Project Committee Chairperson

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Project Defended

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Abstract

[The abstract is presented before Chapter I. It consists of 120 word (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 Product ……………………………………………………………………………………………… 66

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

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 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.

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 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.

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 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.

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, 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 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).

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 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).

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).

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 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).

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 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 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