This is a graded discussion: 50 points possible
due Dec 4
Week 6: Dissemination
11 unread reply.11 reply.
The collaborative discussion for this week is focused on your ideas for dissemination of your DNP project and share your thoughts about your peer colleagues’ posters.
This week, along with your response to the collaborative topic question, I am also asking you to share how your preceptor has supported your work this session. Please answer these two short questions for your preceptor and answer these separately for your mentor, if you have a mentor. Please share your thoughts on the following:
1. How did your preceptor/mentor provide you with timely feedback when you had questions?
2. How did your preceptor/ mentor serve as a professional role model as you implemented your project?
I look forward to your feedback regarding collaboration with your preceptor and your mentor.
Please click on the following link to review the DNP Discussion Guidelines on the Student Resource Center program page:
• Link (webpage): DNP Discussion Guidelines

When posting, please first share your PICOT question in question format and then respond to the weekly question. This will help us all to be able to provide quality feedback in these weekly collaborative discussions.

FOR WRITER, THIS IS MY PICOT question

“For adult patients with a BMI>30 in a primary care clinic, does the implementation of the American Heart Association Dietary and Physical Activity Guidelines, compared to current practice, impact participants’ weight over 8-10 weeks?”

In 100 words or less, examine potential barriers to the dissemination of DNP practice change projects and how these barriers can be overcome.
This week, along with your response to the collaborative topic question, I am also asking you to share how your preceptor has supported your work this session. Please answer these two short questions for your preceptor and answer these separately for your mentor, if you have a mentor. Please share your thoughts on the following:
How did your preceptor/mentor provide you with timely feedback when you had questions?
How did your preceptor/ mentor serve as a professional role model as you implemented your project?
Please review the discussion grading guidelines and support your post with scholarly references.

Leonard Einstein
Case Study

Preparing the Discussions and Assignment
Follow these guidelines when completing each week of the simulated case study assignment. Contact your course faculty if you have questions.

Case Study Template

Case Study Week One in NR-707
Use the headings below. (Use the implementation plan as accepted in the DNP IRB Prescreening process).

Week 1: The Role of the DNP Practice Scholar
Part 1
So far, I have demonstrated my role as a clinical scholar in various ways in my current position. For instance, on several occasions, I have translated new nursing evidence into practice and helped improve outcomes in the clinical setting. This role is consistent with the view that a clinical scholar utilizes the skills needed for evidence-based practice to implement the best available evidence in the care environment and boost patient healthcare outcomes (National Organization of Nurse Practitioner Faculties, 2016). I also engaged in more advanced clinical practice and applied new nursing knowledge in different care situations. Sometimes, I used inductive reasoning and theories in clinical practice to generate more effective clinical interventions. In addition, I demonstrated my role as a clinical scholar by exhibiting intellectual curiosity and trying to fill knowledge gaps in the practice environment. As a result, I helped resolve multiple problems in the care setting. It required utilizing concepts or constructs captured in the theoretical frameworks and often resulted in better and more effective solutions.
I anticipate integrating the clinical scholar role into my current and future career to enhance practice and patient outcomes. Trautman et al. (2018) state that nurses with the Doctor of Nursing Practice (DNP) qualification usually deal with translating evidence in the practice environment to improve care delivery. Their advanced academic preparation suits their role in implementing evidence-based practice and transforming nursing. On this note, DNP-prepared nurses must assume clinical scholar responsibilities as part of their professional duty. As a nurse pursuing a DNP degree, I hope to integrate this role into my practice and use it to push for evidence-based clinical interventions. I will employ new research findings to guide decisions in the care setting and adopt innovative solutions. In addition, I will integrate the clinical scholar role into my career to help solve the complex issues impacting clinical practices and patient care in the contemporary world. Integrating this role will further ensure that “the best evidence reaches the bedside in the most effective and efficacious ways” (Trautman et al., 2018, para. 13). These moves will lead to better outcomes for people seeking healthcare services.
Part II
Practice Question
For adult patients with a BMI>30 in a primary care clinic, does the implementation of the American Heart Association Dietary and Physical Activity Guidelines, compared to current practice, impact participants’ weight over 8-10 weeks?
Simulated Project Implementation
In the first week, the DNP student will choose the individuals who fit the inclusion criteria. The student will also educate providers participating in the project about the guidelines and their role. The participants will provide informed consent in written form, and appropriate action will be taken to safeguard their details. In addition, the participants will receive proper orientation about this project, after which the clinicians will take their pre-implementation weight. The DNP student will also take this opportunity to select the health professionals to assist in implementing this project.
From the second to the ninth week, the participants will apply all interventions as indicated in the American Heart Association (AHA) guidelines on physical activity and diet. They will also take note of their weight, exercise, and food intake and document this information in the provided journals, logs, and checklists. Throughout this period, they will interact with the exercise physiologist, the DNP student, and the dietitian via the telephone as part of the follow-up routine. The DNP student will also perform formative evaluation and avail themselves at least three times weekly to address outstanding issues.
In the tenth week, the participants take their final weight and fill out their logs before heading to the clinic. While there, the DNP student working with other providers will examine the records and recommend approaches for maintaining progress for each participant. The student will also confirm and document the final weights of all participants before compiling this information for data analysis with the help of a statistician.
Effects of the COVID-19 Pandemic on the Development of the Project
The COVID-19 pandemic significantly impacted organizational operations and the development of this project. It has affected the number of people who can convene in one place within the organization without raising the infection risk. It also determines the safety protocols health providers and others must observe while on the premises. Kesten and El-Banna (2021) further note that DNP programs have faced various barriers revolving around implementing practice projects in the wake of the COVID-19 pandemic. In this case, the pandemic has influenced the development of this project because the DNP student needed to meet with the participants, the exercise physiologist, the dietitian, and other staff to discuss different elements before, during, and after adopting the proposed interventions. On this note, it was necessary to observe the existing COVID-19 protocols.
Addressing or Overcoming Potential Issues
The DNP student should set aside time to meet with the staff and patients who did not attend the meetings as planned to inform them of any new developments that happened when they were not present. The follow-up sessions will begin by establishing what they already know about the project. Then, the DNP student will fill the gap to ensure the participants fully understand their roles and contributions. The sessions will first happen in person to build trust and provide adequate opportunities for raising and addressing concerns. Subsequently, follow-up meetings will occur virtually. It follows the logic that scheduling a face-to-face session first helps create trust and a more lasting relationship (Winther et al., 2020). Ultimately, the follow-up will enable the staff and patients to remain updated about the project.
The float and traveler nurses did not impact the project. However, the exercise physiologist and dietitian significantly affected the implementation plan because they had to meet with every participant for one hour for a briefing regarding the intervention plans, data collection, and recording responsibilities. During this visit, these professionals also furnished patients with logbooks for documenting their exercise, food intake, and weight. Finally, they supplied them with AHA guidelines. At the same time, the exercise physiologist and dietitian still needed to fulfill their duties to other patients who did not participate in this project. The issue impacted the implementation as they had to set aside time to meet the participants.
The DNP student should provide presentation slides and handouts to all participants as a backup to guide everyone in case internet problems disrupt virtual meetings. They should receive these materials during face-to-face engagements. A phone conference is another backup option for when the DNP student needs to communicate urgent information to the participants. However, Kennedy et al. (2021) acknowledge the need to coordinate with other participants to ensure no one is left out before the call begins. It may also require everyone to introduce themselves to minimize confusion.

Case Study Week Two in NR-707
Use the headings below. (Use the implementation plan on your DNP Practicum Form).

Healthcare Systems Leadership
Part I
The DNP-prepared healthcare systems leader can influence policies and procedures that improve patient care. Nurses acquire advanced knowledge and skills at the DNP level to enhance their evidence-based care strategies (McCauley et al., 2020). Thus, when DNP nurses assume leadership positions, they advocate for policies that can ensure evidence-based care. Additionally, they can participate in developing guidelines to help nurses deliver evidence-based care. Considerably, the DNP-prepared nurse leader can help other nurses understand how to utilize evidence-based guidelines to provide effective nursing care.
I anticipate integrating the leadership role into my career by helping nurses identify problems and evidence on how to address various healthcare issues. A leader’s primary function is influencing followers to achieve the goals set (Sfantou et al., 2017). As a DNP leader, I will promote nurses who work directly with patients to detect clinical problems that affect patient care. Moreover, I will assist them in identifying databases to retrieve evidence to make appropriate healthcare decisions. The influence of my leadership in my current and future career will be based on problem solving in healthcare.
Knowledge, integrity, and self-motivation are needed to successfully form a professional identity in DNP students to help achieve healthcare systems leadership roles after graduation. I believe knowledge is significant as it can help nurses make rational decisions. Integrity is equally important to face challenging situations that may comprise their values. Thus, they should have the integrity to gain the trust of followers. Finally, self-motivation compels leaders to make independent and correct decisions in their work. The three values can help DNP students gain the right influence in healthcare
Part II
PICOT: For adult patients with a BMI>30 in a primary care clinic, does the implementation of the American Heart Association (AHA) Dietary and Physical Activity Guidelines, compared to current practice, impact participants’ weight over 8-10 weeks?
Best Practices for Implementing Evidence-Based Practice Guidelines
The most suitable practices for implementing evidence-based guidelines include understanding the data, considering the resources, and establishing patient-centered goals. Evidence-based guidelines data should be relevant to the organization and the practice problem to be considered appropriate (Abu-Baker et al., 2021). In this case, the American Heart Association (AHA) Dietary and Physical Activity Guidelines are suitable for managing obese patients. Additionally, resources should be available within the practice setting to facilitate the implementation of the guidelines (Abu-Baker et al., 2021). For example, policies that require patient education, such as the AHA guidelines, require the presence of nurses who can educate clients. The selected healthcare setting has nurses who can educate patients and facilitate the AHA guideline implementation. Moreover, goals should be established based on patient outcomes before implementing a guideline (Abu-Baker et al., 2021). In this case, the goal is to reduce the patient’s weight in ten weeks. Overall, an evidence-based guideline should be appropriate, and resources should be available to facilitate guideline implementation to improve patient outcomes.

Strategies for Overcoming Barriers
Barriers to implementing evidence-based practice can be overcome using an evidence-based model, initiating teamwork, and availing resources. Evidence-based models provide frameworks that nurses can use to implement evidence-based guidelines (Cullen et al., 2022). Therefore, such models help nurses recognize anticipated challenges and prepare to mitigate them. Additionally, teamwork is needed to ensure seamless planning and implementation of evidence-based practice guidelines (Rosen et al., 2018). Individuals may experience challenges in implementing certain aspects of evidence-based guidelines. For example, a nurse may not educate patients and initiate regular follow-ups as described in the AHA guidelines due to the increased workload. Several nurses can plan and coordinate tasks to ensure that patients are educated and followed up. Therefore, the last strategy is to avail the resources needed to implement evidence-based guidelines. The increased workload is a significant barrier to implementing them (Mathieson et al., 2019). Healthcare settings may have to employ additional nurses to reduce workload and help nurses focus on tasks in evidence-based practices.
The Formative Evaluation Plan
My formative evaluation plan is to ensure a weekly review of the logs, diet journals, and checklists. In week 1, patients will be educated on following the recommendations for dietary and physical activity according to the AHA guidelines. Patients should follow the guidance and update daily logs, diet journals, and checklists. At the end of the week, all their activities will be updated. Patient participation in managing diseases can strengthen compliance with healthcare recommendations (Wong et al., 2020). Thus, involving the patient in updating the logs, diet journals, and checklists will enhance adherence to the recommendations and ensure that the patient meets the goals per the AHA guidelines by the end of the week.
If the Intervention was not Implemented
Three steps should be taken if the staff has not implemented the intervention by week two. The first step is to assess the reasons for not implementing the intervention. Nurses may fail to participate in the evidence-based project due to an increased workload (Mathieson et al., 2019). This problem is beyond nurses’ abilities and should be understood. Neglect should also be noted if it occurred. The second step is to address the problem identified in the first step. For example, if there was increased workload, the tasks for nurses participating in the program should be reduced. If the staff is unwilling to continue the project due to evident challenges, they should be replaced. The last step is to adjust and redistribute activities within the implementation timeframe. The project should be completed in ten weeks, and all activities must be finished within this timeframe.
Addressing the Unwilling Staff
If the nurse does not see the need to engage in change practices, I will explain to them the information I have read about evidence-based practice. I would tell the nurse that evidence-based practices entail clinical evidence, individual expertise, and patient references (Abu-Baker et al., 2021). I would first agree with the nurse that their expertise may have contributed to improving things in the healthcare setting. However, I would tell them to examine patient outcomes based on their actions. For instance, the obesity prevalence continues to increase and cause various complications despite nursing education to manage weight (AHA, 2018). For this reason, I would tell the nurse to consider using clinical evidence or evidence-based guidelines and patient preferences to improve patient outcomes.

Working With Resisting Stakeholders
If stakeholders were not included and are resisting change, I would first need to know the reason for resisting change. Once the reasons are identified, I would inform stakeholders that the change project aims to improve patient outcomes. For instance, the AHA guidelines help patients manage their weight and avoid obesity (AHA, 2018). Obesity causes complications that can be costly to manage and can strain resources within the health facility. Therefore, I would insist that the project can improve patient outcomes and resource management in the health facility. In this way, I can ensure that they support the project.
Additional Resources to Strengthen Intervention Fidelity
Adding a community health worker would be essential for successful implementation. The project entails initial patient education on the AHA guidelines. Patients should follow the guidelines and update logs, diet journals, and checklists. However, they may experience challenges with some activities. Community health workers create connections between patients in communities and healthcare providers in healthcare settings (Rahman et al., 2021). Thus, they can help monitor patients at home and ensure that they have complied with the activities and updated the information. Consequently, community health workers can strengthen intervention fidelity.

Case Study Week Three in NR-707
Use the headings below. (Use the implementation plan on your DNP Practicum Form).

Week 3: The DNP-Prepared Nurses as Educators
DNP-prepared nurses know how to implement change in healthcare. One of the primary roles of these nurses is to be educators. Concurrently, as evidence-based practice champions, DNP students should employ the right strategies to improve the success of their DNP project interventions. These nurses can integrate the educator role through research, collaborate with nurses in designing their interventions, and use tailored implementation and evaluation mechanisms to support the intervention’s fidelity.
Part 1
DNP-Prepared Nurse as an Educator
DNP nurses play a crucial role in both academic and non-academic settings. As a DNP-prepared nurse, I will integrate the educator role in my future career by advancing nursing through research. According to Menonna-Quinn and Tortorella (2019), DNP-prepared nurses are well equipped to connect education and practice that is missing in today’s healthcare sector. In my future career, I will embrace this role through research to inform the nursing curriculum and teaching strategies. In addition, I will be a proactive clinical educator, educating my colleagues, the community, and patients. In this role, I will strive to keep my colleagues up-to-date with the latest evidence-based guidelines and provide patient education to achieve the desired outcomes for all my patients. Therefore, there are different ways in which DNP-prepared nurses can integrate the educator role into their careers.
Comparing the Role of DNP Nurse as Faculty and Clinical Educator
When adopting their role as educators, DNP-prepared nurses can be faculty educators or clinical educators. As a faculty educator, the DNP-prepared nurse participates in designing the nursing curriculum to ensure that students can function in interdisciplinary teams, deliver patient-centered care, and meet population needs (Doctor of Nursing Practice DNP, n.d.). Moreover, these nurses provide opportunities for students to work in multidisciplinary research teams, identify, evaluate, and implement large-scale educational innovations, and manage a large learning environment while ensuring diversity. In academic settings, DNP educators oversee the translation of research results and their implementation into practice and advocate adopting evidence-based learning strategies. As clinical educators, the activities of DNP-prepared nurses include educating staff, patients, their families, and the community (Doctor of Nursing Practice DNP, n.d.). Furthermore, these nurses translate research into practice and educate staff on the need to embrace the evidence-based practice. Therefore, the two roles differ.
Part 2
PICOT: For adult patients with a BMI>30 in a primary care clinic, does the implementation of the American Heart Association Dietary and Physical Activity Guidelines, compared to current practice, impact participants’ weight over 8-10 weeks?
Creative Solutions
The DNP project encourages nurses to adopt dietary and physical management guidelines of the American Health Association (AHA) to mitigate obesity-related complications, which may face resistance from nurses. According to Arsenault Knudsen et al. (2021), practice change is a crucial aspect of the nursing profession, yet nurses sometimes resist it. In this case, nurses may complain of the work overload associated with frequent patient follow-ups, as primary care nurses face emerging challenges and increased workloads due to the COVID-19 pandemic. One of the most effective strategies for overcoming this barrier is to involve nurses in the proposed practice change intervention (Arsenault Knudsen et al., 2021). Including these nurses in designing the intervention can increase the sense of ownership, improving their willingness to embrace the change. Another strategy would be to work with the facility to redesign the work shifts for the nurses involved in the intervention. This move will balance the competing needs of primary care nurses and ensure that the workload associated with this change does not create burnout.
Lessons on Project Implementation
As I continue to receive feedback on the intervention’s fidelity, I have learned various lessons. A key takeaway is the need to customize the intervention to the healthcare setting. According to Powell et al. (2019), healthcare settings differ and require customization. An intervention that proved effective in one environment may prove challenging to implement in another. In this case, the practice change is in a primary care setting. Thus, I must ensure that it is suitable for this care setting. Additionally, I have learned that there is a need to specify the test mechanisms for change, evaluation, and reporting criteria. In their article, Powell et al. (2019) argue that interventions without systematic and clear definitions of contextual determinants are bound to fail. Thus, it is necessary to abandon the generalist mentality and have clearly defined test and evaluation mechanisms tailored to the project.
Project’s Fidelity
Promoting the project’s fidelity is essential in facilitating its success. The fidelity of the intervention ensures that participants receive the instructions stipulated in the project design (Pastva et al., 2018). In this case, a vital practice prompt is to allow providers to practice together, ensuring that they relate to the guidelines similarly. This practice is crucial as it will enable the DNP student to assess whether the nurses implement the procedures according to the project specifications. Second, a chart must be prepared that stipulates the guidelines and how they should be implemented. This information is crucial in providing the nurses with a reference point for the invention’s implementation (Sandra, 2018). Ultimately, these methods will enhance the intervention’s fidelity.
Data Collection
Although data collection in the simulated case is not very difficult, there are some barriers. The primary challenge is that the data depends on the participant’s willingness to adhere to the project. For instance, if patients refuse to fill the daily log or come for their weekly evaluation, there is little that the DNP student can do. To ensure sufficient data, the student will follow up with the participants and encourage them to adhere to the intervention. Given the project’s design, there are no other methods to obtain or document the data quickly.
Conclusion
DNP nurses can integrate the educator’s role in their practice through research and becoming educators in their work settings. In the DNP project implementation, involving nurses in designing the intervention can help reduce resistance. Additionally, having measures customized to the project can help improve its fidelity, while frequent follow-ups with the participants will facilitate adequate data.

Case Study Week 4 in NR-707
Use the headings below. (Use the implementation plan on your DNP Practicum Form).

Question 1: Conference Details
The most appropriate national conference to present the DNP project on the implementation of American Heart Association’s Dietary and Physical Activity guidelines is the “4th World Congress on Cardiology and Nursing Care.” The conference’s theme is “Insight into Recent Trends in Cardiology.” The topic of this convention is compatible with mine since it entails presentations that provide information on ways to improve heart health. In this case, dietary and physical activity guidelines as primary methods of improving cardiac health are fundamental concepts that match the demands of previously stated conference. The congress will be held in Dubai, UAE, and will attract presenters, such as doctors, students, cardiologists, and cardiothoracic surgeons, which makes it possible for the qualified medical specialists to participate and offer my presentations (Pulsus, n.d.). Besides, this convention will allow informative poster presentations and discussions on the cardiology industry. The call for abstracts for this conference consists of track categories with 22 headings under which the submitted abstracts will be evaluated before publishing during the convention. Additionally, “Role of Diet, Nutrition in CVDs” is the sixth heading, which gives me the opportunity for the poster presentation with my topic on a similar subject.
Question 2: Abstract
The conference identifies two categories of requirements for every presenter. They contain primary details, such as title, name, country, phone number, author’s email, and full postal address, as well as abstract submission details, including category, track name, attachment tab. On this note, the conference website also provides a template for abstract that will be followed by each presenter during the discussion. Thus, the following details will be contained in my abstract.
Statement of the Problem: Gaining weight and ultimately becoming overweight and obese is common even with the delineated AHA guidelines and recommendations for exercise and diet. Obesity mainly affects women in the US. However, the increased obesity rates observed over the last decades concern the healthcare sector due to the higher risk of cardiovascular disease correlated with increased adiposity, which results in unacceptable costs to manage healthcare and a diminished quality of life.
Purpose of the Study: The purpose of this project is to help patients adopt the AHA diet and physical activity recommendations to manage and mitigate weight gain for reducing the risk of mortality, morbidity, and cardiovascular disease attributed to high BMI.
Methodology and Theoretical Orientation: This project aims to assist overweight participants in losing weight by following the American Heart Association Dietary and Physical Activity Guidelines. These elements will be proven using evidence-based practice that the outlined interventions are crucial in reducing adiposity, weight gain, and improving health, as well as minimizing predisposition to illnesses such as diabetes, hypertension, stroke and heart conditions. The Knowledge-To-Action (KTA) Framework will be used for this translational science project.
Findings: The main outcome of this project is weight reduction rate of obese or overweight adults in South Florida. Both male and female weight reduction rate will be measured over a period of ten weeks to determine whether the American Heart Association’s (AHA) guidelines for diet and physical activity are effective in reducing weight of the adults at the facility.
Conclusion and Significance: The project will prove that dietary measures and physical activities can help to reduce obesity and cardiovascular diseases among children and adult populations.
Recommendations: The outcomes of the project should target the nursing profession and society in general, and to specific nursing leaders by helping them to implement dietary and physical activity interventions to reduce obesity and cardiovascular diseases.
Question 3
I did not apply for the conference presentation. This convention will occur in 2023. Therefore, I will consider applying for the poster presentation within the next four months. Moreover, I will take into account the cost implications and make appropriate budgetary considerations before applying the “4th World Congress on Cardiology and Nursing Care” conference.
Part II: Case Study
Practice Question in PICOT Format
For adult patients with a BMI of 25-30, does the implementation of the American Heart Association Recommendations for Physical Activity in Adults and Kids, compared to current practice, impact participants’ weight over 8-10 weeks?
You are continuing to conduct your formative evaluation for intervention fidelity and provide feedback. What are you learning about project implementation?
I am learning that the project implementation should be done in stages to facilitate easy understanding of the processes by the research subjects. Moreover, I am discovering the need to have clear guidelines when applying each phase during implementation to avoid confusion and delay due to misunderstanding among the stakeholders.
• How is the COVID-19 pandemic or other factors affecting the implementation of your practice change project?
The COVID-19 pandemic is creating a delay in implementation by presenting physical meeting challenges with the 20 research participants. Therefore, some participants are unwilling to fully commit to the study.
• What alternate approaches could be implemented to facilitate the success of your project implementation and evaluation project phases?
The application of family support and frequent communication measures are essential in encouraging patients who are family members to participate and follow the AHA guidelines (Beltran-Martin & Bou-Llusar, 2018). Moreover, the staff may be resistant to the additional workload but will be reminded of the purpose of the project is to celebrate the participants’ small wins.
• What type of course correction may be needed? Do you need to modify your project plan? If so, what modifications would you make? (Keep in mind that only minor modifications can be made to the project plan after IRB approval. No changes can be made where the project is being implemented, population, intervention, comparison, outcome, or timeframe).
I need to make only one significant modification in the implementation process. In this case, I should apply sequential interventions in 10-week stages to avoid overloading the staff with duties.
• What type of communication and with whom is needed for project success now? How are you engaging the stakeholders and the participants of your project?
The most significant communication required is with the staff to enhance proper coordination of the research subjects. I am engaging the stakeholders through constant motivational speeches and consultation on challenging processes (Dasi et al., 2021). Besides, I insist on constant collaboration among the staff members to reduce time wastage (Caniëls et al., 2019). Moreover, I keep encouraging the participants to follow the dietary and physical-activity program despite the challenges in adherence to the plan.
• What additional support might you need from nursing, organizational leadership, course faculty, and your preceptor to successfully implement the evidence-based intervention? What does that support look like to you?
The nursing department can provide additional staff to help me monitor the 20 research subjects. On the other hand, the organizational leadership can help me in the project by providing more funds for the program. The course faculty can offer more comprehensive supervision and feedback to enable me stick to the project guidelines (Browning, 2019). These additional initiatives will boost my implementation process by eliminating project management challenges.

Case Study Week 5 in NR-707
Use the headings below. (Use the implementation plan on your DNP Practicum Form).

Week 5: DNP Project Dissemination Through a Podium Presentation
Part I
I learned various lessons about a podium presentation. Generally, podium presentations are critical in disseminating evidence from a nursing research project (Astroth & Hain, 2019). It requires summarizing the research work into a short presentation. It is often challenging for most people, considering the breadth of the information in a DNP project. On this note, I learned podium presentations should only include the most important details. It ensures that the presentation does not have unnecessary information. This move recognizes that the audience will have limited time to digest the material. Thus, keeping the details to a minimum allows people to understand the presentation much better. I also learned that one should maintain silence at some point to allow the audience to reflect on the main points. This step enables nursing peers and other participants to digest the findings and establish what the new evidence means to them and their clinical practice. It also gives the speaker time to relax because a podium presentation often requires individuals to talk fast to cover all areas. In addition, I learned that one should acquire proper public speaking skills and deal with shyness and hesitation to deliver the presentation in the most effective way possible.
I will incorporate the different lessons learned about making PowerPoint and professional presentations into my project implementation presentation task. As noted in my DNP practicum form, I intend to share my project with others as a podium presentation. In this regard, I will employ the best practices learned this week to create an effective presentation. I will make the result and aggregate data as presentable as possible. In addition, I will keep the presentation short and only capture the main points because including unimportant details will distract the audience and interfere with their understanding of the most important information. I will also use visual aids to summarize the evidence and help the audience to digest the presentation easily. I further intend to incorporate the best practices learned this week into presentations beyond my project. In particular, these best practices will guide my development of future presentations at the workplace or during professional nursing events such as workshops and conferences. On this note, the insights about creating presentations will be valuable now and in the future.
Part II
Practice Question
For adult patients with a BMI of 25-30, does the implementation of the American Heart Association Recommendations for Physical Activity in Adults and Kids, compared to current practice, impact participants’ weight over 8-10 weeks?
Best Practices for Implementing Evidence-Based Practice Guidelines
Evidence-based practice (EBP) guidelines hold the key to quality care and better patient outcomes. However, clinicians must follow best practices when implementing them to guarantee success. One best practice worth applying is customizing the guideline to fit the scenario. Pereira et al. (2022) note that modifying the guidelines to suit the local context is critical. It promotes successful uptake at the clinical level. Another best practice involves identifying barriers to implementation and addressing them early to improve their success (Pereira et al., 2022). In addition, clinicians should consider resource requirements, including cost, because healthcare organizations often have limited resources. Therefore, the lack of sufficient resources will likely undermine the implementation of EBP guidelines. It is also best practice to evaluate recommendations and outcomes to assess their level of sustainability (Pereira et al., 2022). It ensures healthcare organizations only implement guidelines that they can sustain in the long term.
Strategies for Overcoming Barriers
Clinicians face different barriers when implementing EBP in their care settings. Even so, they can adopt various strategies to overcome these obstacles. First, Mathieson et al. (2018) acknowledge that training nurses about the new evidence-based intervention before its implementation improves the chances of success. Health providers should also assign roles and responsibilities to the implementation team members to promote successful adoption. Local champions also facilitate implementation and support EBP by helping overcome resistance to change. They usually articulate positive experiences and deliver useful information to nursing colleagues (Mathieson et al., 2018). Engaging all stakeholders before implementing EBP further helps recognize obstacles and tackle them. In addition, having adequate management support can assist in overcoming barriers to implementing EBP. It ensures nurses have sufficient resources and organizational assistance.
Ongoing Implementation Progress
So far, implementation is going on well. The patients have already consented to participate in this project. The initial weight measurement is also complete. The participants have also met with the staff and received instructions, including their weekly checklists, diet journals, and logs. In addition, data collection has begun, suggesting that the implementation phase is underway. The meetings with staff have been fruitful because they have helped address a few challenges. For stakeholders not involved in previous project planning meetings, the best way to transform their resistance into support is by recognizing their role and providing sufficient information about the project. They need to understand every detail, including the initiative’s value, to buy into the idea.
Formative Evaluation
The formative evaluation will gauge whether patients and staff are following the intervention. The exercise physiologist, DNP student, and dietitian will follow up on intervention implementation and ensure patients adhere to all guidelines. They will also give weekly feedback after reviewing patient logs and provide opportunities to ask questions. If a few staff have not implemented the intervention, the next step will involve trying to understand the underlying issues or concerns before taking appropriate action. For those who resist change, I will inform them about why this change is important and point out how the new intervention differs from an evidence-based perspective. I will also highlight its benefits using the positive experiences of coworkers and participating patients.
Learning About Project Implementation
I expected that project implementation would be smooth because I did everything possible to address underlying challenges. However, new obstacles arose every step of the way, causing me to go back to the drawing board. The experience has helped me to understand that project implementation is a highly dynamic process laden with multiple challenges.
Leadership Style
I employ the transformational leadership style in every circumstance.
Leadership Style Works
The leadership style works well in this situation because it supports and encourages EBP implementation. According to Guerrero et al. (2020), transformational leadership takes advantage of communication and personal strengths to shape the attitudes and behaviors of the followers. As a result, it improves nurse attitudes toward EBP implementation and pushes them to buy into the change.
The Benefits and Risks of the Leadership Style
Transformational leadership is very beneficial in dealing with current challenges. According to Chu et al. (2021), it pushes employees to achieve better outcomes by stimulating their intellect and commitment to the organizational mission. Therefore, it empowers them to solve problems whenever they arise. Transformational leadership further drives individuals towards higher performance and success (Chu et al., 2021). As a result, they will likely work harder to navigate their current challenges. One major risk of transformational leadership is that it might lead to the transfer of undesirable behaviors that might undermine EBP implementation.

Case Study Week 6 in NR-707
Use the headings below. (Use the implementation plan on your DNP Practicum Form).

Dissemination of Scholarly Work through Publication
PICOT Question
For adult patients with a BMI of 25-30, does the implementation of the American Heart Association Recommendations for Physical Activity in Adults and Kids, compared to current practice, impact participants’ weight over 8-10 weeks?
Part I
The selected journal is Frontiers, and the link for authors’ guidelines is https://www.frontiersin.org/guidelines/author-guidelines. The proposed length of the manuscript of original research is 12,000 words. The deadline for submitting manuscripts is three months. The topic of employing the American Heart Association Recommendations for Physical Activity to address obesity in children and adults is relevant to nursing practice as it seeks to improve community health by reducing the incidence of obesity.
Part II
Best Practices for the Implementation of EBP Guidelines
One of the best practices for the implementation of EBP (Evidence-based Practice) guidelines is effective communication. In many cases, EBP guidelines cannot be implemented by a single health professional. Therefore, all health practitioners involved should share their understanding of the implementation process before beginning. Similarly, effective communication should be upheld with patients if they participate in the implementation of EBP guidelines (Zdunek et al., 2021). Another best practice is exercising transparency. Transparency is necessary to eliminate concerns about the ethicality of the EBP guidelines being applied and to ensure accountability (Mathieson et al., 2019). As such, transparency is needed to enable collaboration among healthcare practitioners, which is important for the effective implementation of EBP guidelines.
Strategies for Overcoming Barriers in EBP Implementation
One of the approaches for overcoming barriers to EBP implementation is stakeholder engagement. Depending on the type of EBP, the number of relevant stakeholders may change. Nonetheless, all key stakeholders must be engaged before the process of EBP implementation begins. The purpose of engaging stakeholders is to prevent resistance to the implementation of and to ensure that each stakeholder fulfills their role (Triplett et al., 2022). Another strategy for effectively eliminating barriers to EBP implementation is seeking sufficient support from the administration (Mathieson et al., 2019). In particular, the process cannot be completed without sufficient financial, human, and infrastructural resources. Subsequently, adequate support from hospital administration is vital as it ensures that there are adequate resources to facilitate successful EBP implementation.
Formative Evaluations
Formative evaluations entail reviewing the weekly activity logs for patients. The daily activity logs are reviewed to determine whether participants are adhering to the intervention and note changes in the body weight of the patients. I am using daily communication with participants to address challenges in formative evaluations. Daily phone conversations with participants allow me to learn about the issues preventing some respondents from filling in their daily activity logs and recommend viable solutions. Feedback is provided to all participants through phone conversations each week.

Learning about Translational Science Model
I have learned that the KTA (knowledge to action) framework is effective in implementing EBP in communities. I have observed that it helps in planning the different phases of implementing EBP. However, I have also understood that the KTA framework requires a team of healthcare professionals to inform appropriate EBP implementation. Thus, it is effective only if there is a collaborative effort.
Strengths of the Translational Science Model
The key strength of the KTA framework is that it requires EBP implementation by six phases. These phases include problem identification, knowledge adaptation, evaluating challenges, employment of the intervention, intervention monitoring, and evaluating the implemented intervention (Field et al., 2014). The model works congruently with my implementation plan as it also incorporates activities such as problem identification, equipping participants with the knowledge, identifying and addressing potential barriers to EBP implementation. It also entails implementation, monitoring, and evaluation of the EBP.
DNP Implementation Updates
The leading activity for this week was reviewing the daily activity logs for respondents. The main success was that all participants filled their daily logs as required. The main challenge was that one of the respondents could not be reached for three days because of technical issues with his phone. The primary barrier noted this week was a breakdown of communication between one participant and the DNP student.

Case Study Week 7 in NR-707
Use the headings below. (Use the implementation plan on your DNP Practicum Form).

Governmental departments, public and private trusts and foundations are all demonstrating their concerted efforts of improving the education sector through provision of funding in the form of grants to schools, students and teachers for academic purposes. Therefore, this report entails a discussion of whether I have ever applied for a scholarship work grant and whether I have a project idea that currently needs grant funding since many clinical projects may be associated with barriers that can lead to unsuccessful implementation processes. Although academic grants are highly competitive and non-repayable, they are necessary in fostering the integration of best practices and overcoming barriers related to the implementation of Evidence-based practice (EBP) guidelines.
Part I
My PICOT question that will be of significant interest to my scholarship project idea is, “For adults with a BMI of 25 to 30, does the implementation of the American Heart Association Recommendations for physical activity in adults and children compared to current practice impact participants’ weight over 8 to 10 weeks”. The process of implementing such practice question has been successful to a significant extent given that there has been a steady decline in the BMIs of participants during the past few weeks. Some of successes of the project have been increased interest among participants to lose weight and social and family support to realize the efficacy of the proposal. Nevertheless, the project has also been associated with challenges such as reluctance by some participants to implement the intervention and lack of funding and capital. In this way, there is need to address these challenges to achieve the goals and objectives of the research project.
Whether I Have Ever Applied for a Scholarship Work Grant
As many students, I have undertaken certain decisions that have majorly been aimed at fulfilling my ambition of contributing positively towards the field of nursing and health sciences with an overall goal of improving the process of healthcare delivery both nationally and globally. One of such decisions was applying for two grants so that I could complete certain scholarship projects that would have led to the development of an evidence-based practice guidelines to improve the delivery of patient care in line with the goals and objectives of the Healthy People 2030 initiative. Therefore, I have in the past applied for two scholarship work grants which include Federal Pell Grant and the Studies on Ambulatory Nursing Grant. Nonetheless, due to the highly competitive nature of such grants, I did not successfully win their financial support and will be waiting years for the subsequent grant award to re-apply.
Whether I Have a Scholarship Project Idea Which Needs Grant Funding
The specific scholarship project idea which currently needs grant funding is the implementation of the American Heart Association (AHA) recommendations for physical activity with the main aim of assisting obese and overweight patients to lose weight in a primary care clinic. Through this project idea, I intend to prove that many of such forms of physical activity relate to the ambulation of the outlined patients due to their high Body Mass Indices (BMIs) (Winik & Bonham, 2018). Therefore, a successful implementation of such AHA recommendations for physical activity will largely depend on the extent to which my scholarship project is funded using grants.
Part II
As aforementioned above, my practice question that is associated with the implementation of the research project is, “For adults with a BMI of 25 to 30 (P), does the implementation of the American Heart Association Recommendations for physical activity (I) in adults and children compared to current practice (C) impact participants’ weight (O) over 8 to 10 weeks (T). To successfully answer such practice question, a better understanding of the process of the project’s implementation, its successes and barriers is necessary.
The Best Practices for the Implementation of Evidence-Based Practice Guidelines
There are a wide range of best practices that are necessary for a successful implementation of evidence-based practice guidelines. However, some of such practices that are essential for implementing the EBP guidelines addressing the project question stated above include understanding of the collected data and establishment of patient centered goals. For the above question, it will be necessary to comprehend the collected findings related to the participants’ weight over an 8 to 10 week period in order to determine whether the AHA recommendations for physical activity are effective in the management of obesity (Burke et al., 2019). Contrarily, it will also be important to establish patient centered goals given that the participants will be focusing on realizing the effectiveness of such recommendations in improving the quality of their life through decreasing their BMIs (Burke et al., 2019). Resultantly, an effective implementation of the AHA recommendations for physical activity in the management of obesity will largely depend on realization of a BMI of less than 25kg/m2 by the participants.
The Strategies for Overcoming Barriers in the Implementation of Evidence-Based Practice
There are various strategies that can be used to overcome barriers associated with the implementation of EBP guidelines addressing a specific practice question. However, one of the most effective strategies for the practice question stated above is critically appraising the existing evidence related to a specific practice question (Boustani et al., 2018). In doing so, it is possible to determine its feasibility in creating EBP guidelines that can lead to improved clinical practice (Boustani et al., 2018). Another most effective strategy for overcoming barriers associated with the process of implementing the EBP guidelines addressing the aforementioned practice question is communication with the involved parties (Boustani et al., 2018). It will be necessary to communicate with both clinicians and obese patients to improve their willingness to initiate a change process through implementing the AHA recommendations for physical activity (Boustani et al., 2018). In this manner, communication will be central in improving the making of clinical decisions and avoiding stakeholders’ conflicts that may be realized during the implementation of such recommendations as EBP guidelines.
Formative Evaluations: How I am Addressing Challenges and Providing Feedback
Clearly, the process of implementing the EBP guidelines associated with the aforementioned practice questions has not been without challenges. However, I am addressing challenges such as reluctance to implement change, poor communication and lack of human resources among others through integrating of clinical evidence on the effectiveness of AHA recommendations of physical activity against obesity from an intensive research process with clinicians and patients (Burke et al., 2019). In this way, it is possible to improve their understanding of the possibility of such EBP guidelines in managing obesity effectively and mitigate their risk of resistance to change. Contrarily, I am providing feedback related to the effectiveness of such EBP guidelines by sharing credible and accurate data related to changes in the BMI of the patients over a period of weeks following the implementation of the AHA recommendations for physical activity (Boustani et al., 2018). Resultantly, it has been possible to evaluate whether the outcome of the research project will be positive.
Provision of Education to Stakeholders
Stakeholders’ education is undoubtedly necessary in realizing their full support towards the implementation process of any EBP guidelines related to a specific practice question. Therefore, to provide stakeholders’ education at this point, I would not only listen to their opinions and feedbacks regarding the feasibility of the research project but also foster constant communication with them to create a comfortable environment for change initiative (Bahadorestani et al., 2020). Through such strategies, it will be possible to reduce the risk of stakeholders’ conflicts that may lead to withdrawal of their strategic and financial support from the project.
What I Have Learnt about My Project
What I have learnt about my project during the 8-week course is that there is much support from relevant stakeholders such as clinicians and patients to clinical projects that are aimed at improving the healthcare sector through preventative measures. Therefore, the fact that my project not only aims at improving the quality of life of obese patients but also decreasing their risk of chronic illnesses has enabled it to gain much stakeholder support which has significantly contributed to its successful implementation process (Akhtar & Irfan, 2021). I believe that I am indeed learning what I expected which is the management of chronic illnesses related to obesity through implementation of AHA recommendations of physical activity. Consequently, I am learning that the reduction of hospitalization rates of obese patient due to chronic diseases such as diabetes and hypertension can best be realized through effective management of their BMIs.
Conclusion
To conclude, academic grants are very important in promoting the integration of best practices and overcoming barriers during the implementation of EBP guidelines even though they are mostly competitive but non-repayable. I have indeed applied for a scholarship work grants in the past but unsuccessfully failed to win such financial awards. Nonetheless, I believe that the value of my current research project on the implementation of AHA recommendations on physical activity to facilitate weight loss among obese and overweight patients is significant and will certainly be considered for a grant funding. Consequently, through proper funding using academic grants, I will not only address challenges associated with its implementation processes but also provide feedback necessary for the realization of its goals and objectives.

Case Study Week 8 in NR-707
Use the headings below. (Use the implementation plan on your DNP Practicum Form).

• Practice Question in PICOT Format
“For adult patients with a BMI of between 25 and 30 kg/m2, does the implementation of the American Heart Association (AHA) recommendations for physical activity in adults and children compared to practice impact participants’ weight over 8 to 10 weeks?

• Discuss best practices for implementing evidence-based practice guidelines with references sufficient to support best practice.
In order to implement the best practices we should start by identifying an evidence-based practice model that will support with the health care structure structure involving its objective. For nurses and nurse practitioners is essential to implement evidence-based practice in clinical practice. This is achieved by using research findings on obesity management, guidelines for weight loss, medical weight loss protocols and opinion by experts that will include physicians and nutritionist counsel. In order to support the intervention in my PICOT question. I would have to use the latest research on obesity. The newest guidelines and weight loss protocols developed by experts. Consulting with a nutritionist can also help developing the appropriate diet and calories control to develop the intervention plan (Dagne,2021).

• Discuss strategies for overcoming barriers in implementing evidence-based practice with references sufficient to support strategies.
In order to overcome the barriers affecting the implementation, we need to provide training and education to all the participants on the DNP project. The organization personnel , the staff in charge of the patients should be also included in this education. The lack of experience and knowledge and skill to make use of evidence like research conclusions, unproper management of time, absence of motivation, the absence of funds and resources as well as unproper training were the observed barriers to the implementation of evidence-based practice (Jaafar, 2019).

The first step to overcoming barriers to EBP is assessing and identifying the obstacles to evidence-based care. Insight into the obstacles that exist in delivering evidence-based care will frequently pave the way for an action plan that yields success. For example, surveys or focus groups (i.e., group discussions that facilitate open communication) can be held in an organization to determine nurses’ knowledge, attitudes, and beliefs about EBP as well as challenges in implementing evidence-based care (Jaafar, 2019).

If we provide enough education and training, this could be a very efficient way to overcome barriers toward the application of evidence-based practice interventions. The use of transparency with all the participants involved in the project is also another way to overcome these barriers. We also need to consider the participants interest and demands since this will most likely allow us to implement our project without interruption (Williams, et al., 2022).

• Discuss your formative evaluations. How are you addressing challenges and providing feedback?
Formative evaluation is typically started early on in the development of the program to advise the workers and stakeholders about the trends in the outcomes, whether the goals of the plan are expected to be accomplished, and to recognize the difficulties and obstacles and facilitators of implementation. Findings of the formative evaluation are then integrated into the program with the required modifications done to improve program implementation (Morris,2021).

In order to provide intervention fidelity, the DNP project manager, aided by the nurse champions involved in the project, will maintain to carry out decisive appraisals at least two times per week, usually Wednesdays and Fridays. Findings from the assessment will lead subsequent steps in the implementation of the project. We will also use a compliance checklist during this assessment and evaluation to verify the staff’s knowledge of the implementation process. Any questions or challenges produced will be given appropriate advice and feedback with the goal of improvement. Reviewing objectives and adapting to further adjustment will be applied as needed (Morris,2021).

• Describe your sustainability plan:
The sustainability plan explains the different characteristics in which the project has to be continued in the long run to still operate. The sustainability plan brings out how the DNP project will continue in the long term. It does make sure that reserves used on the project are not wasted unappropriated. We will meet with the participants and provide support and awareness, positive persuasion and reinforcement, offering evidence of success rates, and assistance from organization and administrative leaders. I will offer education on the ways to effectively execute this intervention and guarantee reliability using the whiteboard, assuring participation on every day groups meetings, and rounding (Presseau, 2017).

Discuss how the stakeholders will maintain intervention fidelity moving forward.
Consideration to intervention fidelity is a vital element in study design and implementation. Well-trained interventionists are less prone to deviate from the intervention protocols. The participants will keep intervention fidelity in a style like mine. They will cooperate with the nurses and answer issues and questions that arise. I will also be accessible by phone or email to reply to questions or issues that may arise during the 8 weeks length of the project. The champions will also be checking the whiteboard in the breakroom for opinions from the nurses. They will also go on twice at week debates and updates at the beginning of turn huddles (Esteban‐Sepúlveda,2020).

Are champions appointed to assure sustainability?
Champions encourage new ideas for change, supporting the vision and motivating others to communicate in this experience is the role of a champion . As a DNP student the aim of my project is to be active member within the change management project during all its stages. Champions are crucial to the completion of a project’s intervention and to ensure sustainability, and are consequently chosen for these responsibilities. With proper and developing competence and capacity, champions will encourage the sustainability and spread of a project’s involvement outcome and its improvement (Camargo,2018).

Does the site plan to implement this project on other units?
Once that the other practice managers and administrators have been notified about the accomplishment of this intervention in decreasing obesity in the primary care setting. I will got emails from them asking about the procedure and how to execute this intervention on their own primary care clinics. The managers will be also amazed with the findings of my DNP project using the AHA guidelies on the patients with a BMI greater than 30 and have agreed to support any unit that wants to initiate this interventions for their obese population (Camargo,2018).

Are there required changes to the technology to sustain your project? If so, how will your champions advocate for these changes?
The equipment required for the implementation of my DNP project is a cellphone, mainly the mobile phone, the text messaging system, and internet access to use the website and resources. There are no necessary modifications to the technology to sustain my project at this time. Nevertheless, should the requirement for technical change arise at any time, champions will support for these changes. The project champion is a strong speaker and advocate of completing the project by consulting, safeguarding, and encouraging for change with the proper personnel such as technology alterations to sustain the project (Bonar,2020).

Describe how your project will become the new standard of care and include how the data may be used to inform health care policy for this unit.
Confidently, the data obtained after the 8 weeks implementation of the project will be used to show how the general health status for the obese patients has increased with the project implementation. When the data has been examined and debated with the clinical team and stakeholders, a Protocol and health Policy will be created to be officially a part of the clinic’s routine act of care in patients looking for weight loss (Kahan,2018).

What changes do you believe would be needed at the micro, meso, and macro systems levels to ensure this project’s continuation?
At the micro-level, patients should have decreased body weight, improved quality of life, and improvement of comorbidities such as diabetes and hypertension. At the meso-level, nursing practice will improve the quality of care and instill patient-provider trust. And the macro level, the organization will be aligned with the goals, mission, and vision of the AHA American Heart Association to decrease the prevalence of obesity by developing an effective weight loss plan (Kahan,2018).

•How will you plan to disseminate your project outcomes?
Once the data obtained after the 8 weeks implementation of the project is analyzed and evaluated for effectiveness , then a dissemination objective and the audience are identified, there are a variety of ways to share the developed content. Regular and ongoing contact with program partners and community members within the service area can support dissemination of messages. We can also publish project findings in national journals and statewide publications such as The Journal of the American Academy of Nurse Practitioners. We can also present at national and state conferences and meetings with professional organizations like the American Academy of Nurse Practitioners. Creating and distributing program materials, such as flyers, guides, pamphlets and DVDs. Sharing information through social media such as facebook, Instagram and even tik tok which has been very efficient , we can also publish a post on an organization’s website (Williams,2022).

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Implementation of the American Heart Association Recommendations for Physical Activity in Adults and Kids to Assist Obese and Overweight Adult Patients in Losing Weight in a Primary Care Clinic

Leonard Einstein
Chamberlain College of Nursing
Contents
Problem 4
Considerations and Challenges for Implementation 7
Outcomes 8
Practice Question 11
Literature Synthesis (DONE IN NR 705) 11
Purpose 14
Evidence-Based Intervention 15
Week 1 15
Week 2 16
Week 3 17
Weeks 4 to 8 17
Week 9 17
Week 10 18
Translational Science Model 18
Organizational Setting 20
Population Description 20
Considerations and Challenges for Implementation 21
Outcomes 22
Data Management Plan 24
Project Management Plan and Gantt Chart 26
Proposed Budget 27
Results 29
Discussion 31
Recommendations 32
Conclusions and Implications for Nursing Practice 32
Plans for Sustainability 33
Appendix A: Project Schedule 39
Appendix B: Data Collection Tool for Evaluation (24 Hour Dietary Recall) 44
Appendix D: Weekly Physical Activity Report 48
Appendix E: Practicum Site Approval Letter 49
Appendix F: INFORMED CONSENT FORM 50
Appendix G: Plan for Educational Offering 56

Implementation of the American Heart Association Recommendations for Physical Activity in Adults and Kids to Assist Obese and Overweight Adult Patients in Losing Weight in a Primary Care Clinic
A patient’s weight loss and maintaining it should never be considered the primary metric of success in treating and managing obesity and weight gain. Instead, healthcare professionals should focus on supporting and encouraging their patients to incorporate and make sustainable improvements in their physical activity routines and improve the quality of their diet if the behaviors do not meet the national guidelines. These lifestyle changes are essential for long-term weight gain and obesity management and are likely to improve patients’ health even without significant weight loss (Carbone et al., 2019). Obesity and overweight are significantly associated with excess adiposity in about two-thirds of the American population, where obesity alone has a prevalence rate of 39.5% (37.9% in men and 41.1% in women), while severe obesity accounts for 7.7% (5.6% in men and 9.7% in women). What distinguishes obesity from being overweight is a factor that incorporates height and weight, referred to as the Body Mass Index (BMI). In essence, a BMI below 25 kg/m2 is normal, between 25 kg/m2and 30 kg/m2 is described as overweight, while a BMI equal to or greater than 30 kg/m2 is classified as obese (Mehta et al., 2019). Therefore, obesity mainly affects women in the US. However, the increased obesity rates observed over the last decades concern the healthcare sector due to the increased risk of cardiovascular disease correlated with increased adiposity, which results in unacceptable costs to manage healthcare and a diminished quality of life.
The purpose of this DNP project is to help patients adopt the AHA diet and physical activity recommendations to manage and mitigate weight gain to reduce the risk of mortality, morbidity, and cardiovascular disease attributed to high BMI. Studies focusing on weight loss proved the success of lifestyle changes, such as dietary changes, implying the intake of healthier foods, and adopting an exercise routine. The project entails using lifestyle changes as an intervention to improve healthcare by cutting weight to manage and reverse obesity and overweight. Lifestyle changes are cost-effective strategies for patients to adopt to address weight issues.
The planned intervention consists of implementing physical activities and dietary recommendations of the American Heart Association (AHA) to reduce participants’ weight. AHA guidelines are nationally approved recommendations for maintaining good health that propose diet and physical activity to achieve a healthy lifestyle. AHA has recommended the intake of healthy foods, including vegetables and fruits, white meat, and avoiding red meat for beneficial diet improvements. Additionally, the guidelines suggest incorporating at least 150 minutes of weekly physical exercise, two days of high-intensity muscle strengthening, and avoiding extended sitting hours (AHA, 2018; Powell-Wiley et al., 2021). According to AHA (2018), failing to adopt these guidelines increases the likelihood of gaining weight, contributing to obesity and being overweight. Therefore, Semlitsch et al. (2019) highlight that a BMI growth of approximately two percentage points cuts life expectancy by almost a year. For this reason, adopting the intervention is crucial to achieving weight loss. This paper explains the problem, practice question, literature review, purpose, evidence-based intervention, translational mode, practice setting, population, considerations and challenges, outcomes, data management plan, project management plan and Gantt chart, proposed budget, ethical issues, results, discussions, and recommendations.
Problem
Gaining weight and ultimately becoming overweight and obese is common even with the delineated AHA guidelines and recommendations for exercise and diet. Semlitsch et al. (2019) postulate that the mean body mass index of 22 kg/m2 increased to 24 kg/m2 between 1975 and 2014, with symmetric increases in BMI in both men (3.2-10.8%) and women (6.4-14.9%). The trend of an increasing prevalence of obesity and overweight in the US is a significant problem. Specifically, a BMI greater than 25 kg/m2 is associated with increased cardiovascular diseases, diabetes, increased morbidity and mortality, and sleep disorders (Banack et al., 2018; Carbone et al., 2019; Kivimäki et al., 2018; Powell-Wiley et al., 2021; Semlitsch et al., 2019). Since weight gain leads to overweight and obesity and harms an individual’s well-being, it is vital to implement interventions that call for lifestyle changes to manage, control, and mitigate increasing adiposity.
Being overweight strains the average American’s health status, productivity, and healthcare costs. Adults with extra weight are more susceptible to complications of multiple organs and an increased risk of developing heart disease, cancer, stroke, and diabetes. Additionally, excess weight is associated with higher medical costs to manage and treat the condition. Cawley et al. (2021) reported that medical expenses to address overweight and obesity doubled in the last two decades, from $124.2 billion to $260.6 billion. Moreover, medical expenses for an overweight individual are approximately $1,429 or 42% higher than those who are not overweight (Petersen et al., 2020). Considering these data, obesity and weight gain issues must be addressed to reduce the prevalence of being overweight in the US. The problem is the increase in overweight cases in the primary care clinic, with more than 50% of overweight patients. Although nurses provide exercise and diet handouts as part of discharge education, there is no formalized program to assist the patients.
Obesity leads to excessive health expenditures and imposes high costs on the economy due to lost productivity and limiting a country’s economic growth both at the state and national levels. Essentially, the costs are due to increased mortality and morbidity, decreased productivity and performance among workers, and lost days attributed to absenteeism (Chaudhry, 2020). Compared to people of average weight, obesity increases job absenteeism by up to 3.00 workdays, specifically from 2.34 to 5.34 days at a national level, signifying an increase of 128.2%. Essentially, excessive weight on absenteeism is directly correlated with a rise in the class of obesity. For instance, according to Cawley et al. (2021), compared to ordinary weight people, the national level of absenteeism at work was significantly higher by approximately 7.13 days for persons with class 3 obesity, 2.07 days for individuals with class 1 obesity, and 3.67 days for people with class 2 obesity. Statistics illustrate a similar analysis at the state level. For example, Cawley et al. (2021) found that obesity increases absenteeism by approximately 2.45 workdays in California, 2.82 workdays in Texas, 2.73 days in Virginia, and 2.86 days in Wisconsin. Moreover, absenteeism increases with the class of obesity. Cawley et al. (2021) highlighted that the annual productivity loss per employee due to obesity, assuming that half a day was lost, was between $270.79 and $541.58 nationally. Similar casualties were reported at the state level, with lower and upper loss limits ranging from $293-$586 in Virginia, $221-443 in California, $255-510 in Wisconsin, and $228-456 in Texas. According to Cawley et al. (2021), Michigan reported the highest losses based on individual productivity compared to the other states, between $911 and $1823. For this reason, the objective is to curb obesity both nationally and in individual states to reduce national and state losses owing to decreased productivity as a result of obesity. Essentially, this will help reduce the costs attributed to obesity management and productivity loss.
Therefore, it is necessary to curb weight gain for better health in the national and state population. Ensuring that people follow the AHA guidelines on diet and physical exercise would be easier to manage weight. Therefore, in the local clinic, it is essential to guide overweight and obese patients to adopt such a routine, as over 50% of patients with overweight and obesity do not have an exercise routine or a strict diet. Adopting these guidelines can be essential to managing the condition. Ethical considerations when addressing the issue include being aware of the physical health and psychosocial well-being of the people involved in the intervention while ensuring their confidentiality. Legally, the people must provide informed consent to participate in the study. The safety of the exercises adopted for physical activity is vital to avoid injury. The success of the intervention is based on the quality of diet and physical activities adopted for weight management.
The project has significance in nursing care, nurses, and healthcare organizations in that the interventions can be adopted to curb issues of overweight and obesity. Essentially, the intervention can be used as a preventive measure to help curb issues with obesity and overweight among the US adult population. Besides, nurses can recommend the intervention to address issues of obesity, which will help patients with increased adiposity complications including heart conditions and diabetes to revert or mitigate weight gain. Nurses can recommend the intervention to all patients to help maintain a healthy weight. In effect, the overall improvement of weight in the adult population will be essential in reducing the skyrocketing patients with complications of weight, thereby giving healthcare organizations an edge towards overall health, longevity, improvement of quality of life, and reduce human suffering due to obesity and overweight.
Considerations and Challenges for Implementation
The potential facilitators include the fact that it is feasible for the participants to lose weight over eight to ten weeks. The project is feasible since the tools for conducting the DNP project are free and easily available. The ten weeks are viable to collect enough data for analysis. The nursing staff is not resistant to change due to the setting’s adoption of new methodologies of dealing with patients and treating diseases. In addition, nurses always capitalize on evidence-based practices to better the welfare of patients. For instance, nurses have adopted various mechanisms to deal with falls among the elderly, including using rough instead of slippery floors, as well as the inclusion of family members in taking care of the needs of patients, which has proven to be effective in clinical settings. However, there are potential challenges that might hamper the implementation of the DNP project, and these are the challenges that may be faced while implementing the project. Possible challenges include the unwillingness of participants to fully commit to the study. However, to overcome this challenge, family support and frequent communication will be essential in encouraging full participation and commitment to the AHA guidelines. The staff may be resistant to the additional workload but will be reminded of the purpose of the project and to celebrate the participants’ small wins.
Outcomes
To determine the impact of the intervention, which in this project pertains to physical activity and dietary changes to manage the weight of the participants, it is necessary to track such data in the ten weeks of implementation. This DNP project aims to assist overweight participants in losing weight by following the American Heart Association Dietary and Physical Activity Guidelines. Essentially, researchers have proved through evidence-based practice that these interventions are essential in reducing adiposity, weight gain, and improving health, as well as reducing predisposition to illnesses such as diabetes, hypertension, and strong and heart conditions (Koliaki et al., 2018; Oh et al., 2018). The DNP student will use The Knowledge-To-Action (KTA) Framework for this translational science project (Field et al., 2014). Adopting these interventions will be essential in addressing the issue of overweight and obesity, which is associated with a myriad of diseases, including heart diseases, diabetes, stroke, and hypertension, along with a loss to economic development as funds are directed towards dealing with health issues. For data collection, each participant’s weight will be obtained in week one and week ten of the implementation. Process compliance will be determined by the completion of chart audits of EMR and the compliance checklist. The AHA guidelines are freely available and therefore, no permission will be required for use.
Two weeks before the implementation of the interventions, the DNP student will meet with the interdisciplinary team and provide information regarding the project. The primary healthcare organization has agreed to the work hours needed by the dietitian and exercise physiologist to meet with the participants and conduct follow-up calls with each participant. The program results will be submitted to manage care as part of the practice’s quality outcomes as weight loss is considered a measurable outcome of the managed care insurance provider.
For data collection, the DNP student will follow a well-laid plan for collecting data from weeks one through ten. In the first week, the staff at the local hospital will be informed of the project and subsequently be provided with the American Heart Association Dietary and Physical Activity Guidelines (AHA, 2018). These guidelines are the basis for the intervention. Therefore, the staff, as well as the participants, should get acquainted to adopt the guidelines early enough into the project. Therefore, the team will be essential in assisting the DNP student to implement the interventions. Besides, the staff will be crucial in the identification of any potential participants since nurses care for patients and can invite the patients to enroll in the project. The participants have to accept to participate in the project. Therefore, the participants will all need to sign an informed consent form on appendix F before participating in the program. However, the participants will also have to meet the inclusion criteria to participate in the study. There are well-laid inclusion and exclusion criteria that participants will have to meet to be eligible to participate. This is described in the population section.
To adopt the interventions, each selected participant will meet with the dietitian and the exercise physiologist for a one-hour office visit to receive individual diet and exercise plans. The DNP student will weigh the participants. Each participant will be provided with the American Heart Association Dietary and Physical Activity Guidelines and logbooks. Essentially, this is essential since the participants have to get acquainted and comply with the guidelines and toget accurate results. In addition, the participants will be asked to log their daily food intake, exercise, and weight.
In weeks two through nine, the participants will actively be involved in adopting and observing the AHA dietary and physical activity guidelines. Participants will be required to log their daily food intake, exercise, and weight each morning in the logbook. The DNP student, dietitian, and exercise physiologist will call participants each week to review their logs, provide support, and answer questions. In essence, this is important, as it will allow for easy follow-up, and ensure that the participants are constantly updating their logs so that it would be easier to track the success of the intervention. The data collected during the call will then be entered into the electronic medical record. The DNP student will develop a compliance checklist to document calls, and complete chart audits weekly for formative evaluation. All data will be redacted to protect the privacy of participants, especially for health interventions requiring lifestyle alterations (Hickey et al., 2019). In essence, confidentiality is important for this project and participant anonymity will be upheld in all project aspects and intervention implementation. Each week, the DNP student will send out a group text of encouragement to the participants. The interdisciplinary team will meet each week to review the participants’ progress. If a participant does not respond to the call, the DNP student will try to contact that participant.
In the last week, week ten, patients will return to the clinic for weight measurement. Weight changes will be determined for each participant. With the help of a statistician, the data analysis will be completed. This is an important week since the data will be summed up and ready to be analyzed. The measurable outcomes will be weight loss and compliance with the process of adhering to the AHA guidelines. For weight loss, each participant’s weight will be obtained in week one and week ten and recorded on a spreadsheet. On the other hand, for compliance with AHA guidelines, data from the compliance checklist will be entered on a spreadsheet with all information redacted. All the activities of each week are indicated on appendix A, and the checklists are on appendix D.
Practice Question
The following practice question will serve as the basis for the proposed DNP project: For adult patients with a BMI of 25-30, does the implementation of the American Heart Association Recommendations for Physical Activity in Adults and Kids, compared to current practice, impact participants’ weight over 8-10 weeks?
Literature Synthesis (DONE IN NR 705)
The American Heart Association (AHA) mainly concentrates on reducing factors that would otherwise increase risk to stroke and heart diseases by highlighting a combination of physical activity and dietary guidelines. Adopting these AHA recommendations help improve cardiovascular health among Americans, and reduces morbidity and mortality rates associated with cardiovascular conditions and stroke by approximately 20% (Piercy & Troiano, 2018). According to Piercy and Troiano (2018), physical activity is characterized by positive impact on several factors that could be endangered by overweight and obesity, including blood pressure, body weight, and blood glucose, in addition to minimizing risk of cardiovascular disease mortality and incidence. The physical activity guidelines were based on the work of 17 member advisory committee after a review of various studies. The recommendation was at least 150-3000 minutes of moderate intensity aerobic physical exercises on a weekly basis or a 75-150 minute intensive workout. The intensity is measured in a variety of ways but AHA recommends that during moderate intensity exercise, an individual is capable of talking but not singing while a person performing high intensity exercise is unable to say a few words without pausing to take a breath. Also, the AHA recommends that adults should engage in muscle strengthening exercises that involve the major muscle groups for at least two days on a weekly basis. Adopting the physical activity guidelines yields numerous benefits including decreased incidence of hypertension diabetes mellitus and cardiovascular diseases (stroke and heart failure), weight loss, and reduced blood pressure. Besides, the AHA recommends adopting a dietary routine that involves healthy foods such as fruits and vegetables, as well as high quality carbohydrates and fats. Therefore, adopting both diet and exercise interventions would be essential in managing weight gain, and significantly help in weight loss for people who are either obese or overweight.
Physical activity and diet modification are essential in controlling obesity and overweight. Syngelaki, et al. (2019) conducted a systematic review and metanalysis of randomized controlled trials (RCTs) with the aim of investigating the impact of diet and exercise as interventions in obese or overweight women who were pregnant on the risk of preeclampsia and hypertensive disorders. Syngelaki et al. (2019) found 23 eligible trials involving 7236 participants, including 11 that involved 5,023 participants investigating the impact of diet and three, involving 387 participants looking into the impact of exercise on preeclampsia risk. 14 of the studies entailing 4,345 participants investigated the effect of diet and five involving 884 participants looking into the impact of exercise, as well as one that involved 304 participants investigating the impact of diet and exercise in mitigating disorders involving hypertension. Among women randomized to diet and exercise, the researchers found that there was no significant risk of preeclampsia or hypertensive disorders correlated with pregnancy. Specifically, in the intervention group, where exercise and diet were applied to reduce weight gain, gestational weight gain was lower. The researchers concluded that exercise and diet in obese or overweight pregnant women was significantly beneficial in reduction of gestational weight gain. As such, this evidences the need or incorporating physical activity and exercise as means for controlling weight gain. Thereby helping alleviate obesity and being overweight.
In yet another study, adoption of exercise routines and dietary interventions was essential in weight management. Oh et al. (2018) conducted a randomized controlled study examining the impact of alternate day calorie restriction (ADCR) and exercise on cardio-metabolic risks among 45 adults who were overweight and obese. The 45 adults who were obese or overweight were also healthy, with 26 being female and 19 males and aged between 32 and 40 years. The 45 participants were subdivided into four groups: (i) ADCR (13), exercise (10), ADCR plus exercise (12), and control group (10) and the study took eight weeks. Oh et al. (2018) used the intention to treat methodology to analyze the randomized participants. 35 of the participants completed the study. The researchers reduced the body weight, body mass index (BMI), waist circumference, and body fat percentage in the ADCT plus exercise group. From the trial, Oh et al. (2018) found a decrease in insulin resistance in the ADCR plus exercise group only. Essentially, eight weeks with a combination of ADCR and exercise was effective in changing body composition, resistance to insulin, body weight, as well as improvement of triglyceride and low-density lipoprotein cholesterol. As such, the study revealed that combining exercise and adopting a healthier diet is essential in managing weight among obese or overweight adults. The intervention worked to improve the health status of the obese and overweight participants, which implies that the intervention can be applied for those who are overweight and obese to effectively manage their weight over time.
Diet is an essential component of managing weight gain. Koliaki et al. (2018) conducted a mini-review to provide principles and recommendations for diet management for individuals with obesity and coming up with an optimal intervention with diet changes as the main consideration. From themeta analysis, the researchers found that energy intake plays a huge role in gain weight, and the most effective strategy of achieving weight-loss in the long-term and viable cardiometabolic health is by shifting to healthier dietary patters. Kioliaki et al. (2018) suggested restrictions in added sugars, refined grains, as well as highly processed foods while instead including vegetables, fruits, whole grains, as well as low-fat dairy products. Besides, the researchers suggested that combining healthy diets with intensive education, behavior modification, and motivation would best yield steady weight loss. Furthermore, Kioliaki et al. (2018) recommended setting goals by adopting continuous but easy to comply with dietary pattern, including taking high quality fats and carbs. Therefore, a combination of these factors would be useful in promoting weight loss, as well as prevention of heart diseases and diabetes.
In conclusion, the dietary and physical exercise combination is an effective mediation for weight loss. These measures can be crafted as an intervention for managing weight. The intervention is essential since it can help adopt a healthy lifestyle. In effect, adopting the intervention could be essential in curbing mortality and morbidity caused by lifestyle diseases, as well as maintaining a healthy population. By adopting such intervention, the incidence of cardiovascular diseases and type two diabetes, which would otherwise be high among individuals who are obese and overweight.
Purpose
This aim of the DNP project is helping participants who have weight issues, including overweight and obesity conditions, to lose weight by closely following the American Heart Association Dietary and Physical Activity Guidelines. The objectives of the project include:
• To determine and establish physical activity levels for participants with overweight and obesity conditions.
• To assess the correlation of physical activity and diet with weight issues of obesity and overweight.
• To determine and establish dietary patterns for participants with overweight and obesity conditions.
• To propose and implement dietary and physical activity recommendations based on American Heart Association’s (AHA) guidelines
Evidence-Based Intervention
In collecting the data, the DNP student has incorporated a strategy for evidence-based intervention, which will facilitate the process from week one to ten. Most importantly, the DNP student will have to closely work with the staff at the local clinic, as well as the patients that will be recruited as participants in the study. The recruitment process will adhere to the inclusion and exclusion criteria highlighted in the population section of the DNP project. In addition, the intervention will be correlated with the American Heart Association Dietary and Physical Activity Guidelines. Besides, the case study will be implemented only after the approval of the Chamberlain University Institution Review Board (IRB). Therefore, the case study will comply with ethical requirements.
Week 1
In the first week, the staff at the local clinic will be informed of the project and what it entails. The intervention procedure, as well as the American Heart Association Dietary and Physical Activity Guidelines will be provided. In essence, the participants will have to be acquainted with the intervention guidelines. The guidelines are the basis for the intervention, and therefore, the staff, as well as the participants needs to get familiarized with the guidelines before the start of the project. Importantly, the staff at the local clinic will be indispensable in the implementation of the interventions. During the first week, the clinic’s top management will be approached and informed about the project, the need to recruit participants the significance of the project to nurses, the nursing profession, and healthcare organizations as a whole. After acceptance by the top management to conduct the project, the nursing staff will also be approached, and informed about the project, and their purpose in implementing the project. The staff will be crucial in identifying potential participants to facilitate collaborative efforts. Besides, the participants have to accept to participate. To guarantee that, the participants will have to sign an informed consent form, which provides evidence that no one will be coerced to participate. The participants have to meet all the criteria for inclusion in the study, which shows their eligibility to be included as participants.
The DNP student will also identify a dietician and an exercise physiologist to help in the adoption of the AHA guidelines for physical activity and diet. In essence, to adopt the interventions, each of the selected participants will have to meet with the dietitian and the exercise physiologist for a one-hour office visit to receive individual diet and exercise plans. In these sessions, the DNP student will assist in weighing the participants. Furthermore, to ensure that the participants have absolute knowledge about the interventions, each participant will be provided with the AHA Guidelines and logbooks that will be used for keying in information about the progress of the intervention. Essentially, this is essential since the participants have to get acquainted with the guidelines and how to properly comply with the guidelines for accurate results. The participants will be asked to log their daily food intake, exercise, and weight.
Week 2
In week two, the participants will be involved in actively adopting and observing the AHA dietary and physical activity guidelines. Participants will be required to log their daily food intake, exercise, and weight each morning in the logbook. The DNP student, dietitian, and exercise physiologist will call participants each week to review their logs, provide support, and answer questions. In essence, this is important, as it will allow for easy follow-up, and ensure that the participants are constantly updating their logs so that it would be easier to track the success of the intervention. The data collected during the call will then be entered into the electronic medical record. The DNP student will develop a compliance checklist to document calls, and complete chart audits weekly for formative evaluation.
Data confidentiality is essential for the project. All data will be redacted to protect the privacy of participants, especially for health interventions requiring lifestyle alterations. In essence, confidentiality is important for this project and participant anonymity will be upheld in all project aspects and intervention implementation. Each week, the DNP student will send out a group text of encouragement to the participants. The interdisciplinary team will meet each week to review the participants’ progress. If a participant does not respond to the call, the DNP student will conduct follow-up to reestablish a connection with that participant.
Week 3
In week three, the participants will also actively be involved in adopting the guidelines. The participants will be called to ensure strict compliance with the guidelines. In addition, participants will be asked and reminded to fill in their weight at the end of the week. As such, the participants will have to update the logs and fill in the checklist that shows that the participants are following the diet recommendations and physical activity guidelines.
Weeks 4 to 8
In weeks four through eight, the participants will also actively be involved in adopting the guidelines. The participants will have to fill out the checklist and will be called to ensure compliance with the guidelines. In addition, participants will be asked and reminded to fill in their weight at the end of the week. As such, participants will have to update the logs. In both weeks four and eight, the participants will have to visit the clinic to verify their weight recordings and monitor compliance with the AHA guidelines.
Week 9
In week nine, the participants will record their weight and also fill in the checklist. In addition, the statistician will be involved in verifying the accuracy of the data recordings and any corrections done to ensure that the data is accurate.
Week 10
In week ten, the last week of the project, participants will return to the clinic for weight measurement. The statistician will verify and record the final weight change of each participant. The statistician will compile the weight data and start the data analysis process. This week is crucial for the project since all data will be verified, summed, and recorded for analysis. The data collection tools are on appendix B.
Translational Science Model
Translational science frameworks provide a direction for implementing DNP evidence-based practice changes. The specific framework that will be applied in this project is the Knowledge to Action (KTA) framework, developed by Dr. Ian Graham & colleagues in 2006 (Xu et al., 2020). The KTA framework consists of two components: (a) knowledge creation and (b) action cycle (Boscart et al., 2020; Esmail et al., 2021). Each of these components is made of several phases that overlap and are iterative. The action phases are typically carried out simultaneously or sequentially. The knowledge phases entail adapting knowledge to local contexts while also addressing challenges and facilitators. Importantly, stakeholder involvement is crucial; which highlights how the project’s acquired knowledge can be tailored to the specific needs of the population (Heckman et al., 2022). Based on these phases, the KTA framework can be broken down into seven stages that focus on stakeholder involvement, engagement, leadership, and managing change. These seven phases will provide the blueprint for implementing this DNP project.
The first phase involves the identification of the problem. In the DNP project, the practice problem includes the growing rates of overweight and obesity in a local clinic located in South Florida. The primary care clinic specializes in weight loss and primary care. The setting has ten nurses and two physicians whose roles include assessing patients, diagnosing diseases, and treating diseases. The setting also has case managers who implement patient follow-ups. The primary issue in this setting is the increased rates of obesity. The second phase of the KTA framework is the adaptation of the knowledge into the local context. The current DNP practice that falls within this phase is educating healthcare facilities and staff on the global threat of obesity and overweight on the population since it predisposes overweight and obese people to heart conditions and diabetes, which potentially increase the morbidity and mortality of the population. In this phase, participants in the study will be introduced to American Heart Association’s (AHA) physical activity and dietary recommendations as the intervention (AHA, 218). The third phase entails assessing challenges that could include practice behaviors and not adhering to the AHA recommendations but can be addressed by ensuring proper education of the participants using the teaching plan on appendix G along with weekly follow-ups.
The fourth stage entails the implementation of the proposed intervention, by specifically focusing on adhering to the AHA recommendations and weight changes over the intervention period culminating in strictly following the AHA guidelines for diet and physical activity. Essentially, the researchers have proven that exercise and diet in obese or overweight individuals are significantly beneficial in terms of reduction of weight gain (Syngelaki et al., 2019; Piercy & Troiano, 2018). The fifth phase entails monitoring the intervention implementation process to ensure that it is implemented as per the proposal. The DNP student will include checklists for ensuring that the participants follow the AHA guidelines, as well as weekly follow-ups, and reporting at the clinic for constant monitoring of weight changes. The sixth phase entails evaluating the outcomes, and the DNP student plans on conducting data analysis to assess whether the intervention has statistical significance. The last stage involves sustaining the evidence-based intervention, while also focusing on the transfer of knowledge to the staff at the local clinic s that the intervention becomes part and parcel of the institution in managing weight.
Organizational Setting
The setting of the project would be a primary care clinic located in South Florida. The clinic specializes in weight loss and primary care. It is a community health facility that deals with chronic disease management, referrals, preventive medicine, and medical aesthetics and well-being services to all adults in the Miami Area. The clinic typically works on issues and complications advanced by issues of weight gain, including obesity, diabetes, overweight, and heart conditions. It is typical to find many patients weekly aiming to manage these lifestyle conditions. The primary care providers at the clinic diagnose the specific lifestyle conditions and then discuss measures the patients can take for disease management. The patients are seen weekly and can have up to four visits to the facility every month. In this way, this provides the basis for selecting the clinic and the availability of patients seeking help at the clinic to manage weight issues. The clinic deals with lifestyle diseases, and therefore, it is a suitable site for the study. It serves up to 3,000 patients monthly and has a care team composed of physicians, nurses, EMTs, dieticians, physical therapists, radiologists, and surgeons. The physicians typically conduct a diagnosis. Nurses typically take care of inpatients. For the case of the current project, the dietician physical therapists, and nurses will be included in the intervention team.
Population Description
The sample size for this project would be 20 patients who meet the inclusion criteria at in South Florida. The participants would be recruited at the local clinic with the help of nurses, physical therapists, dieticians, as well as top management. Inclusion criteria are patients aged at least 18 years with a BMI ranging between 25 and 30, living permanently near the local primary care clinic. The participants should also be available over the span of 8-10 weeks and have a working phone for communication, access to the internet, and a physical activity tracker such as a smartwatch. The smartwatch would be essential to provide evidence that a participant followed the AHA physical activity guidelines. The exclusion criteria for the project include patients aged below18 years. Patients with a BMI of below 25 will also be excluded from the study since the focus of the project is patients who are overweight or obese. In addition, participants who will be unavailable for the 8-10 weeks of implementation will be excluded. Participants without a phone and internet access for easier communication and who lack a physical activity tracker, such as a smartwatch will also be excluded from the selection.
Considerations and Challenges for Implementation
The potential facilitators include the fact that it is feasible for the participants to lose weight over eight to ten weeks. The DNP project is realistic since the tools for conducting such a study are free and easily available. The ten weeks are viable to collect enough data for analysis. The nursing staff professionals are not resistant to change due to the nurses’ adoption of new methodologies of dealing with patients and treating diseases. In addition, nurses always capitalize on evidence-based practices to better the welfare of patients. For instance, nurses have adopted various mechanisms to deal with falls among the elderly, thus using rough instead of slippery floors, as well as the inclusion of family members in taking care of the patients, which has proven to be effective in clinical settings. However, there are potential challenges that might hamper the implementation of the DNP project, and these challenges include the unwillingness of participants to fully commit to the study. However, to overcome these challenges, family support and frequent communication will be essential in encouraging patients who are family members to participate and follow the AHA guidelines. The staff may be resistant to the additional workload but will be reminded of the purpose of the project is to celebrate the participants’ small wins.
Outcomes
To determine the impact of the intervention, which in this project pertains to physical activity and dietary changes to manage the weight of the participants, it is necessary to track such data in the ten weeks of implementation. This DNP project aims to assist overweight participants in losing weight by following the American Heart Association Dietary and Physical Activity Guidelines. Essentially, researchers have proved through evidence-based practice that these interventions are crucial in reducing adiposity, weight gain, and improving health, as well as minimizing predisposition to illnesses such as diabetes, hypertension, stroke and heart conditions (Koliaki et al., 2018; Oh et al., 2018). The DNP student will use The Knowledge-To-Action (KTA) Framework for this translational science project (Field et al., 2014). Adopting these interventions will be essential in addressing the issue of overweight and obesity, which is associated with a myriad of diseases, including heart diseases, diabetes, stroke, and hypertension, along with the enormous economic loss as funds are directed towards dealing with health issues. For data collection, each participant’s weight will be obtained in week one and week ten of the implementation. Process compliance will be determined by the completion of chart audits of EMR and the compliance checklist. The AHA guidelines are freely available and therefore, no permission will be required for use.
The main outcome of this DNP project is weight reduction rate of obese or overweight adults in South Florida. Both male and female weight reduction rate will be measured over a period of ten weeks to determine whether the American Heart Association’s (AHA) guidelines for diet and physical activity are effective in reducing weight of the adults at the facility. The ten-week weight reduction rate is defined as the final tenth week weight subtract the initial week one weight and then statistically computing whether the weight actually reduced for both male and female adult participates. In essence, this will enable the DNP student to determine whether the AHA guidelines affect different demographics.
The ten-week weight reduction rate for obese and overweight male and female adults will be collected over a period of ten weeks, immediately after the start of the intervention. To adopt the interventions, each selected participant will meet with the dietitian and the exercise physiologist to receive individual diet and exercise plans during one-hour office visit. The DNP student will weigh the participants. Each participant will be provided with the American Heart Association Dietary and Physical Activity Guidelines and logbooks (AHA, 2018). Essentially, this is important to acquaint the participants with the guidelines to be followed for accurate results. In addition, the participants will be asked to log their daily food intake, exercise, and weight. In weeks one through ten, the participants will be actively involved in adopting and observing the AHA dietary and physical activity guidelines. The individuals will be required to log their daily food intake, exercise, and weight each morning in the logbook. The DNP student, dietitian, and exercise physiologist will call every participant each week to review their logs, provide support, and answer questions. In essence, this is important, as it will allow for easy follow-up, and ensure that the participants are constantly updating their logs so that it would be easier to track the success of the intervention. The data collected during the call will then be entered into the electronic medical record. The DNP student will develop a compliance checklist to document calls, and complete chart audits weekly for formative evaluation. All data will be redacted to protect the privacy of participants, especially for health interventions requiring lifestyle alterations (Hickey et al., 2019). In essence, this helps to respect participant confidentiality and privacy.
The data collected for the ten-week weight reduction rate for obese and overweight male and female adult patients will come directly from the weekly logs of the participants, which will subsequently stored as electronic medical records. The data from the electronic records will be entered into a preformatted spreadsheet and kept in a flash drive in a locked drawer and a locked office. At the end of the project, the data will be kept for seven years, upon which it will be destroyed. If the ten-week weight reduction rate is lower after implementation, the project intervention will be considered successful.
In conclusion, male and female demographic data will be collected, but as stated in the inclusion criteria, only those aged at least 18 years will be allowed to participate in the study. The validity and reliability of the AHA guidelines have already been proven using evidence-based practice. Thus, the guidelines will be utilized in the current study to help patients in managing their weight. In addition, abstracting of Electronic Health Records will be conducted.
Data Management Plan
The evaluation tool will use weight as the main variable to determine whether the intervention worked or not. In essence, the study aims to implement the AHA guidelines of physical activity and dietary recommendations as an intervention for participants struggling with weight issues. The data that will be relevant for the study is weight. Weight is considered a ratio data type since it is measured on the ratio scale. Ratio data is the same as interval data, only that the zero on the ratio scale does not exist since a weight of zero does not exist (Philippi, 2021). Essentially, ratio data is quantitative in nature and exhibits similar properties as interval data, with a definitive ratio between the data type (Philippi, 2021). Extraneous variables need to be controlled. In the current study, there are different types of extraneous variables, including experimenter effects and participant variables. Experimenter or investigator effects entail where researchers unintentionally affect the research outcomes by giving clues on how participants need to behave, which might affect the intervention results significantly (Kaur & Mittal, 2021). The participant variables include prior knowledge of weight management that the participants may currently be applying, which may ultimately affect the intervention outcome.
The best approach to addressing extraneous variables is through randomization. Random sampling, however, does not eliminate the extraneous variables (Jacobs, 2019). With randomization, extraneous variables are equal in the groups. In this approach, the selection of participants will be random since the clinic has hundreds of patients that come for treatment and management of weight. For instance, in random selection, many research subjects are needed to select appropriate participants. The process is done randomly to ensure that each participant represents various people within the study population (Jacobs, 2019). Many patients seek care in the primary care clinic. While following random selection, the study population will be enough, samples will represent the population, there will be reduced bias due to proper representation, and the findings will apply to many patients with conditions similar to those of the participants. The process of determining the sample size involved using G*power. A t-test on the G*power software was selected. The mean, referring to the difference between the two groups, was chosen. The computation of the required sample size was also selected. The calculation was for two-tail tests. The effect size was 0.5, and the alpha error probability was 0.05. The power, referring to the one-minute error probability, was 0.80. The calculation revealed the need for a sample size of 64 patients. The project would only take ten weeks, and the patients visiting the health facility within that period were only 40. Thus, only a third of the sample was needed, namely 20 participants were considered. Only participants who meet the inclusion criteria as described in the population section will be selected from the random sample. Ten out of 20 participants will be subjected to the intervention. A control group of 10 more participants, who will not be subjected to the intervention, will also be included in the study to allow for a comparison between the two groups.
To gather the data, weekly recording or journaling will be used to keep track of the intervention group, for both the dietary and physical activity interventions. Their diet plans and physical activity for each of the eight weeks will be recorded weekly. A t-test will be applied in assessing correlation between increased physical activity and AHA dietary guidelines. To compare variables, the independent t-test is the best analysis for this project. As such, the data analysis will be done using the statistical package, SPSS (Masuadi et al., 2021). Afifahet al. (2022) recommend certain steps to maintain data integrity. The original data should be copied, recorded, and backed up after being entered into SPSS. Data points should be set for the numerically coded information, and missing data should be identified after running a frequency distribution. This process ensures that all the collected data has been used for analysis, and the comparisons reflect the entire data, which is not lost. For the final results, if there is significant weight loss over the eight weeks in the intervention group compared to the control group, then the intervention would have worked. If not, the hypothesis that the intervention would potentially work for the given population will be rejected.
Project Management Plan and Gantt Chart
The project will entail the pre-implementation phase, the implementation and data collection phase, and the data analysis and report writing phases. The detailed project management plan is highlighted using a Gantt Chart in Appendix C. For the pre-implementation phase, the DNP student will, with the help of the clinic, select participants who will participate in the study. In addition, this also includes the writing of the proposal, which highlights how the project will be carried out. In addition, the DNP student will acquaint the participants with the study and its significance. After understanding the nature of the project and accepting their involvement, they will need to sign an informed consent. During the implementation phase, the DNP student will ensure that the participants in the intervention group adopt the AHA dietary and physical activity guidelines. Within the eight weeks of intervention implementation, data will be collected, journaled, and recorded every week using the checklists. Data analysis will be conducted in weeks eight to 11 to help establish the degree of efficacy of the intervention. The results and discussions will be provided. A conclusion will be written along with the recommendations. The formatting of the final draft will be done with the help of the supervisor. Lastly, the project will be submitted in week 16.
Proposed Budget
There are various resources that the DNP student will need to accomplish the project. Money will be needed to facilitate the project There are no grants, and, therefore, all bills essential for the project will have to be footed by the student, including transportation costs, supplies, and overhead costs. The overhead costs will include miscellaneous costs that may not be anticipated while completing the project. The overhead costs of $400 will include miscellaneous costs that may not be anticipated while completing the project. Half of the overhead costs will go to the materials, and the other half will go to the transportation. The transportation costs are the that will be used to travel to the health facility. $30 will be required each week for ten weeks. Thus, $300 is needed The DNP student will require capital for supplies, including paperwork along other materials needed to complete the intervention. Copies of the AHA recommendations will be provided, implying that printing will be part of the intervention covered under the supplies category. In addition, the DNP student has a friend who is a statistician and will gladly do the statistics work for free. The DNP student does not expect any salaries, benefits, or revenues from conducting this study. The DNP student will ensure that the expenses are kept at a minimum, and therefore, there is little likelihood that the total expenditure will surpass $1,000, The budget allocation is highlighted in Table 1 below.

Table 1.
Budget
EXPENSES REVENUE
Direct Billing NA
Salary and benefits NA Grants NA
Supplies ($20 for each of the ten patients) $200 Institutional budget support NA
Services NA Personal Resources $900
Statistician 0
Transport ($30 each week for ten weeks) $300

Indirect
Overhead costs ($200 for transportation and $200 for supplies) $400

Total Expenses $900 Total Revenue from personal resources $900

Ethical Issues and Considerations
Ethical guidelines for conducting human research will be followed based on the Institutional Review Board (IRB) of Chamberlain University. The IRB prescreening process entails three steps. The first involves determining whether the project is research. The current DNP is categorized as research since the project involves the implementation of an intervention. The second step entails determining whether the project involves human subjects. This DNP project involves them since 20 participants will be involved. The third step entails providing additional information about the project, as well as the PICT question. The current DNP project satisfies the above criteria, and thus necessitating the IRB approval.
To protect data collected over time, ethical standards will be maintained to avoid jeopardizing participant confidentiality and privacy. Confidentiality and informed consent are essential tenets of research (Arifin, 2018). Individual personally identifiable data will not be used in reporting the results, and neither will contain protected health information (PHI). Informed consent is essential since the project entails recruiting participants who will sign to show their willingness to participate, hence proving that they were not forced into the project. The DNP student will omit all PHI and store data in a protected flash disk for electronic data, as well as store paper-based data in locked drawers. All data will eventually be destroyed after seven years. There are no conflicts of interest for the project and the proposal will have to be reviewed and approved by the IRB, thereby basing the study on ethics and privacy.
Results
Sample: This portion should describe in detail the setting, the target or accessible population, the number contacted, the percentage participating, and the details of who participated. For inferences, an analysis of the representativeness of your sample characteristics should be done by comparing your sample to your accessible or target population. These data is best presented in tables detailing those demographic details that are important to the project. An analysis of the demographic data is required.
Table 2
[Table Title]
Column Head
Column Head
Column Head
Column Head
Column Head

Row Head
123
123
123
123

Row Head
456
456
456
456

Row Head
789
789
789
789

Row Head
123
123
123
123

Row Head
456
456
456
456

Row Head
789
789
789
789

Note: [Place all tables for your paper in a tables section, following references (and, if applicable, footnotes). Start a new page for each table, include a table number and table title for each, as shown on this page. All explanatory text appears in a table note that follows the table, such as this one. Use the Table/Figure style, available on the Home tab, in the Styles gallery, to get the spacing between table and note. Tables in APA format can use single or 1.5 line spacing. Include a heading for every row and column, even if the content seems obvious. A default table style has been setup for this template that fits APA guidelines. To insert a table, on the Insert tab, click Table.]
Findings: This portion provides an interpretation of the major findings in the context of the overall purpose of the project. Present the statistical analyses of your primary outcome and process measures. Discuss how your major findings provide new knowledge or support previous findings that you found in the literature. Note how these findings add to the body of knowledge on this topic and support or expand on the theoretical framework you provided in the framework section of the proposal. There should be a clear relationship between the theory that drove the project to the findings presented and analyzed.
Figures Title

Figure 1. [Include all figures in their own section, following references (and footnotes and tables, if applicable). Include a numbered caption for each figure. Use the Table/Figure style for easy spacing between figure and caption.]
For more information about all elements of APA formatting, please consult the APA Style Manual, 6th Edition.
Discussion
This is where you can, and should, express your opinions regarding the results, implications, recommendations and the strengths and limitations of your project. Every project has strengths and limitations, so these should be stated.
If your results are similar to those found in previous studies, you may cautiously infer the results beyond your population and setting. However, if your results are completely different and/or contradict previous studies, you should let the reader know that these results cannot be used beyond the project population and setting.
Recommendations
Recommendations based on the findings should be for the nursing profession and society in general, and to specific nursing leaders as mentioned in the significance portion. A summary of the major findings concludes the findings and interpretations portion with a transitional paragraph introducing the recommendations portion. Recommendations should follow the same logical flow as the findings and interpretations. Include a narrative of topics that need closer examination to generate a new round of questions. Be sure to make specific recommendations for leaders in the nursing field and policy makers. Recommendations for future research should be detailed and extensive. This is a key area that students often fail to elaborate. What could other researchers do with the new information to find out more gaps as indicated by the new results? New doctoral learners often look in this portion for ideas on problems that remain to be solved so elaborating with detail leaves a legacy to new doctoral students to continue.
Conclusions and Implications for Nursing Practice
Conclusions should relate directly to your purpose and project question. They are generalizations that loop back to the existing literature on your topic. For each conclusion you make, cite the sources that support or contradict your findings. The conclusion should represent the contribution your practice project has made to the body of scientific knowledge on this topic and relate this to the significance of the project, which is always, in some way, to improve nursing practice. Conclusions indicate what is now known regarding nursing practice when your results and results from prior literature are considered together. Implications for nursing should report findings in Section I not reported by any other literature. Why should nursing leaders care? Meanings of any gaps or similarities to literature are critically analyzed and discussed for every unusual finding. What do the findings mean to nurse leaders, and would society care about the results?
Plans for Sustainability
Explain what will be done to sustain the project over time. What strategies will you put into place for the practicum site to ensure the project has ongoing evaluation and modification as needed to ensure its success after your implementation phase is complete?
References
Afifah, S., Mudzakir, A., & Nandiyanto, A. B. D. (2022). How to calculate paired sample t-test using SPSS software: From step-by-step processing for users to the practical examples in the analysis of the effect of application anti-fire bamboo teaching materials on student learning outcomes. Indonesian Journal of Teaching in Science, 2(1), 81-92. https://doi.org/10.17509/ijotis.v2i1.45895
American Heart Association [AHA] (2018). American Heart Association recommendations for physical activity in adults and kids. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
Arifin, S. R. M. (2018). Ethical considerations in qualitative study. International Journal of Care Scholars,1(2), 30-33. https://doi.org/10.31436/ijcs.v1i2.82
Banack, H. R., Wactawski-Wende, J., Hovey, K. M., & Stokes, A. (2018). Is BMI a valid measure of obesity in postmenopausal women? Menopause – The Journal of The North American Menopause Society, 25(3), 307–313. https://dx.doi.org/10.1097%2FGME.0000000000000989
Boscart, V., Davey, M., Crutchlow, L., Heyer, M., Johnson, K., Taucar, L. S., Costa, A., & Heckman, G. (2020). Effective chronic disease interventions in nursing homes: A scoping review based on the knowledge-to-action framework. Clinical Gerontologist https://doi.org/10.1080/07317115.2019.1707339
Carbone, S., Del Buono, M. G., Ozemek, C., & Lavie, C. J. (2019). Obesity, risk of diabetes and role of physical activity, exercise training and cardiorespiratory fitness. Progress in Cardiovascular Diseases, 62(4), 327–333. https://doi.org/10.1016/j.pcad.2019.08.004
Cawley, J., Biener, A., Meyerhoefer, C., Ding, Y., Zvenyach, T., Smolarz, B. G., & Ramasamy, A. (2021). Job absenteeism costs of obesity in the United States: National and state-level estimates. Journal of Occupational and Environmental Medicine, 63(7), 565–573. https://doi.org/10.1097/JOM.0000000000002198
Chamberlain University (n.d.). Institutional Review Board (IRB). https://www.chamberlain.edu/about/leadership/institutional-review-board
Chaudhry, S. (2020). Pharmacotherapy in obesity. IP International Journal of Comprehensive and Advanced Pharmacology, 5(3), 110–117. https://www.ijcap.in/html-article/12492
Esmail, R., Hanson, H. M., Holroyd-Leduc, J., Niven, D. J., & Clement, F. M. (2021). Identification of knowledge translation theories, models or frameworks suitable for health technology reassessment: A survey of international experts. BMJ Open, 11(6), Article e042251. http://dx.doi.org/10.1136/bmjopen-2020-042251
Field, B., Booth, A., Ilott, I., & Gerrish, K. (2014). Using the knowledge to action framework in practice: A citation analysis and systematic review. Implementation Science, 9, Article 172. https://doi.org/10.1186/s13012-014-0172-2
Heckman, G. A., Boscart, V., Quail, P., Keller, H., Ramsey, C., Vucea, V., King, S., Bains, I., Choi, N., & Garland, A. (2022). Applying the knowledge-to-action framework to engage stakeholders and solve shared challenges with person-centered advance care planning in long-term care homes. Canadian Journal on Aging/La Revue Canadienne du Vieillissement, 41(1), 110-120. http://doi.org/10.1017/S0714980820000410
Hickey, K. T., Bakken, S., Byrne, M. W., Demiris, G., Docherty, S. L., Dorsey, S. G., Guthrie, B. J., Heitkemper, M. M., Jacelon, C. S., Kelechi, T. J., Moore, S. M., Redeker, N S., Renn, C. L., Resnick, B., Starkweather, A., Thompson, H., Ward, T. M., McCloskey, D. J. … Grady, P. A. (2019). Precision health: Advancing symptom and self-management science. Nursing Outlook, 67(4), 462-475. https://doi.org/10.1016/j.outlook.2019.01.003
Jacobs, K. W. (2019). Replicability and randomization test logic in behavior analysis. Journal of the Experimental Analysis of Behavior, 111(2), 329-341. https://doi.org/10.1002/jeab.501
Kaur, L., & Mittal, R. (2021). Variables in social science research. Indian Research Journal of Extension. Education, 21(2-3), 64-69.
Kivimäki, M., Luukkonen, R., Batty, G. D., Ferrie, J. E., Pentti, J., Nyberg, S. T., Shipley, M. J., Alfredsson, L., Fransson, E. I., Goldberg, M., Knutsson, A., Koskenvuo, M., Kuosma, E., Nordin, M., Suominen, S. B., Theorell, T., Vuoksimma, E., Westerholm, P., Westerlund, H. … Jokela, M. (2018). Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals. Alzheimer’s & Dementia, 14(5), 601–609. https://doi.org/10.1016/j.jalz.2017.09.016
Koliaki, C., Spinos, T., Spinou, Μ., Brinia, Μ. E., Mitsopoulou, D., & Katsilambros, N. (2018, September). Defining the optimal dietary approach for safe, effective and sustainable weight loss in overweight and obese adults. Healthcare, 6(3), Article 73. http://dx.doi.org/10.3390/healthcare6030073
Masuadi, E., Mohamud, M., Almutairi, M., Alsunaidi, A., Alswayed, A. K., & Aldhafeeri, O. F. (2021). Trends in the usage of statistical software and their associated study designs in health sciences research: A bibliometric analysis. Cureus, 13(1), Article e12639. https://doi.org/10.7759/cureus.12639
Mehta, A., Ghazanfar, A., Marriott, A., & Morsy, M. (2019). Where to draw the line in surgical obesity for renal transplant recipients: An outcome analysis based on body mass index. Experimental and Clinical Transplantation, 17(1), 37-41. https://doi.org/10.6002/ect.2017.0167
Oh, M., Kim, S., An, K. Y., Min, J., Yang, H. I., Lee, J., Kim, D.-I., Lee, H.-S., Lee, J.-W., & Jeon, J. Y. (2018). Effects of alternate day calorie restriction and exercise on cardio-metabolic risk factors in overweight and obese adults: an exploratory randomized controlled study. BMC Public Health, 18, Article 1124. https://doi.org/10.1186/s12889-018-6009-1
Petersen, R., Pan, L., & Blanck, H. M. (2019). Racial and ethnic disparities in adult obesity in the United States: CDC’s tracking to inform state and local action. Preventing Chronic Disease, 16. Article E46. https://dx.doi.org/10.5888%2Fpcd16.180579
Philippi, C. L. (2021). On measurement scales: Neither ordinal nor interval? Philosophy of Science, 88(5), 929-939. https://doi.org/10.1086/714873
Piercy, K. L., & Troiano, R. P. (2018). Physical activity guidelines for Americans from the US department of health and human services: Cardiovascular benefits and recommendations. Circulation: Cardiovascular Quality and Outcomes, 11(11), Article e005263. https://dx.doi.org/10.1161/CIRCOUTCOMES.118.005263
Powell-Wiley, T. M., Poirier, P., Burke, L. E., Després, J.-P., Gordon-Larsen, P., Lavie, C. J., Lear, S. A., Ndumele, C. E., Neeland, I. J., Sanders, P., & St-Onge, M.P. (2021). Obesity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 143(21), e984–e1010. https://doi.org/10.1161/CIR.0000000000000973
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, 20(9), 1218–1230. https://doi.org/10.1111/obr.12889
Syngelaki, A., Sequeira Campos, M., Roberge, S., Andrade, W., & Nicolaides, K. H. (2019). Diet and exercise for preeclampsia prevention in overweight and obese pregnant women: Systematic review and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine, 32(20), 3495-3501. https://doi.org/10.1080/14767058.2018.1481037
Xu, Y., Li, S., Zhao, P., & Zhao, J. (2020). Using the knowledge-to-action framework with joint arthroplasty patients to improve the quality of care transition: a quasi-experimental study. Journal of Orthopaedic Surgery and Research, 15(1), Article 31. https://doi.org/10.1186/s13018-020-1561-7
Appendix A: Project Schedule
NR702 NR705
Activity Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8
Meet with faculty/preceptor X x x x x x x x X ☐
x x x x x x
Develop DNP project proposal X x x x x x x x ☐






Submit Chamberlain University IRB predetermination process review ☐







x x x x ☐


IRB approval ☐










x ☐


Education for staff, participants ☐











x ☐

Pre-implementation data collection ☐











x ☐

Full implementation of the intervention ☐












x x x
Observations and feedback, and provision of education ☐












x x x













































NR707
NR709
Activity Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8
Meet with faculty/preceptor and communicate with faculty x x x x x x x x x x x x x x x x
Continued implementation of the intervention x x x x x x x ☐







Participant observations and feedback x x x x x x x ☐







Weekly progress reports on implementation x x x x x x x ☐







Post-implementation data collection ☐






x ☐






Project outcomes communicated to staff and leadership ☐







x x x ☐
















































Appendix B: Data Collection Tool for Evaluation (24 Hour Dietary Recall)
These tools will be used to collect data.
Tick the day of the week, which you are recalling:

Sun Mon Tue Wed Thu Fri Sat
Step 1: List of Foods Consumed
Time Food /Drink taken during the day

Recording Sheet for the Information Collected (Step 1 above)
Item Time Meal Description of
Food Items

Seven-Day Food Frequency Questionnaire
Indicate ticking the most suitable response:
Food Group Example of Food Quantity Number of Times Consumed
in the Last Seven Days
Cereals Whole grains

Vitamin A rich vegetables and tubers Sweet potatoes, carrots and pumpkins
Dark green vegetables Greens, e.g. spinach
Other vegetables Eggplant, onions, tomatoes
White tubers and roots Green bananas, sweet potatoes
Vitamin A rich fruits Pawpaw, mangoes
Other fruits Oranges, pineapple, bananas
Organ meat (iron-rich) Liver
Eggs Eggs
Fish Salmon, tuna
Fresh meat Beef, pork, chicken,
Legumes, nuts and seeds Beans, lentils, cashew nuts, peanut
Milk and milk products Yoghurt, cheese, fermented milk
Oil and fat Almond and olive oil
Kindly list the snacks you consumed over the week

Appendix D: Weekly Physical Activity Report
Checklists to be filled by candidates weekly

Day High Intensity (Tick where appropriate)
Duration Low-Intensity
(Tick where appropriate)
Duration
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Weekly BMI Measurements
Measurement Reading 1 Reading 2 Reading 3 Average
Height (m²)
Weight KGs
Body mass index = weight in kilograms/height in meters
squared

Appendix E: Practicum Site Approval Letter
Practicum Site Approval Letter (Place the letter here.)
• No needed since this is a Case Study Option for DNP Project
Appendix F: Informed Consent Form
INFORMED CONSENT FOR PARTICIPATION IN
A DNP PROJECT

Project Title:
Implementation of the American Heart Association (AHA) Recommendations for Physical Activity in Adults and Kids to Assist Obese and Overweight Adult Patients in Losing Weight in a Primary Care Clinic
Project Manager:

Project Location:
Primary Care Clinic

What is the purpose of this project?
To assess the effect of AHA guidelines for physical activity in adults and kids to assist obese on weight loss in overweight adult patients in a primary care clinic.
What will I be asked to do if I choose to be in this project?
To perform physical exercises as recommended by the AHA guidelines.

How much time will I be asked to devote to this project?
Eight Weeks

What are the possible risks or discomforts that I might experience?
The only risk or discomfort is fatigue after exercise.

What are the possible benefits for me or others?
You will regulate your weight and minimize your risk of

What alternatives are available?
None for this project.

Do I have to participate?
No

What will happen if I do not participate?
Nothing

What will happen if I leave the project?
Nothing

Will it cost me anything to participate?
You will not be charged anything.

Will I get paid anything if I participate?
The project has no compensation.

How will my confidentiality and privacy rights be protected?
Your name or identifying information will not be shared among the investigators or any third party.

In this project:
• Identifiable private information or specimens (private information or specimens that can be traced back to you) will be collected:

No 0

If yes:
• Identifiable private information or specimens may be used for future quality improvement projects without gaining further permission:

Yes 0 No 0

• Identifiable private information or specimens may be used for future quality improvement projects, but only with your permission:

Yes 0 No 0

• Identifiable private information or specimens will not be used for future quality improvement projects:

Yes 0 No 0

Who do I contact for any questions about this project?
The nurse leader.

Is there anything else I need to know?
You may need to sacrifice time for implementing the recommended evidence-based intervention.

What are my rights?
• If you choose to be in this project, you have the right to be treated with respect, including respect for your decision to stop being in the project.
• You are free to stop being in the project at any time.
• Choosing not to be in this project or to stop being in this project will not result in any penalty to you or loss of benefits to which you are otherwise entitled.
• You will be given any information that either the project manager or the IRB reasonably believes is important to your choice about whether or not to be in this project.
• We will make every effort to keep information obtained as part of this project confidential. However, information about abuse or neglect may be required to be reported to the appropriate local or state agency in accordance with applicable law.
• If you want to speak with someone who is not directly involved in this project, or if you have questions about your rights as a participant, contact the DNP Program Dean dnpdean@chamberlain.edu.

The following project has been reviewed by the Chamberlain College of Nursing and prescreened as a practice-change/ quality improvement project in collaboration with the Chamberlain University Institutional Review Board.
(If Applicable)
I give permission for photographs or videotapes of me to be used in this project:
__________ (initials)
I DO NOT give permission for photographs or videotapes of me to be used in this project:
___________ (initials)
I have read this form and the project has been explained to me. I have been given the opportunity to ask questions and my questions have been answered. If I have additional questions, I have been told whom to contact. I agree to participate in the project described above and will receive a copy of this consent form after I sign it.

______________________ ___________________________
Signature of Participant Date
Revised 2/14/2022
Appendix G: Plan for Educational Offering
OBJECTIVES CONTENT (Topics) TEACHING METHODS TIMEFRAME EVALUATION METHOD
The first groups to be educated are the staff on the contents of the guideline. The content includes the dietary and exercise requirements as recommended in the plan. The teaching will be done using PowerPoint presentations. Questions and answers will also be used. One hour Multiple choice questions will be used to assess the understanding of the guideline.
The second group will be participants who will be acquainted with AHA dietary and physical activity guidelines. The content is the dietary and physical activity components of the guideline. Recording a video of the guidelines – how to adopt the recommendations, its benefits, and risks of obesity and overweight for both diet and physical activity.
I will also provide the AHA guidelines document.
Highlight the significance of maintaining a healthy weight. 40 minutes each The method of evaluation will be question and answer method, where different choices of the answers will be provided, and then the participant will be asked to tick the correct one.
A test score of above 70% is considered satisfactory. Therefore, the participant will be eligible for the intervention.
If the participant scores less than 70%, they will go through the materials once more and given a second chance to fulfill the evaluation.
The third group is the stakeholders. They will be educated on the dietary and physical exercise components of the guideline. PowerPoint presentations and pamphlets will be used for education. 40 minutes for the entire program Questions and answers will be used for evaluation.

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