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Final Re-Arranging And Adding Capstone

Final capstone Re-arrange and add as needed

(based on able to content below)- you can refer to sample paper submitted in assignment order.

Table of Contents Final Capstone Project Manuscript 5 Background & Significance 5 Literature Review 6 Supporting Evidence 6 Purpose or Aims of the Study 7 Theoretical Model or Framework 8 Methods/Design/Sampling 11 Proposed Interventions 13 Expected Results/Outcomes 16 Anticipated Conclusion 16 Possible Limitations 17 Potential Implications to Practice 18 References 20 Appendix A 23 Appendix B 24



The capstone project is completed and developed as a scholarly paper. This is a final project designed to apply skills learned in the program. Students will build on previously completed work in the required sections. Include a clear, problem statement. Establish synthesis of literature and evidence-based practice in all content sections. Apply concepts of cultural competency and cultural literacy within the background section and Purpose or Aims of the Study section. Integrate thorough discussion of effective collaboration of the advanced nursing role through leadership, collaboration and improving outcomes in the proposed interventions section. Apply ethical reasoning and integrate advocacy and decision making within the methods/design/sampling section. Throughout the paper, develop critical, relevant, and consistent connections between evidence and the thesis.

The capstone project includes the following sections:


Title page


Background & Significance

Literature Review

Supporting Evidence

Purpose or Aims of the Study

Theoretical Model or Framework


Proposed Interventions

Expected Results/Outcomes

Anticipated Conclusion

Possible Limitations

Potential Implications to Practice








PICOT question: Use of sertraline versus sertraline with CBT (cognitive behavioral therapy) to treat depression in teenagers age 12-18 over a 1-year period of time. – Approved by Dr. Silverman.



Theoretical Framework or Models to Guide in Implementation of EBP

Any capstone project should have a theoretical framework or model in place.  The chosen model is the intent-to-treat model, which is a strategy that analyzes the outcomes of a randomized trial in which the participants are enrolled. No consideration is given to whether or not a patient received the treatment they were randomized to receive, and all randomized subjects are included in the statistical analysis. When it comes to this model, noncompliance, deviation from protocol, withdrawal, and other events that occur after randomization are not taken into account; rather, this model evaluates each randomized participant according to their treatment assignment (Peterson et al., 2021). Both the original random treatment allocation and conservative effect are maintained in this new method. Each group’s randomly assigned patients are an essential component.

Research on the effects of Sertraline on depressed adolescents aged 12 to 18 years and older in critical trials is necessary before drawing any conclusions about the relative merits of Sertraline and Cognitive Behavioral Therapy (CBT) (Peterson et al., 2021). Therefore, the intention-to-treat assessment is a strategy that requires a randomized trial in advance. All participants are evaluated using the original groups to which they were randomly allocated in a randomized study, regardless of the type of treatment offered. Researchers can reach precise conclusions regarding the effectiveness of an intervention using this strategy (Peterson et al., 2021). Since it compares the randomized CBT group to the sertraline group, the model matches the randomized trial.

According to this approach, there is no doubt that the results are quantitative. Quantitative research are concerned with the development and testing of hypothesis, generating the model and theories that explain the behavior and generalizing  the result  across the many samples (Hoy & Adams, 2015).Sertraline and Cognitive Behavioral Therapy (CBT) are both used to treat depression in the targeted patients, hence the model is quantitative in nature. RCT studies are always quantitative, comparative, and controlled experiments in which the researchers’ study two or more interventions; for example, in this case, is the use of sertraline and CBT in a series of individuals (adolescents aged 12 to 18 years) who receive these treatments in random order.



Week 3 discussion

Discussion Question – Assessing Individual & Community Needs


When treating depression in teens, the effectiveness of antidepressant medicines like sertraline when used in conjunction with psychotherapy like cognitive behavioral therapy (CBT) is debatable, which is why the capstone study was done to see how well the two treatments were used worked together. Anxiety and depressive disorders are quite frequent among children and adolescents. My capstone research topic is based on various individual and/or community needs. Expectations that are too high in terms of school, friends, or family might lead to feelings of rejection and disappointment. Unfortunately, whether anything goes wrong at home or school, teens tend to overreact. Young people generally believe that life is unfair and that things do not always turn out for the best for them. There are angry and perplexed. There are a lot of contradicting signals coming from parents, peers, and society for teenagers. During adolescent years, teens are likely to be subjected to a variety of stressors that might worsen their melancholy. The onset of puberty sees substantial biological growth and development, but the biochemical and psychological changes are more challenging and less visible. These changes can overwhelm and affect an adolescent’s sense of where they fit into the world. Resulting behaviors and unpredictable emotional responses are confusing, but inevitably destabilise the family dynamic, even taking relationships to their breaking point. Teenagers can get involve in substance abuse like alcohol problem and marijuana. They are also For example, on television, in school, in publications, and on the Internet, teenagers are exposed to more of life’s ups and downs than ever before(Morgan, 2019).

Because the goal of CBT is to help people rediscover who they are as individuals, I think my study results will fulfill the stated teenager’s needs in the preceding paragraph. Using CBT, a patient may learn effective coping and self-recovery techniques that will serve them both immediately and in the long run. If you’ve been diagnosed with depression and have anxiety or a history of manic episodes, you may benefit from sertraline; an antidepressant used to treat such symptoms (Liu et al., 2021).

Week 4 discussion

Discussion Question – Implementing Evidence in Clinical Practice


The effectiveness of the proposed evidence-based intervention is achieved through the implementation process. Various activities are undertaken to ensure a successful implementation process. One of the activities will be to inform the stakeholders, such as nurses and other team members, about the need for change and how the proposed intervention will help in improving the overall health outcomes of the patients and how it can affect their practices. This is important in reducing the level of resistance encountered during the implementation. The data on the incidences of depression amongst the selected participants before the implementation will be collected to help in evaluating the effectiveness of the intervention (Liu et al., 2021). The next step is to gather the required resources and the team responsible for the implementation. The team include nurses, caregivers, family members, therapists, and the patients.

The team is informed about the treatment approaches undertaken using both pharmacological approaches (sertraline) combined with the non-pharmacological approach (cognitive behavioral therapy). The teenagers of 12 to 18 years will be placed on medication, and nurses, caregivers, and family members will be informed about their roles in the implementation process. These stakeholders will help ensure that therapists are assisted in achieving the desired goal throughout the one year of implementation (Liu et al., 2021). They will collaborate to ensure that necessary changes or adjustments are made to achieve the desired goal. Once the targeted period elapses, the overall outcomes will be compared to the baseline data before the implementation process to determine whether there was a drop in the incidences of depression amongst teenagers of 12 to 18 years.

The Anticipated Challenges

The anticipated challenges during the implementation can include the language barrier and challenges brought by the cultural differences since patients come from different ethnic and cultural backgrounds. The other challenge is the possibility of failure in the communication amongst the key stakeholders (Castaldelli-Maia et al., 2019). The other challenge that might be encountered is the resistance from some caregivers, such as nurses.

How to overcome the challenges

The resistance from the nurses and other team members will be overcome by informing them earlier about the proposed intervention. They will be informed about the importance of the proposed intervention in addressing the issue of depression amongst the targeted population and how it will improve their work and satisfaction during service delivery (Castaldelli-Maia et al., 2019). A translator will be hired to help overcome the challenge associated with cultural barriers. Senior providers will be consulted throughout to help in understanding some of the cultural differences.


Week 5 discussion


Discussion Question – Evaluation and Linking Evidence-Based Practice to Clinical Outcomes

Mental health diseases are among the health issues that affect the well-being and health of the population. Various treatment approaches are adopted to help improve the symptoms caused by mental diseases such as depression. The treatment approaches to mental disease involve pharmacological and non-pharmacological interventions. According to David et al. (2018), combined therapy involving medicine and cognitive behavioral therapy (CBT) promotes the successful management of mental disease and the development of coping skills. According to Carpenter et al. (2018), the CBT approach helps manage mental disorders such as anxiety. It also helps address mental health issues such as panic disorders and post-traumatic disorder. It reduces the depressive symptoms as an independent strategy or when combined with other medications like antidepressants. Among many anti-depression medication project will concentrate on use of sertraline among teenager with depression and use of CBT in combination with sertraline.

Therefore, based on the above pieces of evidence, the implementation of the sertraline medication in combination with the cognitive behavioral therapy is expected to result in a reduction in the rates of the mental diseases like depression, improvement and full recovery of the patients, reduction in the negative thoughts such as suicidal ideation that are replaced by the positive behaviors, improvement in the thought patterns, improvement in the behaviors, and improvement in the ability to develop the coping strategies with the symptoms.

The success of the implementation is assessed to ensure that the intervention helps achieve the program’s objectives. The assessment also helps make the necessary adjustments to the activities or changes that ensure that the objectives are achieved. Therefore, the baseline data will be collected before the implementation. This data will be compared to the data generated after implementing sertraline and cognitive behavioral therapy (Lange, 2021). Therefore, the success of the program is assessed based on whether there is a reduction in the rates and severity of diseases reported, improvement in the behavior, thoughts, and an increase in the ability to cope with the symptoms of the mental illness such as depression.

In order to evaluate the capstone project, author plan to check the patient’s outcome in specific timeline where author will be checking the symptoms relief or complete remission of the disease, how effective was the medication and or the medication plus the CBT. Author  also planning to check the accuracy off the research articles and to see if they were supported by evidence. Provided information on the treatment plan are aligns with the newer guideline for depression management as that can affect the outcome of the project. Author also planning to see the relevance of the articles to see if it’s not too advanced or elementary





WEEK-6 discussion


Role of Outcomes in Evaluating Practice Change Through Research

The benefits linked to the process of evaluating the role of the outcomes within a practice change via research.

Various benefits are associated with evaluating the functions of the outcomes in the practice change through the research process. The evaluation leads to the enhancement of the chances that the objectives and goals of such initiatives are likely to be achieved. The evaluation process of the role of the outcomes in practice makes it possible to determine the value of the practice change in terms of money. For example, it is expected that the allocated resources will yield the greatest benefits for the customers and the stakeholders. Such evaluation procedures help identify the components of an initiative that do not work and the possible causes (Staley & Barron, 2019). In this case, it allows making an adjustment or improvement to ensure that the proposed practice change leads towards attaining the objective or goals it was intended for.

The procedure of evaluating the roles of the outcome via change practice from the research outcomes

The effectiveness of the outcomes from the change practice is evaluated to determine whether they meet the objective or the goals of the intervention. One of the strategies used to evaluate the roles of the outcomes is asking the clinical questions. The development of the clinical questions helps find out whether the proposed intervention for the practice change helps in attaining the objectives from the clinical questions. Other strategies adopted to help evaluate the roles of the outcomes involve the collection of the best research literature to find the information about some of the effectiveness of the proposed intervention for the practice change (American Association of Nurse Anesthesiology, 2022). It is also important to use the critical appraisal approach of the evidence and effectively integrate the evidence using the critical expertise and the patient preferences.



Theory Logic Model for Depression Treatment Using Sertraline and Cognitive Behavioral Therapying in Teenager





Need or Problem to be Addressed using the program

The treatment of depression among teenagers between age 13-19 using Sertraline and sertraline with CBT.

The teenagers’ signs and symptoms of depression. These symptoms tend to be considered the normal part of the growth (Loades et al., 2021).

How to get better outcome weather to use only sertraline or sertraline with CBT.

Strategies proposed to address the need

Targets the early screening using different tools for teenagers’ depression as recommended by USPSTF for kids between 12-18(Mufson et al., 2022).

Choosing treatment using sertraline or CBT.

Using combination therapy with CBT and sertraline.

It helps meet the goals set by the United States Preventive Services Task Force (USPSTF), which proposes for early screening procedure (Mufson et al., 2022).


Context for the project/program

Depression is a major health concern for teenagers.

The United States Preventive Services Task Force (USPSTF) has recommended the ongoing screening procedure for depression in 12 to 18 years old within the primary care settings (Patra & Kumar, 2022).

First line therapy and only approved antidepressant is Sertraline (SSRI)(Moreland & Bonin, 2021).

Effectiveness of treatment with only sertraline and conjunction with CBT.






The Expected Outcomes

The expected outcome is an increase in the number of patients visiting the facility for early screening for depression. And receiving relief from depression using sertraline or sertraline with CBT.

The other expected outcome is a reduction in the rates of teenagers’ depression or symptoms.




Theoretical foundation for depression treatment using sertraline and CBT in teen age 12-18



Factors that will influence the use of strategy

The implementation of the treatment tool for depression to help in the early screening and symptom management process is influenced by several factors:

Such as the level of willingness and cooperation amongst healthcare providers, patients and parents.

Availability of mental health support for in and outpatient mental health need. (Mufson et al., 2022).

The partnership between the primary care practice and the mental health practitioners is also important in more in-depth CBT and treatment hence improving the clinical utility of this recourses.





Evidence-based for the proposed strategies

According to Moreland & Bonin, (2021) Roughly 40 percent of children and adolescents with depressive disorders are not treated in USA

Psychotherapy alone is used most often

Second choice is monotherapy

List use treatment is psychotherapy plus an antidepressant.





The resulting impact of the project if the outcomes are achieved

The program’s effect is the institution of the universal program for depression in teenagers of ages 12to 18 years.

The program will ensure effective implementation and use of the available treatment tools, thus lowering the symptoms and progression of depression.








Theoretical Framework or Models for Evidence Based Capstone Project

The Key Features of The Selected Framework or Model and Its Major Components

The selected model is the intent-to-treat model, which is a method that involves the analysis of the outcomes in a prospective randomized study. There is inclusion of all the randomized study subjects into the statistical analysis and assessed according to the group they were originally assigned, without considerations of the treatments provided. The key feature of this model is that it considers every randomized participants according to the treatment assignment; it does not consider noncompliance, deviations in the protocol, withdrawal, and anything happening after randomization (Peterson et al., 2021). It also maintains the prognostic balance produced from the original random treatment allocation and estimates the conservative impact. The key component is the randomized patients in the groups randomly assigned.

The specific research strategy suitable for the use of the theoretical model and how it fits the intended project

The clinicians, institutions, and policymakers utilize the results from the randomized controlled trials to decide on therapeutic interventions for the population and patients. Comparing the Sertraline vs. Cognitive Behavioral Therapy (CBT) for the treatment of depression amongst teenagers 12-18 years and above requires knowing the effects of the intervention on these patients within critical trials (Peterson et al., 2021). Therefore, the intention-to-treat evaluation is a method that involves a prospective randomized study.

In the randomized study, the randomized participants become part of the statistical evaluation process and assessed based on the original groups that the participants were assigned, regardless of the type of treatment provided. This method is important as it enables a researcher to draw accurate conclusions about the effectiveness of the intervention (Peterson et al., 2021). The model, therefore, fits the randomized study since it compares the population randomized to sertraline vs. the randomized CBT.

Whether the model is quantitative or qualitative methods or both

This model involves a randomized control study; therefore, it is most certainly quantitative. The outcomes in comparing the use of sertraline vs. CBT for the treatment of depression in the targeted individuals are measured, thus making the model based on the quantitative method. The randomized control trial studies always tend to be quantitative, comparative, and controlled experiments whereby the investigators study two or more interventions; for example, in this case, is the use of sertraline and CBT in a series of individuals (teenagers of 12-18 years) who are receiving these treatments in the random order.

The quantitative methods that are most appropriate

The quantitative method for this method involves the experimental method that uses the sequential multiple assignment randomized trial (SMART). This method helps in successfully assessing whether the start of the CBT or sertraline medication appears to be more effective for improving the teenagers’ rated anxiety symptoms (main effect 1). Suppose the initial intervention does not cause a clinical remission within the specific period of one year. In that case, there will be an opportunity to evaluate whether maximum use of the initial treatment method alone or the addition of other methods while making maximum use of the first leads to the improvement of the symptoms within one year (main effect 2). The method also gives the chance to assess the stability of the treatment for more than one year after the completion of the one-year trial.

How the theoretical model might be used to assess the program or project and critique how well it fits the program

Appropriateness of Model for Program or Project

The intent-to-treat model helps in the assessment of the program. It helps compare the teenagers randomized to the sertraline vs. teenagers randomized to the CBT first. It allows assessing the treatment sequence that can be adapted to help treat the patient’s conditions, for example, whether the CBT-CBT-CBT-MED or the MED-MED-MED-CBT in non-remitters (Peterson et al., 2021). This helps predict whether there are significantly better or worse outcomes using the four treatment sequences compared to main effects alone, i.e., CBT or sertraline alone.

The method fits the program since it allows for analyzing the participants based on the randomized interventions that are consistent with the standard practice in clinical trials. It enables the research to provide the distribution of the outcomes using the graphically examined variable. The model is effective since it allows assessing the moderating impacts of the patients’ features on main effects 1 and 2 and on their interaction to help in the identification of the tailoring variables that can support the personalized interventions for the selection of the initial and subsequent sequencing of the treatment modalities for the teenager’s depression (McCoy, 2017). It is possible to find out the differential impacts of the proposed intervention, i.e., use of sertraline vs. CBT, on other patient-centered outcomes such as their well0being, the abilities in the school activities, the ability to cope with change, the adverse effects of the treatments, the comorbid psychiatric symptoms, the self-efficacy, satisfaction in life, well-being, family, social function, and the ability to regulate emotions.





· Adolescents may benefit from psychotherapy and pharmacotherapy since therapy provides them with life skills that will aid them in the future when they become adults (Stikkelbroek et al., 2020).

Using combined therapy , individuals may better understand and control their emotions and ideas by exploring their thoughts, beliefs, and behaviors


· As a result, treatment effectiveness decreases and patients develop drug resistance more quickly when they are treated with psychotherapy and medication.

· Geographical limitations, therapist shortages, costs, the need for continued treatment, and therapy time consumption are all drawbacks (Liu et al., 2021).


· Although this sertraline is useful in treating teenage depressive symptoms, it is more effective when paired with CBT.

· Future treatment recommendations may be substantially altered if CBT is shown to have a more therapeutic impact through providing behavioral adjustments, rather than a short-term benefit of medication (Liu et al., 2021).


· Behavior and emotional problems have a high occurrence rate.

· As a result, some opponents say that CBT may not adequately address the probable underlying causes of mental health concerns, such as an unhappy upbringing (Stikkelbroek et al., 2020).


Role and Engagement of Stakeholders Summary

The successful management of the mental health disorder requires effective treatment approaches. Various treatment approaches are used, including the pharmacological approach alone, the non-pharmacological or the psychotherapeutic and the combination of the two approaches (pharmacological and the non-pharmacological) (Liu et al., 2021). This paper offers a discussion on the role and the engagement of the stakeholders concerning the picot question focused on the use of the sertraline vs the sertraline with Cognitive behavioral therapy (CBT).

The roles of the stakeholders

The successful implementation of the proposed evidence-based practice or intervention requires the involvement of the key stakeholders. One of the key stakeholders who is directly affected is the patients. Patients as the stakeholders play an important role in the implementation since they are used as the participants in determining the effectiveness of a combined therapy that involves CBT and sertraline for the treatment of mental health conditions such as depression. In this case, the patients can have an opportunity to act as their therapists and develop the skills that enable them to experience a change in thoughts, emotional issues, and behaviors. The other stakeholder is the therapists who help in prescribing the medication and guiding the CBT process. Nurses and caregivers act as mediators between the therapists and the patients or the family members. They help dispense the medications recommended by the therapists and guide the CBT process in the absence of the therapists. The family members also form an important role in ensuring that the patient adheres to medications and effectively participates in the proposed CBT treatment process (Eisman et al., 2021). The other stakeholder is the mental health institute or department that deals with mental conditions. Their role, in this case, is to help in the collection of the data after implementation so that they can form a basic guideline for the treatment of mental illnesses.

Identification of the stakeholders

The key stakeholders for the proposed project are the patient, nurses, family members, caregivers at home, therapists, and the institutional staff working in the mental health department. These stakeholders are supportive since they are both focused on the patients’ overall well-being and on arriving at an effective solution for addressing the issue of mental health disorders. Nurses, therapists, and the institutional mental staff focus on arriving at effective evidence-based practice intervention (Eisman et al., 2021). The nurse, caregiver, patients, and family members focus on the overall well-being and reduction in the symptoms of the mental health disease.

The list of the stakeholders who will be interested in the outcomes of the project

The project’s focus is to arrive at the best intervention to address the issue of depression, especially for teenagers aged 12 to 18 years. The common practice involves using sertraline alone, while others use sertraline combined with CBT. Therefore, arriving at an effective intervention will give the interested stakeholders, such as nurses, therapists, and the medical staff at the mental health department to develop a guideline for the treatment of depression. These stakeholders will be focused on comparing the baseline data on the incidence of depression when using sertraline alone and then comparing it with the outcomes from the proposed evidence-based project of CBT (Johnson et al., 2019). The positive outcome, i.e. reduction in the depression incidences amongst teenagers of 12 to 18 years, will conclude that the combined treatment approach of sertraline with CBT is effective in treating depression in these individuals.

Promotion of the stakeholder participation

It is important to ensure that every stakeholder is involved in implementing the project. In this case, the family members, patients, nurses, caregivers, therapists, and the staff members from the department of mental health must engage in a collaborative approach to ensure that implementation goes successfully. The participation process must have clear guidelines for both parties to be aware of the necessary steps or procedures (Nabors, 2020). Nurses/caregivers must work hand in hand with family members to ensure that patients adhere to the medications and attend the psychotherapy program recommended by the therapists.

Possible concerns or barriers

The successful implementation process of the proposed intervention can be affected by various barriers. One of the barriers is the language barrier that can be brought by the misunderstanding of the language used by the providers. The other challenge is the cultural differences; for example, the patient might believe in the traditional practices and reject the proposed intervention or fail to adhere to the treatment guidelines. The cultural barrier can also be brought by the refusal to be treated by the opposite gender. The other barrier is poor communication between the stakeholders; for example, the nurse or caregiver might fail to update the therapists about the progress of the patient or the need for changes (Castaldelli-Maia et al., 2019). The nurses might also fail to communicate or give feedback to the family members on some of the changes made in the treatment process. The other challenge is the resistance from the nurses and the caregivers to the changes in the practices whereby the new treatment and new intervention are introduced.

The strategies to gain support and assistance from the stakeholders

It is important to ensure that the above barriers are addressed and reduced. One of the approaches that can be adopted is to inform the providers, such as nurses, about the proposed changes and how it is likely to affect their practice and improve the overall outcomes of the patients. This approach is important in reducing the resistance level of the affected providers. The other intervention is to be culturally competent. The approach is important since it allows learning about the patients’ culture and appreciating them. The other approach is to ensure the inclusion of the senior provider who has worked in this field for a long and understands the challenges associated with cultural differences (Castaldelli-Maia et al., 2019). It is also important to include the translator to help overcome the language barrier issues. Effective communication amongst the stakeholders is also important in ensuring that the proposed changes are made.


Design and Statistical Analysis

Evaluative Criteria in Responding to The Evaluation Question

The program’s focus is to determine the effectiveness of using the sertraline alone versus using the sertraline with cognitive-behavioral therapy (CBT) in treating depression amongst teenagers of ages 12 to 18 years. The first variable, in this case, is the independent variable related to therapy. The independent variable includes the use of sertraline with the CBT. The other variable considered the dependent variable is the successful treatment of depression (David et al., 2018). Therefore, the success of the independent variable implementation leads to positive outcomes for the dependent variable.

The evaluation criteria for these variables involve the assessment of the marked improvement in the outcomes in terms of the depression cases and symptom exposure to CBT approaches such as the exposure, the behavioral activation, reduction of the safety, and the avoidance behavior resulting in long-term success in the management of depression. The evaluation criteria also focus on developing the coping ability of the patients in dealing with the symptoms (von Brachel et al.,2019). In this case, patients must be able to use their coping strategies and direct instructions to enable them to apply their approaches after the termination of the treatment process.

Research Approaches to Be Adopted to Respond to The Questions

The research approach adopted involved using the stratified sampling method to select the targeted population from the targeted setting of Shanty Healing Center. This procedure is important since it aids the division of the population into small groups known as strata. This method considers the shared features of the population (von Brachel et al.,2019). The research will also involve purposive sampling, especially for the therapists from the targeted setting. The method helps ensure that therapists are provided with equal opportunity of being selected to attain the study’s objectives.

The study will be conducted quantitatively to enable stronger statistical inferences for the whole group. The quantitative study method helps give the figures and the percentages in terms of the effectiveness of the sertraline with CBT in the management of depression amongst teenagers of 12 to 18 within one year (von Brachel et al.,2019). The diagnostic interview, the brief-symptom inventory (BSI), and the Beck Depression Inventory (BDI) will aid the performance of the interview for the collection of the relevant data.

Collecting Concerning Evaluative Criteria or Indicators, Validity and Reliability of The Tools, The Data Collection Tools, And Data Collection Methods

The collection of the data will be made successful through the interview process. In this case, the semi-structured interview (MINI-DIPs) will be utilized to assess the present and all-life time diagnosis of the disease either via phone or face-to-face. The interview will target the graduate learners in clinical psychology who had undertaken 30 hours of training during the interview. The other method adopted for collecting data is the questionnaire, and this involved the use of the Brief Symptom and the Beck Depression Inventory (BDI). The Brief Symptom Inventory (BSI) is a 53-item scale capturing symptom severity of obsession-compulsion, interpersonal sensitivity, depression, anxiety, somatization, phobic anxiety, and psychoticism (Lange, 2021). The BDI is an important tool effective in the assessment of depression. It has 21-items that have a forced-choice scale of 0 to 3 and has four different statements on none to severely depressed mood. This tool will be used to collect data on the feeling of the patients during the implementation process. The convergent validity of the BDI with other self-reported measures for mental illness such as depression and the observer ratings tend to be high.

The Analysis of The Data with Specific Statistical Tests to Be Utilized

The data were analyzed using five steps. The first one will involve describing the status of the study subjects at the follow-up process through descriptive statistics such as mode and standard deviations. The t-test will test the existing variations in the participants who agreed to participate and those who did not agree. The second step will involve tabulating the patients’ ratings concerning their previous therapy, the recurrence of the issues, and the post-therapy enhancement. The third step will involve testing the effectiveness of the proposed intervention in the post-treatment and the follow-up program. This will be achieved by using the Cohens’ D test to help quantify the magnitude of the changes in the pre and post to follow-up process (von Brachel et al.,2019). There will be scrutinization of the clinical impacts of the proposed changes at the individual level. The reliable change index will be calculated to help find out the patients showing the changes that will be larger than the changes in the changes in the change.



Proposed Project Interventions

The Extent of The Evidence-Based the Proposed Interventions

The use of the sertraline with cognitive-behavioral therapy (CBT) has been studied to compare its effectiveness in reducing mental health symptoms compared to the use of sertraline alone. A study by David et al. (2018) shows that the use of the combined therapy involving the use of medicine and the CBT helps promote successful management of mental disease and improve the coping ability of the patients.

CBT effectively manages anxiety and other mental health issues like panic disorders and post-traumatic disorders. It assists in reducing depression when used as a single therapeutic approach or in combination with other medications such as antidepressants. Based on this evidence from the research works (Carpenter et al., 2018). It is clear that CBT, together with the medications such as sertraline, helps reduce the symptoms and successful treatments of mental health conditions.

Factors That Can Impact the Use of The Proposed Interventions

The use of the proposed interventions can be impacted by factors that might affect the attainment of its objectives. One of the factors is the poor understanding of the procedures involved in the activities during the implementation process. It is important to ensure that both the affected persons and the implementers understand the use of the interventions. The failure of the patient to adhere to the medication procedure can affect the outcome of the implementation process, thus making it hard to determine whether the intervention was effective. The providers need to inform the patients on whom the medications and the CBT are used to remain compliant throughout the process (Carrier et al., 2022). The miscommunication between the providers and the patients is another factor that must be looked into. The patients must be informed whether there is an improvement in the symptoms to make adjustments.

Identification of The Barriers Related to The Proposed Interventions

The barriers to the proposed interventions can be linked to the poor implementation of this procedure. The failure to follow the required implementation procedures implies that the expected outcomes are unlikely to be achieved. The other barrier is the poor communication process between the team of the providers and the family members. The effectiveness of this intervention requires updating on the progress of the patients and informing one another about the adjustments made. The lack of a clear channel of communication and feedback reduces the chances of adjustment that needs to be made. The other barrier can be linked to resistance from the healthcare providers. Usually, the implementation of the CBT requires spending time with the patient and learning about the strength, weaknesses, and coping strategies. The patients are also put under stimuli to observe their behaviors (Liu et al., 2021). On the other hand, medication use requires a prescription and then discharging the patient. Combining the two treatment approaches might be a hard task that requires commitment, and some providers might not be willing to endure the process, leading to resistance.

The List of Resources Required

Amongst the key resources required is medication such as sertraline. The other resource includes the facility or a room that can be used for the performance of the CBT program. The online tools and the learning communities are required to support the training of the providers to ensure that they acquire the skills and knowledge for the provision of evidence-based CBT. Support system actors must offer the clinicians resources such as the treatment manuals or the technological infrastructure (Carrier et al., 2022). It is also possible to use videoconferencing or telephone to deliver the remote CBT in real-time when there are barriers such as logistics.

Steps or The Sequence of Events or Specific Implementation Activities

The first step in the implementation process is to inform the key stakeholders involved in the implementation process, for example, the nurses and clinicians. They are informed about the need for the change, the effectiveness of the proposed intervention, how it will affect their operations, the expected overall outcomes, and the impacts on the quality of services to the patients and the satisfaction levels of the providers. The other step is to ensure the availability of the required resources and the implementation team. The data on the number of the targeted population with depression are collected to help in the implementation process and compare the outcomes. The team is briefed on the procedures of the implementation process, i.e., the CBT and sertraline treatment process. The targeted population of teenagers ages 12 to 18 are placed on the two treatment procedures. Each stakeholder is informed about their roles. The implementation takes place for one year, and during this time, the adjustment will be made to ensure that the objectives are attained. The final results will be collected and compared with the baseline data to determine whether there is success in the program.

Monitoring, Tracking, And the Ongoing Review

The patients are monitored during the implementation process to ensure that they adhere to the medications and follow or attend the CBT program. The providers are also expected to ensure that they adhere to the implementation of all the procedures during the treatment of patients using the sertraline and CBT therapy. The tracking process involves the process where the providers communicate with the fellow providers and the family members or patients to consult and inquire about the progress of the patients. The necessary adjustments are made when the patient fails to stick to the recommended treatment guidelines (Liu et al., 2021). The ongoing review process is done to determine the changes in the patients’ symptoms during the implementation process.

Performance of Tasks Needed for The Implementation, Staff Responsible for The Implementation Process, and Their Qualifications

The tasks will involve the training of the providers who will be expected to help in the implementation of the proposed intervention. The clinical psychologists and other therapists or providers will be trained adequately on CBT (Carrier et al., 2022). The online training programs will also be adopted to ensure that the CBT components are delivered to help compensate for the lack of specialized human resources.

The healthcare providers such as nurses, therapists, or clinicians will assist in delivering healthcare services to the targeted population group. They will assist in delivering the sertraline, and CBT combined therapy, whose effectiveness is later compared to the previous medication that involved the use of sertraline alone. The CBT providers can use the remote CBT delivery to circumvent the common personal barriers, such as logistics (Liu et al., 2021). The providers will also offer self-guided treatment augmented with the asynchronous interactions with the therapists or coach. This approach will give a chance to cover many patients without increasing the number of therapists.

The clinicians or nurses will provide the patients with the book or manuals. On some occasions, group therapy will be initiated to help in the reduction of the therapist’s time per patient. The transdiagnostic CBT procedures will target the common signs and the processes across anxiety disorders (Carrier et al., 2022). The procedure will enable the therapists to offer a higher percentage of patients with similar training.

Strategies That Promote the Implementation of The Proposed Intervention

One of the strategies is to ensure that the required resources are provided to help implement each step of the program. The other strategy is to ensure full support from the management. The management must offer every resource required by the team. The providers must also be involved in every decision made by the management of their leaders. This will help in reducing the level of resistance hence successful implementation. The other strategy is the ongoing communication process (Carrier et al., 2022). There must be a clear channel of communication between the team to prevent any errors. The ongoing review of the procedures utilized in the implementation must be done to ensure that the required adjustments are made.


To ensure that the success of the combined therapy of CBT and sertraline compared to sertraline alone is achieved in reducing or treating depression amongst 12 to 18 teenagers, the implementation is planned to take place for one year. This period is enough to conclude the effectiveness of the proposed intervention.

The Expected Outcomes to Be Achieved

The successful implementation of the combined therapy of CBT with sertraline medication for depression is expected to help in the successful treatment of depression in teenagers of age 12 to 18 years. It is expected that there will be an improvement in the symptoms as the teenagers will demonstrate improved behaviors. There will be an improvement in the coping skills. It is expected that there will be a full recovery process, reduction in the negative thoughts like the suicidal ideation, and replacement of the negative thoughts with positive thoughts.





Poster for capstone



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Final Capstone Project Manuscript Kathyrina Pham The United States University MSN 600 April 19, 2022

Abstract Obesity was approximately 43 percent in the U. S. in 2017–2018. In the United States, obesity prevalence increased from 30 percent in 1999 to 42 percent in 2018. Over the same time span, the prevalence of extreme obesity climbed from 4.7 percent to 9.2 percent. Obesity has been linked to strokes, heart attacks, DM2, and a variety of malignancies. Those are among the most common causes of death that can be avoided. In 2008, obesity was predicted to cost the US $147 billion in healthcare costs. Obesity-related medical costs were $1,429 more than those linked with such a healthy body weight (CDC, 2021). It is the second most preventable cause of death after smoking (Panuganti et al., 2021). Obesity therapy, whether by diet and exercise or gastric sleeve surgery, is graded on its capacity to effectively reduce weight in individuals with certain high-impact disorders over a 6-month period. The proteome analysis of the patients was used in this experiment, and they were categorized into two groups based on highest score of the BMI or its severity. A low-calorie diet has linked with weight loss with minimum side effects or rebound. Researchers employed a randomized controlled trial to provide guidance for a specific plan with recommend a 6- to 12-month full lifestyle changes that includes reduced caloric intake, exercising regularly, and behavioral modification tactics (Semlitsch et al., 2019). On the other hand, the other participant groups are recommended shrinking the stomach’s size through laparoscopic surgery and limiting the number of calories consumed at one time (Puzziferri & Almandoz, 2018). After six months period, a report will generate the amount of weight loss through these groups including and side effects and rebound weight gained. The action plan’s goal is for obese individuals to lose weight and achieve a BMI about less than 25. Obesity management might be challenging owing to a lack of commitment to the diet plan and a desire to complete the program. Clinicians can better target resources to individuals who are often at threat in this project concert by examining patients’ issues or rebound weight gain. The Medical Outcomes Study is a study that looks at how medical interventions affect people’s quality of life. Physical functioning, role limitations owing to physical health concerns, physiological discomfort, iv) overall health perspectives, v) energy, vi) social functioning, vii) position restrictions caused by emotional issues, and viii) psychological health are the eight categories assessed by the SF-36 (Panuganti et al., 2021). Keywords: obesity, overweight, diet, exercise, low-calorie diet, gastric sleeve surgery

Table of Contents Final Capstone Project Manuscript 5 Background & Significance 5 Literature Review 6 Supporting Evidence 6 Purpose or Aims of the Study 7 Theoretical Model or Framework 8 Methods/Design/Sampling 11 Proposed Interventions 13 Expected Results/Outcomes 16 Anticipated Conclusion 16 Possible Limitations 17 Potential Implications to Practice 18 References 20 Appendix A 23 Appendix B 24

Final Capstone Project Manuscript

Background & Significance

In the United States, obesity was 42.4 percent in 2017–2018. Obesity prevalence in the United States climbed from 30.5 percent in 1999 to 42.4 percent in 2018. Extreme obesity prevalence increased from 4.7 percent to 9.2 percent within the same time period. Obesity is connected to stroke, heart disease, type 2 diabetes, and several cancers. These are some of the most common preventable causes of death. Obesity was expected to cost $147 billion in medical costs in the United States in 2008. Medical costs associated with obesity were $1,429 more than those associated with a healthy weight (Centers for Disease Control and Prevention [CDC], 2021). As a result, the theoretical framework will be focused on better-individualized patient education tactics to forecast eating habits and effectively lose weight. Rather than engaging solely when a crisis has developed, this approach promotes long-term obesity prevention as the ideal model.

My capstone research investigates the efficacy of weight-loss programs. My PICOT issue statement is: Does the implementation of bariatric surgery (I) compared to lifestyle adjustments (C) deliver weight-loss effectiveness outcome (O) in at least six months periods (T) among individuals aged 18 and up with obesity (P)? One of the most often used models for avoiding and altering bad behaviors while Pender’s philosophy of health promotion is focused on excellent health. The fundamental components of Pender’s health promotion model are individual attributes and experiences, cognition and affect specific to behavior, and behavioral results. (Khodaveisi et al., 2017). Pender’s health promotion model is a nursing-based framework for predicting health behaviors. Pender’s health promotion model was created to identify the factors that contribute to better health through personal and behaviorally specific cognitions and affect. When constructing interventions, behavior-specific cognitions and outcomes are crucial motivating factors to consider (Hwang & Kim, 2020). Obese individuals who are participants in the study should commit to lifestyle modifications such as maintaining adequate and routine exercise regimens in order to prevent and change bad behaviors. Patients who do not maintain a healthy lifestyle following bariatric surgery will relapse to obesity.

Literature Review

The proposed solutions must be based on a predetermined strategy that has already proven to be beneficial. Semlitsch et al. (2019) and Puzziferri & Almandoz (2018) make recommendations based on their research, which yielded positive results. Semlitsch et al. (2019), for example, advise for a 6- to 12-month complete lifestyle plan that requires decreased calorie consumption, increased physical activity, and strategies to facilitate behavioural change. Puzziferri & Almandoz (2018) suggested using laparoscopic surgery to remove a portion of the stomachs through small incisions, resulting in a narrow “sleeve” out of the stomach. The surgery reduces the size of the stomach, restricting the amount of foods that may be consumed at one time. It aids patients in feeling satisfied with less meals. The procedure also alters the synthesis of hunger-suppressing hormones that stomach and intestines produce.

Supporting Evidence

All but three of the 19 suggestions contained suggested lifestyle adjustments, which included food, physical activity, and behavioral treatments. People with a BMI of more than or equal to 30 kg/m2 or a BMI of more than or equal to 25 kg/m2 and weight-related problems should lose weight (eg, diabetes mellitus type 2, hypertension). Bariatric surgery is a therapy option for persons with a BMI >= larger 40 kg/m2 or a BMI >= 35 kg/m2 with weight-related problems, according to eleven guidelines. (Semlitsch et al., 2019).

Purpose or Aims of the Study

Patients, clinicians (who will be directly involved), and the government (who will be indirectly stakeholders) will be the project’s key stakeholders. The intervention (education) is anticipated to be a healthcare reform that would necessitate the participation of all stakeholders in their various roles. Patients are expected to engage in the study willingly and obediently as primary suppliers of weight loss information. Patients who have lost weight successfully will be included in the experiment. Clinicians are the first to respond, and they are expected to provide their patients with useful health education. The government will have an influence on policy reforms requiring all overweight and obese patients to get mandatory education.The project’s primary stakeholders, patients, providers, and the government, will improve the outcome if they collaborate closely.

All the project’s stakeholders are enthusiastic about it and are prepared to help where they can, whether through direct influence or resource supply. The findings of the study will be of relevance to health services as a whole, as well as medical facilities and patients’ family and friends. It could also benefit pharmaceutical and insurance corporations in terms of profit margins and their moral obligation to patients. Given the burden created by complication of obesity and the cost impact on health care as a whole, encouraging stakeholder participation should not be a challenging task. Mandatory public meetings will be held to establish these ties, allowing each participant to participate by submitting evidence pertinent to the research. Stakeholders will also be asked to collaborative the research when it is completed, based on specific field of expertise. This will boost the research’s validity and acceptability. To guarantee that all of their ideas are included in the findings, all stakeholders must work together to decide the nature of the analysis.

Because different stakeholders place varying values on different areas of healthcare, there will almost certainly be conflict over which project goal should be prioritized. Stakeholders are likely to have biases that could jeopardize the project’s success, depending on the specific value provided by the research findings. Most patients are concerned with their health while functioning, whereas physicians are concentrated on compliance (de Gooyert et al., 2017). If each stakeholder assigns a distinct value to a given variable, the outcome may be influenced. The goal of the study is to focus stakeholders’ minds on the issues and make it a key part for each participant. Evidence-based research is generally expensive, which is another problem that can delay the research’s conclusion.

Complete stakeholder engagement is required for any quality research to be effective. I propose to open and build clear communication channels, taking into account the different viewpoints and perspective among stakeholders. To prevent confusion and promote equity, all involvement should be public and standard (de Gooyert et al., 2017). Stakeholder education is also necessary to ensure that all parties adopted in this research are aware of their roles and responsibilities. Every participant will also be required to pursue research with whichever capacity they desire, based on their experience. Similarly, education must have constraints in order to allow sufficient study to take place without external interference. As a result, all stakeholders will be asked to participate in the development of guidelines via deliberation. To sustain health-care standards, all guidelines must be ethically and morally enforceable (de Gooyert et al., 2017).

Theoretical Model or Framework

Pender’s health promotion theory is mostly social cognitive, focusing on variables such as an individual’s experiences and attributes, behavior-specific cognition, and outcomes (Chen & Hsieh, 2021). Its features examine the perceived advantages of patient education while also considering potential impediments. It also emphasizes the importance of each stakeholder’s involvement in maximizing engagement. The study will look into why people have certain worldviews about health, how these attitudes affect their response to treatment, external influences such as friends and family, and their linkages to weight-loss programs using an experimental research technique. The study’s methodology focuses on establishing causal linkages between patients and their eating habits, which helps to answer issues about how to properly manage weight-loss situations.

Because it is beneficial in gathering and analyzing various types of numerical weight-loss data, the model effectively presupposes both qualitative and quantitative methods. There is a growing understanding that combining quantitative and qualitative findings in a mixed-method synthesis can aid in understanding how complexity affects treatments in specific circumstances (Noyes et al., 2019). Data, which are measures of counts and values, are commonly characterized using statistical approaches in quantitative research, which helps the researcher draw judgments. In order to discover the underlying meanings of human experiences and behaviors, qualitative research includes the recording, interpretation, and analysis of non-numerical data. The third methodological technique, mixed methods research, entails gathering and analyzing both qualitative and quantitative data with the goal of answering separate but related questions, or even the same questions (Renjith et al., 2021). Quantitative research examines patient connections in order to identify trends and create predictions that may be applied to a larger population. Assuming this type of study ensures that a patient’s sociocultural ideas are taken into account when establishing the best treatment plans after the study is over. The efficacy of the intervention is dependent on the patient’s willingness to accept it; as a result, certain attitude concerns must be included in the research. Structured observation will be the primary method of data gathering in qualitative research. The method will allow for the classification of behaviors as well as their attribution to specific outcomes. The study will use document review, such as retrospective electronic chart review, as the major data collecting strategy to acquire medical evidence of eating habits and treatment plans in order to identify patterns that will help researchers answer the research question. The study will look at personal records that have been authorized and populated by healthcare facilities, as well as physical evidence that has been uncovered. Comparisons will be performed between the time of the first diagnosis of obesity and six months later, with an emphasis on eating habits trends in gaining or decreasing weight (Nebeker et al., 2020).

Education, as a theoretical framework, will be used to assess the development of the research from start to finish. The study’s assertions will be supported by a comparison of patients’ behavior before and after an intervention. The model instinctively confirms the research’s theory and offers a tailored outlook on weight-loss interventions. Pender’s health promotion model focuses on behavioral counseling to assist lifestyle changes, which allows for successful change to any problem (Khodaveisi et al., 2017).

The approach effectively asserts that inherited beliefs have an impact on how a person is treated. As a result, people only commit to interventions that appear to be beneficial. Patient compliance, and hence their commitment to participate in health-promoting activities, is also influenced by family, peers, and clinicians. Patients can make a commitment to the desired habit and stick to it over time. Patients are enticed to join in the study through health incentives. The model presents a long-term weight-loss regimen that is appealing to many patients. Unfortunately, the model fails to accurately define the fundamental elements of any nursing philosophy including environment, health, and man (Hwang & Kim, 2020). Education is identified as the key health-promoting intervention in the study, which supports the hypothesis.


An uncontrolled randomized experimental research design will be employed in this investigation. The practical study design is the term used to describe the impact of changes between dependent variables or independent groups (Miller et al., 2020). Variables are frequently referred to as independent and dependent variables. The group variables are the independent variables in the study design, whereas the study variables or results are the dependent variables. As a result, the research will look at the two distinct groups in the study and analyze the changes that occurred as a result of their program.

The study’s measurement tools will be a low-calorie diet combined with 30 minutes of exercise for obese patients without any surgery compared to a regular diet for post-gastric sleeve surgery patients. Obesity is generally caused by a discrepancy between calories consumed and calories expended, while genetics and illnesses such as hypothyroidism, despair, Cushing’s disease, through the use of antiepileptic drugs and antidepressants can all contribute to fat accumulation in the body. Obesity is treated mostly through diet, augmented by workouts and supported by cognitive behavior therapy. Calorie restriction is one of the most used dietary plans. A low-calorie meal is defined as one which eats around 800 to 1500 calories a day, though a very low-calorie meal is defined as one that consumes less than 800 calories each day. In regards to macronutrients, mineral deposits, and vitamins, most diets must be well-balanced. Carbohydrates should make up 55 percent of the total calories, proteins ten percent, and fats thirty percent, with saturated fatty acids accounting for ten percent of total fat. After you’ve reached your target body mass, gradually increase your dietary calorie intake to maintain a balance between caloric intake and calorie expenditure. Regular physical activity boosts diet efficiency by enhancing the satiating power of a fixed meal, and it’s crucial for maintaining diet-induced weight loss (Perreault & Apovian, 2021). Thus, the study will investigate how effectively the low-calorie diet with exercise comparing to the gastric sleeve surgery in weight loss management. These patients will be weight daily and monitor their lab works weekly to monitor their body reaction.

To kick off the effort, flyers will be prepared and distributed throughout the College Hospital in Costa Mesa and primary doctor offices throughout Orange County. All the qualifications and attributes that a volunteer must possess in order to participation in the study will be listed on the flyers. Participants will be asked to provide their full name, contact information, e-mail address, and diagnoses on a website that will serve as a sign-up page. The log sheet will be open for a short time before automatically closing. Once the deadline passes, the team will prepare a questionnaire that includes all the credentials they’ll need. What type of exercise do you do, for example: cardio, weight-bearing, yoga, or Zumba? How much time do you spend exercising each day? How many times a week do you exercise? What kind of food do you eat? Do you keep a food journal? Do you follow a special diet or a conventional one? Participants will be picked at random based on their answers to these questions. At the first day of our conference, all participants will be given an informed consent form following the sequence of the patients. On the first day of the meeting, you will receive a series of instructions. Before the session, the recommendations will describe the kind of foods which can be fed and the amount of exercise that can be undertaken.

I’ll go over the various types of exercises that will be done during the first day of the program. In the same way, I’ll schedule everyone on different times and days; schedules will be provided. I’ll conduct the assessments and discuss what they comprise on the same day. I’ll keep track of weight as well as any changes in the body on a weekly basis.

To manage obesity using the low-calorie diet and exercise, I will provide a specific menu for each week in combination with the exercise scheduling. The meal menu will specify the amount, portion, the ingredient, and the time for consumption. The exercise schedule will entail the type of exercise, duration and the frequency of exercise set. It will provide the specific exercise lesson to burn a specific amount of calorie each day. Participants also keep a daily weight diary. Moreover, the patient will keep a dairy of any changes in their body such as energy level, nausea, vomiting, diarrhea, constipation, dizziness, fatigue and so forth.

On the other hand, to manage obesity using regular diet for post gastric sleeves surgery patients, I will ask for the daily diet diary from the participants with the daily weight diary. In addition, I will call weekly talking over the phone or telehealth with the patient to assess for any changes in the body including nausea, vomiting, constipation, diarrhea, dizziness, fatigue, and so on.

Proposed Interventions

Obesity has evolved into an epidemic that has gotten worse over the previous 50 years. The cost is projected to be around $100 billion every year in the United States. Obesity is a complicated disease with numerous causes. After smoking, it is the 2nd major cause of death that can be avoided (Panuganti et al., 2021). Obese people have a higher risk of dying and are more likely to suffer from a variety of health problems. They die at a higher rate as they get older, owing to intrinsically poorer defense systems versus their younger generation. Lower income is linked to a higher risk of obesity. However, the possibility of a reverse causality, in which obesity is regarded a cause of reduced income when obese persons drift into lower-paying employment due to labor–market discrimination and public stigmatization, is frequently overlooked (Kim & von dem Knesebeck, 2018). Obesity patients bear a significant social and financial burden, not just on themselves but also on the society.

Obesity is challenging, making it tough to lose weight successfully. Patients with obesity who have yet to lose weight typically have a number of comorbidities (Hall & Kahan, 2018). Interdisciplinary and patient-centered weight loss techniques are the most effective. They must enlist the assistance of many other team members to help the patient. Weight loss must be coordinated at all levels, including chronic management to medical clinics and acute care institutions (Panuganti et al., 2021).

Providers must use an evidence-based change model to establish an effective weight loss treatment system. In this case, the ACE STAR Model of Transformation is the preferred framework for change, as it combines data gathered in the clinical setting and applies it into practice (Dolezel et al., 2021). The paradigm is an interactive learning cycle that provides a clear structure for an evidence-based practice method to function inside. To improve patient outcomes, nursing practitioners want to employ the technique to combine cumulative knowledge using individual skill. As a result, it is likely that its adoption will have a positive impact on the communities who are now being targeted.

Only a few important stakeholders will be participating in this proposal, but their collaborative power will be crucial to the development’s success: a project coordinator, a physician, a nurse, a state official, and a representative from the institution. The physician and nurse are important because they bring experience and skill to the process, as well as crucial input on how the procedures should be conducted and practical ideas for professionally addressing the issue. Stakeholder proposals will be organized by institutional representatives, who will examine if they are appropriate for the organization’s setting, possibly contributing in the integration of knowledge and experience.In this situation, an official delegate will assess the quality of patient care and evaluate if it meets national standards. A project manager’s major responsibility is to structure the project and ensure that individual tasks and responsibilities are accomplished properly.

The hospital will create a welfare community initiative, through which patients will be able to get financial and social help, especially if they have chronic illnesses. Investors, healthcare professionals, and participants will all be participating in the wellness, and they will be brought in via education workshops and seminars to assist protect themselves against weight loss. The welfare group’s booklets will be sent to suitable patients for evaluation.

The goal of the action plan is for obese patients to reduce weight to a BMI of less than 25. As a consequence, the body composition such as height and weight of the patient are evaluated throughout the therapy as essential indicators. The committee will make a report after six months to see if there has been any improvement.

If the hospital’s results are satisfactory, the initiative could be broadened all across the area to cover a variety of institutions with a wider patient population. Other states’ hospitals may be permitted to take similar action to make sure that these changes are made in their facilities.

The team will need a website to communicate with various stakeholders. Internally, monthly reports detailing the job completed will be generated. They can also hold a Zoom conference meeting every two months to tweak or analyze the project’s progress.

A reform strategy of this sort is expected to lead in future medical gains for chronically ill people as well as cost savings. Professionals expertise and experiences, as well as data from academic evaluations, were used to turn the concepts garnered into proof. The evidence was then put into effect, and once in place, it will undoubtedly benefit patients and healthcare organizations.

Expected Results/Outcomes

Obesity, as previously mentioned, has a variety of overall health consequences. As a result, individuals must take appropriate steps to ensure that they achieve and maintain a healthy weight for a quality life. A few of the expected outcomes of adult obesity treatment are listed below.

The first goal of the approach is to help obese people lose weight. Obese patients benefit from weight loss for a variety of reasons. They include decreased blood pressure, lower cholesterol levels in the blood, and increased mobility due to less stress on the bones and joints of the feet and hands.

Another planned outcome of the treatment is that the reduced body weight would be maintained. Furthermore, the patients are urged to avoid regaining their previous excess body weight. Despite their weight decrease, healed obese individuals must follow a healthy meal plan. This method will not only keep people from gaining weight, but it will also feed the body with important nutrients and vitamins (Kim & von dem Knesebeck, 2018).

Anticipated Conclusion

The longer a person is overweight, the more serious the obesity-related risk factors become. Obesity also raises the likelihood of developing additional chronic illnesses and symptoms. As a result, preventing obesity in the general public is crucial for health care professionals and other health related stakeholders. Increased public awareness of weight gain, its risk factors, and management techniques is one way to manage the disease.

In addition, for a healthy nation, the authorities and other medical players can engage in prevention and treatment. Subsidizing nutritious foods like fruits and vegetables is one example of an intervention strategy that the government may use. In addition, the government can organize community events and rallies to promote physical activity in the community. In furthermore, the government might allow public playgrounds encouraging obese patients to participate in physical activities.

Finally, adult obesity therapy may lead to a reduction in obesity-related morbidity and death. The anticipated outcome for the program is reduced mortality rate of the population in the country. Furthermore, symptoms and diseases associated with obesity, including such hypertension and cardiovascular disease, will be less prevalent (Kim & von dem Knesebeck, 2018).

Possible Limitations

Evidence-based patient care is an important method for nurses to include patients in their treatment strategies. Some of the important aspects that contribute to the efficacy of EBP and the use of telemedicine care in the health context are as follows: Professionals with a high level of knowledge in the field of health care. More quality patient care has emerged from the rapid advancement and usage of information and telecommunications technology. There are online peer-to-peer discussion forums that can be helpful. Screening consultant. Telemedicine enhances patient satisfaction and habits by providing appropriate health care counseling and treatments. EBP, on the other hand, is formed by a plethora of defects that have an impact on its outcomes. Among these faults are the risks of a lower screening incentive, a lack of health awareness of medical services offered through telemedicine infrastructure and systems, and high expenses of getting medical services (Zolfaghari et al., 2018).

Insufficient health care facilities, the greater cost of health care appliances, teaching, and preservation of telehealth remedies, limited network internet access in rural areas, inadequate training, knowledge, and assets, social construction barriers in developing and industrialized economies, and client confidentiality potential dangers are just a few of the major threats to nurses’ EBP implementation. Nonetheless, EBP adoption has significant potential for improving healthcare services. Such possibilities include access to the technology that has assisted robust development in healthcare, WHO sustainability, the growth of telehealth connections to communicate effectively between rural areas and medical providers, reducing the healthcare cost, and patients in trying to raise recommendations for service delivery (Ladd et al., 2020).


Potential Implications to Practice

The increased number of obese individuals, and the severity of their disease, has an impact on healthcare profession, particularly nurses who provide direct patient care. According to new research, client overweight may enhance nurse tasks and time spent delivering clinical care. The increased number of obese individuals, or the complexity of their disease, puts more pressure on nurses by cutting the level of time they have to care for them. To meet these growing demands, more nurses are needed, especially those who have advanced clinical abilities.

Obese persons often necessitate specialized and costly medical and paramedic equipment for medical treatment and transfer. Health care workers may be at a greater risk of moving and handling accidents when treating obese patients. Adult obesity management that is effective minimizes the burden involved in caring for these patients. As a result, nurses’ workloads are less burdened. Nurses also report greater job satisfaction while their clients are at a lower risk of negative medical consequences (Hall & Kahan, 2018).

In conclusion, overweight amongst adults in the United States became a major source of worry in the medical community. Obese adults are on the rise in substantial numbers. The numbers are anticipated to climb again in the following five years, according to reports. Obesity is caused by a combination of factors including inadequate nutrition, physical inactivity, and underlying medical issues. A number of obese individuals in the country has also increased as a result of technological improvement. Individuals spend a lot of their leisure time on their phones, television screens, and computers instead of participating in physical activities, which is bad for their health.

Obesity puts the life of these individuals and their children in jeopardy. When compared with children nurtured by healthy parents, kids who grow up by obese adults become double as likely to become obese in the future. As a result, it is critical for individuals to assume responsibility for their own health in the interests of future generations. Obesity management efforts must also be supported by healthcare stakeholders for a healthy and productive population (Hall & Kahan, 2018).

References Centers for Disease Control and Prevention. (2021, November 19). Obesity is a common, serious, and costly disease. Centers for disease control and prevention. Chen, H.-H., & Hsieh, P.-L. (2021). Applying the pender’s health promotion model to identify the factors related to older adults’ participation in community-based health promotion activities. International Journal of Environmental Research and Public Health, 18(19), 9985. de Gooyert, V., Rouwette, E., van Kranenburg, H., & Freeman, E. (2017). Reviewing the role of stakeholders in operational research: A stakeholder theory perspective. European Journal of Operational Research, 262(2), 402–410. Dolezel, J., Zelenikova, R., Finotto, S., Mecugni, D., Patelarou, A., Panczyk, M., Ruzafa-Martínez, M., Ramos-Morcillo, A., Skela-Savič, B., Gotlib, J., Patelarou, E., Smodiš, M., & Jarosova, D. (2021). Core evidence-based practice competencies and learning outcomes for european nurses: Consensus statements. Worldviews on evidence-based nursing, 18(3), 226–233. Hall, K. D., & Kahan, S. (2018). Maintenance of lost weight and long-term management of obesity. The Medical clinics of North America, 102(1), 183–197. Hwang, W., & Kim, M. (2020). Risk perception & risk-reduction behavior model for blue-collar workers: Adapted from the health promotion model. Frontiers in Psychology, 11. Khodaveisi, M., Omidi, A., Farokhi, S., & Soltanian, A. (2017). The effect of pender’s health promotion model in improving the nutritional behavior of overweight and obese women. International journal of community based nursing and midwifery, 5(2), 165–174. Kim, T., & von dem Knesebeck, O. (2018). Income and obesity: What is the direction of the relationship? a systematic review and meta-analysis. BMJ open, 8(1), e019862. Miller, C. J., Smith, S. N., & Pugatch, M. (2020). Experimental and quasi-experimental designs in implementation research. Psychiatry Research, 283, 112452. Nebeker, C., Dunseath, S. E., & Linares-Orozco, R. (2020). A retrospective analysis of nih-funded digital health research using social media platforms. DIGITAL HEALTH, 6, 205520761990108. Noyes, J., Booth, A., Moore, G., Flemming, K., Tunçalp, Ö., & Shakibazadeh, E. (2019). Synthesising quantitative and qualitative evidence to inform guidelines on complex interventions: Clarifying the purposes, designs and outlining some methods. BMJ Global Health, 4(Suppl 1), e000893. Panuganti, K. K., Nguyen, M., & Kshirsagar, R. K. (2021). Obesity. NCBI. Perreault, L., & Apovian, C. (2021). Obesity in adults: Overview of management (F. X. Pi-Sunyer, D. Seres, & L. Kunins, Eds.). UpToDate. Retrieved April 3, 2022, from Puzziferri, N., & Almandoz, J. P. (2018). Sleeve gastrectomy for weight loss. JAMA, 319(3), 316. Renjith, V., Yesodharan, R., Noronha, J. A., Ladd, E., & George, A. (2021). Qualitative methods in health care research. International journal of preventive medicine, 12, 20. Semlitsch, T., Stigler, F. L., Jeitler, K., Horvath, K., & Siebenhofer, A. (2019). Management of overweight and obesity in primary care-a systematic overview of international evidence-based guidelines. Obesity reviews : an official journal of the International Association for the Study of Obesity, 20(9), 1218–1230. Zolfaghari, Z., Rezaee, N., Shakiba, M., & Navidian, A. (2018). Motivational interviewing–based training vs traditional training on the uptake of cervical screening: A quasi-experimental study. Public Health, 160, 94–99.

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Appendix B

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