FPX 6030: Implementation Plan Design

“Part 1: Management and Leadership”

Strategies for Leading, Managing, and Implementing Professional Nursing Practices 

The project proposes community-based approaches in schools and at home to address the problem of adolescent obesity among school-going children and adolescents in a Pediatric Outpatient hospital that treats toddlers to 18 years old. The intervention entails strategic approaches such as healthy eating, physical activity habits, improved community obesity awareness to manage and prevent adolescent obesity. This intervention will involve several participants, some of which come from outside the healthcare settings, thereby requiring an interprofessional collaboration to facilitate the process of delivering the intervention. Through this interprofessional collaboration, professional practice and healthcare outcomes are enhanced (Sangaleti et a., 2017). An interdisciplinary team that will deliver this proposed intervention will include a school nurse, nutritionist, physiotherapist, and classroom teachers. 

As Bell et al. (2018) stated, during the implementation process, coordination, communication, and collaboration should occur across the diverse disciplines irrespective of the differences in professional norms, training, and specialized language that exists within the interprofessional team. The team aspects allow the establishment of positive relationships among team members, promoting continuity of care and enhanced patient outcomes (Hustoft et a., 2019). 

In the implementation process, the interprofessional team members will explore and discuss prevailing evidence concerning the most desirable foods, physical activities, lifestyle adjustments, awareness about obesity, and environmental adjustments for weight management among school-going children and adolescents. This team will also review the current evidence that supports the effectiveness of the intervention in preventing and managing adolescent obesity. 

The interdisciplinary team members will be assigned roles for which they are qualified and specialize in making sure that the intervention is delivered optimally. Further, the interdisciplinary team will have to agree on how they will evaluate the success of the approaches to determine whether the intervention affects weight management to deal with the issue of adolescent obesity. For example, monthly weigh-ins may indicate whether one is losing, gaining, or maintaining it. To deliver the intervention, the interprofessional team will employ the Self-Regulated Behavioral Change (SRBC) framework to help children and adolescents manage their weights. The SRBC model will start by reflection, in which the team will help the participants to reflect on opposing goals, like the desire to consume sweetened food products and the need to maintain healthy body weight (Keller et al., 2019). 

Once the interprofessional team acquires such information, they can guide the participating to select an appropriate strategic approach to address the competing desires contributing to adolescent obesity. After implementing the strategic approaches, participants will require directions on evaluating, maintaining, and controlling the temptations. In the awareness or education section of the intervention, the interprofessional team will have to prepare printed training materials that can be easily comprehended by children and adolescents, as well as their parents. The main strategies for the delivery of the proposed intervention incorporate interaction with obese adolescents and children, educating them on measures to manage their weight, and leading them throughout the actual intervention.

The Implications of Change 

The proposed intervention targets toddlers to 18 years, old children and adolescents. Notably, children and adolescents are at high risk of obesity because of the decreased physical activity, making obesity prevention and management an important issue that must be solved to prevent future health complications and conditions like diabetes and cardiovascular problems (Sommer & Twig, 2018). In children and adolescents, the main factors that cause obesity are a sedentary lifestyle and reduced or inadequate physical activity. The main implication of the proposed intervention is to instill behavioral changes in children, adolescents, and their parents. Children and adolescents are anticipated to shift their eating habits from eating unhealthy foods, like sweetened food products, fast foods, and high calorie-rich meals, to eating healthy foods that consist of whole grains, fruits, and vegetables. Again, children are expected to establish the capability to choose healthy food products, with proper information regarding the effects of unhealthy food products. 

This intervention is also expected to change adolescents' and childrens' perception of sedentary lifestyles like watching television for long durations and playing computerized games that involve sitting for long hours. Instead, children and adolescents will be expected to adopt physical activity as a way of cutting and managing their body weight. Further, parents and the community are also expected to create a healthy environment where the sale of unhealthy foods is discouraged and consuming healthy foods is encouraged, including having proper infrastructures that promote physical activity. Notably, such changes will affect children and their parents or guardians, who are mostly involved in preparing their foods at home. The parents and guardians need to adjust their food choices and lifestyle to support their children's goals in managing their weight.

“Part 2: Delivery and Technology”

Appropriate Delivery Methods to Implement the Intervention

The proposed intervention will be delivered in a Pediatric Outpatient facility setting that treats toddlers to 18 years, old adolescents. In this setting, the interdisciplinary team will interact directly with participants to initiate the change. This intervention may constitute a community health education that employs a multiplicity. Teaching methods include lectures, demonstrations, practicing what is taught, field visits and trips, or readiness to adopt the change (Mahaffey, 2018). This intervention will employ the first three methods, that is, lecture, demonstrations, and practice. The school nurse will work with parents and the facility’s nurses to identify the children and adolescents that qualify to be included in the project. The selection of obese adolescents and children will be grounded on the standard definitions of obesity, as stated by Skinner et al. (2018), “overweight as ≥85th percentile for age‐ and sex‐specific BMI; class I obesity as ≥95th percentile; class II obesity as ≥120 of the 95th percentile, or BMI ≥35; and class III obesity as ≥140% of the 95th percentile, or BMI ≥40.” Informed consent will be acquired from the parents or guardians of the selected adolescents and children before participating in the project. The intervention team will provide lectures to children, adolescents, and their parents on the causes and impacts of obesity. The participants (children and adolescents) will be required to reflect on their individual opposing goals. Further, the nutritionists and physiotherapists will teach the participants appropriate measures of managing their weights through appropriate dieting and adequate physical activity. Typically, printed materials stuck on walls will accompany these lectures, and they will show the causes, impacts, and how obesity can be managed. The interprofessional team will further demonstrate what a healthy meal and effective physical exercise entail. In the practicing step, the facility’s nurses, nutritionists, and physiotherapists will assist the participants in choosing healthy foods, performing adequate physical activities, adjusting their lifestyles, modify the environment. This intervention will entail four weekly sessions, marked by weigh-ins, diet and activity reviews, evaluation of progress and behaviors, deliberation of challenges, problem-solving, and goal-setting lessons. After the end of every session, participants will have the opportunity to ask questions that will require responses from the intervention team. The children and adolescents will then participate in training sports, fun game competitions, and suitable fitness exercises.

The Current and Emerging Technological Options 

Various technological equipment can provide alternative ways of delivery. The first emerging technology is videoconferencing. Even though constant face-to-face meetings effectively manage weight, they tend to be inconvenient for healthcare practitioners. Videoconferencing will enable virtual meetings and eradicate the need for health coaches to be present at the meeting points (Forman et al., 2016). The participants will receive weight management education via videoconferencing in their classrooms or homes. The other emerging technology is the use of exergames. Sometimes, children and adolescents find physical activities performed at school tedious. However, when exergames, which combine exercise with fun to make physical activity appealing, students will be willing to participate. The components of exergames like virtual reality and augmented reality establish an illusion of interaction with the virtual world, motivating children to participate. Most important, text messages can be utilized to provide personalized feedback to parents and their children on goal attain, reminders, and tips on weight loss, and the children and adolescents can utilize mobile phones to ask personal questions concerning their body weight (Kozak et al., 2017). 

“Part 3: Stakeholders, Policy, and Regulations”

Analysis of Stakeholders and Regulatory Implications

The stakeholders in this project include government institutions like the Center for Disease Control and Prevention (CDC), adolescents and children and their parents, healthcare practitioners, teachers, and school administrators. In the US, schools are directed to ensure that students eat healthy foods through lunch programs. For instance, the Healthy Hunger-Free Kids Act (HHFKA) of 2010 required that school lunch programs increase the portion of whole grains, fruits, and vegetables while limiting calories (Hecht et al., 2020). Educational institutions can, therefore, facilitate the selection of healthy meals by students. Further, CDC encourages parents to assist their children in developing healthy eating behaviors by eliminating calorie-rich temptations, reduce sedentary durations, promote physical activity, limit sweetened food products, and provide adequate whole grains, fruits, and vegetables (CDC, 2021). Notably, as this intervention team teaches obese children and adolescents regarding weight management, schools, parents, and community-based institutions can support this intervention as the primary stakeholders involved in obesity prevention and management.

Existing or New Policy Considerations 

This project will involve school-going children and adolescents. Since the participants are adolescents and children with little knowledge about infringement of their rights, informed consent will be obtained from the parents of the selected participants before the intervention can be applied. This intervention will consider the policy that requires the protection of patients’ health information as required by The Health Insurance Portability and Accountability Act of 1996 (HIPAA) (HIPAA, 2021). Again, when reporting the intervention, the names of the participants and their families be made confidential, and only authorized persons who will close the deal with the participants will be allowed access. Further, because the project involves human subjects, the Institutional Review Board’s (IRB) approval will be sought to ensure that the project adheres to all ethical requirements.

“Part 4: Timeline”

This proposed intervention will run for four continuous months. Managing obesity comprises weight loss, healthy eating habits, lifestyle changes, knowledge about obesity awareness, and environmental modifications. All these concepts will entail behavioral changes, which may take some time to achieve. Again, since children and adolescents have minimal self-regulation capabilities, they might experience challenges while sustaining the newly instilled habits. For example, children and adolescents are often tempted to consume snacks, sugary food products, and fast foods, which could work against their set weight goals. The intervention consists of four weeks of training and physical activity, followed by two months of maintenance.

References

Bell, S. T., Brown, S. G., Colaneri, A., & Outland, N. (2018). Team composition and the ABCs of teamwork. American Psychologist, 73(4), 349.

Centers for Disease Control and Prevention. (2021). Help Children Maintain Healthy Weight. https://www.cdc.gov/healthyweight/children/.

Forman, E. M., Evans, B. C., Flack, D., & Goldstein, S. P. (2016). Could technology help us tackle the obesity crisis?

Hecht, A. A., Pollack Porter, K. M., & Turner, L. (2020). Impact of the Community Eligibility Provision of the Healthy, Hunger-Free Kids Act on student nutrition, behavior, and academic outcomes: 2011–2019. American journal of public health, 110(9), 1405-1410.

HIPAA. (2021). Official 2021 HIPAA Compliance Checklist. Retrieved 16 October 2021, from https://www.hipaajournal.com/hipaa-compliance-checklist/.

Hustoft, M., Biringer, E., Gjesdal, S., Moen, V. P., Aβmus, J., & Hetlevik, Ø. (2019). The effect of team collaboration and continuity of care on health and disability among rehabilitation patients: a longitudinal survey-based study from western Norway. Quality of Life Research, 28(10), 2773-2785.

Keller, A., Eisen, C., & Hanss, D. (2019). Lessons learned from applications of the stage model of self-regulated behavioral change: A review. Frontiers in psychology, 10, 1091.

Kozak, A. T., Buscemi, J., Hawkins, M. A., Wang, M. L., Breland, J. Y., Ross, K. M., & Kommu, A. (2017). Technology-based interventions for weight management: current randomized controlled trial evidence and future directions. Journal of behavioral medicine, 40(1), 99-111.

Mahaffey, A. L. (2018). Interfacing virtual and face-to-face teaching methods in an undergraduate human physiology course for health professions students. Advances in physiology education, 42(3), 477-481.

Sangaleti, C., Schveitzer, M. C., Peduzzi, M., Zoboli, E. L. C. P., & Soares, C. B. (2017). Experiences and shared meaning of teamwork and interprofessional collaboration among health care professionals in primary health care settings: a systematic review. JBI Evidence Synthesis, 15(11), 2723-2788.

Skinner, A. C., Ravanbakht, S. N., Skelton, J. A., Perrin, E. M., & Armstrong, S. C. (2018). Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics, 141(3).

Sommer, A., & Twig, G. (2018). The impact of childhood and adolescent obesity on cardiovascular risk in adulthood: a systematic review. Current diabetes reports, 18(10), 1-6.