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

Student name

A Project

Submitted to the Faculty of D’Youville

Division of Academic Affairs

In partial fulfillment of the requirements for the degree of

Master of Science in Family Nurse Practitioner

Buffalo, NY

[Month Day, Year]

PROJECT APPROVAL

Project Committee Chairperson

Name: __ ____________________________________________________

Signature: ___________________________________________________

Discipline: ___________________________________________________

Project Defended

[Month Day, Year]

Abstract

[The abstract is presented before Chapter I. It consists of 120 words (maximum) succinct summary of the entire project and highlights the details of the identified problem, the project purpose, the theoretical framework(s), and evaluative measures. The abstract heading is not bolded or indented 5 to 7 spaces.]

Acknowledgment

[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

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 ………………………………………………………………………………………

REVIEW OF LITERATURE …………………………………………………………..

Summary ………………………………………………………………………………………

PROJECT DEVELOPMENT PLAN. ……………………………………………….

Project Setting and Population… ……………………………………………………..

Content Expert Participants …………………………………………………………….. Data Collection Methods …………………………………………………………………

Project Tools …………………………………………………………………………………

The Protection of Human Subjects ………………………………………………………

Summary ………………………………………………………………………………………

PROJECT EVALUATION, IMPLICATIONS, AND FUTURE RECOMMENDATIONS

……………………………………………..

Project Evaluation ………………………………………………………………………….

Implications for Future Practice ……………………………………………………….

Future Recommendations ………………………………………………………………..

Summary ………………………………………………………………………………………

References ……………………………………………………………………………………. 21

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

List of Appendices

Appendix

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

…………………….…. 60

Letter of Intent ……………………………………………………………………………………. 62
Evaluation Tool ………………………………………………………………………………….. 64
Education Training Program ………………………………………………………………… 66
Survey tool results in graph……………………………………………….

Chapter I

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

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

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). Some people are susceptible to changes they perceive as threats to their social environment, including the workplace. Individuals may develop resistance to change when they feel uncertain about the intervention or when the change comes as a surprise without the time to prepare mentally. The questions about the competency of the intervention concerning the new environment—the resistance results in difficulty in implementing the intervention to achieve social change (Ross et al., 2019). This study will assess interpersonal relations in nursing theory to draw mechanisms for developing effective strategies for an educational plan for nurses taking care of patients with obesity in an outpatient department. 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.

Statement of Purpose

The purpose of this project is to develop an educational training program for nurses in an outpatient setting to provide education regarding the importance of a healthy diet for patients with obesity.

Theoretical Framework

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

Interpersonal Relations Theory in Nursing Theory

Hildegard E. Peplau’s impact on nursing and patient care are reflected in her development and establishment of the Interpersonal Relations Theory. Her theory development began with questions of the philosophical underpinning of psychology as fundamental in-patient care especially when it came to nursing and patient relationships (Peplau, 1991). Peplau (1991) begins the development by understanding the foundational elements as concepts of nursing care. namely, the orientation, identification, exploitation, and resolution defined. In her book, Interpersonal Relations in Nursing, the theory emphasizes the importance of crosscutting issues and their effect on nursing care and patient wellness, such as nursing education on dietary interventions for patients with obesity. Orientation refers to the reaction of the patient and the difference from one to another with consideration to resolve in treatment difficulty. Exploitation on the other hand is the ability of the patient to recognize interpersonal relationships and use the services offered effectively. Lastly, there is a resolution that refers to the relinquishing of ties in the relationship as the patient utilizes the lesson learned to better manage their health (Peplau, 1991).

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

Significance of Interpersonal Relations Theory

As a mother of nursing psychiatry, Peplau (1991) describes interpersonal relations as a conditional aspect that includes first the interaction of the nurse and patient. She points out that this is attained when understanding each patient’s condition is an experience that allows for improving nursing care (Peplau, 1991). Therefore, the focus in the definition of the theory begins with grasping the nurse and patient metaparadigm concepts as the interaction between patient and nurse makes the relationship personal. Similarly, considerable insights thus point out that the patient care process is personalized in a way that responsibility is both technical and emotional. Peplau (1991) explains that effective patient outcome delivery comes from trust in diagnostics and thus acceptance of health as an essential metaparadigm aspect. The theory focuses on developing the relationship between a nurse and a patient to emphasize trust and collaboration.

Based on Peplau (1991), the experience of establishing a connection between a nurse and a patient is an indicator of progress reporting and is the only source of data for patient experience information. Perception of the phenomena of patient information as instrumental to positive is highlighted as a primary measure of the direction of health. Based on the fact that health is described to be only a success when it moves in the positive direction, by looking at the patient with obesity this means loss of weight. At the same time, with the insistence on the sustainability of better health as the result being sought, there is direct evidence that the management of health, in the long run, is the better outcome for the patient in this project.

Peplau (1991) is supported by her in-depth analysis of the achievability of better health through utilitarian task alignment. Using communication as the necessary tool for the nurse to ensure that a patient attains a favorable outcome, as a theory, Interpersonal Relations emphasize the built-in interaction as a psychodynamic need. This need is important as it is directionally focused on relieving the patient’s anxiety and improving their confidence regardless of external and self-perceived variables. There is thus centralization of goal setting for a patient with obesity that is linked directly to the strengthening of the nurse-patient relationship as the best approach to attaining better health outcomes.

This theorist is a perfect fit for the proposed educational training program for nurses in an outpatient setting to provide education regarding the importance of a healthy diet for patients with obesity. The relationship between the outpatient and the nurse must be founded on trust so that information can be shared comfortably and with trusted support from nurses. A support system must be developed because obesity and the issues surrounding obesity can often bleed into self-esteem and mental health. This theorist ideology will assist in identifying and orienting nurses to the causes of obesity, introducing a perfectly balanced diet with regular exercise, and finally producing solutions for diabetic prevention, a foundation that this theoretical framework supports.

Interpersonal Relations Nursing Theory and Nursing Metaparadigm

Concerning the four meta paradigms, in her Interpersonal Relations in Nursing Theory, Peplau (1991) define it as input for developing positive outcomes and relinquishing the relationship with a support system that enhances positive outcomes. It is the promotion of health through appropriate methods and illness prevention by recognizing triggers for all patients (p.5). Therefore, the nurse can only facilitate treatment and not make a diagnosis; hence, the critical aspect is ensuring that the environment is conducive and that communication in the relationship with patients is constant. This means the nurse favors patients’ understanding of their issues by explaining the problem and the treatment plan. This includes a preventive measure to ensure informed decision-making is enhanced and thus a partnership that, in essence, is therapeutic.

For this project, the nurse is a supporter who ensures that patient needs are unique and met adequately and suitably to their circumstance. This recognizes that a different relationship develops between nurse and patient from one. In the same stance, a person is operationally defined as an entity with individual preconceptions and a mutual understanding of the nature of a medical issue. Within this understanding, they can collaborate with informed decision-making toward a productive solution.

Health is operationally defined as contextualized patient conditions that allow for human processes that facilitate tendencies supportive of positive development to attain health (Peplau, 1991, p. 12). For this project, health is defined as a symbolic future positive goal that is attained after effective healthcare hence instrumental for the person moving in the forward direction of wellbeing

A patient is operationally defined by Peplau (1991) as a person in need who develops a relationship with a nurse to seek adequate support suitable for the promotion of better health. For this project, the patient is referred to as the outpatient navigating the interpersonal relationships with a medical service provider seeking the implementation of need-based healthcare delivery through the respectable promotion of perception and prevention of escalation of obesity (Peplau, 1991, p. 9)

Peplau (1991) operationally defines environment as the unique position of the patient leading to the development of a different relationship with the nurse and health-related delivery in a way that affects the success rate of their health promotion (p. 13). For this project, the environment will be operationally defined as conditions that allow for human processes that facilitate tendencies supportive of positive development to attain health. It is contextualized as the symbolic future positive goal that is attained after effective healthcare hence instrumental for the person moving in the forward direction of well-being (Peplau, 1991). As such, following Peplau’s underpinning of outpatient care for obese patients is ensuring that patient that individual preconceptions and mutual understanding of the nature of a medical issue allow for better collaboration toward a productive solution.

Initial Review of the Literature

The review of the literature will be conducted to explore studies that are associated with nursing education for obesity and a healthy diet. Using the following words both singularly and in multiple combinations: nursing training, obesity, outpatient care, nursing psychiatry, overweight, diet, obesity facts, obesity prevention, body weight, and care management planning. Databases searched, limited to the years 2017 and 2022, will include AMED, Alt Health Watch, CINAHL Plus with Full Text, EBSCO, Medical Journal sites for nursing care, nursing training, PubMed, Scopus, Science Direct, Directory of Open Access Journals, Google Scholar, JSTORand the D’Youville library to loan articles through interlibrary loan. The search is limited to the years 2017 to 2022 to ensure that current evidence-based literature is reviewed and summarized for this project. A summary of the review of 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 point out that the exploration of the association between obesity and chronic diseases is something that should be understood. This is because there is a direct relation between the severity of the outcomes seen in intensive care units and admission rates. For example, research that analyzes a retrospective cohort with 103 patients found that of the patients admitted to the hospital history of heart disease is a direct result of obesity. Therefore, a recommendation is that vigilance should be given to treating patients with obesity starting from the outpatient setting, alluding to necessitated prevention of escalation when faced with other conditions (Kalligeros et al., 2020).

Role of Nursing

The role of nursing is to provide integrated care and enhance patient comfort by providing interventions to alleviate symptoms of obesity. Findings from Rezaei et al. (2022) study point out that high morbidity rates are caused by poor health maintenance, which aligns with the results in studies by Smith et al. 2020; Sutaria et al., 2020. Furthermore, Gadde et al. (2018) study findings indicate a significant reduction in morbidity and mortality rates among patients in weight maintenance trials. The high number of obesity cases creates a risk factor in the population; this points to the need to emphasize training for this. Recognizing physician efforts in collaboration with outpatients by sensitization on environmental awareness is essential (Walia et al., 2022). This includes considering that proper evaluation starts by recognizing the appropriateness of the environment for supporting weight management. Achieving and maintaining weight loss or gain requires physician-patient collaboration in a way that can be facilitated by nurses providing pertinent information. Again, support and motivation are also determined by letting a carefully defined plan be identified with the patient to understand the expected health outcomes. This is the nurse’s work as it allows for the recognition of a strategy of control for each patient (Stonerock & Blumenthal, 2017: p.1457).

According to Rezaei et al. (2022), the combination of aspects such as the cost of health, care expenditures, and hospitalization risks are some of the reasons that can be used in motivating outpatients to adhere to their plan of losing weight. This study aligns with the findings of Piché et al. (2020) study findings. The findings indicate that advanced heart diseases are often caused by obesity and lack of maintenance, and the determinant of failure lies in the early handling of the issue. Therefore, health literacy is an integral part of the nursing fraternity to impart to the patients as it allows for the opportunity to understand the implication of obesity in the long run. Consequently, the narrative is applicable because by the time medication is involved, the progression will be higher risk associated and thus significant mortality risk, however, creating a provider-patient relationship with a healthy diet, diabetes and obesity teaching without having a judgmental response, whereby both parties agrees on goals, share a vision of improvement in general metabolic health status, the patient and provider will be able to create a personalized and participatory lifestyle changes plan as described by Foley et al. (2019) study. Furthermore, Alexander et al. (2021) study findings indicate that health literacy as part of outpatient training will provide the necessary support for proper weight loss and maintain it while allowing room for recognition of mental health too. This caters to the grasping of the incorporation of strategies that align outcomes centered on the totality of patient care within the six sigma of quality improvement in healthcare delivery.

Alexander et al. (2021) research focuses on promoting healthcare delivery as a focal point in preventive care and is supported by Levine et al. (2019), which look at a similar issue but with a different approach. Levine et al. (2019) surveyed to find out why the use of preventive healthcare is still low in the modern healthcare system. The findings from the survey linked modernization and the advancement in technology as one the contributors to the limited use of preventive medicine. Nevertheless, Harris et al. (2017) points out how using preventive healthcare would enhance the efficiency of care and result in better outcomes. Therefore, Alexander et al. (2021), Levine et al. (2019), and Harris et al. (2017) studies collectively look at transitioning patients from outpatient to inpatient and provide insight into what to avoid and what is necessary to promote better care. From the start, the studies allow room for relativity in practices that promote and optimize safety, and within those points to the relevance of individual patient circumstances. While the project gives valuable information on the standard procedure, it contributes to the general discussion on the improvement of health by nurses. It thus applies that, for all patients, recognition of the value in situation background assessment facilitates the improvement of health outcomes. The improvement starts with a reduction in risks hence understanding beneficial outcomes accurately first (Alexander et al., 2021).

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.

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 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 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 (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 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, Schetz et al. (2019) describe obesity as one of the current health concerns affecting a large proportion of the world’s population. 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: p.667).

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 are 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.

Significance and Justification

Findings from the initial literature review revealed that a lack of knowledge exists in nursing and patient care practice regarding obesity management. In their study, Bucher Della Torre 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 Della Torre et al., 2018: p.126). This gap exists, yet healthcare professionals ought to be at the forefront of executing various interventions in managing obesity. 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. Similarly, 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 study must enable nurses to have a training program where they will get more knowledge and skills concerning the management of obesity through dietary interventions. It will optimize patient outcomes through effective nursing education.

Project Objectives

The objectives of this project are to:

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 2017 to 2022, will include, AMED, Alt Health Watch, CINAHL Plus with Full Text, EBSCO, Medical Journal sites for nursing care, nursing training, PubMed, Scopus, Science Direct, Directory of Open Access Journals, Google Scholar, JSTOR and the D’Youville library to loan articles through interlibrary loan;

Develop a PowerPoint presentation; and

Have a panel of five content experts with extensive knowledge and expertise in a healthy diet for patients with obesity evaluate and critique the projectfor 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 (Boersema et al., 2021).

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.

Limitations

The Project Author recognizes the following project limitations:

The implementation of the PowerPoint presentation is not within the context of this project;

The PowerPoint presentation 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 (product) content is created based on the extensive review of evidence-based literature and the theoretical framework used to support and guide the development of the (product). 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 healthcare nursing for outpatients with obesity will be asked if they are interested in voluntarily participating as expert content reviewers for the PowerPoint presentation. The content expert panel will consist of two APRNs, two administrative nurses, and one nurse informatics expert in charge of resource control and strategy development for outpatient healthcare service delivery. 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 PowerPoint presentation (Appendix D), and a letter addressed to the recipient of the request for review. The Letter of intent will focus on explaining the purpose of the project and the population of focus while detailing the instruction to use in the completion of the Content Expert Project Evaluation Tool and sending it back to the Project Author. On the other hand, the Content Expert Project Evaluation Tool will have six evaluative items with space for a scoring and comment section where reviews and suggestions will be expected. It is expected that the review of the PowerPoint presentation will require at least 15 minutes with an additional 5 minutes to complete the evaluation tool. When all the evaluation tools have been returned to the Project Author, the information will be analyzed and reported in a chart and a narrative with the summarized finding of the six evaluative items provided within the content. This will be sent to the expert reviewers by email.

Plan for Promotion of Safety and Protection of Human Subjects

The key to the protection that is taken into account in this project is the voluntariness of participation. Following approval from D’Youville Patricia H. Garman School of Nursing, the graduate faculty designee (Appendix A), the experts in the area of healthcare nursing for outpatients with obesity, and the five professionals will be approached. They will be asked to voluntarily participate in the review process and evaluation of the PowerPoint presentation (Appendix D). There will be advisement through assurance that the participants will not affect the individual’s personal or professional life in any way. This will help in reinforcing the mainstreaming protection elements by making sure that coercion or room for coercion is not present within the process.

Additionally, to protect the individual information only the Project Author will know the participant’s names. The Content Expert Project Evaluation Tool will also not reveal the participant’s names and neither will the project manuscripts. It is expected that the return of the Content Expert Project Evaluation Tool (Appendix C) will be an indication of voluntariness of participation. There will be no coercion towards the experts who do not return the evaluation tool after confirmation of their unwillingness. Other experts will be sort about the replacement. Once the experts have delivered the Content Expert Project Evaluation Tool (Appendix C), they will be informed of the fact that they would not be able to withdraw from the participation but assurance will be given of the return of the evaluation tool confidentially by the Project Author. This will be sealed and protected following the D’Youville Patricia H. Garman School of Nursing protocols on safety and protection.

Project Evaluation Plan

Immediately after the approval by D’Youville Patricia H. Garman School of Nursing (Appendix A), mail kits containing a copy of the Letter of Intent (Appendix B), the Content Expert Project Evaluation Tool (Appendix C), PowerPoint presentation (Appendix D), and a self-addressed stamped envelope will be packaged and sent to the identified experts. Content Expert Project Evaluation Tool will contain 8 elements to be evaluated, the content organization, reflection of task flow, distinct clinically relevant contents, consistency, visual appeal readability, and accuracy to a topic weighed against a scoring criterion. The scoring criteria will use a Likert scale (1) Strongly Disagree, (2) Disagree, (3) Agree, and (4) Strongly Agree. Experts will be given 5 working days to complete and return the evaluation tool to the Project Author via the given address in the self-addressed mail. Cumulative scores from the Likert scale will be presented graphically for presentation and comments and suggestions explained in a narrative summary. Thereafter, the evaluation summary findings will be made available to the experts’ reviewers by mail.

Summary

The project is arranged into chapters each with a concrete concept or description of the topic of outpatient nursing care for a patient with obesity. Chapter I presents the project introduction, statement of purpose, and an overview of the theoretical framework. These guide the project development process and pave way for initial review. The initial review of the literature focuses the discussion on a specific subject theme of weight management and nursing care for outpatients. It is then followed by 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 finally the chapter summary.

Chapter II will focus on providing an in-depth review of the literature on developing educational training for nursing with outpatient with obesity completed with a chapter summary. Additional to the discussion Chapter III will focus on the population and setting, content expert participants, data collection methods, project tools, and the protection of human subjects, and end with a chapter summary. Chapter IV will culminate the project by looking at the project evaluation, future implications for nursing practice, and recommendations for further research and end with a chapter summary.

References

Alexander, C. C., Tschannen, D., Hays, D., Clouse, M., Zellefrow, C., Amer, K. S., … & Milner, K. A. (2022). An integrative review of the barriers and facilitators to nursing engagement in quality improvement in the clinical practice setting. Journal of Nursing Care Quality, 37(1), 94-100.

Alexander, C., Rovinski-Wagner, C., Wagner, S., & Oliver, B. J. (2021). Building a Reliable Health Care System: A Lean Six Sigma Quality Improvement Initiative on Patient Handoff. Journal of Nursing Care Quality, 36(3), 195-201.

Allan, J. (2020). Theorizing new developments in critical social work. In Critical social work (pp. 30–44). Routledge.

Balani, R., Herrington, H., Bryant, E., Lucas, C., & Kim, S. C. (2019). Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity. Journal of the American Association of Nurse Practitioners, 31(9), 502-510.

Block, B. L., Smith, A. K., & Sudore, R. L. (2020). During COVID‐19, outpatient advance care planning is imperative: We need all hands on deck. Journal of the American Geriatrics Society.

Bloor, M., & McIntosh, J. (2019). Surveillance and concealment: a comparison of techniques of client resistance in therapeutic communities and health visiting. In Selected Writings in Medical Sociological Research (pp. 93–116). Routledge.

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Appendix A

Patricia H. Garman School of Nursing

Full Approval Letter

Appendix B

Letter of Intent

Appendix C

Content Expert Letter of Intent

Dear Content Expert,

Hello, my name is ___________________________ I am a graduate student completing a Master of Science in Nursing degree at D’Youville College in Buffalo, New York. Currently, I am developing a resource guide for nurses in the hospital setting.

I am submitting the resource guide for your expert review and evaluation. Recommendations and critiques of this work in progress will be taken into serious consideration during the final revisions of this work. You are being asked to review and evaluate the resource guide for clarity, readability, applicability, quality, organization, and evidence-based relevance. Your review of the resource guide should take approximately 20 minutes of your time. The evaluation process is completely voluntary and your refusal to participate will involve no penalty or loss to you. Your responses will be kept confidential and will be available only to me. If you choose to participate, please return the evaluation tool within the next seven (7) days using the enclosed self-addressed stamped envelope. Consent to participate in the evaluation is implied upon the completion and return of the evaluation tool. Once you return the evaluation tool, there is no way to withdraw your responses, as there are no identifying markers included in the tool. Returned evaluation tools will be stored in my home for six years and then destroyed. There are no direct benefits to you as a content expert participant. A copy of the results including the findings of the six evaluative items in the content expert project evaluation tool will be mailed to you after this project.

If you have any questions regarding my project or the evaluation process, please contact me via email at ___________________________. Any specific questions may be directed to _____, my Project Chair, at (716) ____ or via email at____. Thank you for your assistance and participation as a content expert. I look forward to receiving your evaluation of my project.

Best Regards,

Appendix D

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 resource guide. The purpose of the project is to develop a resource guide to provide nurses with information on the importance of a healthy diet for outpatients with obesity in the hospital 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 resource guide. To maintain your confidentiality, please do not make any identifying marks on the evaluation tool.

1. Content Organization

The document is globally organized and the information presented in the PowerPoint is in a standard manner. It is understood at a glance as a drafted PowerPoint presentation and is professionally presented

Strongly disagree	Disagree	Agree	Strongly agree
1	2	3	4

Comments and Suggestions:

2.Readability/ Reflection of task flow

The information in the PowerPoint presentation is delivered at an appropriate and comprehensive level of reading for nurses in the hospital setting with a smooth flow of content buildup.

Strongly disagree	Disagree	Agree	Strongly agree
1	2	3	4
Comments and Suggestions:

3.Applicability/ Distinct clinically relevant contents The information presented in the PowerPoint presentation is relevant to the project study scope and fits the project’s purpose.
Strongly disagree	Disagree	Agree	Strongly agree
1	2	3	4

Comments and Suggestions:

4. Consistency

The resource guide is well-designed and with a consistent flow.

Strongly disagree	Disagree	Agree	Strongly agree
1	2	3	4

Comments and Suggestions:


5.Organization/Visual appeal The resource guide is logical in order and well organized and simplistic in its appeal.
Strongly disagree	Disagree	Agree	Strongly agree
1	2	3	4
Comments and Suggestions:

6.Evidence-Based Clinical Relevance/ Accuracy to a topic

The resource guide 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 resource guide. Your feedback is deeply appreciated and will strengthen the development of the resource guide for nurses in the hospital setting.

Appendix E

Survey Tool Results