assignment

The Psychological Impact of Diabetes on Adolescents with Obesity and Overweight

Introduction

Diabetes is known to have a major psychological impact on persons who are overweight or obese. Adolescents with diabetes are at greater risk for emotional and behavioral problems than the general population. These include anxiety, depression, and suicidal ideation likely due their immature emotional development. The psychological realm of diabetes has not been studied in a larger dimension. This project evaluates some of the critical aspects of psychological effect of being overweight and obese on students with diabetes.

In recent years, the estimated number of adolescents diagnosed with diabetes has been on the rise. This research might enhance the current body of knowledge in the area. On going review is required to analyze the degree and implication of psychological comorbidities as well as identifying important gaps for future research. There exists the need to identify and evaluate whether the presence of diabetes complicates the psychological problems related to overweight and obesity in adolescents as this will improve nursing intervention and general wellbeing of the student. Students who are obese and overweight are more likely to have increased psychological problems if they also have diabetes than their counterparts who are only obese and overweight.

Background

The selected topic for the capstone project was based on experiences encountered during a high school nursing internship. The interaction with a lot of students who were overweight and obese made one realize that most of them had some aspect of depression. However, the depression seemed more pronounced in students who had concomitant diabetes. Thus, it became important to investigate whether diabetes makes life more unbearable for high school students with overweight and obesity problems by increasing psychological problems and suicidal tendencies.

Clinical Problem Statement

Adolescents in high school are already emotionally disadvantaged as they navigate their psychological development. When their development is compounded by being overweight, obese and concomitant diabetes, it complicates the psychological terrain being navigated. As healthcare professionals, in the school setting, it is important to improve interventional care by responding appropriately to students with psychological issues like negative self- image and other depressive symptoms. The impact of diabetes on psychological development of students with obesity should be investigated as it carries high mortality rates. The presence of diabetes complicates psychological problems related to overweight and obesity in the adolescent population.

Purpose of the Change Proposal

The study can be the basis of recommending high-school-based coping strategies. Indeed, it can inform whether to assess or treat diabetic adolescents with obesity and overweight problems similarly or differently from adolescents without diabetes. The issue relates to nursing intervention and patient care. Nurses learn by investigating possible outcomes while acting within boundaries of practice (Black et al., 2015). Nurses can respond appropriately to students with negative self-image due to being overweight or obese. They can determine how diabetes affects students with such problems, and try to lessen the negative impact on self-image. They can encourage positive living, and recommend activities, diet, pursuits, and associations that foster a positive self-perception. They can keep contact with patients and maintain a close, supportive relationship, and can also recommend individualized coping strategies, alongside physicians and psychologists.

Health agencies contracted to take care of the students will benefit from the study. It will add to its knowledge base, new information on how diabetes impacts high school students already with overweight and obesity problems. High schools can be different from other institutions where it provides services due to a variety of factors such as bullying, availability of coping strategies, and social cohesion.

PICOT Question

The PICOT question is as follows:

The (C) element, in the PICOT question is “no diabetes disease" while the outcome is “psychological state of students with overweight and obesity problem.” Other probable or useful outcomes of interest could be coping mechanisms, grades, and relationship with other students and family members.

The PICOT solution is somewhat related to the evidence-based mindset that is inclined to the redress of psychological problems concurrently with medical treatment of physical conditions. Often people become more ill when they have psychological problems such as stress and anxiety. Healthy living often comprises eating proper diet, engaging in physical exercise, having social support, and cultivating a positive mindset. Holistic development of an individual encompasses psychological and physical development, and holistic treatment is more effective than physical treatment alone. Observing how diabetes impacts the psychological states of adolescents with overweight and obesity issues can be the foundation for designing holistic treatment programs.

Literature Search Strategy

The literature search focused on articles on diabetes and treatment of diabetic adolescents, school-based treatments, nurse-centered interventions on treatment of diabetes, the assessment and management of overweight and obesity among school-going adolescents. The articles chosen for literature review in this study are not similar. Some are largely descriptive and systematic reviews of different studies, while others are reports of real studies. Thus, it is difficult to compare the studies and the questions. The research questions for real studies are evident, and it is vital to formulate the research questions for the largely descriptive and systematic/analytic reviews/studies. Since all studies focus on different issues that were relevant to this study, such as training nurses to handle adolescent patients, assessing the impact of obesity and diabetes, and providing appropriate school-based interventions, the studies more or less complement each other. Consequently, comparisons of research questions, sample populations, or even limitations of the studies may not be straightforward. It is vital to only focus on the main research question for each study as opposed to several research questions as there are in some studies. The articles were published between 2015 and 2020, and one article was published in 2014.

Evaluation of The Literature

A comparison of research questions for the study reveals different questions which are self-explanatory. The research question for the study by Black et al. (2015) is, what is the impact of a research training program on clinicians' knowledge, attitudes, and practices on evidence-based practice (EBP)? The research question for the study by Bhupathiraju & Hu (2016) is, what is the impact of obesity and diabetes on cardiovascular populations? The research question for the study by Darling-Hammond et al. (2019) is, how can a developmental systems framework be used to establish learning opportunities that promote children’s well-being, healthy development, and transferable learning? The research question for the study by Das et al. (2016) is, what are the most appropriate interventions for adolescents with mental health illnesses, such as low self-esteem, anxiety, depression, and suicidal tendencies? The four research questions are for half of the articles used in the study. The research questions for the other four studies chosen for this project revolve around important competencies for health promotion among adolescents in school context, the impact of depression and diabetes-related distress on health status, the emotional needs of people with diabetes, and the development of a hospital-based child and adolescent overweight and obesity treatment protocol which can then be transferred into a community healthcare setting. Thus, various articles or authors did not focus on similar issues. Still, they focused on issues that are vital in the spectrum of health and wellness for diabetes patients, competent care for patients in general, and training on healthy living and development. Change or Nursing theory

The selected change theory is Everette Rogers’s change theory. She modified Kurt Lewin’s theory, which involves three stages: the unfreezing stage, the moving stage and the refreezing stage. The stages more or less stand for selling the idea, implementing new ideas, and abandoning old ideas. Rogers suggested that the change process has five steps: awareness, interest, evaluation, implementation, and adoption. Her theory is appropriate for long-term change projects, and can be used to motivate reluctant workers, who hear about the success story of fellow workers who welcomed changed earlier. The theory that is ideal for the proposed EBP is the Everett Rogers’s change theory because the project is a long-term one, and also requires collaboration and persuasion of stakeholders.

Proposed Implementation Plan with Outcome Measures

The development of diabetes has been associated with increased incidences of overweight and obesity and this in turn has led to increased psychological problems in adolescents. As this risk increases, it becomes pertinent that healthcare workers identify ways to manage disease progression to prevent deadly complications. Identifying the psychological impacts of diabetes on obese adolescents will warrant appropriate mental health screening and counseling as needed (Styne et al, 2017). Thus, obesity can be prevented by encouraging lifestyle modification through physical training, dietary measures, weight loss and most importantly peer support. The most important implementation steps will revolve around mobilization and assessment of students. The mobilization of stakeholders is necessary and they need persuasion to accept and approve the project, and provide some of the resources they can. Some resources include space, computers, and papers. Project approval also means allowing students to participate in the study. Then, all students with overweight problems will be psychologically assessed using psychological instruments and with the help of licensed counselor. Nurses and the counselor will agree on some rating scales. After assessment, the professionals will present the data.

The expected outcome is that the presence of diabetes worsens the psychological conditions of students with obesity and overweight problems. The finding will be the basis of recommending different treatment strategies for students with overweight and obesity problems, compared to those whose problems are complicated by diabetes. Some recommended treatment strategies might have a psychological component or involve multiple approaches.

Plan for Evaluating the Proposed Nursing Intervention

The evaluation of the impact of this project will be done by determining whether health care professionals produce the expected assessment and treatment results when they follow the recommended procedures. That way, future implementation is informed by study outcomes. It would be ideal for professionals to know the reason for recommending specific assessment and treatment strategies, and adopt the right attitudes to produce credible outcomes. Some studies have revealed that some health care professionals do not ascertain rigorous evidence-based information (Harris, Garrubba, & Allen, 2015). Thus, this study will provide guidelines for professionals to use and also specify models of health care delivery. That way, implementation becomes informed, strict, and accurate.

Potential Barriers to Plan Implementation

One major barrier might be the resistance from staff/management. It is likely that the project’s enthusiasm will dwindle with time, and it might appear as an unnecessary project over time. Strategies for overcoming the barrier include continuously training stakeholders, and making it imperative that challenges related to uncontrollable infections will require separation of infected and non-infected patients. The project may also be hampered by a lack of funding. The school might not provide additional funds to treat students beyond the traditional nursing/medical interventions and the isolated psychological interventions by the school counselor. It will be vital to remind the management and other stakeholders to continuously secure the wins made by the study.

References

Black, A. T., Balneaves, L. G., Garossino, C., Puyat, J. H., & Qian, H. (2015). Promoting evidence-based practice through a research training program for point-of-care clinicians. The Journal of nursing administration, 45(1), 14–20. https://doi.org/10.1097/NNA.0000000000000151

Bhupathiraju, S. N., & Hu, F. B. (2016). Epidemiology of Obesity and Diabetes and Their Cardiovascular Complications. Circulation research, 118(11), 1723–1735. doi:10.1161/CIRCRESAHA.115.306825.