Capstone Project Change Proposal Sample

Capstone Project Change Proposal

Obesity is increasingly becoming a common term and a way of life for many people across the world, both the old and the young (Pan, Blanck, Sherry, Dalenius, & Grummer-Strawn, 2012). Across the globe – from far west in the USA, to the far east Asian countries, down in some of the African countries and further in Australia; obesity is increasingly growing into a vice, causing an alarm among the health care givers. The latest trend in obesity, and which has raised much of the concern is the rate of obesity among children (Burkhalter & Hillman, 2011). In the USA and the European countries, childhood obesity has become so prevalent that it has created a big need and opportunity for studies and advocacy programs to be conducted aimed at finding a lasting solution to the menace. The current rate of obesity among children is at 17% as per 2015 Robert Wood Johnson Foundation (RWJF), while the rate was expected to go up if nothing is done to remedy the situation. Three main factors have been found to be the causative of this problem; environmental factors, including lifestyle, hereditary factors, and genetics (Wabitsch, Moss, and Kromeyer-Hauschild, 2014). Proper nutrition and regular exercises are the best ways of addressing this problem. Additionally, prevention methods and treatment of the condition in early stages have been found to be significant in curbing the vice (Wilson, 2013). Ways this prevention and treatment of obesity among children can be done is through the spread of information regarding the effects of obesity, both physical and psychological, and then the intervention of nurses in offering professional help (Puhl, Peterson, and Luedicke, 2013). This project will focus on the role of nurses in mitigating obesity among school-aged children and the remedies nurses can provide in terms of prevention and treatment in a bid to bring the rate of obesity among children down and the burden it causes to the society. Nurses will be educating parents and obese children in the proposed practice change. The PICOT statement is – In school-aged children with obesity (P), how will nurses educate effectively (I) to prevent and fight obesity (O) during their time in hospital (T)?

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This project will be set in John H. Stroger Jr. Hospital of Cook County which is in Chicago, Illinois. Being a public facility, the hospital provides basic, specialized, and secondary healthcare services to over five million residents of Cook County, Illinois. With over 700 employees, including physicians and general staff, John H. Stronger Jr. Hospital is suitable for hosting this project.


There is an increasing need for nurses to intervene in this problem of obesity among children. As health care providers, nurses are best suited for addressing and implementing the two ways found suitable for controlling obesity, that is prevention and treatment. The prevention trials focus on precluding normal-weight children from becoming obese. The responses include the monitoring of weight of all school-aged children. The nurses develop plans on ensuring that the participants d complications. Among other health consequences listed are atrial fibrillation/flutter, cancer, coronary disease, dementia, dyslipidemia, type-2 diabetes, insulin resistance, hepatobiliary disease, hypertension, GERD/GI cancer, gout, heart disease, heart failure, infection, kidney disease, myocardial steatosis, osteoarthritis, respiratory problems, stroke, skin changes, urinary incontinence, venous thrombosis, and psychological problems (Freemark, 2014). Children not only suffer the effects of carrying excess weight, and risks of contracting diseases related to obesity, but either maintain, gain or lose depending on their set targets. Consequently, the children remain able to maintain a healthy body mass index as recommended by the nurses (Moss, 2014). On the contrast, the treatment option focuses on enabling the obese participants to lose and maintain a healthy weight. The evaluation of the outcomes is an important part of the procedures. The practitioners utilize several certified weight-related measures. They include the body mass index (BMI), the BMI Z-score, skinfold thickness, obesity prevalence and the body fat percentage (Strawn, 2012). The assessment must be conducted on a regular basis to ensure the consistency of the interventions. Nurses can address the severity and gravity of the obesity epidemic, identify guidelines, protocols and school based approaches in obesity management and disseminating information to obese children and families with an aim of arming them with the tool to help with the prevention, reduction, and resolution of the vice. Example_Paper_Capstone_Project_Change_Proposal. Promotion of physical exercises and preaching about the importance of taking only high nutritious foods in children is an activity that nurses can effectively do. Being a matter that is left for the government to address, it is high time that trusted and capable health practitioners, mainly nurses to take the task. There are hopes that if nurses take a right action, however small, will gradually become an effective way of controlling the prevalence of obesity among school-aged children. The main challenge, however, is that many children are brought up in environments that limit their physical activity and hamper proper nutrition through the promotion of unhealthy diets. Raising children in such environments under a misguided structure is one of the causes of the high obesity prevalence. Thus, there is a growing need for parental awareness towards their child’s health matters, application of strong nutritional standards in schools and for nurses having professional guidance with the society.

Problem Statement

Obesity among children is more problematic than it is among adults. The school going children are the most vulnerable to obesity since they are not only young, but are also yet to discover the essence and vitality of proper dieting and exercise. A review of the literature has proven that children suffering from obesity are more likely to develop other health complications such as asthma, type-2 diabetes and heart relate also go through psychological stress instigated by their peers at school. The overweight children suffer emotional abuse and are bullied because of their body sizes (Cunningham, Kramer & Narayan, 2014). Such treatment may drive them into solitude, cause reduced self-esteem, emotional stress and finally develop into depression. Evidence reveals that parents armed with the right health information and effects of obesity on their children are better prepared to deal with the vice (Bonde, Bentsen, & Hindhede, 2014). Such parents not only help in keeping their children healthy, but also avoid high costs in treatment of the resulting illnesses and getting their children back to the right weight and health. However, there exists a gap in the dissemination of obesity information to the right people- parents, for preventing escalation of obesity (Wang, Wu, Wilson, Bleich, Cheskin, Weston, Showell, Fawole, Lau, & Segal, 2015). Additionally, with the prevalence being so high, the vice overwhelms the health providers. Nurses will need to be sensitized about their role in preventing and treating obesity among school-aged children by implementing the possible tools at their disposal.

Purpose of the Change Proposal

Trust is fundamental when it comes to the nurse-patient relationship. Patients rely on the trust that nurses are well trained and that their health care provision is based on professionalism and experience. Thus, it is important that nurses recognize their role in healthcare, both in terms of prevention and treatment of ill health. The acquisition of knowledge and enhancement of their understanding of obesity as well as experience in the matter will be the tool by which they can help obese children and parents through their role as educators. Example_Paper_Capstone_Project_Change_Proposal. Nurses should work on the development of innovative and evidence-based policies to create solutions for the problem. Parental awareness towards their child’s overweight, implementation of strong nutritional standards in schools and nurses having motivational conversation is recommended. The purpose of this change proposal is to call nurses into action in preventing and treating obesity among school-aged children by reducing their BMI and ultimately supporting the global goal of reducing the rate of obesity among children from 17% to below 5% by 2019.


In school-aged children with obesity (P), how will nurses educate effectively (I) to prevent and fight obesity (O) during their time in hospital (T)?

Literature Search Strategy Employed

To implement a proposed practice change based on evidence-based practice the author retrieved and selected peer reviewed articles that were less than five years old from the Grand Canyon University Library. A total of 13 articles were found that supported the proposed practice change. The literature had to include nurse’s role in healthcare and proved ways that nurses could intervene in such a problem as the one in this project. Example_Paper_Capstone_Project_Change_Proposal. Terms used in selecting the relevant articles, included obesity in children and nurses’ role in preventing and treating obesity. The selected research articles focused on the causes, treatments that have worked and role of nurses in dealing with obesity in school-aged children. The use of interviews and questionnaires for data collection as well modes of interventions were revealed in the articles which were qualitative or quantitative research.

Evaluation of the Literature

An evaluation of the literature has revealed that nurses ought to concentrate on the issue of obesity among children if the problem is to be addressed quickly and effectively (Freemark 2014). Literature from Gerards and his collaborators reported that getting participants to enroll for childhood overweight and obesity prevention interventions can be difficult. Their investigation attempted to recognize the obstacles that Dutch youth health care (YHC) professionals observe when referring parents of overweight children to an obesity prevention intervention. Among the YHC professionals including nurses, physicians and management staff, sixteen (16) of them were selected from eleven child health clinics and enrolled in semi-structured interviews. To carry out, analyze, and explain the interviews, they utilized a structure known as intervention implementation model. The results of the rate of occurrence and observed effect revealed that the major obstacle for referring parents of overweight children to an intervention were parent’s refusal to acknowledge the problem of being overweight and their hostility to discussing issues about weight. Some of the YHC professionals admitted they could overcome this obstacle by improving their communication skills. Another research by Müllersdorf and his associates showed that although school nurses recognize the significance of arresting obesity in school children, they do not have an action plan to handle the problem carefully. The researchers reported the observation of how school nurses work with obese children with the support of an action plan. Six (6) municipality school nurses working with obese school-age children were interviewed extensively. The results of the action plan implemented identified the drawbacks and the major role nurses have in consciously addressing obesity. More revelation from the study was that the nurses did not have profound knowledge of operating such as motivational conversation. The study dealt with cooperation, education and guidelines which the nurses saw as a tough duty. The action plan was a structure for retaining and boosting their skill during the whole study period, but it still allowed them to improve.

The gap that exists should be filled by nurses in their active role in fighting this menace from actions of disseminating information to the public and providing guidance and care in treating the resulting illnesses and helping the obese children get back to the right shapes and health (Wake & Lycett, 2014). It has been revealed by the literature, that the trust that the public accords nurses can be impactful in ensuring that the public listens to them and that people change from their unhealthy lifestyles. Sahoo, Sahoo, Choudhury, Sofi, Kumar, & Bhadoria (2015) assert that treating and preventing obesity in children in good time inhibits its escalation hence a healthy adulthood. Nurses have also been found to be better cited in promoting healthy diets among children by their involvement in schools and other public events where they can emphasize consumption of healthy foods, such as vegetables, fruits, low fat foods and intake of more water. The studies also revealed that lack of regular and enough exercises catalyzes this vice. Unfortunately, it was also found that most children are not exposed to environments that promote physical activity. Parental awareness was also found to be wanting and therefore recommended.

Applicable Change

The change that is applicable for this project is the sensitization of nurses through reminding them of their role in healthcare and that they are best suited to addresses this problem among school-aged children. Nurses can then be guided through the way to go in reaching out to school-aged children where they are found. Example_Paper_Capstone_Project_Change_Proposal.

Proposed Implementation Plan

To make implementation and adoption of evidenced based practice (EBP) long lasting calls for a lot of patience which means time must be devoted to making sure the education of children and their parents is done right. Example_Paper_Capstone_Project_Change_Proposal. It has been shown that “behavior change is tough” but “the key seems to lie in creating a context and support system under which EBP efforts can be sustained. Nurse Leaders who want to encourage EBP among their staff, need to realize that a one- or two-day workshop isn’t likely to cause sustainable change” (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012). In health care facilities where they can, it is recommended to set up a department for obesity among children. In this department and the hospital children’s unit nurses can pass the important information about obesity and its risk factors to prevent further escalation. In the same department as well as the hospital children’s unit, they can treat those victims of obesity and use them as case studies for the learning parents. Nurses can also target schools where they can hold special meetings with teachers and coach them on how to prepare healthy foods for children.

Potential Barriers

The project might be impeded with several issues; first, lack of sufficient funds to create awareness among the nurses and the public. Secondly, the project may take more time than expected due to issues such as coordination, resistance of stakeholders including fast food businesses, and even nurses who might ignore the call.


Bonde, A. H., Bentsen, P., Hindhede, A. L. (2014). School nurses’ experiences with motivational

interviewing for preventing childhood obesity. Journal of School Nursing 30(6), 448-455. doi: 10.1177/1059840514521240. Example_Paper_Capstone_Project_Change_Proposal

Burkhalter, M., & Hillman, H. (2011). A narrative review of physical activity, nutrition, and obesity to cognition and scholastic performance across the human lifespan. Advances in Nutrition, 2, 201S–206S.

doi: 10.3945/an.111.000331. Example_Paper_Capstone_Project_Change_Proposal

Cunningham, S. A., Kramer, M. R., & Narayan, K. V. (2014). The incidence of childhood            obesity in the United States. New England Journal of Medicine, 370(5). 403-11. doi:       10.1056/NEJMoa1309753.

Freemark, M. (2014). Predictors of childhood obesity and pathogenesis of comorbidities.  Pediatric Ann43(9):357–360. Retrieved from DOI: 10.3928/00904481 20140825 06

Gerards, S.M., Dagnelie, P., Jansen, M. C., De Vries, N. K., & Kremers, S. P. (2012). Barriers to successful recruitment of parents of overweight children for an obesity prevention intervention: a qualitative study among youth health care professionals. BMC Family Practice13(1), 37-46. doi:10.1186/1471-2296-13-37

Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: critical implications for nurse leaders and educators. J Nurs Adm 2012; 42(9): 410-7. DOI: 10.1097/NNA.0b013e3182664e0a.

Müllersdorf, M., Zuccato, L., Nimborg, J., & Eriksson, H. (2010). Maintaining professional           confidence — monitoring work with obese schoolchildren with support of an action plan. Scandinavian Journal of Caring Sciences24(1), 131-138. doi:10.1111/j.1471-6712.2009.00696.x

Pan, L., Blanck, M., Sherry, B., Dalenius, K., & Grummer-Strawn, M. (2012). Trends in the prevalence of extreme obesity among U.S. preschool-aged children living in low-income families, 1998–2010. JAMA308 (24), 2563–2565. Retrieved from  http://doi.org/10.1001/jama.2012.108099

Puhl, R., Peterson, L., & Luedicke, J. (2013). Weight-based victimization: Bullying experiences of weight loss treatment-seeking youth. Pediatrics 131 (1). doi: 10.1542/peds.2012-1106.

Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015). Childhood obesity: Causes and consequences. Journal of Family Medicine and Primary Care4(2), 187-192.

doi:  10.4103/2249-4863.154628. Example_Paper_Capstone_Project_Change_Proposal

Wake, M. & Lycett, K. (2014). Let’s call it as it is: on results, reach, and resolution in population-based obesity trials. Pediatrics, 134(3), e846-e847. doi: 10.1542/peds.2014-1940.

Wabitsch, M., Moss, A., & Kromeyer-Hauschild, K. (2014). Unexpected plateauing of childhood obesity rates in developed countries. BMC medicine, 12(1), 17. doi:10.1186/1741-7015-    12-17.

Wang, Y., Cai, L., Wu, Y., Wilson, R. F., Weston, C., Fawole, O., Bleich, S. N., Cheskin, L. J.,   Showell, N. N., Lau, B. D., Chiu, D. T., Zhang, A., and Segal, J. (2015). What childhood   obesity prevention programs work? A systematic review and meta-analysis. Obesity Reviews, 16 (7), 547-565. doi: 10.1111/obr.12277.

Example_Paper_Capstone_Project_Change_Proposal Appendix Section

Appendix A

References Reviewed for Research

Gurnani, M., Birken, C., & Hamilton, J. (2015). Childhood obesity: Causes, consequences, and    management. Pediatric Clinics of North America62(4), 821-840.  doi: 10.1016/j.pcl.2015.04.001.

Hasnain, S. R., Singer, M. R., Bradlee, M. L., & Moore, L. L. (2014). Beverage intake in early      childhood and change in body fat from preschool to adolescence. Childhood Obesity10(1), 42-49.

doi:  10.1089/chi.2013.0004. Example_Paper_Capstone_Project_Change_Proposal

Karnik, S., & Kanekar, A. (2015). Childhood obesity: A global public health crisis. International Journal of Preventive Medicine, 2012. 3 (1), 1-7. Retrieved from:             https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278864/

Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Jama311(8), 806-814. doi: 10.1001/jama.2014.732. Example_Paper_Capstone_Project_Change_Proposal

Xu, S., & Xue, Y. (2016). Pediatric obesity: Causes, symptoms, prevention and treatment (Review). Experimental and Therapeutic Medicine11(1), 15-20. doi:  10.3892/etm.2015.2853 

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