Term Paper on "Obesity Ma Adolecents: Family Centered Intervention"

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Obesity Ma Adolecents: Family Centered Intervention

Obesity Among Mexican-American Adolescents: Family Centered Nursing Intervention

Community Diagnosis

Overweight/obesity among Mexican-American middle-school aged children related to unhealthy snacks high in fat and calories, and drinks high in calories and sugar as evidenced by Healthy People 2010 objective 19-3 to reduce the proportion of children and adolescents who are overweight or obese; Baseline: 11% for children ages 6 to 11; 11% for adolescents aged 12 to 19; Target: 5% for children ages 6 to 11; 5% for adolescents ages 12 to 19 (U.S. Department of Health and Human Services, 2001)

Aspects of Cultural Assessment

Ethnic/racial identity

Hispanics are the largest and fastest growing ethnic minority in the U.S. And the largest proportion of that growing population self-identifies as Mexican or Mexican-American (66%). (Flegal, Ogden & Carroll, 2004, p. S144) Most adolescents within this group self-identify as Mexican-American and most attend public schools and interact both inside and outside of their own identified cultural/ethnic groups, to varied degrees. Outside of educational and some mixed community interaction many Mexican-American adolescents interact mainly within their own cultural/ethnic groups and among similar aged peers of like backgrounds.

Values

That having been said it is clear that Mexican-Americans have values associated with a family-centric cultural global view. Families can be large and extended family is often very active in the lives of these adolescents. Addi

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tionally, parenting styles are often seen as authoritarian in nature which many believe can have broad implications in values as well as activities related to health and wellness. (Ward, 2008, p.410)

Language

The degree to which these adolescents communicate in their parent's or grandparent's native language is variable and often associated with the generation of immigration, for example if the individual and his or her parents immigrated they are more likely to speak Spanish, and English as a second language, while if the individual's parents immigrated before they were born or shortly thereafter they might also only speak limited Spanish and often only at home. While if their grandparent's immigrated they are more likely to speak only limited Spanish in the home, and often what they term as "Spanglish" or an amalgamation of English and Spanish words. Few second and third generation Mexican-American young people speak what could be called fluent Spanish and are more comfortable communicating in English especially to outsiders of the culture.

Health Beliefs

Access to health care can be limited, depending on socioeconomic status which in general is below the mainstream. The health care system in Mexico must also be mentioned here, as many people in the nation live at or below the poverty level self administration of pharmaceutical drugs is common, and pharmacies/pharmacist are the main source of healthcare education and intervention. Most prescription drugs are over the counter and require no real diagnostic process to obtain, other than the general guidance of a pharmacist. Therefore it is not common to seek medical care from a doctor, unless the situation is perceived as grave. For those who have access to health care intervention may be delayed, if the perception of the illness of unhealthy condition is low risk and some may even be encouraged to self-medicate.

Religious Beliefs

Many Mexican-American families self-identify as Christian (often Catholic), more so in first generation female immigrants and have strong ties to church and conversely to family and culture through church. Second and third generation families are only marginally removed from the rigors of church affiliation. Spirituality is often defined through religious beliefs, though this can be much less for latter generations of immigrants. Adolescents, like those in many cultures often reject strong ties to religion and prefer to define spirituality as separate from religion, though most likely express a strong belief in a higher power and are more or less involved depending on their family demands.

Lifecycle Events

Birth, coming of age, marriage and death are all crucially important to most Mexican-Americans, within the confines of a strong family dynamic, as well as a historically religious culture. Birth is a celebrated event with multigenerational celebration and welcoming of new life into the family. Coming of age is celebrated with elaborate parties that are associated with the culture and faith, (Quincenera) more often for girls than boys at the age of 15 (though some boys also celebrate the passage). Marriage is also an often elaborate family event, within the confines of religion and even in more secular traditions. Death is also a large part of the Mexican-American culture, as ancestors are celebrated in Mexico during an elaborate day of the dead traditions that focus on the comfort and connection one has in the afterlife to the current generations.

Nutritional Behavior/Diet

It must also be said that many individual immigrants have very recent memories regarding food deprivation or food insecurity in their home culture. Culturally speaking many Mexican-American (mother's especially) see a moderately overweight child as healthy, given that their cultural origins are in a nation where malnutrition is common as are intestinal parasitic infestations. For this reason and others the culture has a broad concept of the thin child as being unhealthy and a moderately overweight child, who can still function normally as being healthy rather than overweight and Mother's/Grandmother's are often very insistent on "feeding" children regularly. (Ward, 2008, pp. 410-411) Though these perceptions are changing the availability of unhealthy food is so common in the U.S., and especially low cost food alternatives that the transition from one culture to the other does not allow for very healthy eating. Lastly a very logical though underappreciated problem is that in high-density communities there are fewer supermarkets and grocery stores, where many fresh fruits and vegetables as well as other healthier foods are sold at very reasonable prices. In high population-density areas the options for shopping are limited to corner markets, and are especially limited for those who for reasons of time and language barriers do not frequently leave their communities to shop for food. One very clear reason why some Mexican-American adolescents have a particularly high rate of overweight and obesity could in part be associated with limited availability of healthier options close to where their mothers and grandmothers live and therefore shop.(Kumanyika & Grier, 2006, p.187) Availability of fresh and good looking fruits and vegetables is relatively high in Mexico and the comparative sample of the offerings in American corner stores would leave most people wanting. Many families also rely heavily on the public school nutritional system, which is increasingly in question, especially with regard to fresh fruits and vegetables offerings as compared to cheaper fast-food like offerings and many sugary drinks and snacks.

Review of Literature on the Health Problem

Why is this diagnosis a health problem for this target group?

Overweight/obesity among Mexican-American middle-school aged children related to unhealthy snacks high in fat and calories, and drinks high in calories and sugar as evidenced by Healthy People 2010 objective 19-3 to reduce the proportion of children and adolescents who are overweight or obese; Baseline: 11% for children ages 6 to 11; 11% for adolescents aged 12 to 19; Target: 5% for children ages 6 to 11; 5% for adolescents ages 12 to 19 (U.S. Department of Health and Human Services, 2001) According to the midpoint review the problem among children is in fact increasing rather than decreasing, despite greater awareness and multiple levels of intervention strategies. According to Heiss (2008) the statistical increase is a full 5% with the HP 2010 start point at 11% increasing to 16% during the period of midpoint review. (p. 475) Specifically for the Mexican-American population the increases are even more staggering.

For Mexican-American boys ages 2 to 19 years, the prevalence of overweight was greater (22.0%) than for non-Hispanic Black (16.4%) or non-Hispanic White (17.8%) boys. The prevalence for overweight among Mexican-American girls ages 2 to 19 years (16.2%) was greater than non-Hispanic White girls (14.8%) (Ward, 2008, p. 408)

Additionally, the incidence of obesity among Mexican-American (MA) children like in other populations is increasingly associated with younger and younger incidence of obesity related diseases, including; type 2 diabetes, heart disease, high blood pressure, hyperlipidemia and a host of health related problems. According to Fortmeier-Saucier, Savrin, Heinzer & Hudak MA children diagnosed with type 2 diabetes had higher BMI and higher than normal total cholesterol and triglyceride levels. (2008, p. 142) the findings indicate that overweight/obese MA children show incidence of obesity related disease indicators that are similar to obesity related disease indicators in adults.

What are the current nursing interventions for this problem?

Fortmeier-Saucier, Savrin, Heinzer & Hudak indicate that the health connections between the incidence of obesity in MA children and adolescents and high early markers for cardiovascular disease, i.e. high lipid levels in the blood indicate that one of the best nursing interventions would be to advocate for increased testing of blood lipid levels among at risk youth. The same researchers also stress the need to focus, "… on nursing interventions aimed at maintaining normal lipid values, a leading health indicator… READ MORE

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Quoted Instructions for "Obesity Ma Adolecents: Family Centered Intervention" Assignment:

“

Cultural Health Promotion Plan Paper

This is an INDIVIDUAL assignment based on community data and the Healthy People 2010/2020 National Objectives.

DUE DATE: July 6, 2010 by 10:00 p.m. with late submission policy application to this assignment.

Complete the paper according to APA 6th Edition Guidelines as a word processed document. The paper must be submitted electronically via course Web Courses Assignment function.

The paper is limited to a MAXIMUM of Ten (10) pages (including the title page and references pages; NO Abstract is needed for this assignment). Do not exceed the ten page limit as only ten pages will be read and graded! The paper must double spaced in font size 12. Include Title Page with a running head and a page number according to APA Sixth Edition format. Page one begins on the title page. References using APA format are included in the total page count.

The Cultural Health Promotion Plan paper topics are derived from the work that was previously identified by faculty, students, and other pertinent resources in the community. The problems/needs/risks are drawn from Community Data/Healthy People 2010/2020.

1. Each student will select ONE problem/need/risk from the list provided by Dr. Ark. The list is located in Web Courses Course Web Site on a separate Discussion Board. The problem/need/risk is written in the four-part community diagnosis format. The student should not alter the diagnosis.

2. Develop a cultural health promotion plan *****as if***** the plan would be implemented for a target group within any community, not particular to your assigned Community Nursing Coalition. Writing the plan paper assignment will aid in the development of the program planning and evaluation skills that you will use in the development of the senior project in Public Health Nursing Clinical in the last semester of the Basic BSN Program ï¿½*****" the topic area of your paper is not necessarily the topic area for the community intervention plan in the Public Health Nursing clinical, however the skills you learn in this course will prepare you for the important service-learning work in the community during the last semester of the program. RN-BSN students conduct a teaching project/evaluation in NUR 4604L Community/Public Health Nursing Practicum.

3. Submit the plan paper by the due date and time.

Here are thoughts to guide the development of the paper regarding health variations by cultural heritage:

Cultural Diversity refers to the differences among people based upon shared ideology and valued sets of beliefs, norms, customs, and meanings evidenced in way of life (ANA, 1996, Position Statement on Cultural Diversity). This diversity is expressed in various ways. Diversity in history, beliefs, practices, and opportunities not only exist among cultural groups, but also typically exist across a wide continuum within the group. Health behaviors are influenced by culture and cultural values as well as by socioeconomic status.

In this assignment, students develop a health promotion plan for a cultural group living in the United States, not necessarily in your CNC community location. You are to learn as much as you can about the cultural norms and patterns and how these norms and patterns influence health practices. The purpose of this assignment is for the student to develop a deeper understanding and sensitivity regarding the role of culture in life of the client and in nursing through the examination of a cultural/ethnic group.

Thoughts to consider as you develop the paper:

Health and Culture: The nurse must recognize that members of various cultures define *****health***** differently. Individuals may define themselves or others in their group as healthy even though the nurse identifies symptoms of disease. Cultural priorities of the client may differ from that of the nurse.

Culture and Healing: Individuals and families in various cultural groups may also use traditional healing systems, sometimes called lay or folk-healing systems, with or without allopathic (modern) medicine. In addition to seeking help from the nurse as a health care provider, clients may also seek help from traditional or religious healers. Most nurses have experienced clients who combine medical care with prayer. Nurses need to be sensitive to, respectful of and nonjudgmental regarding patients***** health beliefs and practices in order to maximize patient outcomes.

Health status of all clients is influenced by the interaction of physiological, cultural, psychological, economic and societal factors. Diversity within and among groups necessitates data collection activities and programs that are tailored to meet the unique health care needs of different subgroups.

Health beliefs are translated into health care practices, which then affect health status. What constitutes appropriate care for specific health conditions may be guided by cultural and social class expectations held by members of the culture.

Health Information and Education:

Planning health education programs requires identifying and building on cultural strengths and ensuring sensitivity to cultural factors. Meeting the language and cultural needs of each identified minority group, using minority specific community resources to tailor educational approaches, and developing materials and methods of presentation that are at the educational level of the target population are essential considerations in the planning process. Health programs should be sustainable over a long period of time and accountable to the clients.

Paper Guidelines

Format the paper according to APA Sixth edition guidelines; you will have Level 1 and Level 2 Headers in this paper.

Insert a Title Page

Then, page two (repeat title of paper on page two)

Community Diagnosis

State the community diagnosis addressing the problem/need/risk that you selected from the approved list for this paper. Be sure to include the in text cite for Healthy People 2010 in your References list.

First address the

Aspects of Cultural Assessment

Ethnic/racial identity How does the group identify itself in terms ethnicity and racial background? What is the range of interaction outside of the cultural group? Are recreational, educational, and other social activities within the ethnic reference group, the wider community, or both?

History and Value Orientation How are values derived? What is the historical experience of the group that may have impacted values?

Language-communication process What languages are spoken in the home? And by whom? What language is preferred when speaking to outsiders? Do second and third generations in the U.S. speak the language of their grandparents?

Health Belief and Practices What are the traditional health beliefs? How common are these beliefs and practices within this group? To what extent are folk healing practices and practitioners used? Is access to care and equality of care an issue for this group?

Religious Beliefs Religious articles & practices, how spirituality is defined. Remember that Religious Beliefs and Spirituality are different concepts.

Spirituality How is spirituality defined? Remember that Religious Beliefs and Spirituality are different concepts.

Lifecycle events Which life cycle events are important to the culture? What are the customs associated with births, coming of age, marriage, and death?

Nutritional Behavior/Diet Are there restrictions? Are there common practices?

Review of Literature on the Health Problem

Complete a review of the literature highlighting the health problem and the target group. Be sure to use headers to organize this section of the paper. Students must use the Maurer & Smith textbook and optional use of other textbooks from the first semester courses as references. You may use literature from Allied Health however you must have THREE evidence-based nursing references (nursing literature/nursing journals) published within the last five years included in your in text citations within the paper and on the list of references. In other words, include cites in the body of the paper and the full citations of all sources in the References section of the paper according to APA format. Remember that not all journals listed in the CINAHL database are nursing journals.

You should answer these questions in the review of literature ï¿½*****" these three categories are headers:

Why is this diagnosis a health problem for this target group?

What are the current nursing interventions for this problem?

What interventions have been successful and what interventions have NOT been successful?

Planning

Plan Title

Give the plan a title ï¿½*****" this title must be consistent on the title page, on the second page, and here.

Short Term Goal

List one short term goal with the time frame of the final semester (15 week 45-hour clinical) in the BSN program. Remember that education is a strategy not an outcome or goal.

Measurable Objectives

Write three measurable, time specific learner objectives. State the learning domain for each of the three objectives; you should write in the domains of Cognitive; Affective; and/or Psychomotor. Remember that in order to have an effective program intervention, you would not have all three of the objectives in the cognitive domain, nor would you necessarily have one objective for each of the domains.

Objectives Summary

Consider all of the objectives together; write two paragraphs (maximum) addressing these areas:

The Objectives are: (1.) Specific; (2.) Measurable; (3.) Reasonable/Feasible; (4.) Fit with a community-based setting; and (5.) Easily understood by clients.

Budget

Create a Brief Budget (must be in Table format according to APA)

Determine a budget for the project.

Time: Consider $14.00/hour for the student nurse rate (remember that you will have a 45-hour clinical course in which to complete the project ~ you may have other student nurses assisting you on the project).

Materials: while brochures may be donated - in kind - there is still a cost.

List other resources needed for the project.

Be sure to total out the amount of the project using the Table format guidelines in the APA manual.

Intervention

Health Promotion Strategies/Methods

Describe in detail the strategies/methods for each of the three objectives. Remember to use headers throughout this section to clearly articulate the intervention. You should list Objective One, then describe the primary and secondary prevention strategies; then, Objective Two, describing the primary and secondary prevention strategies; then, Objective Three, describing the primary and secondary prevention strategies. Explain the rationale for selecting the strategies/methods. Remember that you are writing strategies at the levels of Primary Prevention & Secondary Prevention levels, and not Tertiary Prevention level strategies in this paper.

Evaluation

Use three headers

Objective One

Objective Two

Objective Three

The text in paragraph form will follow each of the headers as displayed above. In the text, tell the reader how the outcomes of each objective are measured/assessed at both the primary and secondary level of prevention. Remember that an evaluation is based on objectives. An evaluation is the appraisal of the effects of activities and/or program interventions. An evaluation is conducted in order to determine the relevance, progress, efficiency, effectiveness & impact of program activities.

References

Formatted according to APA Sixth edition guidelines

*****

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