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

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]

Table of Contents

PROJECT APPROVAL

Name: __ ________

Signature: ___________________________________________

Discipline: ________________Nursing________________

Project Defended

[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

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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

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

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

D Educational Training Program …………………………………………………………

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 (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).