Project Objectives_BEST_EDUCATION

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EDUCATIONAL TRAINING PROGRAM FOR NURSES IN AN OUTPATIENT SETTING

TO PROVIDE EDUCATION REGARDING THE IMPORTANCE OF A HEALTHY DIET

FOR PATIENTS WITH OBESITY

By

Funmilola A Akerele

A Project Submitted to the Faculty of D’Youville

Division of Academic Affairs In partial fulfillment of the

requirements for the degree of

Master of

Science in

Family Nurse Practitioner

Buffalo, NY

[Month Day, Year]

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Copyright © 2022 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.

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PROJECT APPROVAL

Project Committee Chairperson

Name: __ ____________________________________________________

Signature: ___________________________________________________

Discipline: ___________________________________________________

Project Defended

On

[Month Day, Year]

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Abstract

5

Acknowledgment

6

Table of Contents

Chapter

I. PROJECT INTRODUCTION ..................................................................... 8

Statement of Purpose ................................................................................... 9 Theoretical Framework ............................................................................... 9 Initial Review of the Literature ...................................................................13 Significance and Justification .....................................................................19 Project Objectives .......................................................................................19 Definition of Terms ................................................................................... Project Limitations .................................................................................... Project Development Plan ......................................................................... Plan for Protection of Human Subjects ..................................................... Plan for Project Evaluation........................................................................ Summary ...................................................................................................

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 ................................................................................................. 20

Appendices ................................................................................................

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List of Appendices

Appendix

A D’Youville Patricia H. Garman School of Nursing Full Approval Letter

…………………….….

B Letter of Intent .................................................................................................

C Evaluation Tool ...............................................................................................

D Product ............................................................................................................

E Survey tool results in graph……………………………………………….

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Chapter I

The age of fast food and instant gratification brought about by the growth of technology

has affected the general population in many ways. In America, obesity is becoming problematic,

with a prevalence estimate of 41% leading to risk in the severity of diseases (Kalligeros et al.,

2020). As a result, there is a need for nursing practice to take accountability in developing a

relationship with collaborative patient care. Obesity can be a lifestyle disease. Therefore, all

stakeholder participation must be considered a need to look at the four-metaparadigm perspectives

in caregiving using a foundational basis in a theoretical framework. First, a nurse needs expertise

in addressing health issues, especially those reversible through natural means, for example,

obesity. Obesity is reversible through natural means, including dietary modification and practicing

fasting.

The factors that make a successful program include proper planning. Proper planning

allows for allocating adequate time and resources toward the project, resulting in the successful

implementation of the program (Shi, 2017:p.80). 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 (Alulis & Grabowski, 2017:p.630).

The programs in the articles are good ways to effect cultural change. 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

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health checkups and screening. However, personal barriers such as individual change resistance

may negatively impact the success of the social change (Allan, 2020:p.350). 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, when the change comes as a surprise without the time to prepare mentally, and 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. This

study will assess interpersonal relations in nursing theory to draw mechanisms for developing

effective strategies for an educational plan for nurses taking care of patients with obesity in an

outpatient department. The program will major on how nurses can effectively pass educative

information to the clients on dietary intervention as a critical mechanism for reversing obesity. The

idea considers all the possible challenges that nurse educators may experience while trying to

enhance social change among patients.

Statement of Purpose

This project aims to develop an educational training program for nurses in an outpatient

setting to provide education regarding the importance of a healthy diet for patients with obesity.

Theoretical Framework

Hildegard Peplau's (2004) 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 (2004) theoretical definitions for nursing’s four metaparadigm sequential

interpersonal relationships and concepts and the Project Author's operational definitions for

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nursing's four metaparadigm concepts will be presented. These metaparadigm concepts are

foundational elements as orientation, identification, exploitation, and resolution defined within

nurse, health, patient, and environments aspects of nursing healthcare provision. As such, 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, as in this

study.

It thus facilitates better planning to understand the complexities of issues underlying the

patient's conditions, which would hinder getting well. In recognition of this, this paper aims to

bring to attention the definition of the metaparadigm concept of patient care within this theory by

looking at its significance and interpersonal relationship as contextualization in patient care. At

the same time, the paper will look at its actual application as employed in modern nursing care as

a mainstream cultural competency component. Finally, the deliberate look of this theory within

this aspect will facilitate a conclusion on the modern-day emphasis and necessitated patient-

centered model of care.

Significance of Interpersonal Relations Nursing Theory

As a mother of nursing psychiatry, Peplau (2004) 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, 2004, p. 2). 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 (2004) explains that effective patient outcome delivery comes from trust in

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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.

This theorist is a perfect fit for the proposed educational training program for nurses in an

outpatient setting to provide education regarding the importance of a healthy diet for patients with

obesity. The relationship between the outpatient and the nurse must be founded on trust so that

information can be shared comfortably and with trusted support from nurses. A support system

must be developed because obesity and the issues surrounding obesity can often bleed into self-

esteem and mental health. This theorist ideology will assist in identifying and orienting nurses to

the causes of obesity, introducing a perfectly balanced diet with regular exercise, and finally

producing solutions for diabetic prevention, a foundation that this theoretical framework supports.

Metaparadigm Concepts in Interpersonal Relations Nursing Theory

Thus, nursing can be defined based on culture and concrete work (Peplau, 2004; p.5). Thus,

it promotes 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.

Communicative action in the digital age between nurse and patient is bold navigation of

interpersonal relationships. On the other hand, the increase in maintenance tendency takes a newer

approach, as information overload can be present due to media. This could be advantageous for

outpatient care, but the opposite is true. As such, following Peplau’s underpinning of patient care,

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nursing is the implementation of need-based healthcare delivery through the respectable promotion

of perception and prevention of escalation of illness (Peplau, 2004, p. 9). Therefore, it can be said

that the operational definition of nursing is ensuring that patient needs are met adequately and

suitably hence unique to the patient. With that, a different relationship develops between nurse and

patient.

In recognition, a person is operationally defined as an entity with individual preconceptions

and mutual understanding of the nature of a medical issue and collaborates towards a productive

solution. Therefore, this contextualizes the environment as conditions that allow for human

processes that facilitate tendencies supportive of positive development to attain health (Peplau,

2004, p. 12). By this definition, health can operationally be 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 (Peplau, 2004, p. 13).

Operations Definition of Nursing Metaparadigm Under Interpersonal Relations Nursing

Theory

For this project, the operational definition of 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. It thus supports the operational

definition of the environment as contextualized conditions that allow for human processes that

facilitate tendencies supportive of positive development to attain health (Peplau, 2004, p. 12). By

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this definition, there is support for operationally defined health as a symbolic future positive goal

that is attained after effective healthcare hence instrumental for the person moving in the forward

direction of wellbeing (Peplau, 2004, p. 13).

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 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 2017 and 2022, will include AMED, Alt Health Watch, CINAHL

Plus with Full Text, EBSCO, Medical Journal sites for nursing care, nursing training, PubMed,

Scopus, Science Direct, Directory of Open Access Journals, Google Scholar, JSTOR and the

D'Youville library to loan articles through interlibrary loan. The search is limited to the years 2017

to 2022 to ensure that current evidence-based literature is reviewed and summarized for the

purpose of 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

continue 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

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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 out that

of 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

Smith et al.'s (2020) and Sutaria et al. (2020) studies. 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 the training for this. Recognizing physician effort in collaboration

with outpatient 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).

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According to Rezaei et al. (2022), the combination of aspects such as 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 healthy diet, diabetic 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 been 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

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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), and Harris et al. (2017) studies collectively look at transitioning patients from

outpatient to inpatient and provide insight on 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

paper 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, 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 for 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

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factors affecting healthy weight in the community, the study explained that obesity is not basically

a lifestyle crisis, but rather is a complicated, chronic disease affecting areas of behavioral,

psychosocial, biological, and environmental factors. For this reason, there is a need for

collaborative and comprehensive approach for 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, 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 at 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 implementations.

It is imperative 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

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can only weigh competent management. Furthermore, obesity practitioners must have complete

comprehension and apply evidence-based knowledge while administering care for 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,

Schetz et al. (2019) describe obesity as one of the current health concerns affecting a large

proportion of the world's population. 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 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

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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.

Health care 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:p.667).

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 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 are 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 conflicts 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.

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