program for your expert review and evaluation.
Recommendations and critiques of this work in progress will be taken into serious consideration
during the final revisions of this work. You are being asked to review and evaluate the resource
guide for clarity, readability, applicability, quality, organization, and evidence-based relevance.
Your review of the Educational Training Program should take approximately 20 minutes of your
time. The evaluation process is completely voluntary and your refusal to participate will involve
no penalty or loss to you. Your responses will be kept confidential and will be available only to
me. If you choose to participate, please return the evaluation tool within the next seven (7) days
using the enclosed self-addressed stamped envelope. Consent to participate in the evaluation is
implied upon the completion and return of the evaluation tool. Once you return the evaluation tool,
there is no way to withdraw your responses, as there are no identifying markers included on the
tool. Returned evaluation tools will be stored in my home for a period of three years and then
destroyed. There are no direct benefits to you as a content expert participant. A copy of the results
including the findings of the six evaluative items in the content expert project evaluation tool will
be mailed to you at the conclusion of this project.
If you have any questions regarding my project or the evaluation process, please contact
me via email at akeref24@dyc.edu. Any specific questions may be directed to Dr Sharon Mang,
my Project Chair, at (716) 829-8376 or via email at mangs@dyc.edu. Thank you for your
assistance and participation as a content expert. I look forward to receiving your evaluation of my
project.
Best Regards,
Funmilola A Akerele
Sharon Mang
45010000000001725
University
Sharon Mang
45010000000001725
in a locked drawer
Sharon Mang
45010000000001725
Dr.
35
Appendix C
Content Expert Project Evaluation Tool
36
Instructions:
The purpose of this tool is to provide you with a guideline for evaluating the clarity, readability,
applicability, quality, organization, and relevance of the current evidence-based practice of the
proposed an Educational Training Program. The purpose of the project is to develop an
Educational Training Program to provide nurses with information on the importance of a healthy
diet for obese patients in an outpatient setting. Using the four-point Likert Scale, please circle one
choice that best reflects your opinion. Space is provided after each of the six evaluative items for
further feedback and direction regarding the Educational Training Program. To maintain your
confidentiality, please do not make any identifying marks on the evaluation tool.
1. Clarity
The information presented in the Educational Training Program is clearly understood and easy to
follow
Strongly disagree Disagree Agree Strongly agree
1 2 3 4
Comments and Suggestions:
2. Readability
The information in the Educational Training Program is presented at an appropriate and
comprehensive level of reading for pediatric healthcare providers.
Strongly disagree Disagree Agree Strongly agree
1 2 3 4
Comments and Suggestions:
3. Applicability
The information presented in the Educational Training Program is relevant and fits the project’s
purpose.
Strongly disagree Disagree Agree Strongly agree
37
1 2 3 4
Comments and Suggestions:
4. Consistency
The Educational Training Program is well-designed and with a consistent flow.
Strongly disagree Disagree Agree Strongly agree
1 2 3 4
Comments and Suggestions:
5. Organization
The Educational Training Program is in order and well organized
Strongly disagree Disagree Agree Strongly agree
1 2 3 4
Comments and Suggestions:
6. Evidence-Based Clinical Relevance
The Educational Training Program addresses a current and clinically relevant problem in nursing
and patient care practice and utilizes current clinical evidence.
Strongly disagree Disagree Agree Strongly agree
1 2 3 4
Comments and Suggestions:
Thank you for taking the time to evaluate the Educational Training Program. Your feedback is
deeply appreciated and will strengthen the development of the Educational Training Program for
nurses in an outpatient setting.
38
Appendix D
Educational Training Program
39
Appendix E
Survey Tool Results
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