final capstone project

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In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a coursework portfolio inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Students will develop a 1,250-1,500-word paper which includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the Change Proposal:

  1. Background
  2. Problem statement
  3. Purpose of the Change Proposal
  4. PICO(T)
  5. Literature search strategy employed
  6. Evaluation of the literature
  7. Applicable change or nursing theory utilized
  8. Proposed implementation plan with outcome measures
  9. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
  10. Appendix section, inclusive of all required documentation regarding the practice immersion clinical component to the course.

Review the feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.

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Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

final capstone project
ADULT OBESITY 5 Lola Olubiyi NRS 490 Heather Ziemianski December 2016 In obese adults aged above 40 years, what is the effect of health education in their quality of lives as compared to those not receiving health educations ? PICOT STATEMENT POPULATION: Obese adults aged above 40 years INTERVENTION: The effect of health education in their quality of life COMPARISON: Those not receiving health education OUTCOME: Lifestyle changes TIME: Outcome will be measured for 4weeks In obese adults aged above 40 years, what is the impact of health education provision on their quality of lives as compared to those not receiving health educations ? Obesity is an instance in which adult individuals have a body mass index (BMI) that is greater than 30 kg/ M2. This is a measure that is calculated by dividing the weight of an individual by the square of their height that is usually in meters. Obesity affects all age populations but it those at high risk is the geriatric populations aged above 40 years due to a sedentary lifestyle, natural reduction of lean muscle mass and increase in fat deposition in parts of the body as well as imbalanced nutrition. In females, weight gain and obesity may ensue due to menopause besides other contributing factors (Bendich & Deckelbaum, 2015). Obesity is associated with various effects on people in different age groups but especially among the elderly. These effects pose some risks to their health and consequently having a significant detrimental effect on their quality of lives as compared to those that are not obese. It is known to be a risk factor for coronary heart disease, heart failure, heart attack and stroke. It contributes significantly to the development of these heart pathologies which reduce the heart’s efficiency, a factor that may result in death. It also leads to the development of hypertension and other pathologies associated with it such as renal failure. Additionally, obesity has been known to be the sole and main contributor to insulin resistance that disrupts the normal body mechanism of controlling blood glucose levels. This, therefore, leads to type 2 diabetes mellitus in both children and adults. The impact of such diabetes in the community is reduced productivity, early death, and overdependence on other people by the affected individuals for sustenance and treatment. On the other hand, obesity has been considered a risk factor for cancer, osteoarthritis, respiratory, reproductive and urinary problems (Fillit et al. 2016). As a matter of fact, there are approximately up to thre3 million elderly individuals that are provided with emergency treatment of injuries and fractures that are as a result of falls. Obesity has a big role to play in both falls and fractures. Obesity is itself a risk factor for falls, and it contributes much towards the level of injuries that can be sustained. Also, greater BMI is one of the causes of bone resorption and osteoporosis which subsequently leads to easy fracture of the bones due to a slight impact. These factors that contribute this state of poor quality of life due to disability can, however, be controlled so as not to cause obesity. Nursing interventions such as health education provision to the affected and the “at risk” populations can be done. According to Luquis and Perez (2014), the education is aimed at changing lifestyle with regard to diet and exercises. As stipulated by Bendich and Deckelbaum, (2015), more than 67% of those subjected to health education exhibit practices of taking balanced diet according to daily recommended dietary allowance besides being physically active as compared to their counterparts who receive no health education in which only 12% of them exhibit the same practices. Governmental and non-governmental agencies that deal with nutrition can utilize conflict sociological theory whose perspective focuses on the social and political inequality to ensure that obesity does not develop as a result of social inequalities such as inaccessibility to healthy foods (Fillit et al. 2016). Evidently, social disparities can bar individuals from participating in healthy exercises due to a shortage of facilities, funds and sufficient time. References Bendich, A., & Deckelbaum, R. J. (2015). Preventive Nutrition: The comprehensive guide for health professionals. Totowa, N.J: Humana Press. Fillit, H. M., Rockwood, K., & Young, J. B. (2016). Brocklehurst’s Textbook of Geriatric Medicine and Gerontology. Elsevier Health Sciences UK. Luquis, R. R., & Perez, M. A. (2014). Cultural competence in health education and health promotion. San Francisco, Calif: Jossey-Bass. Lola, good job. Please see my comments and track changes within your paper.
final capstone project
OBESITY 10 Adult Obesity Lola Olubiyi NRS 490 Heather Ziemianski December 2016 Indentifying a Problem Obesity is the abnormal or excess accumulation of fat within the adipose tissue thus impairing the health of the victims. Obesity is a public health issue that has become a global concern. According to the World Health Organization, over 2.3 billion adults suffer from obesity (World Health Organization, 2012). There is a drop in the prevalence rate of adult obesity in developed countries like the United Kingdom and Germany (Zhao, 2013). However, there is a continuous rise in the prevalence rate of adult obesity in nations like Pacific regions of Asia. In Japan, the incidence rate increased from 16.7 percent to 46 percent between the year of 1976-1980 and to 24 percent in 2000 while that of China rose from 3.7 percent in 1982 to 19 percent in the year 2002 (Zhao, 2013). Problem Discussion Several works of literature show that adult obesity is the causes of the co-morbidities such as the category II diabetes, complications from cardiovascular illness, cancers and other health challenges that result into morbidity and mortality as well. Adult obesity is costly when it comes to its management and therefore, community settings approach in coming up with adult based strategies for the prevention of the adult obesity are more significant. Substantial literature shows that the United States spends a total cost of 1.2 percent of their gross domestic product (GDP) in the treatment of adult obesity. In European nations, a total of 10.4 billion Euros is being spent in addressing the issue. According to these pieces of literature, the relative economic burden to the Europe ranges from 0.09 to 0.61 percent of the country’s Growth domestic products. China spent a total 2.74 billion of the US dollars for the medical expenditures in the year 2003 (Zhao, 2013). Measurement of adult obesity is done using Body Mass Index (BMI) whose unit is weight in kilogram (kg). According to the WHO, adult obesity is classified based on the Body Mass Index cutoffs that are set according to the co-morbidities that are associated with the Body Mass Index. Adult obesity among the ageing adults makes it difficult for the nurses to BMI in the classification of the obesity. The reason for this is that BMI sometimes overestimates the adiposity of the ageing adults. It is also not capable of making the discrepancy between the muscle mass and the fat thus making its reliability to be under question. Therefore, anthropometric indices like waist circumference (WC), waist to height ratio (WHR), waist to height ration (WHR) and the sagittal abdominal diameter are the recommended approach in the determination of the degree of the fatness among the ageing adults (World Health Organization, 2012). Impact of Adult Obesity The impacts of adult obesity are the cases of type II diabetes, cardiovascular disease, and cancers. Diabetes causes the elevation of the BMI and the WC in adults with obesity. According to the study by Ruth and Jean (2011), the pooled relative risks in BMI were 6.75 (5.55 to 8.19) among men adults and 12.41 (9.03 to 17.06) in women adults (Ruth, 2011). The meta-analysis data by Jean and Ruth showed that pooled relative complications in the category of BMI of discrete classes of cancers ranged from 1.05 to 2.29 in men adults while that of women ranged from 1.13 to 3.22 (Ruth, 2011). According to the recent researches by World Cancer Research Fund together with the American Institute for Cancer Research esophagus, colon, rectum, pancreas, postmenopausal, kidney, and the endometrium are the cancers that come as a result of adult obesity (World Cancer Research Fund and American Institute for Cancer Research, 2014). A study in Asia Pacific regions reveals that there has been a standard deviation increase in the index results in the risk of developing ischemic heart illness (World Health Organization, 2012). Obesity is caused by hormones, genetic backgroundand varied social and the environmental factors like the sedentary lifestyle and the unhealthy dietary behavior. Dietary cases include the high energy density diet with increase fats, sugary foods, intake of saturated fats, reduced intakes of carbohydrates and the fiber foods, reduction in the consumption of fruits and vegetables. Social inequality influences the diet and health of the community. Environmental interactions, the predisposition of the genetic and the behavior of the community on the gain weight are affected by the adaptation to the environmental agents like behavior, alteration in the behavior that impacts on the genotypes of the community. The adverse environment during postnatal periods causes the development of adult obesity. The negative situation is due to the nutrition of the mother or the perinatal lifestyle of the mother impacts on the program of development in a fetus. Community health approach in developing the community-based approach to the adult obesity is the effective way of dealing with this issue. The approaches have to be those that develops and implements the prevention strategies of the adult obesity. Some of these approaches can be those that aim at targeting the barriers to changes in the lifestyle of the persons in the community, the socioeconomic and the environmental factors. Variations in the environment of food and the physical activities are important in dealing with the adult obesity. Policies like fiscal food, a must nutrition panels that formulates and reforms the manufacturing of foods, the implementing the labeling of foods and nutrition, and the restriction in the selling and banning the advertisement of unhealthy foods are effective in influencing food environment. Another approach is changing the eating and physical activity behavior of the individuals at the community level. The community must be educated on the aware of the critical of the exercise and the types of food to be taken to reduce the risk of developing obesity. Therefore, it is important to use policy-based community interventions like educating them community. There should also be a supporting health service and clinical interventions to remove the barriers to the management of the adult obesity. At the level of physician practice, there is a lack of enough time in addressing the adult obesity during continuous clinical visits, no reimbursement, lack of enough training and lower self-efficacy in dealing with obese patients. There is also stigmatization at the patient level, no financial incentives, and challenges in the accessory to the services of obesity management. When the education and awareness concerning obesity are conducted, the number of patients administered to the clinics will reduce thus reducing the nursing workforce in the administration of the obese patients . References Ruth, C. W. (2011, March). Prevention of Overweight and Obesity: How Effective is The Current Public Health Approach. International Journal of Environmental Research and Public Health, 7(3), 765-783. World Cancer Research Fund and American Institute for Cancer Research. (2014). Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. American Institute for Cancer Research. World Health Organization. (2012, October 5). Obesity and Overweight. Retrieved December 11, 2016, from Zhao, W. (2013).Epidemiologic and Economic Consequences of the Global Epidemics of Obesity and Diabetes. Nature Med, 12, 62-66. Lola, good job. Please see my comments within your paper. What is the significance of pronlem and the implications to the nursing profession? Topic Task Completion Comments/Feedback Points Project Topic Identification Explains setting and/or context in which nursing problem, issue, suggestion, initiative, or educational need is observed. ☐ _____ / 10 Explains theproblem, issue, suggestion, initiative, or educational need. ☐ _____ / 10 Describes the impact of the project topic on a) the work environment,b) the quality of care provision, and c) patient outcomes. ☐ _____ / 5 Discusses the significance of and the implications to the nursing profession. ☐ _____ / 5 Proposes a solution to the identified project topic. ☐ _____ / 10 Total _____ / 40 Question Development Identified components of PICOT: P – Population of Focus I – Intervention C – Comparison O – Outcome (T – Time) ☐ _____ / 30 PICO (T) question/statement development. ☐ _____ / 10 Total _____ / 40 Literature Source Selection Performance of Rapid Appraisal (see below) on a minimum of 15 peer-reviewed articles. ☐ _____ / 100 Total _____ / 100
final capstone project
ADULT OBESITY LITERATURE REVIEW 8 Adult Obesity Literature Review Lola Olubiyi NRS 490 Heather Ziemianski January 22, 2017 Introduction Obesity is a health situation whereby the affected person(s) has fats in excessive level in the body. Some individuals are unaware of the growing incidences or number of cases related to the obesity. In the United States, there are more than 70 percent of men and 60 percent women in adult population that are overweight. The risks that are associated with obesity include the development of life-threatening diseases like heart failure, cancer, hypertension gall bladder, osteoarthritis, and the category II of diabetes (Zhao, 2013). This paper, therefore, aims at looking at the literature review of the past studies on adult obesity. In this study, data is collected from different previous studies that have discussed adult obesity. Areas of the present research and coming research on adult obesity and its complications are also addressed in this paper. Literature Reviews According to the study by Goededcke and his colleague, in 7786 sampled women of ages between nineteen to ninety-five years in South Africa, the black females recorded a higher prevalent of obesity and overweight.Females of different ancestry were at 52 percent, females with the white complex at 49.2 percent while the women of Indian origin were at 42.8 percent. There was higher Body Mass Index among the women residing in the towns as compared to the women living in rural places. It was noted that the Body Mass Index increased as one age. The overall rate of obesity was higher in men (29 percent) and women (56 percent) (Goededcke, 2010). This prevalence is higher as compared to other nations in Africa especially females because 30 percent of women in South Africa of age 30 to 59 have cases of obesity. North Africa also has a higher prevalence of obesity as South Africa . In his cross sectional study using 1430 rural and urban individuals from Luo, Maasai, and Kamba females of ages 17 to 68 years, Christensen and his colleagues found out that there was an increase in the inside and under skin fats, fat in the area of the arms and the waist circumference as one gets older. This was common among the Maasai females as well as in individuals in the urban areas. The incidence of the overweight BMI (≥ 25) and obesity BMI (≥ 30) was greater among people dwelling in town as compared to those in villages. The rate of the overweight was at 39.8 and 15.8 percent of the city and community areas respectively. Residents from cities recorded a higher rate of abdominal viscera and under skin fat thickness. High prevalence of overweight was due to the accumulation of fats among the Maasai (Christensen, 2011). Report from the World Health Organization indicates that China, Asia, Indonesia, Japan, as well as Bangladesh have higher obesity prevalence. The pathological obesity in India is at 5five percent of the entire country’s population with China having 12 percent of their adults being overweight (WHO, 2010 ). It is evident that partnership between the health professionals whereby the patients receives counseling proves to be useful in improving the outcome of the overweight patients. The older patients quickly adapt to the behavioral health changes. According to Hillsdon and his colleague, there is effectiveness in the professional counseling and advice in the promotion of the level of the activity of the patients with obesity within a short to mid-term periods. According to their study, greater intervention intensity accompanied with more sessions tends to be more efficient. However, the limitation of this study is that it did not provide clear differences between the home and the facility-based exercise sessions, as well as the professional support and the self-directed after the guidance from the professionals (Zhao, 2013). Environmental and policy approach also prove to be an effective intervention in reducing the cases of obesity among the adults.Environmental and policy strategy promotes the physical activities and the nutrition of the overweight individuals.Matson-Koffman and his colleague noted approve on the effectiveness of the through interventions like schooling, group assistance, rewards and the accessory to showers, gyms, and the change rooms. In conclusion, change in the menu, price reduction; labeling, improved accessory to the healthier foods in the vending machine and food services increases the purchase and consumption of the healthy foods (Soler, 2010). Also, Swinburn and his colleagues analyzed some of the key interventions as well as the nutrition strategies that are effective in preventing the excess weight gain and the obesity. The study considered a range of interventions strategies of specific relevance to adults and named the strategies that effectively alters the purchasing of food including the nutrition signposting, the policies regarding the nutrition panels (Gortmaker, 2011). Physical activities like walking help in reducing the body weight. A study by Ogilvie and colleagues aimed at addressing the approaches that can be applied in dealing with weight gain in a population. This study looked at whether the change in walking and cycling infrastructures leads to the reduction in the car use and change in the active transport. According to them, intervention through the modification of the support has some impacts on the weight loss. The effect caused by the infrastructural change can only be useful when there are other psychological and social factors. Therefore, the infrastructure, psychological factors, and the social factors must be modified simultaneously (Heckam, 2013). Osteoarthritis as a complication associated with the obesity seems to go hand in hand with overweight. In his cohort study using 1420 subjects, Framingham showed that obesity was an independent risk element for the osteoarthritis complications following the adjustment of the age, physical activity, and level of the uric acid (Segula, 2014). Conclusions Obesity is an emerging problem in the society of today. It does not affect only the communities but also the entire nations; especially in developing countries.There is a need for proper interventions that aims at reducing the burden of the obesity. The interventions approach developed should partly depend on the recognition and understanding of the complications associated with the adult obesity. Therefore, there is a need by the medical professionals including nurses and clinicians to consider the complications in the obese patients and come up with precise interventions that emphasize on the benefits of the weight loss. References Christensen, A.-J. (2011). Obesity and Regional Fat Distribution in Kenyan Population: Impact of Ethnicity and Urbanization. Ann. Hum. Biol, 35(2), 232-249. Goededcke, J. C. (2010, August 28). Chronic Diseases of Lifestyle in South Africa. Retrieved January 6, 2017, from Department of Biology, Faculty of Health Sciences, University of Cape Town, South Africa: Gortmaker, S. L. (2011). Changing the Future of Obesity: Science, Policy, and Action. The Lancet, 378(9793), 838-847. Heckam, D. A. (2013).The 2013 Canadian Hypertension Education Program Recommendations for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Canadian Journal of Cardiology, 29(5), 528-542. Segula, D. (2014). Complications of Obesity in Adults: A Short Review of the Literature. Malawi Medical Journal, 26(1), 20-24. Soler, R. (2010). A Systematic Review of Selected Interventions for Worksite Health Promotion: The Assesment of Health Risks with Feedback. American Journal of Preventive Medicine, 38(2), S237-S262. WHO.(2010). Global Strategy on Diet, Physical Activity, and Health. Retrieved January 6, 2017, from Zhao, W. (2013).Epidemiologic and Economic Consequences of the Global Epidemics of Obesity and Diabetes. Nature Med, 12, 62-66. Lola, good job. Please see my comments and track changes within your paper.

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