Integrative Review

Jane Doe

University

Project and Practicum

The prevalence of obesity and sedentary lifestyle complications are increasing at alarming rates, representing a common but preventable cause of severe medical complications like diabetes, cardiovascular diseases, and early mortality. This chronic condition has been for a long time a public health concern and social determinant. The Fitbit app offers a unique opportunity to enhance the efficacy of weight loss plans as it is used to track activity, monitor steps, heart rate, energy expenditure, sleep, and sedentary behavior. The integrative review focused on how the American Heart Association (AHA) Diet and Lifestyle recommendations and the Fitbit app are used as innovative solutions to reduce obesity in adult patients.

Results and Discussion: The databases searched were Chamberlain Library, PubMed, and CINHAL. Initial searches yielded over 2000 articles, of which 45 were chosen and examined because they fit the integrative review's theme. The 15 papers most relevant to the PICOT question were studied in further detail and appraised using the Johns Hopkins Evidence Appraisal table. The studies reported positive physical activity outcomes.

Conclusions and Further Recommendations:  This systematic review supported the effectiveness of the AHA Diet and Lifestyle recommendations to reduce obesity, and clinical use generalization is recommended. Fitbit app provides new ways to improve physical activity habits, and the easy availability of electronic devices may enhance their generalizability use.

Keywords: Obesity care; Obesity complications; Lifestyle recommendations; Obesity management; Physical activity intervention using Fitbit activity trackers.

Thanks to my family for their unwavering support of this project; their cooperation means a lot to me. To my husband Armando, thank you for your love, understanding, and patience during this time. I credit my achievement to all of you for your unwavering love and belief in me.

First, I must acknowledge the help of all my professors who inspired, encouraged, and supported me throughout the DNP program. My heartfelt thanks to my teammates, without whom I would never have completed this phase in my life. Their encouragement has had a significant influence on my strong determination during this trip.

Contents American Heart Association Lifestyle Recommendations to Reduce Obesity 1 Abstract 2 Introduction Error! Bookmark not defined. Dedication 3 Acknowledgments 4 American Heart Association Lifestyle Recommendations to Reduce Obesity 6 Problem Statement 6 Significance of the Practice Problem 7 Theory or Translational Science Framework 8 Methodology 10 Review Protocol 10 Inclusion/Exclusion Criteria 10 Data Analysis 10 Results and Discussion 11 Characterization of the Body of Literature 11 Findings Synthesis 11 Conclusions and Further Recommendations 12 Implications for Nursing Practice 12 Conclusions and Contributions to the Professions of Nursing 12 Recommendations 12 References 13 Appendix A 18

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The Practice Problem Statement section is 1 paragraph in length. Your introduction section should smoothly transition into your problem statement. It should flow logically from the information you provided. Include your inquiry question, which will provide direction for your work. Explain your approach to the problem and how your intervention would be addressed.

Obesity represents a common but preventable cause of morbidity and severe medical complications. Despite efforts to curb the issue, globally, the annual cases of obesity continue to rise. Obesity has reached epidemic proportions worldwide, affecting people's health (Carbone et al., 2022). Physical activity is advised to minimize the risk of chronic diseases such as diabetes, cardiovascular disease, and cancer. According to the literature, it is common to find patients with a sedentary lifestyle and physical inactivity. Still, wearables and smartphone apps provide new ways to improve physical activity habits (Gal et al., 2018). The easy availability of sophisticated activity trackers such as Fitbit offers a unique opportunity to enhance the efficacy of computer-tailored interventions. These advanced activity trackers can monitor steps, heart rate, energy expenditure, sleep, sedentary behavior, and physical activity intensity (Vandelanotte et al., 2018). The inquiry question which provided direction for the integrative review is: In overweight adult patients in a primary care clinic, what is the impact of implementing the American Heart Association Diet and Lifestyle recommendations, compared to standard care, on body weight in 8-10 weeks?

The Significance of the Practice Problem section is 1-2 pages in length. Start this section with identification of the practice problem. This section articulates the issue and its significance from both a global/nationwide perspective, as well as within the practicum site.

From a global/nationwide perspective, how does the issue impact nurses, nursing care, healthcare organizations, the quality of care being provided, society (costs, healthcare policy, etc.), the patient/client (e.g., pain, suffering, quality of life, impact on income potential, etc.), the family, healthcare system (e.g., impact on cost or delivery systems). Discuss the incidence and/or prevalence and include the financial impact, if at all possible. You might discuss the impact on length of stay, readmission, home health care requirements, disability and/or mortality. Also, you should address any quality, safety, legal, and ethical implications. This discussion must be substantiated by citations from professional literature. This also applies in regard to the impact of the issue within the practicum site.

Obesity has become a global epidemic, with at least 2.8 million people dying yearly from being overweight or obese (WHO, 2021). Obesity has several negative consequences for population health and healthcare costs (Carbone et al., 2022). Sedentary behavior and physical inactivity are two of the most common modifiable risk factors in obese patients. Obesity is a chronic condition linked to higher mortality and morbidity rates (WHO,2021). According to the Centers for Disease Control and Prevention, it causes an estimated 300,000 fatalities yearly in the United States (CDC, 2021). Obesity co-morbidities include heart disease, stroke, type 2 diabetes, and some kinds of cancer, contributing to a lower quality of life and shorter life expectancy. Obesity affects 93.3 million persons in the United States and is one of the primary causes of avoidable and early mortality (CDC, 2021). Internal clinical reports have shown a significant increase in obese patients at the primary care clinic practicum site. Physical activity and exercise training help improve and avoid many chronic diseases, including cardiovascular disease, in people of all ages, races, ethnicities, and sexes (Lavie et al., 2019).

At the national level, the rate of obesity-related diseases represents a severe public health concern that negatively impacts the community’s quality of life and nursing care expenses. According to the CDC 2021, obesity is a common, powerful, and costly disease, and the prevalence and incidence remain high in the United States. The Centers for Disease Control and Prevention (CDC) reports that 42.4% of all adults in the United States are fat, and 650 million individuals worldwide are obese. Obesity cost USA $190.2 billion in 2018, accounting for 21% of total healthcare expenses. The government continues investing a lot of money in healthcare institutions to provide the most excellent care to patients, and the economic implications are enormous. Based on the high number of obese patients found at the clinical site, is needed an innovative intervention to reduce obesity and enhance clinical outcomes.

The second phase is to adapt knowledge to the local context. There is a need to identify available stakeholders in the local context, including available healthcare providers, nurse managers, and patients. The stage also involves building a robust infrastructure in the local context and linking the local context to other model locations.

The third phase is to assess facilitators and barriers to knowledge use. This stage involves identifying facilitators to change and the obstacles that may drag the process or reduce the outcomes (Kitson et al., 2018). The location is essential as it helps stakeholders utilize the facilitators and address the barriers. The facilitators include a cooperative patient care team, and the potential wall is participants may forget to input data in the tracking app, and others lack proper mobile access. The challenges can be addressed by educating patients and sending weekly reminders.

The fourth stage is to select, tailor, and knowledge use . The step involves mapping and applying the AHA diet and lifestyle recommendations and use the tracking app to ensure compliance in the best way possible.

The fifth phase is to monitor knowledge use. Collecting data on knowledge use is essential and providing the service aligns with the project purpose (Bryant et al., 2019). It will help stakeholders make some changes if needed to facilitate the project.

The sixth phase is to evaluate the outcomes. It is vital to assess the effects of the strategy intervention to inform future decisions. Intervention evaluation helps determine if any goals should be addressed to enhance the project outcomes (Zhao et al., 2021). The DNP student may evaluate the results by interviewing patients and the patient’s care team. Internal sources may also include weight changes, as evident in the clinic’s data.

Phase seven of the KTA model is to sustain knowledge. There should be strategies for supporting evidence-based knowledge to enhance and impact the current practice. Knowledge implementation is more effective if it is maintained for a long time. To sustain long-term weight control, nutrition knowledge, attitudes, and dietary self-regulation are significant predictors of overweight and obesity (Balani et al., 2019).

The Review Protocol section is 1-2 pages in length. This section is written so that others can replicate the integrative review. There is a description in detail of how the integrative review was conducted, including a description of the search strategy, the selection of databases used, with justification and the search terms.

The Inclusion/Exclusion Criteria section is 1-2 pages in length. The specific selection approach is discussed, with an explanation of the selection of sources included in the review.

The Data Analysis section is 1-2 pages in length. Explains how data were extracted from the sources you selected for the integrative review, and describes how results from the studies were handled and combined. Explains the process for how the sources were analyzed, whether quantitatively or qualitatively, with a justification of the analytic methods you used and their appropriateness.

The 15 (minimum) primary research studies and/or systematic reviews are included in Appendix A – The Johns Hopkins Nursing Evidence-Based Practice Individual Evidence Summary Tool. Only research evidence is included in the synthesis and on the evidence table. No secondary sources are included.

The Implications for Nursing Practice section is 1-2 pages in length. The implications of the project on nursing and healthcare is effectively described, based on the integrative review. The impact on the appropriate system (i.e., micro, meso, macro) and recommendations are included.

Some ideas:

· Incorporating regular physical activity, a healthy diet, and a lifestyle are crucial in preventing and reducing obesity. (micro= patient level, meso= nursing care, macro= organization level)

· Physical activity and exercise training help improve patient outcomes and avoid several chronic diseases in people of all ages, races, ethnicities, and sexes (Lavie et al., 2019).

· Implementing the American Heart Association (AHA) Diet Lifestyle Recommendations reduces organizations’ costs associated with obesity care and multiple medical complications related to obesity.

The Conclusions and Contributions to the Professions of Nursing section is 1-2 pages in length.

The conclusion reviews the main topics presented and clearly and effectively summarizes significant conclusions from the integrative review. Conclusions should relate directly to your purpose and project question. They are generalizations that loop back to the existing literature on your topic. For each conclusion you make, cite the sources that support or contradict your findings. Conclusions indicate what is now known regarding nursing practice when your results and results from prior literature are considered together.

The References page begins on a new page and there must be a corresponding reference for every intext citation used within the paper. References are current (published within last five years or seminal studies), from peer-reviewed journals, minimal secondary sources, and all are appropriate to the identified nursing problem and intervention. Also include the 15 articles that supports the integrative review and are containing in the appendix A. ***(The 15 articles that are supposed to be used for the integrative review are highlighted, and some other used before or possible article for use are in the following references list for your consideration. Feel free to use the ones you find pertinent. Appendix A is in the right place, it is completed, and reviewed, please keep it as is).***

Johns Hopkins Nursing Evidence-Based Practice

Individual Evidence Summary Tool

© The Johns Hopkins Hospital/Johns Hopkins University. May not be used or reprinted without permission.

Date: 11/10/2022