Year of Publication

2014

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Leslie Scott

Clinical Mentor

Dr. Aurelia Radulescu

Committee Member

Dr. Mollie Aleshire

Abstract

CAPSTONE INTRODUCTION

Childhood overweight/obesity is a critical public health problem with devastating consequences. Many factors have combined to create the epidemic, and primary care providers can play an important role in addressing the problem by identifying overweight/obese children and encouraging them to engage in healthy behaviors. However, providers face a number of competing priorities making it difficult for them to provide these services effectively without outside support.

Obesity has reached an epidemic proportion in the nation’s youth. The Data Resource Center for Child and Adolescent Health (2011) found that 35.7% of children age 10 – 17 in Kentucky are overweight or obese. This is higher than the United States’ (U.S.) national average of 31.3%. Kentucky also ranks seventh of the most obese states in the U.S. (Robert Wood Johnson Foundation, 2010). According to Flower, Perrin, Viadro, and Ammerman (2007) the obesity epidemic is one of the most predominant health conditions pediatric primary care providers face.

Childhood obesity can lead to many other chronic health problems including hypertension, diabetes, hyperlipidemia, and psychosocial problems. These health conditions can lead to increased morbidity and mortality for the nations’ pediatric population. It has been estimated that one in three children born in 2000 will develop diabetes (McConnaughey, 2003). The primary care setting provides a unique opportunity to identify concerns and potential problems and educate children and parents. Well child or preventative visits have many components, which can be time consuming and leave little time for education and preventative screening. Although the statistics are alarming and guidelines related to pediatric overweight and obesity have been clearly established, many providers are not meeting the standards for screening, diagnosis, treatment, and education related to this epidemic.

Prior to beginning the capstone project three goals were established. The first goal was to determine the current practices in relation to practice guidelines for the screening, diagnosis, and treatment of pediatric overweight or obesity. The second goal was to examine reports and opinions from primary care providers regarding current practice and barriers to following practice guidelines. The final goal was to develop a reference tool for providers to utilize in practice toensure they are following practice guidelines. Each of the three manuscripts addressed one of the three goals.

The first capstone manuscript is an integrative literature review regarding pediatric provider knowledge of the current practice guidelines of pediatric overweight/obesity management in the primary care setting. The review begins with current practice guidelines and recommendations for pediatric overweight/obesity and outlines evidence based practice research on this topic from 2008 to 2014. The manuscript also discusses the current reported practices of primary care providers and knowledge gaps identified regarding pediatric overweight/obesity management. Gaps in the literature pertaining to pediatric overweight/obesity andrecommendations for future research are included.

The second capstone manuscript summarizes a 2014 investigation: “Assessment of Pediatric Primary Care Providers Behaviors and Procedures Regarding Pediatric Overweight and Obesity,” a survey administered to pediatric primary care providers in the state of Kentucky belonging to the Kentucky Coalition of Nurse Practitioners and Nurse Midwives and/or the Kentucky Chapter of the American Academy of Pediatrics.The survey results indicated that there is a knowledge deficit in relation to the current practice guidelines for identification, management, and treatment of pediatric overweight/obesity and a lack of community and referral resources available to primary care providers.

The final manuscript is an educational reference resource for providers, developed in response to the findings of the literature review and survey results. The need for additional education regarding, screening, identification, diagnosis, and treatment, in the primary care setting, was identified in the pediatric obesity survey. “Pediatric Obesity Management in the Primary Care Setting: Reference Guide for Providers” includes an algorithm for providers outlining the steps to successful management of pediatric overweight/obesity in the primary care setting.

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