Chapter ii – literature synopsis.

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In the literature review section, we are changing the verb to past tense

* After a student successfully defends Chapter I (the Project Proposal),

The initial review of the literature is then moved into Chapter II with a section replacing the initial review of the literature in Chapter I entitled Literature Synopsis.

In the literature review section, we are changing the verb
to past tense

* After a student successfully defends Chapter I (the Project Proposal),

The initial review of the literature
is then moved into Chapter II with a section replacing the initial review of the literature in Chapter
I entitled Literature Synopsis.

The Literature Synopsis section in Chapter I presents a summary of literature review findings in Chapter II once the literature review is completed in Chapter II.

*STUDENT SAMPLE ON ANOTHER TOPIC*

Literature Synopsis



The literature review has revealed CNs are not considered formal leaders and therefore, lack education, training, and mentorship to take on the clinical and administrative duties they are tasked with during their shifts. CNs deal with issues including but not limited to conflict resolution, patient care delivery and meeting organizational needs. This results in meeting competing demands and can lead to ineffective leadership. Most of CN training occurs on the job and ongoing education and leadership training is limited or non-existent. Many of the studies in this project highlighted the importance of ongoing education and mentorship of CNs towards their development as leaders.

Without leadership training, CNs cannot grow as frontline leaders and integrate TL strategies, and this has been shown to negatively impact patient care outcomes and impact job satisfaction and retention rates. The CN is the most accessible and present leader at the bedside and frontline. CNs spend their entire shifts managing competing demands, while providing undertaking patient assignments in most cases. This contributes to role ambiguity and is a barrier to undertaking TL strategies to be effective leaders. Therefore, their ability to effectively lead and communicate within their units and organizations is compromised. This is a matter that requires due attention towards addressing deficiencies within the current healthcare system and building stronger frontline leaders in the future.

The nursing landscape is undergoing significant changes with record number of nurses leaving the profession due to burnout and the current global pandemic. Skill development in communication is a strategy to contribute to the leadership capabilities of CNs. Providing them with necessary skills such as communication is central to their leadership development and ability to do their jobs. When they are provided the tools to succeed and work within an environment that is empowering, this increases job satisfaction and retention of CNs and those that work with them.

2

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

By

RTYYUUUIII

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

Buffalo, NY

[February 03, 2023]

Copyright © 2023 by ERTTYYYY. All rights reserved. No part of this project may be copied or reproduced in any form or by any means without the written permission of TYUIOLKJJJJ.

2


PROJECT APPROVAL

Name:
__ ________Dr. UUUUUUUU_____________________

Signature: ___________________________________________

Discipline:
________________Nursing________________

Project Defended

On

[February 03, 2023]

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 …………………………………………………………… 7

Statement of Purpose ……………………………………………………………………….. 8

Theoretical Framework ……………………………………………………………………. 8

Initial Review of the Literature ………………………………………………………….12

Significance and Justification ……………………………………………………………19

Project Objectives ……………………………………………………………………………20

Definition of Terms ……………………………………………………………………….. 20

Project Limitations ………………………………………………………………………… 21

Project Development Plan ………………………………………………………………. 22

Plan for Protection of Human Subjects …………………………………………….. 22

Plan for Project Evaluation……………………………………………………………… 23

Summary ……………………………………………………………………………………… 24

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 ……………………………………………………………………………………. 27

Appendices …………………………………………………………………………………… 32


List of Appendices

Appendix

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

…………………….….

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

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

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

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





2

2





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). The literature supports the need for education of a 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.


In her
Interpersonal Relations in Nursing Theory, Peplau (1991) defined nursing’s four metaparadigm concepts (patient, environment, health, and nurse) as follows. A
nurse is defined by Peplau (1991) as the healthcare delivery personnel who respectably facilitates the promotion of wellness to reduce negative perception of the process and escalation of the illness . For the purpose of this project, a
nurse is operationally defined as 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, for the purpose of this project, 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. Peplau (1991) defined
health as the multidimensional extent to which a person attains wellness for a qualitative life. For the purpose of this project,
health is operationally defined as the contextualized patient conditions that allow for human processes that facilitate tendencies supportive of positive development to attain health . Furthermore,
health is also identified 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 person is defined as the receiver of nursing care whose needs should be assessed all round and catered for accordingl
y (Peplau, 1991). For the purpose of this project,
A patient is operationally defined as a person in need who develops a relationship with a nurse to seek adequate support suitable for the promotion of better health. For the purpose of 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). Finally,
environment is defined as the surroundings of the patient which influences their bearing of health and wellness (Peplau, 1991). For the purpose of this project,
environment is operationally defined as the 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.

Literature Synopsis

The literature review has revealed……….

In the literature review section, we are changing the verb
to past tense.. I changed it already.

* After a student successfully defends Chapter I (the Project Proposal),

the initial review of the literature
is then moved into Chapter II with a section replacing the initial review of the literature in Chapter
I entitled Literature Synopsis.


The Literature Synopsis section in Chapter I presents a summary of literature review findings in Chapter II once the literature review is completed in Chapter II.





Significance and Justification



Findings from the initial literature review revealed that a lack of knowledge exists in nursing and patient care practice regarding obesity and diet management. In their study, Bucher et al. (2018) revealed a significant inadequacy of knowledge and skill among nurses and physicians working in a university hospital concerning the management of obesity (Bucher et al., 2018). This gap exists, yet healthcare professionals ought to be at the forefront of executing various interventions in managing obesity and healthy diet. It is an implication that patients suffering from obesity and related complications will find it challenging to get adequate and effective nursing education concerning diet to manage and treat their condition. In addition, there is inconsistency in provider understanding of appropriate clinical care for obesity. The study recommends that there is a need for healthcare professionals to develop an understanding of how to effectively leverage health interventions to promote outcomes for patients with obesity. This article is a good choice for supporting the proposed project because it points out the limitations of proper management of obesity, one of which is the low knowledge level among health professionals and the need to address them towards achieving the goal of healthcare. Therefore, this project will enable nurses to have a training program where they will obtain more knowledge and skills concerning the management of obesity through dietary interventions.

Project Objectives

The objectives of this project are to:

1. Conduct an extensive review of the literature exploring a healthy diet for patients with obesity using the following keywords both singularly and in multiple combinations: nursing training, obesity, obesity prevention, outpatient care, overweight, diet, and healthy diet. 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, and Google Scholar.

2. Develop an Educational Training Program; and

3.

Have a panel of five content experts with extensive knowledge and expertise in a healthy diet for patients with obesity evaluate and critique the project for clarity, readability, applicability, quality, organization, and evidence-based clinical relevance.

Definition of Terms

The following concepts are defined both theoretically and operationally for the purpose of this project:

Health Promotion

Theoretical Definition: Facilitation of motivational behavior to recognize a positive outcome as an approach to better health management (Peplau, 1991).

Operational Definition: conducting and directing the implementation of weight management strategies that enhance forward-focused change for a better quality of life for outpatients that are diagnosed with obesity.

Healthcare Support

Theoretical and Operational Definition: integrative healthcare service delivery that facilitates the provision of effective and efficient aid to the patient in a way that is essential to their safety, improved quality of life, and development of better coping tools (Maciejewski et al., 2019). Operational Definition: A nursing duty that recognizes the provision of the totality of care for outpatients with obesity through readiness in resource and information availability that allows sustainable improvement of patient’s health.

Healthy diet

Theoretical definition: Refers to both a health-promoting and disease-preventing diet. It delivers adequate nutrients and other health-promoting ingredients from wholesome foods while avoiding ingesting harmful substances (Chaudhary et al., 2018). Operational Definition: A diet composed of macronutrients, micronutrients, and vitamins necessary for maintaining the body’s normal functioning and promoting health through enhancing healthy weight loss in obese and overweight patients.

Limitations

The Project Author recognizes the following project limitations:

1. The implementation of the educational training program is not within the context of this project;

2. The educational training program is developed in the English language only and may benefit a more culturally diverse population if written in additional languages.

Project Development Plan




A detailed topical outline of the educational training program content is created based on the extensive review of evidence-based literature and the theoretical framework used to support and guide the development of an educational training program. After permission is granted from the D’Youville Patricia H. Garman School of Nursing, graduate faculty designee (Appendix A), five professionals with knowledge and expertise in a healthy diet for patients with obesity will be asked if they are interested in voluntarily participating as expert content reviewers for an educational training program. The content expert panel will consist of two registered nurses working in an outpatient healthcare service delivery, one nutritionist working in a public health system that educates about healthy diets, and two clinical dieticians working in an outpatient clinic. If interested, the Project Author will mail a packet containing a Letter of Intent (Appendix B), a copy of the Content Expert Project Evaluation Tool created by the Project Author specifically for the project (Appendix C), a copy of the educational training program (Appendix D), and a self-addressed stamped envelope. The Letter of Intent will explain the project purpose and instructions for completing and returning the Content Expert Project Evaluation Tool to the Project Author. The Content Expert Project Evaluation Tool contains six evaluative items with space for narrative comments and suggestions. Approximately 20 minutes will be required to review the educational training program and to complete the Content Expert Project Evaluation Tool. Content experts will be provided a self-addressed envelope to return the Content Expert Project Evaluation Tool to the Project Author. Once all evaluation tools are returned to the Project Author, data will be analyzed and reported narratively and in bar graph format. A summary of the evaluation results, including the findings of the six evaluative items in the content expert project evaluation tool, will be provided to the content expert reviewers by postal mail.

Plan for the Protection of Human Subjects

Following approval from D’Youville Patricia H. Garman School of Nursing, the graduate faculty designee (Appendix A) five professionals with knowledge and expertise in the area of healthy diet for patients with obesity will be personally approached and asked to voluntarily participate as a content expert in the review and evaluation of an educational training program (Appendix D). Content experts will be advised that participation or non-participation as an expert reviewer will have no effect on their employment status. The Project Author has a collegial, professional, and nonsupervisory relationship with the content expert reviewers thereby protecting the participants from any risk of coercion. Content experts will be guaranteed confidentiality because identifying characteristics will not be collected on the Content Expert Project Evaluation Tool and because their names will not be revealed anywhere in the project manuscript or in required project presentations. Only the Project Author will know the names of the content expert reviewers. Return of the completed content expert Project Evaluation Tool (Appendix C) will indicate implied voluntary consent to participate as a content expert reviewer. Content experts will be advised that they will not be able to withdraw from project participation once the project evaluation tool is returned to the Project Author because the evaluation tool will be returned without identifying information. Returned Content Expert Project Evaluation Tools will be stored according to the D’Youville Patricia H. Garman School of Nursing protocol in a locked drawer located in the Project Author’s home for a period of three years and then destroyed.

Plan for Project Evaluation

After obtaining full approval from the D’Youville Patricia H. Garman School of Nursing (Appendix A), the Project Author will mail a packet to each content expert reviewer containing one Letter of Intent (Appendix B), one copy of the Content Expert Project Evaluation Tool (Appendix C), one copy of the educational training program (Appendix D), and one self-addressed stamped envelope. The Letter of Intent will explain the project purpose and instructions for completing and returning the Content Expert Project Evaluation Tool to the Project Author.

The Content Expert Project Evaluation Tool will consist of six evaluative items scored on a four-point Likert Scale that ranges from (1) Strongly Disagree, (2) Disagree, (3) Agree, and (4) Strongly Agree. Space will be provided for narrative comments and suggestions following each evaluative item. Evaluative items will ask reviewers to rate the educational training program on clarity, readability, applicability, quality, organization, and evidence-based clinical relevance. Approximately 20 minutes will be required to review the resource guide and to complete the Content Expert Project Evaluation Tool. Content experts will be given seven days to complete and return the Content Expert Project Evaluation Tool to the Project Author via postal mail using the self-addressed stamped envelope included in the original packet. Likert scale responses will be presented narratively and displayed in bar graph format. Content expert suggestions and comments will be analyzed for common themes and presented narratively. A summary of the evaluation results including the findings of the six evaluative items in the content expert project evaluation tool will be provided to the content expert reviewers by postal mail.



Summary

Chapter I presented the project introduction, statement of purpose, an overview of the theoretical framework guiding project development, an initial review of the literature focusing on

the development of an educational training program for nurses in an outpatient setting exploring healthy diets for patients with obesity, the project significance and justification, project objectives, definition of terms, project limitations, the project development plan, the protection of human subjects, the plan for project evaluation, and a chapter summary. Chapter II will provide an extensive review of the literature focusing on an educational training program for nurses regarding the importance of a healthy diet for patients with obesity and a chapter summary. Chapter III will discuss the intended project setting and population, the content expert participants, data collection methods, project tools, the protection of human subjects, and a chapter summary. Chapter IV will discuss the evaluation of the project, implications for future advanced nursing practice, recommendations for future projects and research, and a chapter summary.




CHAPTER II



Initial Review of the Literature





The review of the literature
was 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, and Google Scholar . The search
was limited to the years 2018 to 2023 to ensure that current evidence-based literature
was 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. 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; 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).


Recognition of Potential Barriers

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.

According to 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 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 to 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 implementation.

It is imperative that 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 (Maciejewski et al., 2019). 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 to 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, Wharton et al. (2020), tackles nursing and obesity pointing it to be one of the current health concerns affecting a large proportion of the world’s population as it interferes with health outcomes. As such, an intensity level should be employed with preventive controls in line with the responsibility set. This allows for desired treatment to be the main goal rather than the desired end product, such as specific weight. It removes the tension without negating the implication of the process and thus optimizes input by the small measures that can be seen regularly. Therefore, a pathophysiological approach is necessary for an all-hands-on methodology hence simplicity that is specific to the patient in question rather than a generalization as in Block et al. (2020) study findings.


Nurses’ Knowledge of The Management of Obesity

Inadequacy of skills and knowledge among healthcare professionals is one of the significant challenges facing the fight against metabolic conditions such as obesity. Bucher Della Torre et al. (2018) describe one of the challenges in one of the university hospitals as the presentation of poor knowledge, skills, and attitude about obesity among nurses and physicians, which aligns with the findings of Turner et al.’s (2018) study. Turner et al.’s study revealed inadequate knowledge concerning managing obesity effectively. The results imply that provider perception of optimal healthcare services for obesity is at odds with research-based guidelines. Healthcare practitioners must be aware of the best ways to use pharmacotherapy and behavioral counseling, such as adopting a healthy diet; these interventions are widely applied in improving the health of obese patients (Turner et al., 2018).

Reinforcing Positive Environment in Nurse-Patient Relationship

When looking at the studies, it is evident that nurse and patient relationships are integral to both the definition of health and the understanding of treatment planning. These are essential to the pathways to positive outcome expectation and hence accurate to the operational definitions. Given that outpatient care for obesity is almost therapeutic, there is a sense of delivery requiring that verbal and non-verbal communication be read. As such, the nurse must have the core conditioning of genuine concerns, which sometimes could be perceived as going above and beyond the baseline required (Okdie & Ewoldsen, 2018). The relationship between the two is skill-based, examining the level of trust in both directions with absolute truths. The points of conflict should thus be handled with care and isolated from the goals by accepting attitudes as progression hence the removal of fear (Walia et al., 2022). This also removes the anxiety of either side as the nurse can trust that discipline will be employed within the period they have not met. Similarly, the patient will trust that information will not be withheld, anger will not be enforced, and the environment of care will be positively reinforced with empathy rather than pity.

Summary

Chapter II presented a review of……

Student sample on another subject……….Chapter II presented a review of nursing and health related literature exploring the importance and benefits of integrating TL strategies for CNs in their role as frontline leaders. Chapter III will discuss the intended project setting and population, the content expert participants, data collection methods, project tools, the protection of human subjects, and a chapter summary. Chapter IV will discuss the evaluation of the project, implications for future advanced nursing practice, recommendations for future projects and research, and a chapter summary.

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Appendix A

Patricia H. Garman School of Nursing

Full Approval Letter

Appendix B

Letter of Intent

Content Expert Letter of Intent

Dear Content Expert,

Hello, my name……….

Best Regards,

Appendix C

Content Expert Project Evaluation Tool

Instructions:

The purpose of this tool is to provide you with a guideline for evaluating the clarity, readability, applicability, quality, organization, and relevance of the current evidence-based practice of the proposed Educational Training Program. The purpose of the project is to develop an Educational Training Program to provide nurses with information on the importance of a healthy diet for obese patients in an outpatient setting. Using the four-point Likert Scale, please circle one choice that best reflects your opinion. Space is provided after each of the six evaluative items for further feedback and direction regarding the Educational Training Program. To maintain your confidentiality, please do not make any identifying marks on the evaluation tool.

1.
Clarity

The information presented in the Educational Training Program is clearly understood and easy to follow.

Strongly disagree

Disagree

Agree

Strongly agree

1

2

3

4

Comments and Suggestions:

2. Readability

The information in the Educational Training Program is presented at an appropriate and comprehensive level of reading for nurses in an outpatient setting.

Strongly disagree

Disagree

Agree

Strongly agree

1

2

3

4

Comments and Suggestions:


3. Applicability

The information presented in the Educational Training Program is relevant and fits the project’s purpose.

Strongly disagree

Disagree

Agree

Strongly agree

1

2

3

4

Comments and Suggestions:

4. Consistency

The Educational Training Program is well-designed and with a consistent flow.

Strongly disagree

Disagree

Agree

Strongly agree

1

2

3

4

Comments and Suggestions:

5. Organization

The Educational Training Program is in order and well organized

Strongly disagree

Disagree

Agree

Strongly agree

1

2

3

4

Comments and Suggestions:

6. Evidence-Based Clinical Relevance

The Educational Training Program addresses a current and clinically relevant problem in nursing and patient care practice and utilizes current clinical evidence.

Strongly disagree

Disagree

Agree

Strongly agree

1

2

3

4

Comments and Suggestions:

Thank you for taking the time to evaluate the Educational Training Program. Your feedback is deeply appreciated and will strengthen the development of the Educational Training Program for nurses in an outpatient setting.

Appendix D

Educational Training Program

Appendix E

Survey Tool Results

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