The goals of Healthy People 2010 are to increase quality and years of optimal health, along with eradicating disparities. One area of major concern is the alarming epidemic of obesity in children. These children will have lifelong complications if this issue is not addressed. Health problems can include, but are not limited to, Type 2 Diabetes Mellitus, hypertension, dyslipidemia, left ventricular hypertrophy, and metabolic syndrome (Holcomb, 2004). Mrs. D, a pediatric nurse practitioner at The Family Health Center (TFHC) states, there has been an increasing amount of overweight children being treated at the clinic.
Therefore, this project will identify clients’ willingness to change, interventions to assist with the transformation, and a method to evaluate the process. Project Appropriate for Population The clinic is a comprehensive, primary health care practice. Staff is dedicated to building a healthy community and improving the individual health, well-being, and quality of life in each person they serve. When collaborating with Mrs. D. , the pediatric nurse practitioner at the facility, she states the amount of overweight children that visit the facility for treatment is increasing daily.
The goal of the project is that fifty percent of the patients will be motivated to change by way of eating healthier and initiate measures to increase physical activity. Discussion of Project Since the primary causes of childhood obesity are poor nutrition and low activity levels combined with a family history of being overweight, a program will be designed to promote healthier eating habits, and increase physical activity. School age children ranging from ages 6-11 years old will be the target audience. Parents will be included in the process in order to assist with promotion of the project.
Parental readiness and motivational factors that could influence compliance will be assessed. A flow sheet with the child’s name, age, and sex will be the instrument to measure body mass index, weight, fasting blood sugars, and blood pressure each visit. The nurse will record the appropriate information on the flow sheet and provide reinforcement when needed. Afterwards, the nurse will collaborate with the nurse practitioner regarding adjustments or counseling concerning findings on the flow sheet. Obesity has become one of the most important public health problems in the United States.
One out of five U. S. children is overweight. Rates of obesity in South Carolina have not been determined yet due to lack of data (South Carolina Department of Health, Education, and Control, 1999). It is difficult to clearly define obesity in children as the degree of body fat mass depends on ethnic background, gender, developmental stage, and age. Body mass index or BMI (weight in kilograms divided by the square of the height in meters) is easy to calculate and routinely used as a direct measure of body frames.
Kiess, Reich, Muller, Meyer, Galler, Benneck & Kratzsh (2001) define obesity as any child with a BMI greater than 97th percentile, but children are considered overweight with a BMI greater than 90th percentile. It is the most commonly used index of overweight and obesity in children. Research has shown that 80% of obese children become obese adults (Nutritional Information Resource Center, 2003). Long-term consequences of this problem can include mental health problems such as depression, lower self-esteem, and discrimination by peers, family, and teachers.
For the fiscal year of January 1, 2006-December 31, 2006 the staff at TFHC treated 3261 children ranging from ages 0-17. Of this amount, 822 were children ranging in ages 6-11, and 10-15% of them were considered greater than 97% percentile for BMI. In addition, others were 90th percentile for BMI, which is considered a risk factor for overweight. (Statistical Data sheet from the Family health Center). In order for change to occur, the concept of behavior must be analyzed. Repetitive behavior is very difficult to transform.
When someone is asked to do things differently than the way they have been, their habitual ways of doing things is disturbed. This can make individuals feel uncomfortable, as the challenge of terminating old ways and learning new ones takes place. While a person may be aware that the new path could mean a healthier or a more fulfilled life, people tend to dwell on what they will be losing (Change Management). Therefore, it is imperative that the advanced practice nurse be aware of these crucial factors when attempting to initiate change.
Nurse practitioners employed in family practice and general pediatric practice settings are in a unique position to educate and counsel families regarding healthy lifestyle habits (Larsen, Mandleco, Williams& Tiedemann, 2006). While staff at the family health center treat numerous adults on a daily basis, the numbers previously indicated, a substantial amount of children are served in the clinic as well. Therefore, the nurse practitioner is necessary to direct the program goals and assist with outcome measures.
Fasting blood sugars will be ordered, and medical assistants will obtain and record all appropriate information for the advanced practice nurse to evaluate at each encounter. The advanced practice nurse would be responsible for teaching content about food and physical activity at each visit with parent and child. The nurse practitioners will boldly yet tactfully address nutrition and activity at each opportunity. It is imperative that parents and other family members be involved when deciding on a plan to promote a healthier life for children. It benefits everyone and does not single out the overweight child.
Nutritional education sessions and colorful brochures with children playing and eating healthy foods will be given to parents at each visit. Parents will be instructed to give children at least five servings of fruit and three servings of vegetables on a daily basis. In addition, parents can allow children to choose these types of foods in the store, which could actually increase the chances of success of the program. Parents will be informed to allow children eat breakfast every morning. Skipping breakfast can leave the child hungry, tired and looking for less healthy food.
Parents will be encouraged to give children wholesome foods. Increasing water and low fat or non-fat milk intake instead of sugary drinks and soda will be encouraged. In addition, limiting snacks to 150 calories or less can help curb food intake. Meals should not be skipped and food should not be used as a reward or withheld as a punishment. Family meals at the table and not in front of the Television will be encouraged. Parents will be instructed to reinforce to children that it is okay to leave food on their plate if they are full (Holcomb, 2004).
Increase in physical activity is another factor that can help with weight reduction. Parents will be instructed to encourage 30-60 minutes of moderate exercise daily. They can help their children be active in ways such as, bicycling, walking, swimming, skate boarding, karate, and dancing. In order to make these activities fun and personalized, allow children to figure out which activity they like best. Afterwards, parents are encouraged to help children with these favorite exercise interests. Encourage the child to be physically active during recess.
Limit the amount of time spent watching TV, DVD’s, handheld devices, and computers. Reinforcement of the program will occur with parent alone. They will be informed that children learn what they visualize, and as the guardian, they should choose healthy foods and active pastimes for themselves (United States Department of Health and Human Services). Colorful posters were made and hung in each pediatric treatment room. Pictures on the displays identified children eating nutritious colorful foods, jumping rope, bicycling, playing ball, and many other outdoor activities.
Nutritional and physical activity brochures were placed in each treatment room on the counter for parent and child to view and take home. The proposed outcome was that approximately half of child and parent participate in the project. The program will be in effect for one year, which will allow the nurse practitioner to evaluate patients seen at episodic and yearly visits. The Evaluation Process Patients will be evaluated by their actual attempt to eat healthier and increase physical activity, willingness to review information and continued compliance with the program.
Those individuals who achieve the initial goal will be considered highly successful. Other patients will be evaluated by their willingness to explore materials, but no actual physical attempt was made to embark on the program. These patients will be considered successful just for reading the materials. Kurt Lewin’s force field analysis describes three faces, which a change agent must go through before actual change can occur. One is the unfreezing stage. With this process, the patient must believe the change before it can take place, benefits of the change must be evident (Cook, 2005).
Therefore, patients who have the information will at least be able to review and decide on change at their own pace. Approximately, three fourth of the educational brochures were taken by parents. Patients who refuse to obtain information will be considered unsuccessful. All patients will be reevaluated within seven months of the program. This process will explore those that decided to maintain compliance by eating healthier and increasing physically activity, which his expected to be approximately ten percent.
In addition, those who read materials and obtained information, but continued not to make any effort to start the program and those who did not participate at all will be analyzed. Conclusion The Healthy People 2010 initiative is the cornerstone for promoting health and prolonging life. Nurse practitioners can assist in this role by being proactive when introducing and reinforcing habits that can have everlasting effects for parent and child. The results of this project will guide and assist in that endeavor.