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Project Defended

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Abstract

[The abstract is presented before Chapter I. It consists of 120 words (maximum) 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 not bolded or indented 5 to 7 spaces.]

[Inclusion of an acknowledgment page is optional. The student should seek guidance from the project director on whether to include the page in the final project manuscript. If it is included, it is numbered as page Roman numeral v, each paragraph is indented five spaces (1/2"), and the text is double-spaced. This page is placed just after the Abstract and Table of Contents.]

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 ……………………………………………………………………………………. 21

Appendices ……………………………………………………………………………………

List of Appendices

Appendix

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

…………………….…. 60

B Letter of Intent ……………………………………………………………………………………. 62

C Evaluation Tool ………………………………………………………………………………….. 64

D Education Training Program ………………………………………………………………… 66

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

Chapter I

The age of fast food and instant gratification brought about by the growth of technology has affected the general population in many ways. In America, obesity is becoming problematic, with a prevalence estimate of 41% leading to risk in the severity of diseases (Kalligeros et al., 2020). As a result, there is a need for nursing practice to take accountability in developing a relationship with collaborative patient care. Obesity can be a lifestyle disease. Therefore, all stakeholder participation must be considered a need to look at the four-metaparadigm perspectives in caregiving using a foundational basis in a theoretical framework. First, a nurse needs expertise in addressing health issues, especially those reversible through natural means, for example, obesity. Obesity is reversible through natural means, including dietary modification and practicing fasting.

The factors that make a successful program include proper planning. Proper planning allows for allocating adequate time and resources toward the project, resulting in the successful implementation of the program (Shi, 2017). Another factor is incorporating experienced project managers with knowledge about the program. For example, specialists such as nutritionists and experts in physical activity and breastfeeding are essential when developing a program to improve nutrition in children and adults and minimize obesity. Finally, it is essential to practice monitoring and control for a program to succeed. Regular evaluation of the progress and the program results allows for modification and alignment in case of an error or a potential error—effective communication results in a program's success (Ross et al., 2019).

Hildegard Peplau's (1991) Interpersonal Relations in Nursing Theory is utilized as the theoretical framework for developing this project. A brief overview of the theory is presented as well as a discussion regarding how the theory was utilized to guide the project's development. In addition, Peplau’s (1991) theoretical definitions for nursing’s interpersonal relationships and concepts together with the Project Author's operational definitions for nursing's four metaparadigm concepts will be presented.

Interpersonal Relations Theory in Nursing Theory

Hildegard E. Peplau's impact on nursing and patient care are 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). Peplau (1991) begins the development 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).

In recognition of Peplau's (1991), understanding of better health indication, this project aims to bring to attention the definition of the concept of patient care by looking at the significance of the nursing role and interpersonal relationship as applicable to supporting better eating in the obese patient. At the same time, the project will look at the actual application of interpersonal Relations as a theory in modern nursing practice by consideration of mainstreaming competency components. Finally, the deliberate look of this Interpersonal Relation Theory for a patient with obesity as a framework to support better eating habits will consider the modern-day emphasis variables. This would facilitate a look at the necessitated patient-centered model of care specific to the patient with obesity on their weight management.

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 emphasize the built-in interaction as a psychodynamic need. This need is important as it is directionally focused on relieving the patient’s anxiety and improving their confidence regardless of external and self-perceived variables. There is thus centralization of goal setting for a patient with obesity that is linked directly to the strengthening of the nurse-patient relationship as the best approach to attaining better health outcomes.

This 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.

Concerning the four meta paradigms, in her Interpersonal Relations in Nursing Theory, Peplau (1991) define 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 (p.5). 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.

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, p. 12). 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, p. 9)

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 (p. 13). 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.

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 point 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 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).

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), and 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).

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.

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 i