A Care Plan for Addressing Obesity in

Introduction:

The present aim of the assignment is to formulate a health promotion care plan which will investigate and evaluate a health condition of clinical consideration. The condition of obesity was considered for this assignment and it will further discuss the management plan with regard to prevention or ill-health amongst adults depending on their social, emotional and physical health needs. Furthermore, a suitable nursing intervention based on the clinical data of Miss K which is a pseudonym assigned according to the guidelines of Nursing and Midwifery Council code, 2018, will be critically analysed based on the availability of the scientific evidences. The proposed nursing interventions will be appraised and analysed using the underpinning pathophysiology to support evidence to establish the appropriateness of the care offered to Miss K. To summarise, the implementation of the nursing interventions will be evaluated to determine the effectiveness of her care. The care plan will look at whether the interventions could effectively manage the weight loss or control the propensity of individual’s towards unhealthy eating regimen. According to Yvette Brazier (2018), obesity is a condition of clinical importance when an individual accumulates an excessive weight and fat that will eventually affect their health. Body mass index (BMI) is utilized as an index of weight-for-height to determine obesity being equal or higher than 30 (WHO, 2016).

Overweight or obese is characterized as an unusual or extreme deposition of fat that presents a hazard to wellbeing status of an individual. The condition is considered to be a significant hazard factor for various incessant health conditions for instance diabetes, cardiovascular illnesses and malignancy at any part of the body (WHO, 2016). An individual with a BMI equivalent to or higher than 25 is viewed as overweight. Being overweight can cause hindrances in the accurate consideration of interminable conditions and is the second most noteworthy reason for development of varied illness. The condition of overweight has been related to lessen the expected quality-of life (Pearce, 2019). Figure A (appendix 1), Shows the varied damages that obesity can cause; an example of this can be either of the following; heart disease, stroke, liver disease, cancer, reproductive complication, depression and anxiety, sleep apnoea and, T2D etc. Moreover, 27% of grown-ups are overweight in the UK (NHS Digital, 2016), an increment of 12% was observed from 1993 (Health and Social Care Information Center, 2016). The WHO (2015 referred to in Data 2016) foresee that by 2030, 33% of grown-ups will be overweight. The expense due to overweight is considered to be double on the financial and immediate status of the individual (Lobstein, 2015). As indicated by PHE, 2015, the condition costs about £6.1bn every year to the National Health Service. Overweight at childhood has arrived at pestilence levels in both developing and developed nations. Overweight youngsters are probably going to remain obese up to their adulthood and are more prone to acquire non-communicable sicknesses like diabetes and cardiovascular ailments at a more youthful age (Sahoo, 2015). Factors that contribute to the development of obesity both among adults and childhood are air pollution especially nitrogen dioxide, absence of play ground or green space that leads to the sedentary life style also among children, non communicable diseases like diabetes, cardiovascular issues, respiratory problem and stroke, the environment we live in, genetical organisation of the individual and cultural influences. Unhealthy routine of eating is a significant factor for obesity (Locard, 1992). The present case of Miss K is associated with all these factors and is at high risk of the diseases mentioned above.

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Case Study:

Miss K, is a 25-year-old student from the nation Pakistan, weighing 127kg and has a BMI of 55.5. According to the definition of Obesity (WHO, 2016), Miss K falls into the category of being morbidly obese. Her health condition increased the risk of her developing several debilitating and deadly diseases, including diabetes, heart disease, and some cancers consequently decreasing the quality and length of her life (Olajide and Ludbrook, 2012). Miss K, at the young age of 25, is already suffering from high blood pressure and high cholesterol as she regularly consumes high fat and sugar containing food items. A study by Zhang et al. (2019), found that high blood pressure and high cholesterol levels among young adults may lead to an increased risk of heart disease later in life. BMI has a strong relationship with diabetes and insulin resistance. Miss K has a high BMI of 55, putting her at risk of developing insulin resistance which can lead to the development of diabetes in her future (Al-Goblan, AlAlfi and Khan, 2014). Parents of Miss K lacked education or information about the adversity of obesity and the importance of sound health for an individual. There is a direct association between education, socioeconomic status and obesity. In this regard the study of Booth, Charlton and Gulliford (2017), highlighted that the association between obesity and income stems from the fact that food with high fat and sugar content often cost less than healthier fresh food and those who belongs to the category of lower socioeconomic status may be left with no alternative but to opt for the cheaper resources (Drewnowski, 2009). In addition to this, people who lack education may remain unemployed or employed within a low paid setting, which may force them to live in a deprived area, with limited access to opportunities for practicing the healthy life styles for instance practicing physical activity and consumption of healthy food. As such, parent's education may be the only way to avoid obesity in their children (Davis and Chapa, 2015).

In case of Miss K, an unhealthy diet combined with lack of physical activity had led to the development of the condition of clinical consideration. A Health Survey was conducted among the individuals of England in the year, 2015 via online with 10,992 grown up participants concerning about the awareness of the moderate to vigorous physical activity (MVPA) for the least span of 150 minutes every week for the promotion of health. The study findings highlighted that guideline was precisely announced by 15 % of grown-ups whereas 13.8 % of them overestimated, 8.9 % belittled and 62.3 % could not report any measures of the rule (Knox, 2015). Miss K is found to be suffering from back pain due to her weight impacting on her musculoskeletal system, and as a result, her sleep is disturbed, and she feels tired and exhausted, further reducing any physical activity as evidences are available that overweight and obesity have been identified as a risk factor for musculoskeletal disorders (Onyemaechi et al., 2016). It was also evident that many parents of overweight children fail to spot the signs of obesity in their childhood (Health Survey for England, 2012) and Miss K. also belongs to this category. She was always overweight but was never given help or support to change her eating habits, and as a result, she became an obese adult. Another health determinant impacting on the health of Miss K is her ethnicity. Miss K is from a minority background, and according to a study by El-Sayed, Scarborough and Galea (2011), obesity is more prevalent amongst ethnical minorities as they have a lower socioeconomic status than Caucasians. There are many different ethnic groups in the U.K. and nurses need to understand their culture and appreciate their needs (Duffin, 2008) as very often they experience discrimination.

Integrated care approach was considered for Miss K to enable her with good cooperation and coordination between health, social care, public health and other local services. The community nurse should coordinate the multidisciplinary care compromise of the social services and the General Practitioner so as to reduce delay and gaps in the service (GOVE. U.K., 2013). The systematic nursing approach was employed to formulate a care plan consisted of assessment, planning, intervention, and evaluation (APIE) (Yura and Walsh, 2015). Care planning starts with a process of assessment and identification of the patient's needs and is a vital component that allows the multidisciplinary team to identify the care and individualised

The systematic nursing approach was employed to formulate a care plan consisted of assessment, planning, intervention, and evaluation (APIE) (Yura and Walsh, 2015). Care planning starts with a process of assessment and identification of the patient's needs and is a vital component that allows the multidisciplinary team to identify the care and individualised consideration for the nursing interventions (Wright, 2005). Besides, nurses must prioritise the patient's needs and deliver care, based on the care plan to attain the best outcome for the patient (Holloway, 2004). As such the approach of population health is a way to augment the wellbeing status of the whole populace and to diminish wellbeing imbalances among populace gatherings. So as to arrive at these destinations, it takes a gander at and follows up on the expansive scope of elements and conditions that impact our status of wellbeing (PHE, 2019).

Interventions:

The intervention aims to achieve a weight reduction by educating Miss K about the adverse effects of obesity and the benefit she can achieve from reducing her weight even by 5%-10% (Wrieden and Levy, 2016). According to the guidelines of NICE, 2014 the intervention that will be employed based on the individual choice of the patient, the degree of risk based on BMI, the social and environmental factors, any associated comorbidities and any previous treatment exposure that may contradict with the intervention to be employed. For the patient, behavioural interventions, physical exercise along with sound diet regimen was taken into consideration (NICE, 2014). The patient has to face a daily contradiction with regard to the eating regimen that is offered to her and based on her individual consideration. She had the ill habit of drinking a lot of sugary content cold drinks on a daily basis and also do not perform the required level of physical exercises to ensure a healthy lifestyle. Therefore, she complains about chronic back pain and fatigue with her daily schedules. Miss K was advised and encouraged to perform at least 30 minutes of moderate to greater intensity exercise for about 5 days every week to lose weight along with customary dietary changes to reduce the intake of calorie (NICE, 2014).

Study evidences of Wendy and Louis showed that small changes in an individual diet can make a great difference with regard to healthy outcome (Wrieden and Levy, 2016). Behavioural interventions taken into consideration for the patient and the following six steps were followed:

Precontemplation: Patient was found in a denial state, Miss K makes excuses that she is feeling fatigue and doesn’t want to agree that her condition will lead onto more issues in the future like high risk of diabetes.

Contemplation: This step is to assess the barriers that may disturb being on a diet the pros and cons, and the acceptance of the person to pursue the intervention

Preparation: The step incorporates the changing of diet pattern to a healthier one with desired level of physical activity with words of encouragement, goals and settings for short span of time. Action: Having supportive family and friends is considered to be beneficial, to achieve goal, and to get rewarded in return for pursuing the intervention. Maintenance: This step is to plan a strategy that will help to maintain weight loss goal and not fall into temptation and this was carried out according to NICE, 2014 guidelines.

Relapse: In this step the patient had to identify the potential triggers and the barriers that hindered the success of the intervention. Re establishment of the goal is the vital step considered.

Educational model; The educational approach informs and encourages one to learn, gain new skills, understand and enforce these into practice and making healthier choices. Miss K is a university student she is already learning, and this approach will empower her to try and learn new strategies for healthier life style (NICE, 2014).

The Biopsychosocial model considers other factors such as biological, psychological and social factors all contributes to the behavioural of a person. Biological factors like physical health or genetic vulnerabilities should be considered. Psychological issues can be social skills, coping skills, self-esteem, family relationship and any history of violence or abuse. Emotional distress and belief also contribute in up taking certain habits. Social pressures from peers, family situation, married life, cultural factors financial issues economic are significant factors that affect the life of an individual. The model helped to recognize certain issues about Miss K that her psychological state was affected due to work and education stress, her physical condition has led to the development of depression and low self esteem. The nurse along with the G.P. offered support in the form of pharmaceutical (medication to suppress appetite) and behavioural support such as cognitive behavioural therapies CBT to help Miss K to overcome emotional and uncontrolled eating. In between sessions, app was used to monitor progress, and parents of Miss K’s were asked to provide encouragement with healthy meals and emotional boosting. Person-centred care plan structured for Miss K looks at actions taken to change Miss K's behaviour and ways to combat obesity, such as involving community services and family support. The care plan will be reviewed every month than three and six months after completion to evaluate the goals and progress made so far.

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With the support of the CBT, she can engage in healthy behaviours such as sound diet intake, physical activity, stress management, social support, and environmental control strategies which will help her focus on achieving lifestyle goals. The final stage is sustenance, aiming to sustain the change that was made so far. By establishing and utilising relapse prevention and contingency planning strategies, it will enable Miss K to consistently engage in behaviours that focus lifestyle goals as motivators for effectively regulating the aspect of weight. The job of the nurse is to evaluate the effectiveness of the intervention continuously so to adjust and modify it according to the requirements to achieve a long lasting of the sustenance stage (Kemppainen, 2013).

Evaluation

Evaluation helps nurses to understand what works and what does not in a program. It is an independent, rigorous assessment of either completed or ongoing activities to identify the extent to which they are achieving the stated objectives and contributing to decision making (Menon, Karl and Wignaraja, 2009). Monitoring the progress can be made during the intervention by measuring intermediate objectives or at the end of the cycle by measuring knowledge and assessing the adherence to care plan (Hubley and Copeman, 2013). Delivering integrated care is essential to improve outcomes as it enables better coordinated and more continuous care. Integration is the combined set of methods, processes and models that seek to bring about this improved coordination of care (Goodwin,Stein and Amelung, 2017). Using a multidisciplinary approach can aid the nurse in supporting Miss K to achieve weight reduction, and this can involve the social worker who can provide psychological support, a dietician who will provide accurate diet regimen, trainer for practicing physical activities along with the GP for proper treatment and the use of apps for persistent monitoring. To provide continuing and high-quality patient care, it is the responsibility of the nurse to keep a clear and accurate record of the discussions, assessments and treatments to monitor how effective those approaches have been (NMC, 2008).

Conclusion:

The patient Miss K is obese with BMI of 55.5 that increased the risk of her developing several debilitating and deadly diseases, including diabetes, heart disease, and some cancers consequently decreasing the quality and length of her life. She was young but her psychological state was affected due to work and education stress, her physical condition has led to the development of depression and low self esteem. In case of Miss K, an unhealthy diet combined with lack of physical activity had led to the development of the condition of clinical consideration. Therefore, the systematic nursing approach was employed to formulate a care plan consisted of assessment, planning, intervention, and evaluation. Care planning starts with a process of assessment and identification of the patient's needs and is a vital component that allows the multidisciplinary team to identify the care and individualised consideration for the nursing interventions. The intervention aims to achieve a weight reduction by educating Miss K about the adverse effects of obesity and the benefit she can achieve from reducing her weight even by 5%-10%. For the patient, behavioural interventions, physical exercise along with sound diet regimen was taken into consideration (NICE, 2014). Miss K was advised and encouraged to perform at least 30 minutes of moderate to greater intensity exercise for about 5 days every week to lose weight along with customary dietary changes to reduce the intake of calorie (NICE, 2014). A multidisciplinary approach is taken by the nurse in supporting Miss K to achieve weight reduction, and this involved the social worker who provided psychological support, a dietician who provided accurate diet regimen, trainer for practicing physical activities along with the GP for proper treatment and the use of apps for constant supervision. Thus, the evaluation of the success of the treatment plan was done by monitoring during the interventions and also by evaluating the knowledge and adherence to the treatment plan at the end of the programme. It is an independent, rigorous assessment of either completed or ongoing activities to identify the extent to which they are achieving the stated objectives and contributing to decision making. During, the whole process, as a nurse, I understood that nurses play a significant role in promoting the health promotion policies. Throughout the intervention one weakness was noticed was that nurses could allot less amount of time to the patients and this significantly affects the process of decision making and future implementations of the interventions. The reason can lead to relapse of the habit within the patient, therefore, I decided to provide more time in the future to the patient to avoid relapse. This whole procedure has helped to learn the steps of formulating essential health promotion plan structured individually for patients and record of the discussions, assessments and treatments to monitor how effective those approaches have been were kept which will act as a guideline in future.


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