First Advisor

McNeill, Jeanette

Degree Name

Doctor of Nursing Practice

Document Type

Capstone

Date Created

12-2017

Department

College of Natural and Health Sciences, Nursing, Nursing Student Work

Abstract

The number of overweight and obese children continues to rise in the United States and across the world, creating a growing need for providers to practice evidence- based interventions for this population of children and adolescents. An estimated 17% of children and adolescents in the United States are affected by being overweight or obese (Centers for Disease Control and Prevention [CDC], 2016a). Obesity puts these children and adolescents at risk for physical complications such as hypertension, hyperlipidemia, Type 2 diabetes, sleep apnea, asthma, joint pain, gastroesophageal disease, and fatty liver disease (CDC, 2016b). Obesity is even higher among ethnic groups including American Indian children and adolescent populations. Among American Indian populations, 45% of children and adolescents are overweight and obese (Perry & Hoffman, 2010). Research indicated a higher incidence of adult obesity if an individual was obese as a child or adolescent, putting them at greater risk for more serious health conditions (CDC, 2016b). Children and adolescents also suffer psychologically from being overweight or obese (CDC, 2016b). Overweight and obese children and adolescents are more prevalent in rural communities compared to urban settings (Johnson & Johnson, 2015). Along with a higher incidence, rural populations are faced with challenges on how to reverse a child’s overweight or obese status. The American Academy of Pediatrics (2008) has created guidelines to assist in assessing, treating, and preventing overweight and obese children. This Doctor of Nursing Practice (DNP) project addressed the prevalence of overweight and obesity, barriers regarding assessment and treatment, and ways to improve prevention and management of overweight and obesity in the American Indian child and adolescent population. The Delphi method was used to query providers regarding their perceptions of barriers to management of overweight and obesity in American Indian children and adolescents treated at the Wind River Family and Community Health Clinic. The initial survey consisted of open-ended questions allowing for providers to comment on perceptions regarding management of American Indian childhood and adolescent overweight and obesity. Nine surveys were sent to the providers of the clinic with six or 67% completed and returned. The providers were given approximately nine days to return the surveys. The second survey, developed based on the responses to the first survey, consisted of 30 questions with agree, disagree, or other response choices. Nine providers were sent the second survey and five or 55.6% of the providers completed and returned the surveys. Treating and managing children and adolescents at the clinic is very complex and creates many challenges for the providers. Barriers identified by the providers through the surveys included time constraints to accurately document overweight and/or obesity issues, resources for obtaining healthy foods, and lack of family involvement in the treatment of overweight or obese children and adolescents. As indicated through the surveys, not one single barrier created challenges for the providers as the issue has multiple aspects. As many other research reports identified prior to this project, rural health care presents many obstacles. Many challenges are faced when caring for the American Indian population. One basic human need, food, was identified as being a very sizeable challenge for American Indians. When food is discussed by the providers, many food sources offered to the American Indians are based on whether or not they have access to electricity and transportation. In addition, although several programs are offered to the American Indian population, the use of these resources is dependent upon the children and adolescents’ family involvement and acknowledgement of the need for weight loss. Electronic medical record challenges and time constraints were also identified as barriers for the providers. With the time constraints regarding documentation, one recommendation was nursing staff could aid providers in keeping the problem list current. This would aid the clinic in tracking more accurate numbers of overweight and obese children and adolescents. The nutritionist is an active participant in the clinic and health of the pediatric population at the clinic and is believed to be a key component in health improvements of children and adolescents. Continued referrals and use of nutritional services should be encouraged.

Extent

106 pages

Local Identifiers

VignaroliCapstone2017.pdf

Rights Statement

Copyright is held by the author.

Digital Origin

Born digital

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