What is your aim? What is your question and what are your objectives?

TITLE: The nurse practitioner roles in prevention of obesity among teenagers.

It is sad to know that obesity among teenagers is a rising problem in our world. Many students from primary school and high school are suffering from this disease and this is an important topic which needs our attention. Overeating, consuming junk food, drinking carbonated drinks and lack of exercises are few of the reasons which cause obesity among teenagers. In this dissertation paper, the writer provides a background of teenage obesity, examine factors contributing to overweight and obesity in teenagers, review the literature describing interventions and prevention strategies for childhood overweight, and describe nursing skills to prevent teenage obesity. The title of this dissertation is the nurse practitioner roles in prevention of obesity among teenagers. The Research question is how nurses can contribute their role in prevention of obesity among teenagers. CHAPTER 1 : Introducing topic/ background 1. Definition: Obesity is having an excessive amount of body fat.

It means that a person's weight is higher than what is thought to be healthy for his or her height. The appropriate weight is measures using BMI formula. BMI does not measure body fat directly, but is a reliable indicator of body fatness for children, teens, and adults. BMI means Body mass index. It is a simple index of weight-for-height that is commonly used to indicate whether that person is underweight, in a healthy weight range, or overweight. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m2).

Issues to be discussed in this topic are related to the problem of obesity indicating teenagers. Definition of teenagers: Teenagers with obesity age range: 15-20 years old

Must put citation/quotation about definition of teenage (age range).

For children and teens, BMI is age and gender-specific in a way it is not for adults. This is because the amount of body fat changes with age and the amount of body fat differs between girls and boys during childhood and adolescence. Teens can calculate their BMI using their weight and height measurements using a BMI Percentile Calculator for Child and Teen. After BMI is calculated for teens, the BMI number is plotted on a chart appropriate for that teens exact age and gender to get a percentile ranking. The percentile ranking indicates the position of that teens BMI number among adolescents of the same sex and age. Referring the chart below, persons with 95th percentile and above is classified as obese. Weight Status Category Percentile Range Underweight Healthy weight Overweight Obese Less than the 5th percentile 5th percentile to less than the 85th percentile 85th to less than the 95th percentile Equal to or greater than the 95th percentile

The following is an example of how some sample BMI numbers would be interpreted for a 10-year-old boy. (CDC Growth Charts: United States)

2. The aim and objectives should be set up to ensure nurses plan to prevent obesity among adolescents is successful. The main aim is to explore the nurses role in prevention of obesity among teenagers. While 3 other objectives are i. ii. iii. To enumerate the effects of obesity among teenagers. To illustrate the prevention of obesity among teenagers. To analyses the role of nurse practitioners in the prevention of obesity among teenagers.

3. Background - side reading justification & statistics

justification must be stated to give reason/cause why this title is selected eg. Personal experience, prevalent incident

I chose this topic because now that a weight problem has become a major health problem among teenage students. Moreover, the change in the way of life has now been changed to make all the work done easily and not using physical force. As evidence, Malaysia latest statistic (2011) shows Malaysia has the highest obesity rate in Southeast Asia. In England, in 2010, around three in ten boys and girls (aged 2 to 15) were classed as either overweight or obese (31% and 29% respectively), which is very similar to the 2009 findings (31% for boys and 28% for girls).-NHS The cause of obesity in adolescents is usually attributed to the young age of childhood. But what is worrying, if it is not treated at this age, their chance of becoming has an obese adult. Furthermore, the lifestyle of obese adolescents not only interferes with social complications but also in other aspects which includes physical, psychological, emotional, economy. This will have an impact on not only in the adolescent, but in fact related to obesity later in adult life. In addition, teenagers who are overweight often have adaptation problem in social relation especially for youth because they just starting an independent life. Therefore, as a nurse I have the ability to overcome this problem. But before that, I must refer to some resources in preparation and in-depth knowledge. These resources are found from the literature regarding obesity and only topic of this dissertation to take upward this area. As a whole, this benefit is not only being able to add knowledge to other nurses but can even to develop the practice. 4. Nursing roles Nurses regardless of specialty or work setting, perform basic duties that include treating patients, educating patients and the public about various medical conditions, and providing advice and emotional support to patients' family members. Roles and Function of a Nurse : i. ii. iii. iv. v. vi. vii. viii. ix. x. Caregiver Communicator Teacher Client advocate Counselor Change agent Leader Manager Case manager Research consumer - These nursing roles are taken from my notes. It is basic nursing roles that need to be accountable to each nurse. Just explain briefly, but as explain, relate to the topic

Refer:
1. Caregiver

The caregiver role has traditionally included those activities that assist the client physically and psychologically while preserving the clients dignity. Caregiving encompasses the physical, psychosocial, developmental, cultural and spiritual levels. 2. Communicator Communication is an integral to all nursing roles. Nurses communicate with the client, support persons, other health professionals, and people in the community. In the role of communicator, nurses identify client problems and then communicate these verbally or in writing to other members of the health team. The quality of a nurses communication is an important factor in nursing care. 3. Teacher As a teacher, the nurse helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health. The nurse assesses the clients learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies and measures learning. 4. Client advocate Client advocate acts to protect the client. In this role the nurse may represent the clients needs and wishes to other health professionals, such as relaying the clients wishes for information to the physician. They also assist clients in exercising their rights and help them speak up for themselves. 5. Counselor Counseling is a process of helping a client to recognize and cope with stressful psychologic or social problems, to developed improved interpersonal relationships, and to promote personal growth. It involves providing emotional, intellectual, and psychologic support. 6. Change agent The nurse acts as a change agent when assisting others, that is, clients, to make modifications in their own behavior. Nurses also often act to make changes in a system such as clinical care, if it is not helping a client return to health. 7. Leader A leader influences others to work together to accomplish a specific goal. The leader role can be employed at different levels; individual client, family, groups of clients, colleagues, or the community. Effective leadership is a learned process requiring an understanding of the needs and goals that motivate people, the knowledge to apply the leadership skills, and the interpersonal skills to influence others. 8. Manager The nurse manages the nursing care of individuals, families, and communities. The nurse-manager also delegates nursing activities to ancillary workers and other nurses, and supervises and evaluates their performance. 9. Case manager Nurse case managers work with the multidisciplinary health care team to measure the effectiveness of the case management plan and to monitor outcomes. 10. Research consumer nurses often use research to improve client care. In a clinical area nurses need to: Have some awareness of the process and language of research

Be sensitive to issues related to protecting the rights of human subjects Participate in identification of significant researchable problems Be a discriminating consumer of research findings

Expanded role of the nurse : -Nurse administrator A nurse who functions at various levels of management in health settings; responsible for the management and administration of resources and personnel involved in giving patient care.

5.

Theory & practice

6. Research question - explain how do you choose the topic - you refer to PICO Research question: How nurses can contribute their role in prevention of obesity among teenagers - Refer to example of dissertation. 7. Search engine examples of search engines used is Google search / scholar

The purpose is to show that you have many sources of information relevant to the topic. Refer to example of dissertation.

CHAPTER 2 :. This chapter is to enumerate the effects but briefly explains the cause

This second chapter will discuss the effects of obesity on youth. But before knowing the effects, we need to find the cause of obesity. There are various aspects that cause obesity. Taking in more calories than you burn can lead to obesity because the body stores unused calories as fat. Obesity can be caused by eating more food than your body can use. That is why the body needs to do some physical activity. If a teen eats and drinks more than the body needs, the excess energy stores in the form of body fat. And, added to this, if the teen is not doing enough regular exercise, it worsens the problem. Drinking too much alcohol also can cause obesity. Non-food-related behavior can also lead to obesity. These behaviors are sedentary behaviors such as sitting or sleeping for long hours, using lifts as compared to stairwalking, driving to places that are within walking distance. On the most part now there are computers, television, and video gaming systems replacing exercise and sports Other factors that affect weight include quitting smoking. Most people who quit smoking gain 4 - 10 pounds in the first 6 months after quitting. Some people gain as much as 25 - 30 pounds. Sometimes, medical problems or treatments cause weight gain, including underactive thyroid gland (hypothyroidism) and medicines such as birth control pills, antidepressants, and antipsychotics Other things that can cause weight gain are stress, anxiety, feeling sad, or not sleeping well The effects that teen obesity has on health can begin during the teen years and extend throughout a lifetime if not checked. Some of the common health conditions thought to have teen obesity as a risk factors are Type 2 diabetes, asthma, heart disease, hypertension, sleep problems including sleep apnea, and orthopedic problems due to an inability of the developing bones to support the excess weight. Obesity can affect a persons physical ability to a great extent. An obese person would find it difficult to walk, run and do tasks which involve physical effort.

Additionally, teenage obesity can lead to psychological problems associated with negative body image and social issues associated with being treated as an outcast. Obesity has also been associated with low self-esteem in some adolescents. Obese children with low levels of self-esteem are more likely to report feelings of loneliness, sadness and nervousness. This causes them more likely to eat more, smoke and consume alcohol. They also having problem in relationship skill whether in peers or romantic relation. Incidents of bullying, discrimination and social isolation are more likely among overweight teens than normal-weight teens. The depression and social isolation that obese teenager suffer from can influence their academic success too for example lack of interest in learning or do not want to go to public school In future, this matter can cause difficulties upon college application & working interviews.

CHAPTER 3 Illustrate the prevention of obesity among teenagers This chapter is to indicate the intervention of obesity generally.

Most parents claim that they would readily change their own habits if it would help their teenagers avoid obesity. This gets at one of the main means of preventing obesity: family involvement. It is important to help teens acquire healthy lifestyles through family activities and participation.

How to reduce weight? 1. Nutrition i. ii. Base your meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible. Eat plenty of fiber-rich foods such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread, and brown rice and pasta. Eat at least five portions of a variety of fruit and vegetables a day in place of foods higher in fat and calories. Choose low-fat foods. Avoid foods containing a lot of fat and sugar, such as fried food, sweetened drinks, sweets and chocolate. Some takeaways and fast foods contain a lot of fat and sugar.

iii. iv. v.

vi. vii. viii.

Eat breakfast. Watch the portion sizes of meals and snacks, and how often you are eating. Avoid taking in too many calories in the form of alcohol.

Concentrating on replacing unhealthy foods with healthy food choices can significantly reduce teen obesity, as can increased physical activity. Family activities such as walking, biking, hiking and even just playing games outside can help teens lower their risk of obesity 2. Physical activity i. Small everyday changes can make a difference. You dont have to join a gym or sports club (although it can help). Below is some more advice from the NICE guidance. Try walking or cycling to the shops. Avoid sitting for too long in front of the television, at a computer or playing video games. You could try gradually reducing how long you sit down in front of a screen by setting some time limits. Adults could try to build physical activity into the working day. For example, you could take the stairs instead of the lift, or go for a walk at lunchtime

ii. iii.

iv.

3.

Behavior Modification Guiding a teen to gradually change eating habits -- while encouraging a more active lifestyle -- can be effective. Eating slowly, developing a routine, planning healthy meals, using portion control, eating meals as a family, and attending support groups

4.

How parents and carers can help children and young people to keep to a healthy weight Parents and carers are important role models for children and young people and can help them to stay healthy. The NICE guidance offers extra advice to help you keep your children at a healthy weight or, if necessary, to help them to lose weight.

i.

Ensure your children have regular meals, including breakfast, in a sociable atmosphere without distractions (such as watching television). Whenever possible, eat meals with your children. Encourage children to play games that involve moving around a lot like skipping, dancing, running or ball games. Try to be more active as a family, by walking or cycling to school and the shops, or going swimming or to the local park together. Encourage children and young people to participate in sport or other physical activities, and make the most of chances to do this at school. Give some written material (like a leaflet)

ii. iii. iv. v.

vi.

Other treatment: Pills and Supplements, Weight Loss Surgery Not encourage, costly

Maintainance To maintain weight loss, you have to continue eating healthy, exercising and reducing overeating triggers There are health risks associated with being underweight, as well as with being overweight or obese. So it is important to adopt healthy lifestyle habits when it comes to diet and physical activity. Dont skip meals. Eat three meals a day and one or two healthy snacks. Replace junk foods in your house with healthy meal and snack-food items, especially fruits, vegetables and whole grains. Limit high-calorie foods, including sugary drinks, fast foods, and packaged snacks. Remember portion control. Keep food choices varied. Include foods from all the food groups, including a reasonable amount of healthy fats in your diet. Exercise at least three times a week. Dont over-exercise. Try to cut down on couch potato time. Ask your friends and family members to join you in living a healthy lifestyle. Establish regular family mealtimes.

None of these recommendations can be accomplished without the help and support of children's family and community. briefly relate Virginia Henderson (nursing model) theory which states that the 14 basic needs Refer :

breathing normally eating and drinking adequately eliminating body waste moving and maintaining a desirable position sleeping and resting selecting suitable clothes maintaining normal body temperature by adjusting clothing and modifying the environment keeping the body clean and well groomed to promote integument avoiding dangers in the environment and avoiding injuring others communicating w/others in expressing emotions ,needs,fears or opinions worshipping accdg. to one's faith working in such a way that one feels a sense of accomplishment playing or participating in various forms of recreation learning , discovering or satisfying the curiosity that leads to normal development and health, and using available health facilities

CHAPTER 4 In this chapter, need to analyze the role of nurse practitioners in the prevention of obesity among teenagers Briefly notify the importance/ need / benefit of nurses involvement in the intervention. What should nurses do? How? Briefly explain, guided by nursing process, a structured of problem solving approach to nursing practice and its evaluation. It is a systematic, rational method of planning and providing nursing care. A process that seeks to identify a client's healthcare status, actual or potential health problems, to establish plans to meet the client's identified needs, and to deliver specific nursing interventions to address those needs. It contain of assessment, diagnosis, plan, implement and evaluation. Refer to my notes:

Characteristics of the Nursing Process


end

cyclical and dynamic--> components follow a logical sequence but more than once component may be involved at one time; responds to the changing health status of the client so there is no absolute beginning or

open and flexible--> meets the unique needs of the client, family, group, or community client-centered--> the plan of care is organized according to the clients health problems rather than nursing goals interpersonal and collaborative--> to ensure delivery of quality nursing care, the nurse shares concerns and problems regarding the clients health status; rapport is developed and an open communication is established between the client and the nurse to carry out the nursing process effectively

planned goal directed allows client and nurse to devise ways to solve identified health problems--> decision-making is involved in every step of the nursing process and nurses are not bound by standard responses; nurses can use their skills and knowledge to assist the client attend to health-related goals

emphasizes feedback--> determines if there is a need to revise the nursing care plan universally applicable--> it can be used with clients at any age and at any point in the wellness-illness continuum and can be used in a variety of settings. utilizes problem-solving techniques and the systems theory--> decision-making is involved in every component of the nursing process

So as u mention the intervention, relate it to nursing process. Just inform in brief. At the same time you can slot in the points that given below (marked *). Example: 1. Assessment - collecting data. How? - By communicate/taking history from client/parents, observe eating habit/physical activity - Document data: body measurement, weight chart. 2. Diagnosis- interpret data - Compare clients BMI with standard teenage BMI obesity. - Take into account of clients risk, health factors. 3. Plan. - Must be designed based on the ability and adolescent health ..and so on But when you reach the last process (evaluation) you have to mention about reflective theory. See below.. Components of the Nursing Process
Components ASSESSING recording data Purpose Activities To establish a database of clients response -obtain health history manage healthcare needs -review records -review lit. -consult support persons/significant others -consult health professionals -update data -organize data -communicate/document data DIAGNOSING -Analyzing and synthesizing data To identify strengths and health problems to -interpret be addressed by collaborative and analyze data (compare and against standards, cluster data, identify gaps

-Collecting, organizing, validating, and to health condition and the ability to -conduct physical assessment

independent nursing interventions collaborative problems

and inconsistencies) problems -formulate nursing diagnoses and collaborative problem statements

To develop a list of nursing diagnoses and -determine clients strengths, risks, and

PLANNING

To develop an individualized care plan

-collaborate with client regarding -write goals/outcome criteria -select nursing interventions -consult other members of the healthcare team -write nursing orders and care plan -communicate care plan to relevant members of the healthcare team

-Determining how to prevent, resolve, (based on your client needs) that specifies priorities and goals reduce identified health problems; how goals and related nursing interventions to support clients strengths and how to effectively interventions implement nursing

IMPLEMENTING -Carrying interventions out planned

To

assist

the

client

meet

desired-Reassess client to update database -Determine need for assistance -Perform interventions -Document care and clients responses; give verbal reports as needed

nursing goals/outcomes

EVALUATING -Measuring the degree to outcomes have been achieved and identifying factors that influenced goal achievement

To determine whether to continue, modify, -collaborate with client and collect data which or terminate plan of care related to outcomes -determine whether goals have been met -relate nursing interventions to client outcomes -make decisions about problem status -review and modify care plan as indicated

*The nurse practitioner has a duty to interpret government policy and health research findings for the public. The work of healthcare providers is necessary in the area of advocacy at the local and federal level to induce changes in healthcare policies that impact food supply and physical activity opportunities for children. We need to find ways to expand our ability as nurses to advocate for policies at the local, state, and national level that change conditions in society. These changes, including regulatory action, should be designed so that children and their parents can make healthier choices about nutrition and physical activity. Nurses in community-based or public health settings may be the best-positioned healthcare professionals to take action on the promotion or protection strategies aimed at the prevention of adolescent obesity. Found that many nurses consider involvement in policy as an extension of their roles both in speaking for those who may not be able to speak for themselves, and in finding new ways to allocate resources that impact the health of individuals,

families, and communities. Since many factors that lead to obesity, such as health disparities, poor access to nutritious food, and poverty, are often best approached from a systems and health-determinants perspective, policy may be one of our most powerful tools for advocating for changes in conditions that contribute to obesity. One of the methods can be used is to use social marketing approach. A social marketing approach means that one must understand what the target audience is willing to give up or modify in terms of behavior in order to adopt (exchange) the new behavior for the former behavior. Social marketing can be an adjunct to traditional health education. Social marketing focuses on the audience (individual, family, or entire community) targeted for the behavior change, the communication strategies employed to uncover the barriers and benefits of the desired change, and the exchange the individual, family, or community requires in-order-to make the desired change. Consider the case of a public health nurse who is working with a family, the public health nurse needs to identify what is in it for them so that they will make the behavior change. In this case, the public health nurse would need to begin the intervention with the following initial steps of the social marketing process:
Clearly understand the problem (lack of adequate physical activity due in

part to television watching)

Explore the most appropriate actions that would address the problem (finding

alternate desirable activities for the family)

Define the target for the action (parents and adolescents) Explore with the family the desired exchange (weekly trip to the park)

The exchange chosen must be desirable to the target adolescent because there will be barriers to pursuing the desired behavior that are not immediately obvious. The benefits to making a change in behavior may not be obvious either. Because both barriers and benefits are important to understand, it is important to explore why the targets (teenagers) behave as they do and determine what is meaningful to them.

The ability to lead change whether at the individual, family, or community level is an important skill of expert nurses. Leadership at the community level takes a special approach since community participants are essential for assessing health issues, understanding the impact of those issues on the health of their community, and planning approaches that will be met with acceptance and enthusiasm by community members. Collaborative Leadership (Chrislip & Larson, 1994) is an approach to leading change that uses a shared leadership model. This model has a set of tools that helps a group establish shared leadership, trust, insight into the need for change in the community, an understanding of human behavior and power,

and the capacity to use self reflection in understanding how ones own behavior impacts others. What is the role of health care professional in the incident & relevance? Healthcare providers may recommend a personal trainer or simple exercises that you can do based on your health and size. Counseling may be included in behavior modification treatment. Provide nutritional guidelines based on health and caloric needs. This may have a team of professionals working with you and your doctor, including a dietitian or nutritionist.

NICE recommends that the healthcare professional should: talk to them about the benefits of being physically active suggest how they could fit more physical activity into your everyday life, based on what they like doing and how easy it is for them to do it suggest how they could eat more healthily, based on their own likes and dislikes, and discuss how easy it is for them to buy food and prepare meals help them to come up with some realistic goals and give you some tips on how to achieve those goals (these might include, for example, how to cope in a situation where there is a lot of tempting sugary or high-fat food) provide you with written information and offer you ongoing support Reflection i. What is reflection? ii. Why are nurses interested in reflection? Nursing like other professional groups, has recently moved to higher education which has meant working in an educational system which has traditionally divided theoretical & practical knowledge. Nurses develop a feel for what they do practically and bodily so that it becomes part of the knowing process but cannot always be verbally expressed we know more than we can say. Nurses need adequate ways to express themselves and reflection is has the potential to prove such means. iii. Why reflection? Nursing is a practice discipline; effective preparation of nurses means that we can effectively and competently care for our patients and continue to develop skills over a professional life time.

Nurses reflect because it provides a tool or mechanism through which they can communicate and justify the importance of practice and practice knowledge. iv. What does reflection have to offer?

Reflecting on practice provides us with an opportunity to learn from it, to assess effectiveness and as improvement in the future. Give 1 example of Reflection theory: Kolb (1984), Gibbs (1988), John (1994), Atkins and Murphy (1994).

CHAPTER 5 : Conclusion

Teenage is an important phase of our lives. It involves several physical and psychological changes in the body. A teenager experiences radical changes in perceptions every day. Lack of maturity places teenagers in a state of confusion. They feel vulnerable from inside. But the growing sense of the concept of ego stops them from seeking help even from their parents. Expectations of parents and peer pressure further worsen their situation. Self discipline and a strong resolve are required to shed body weight. But the low self esteem of the obese teenagers does not allow them to develop such a positive mind set. As development of a healthy self esteem is hampered in teenage, a large number of insecurities plague the mind of these individuals in their later years. If the menace of teenage obesity is not addressed in teenage itself, its serious consequences affect the adult life of these individuals too.

Most importantly we need an in-depth exploration of how to assure that nurses are equipped with the policy, leadership, and behavioral change intervention skills, such as advocacy, collaborative leadership, and social marketing skills that hold promise for preventing the critical public health challenge of overweight and obesity in teenagers. In summary, important findings that have particular relevance for nursing include: (a) prevention strategies aimed at the family (parent and teens) are key to influencing dietary habits of young children; (b) interventions aimed at preventing or reducing obesity in teenagers must start early in childhood, prior to established poor dietary patterns; and (c) nurses support and involvement in developing opportunities for a healthy lifestyle needs to be combined with any intervention aimed at individuals and families.

http://www.nhlbi.nih.gov/meetings/workshops/child-obesity/index.htm

http://www.overweightteen.com/ http://www.aacap.org/cs/root/facts_for_families/obesity_in_children_and_teens http://www.livestrong.com/article/506796-the-factors-affecting-obesity-in-teenagers-because-offast-food/ http://www.theyesword.com/obesity_in_teenagers.htm