PROJECT IN PROGRESS

THEORECTICAL FRAMEWORK

Project Organization

The written project is organized by Chapters with sections and as follows:

Title Page

The title page is organized according to APA format. The title page must include the title of the project in capital letters, the project author’s name and credentials, and the following statement: “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 Nursing, Buffalo, New York, and the date the final project was approved.” This information is centered between the right and left margins.

Copyright Page

This page has the following statement: “Copyright © year by project author name. 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 the project author.”

Project Approval Page

This page lists the Project Chair and their respective discipline as well as the date the project was defended on.

Abstract

The abstract is presented before Chapter I. The APA Manual 7th edition recommends that the abstract should be no more than 250 words. It consists of a succinct summary of the entire project and highlights the details of the identified problem, the project purpose, the theoretical framework(s), and evaluative measures. The abstract heading is bolded and centered. Prior to the defense, the abstract is written in future tense because the project is not complete. After the defense, the abstract is written in past tense. The project abstract should be formatted as follows after the defense as it is written in past tense here:

Abstract (Educational Projects)

Nursing Resource Team (NRT) staff nurses rotate throughout various clinical units within health care facilities and organizations to meet nurse staffing needs and to alleviate the burden of nurses working understaffed. Because of the nature of their job, NRT staff nurses often encounter profound job challenges. The purpose of this project was to develop an interview schedule to assist NRT nurse managers in exploring factors viewed as important by NRT staff nurses regarding job satisfaction, efficiency, productivity, and retention. Kanter’s (1977, 1993) Structural Theory of Organizational Behavior and Maslow’s Hierarchy of Needs (1987) were utilized as theoretical frameworks. Five content experts voluntarily participated in the review of the NRT interview schedule for content validity.

Abstract (Quality)

Introduction, Research Question, Problem Statement, Literature Review, Methodology, Procedure for setting and subjects, procedure for data collection and tools, and Results.

Acknowledgement

This statement is optional. The project author may choose to acknowledge individuals as appropriate.

Table of Contents

An outline for the table of contents can be developed. Page numbers are added when the project is completed. An example is provided in this handbook.

Section I- Educational Project

Instructions for Chapter I

The project is double spaced, and each paragraph is indented. The following sections of Chapter I include instructions and examples for the project:

CHAPTER I

1. Instructions for the Introduction section

The function of the introduction is to attract or grab the reader’s interest and attention. The introduction consists of a broad overview of the project problem. The introduction should contain information that informs the reader about the basic nature and scope of the problem. References and statistics can be briefly utilized to reinforce the significance of (the importance) and the need (justification) for the project. The student is advised to begin a reference page on a separate page (the last page of the paper and before the appendices) entitled as
References (bolded and centered) with all articles used to write this section cited in APA format. The introduction section should be presented in one to two paragraphs and should range in length between ½ of one page to 1 ½ pages maximum. In accordance with APA guidelines, there is no header for the introduction section because the introduction is clearly identified by its position in the manuscript.

2. Instructions for the Statement of Purpose section

This section follows the introduction. The Statement of Purpose describes the purpose of the project in one succinct and concise statement and clearly identifies to the reader
what (product) is to be produced as a result of the project,
who the project is intended for (participants),
where the project will be utilized (the intended setting), and
why the project is being developed. For example:

Statement of Purpose

The purpose of this project is to develop an educational training program
(what- product) for adult mental health nurses
(who) working in a mental health inpatient hospital setting
(where) regarding the importance of utilizing therapeutic communication to promote positive patient outcomes
(why). **After the defense, this statement is written in past tense i.e. The purpose of this project was to develop……

* The title of the project reflects the Statement of Purpose. For example:

An Educational Training Program for Adult Mental Health Nurses to Regarding the Utilization of Therapeutic Communication

3. Instructions for the Theoretical Framework and Nursing’s Metaparadigm section

This section follows the Statement of Purpose. The student chooses a nursing theory to guide and support the development of the project. A second theory from a discipline outside of nursing such as sociology, education, or management non-nursing theorist may also be used. The theoretical framework section introduces the theory and includes a discussion of the major components, concepts, definitions, assumptions, and propositions found within the theory. The theory needs to “fit” well with original concepts describing the project purpose. The student summarizes how the theory “fits” the project purpose by discussing how the theory’s main components, concepts, definitions, assumptions, and propositions are connected or related to the project purpose. The most current theory source (written by the theorist) is to be used as the primary reference source by the student. No secondary sources are permitted unless approved by the Project Chair
. Additionally, in the theoretical framework section, the student discusses nursing’s four metaparadigm concepts (nurse, health, person, and environment) as they are defined by the nursing theorist and how each of the four metaparadigm concepts are operationally defined by the student. The theoretical definitions are cited in APA format (source, year, page). The theoretical framework section should be a minimum of 3 pages in length. This section should be presented as follows:

Theoretical Framework

Hildegard Peplau’s (2004)
Interpersonal Relations in Nursing Theory is utilized as the theoretical framework for the development of this project. A brief overview of the theory is presented as well as a discussion regarding how the theory was utilized to guide the development of the project. In addition, Peplau’s (2004) theoretical definitions for nursing’s four metaparadigm concepts (nursing, health, person, and environment) as well as the Project

Author’s operational definitions for nursing’s four metaparadigm concepts will be presented.

Interpersonal Relations in Nursing Theory

Hildegard Peplau is often regarded as the mother of psychiatric nursing….

Interpersonal Relations in Nursing Theory and Nursing’s Metaparadigm

In her
Interpersonal Relations in Nursing Theory, Peplau (2004) defines nursing’s four metaparadigm concepts (nurse, health, patient, and environment) as follows.
Nurse is defined by Peplau (2004) as…. (p.). For the purpose of this project,
nurse is operationally defined as…. Peplau (2004) defines
health as…. (p.).
Health is operationally defined for the purpose of this project as….
Person is defined as…. (Peplau, 2004, p.).
Person is operationally defined for the purpose of this project as…. Finally,
environment is defined as …. (Peplau, 2004, p.).
Environment is operationally defined for the purpose of the project as….

Example regarding how to summarize nursing’s four metaparadigm concepts for a theory with implied definitions for nursing’s four metaparadigm concepts:

Although Benner (2001) did not outwardly and explicitly define nursing’s four metaparadigm concepts (nursing, person, health, and environment) in her
Novice to Expert theory, she described them as follows.
Nursing is described by Benner (2001) as a helping role and as giving and receiving help…
Nursing, for the purpose of this project, is operationally defined as a professional nurse in one of Benner’s five stages of skill acquisition…

4. Instructions for the Initial Review of the Literature section

This section follows the Theoretical Framework section. The initial review of the literature presents a brief synthesis of at least 20 original research articles from North American journals (10 of the 20 original articles should originate from North American nursing journals and populations under study must be in US or Canada) that the student has reviewed thus far describing current evidence-based research findings in the project area of interest. Articles should be published within the last 5 years to ensure and to reflect current research-based evidence and practice. Additional articles may be requested by the Project Chair at their discretion. The initial review of the literature is a short summary of what is already known about the project area of interest, what has been successfully implemented, what is lacking and in need of further exploration, and articles emphasizing use of the theoretical framework chosen by the student as it pertains to the project area of interest. At times, classic and seminal work older than the 5-year limit can be included in the review of the literature since they are timeless and continue to support current practice. The Initial Review of the Literature is written following APA format and should include subheadings addressing areas of the literature explored. The Initial Review of the Literature section should be presented as follows:

Initial Review of the Literature

A review of nursing and health related literature was (the initial review of literature has been conducted so in this section, you can write in past tense) conducted to explore (project area of interest) using the following keywords both singularly and in multiple combinations:
,
,
. Databases searched, limited to the years
to
, included AMED, Alt Health Watch, CINAHL Plus with Full Text, and EBSCO. The search was limited to the years to
to ensure that current evidence-based literature was reviewed and summarized for the purpose of this project. A summary of the review of the literature is presented.

Therapeutic Communication

According to Smith (2021) …

* After a student successfully defends Chapter I (the Project Proposal), the initial review of the literature is then moved into Chapter II with a section replacing the initial review of the literature in Chapter I entitled Literature Synopsis. The Literature Synopsis section in Chapter I presents a summary of literature review findings in Chapter II once the literature review is completed in Chapter II.

5. Instructions for the Significance and Justification section

The Significance and Justification section follows the Initial Review of the Literature. The Significance and Justification section presents the necessity of the project (significance) and is supported by clinical evidence (statistics and findings) resulting from the literature review (justification). This section should end with a sentence supporting the project purpose. The Significance and Justification section should be approximately ½ to 1 page in length. This section should begin as follows:

Significance and Justification

Findings from the initial literature review reveal that a lack of knowledge exists in nursing and patient care practice regarding….

6. Instructions for the Project Objectives section

The Project Objectives section follows the Significance and Justification section and is written in the present tense. Project objectives identify at least 3 specific outcomes (aims/goals) describing what the student hopes to accomplish by carrying out the project. All educational projects require students to 1) conduct a review of the literature exploring the background of the project topic/problem/issue; 2) develop and/or create a product such as an educational program, workshop, PowerPoint, or video, an interview schedule, questionnaire or survey, a professional brochure or pamphlet, or a handbook or resource guide; and 3) have the project product evaluated/reviewed by a panel of content experts who have extensive knowledge and expertise in the project area of focus.

Project Objectives

The objectives of this project are to:

1. Conduct an extensive review of the literature exploring (project area of interest) using the following keywords both singularly and in multiple combinations:
, ,
. Databases searched, limited to the years
to
, will include AMED, Alt Health Watch, CINAHL Plus with Full Text, and EBSCO Host;

2. Develop a (product-brochure, PowerPoint, Video, etc.); and

3. Have a panel of (5) content experts with extensive knowledge and expertise in (project area of interest) evaluate and critique the (product) for clarity, readability, applicability, quality, organization, and evidence-based clinical relevance.

*

Throughout the body of your project proposal, when discussing your evaluation tool, make sure that the order of evaluative items matches the order as they appear in your evaluation tool.

7. Instructions for the Definition of Terms section

The Definition of Terms section follows the Project Objectives section. In this section, the Project Author presents additional theoretical and operational definitions (other than nursing’s four metaparadigm concepts) applicable to the project purpose as appropriate. Concepts found in the project Statement of Purpose should be defined. Conceptual/theoretical definitions should be discipline specific and need to reflect the theoretical framework and purpose of the project. Theoretical definitions state the meaning of a concept as it is defined or described by the theorist/theory. Theoretical definitions need to be obtained and cited from the primary source – the most current version or text of the theory. Theoretical definitions can also come from professional organizations and associations. Dictionary and Wikipedia definitions are not acceptable sources for the definition of terms. All theoretical definitions are cited in APA format from the source they are retrieved from. An operational definition is the Project Author’s definition of a theoretical concept as it specifically reflects the project purpose. At times, theoretical and operational definitions may be defined the same. If a student wishes to operationally define a term as it is theoretically defined, the student needs to cite the source the definition was retrieved from. The Definition of Terms section should be presented as follows:

Definition of Terms

The following concepts are defined both theoretically and operationally for the purpose of this project:

Health Promotion

Theoretical Definition: Behavior motivated by the desire to increase well-being and actualize human health potential. It is an approach to wellness (Pender et al., 2011, p. 45).

Operational Definition: Behaviors that promote HGH treatment delivery and adherence resulting in improved health, treatment outcomes, and better quality of life for adolescents diagnosed with HGH deficiency.

Theoretical and Operational Definition: ……

8. Instructions for the Limitations section

This section follows the Definition of Terms section. Every research study or project has limitations (problems/issues/concerns) that the Project Author experienced while conducting a study or developing a project that may be addressed or remedied in future studies/projects…there is no perfect study or project! The Limitations section informs the reader of the study or project’s problems/issues/concerns that the Project Author experienced. The Limitations section begins as follows and may include but are not limited to the following:

Limitations

The Project Author recognizes the following project limitations:

1. The implementation of the (product) is not within the context of this project;

2. The (product) is developed in the English language only and may benefit a more culturally diverse population if written in additional languages

9. Instructions for the Project Development Plan section

The Project Development Plan section follows the Limitations section. In this section, the student describes how they will develop their project. This section should be presented as follows:

Project Development Plan

A detailed topical outline of the (product) content is created based on the extensive review of evidence-based literature and the theoretical framework used to support and guide the development of the (product). After permission is granted from the D’Youville Patricia H.

Garman School of Nursing, graduate faculty designee (Appendix A),

(5) professionals with knowledge and expertise in (the project area of focus/field) will be asked if they are interested in voluntarily participating as an expert content reviewer for the (product).

The content expert panel will consist of one
, one
, one
, one
, and one

. 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 (product) (Appendix D), a

2

2

2

AN EDUCATIONAL TRAINING PROGRAM FOR NURSES IN AN OUTPATIENT SETTING REGARDING THE IMPORTANCE OF A HEALTHY DIET FOR PATIENTS WITH OBESITY

By

Name….

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 Nursing

Family Nurse Practitioner

Buffalo, NY

[Month Day, Year]

Copyright © 2023 by hhjjjjjjjj. 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 dtyyyyyyy , .

2

PROJECT APPROVAL

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’s 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.

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……………………………………………….

2

2

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 (Balani et al., 2019).

One of the main factors that make successful result in patient with obesity is reversal patient recovery program which includes 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 nursing program to facilitate proper education on patient-centered care 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. Evidently, the discussions on obesity and mechanisms for reversing obesity point out that there is a need for patient focused education on healthy diet for patients with obesity.

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 development of the project. In addition, Peplau’s (1991) theoretical definitions for nursing’s four metaparadigm concepts (nursing, health, person, and environment) as well as the Project Author’s operational definitions for nursing’s four metaparadigm concepts will be presented.

Interpersonal Relations in Nursing 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).

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 in Nursing 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. Centralization of goal setting for a patient with obesity 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 this project as the relationship between the nurse and patient 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 may lead to decreased self-esteem and mental health issues. 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 in Nursing Theory and Nursing’s Metaparadigm

Interpersonal Relations in Nursing Theory explains it as an input for developing positive outcomes and relinquishing the relationship with a support system that enhances positive outcomes Peplau (1991) . 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.

Peplau (1991)
defines a person as the receiver of nursing care whose needs should be assessed all-round and catered for accordingly. Peplau (1991)
defines environment as the surroundings of the patient which influences their bearing of health and wellness. Peplau (1991)
defines health as the multidimensional extent to which a person attains wellness for a qualitative life.

For the purpose of this project, a
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.

For the purpose of this project, 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.

For the purpose of this project, 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).

For the purpose of this project, 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 to 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, and 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) points 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 2018 to 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;

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 area of healthy diet 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 educational training program 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.

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 f;;;;;;;;;;;;;, I am a graduate student completing a Master of Science in Nursing/Family Nurse Practitioner degree at D’Youville University 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 a locker drawer 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 …..@dyc.edu. Any specific questions may be directed to Dr. ……, my Project Chair, at (716)……. or via email at …..@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,

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 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

My apologies, the title should be centered

Sharon Mang
450100000000017

25

Nursing

ttttttttttjjjjjjjtttttttjjjtttt

3

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.

rtyuuuuuuuuuuuuuu

yuuuuuuuuuuuuuuu

3

PROJECT APPROVAL

Project Committee Chairperson

Name: __ ________Dr. Sharon Mang_____________________

Signature: ___________________________________________

Discipline: ________________Nursing________________

Project Defended

On

[Month Day, Year]

Sharon Mang
45010000000001725
take out

uuuuuuuuuuuuu

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 was
utilized as the theoretical framework for this project. Five content experts reviewed the
educational training program for content validity.

Sharon Mang
45010000000001725
Peplau’s

5

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

6

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……………………………………………….

7

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 (Balani et al., 2019).

One of the main factors that make successful result in patient with obesity is reversal patient

recovery program which includes 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).

8

The success of any nursing program to facilitate proper education on patient-centered care

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. Evidently, the discussions on

obesity and mechanisms for reversing obesity point out that there is a need for patient focused

education on healthy diet for patients with obesity.

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

Sharon Mang
45010000000001725
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.

9

concepts together with the Project Author’s operational definitions for nursing’s four metaparadigm

concepts will be presented.

Interpersonal Relations in Nursing 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).

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

10

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 in Nursing

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. Centralization of goal setting for a patient with

obesity 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 this project as the relationship between the nurse and patient

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

11

obesity may lead to decreased self-esteem and mental health issues. 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 in Nursing 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, Peplau (1991) defines a person as the receiver of nursing care whose needs

should be assessed all-round and catered for accordingly. Similarly, Peplau (1991) theoretically

defines environment as the surroundings of the patient which influences their bearing of health

and wellness. At the same time, Peplau (1991) theoretically defines 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

(Peplau,

1991).

Sharon Mang
45010000000001725
take out similarly

Sharon Mang
45010000000001725
italicize

Sharon Mang
45010000000001725
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.

Sharon Mang
45010000000001725
italicize

Sharon Mang
45010000000001725
take out this sentence

Sharon Mang
45010000000001725
take out theoretically

Sharon Mang
45010000000001725
take out theoretically

Sharon Mang
45010000000001725
italicize

Sharon Mang
45010000000001725
take out theoretically

Sharon Mang
45010000000001725
take out at the same time

12

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

Sharon Mang
45010000000001725
For the purpose of this project, nurse is operationally defined as…

Sharon Mang
45010000000001725
For the purpose of this project, health is operationally defined as…

Sharon Mang
45010000000001725
For the purpose of this project, environment is operationally defined as…

Sharon Mang
45010000000001725
For the purpose of this project, health is operationally defined as…

Sharon Mang
45010000000001725
The operational definition is your own definition of the metaparadigm concept

13

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 to 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

Sharon Mang
45010000000001725
and JSTOR.

14

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).

Sharon Mang
45010000000001725
2017, p. 1457)

15

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

16

medicine. Nevertheless, Harris et al. (2017) points 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

17

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

18

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,

19

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

20

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 2018 to 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;

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.

21

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

22

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

23

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 area of

healthy diet 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

24

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 educational training program 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

25

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.

26

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.

Sharon Mang
45010000000001725
not original research

27

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

https://doi.org/10.1038/s41467-018-03308-7

28

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.

https://doi.org/10.1177/0894318419881797

https://doi.org/10.1177/10783903221117555

29

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.

30

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

31

Appendix A

Patricia H. Garman School of Nursing

Full Approval Letter

32

Appendix B

Letter of Intent

33

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 University 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 a locker drawer 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

3455455555555

5555555555555555

hhhhhhhhhhhhhh

hhhhhhhhhhh

34

Appendix C

Content Expert Project Evaluation Tool

35

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 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

36

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.

37

Appendix D

Educational Training Program

38

Appendix E

Survey Tool Results