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PROMOTION OF BREASTFEEDING IN FORTH WORTH TEXAS

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Promotion of breastfeeding in Forth Worth Texas

Lesson 1 – Primary Prevention in the community

Before choosing your primary prevention topic:
- Read lesson 1.
- Review the approved topic list found in lesson 2.3
- Review the topic field hour ideas – Not sure what topic to do? Look at some ideas here to help you .

When choosing your primary prevention topic for your community Field work you should feel excited. Email your assigned course mentor with your chosen topic and any questions you might have.In addition to reviewing the learning resources in each lesson, you should create a list of the community assessment activities you plan to complete, including where you will go and when.

Once you are aware of the agencies, organizations, and individuals relevant to your prevention topic, begin reaching out to them by phone, email, and/or drop-in visits to set up interview appointments.If you have specific questions what hours are appropriate please reach out to your assigned course mentor. CA students will work with their assigned Clinical Instructor.

Lesson 2 – Community Assessment

You will find the windshield survey and community assessment information in this lesson. This activity will help you determine places to complete your interviews for your required field hours.
Read:Sample interview questions
Read: Fieldwork FAQ’s
Remember your topic must come from the Approved topic list lesson 2.1
Time log:
- Non regulated states:
  - We suggest students keep track of their hours on a separate log form as they work through their field experience. Once completed you will input this information to the log link found in taskstream.
  - The time log can be found in taskstream under web links as seen below. You will want to input your field experience hours in one sitting and then once complete the log will be emailed to you to submit to taskstream

Regulated states (CA)
- CA student: You, your preceptor and clinical instructor will all need to sign before submission to taskstream.
Plan ahead to find time on your life to complete your hours. This can seem challenging and overwhelming so work with your family and employer to make this an enjoyable and enlightening learning experience.
CA students read before moving forward with hour collection: CA FAQ’s

The remaining lessons in the course will help you write your C229 paper. Please review the task tips and read the material below as you work to formulate your paper. Your task instructions, rubric, and time log link will be found in taskstream.C229 v4 Task tipsC229 v4 RubricLesson 3 – Assessing the Target Population:

While completing your hours think about the target population you will focus on for your paper. You do not need to do all your field hours on your target population but you will want to have some interviews to draw from when discussing your target population and health disparity. Unsure what a health disparity is? Review it here!

Lesson 4 – Evidence Based Practice

Section D of your paper will ask you to discuss the evidence based practice associated with you primary prevention topic at the local state and national level. This chapter will be important in understanding EBP.

Lesson 5 – Developing a community health social media campaign

Section E of your paper you will be developing a social media campaign to convey your health message and address the primary prevention topic. You will find information on professional guidelines for utilizing social media in health care.

Lesson 6 – Social Media Implementation and Data Analysis

Section H of the paper you will discuss how to implement and evaluate your social media campaign.

Lesson 7- final steps

You will submit your APA format paper and signed time log to taskstream.
- CA student remember to send your log to your clinical instructor. If you cannot remember who your CI is please email healthplacement@wgu.edu.
Taskstream issues; Having difficulty accessing TaskStream for C229? Try using this direct link: https://cos.wgu.edu/taskstream/ssohome.html . If C229 is still not showing as loaded in Taskstream, please connect with your Student Mentor for support.-+

CA Students: How to obtain a CA PHN certificate

As you consider your topic for the Field Experience, please think about what resources your community offers. Does the topic make sense for your community? Can you identify at least 10 to 15 different community resources or agencies to visit. Is this topic sustainable to assess in your community? Do my work hours allow me assess this topic?

If you are a California student, please reach out to your Preceptor and Clinical Instructor to ensure your selected list of potential community resources are appropriate.

Prevention of Substance Abuse

Police department, probation officer, school nurse, school counselor, health department, health teacher, mental health agency/workers, church leaders, local hospitals, PCPs, youth center, prosecutor, drug court, social worker, local college/university, bars, liquor stores, homeless agencies, pharmacies, MADD, transportation services

Access to Mental Health Services

Mental Health Agencies, PCPs, EDs, NAMI, health department, social worker/case manager, EMS, police department, prosecutor, substance abuse treatment facilities, mental health court, schools

Prevention of Unintentional Pregnancy

School nurse, health teacher, school counselor, Health department, WIC, Planned Parenthood, OB/GYN, CNM, churches, youth centers, March of Dimes, local college/university, pediatricians, United Way, Big Brothers Big Sisters

Are there any other programs/organizations that try to keep youth out of trouble?

Breastfeeding

WIC, breastmilk bank, OB/GYN/midwives, pediatricians, childbirth educators, breastfeeding classes, lactation consultants, hospitals-mother/baby/NICU/peds, baby-friendly hospitals, United Way, breastfeeding vs former breastfeeding vs bottle-feeding mothers, La Leche League leader, other support groups, March of Dimes, breast pump rental companies, local businesses (working nursing mother policies), any public facilities where breastfeeding could occur, government officials regarding breastfeeding-friendly laws

Prevention of STIs

Health dept., Planned Parenthood, PCP, OB/GYN, pediatrician, health teacher, school nurse, college health center, jails/prison, agencies working with homeless, church clergy, community center, youth center, GLBT groups

Prevention of Falls in Elderly

Senior center, PT, OT, PCP/geriatricians, ortho dr., neurologist, ophthalmologist, hospital, home health, assisted living centers, nursing homes, medical supply companies, pharmacist, department of aging, health department, exercise classes directed toward seniors, city/county offices for programs to support making senior homes and public facilities safer

Prevention of Smoking

Health dept., school nurse, health teacher, government officials, PCP/pediatrician, smokers/former smokers/nonsmokers, American Lung Association local division, youth centers, local businesses, churches

1. A community needs to reduce or better yet eliminate access to cigarettes for youth. Here you would explore what the laws are about selling to minors, where cigarettes are sold, how youth are obtaining cigarettes (adults buy them? They use fake ID? They obtain them through the black market?, etc.). Do stores sell “loosies” meaning one cigarette at a time rather than by the pack? This also contributes to youth smoking.

Talk with police about enforcement of current laws. What is being done to raise the price of a pack of cigarettes through additional taxes on cigarettes to make buying a pack very expensive and so act as a deterrent to smoking? In New York City, a pack of cigarettes is $12. What is being done to enforce the requirement to provide ID when purchasing cigarettes?

2. A community needs to reduce or eliminate the ability to smoke in public spaces such as restaurants, bars, stores, other employers, public buildings, etc. to further deter people from smoking and make it very difficult to smoke. This would include investigating what is being done in the county to reduce or eliminate smoking in public places outdoors as well as indoors.

What are the regulations, what is pending to make the regulations stricter or more encompassing and what is being done to enforce the regulations? What sort of public acceptance is there of these efforts? Are parents allowing children to smoke at home? Are employers allowing youth to smoke at their jobs? What are the schools doing?

3. A community needs to change attitudes and norms to reflect a determination not to be accepting of youth smoking and to actively work against it.

Prevention of Dental Caries

State dental planner, lactation consultant, daycares, dentists, school nurse, pediatricians, family practice physicians, parent’s/community members, businesses (dental insurance)

Suicide Prevention

School counselor, school nurse, GBLT groups, church leaders, youth centers, mental health agencies, PCP, pediatrician, local colleges/universities, military installations/VA centers, NAMI, health dept.

Access to Healthcare

Health dept., government officials, low income clinics, EDs, PCPs, schools, community members, EMS, transportation services, social workers, churches

Prevention of Obesity (Healthy Nutrition & Physical Activity)

Family practice drs/pediatricians, community members, daycares, health dept., school nurse, school dietitian/cafeteria director, principal, PE teacher, health teacher, YMCA, parks & rec department, WIC, dietitian, lactation consultant, food banks, churches with food programs, food stamp office, grocery stores, farmer’s market, nursing homes, assisted living, soup kitchen, meals on wheels

Prevention of Homelessness

Health dept., churches, government officials, police dept., mental health agencies, EMS, emergency dept., department of human services, homeless shelters, homeless coalitions, schools, VA services, low-income clinics, Habitat for Humanity

Focus your efforts on what is being done to keep people in their houses and low-cost housing efforts.

Prevention of Unintentional Childhood Injury

Schools, drivers education, dept. of motor vehicles, coaches, pediatricians, parents, hospital, Safe Kids Coalition/Council, youth centers, daycares, health dept.-injury prevention program, poison control, police department, fire department, churches, appropriate recreational businesses affiliated with your community (i.e. kayak rental, ATV rental, ski resort)

Are there car seat safety, bicycle safety, seat belt safety, pedestrian safety programs? Hunter safety? Gun safety? Babysitting?

Promotion of breastfeeding in Forth Worth Texas

Prevention of Child Abuse

Health dept. (FICMR, Nurse-Family Partnership, child health), Division of Human/Child Services, daycares, schools (nurses, counselors, teachers), CASA, police dept., prosecutor, mental health agencies, churches, EMS, hospitals (post-partum and peds education), crisis child care center, parenting classes, pediatricians, support services for special needs parents

Air Quality

Health dept., local industries, government officials, school nurse, PCP/pediatrician, pulmonologist, allergist, local university, air quality expert, Sierra Club &/or other environmental groups, American Lung Association-local division, local media sources, radon inspection/removal companies, bicycle-riding programs

Disaster Preparedness

American Red Cross, Fire Department, Police Department, Health Department, search and rescue, media, meteorologist, local hospitals, mental health agency, schools, churches, nursing homes, home health companies, assisted living centers, medical supply companies, veterinarians (care of pets), mortuaries, grocery and hardware stores, pharmacies, local colleges/universities, water treatment plant, hazmat, sewage treatment plant, the landfill, electric plant, propane distributors, natural gas distribution plant, Community Emergency Response Team director

Vaccine-Preventable Diseases

Health dept., pediatricians, FP drs., school nurse, daycare providers, hospital-mother/baby & peds, community members, pharmacies, Planned Parenthood, senior centers, nursing homes, home health, adult daycare providers, assisted living centers, college/university (dorm living), Emergency Prep coordinator for the county (H1N1)

Domestic Violence or Sexual Assault

SANE/SAFE programs, domestic violence/sexual assault victim advocates, OB/GYNs, PCPs, EDs, EMS, crisis shelter, safe houses/shelters, health dept., police dept., mental health agencies, prosecutor, religious leaders, hair stylists, social workers, United Way, schools, YWCA, department of human services, Boy’s & Girl’s Club, Boy Scouts, Girl Scouts, youth centers

Look for any programs that teach young men/women positive coping behaviors and self-confidence. Look for parenting classes for older children/teenagers that you can audit.

Promotion of breastfeeding in Forth Worth Texas

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Promotion of breastfeeding in Forth Worth Texas

A: Introduction

According to Reeves and Woods-Giscombe (2014), breastfeeding is beneficial to the children as it plays a vital role in strengthening their immunity. Moreover, breastfeeding reduces the infant mortality and morbidity rate that are attributed to poor health in the baby. Breastfeeding refers to the process of giving the baby milk from the mothers’ breast either directly or indirectly. Breastfeeding provides the baby with minerals, calories, vitamins, and other nutrients for growth, development and health.

The process of breastfeeding is also known as lactating or nursing (UNICEF 2015). Moreover, World Health Organization (2016) states that breastfeeding is the natural way that nutrients are transferred to the child after birth and facilitates their growth. However, most mothers opt not to breastfeed their babies and this is one of the contributors of high infant mortality.

Promotion of breastfeeding in Forth Worth Texas

B: Problem Description

The target population are women who have delivered in Fort Worth Texas. The total population of births in Texas in 2015 was over 28,000. Fort Worth Texas accounted for a higher percentage of immortality rate in this number. According to Daverth (2015), the number of teen pregnancy accounts for a higher margin of the births. The state and trickling down to Fort Worth city they ae ranked to have the fifth highest rate of teen pregnancy in the country. The demographics that will be factored in the social media campaign are age, race/ ethnicity, and income of the mothers. The city is located in the North Central part of the State of Texas and covers an area of 910km².

In Fort Worth Texas, the infant mortality rate is higher when compared to other states. The number of deaths per 1,000 live births in the counties in Fort Worth are as follows. In Tarrant county there ae 7.1, Parker Wise county 4.7, and finally in Denton county 3.6 (“Healthy North Texas: Indicators: Infant Mortality Rate: County, 2017). Based on the analysis Tarrant County has the highest mortality rate when compared to the other counties in the state.

The number of deaths were more likely to occur among the African-American babies when compared to the Hispanic and Caucasian babies in the state during the first year of the child’s life. The African American mothers breastfed minimally when compared to either the Hispanic and Caucasian mothers. This is has resulted in the increase of deaths among their babies (UNTHSC to lead Fort Worth fight against infant mortality- Newsroom, 2017).

Promotion of breastfeeding in Forth Worth Texas

C: Health concern is linked to a health disparity within the targeted population

Data to support health disparity

The national estimates show that during the early postpartum era 58.1% African American women engaged in breastfeeding their babies with a margin of 27.5% of the population continuing after 6 months. Conversely, in the Caucasian women 77.7% and 45.1% respectively while in the Hispanic population 80.6% and 46% respectively. This is an indication that the African-American women few of them breastfed or continued breastfeeding after 6 months hence increasing the infant mortality rate (Belanoff et al. 2012; Reeves and Woods-Giscombé 2014).

Measures to solve the problem

According to the Star Telegram magazine (2017) the public health in Fort Worth for over 30 years have been working on the problem of infant mortality. They have carried out prenatal education on families. Moreover, they encourage the pregnant mothers to go for regular check-ups in the hospital during and after pregnancy. Furthermore, the women are encouraged to breastfeed their children as a way to deal with the problem.

Underlying causes of health concern

Based on Sparks (2011), the high infant mortality rate among the African-American population when compared to the other ethnic groups is attributed to a number of factors. They include limited resources, limited accurate information when it comes to breastfeeding, lack of support from the family members among others. Moreover, the poverty levels in the area affect the people when it comes to getting health insurance.

Furthermore, there are environmental and individual factors that hinder breastfeeding. Dunn et al., (2014), in most communities the negative perception of breastfeeding on the woman’s body makes them shun breastfeeding. The women have limited breastfeeding role models that will encourage them to breastfeed. Additionally, the lack of education on the suitable nutrients to eat during the lactating period affects breastfeeding. The women end up having decreased breastmilk for their babies which demoralizes them.

Promotion of breastfeeding in Forth Worth Texas

D: Evidence-based practice associated with primary prevention

The rate of abandoning breastfeeding is high among the mothers who are younger than 20 years of age. They have a 30% high likelihood of African American mothers younger than 20 years old at 30%; it is highly probable of abandoning breastfeeding when compared to the other racial or ethnic groups (Robinson, VandeVusse, and Foster 2016). Social workers have been sent to different areas in the city to synthesize the women on pregnancy issue.

They work in conjunction with community health and nurses to help women who are pregnant. The state of Texas has gone further ahead to partner with the community to set up clinics. The US Department in 2017, through the UNTHSC provided grants to 87 organizations out of this 4 in Texas received the Health Start grants (UNTHSC to lead Fort Worth fight against infant mortality- Newsroom, 2017).

Promotion of breastfeeding in Forth Worth Texas

E: Social media campaign

The social media campaign deals with synthesizing the women in Fort Texas on breastfeeding. The campaign is targeting the women who have given birth but lack sufficient information on breastfeeding. The objectives of the social media campaign are

Highlighting the benefits of breastfeeding through the social media platforms
Synthesizing women on the foods that will aid them during the breastfeeding period
Community support centers that will aid them during the breastfeeding process

Promotion of breastfeeding in Forth Worth Texas

Two-population focussed approach

The social media marketing intervention deals with educating the women on the value of breastfeeding. Knowledge is power and will aid the women save the life of children. According to UNICEF (2015), breastfeeding fosters the relationship between the mother and children. The social media marketing will focus on showcasing women who are breastfeeding and let them share their message. The women will also explain to the other women the manner in which they can breastfeed appropriately and the food appropriate for them.

The second approach is the involvement of the health practitioners from different medical facilities. They will highlight the benefits of breastfeeding in reducing acute childhood diseases, allergies, chronic diseases, reduction for postneonatal development among others. Moreover, the medical practitioners will focus on the growth and development process of children who have been breastfeed. They will also indicate the support centers for breastfeeding mothers and the form of medical aid that they need…….

Promotion of breastfeeding in Forth Worth Texas

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Euthanasia Evidence-Based Practice Proposal Solution

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Euthanasia Evidence-Based Practice Proposal Solution

Order Instructions:

Write a paper of 500 (not including the title page and reference page) paper for your proposed evidence-based practice project solution.

Address the following criteria:

Proposed Solution:

(a) Describe the proposed solution (or intervention) for the problem and the way(s) in which it is consistent with current evidence. Heavily reference and provide substantial evidence for your solution or intervention.

(b) Consider if the intervention may be unrealistic in your setting, too costly, or there is a lack of appropriate training available to deliver the intervention. If the intervention is unrealistic, you may need to go back and make changes to your PICOT before continuing.Organization Culture: Explain the way(s) in which the proposed solution is consistent with the organization or community culture and resources.

Expected Outcomes:

Explain the expected outcomes of the project. The outcomes should flow from the PICOT.

Method to Achieve Outcomes:

Develop an outline of how the outcomes will be achieved.
List any specific barriers that will need to be assessed and eliminated.
Make sure to mention any assumptions or limitations which may need to be addressed.

Outcome Impact:

Describe the impact the outcomes will have on one or all of the following indicators: quality care improvement, patient-centered quality care, efficiency of processes, environmental changes, and/or professional expertise.

Prepare this assignment according to the APA 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.

Evidence-Based Practice Proposal Solution

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Evidence-Based Practice Proposal: Change Model

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Evidence-Based Practice Proposal: Change Model

Order Instructions:

In 500 (not including the title page and reference page), apply a change model to the implementation plan. Include the following:

Rogers’ diffusion of innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students may also choose to use change models, such as Duck’s change curve model or the transtheoretical model of behavioral change. Other conceptual models presented such as a utilization model (Stetler’s model) and EBP models (the Iowa model and ARCC model) can also be used as a framework for applying your evidence-based intervention in clinical practice.
Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.
In addition, create a conceptual model of the project. Although you will not be submitting the conceptual model you design in Topic 5 with the narrative, the conceptual model should be placed in the appendices for the final paper.

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

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Databases relevant to EBP

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Databases relevant to EBP

Create a 1-2-page resource that will describe databases that are relevant to EBP around a diagnosis you chose and could be used to help a new hire nurse better engage in EBP.

EBP in nursing is an integration of research evidence, clinical expertise and a patient’s preferences. This problem-solving approach to clinical practice encourages nurses to provide individualized patient care.

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Locate the Best Evidence in Clinical Practice

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Locate the Best Evidence

Locate the Best Evidenceof Clinical Practice Guidelines used in the practice setting

Among the bodies in the US that are tasked with the responsibility of developing the clinical practice guidelines include the AADE (American Association of Diabetes Educators) that published the Standards of Practice, Scope of Practice, as well as the Standards of Professional Performance of Diabetes Educators. Based on these documents, pharmacists have a particular role of delivering diabetes education. AADE also came up with a framework related to optimal practice for self management.

During the process, there should be an assessment of the specific education needs in every patient (Garber, Gross & Slonim, 2010). Second is the identification of the particular diabetes self-management goals in every person. This can go a long way in ensuring effectiveness of the strategies used.

Third, the behavioral interaction as well as the education should aim at ensuring that the individual achieves the identified self-management goals (Kapoor & Kleinbart, 2012). In addition, following the education sessions, there should be evaluations aimed at determining the extent to which the individual is achieving the identified self-management goals.

Locate the Best Evidence

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The other body accountable for creating the clinical practice guidelines is ADA (American Diabetes Association). According to this body, the care standards or recommendations should not preclude clinical judgment but should be applied within an excellent clinical care context, with adjustments being made for comorbidities, individual preferences, as well as patient factors. The body also emphasizes on patient education that is patient-specific (Kapoor & Kleinbart, 2012).

Information for conducting systematic reviews

One aspect that can guide the systematic review is evidence supporting self-management training’s effectiveness for diabetes type 2, especially on a short-term basis. Second is evidence showing that education programs that are based on the health belief model are effective in improving self-management (Chijioke, Adamu & Makusidi, 2010). Therefore, their implementation can promote effectiveness in preventing the disease’s complications.

Proper diabetes health education has short-term impacts such as knowledge of diabetes and glycemic control. Health policy makers should consider the need to train diabetes educators so that they can tailor fitting education interventions among the patients (Garber, Gross & Slonim, 2010).

Locate the Best Evidence

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Published research sources- journals to be used

The use of peer-reviewed articles will be cardinal in helping locate credible information. Majorly, those articles are evidence-based and can ensure quality information. The journals will be obtained from authentic databases such as Proquest, GoogleScholar, and Elsevier. Research sources can also be obtained from nursing bodies’ sites as these also deliver quality information.

Experts in the US who provide sources of best evidence

Entities or bodies such as the ADA and AADE are among the experts who promote best evidence. Moreover, individuals, particularly those in the healthcare sector have a cardinal role in spreading best evidence. Moreover, agencies, particularly those focusing on research, help in generation and promoting the use of best evidence.

My personal expertise and how it fits with the EBP

Diabetes type 2 patients need to develop a wide array of competencies so that they can manage being in greater control of their disease. in connection to this, while education should promote health, it should respect the voluntary choices and self-perceived needs. Although there is the possibility of educating patients towards greater autonomy, a good number of professionals are not ready to collaborate with them. moreover, clinical staff should acquire better comprehension on diabetes management and of the theoretical principles that underlie patient empowerment. These factors need to be considered for effective EBP (Mshunqane, Stewart & Rothberg, 2012).

Locate the Best Evidence

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References

Mshunqane, N., Stewart, A. V., & Rothberg, A. D. (2012). Type 2 diabetes management : patient knowledge and health care team perceptions, South Africa : original research. African Primary Health Care and Family Medicine, 4, 1, 1-7.

Kapoor, B., & Kleinbart, M. (2012). Building an Integrated Patient Information System for a Healthcare Network. Journal of Cases on Information Technology (jcit), 14, 2, 27-41.

Garber, J. S., Gross, M., & Slonim, A. D. (2010). Avoiding common nursing errors. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Chijioke, A., Adamu, A. N., & Makusidi, A. M. (2010). Mortality patterns among type 2 diabetes mellitus patients in Ilorin, Nigeria : original research. Journal of Endocrinology, Metabolism and Diabetes in South Africa, 15, 2, 79-82.

Locate the Best Evidence

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Sexual Education Evidence Based Project

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Sexual Education

Idea for evidence based project

My project will be on a systemic review on the effectiveness of sexual education in enhancing knowledge among teenagers, encouraging safe sex practices, and decreasing the incidence of STIs. This is an important project in the field of healthcare because it has been proven that one out of five adolescents will have sex before they are 15 years old and most of those who continue being sexually active rarely use condoms consistently. This exposes themselves to STIs and unwanted pregnancies.

Moreover, what interested me into conducting this project is the sad revelation that more than half of all new HIV patients acquire the HIV virus through unprotected sexual intercourse before they attain the age of 25 years (CDC, 2012). In addition, research by Boonstra (2015) reported that approximately 85,000 teens in the U.S experience pregnancies. It is for these reasons that I chose this project of sexual education which will not only safeguard teenagers from STIs but also from teenage pregnancy that is acquired through unprotected sex.

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Evidence Based or Research Based

This project will be an Evidence Based Project and not a research project because it will rely entirely on systematic review of several peer review sources on the effectiveness of sexual education. A number of scholars have conducted research on this subject and documented their findings which will be essential in my project.

Description of Project Issue

My project will be on sexual education with an aim of filling the gap revealed by studies that majority of teenagers lack adequate knowledge about their sexual behavior and they therefore fail to make responsible decisions leaving them vulnerable to STIs, coercion as well as unintended pregnancy. Most adolescents turn to their families and schools for reliable information. Therefore, my project will aim at support parents and schools for them to do a good job in encouraging the teens to engage in safe sexual practices.

The project will emphasize on provision of detailed whole-school sexual education that will offer accurate and consistent information to young people from an early age. According to Duflo, Dupas & Kremer, (2014), teenagers exercise good behavior when they make good decisions on their sexual health. Furthermore, the project will encourage maintenance of a shared partnership approach between parents, schools, and the local community so that accurate evidence-based sexual education is available for teenagers.

Some of the objectives that this study will aim to attain include; encouraging abstinence, promoting safe sex practices such as the use of condoms for sexually active adolescents, discourage several sexual partners, sensitize teens on the significance of early documentation and management of STIs, and teach the teens crucial sexual communication knowledge, which will be operative in keeping them free from STIs as well as safe from unwanted pregnancies.

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Relevancy to specialization

This project is at the core of my practice. As healthcare practitioners, we are charged with the responsibility coming up with effective strategies for advising and counseling the general on important health practices (Boonstra, 2015). It has been proven that most young people do not receive adequate education on crucial health topics such as sex and sex-related issues (Tolli, 2012). As a result, they end up acquiring this information from other people and platforms such as the mass media which in most cases are misleading.

For instance, teenagers are exposed to several messages about sexuality which they present through highly communicative and fancy styles just to sell their products but not to equip young people with relevant education on health promotion. With such a project, I will be in a better position to introduce new interventions that will counter what young people have been fed by the media and let them know what their parents or teachers might have failed to educate them. It is our role as clinicians to ensure that high health practices are maintained in the society.

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References

Boonstra, D. (2015). Advancing Sexuality Education in Developing Countries: Evidence and Implications. Guttmacher Policy Review, 14 (3), 17-23.

Centers for Disease Control and Prevention (CDC. (2012). HIV, other STD, and pregnancy prevention education in public secondary schools–45 states, 2008-2010. Morbidity and mortality weekly report, 61(13), 222.

Duflo, E., Dupas, P., & Kremer, M. (2014). Education, HIV, and early fertility: Experimental evidence from Kenya(No. w20784). National Bureau of Economic Research.

Tolli, M. V. (2012). Effectiveness of peer education interventions for HIV prevention, adolescent pregnancy prevention and sexual health promotion for young people: a systematic review of European studies. Health Education Research, 27(5), 904-913

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Weight Management for Overweight/Obese Children: Parents Take Charge (PTC)

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Weight Management for Overweight/Obese Children: Parents Take Charge (PTC)

Abstract

This proposal is designed to halt the increasing rate of childhood obesity. Modifications in nutrition, behavior and physical activity are well documented to produce successful outcomes for obesity with the main change agent being the individual. Due to the complexities of childhood obesity, an intervention that includes proven elements that prevent obesity and addresses the special factors that affect children is needed.

Parents Take Charge (PTC) is a multi-component family-based childhood obesity intervention that includes modification in nutrition, behavior and physical activity, but focuses on the parent(s) being the primary change agent for the child, age 10-13 years. Addressed in this evidenced-based proposal are the assessment of need, an analysis of best evidence, design aspects, implementation, evaluation, integration and maintenance of the practice change in a primary care setting.

The focus of the intervention is to teach healthy lifestyle behaviors to the child through parental involvement instead of focusing on weight reduction as the primary outcome.

Weight Management For Overweight/Obese Children: Parents Take Charge (PTC)

Quality care can be defined as appropriately identifying, evaluating, diagnosing and treating patients. The term quality in healthcare is correlated to professional knowledge and desired health outcomes (Institute of Medicine, 2012). It is also defined as being closely associated with patient safety (Mitchell, 2008). Clinical excellence is the goal of providing quality care. The process for achieving clinical excellence includes patient-centered care.

The patient is the focus and includes their concerns regarding their illness, values, beliefs and support network. Making the patient an active participant in their health care results in informed decision-making by the patient. Autonomy, nonmalfeasance, beneficence, justice and fidelity are ethical principles that are addressed as definitions of providing quality care and achieving excellence in primary care.

America Nurses Association, American League of Nursing, and Center for Applied and Professional Ethics are organizations that set guidelines for excellence (Stanley, 2011). Quality and excellence in a clinical site is achieved through appropriate, comprehensive and timely care.

Examples of methods of providing clinical excellence include providing evidence-based treatment, the timely manner in which patients are seen from when they sign in, the offer of generics versus brand-name medications, patient education, open dialogue with patients and referrals to specialist as needed. Ethical considerations taken in account are the patient’s autonomy. The patient is provided information for full understanding of their illness, evaluation, treatment and alternative treatments so that the capability for informed decision-making is established.

Guidelines for the prevention, identification, assessment and management of overweight and obesity in adults and children include how to assess whether people are overweight or obese; what should be done to help people lose weight; how to care for people who are at risk due to their weight and how to help people improve their diets and increase their physical activity (The National Institute for Health and Clinical Excellence NHS, 2012).

The intention of this paper is to present an evidence-based project (EBP) proposal for childhood obesity. Included in this paper is assessing the need for change in practice, appropriate theoretical models and frameworks, statement of problem, intervention, goals, systematic review of current research and design. Assessing the need for change in practice consists of identifying stakeholders, collecting internal data about current practice, comparing external data with internal data, identifying the problem and linking the problem with interventions and outcomes (Larrabee, 2012).

Step 1: Assessing the Need for Change in Practice

Stakeholders

The first step for the model of evidenced-base change is assessing the need for change in practice. To facilitate this, identification of stakeholders is needed. The target population is children, age 10-13 years and their families. Final decisions to change behaviors lies with the children, but parents have great influences over the young child’s meals, snacks and physical activities.

Participating parents therefore, will be the change agent, adding them to the list of stakeholders. Parents make informed decisions regarding the health of their children with the help of a primary healthcare provider (Burns, Dunn, Brady, Starr, & Blosser, 2013). Primary healthcare providers or nurse practitioners (NPs) are stakeholders that will assist in facilitating and implementing change.

Barriers to Change

Barriers for children’s outcomes include their maturity level; ability to understand or commit to the program and their parents, if they are reluctant to participate. The primary barrier to change is participation of the parents. Physical activity and dietary behaviors will need modification in and out of the home. Without the participation of the parents the goal for long lasting results will not occur.

Barriers for the parents include health literacy level; language, if the primary language is not English and attitudes towards modifying foods and physical activity. Another barrier is the participant’s adherences to the nutritional guidelines provided because diet plans do not include the cultural foods that the family consumes.

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Facilitators to Change

Facilitators to change include support from their primary care provider or NP that the participants know and trust, educational classes that will be designed to meet their family’s cultural and specific needs and physical activities that can be done as a family that includes utilizing the workout facilities and pool in the local gym.

Internal Data

Internal data (date retrieved within Porterville Valley PromptCare Medical Center) provides overweight/obesity information that is defined by height, weight, body mass index (BMI), frequency of physical activity and anthropometric measurements of children in rural Tulare County, California.

External Data

External data (data retrieved outside of Porterville Valley PromptCare Medical Center) include the following (Ogden, Carroll, Kit & Flegal, 2012; California Center for Research on Women & Families, 2011):

a). Approximately 31.8 percent of children and adolescents aged 2—19 years are obese in the United States

b). Approximately 1 in 3 (33.2 percent) of children and adolescents age 6 to 19 years are considered to be overweight or obese in the United States

c). An estimated 30.5% of children and adolescents aged 10-17 years are presently overweight or obese in California

d). The total percentage of overweight and obesity from 1999 to 2009 rose from 34.0% to 37.6% for 9-11 year olds in California

e). For teens ages 12-17 years in California, African American youth had the highest percentage of overweight/obesity (39.9%), followed by Latinos (29.4%), Asian/other (18.0%) and white youth (12.0%)

Internal data presents an estimated 30% of the children seen in Porterville Valley PromptCare Medical Center are overweight or obese. When comparing Internal data and External data a change in practice is needed to prevent the incidence of childhood obesity from continuing to grow at an alarming rate.

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Theoretical Model and Framework

Since this EBP proposal involves changes in physical activity and dietary behaviors understanding the effects of behavioral and social aspect of the child is necessary. With this in mind, the Transtheoretical Model will be discussed as an integral element in the design of PTC, an overweight/obese child intervention proposal.

Transtheoretical Model (TM)

The TM integrates clinical psychology and concepts to support a framework to understand the behavior and motivate behavioral change. The concepts of TM are decisional balance, processes of change, self-efficacy and temptation. The five stages of the transtheoretical model are the following: precontemplation (not intending to change), contemplation (considering a change), planning or preparation (actively planning change), action (actively engaging in a new behavior) and maintenance (taking steps to sustain change and resist temptation to relapse) (Kadowki, 2012).

Decisional balance occurs in each stage and involves the weighing of advantages and disadvantages towards changing behavior. The processes of change are the steps that facilitate understanding and behavioral change. Self-efficacy is essential and will vary depending on the TM stage. Temptation to revert back to previous stages will exist throughout the model. Support from the individual’s social network will provide the encouragement to continue within the program’s parameters.

Problem

A correlation between obesity and chronic diseases such as cardiovascular disease, diabetes mellitus and hypertension has been documented. Life expectancy for those who are obese is lower than those that maintain a normal Body Mass Index (BMI) (Centers for Disease Control and Prevention, 2011). Earlier death rates in adulthood have been linked to excess weight in the younger ages (American Heart Association, 2013).

The prevalence of obesity has increased three-fold over the past few decades and is reported as a public health problem within the United States (Singh & Kogan, 2010). The cost of health care for obesity-related diseases (diabetes mellitus, hypertension, cardiovascular disease, etc) has skyrocketed and is predicted to continue to grow.

In the year 2000 an estimated $117 billion and $61 billion was spent both directly (medical costs) and indirectly (lost work time, disability, premature death and subsequent loss of income, etc) on overweight and obese individuals in the United States (Ward Smith, 2010). Chronic diseases linked to obesity were once seen mainly in adults, but are now becoming more and more prevalent in children.

The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Adolescent and School Health (2010) reported “the prevalence of obesity among children aged 6 to 11 years increased from 6.5% in 1980 to 19.6% in 2008…and among adolescents aged 12 to 19 years increased from 5.0% to 18.1%” (NCCDPHP, Division of Adolescent and School Health, 2010). Health concerns for obese children are a reality that must be addressed since the effects of early obesity will impact their health for the rest of their lives.

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Problem Statement

The problem addressed in this EBP proposal is the growing rate of childhood obesity and the negative effects on the child, parents, family and community.

Possible Interventions

Intervention of childhood obesity includes early identification and participating in health promotion activities such as eating healthier and becoming more physically active, as early as possible, to reduce the likelihood of chronic diseases and increase the health in those at risk. Wojcicki and Heyman (2010) stated “studies have shown that early interventions can potentially prevent the development of obesity in school-age children, along with associated health conditions” (Wojcicki & Heyman, 2010, p. 1457).

Interventions of childhood obesity include promoting a balanced diet and increased frequency of physical activity. But, with the complexity behind childhood obesity, it requires other interventions as well. Vos, Wit, Pikl, Kruff and Houdijk (2011) stated their family-based cognitive behavioral multidisciplinary lifestyle treatment “aims to establish long-term weight reduction and stabilization, reduction of obesity related health consequences and improvement of self-image by change of lifestyle and learning cognitive behavioral techniques” (Vos et al., 2011).

Education and physical activity should be provided to the whole family in order to ensure successful lifestyle change to occur for the child. It is hoped that by encouraging whole family participation that a lasting positive outcome would result.

Pender, Murdaugh and Parsons (2011) stated “the significant role the family plays in the development of both health-promotion and health-damaging behaviors, beginning at a very early age is well documented” (p. 243). Golley, Magarey, Baur, Steinbeck and Daniels (2007) stated “parenting-skills training combined with promoting a health family lifestyle may be an effective approach to weigh management in prepurbertal children, particularly boys” (p. 517).

Critical Outcome Indicators

Outcome indicators aim to achieve results that matter to the patient (Larrabee, 2012). Critical outcome indicators include improved BMI, improved laboratory measurements, improved health behavior, improved dietary patterns and increased frequency of physical activity.

Goals and Purpose

The health goal is to improve outcomes of obese children living in rural Tulare County, California. Quality goals are to improve access to diagnostics, early treatment and continuity of care with the use of evidence-based practices that include family participation. Quality measures include the participant’s understanding of the nature of obesity, treatment, the negative impact of obesity on lifestyle and overall health. These aspects will be measured through documentation of BMI status, weight classification, percent of physical activity and nutritional counseling.

Purpose Statement

The purpose of the EBP proposal is to promote health and well being in overweight/obese children and their whole family through participation in a nine-week multi-component, family-based community intervention program.

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Designing a Practice Change: Evidence Based Practice

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Designing a Practice Change

Introduction

Trends have indicated an increase in prevalence in diabetes with 42% of the patients with diabetes aged over 65 years (Chen et al., 2012). Projections have been conducted and proved that this ratio will increase to over 60% by 2050. This increase in diabetes prevalence has also impacted related health care costs.

For instance, the average acute hospital cost for managing diabetic patient with a diabetic foot was estimated to be $9,900 in the USA (Dabelea et al, 2014). According to Wong et al, this rise in the prevalence of diabetes has made it imperious to offer training and practice care for clinicians to manage diabetes (Wong et al., 2015).

This paper is going to focus on the design of Evidence Based Practice training program for practice change that will be aimed at training healthcare practitioners on diabetes and improving the outcomes of patients with diabetes.

Timeline

The training module will involve one basic 50-minute presentation which will be conducted by a well-trained diabetes educator and a physician. The presentation will be conducted on Monday, Wednesday and from 0800hrs to 0850hrs for a period of two months. The presentation will be divided into two parts.

The first part will concentrate on enlightening the trainees on diabetes for practice change, that is, the causes, risk factors, onset, types, signs and symptoms, treatment, and management of this disease. This part will also highlight the complications associated with diabetes. The second part of the presentation will concentrate more on patient education which is an integral component of comprehensive patient care.

Several long term care facilities will be contacted as potential recruitment sites. Comprehensive training modules and assessment measures will also be developed to aid in the evaluation of immediate and long term impact of the training project.

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Key Personnel

To achieve the educational needs of the clinicians the program will focus on training licensed practical nurses (LPNs), registered nurses (RNs), and physical therapists. The module will conduct a follow-up of learning outcomes in one group (RNs). The training will be designed for a small group of between 20-30 trainees in each session. This will ensure that close interaction is maintained between the participants and the instructors, with time set aside for participant comments and questions.

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Supplies Needed

Some of the material that will be required include; PowerPoint presentation, videos, and handouts.

PowerPoint Presentation: Will consist of 40 slides. These slides will entail a brief overview of diabetes, and the associated complications such as foot problems, risk of amputation, blurred vision, and kidney problems. It will also offer information on appropriate history taking, keeping of records, conducting physical examination, and appropriate specialist referral.
Video: This will demonstrate the proper techniques of carrying out patient examination such as conducting a monofilament examination with the aid of a tuning fork.
Handout: Will be issued to the participants for daily patient explaining and for explaining how to conduct physical examination on a patient with diabetes.
An official website that will contain all that will have been taught during this period.

Cost

For successful completion of this module, funds will be used in paying two diabetes instructors, paying the IT technicians who will compile the PowerPoint presentation, the video, creation of website and typing of the handout. Funds will also be used in buying enough training materials such as tuning forks for the monofilament examination and glucometers. All this will be allocated a total of $ 2,000.

How do these items tie up to project goals?

These items will help in achieving the set goal of 10-15% increase in diabetes practice change two month post training. Such training promotes clinical judgment and advance patient care quality. The clinicians will understand how to acquire, interpret, and incorporate the best available research evidence with clinical observations and patient data which are important aspects in clinical practice (Wong et al., 2015).

References

Chen, L., Magliano, D. J., & Zimmet, P. Z. (2012). The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nature Reviews Endocrinology, 8(4), 228-236.

Dabelea, D., Mayer-Davis, E. J., Saydah, S., Imperatore, G., Linder, B., Divers, J., … & Liese, A. D. (2014). Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. Jama, 311(17), 1778-1786.

Wong, C. K. H., Wong, W. C. W., Wan, Y. F., Chan, A. K. C., Chan, F. W. K., & Lam, C. L. K. (2015). Effect of a Structured Diabetes Education Programme in Primary Care on Hospitalizations and Emergency Department visits among people with type 2 diabetes mellitus: results from the Patient Empowerment Programme. Diabetic Medicine.

Wong, C. K., Wong, W. C., Wan, Y. F., Chan, A. K., Chan, F. W., & Lam, C. L. (2015). Patient Empowerment Programme (PEP) and Risk of Microvascular Diseases Among Patients With Type 2 Diabetes in Primary Care: A Population-Based Propensity-Matched Cohort Study. Diabetes care, 38(8), e116-e117

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Locate the Best Evidence: Clinical Practice Guidelines

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Locate the Best Evidence

Clinical Practice Guidelines used in the practice setting

Among the bodies in the US that are tasked with the responsibility of developing the clinical practice guidelines include the AADE (American Association of Diabetes Educators) that published the Standards of Practice, Scope of Practice, as well as the Standards of Professional Performance of Diabetes Educators. Based on these documents and evidence, pharmacists have a particular role of delivering diabetes education.

AADE also came up with a framework related to optimal practice for self management. During the process, there should be an assessment of the specific education needs in every patient (Garber, Gross & Slonim, 2010). Second is the identification of the particular diabetes self-management goals in every person. This can go a long way in ensuring effectiveness of the strategies used.

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Information for conducting systematic reviews

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Published research sources- journals to be used

Experts in the US who provide sources of best evidence

My personal expertise and how it fits with the EBP

Although there is the possibility of educating patients towards greater autonomy, a good number of professionals are not ready to collaborate with them. moreover, clinical staff should acquire better comprehension on diabetes management and of the theoretical principles that underlie patient empowerment. These factors need to be considered for effective EBP (Mshunqane, Stewart & Rothberg, 2012).

References

Kapoor, B., & Kleinbart, M. (2012). Building an Integrated Patient Information System for a Healthcare Network. Journal of Cases on Information Technology (jcit), 14, 2, 27-41.

Garber, J. S., Gross, M., & Slonim, A. D. (2010). Avoiding common nursing errors. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

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