- NURS FPX 8045 Assessment 4 Interprofessional Communication and Practice Gap.
Interprofessional Communication and Practice Gap
Obesity is a growing epidemic (Ceccarini et al., 2015). It is defined as a body mass index (BMI) between 25 and 30 kg m−2; morbid obesity is defined as a BMI of 30 kg m−2 or greater (Caterson et al., 2019).
A sedentary lifestyle combined with the consumption of a high-sugar, refined-carb diet, along with genetic, metabolic, and environmental factors, is currently considered the leading cause of the obesity epidemic (Boutari & Mantzoros). This paper will present a gap in obesity care, explain the evidence, and present a PICOT question.
Summarize a Gap
Obesity affects 42% of adults, costing healthcare spending $3.8 trillion in 2019 (State of Nevada, 2021). A gap in care exists in the management of obese patients; despite increased recognition as a chronic disease, obesity remains considerably underdiagnosed and undertreated (Caterson et al., 2019). The State of Nevada does not include obesity in its chronic disease prevention programming when over a quarter of the population has obesity.
Nevada only invests about $1 per capita directly from the state budget for chronic disease prevention, including diseases that are caused by obesity, such as cardiovascular disease, diabetes, and renal disease (Shane, 2022). Motivation and readiness to change (RTC) should be assessed for patients who face the difficult task of losing weight. The issues Nevadans face are cultural, socioeconomic, behavioral, and physical (Centers for Disease Control and Prevention [CDC], 2022).
NURS FPX 8045 Assessment 4 Interprofessional Communication and Practice Gap
These problems require a multi-angle approach to improve the health and welfare of all citizens. In the clinical setting for this project, healthcare providers (HCP) do not currently establish a patient’s readiness to change regarding being overweight or obese (R. Vadovic, personal communication, January 3, 2023).
Intermountain Healthcare offers classes and nutrition counseling for healthier living and weight management (Intermountain et al.). One area where Nevada is short is in regard to weight loss medications. Many pharmacies, such as Mounjaro, Ozempic, and Saxenda, report a shortage in the supply of drugs. Other weight loss therapies, such as dietary changes and exercise programs, will be recommended.
Explain the Evidence
In Nevada, 28.7% of adults report feeling that they are obese. Obesity is higher in women than in men of any age and is highest between the ages of 50 and 65 years. The prevalence of nationwide obesity has increased from 4.6% in 1980 to 14.0% in 2019 (Boutari & Mantzoros, 2022). Obese patients are more likely to have decreased quality of life and increased risk of developing severe health conditions, such as diabetes, heart disease, hypertension, stroke, sleep apnea and breathing problems, and mental health conditions such as depression and anxiety (ElSayed et al., 2022).
NURS FPX 8045 Assessment 4 Interprofessional Communication and Practice Gap
Weight stigma, or discrimination and stereotyping based on an individual’s weight, may also negatively influence psychological and physical health (State of Nevada, 2021). Prevention and management of obesity continue to use the foundation of lifestyle modification with behavioral change regarding nutrition, sleep, physical activity, and optimizing mental health (Caterson et al., 2019). Due to chronic inflammation, obesity is often associated with cardiovascular disease, kidney disease, and type 2 diabetes.
This is particularly notable in obesity, where the overall immune phenotype converts from anti-inflammatory to pro-inflammatory (Garcia et al., 2022). Obesity-related hypoventilation (OHS) can also occur when the hypercapnia ventilatory response is decreased (Herkenrath et al., 2022). OHS is defined as a combination of obesity, daytime hypercapnia, and sleep disorder breathing; obesity-related hypoventilation can also cause pulmonary hypertension (Masa et al., 2022).
Construct a PICOT
(P) In obese female patients (I), how does screening for readiness to change, the
introduction of a weight loss bundle with diet and exercise education, and monthly check-ins (C)
compared to no intervention (O) influence weight loss education compliance during a primary
care clinic office visit (T) at four and eight weeks. This project aims to screen obese female patients to determine the patient’s readiness for change, and a weight loss bundle, including diet, exercise, and monthly check-ins for eight weeks, will be implemented.
Discussion and feedback
Two different projects were discussed with this author’s preceptor, Robert Vadovic, at a 1:1 telephone conference on 01/03/2023. The conference started with email and was moved to a telephone call to facilitate two-way communication better. In-person discussions were not convenient for either participant at that time. We discussed a project related to opioid overuse identification and a project about identifying readiness to change an obese female patient.
While both projects had some benefits, it was decided that identifying obese female patients’ readiness to change for weight loss would benefit the company as well as the patients as a noted gap exists in obesity care. There is a gap in addressing obesity. At times, the gap is related to the patient not wanting to talk about it, but caregivers sometimes feel that bringing up the patient’s weight might make the patient agitated.
NURS FPX 8045 Assessment 4 Interprofessional Communication and Practice Gap
Since Intermountain Healthcare Care does have an IRB as well as Cappella University, it was decided to do a preassessment with the S weight questionnaire, which assesses patients for readiness to change; patients that are scored as ready to change will be given a health packet bundle which includes weight management exercise information, will be offered a referral to the dietitian or the Intermountain weight loss clinic. At four weeks, the patient will return to the clinic and repeatedly do the S weight questionnaire at the 8-week. Comparisons will be made regarding the pre-, interventional, and post-test to assess the patient’s readiness to change.
Conclusion
Assessing patients’ readiness to change for weight loss is paramount to implementing a good weight loss plan. Healthcare providers and other professionals can and should collaborate to reduce the prevalence of overweight and obesity. This endeavor begins with determining the patient’s readiness to change and meeting the patient at their stage of change and point of need by creating an individualized weight loss plan, including a weight loss bundle with diet, exercise, and monthly check-ins. Read more about our sample NURS FPX 8045 Assessment 3 Differentiate a QI/PI Project from a Research Study for complete information about this class.
References
Boutari, C., & Mantzoros, C. S. (2022). A 2022 update on the epidemiology of obesity and a call to action: As its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism, 133, 155217.
https://doi.org/10.1016/j.metabol.2022.155217
Caterson, I. D., Alfadda, A. A., Auerbach, P., Coutinho, W., Cuevas, A., Dicker, D., Hughes, C., Iwabu, M., Kang, J., Nawar, R., Reynoso, R., Rhee, N., Rigas, G., Salvador, J., Sbraccia, P., Vázquez‐Velázquez, V., & Halford, J. C. (2019). Gaps to bridge: Misalignment between perception, reality, and actions in obesity. Diabetes, Obesity and Metabolism, 21(8), 1914–1924.
https://doi.org/10.1111/dom.13752
Ceccarini, M., Borrello, M., Pietrabissa, G., Manzoni, G., & Castelnuovo, G. (2015). Assessing motivation and readiness to change for weight management and control: An in-depth evaluation of three sets of instruments. Frontiers in Psychology, 6.
https://doi.org/10.3389/fpsyg.2015.00511
Centers for Disease Control and Prevention. (2022, December 12). Social determinants of health.
https://www.cdc.gov/about/sdoh/index.html
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins,
- S., Hilliard, M. E., Isaacs, D., Johnson, E. L., Kahan, S., Khunti, K., Leon, J., Lyons,
- K., Perry, M., Prahalad, P., Pratley, R. E., Seley, J., Stanton, R. C., & Gabbay, R. A. (2022). Obesity and weight management for the prevention and treatment of type 2 diabetes. Diabetes Care, 46(Supplement_1), S128–S139. https://doi.org/10.2337/dc23-s008
Garcia, J. N., Wanjalla, C. N., Mashayekhi, M., & Hasty, A. H. (2022). Immune cell activation in obesity and cardiovascular disease. Current Hypertension Reports, 24(12), 627–637.
https://doi.org/10.1007/s11906-022-01222-4
Herkenrath, S. D., Treml, M., Hagmeyer, L., Matthes, S., & Randerath, W. J. (2022). Severity stages of obesity-related breathing disorders – a cross-sectional cohort study. Sleep Medicine, 90, 9–16.
https://doi.org/10.1016/j.sleep.2021.12.015
Intermountain Healthcare. (n.d.). Weight management. intermountainhealthcare.org. Retrieved January 4, 2023, from
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Shane, S. (2022, October 22). To reverse the tide, Nevada must recognize obesity as a real disease. Reno Gazette Journal. Retrieved January 6, 2023, from
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https://www.leg.state.nv.us/Division/Research/Documents/RTTL_NRS439.521_2022.pdf
