Theoretical and Conceptual Framework

Guidelines for Framework Paper (2 pages maximum for body of paper—does not include title page, reference list, or appendix)

1. Select a theory that you can use as a theoretical framework or combine more than one theory or model to develop a conceptual framework to help guide your review of the evidence paper.
2. Describe your chosen framework.  If your framework is composed of more than one component, state that in the first paragraph and describe each component in subsequent paragraphs. When you describe each component include: 
3. Who developed it and when? 
4. What are the main concepts or constructs? 
5. Use original sources of the framework (e.g citing the author of the framework), though you may also use other examples of how the framework was used by others in their research. You should include a diagram of the framework in the appendix of this paper and mention it in the narrative.
   1. Describe how the framework helps guide your review of the evidence paper.  Then answer the following three questions.
   2. Does the framework help you explain phenomenon that you would like to study?
   3. How does the framework guide each phase of the project?
   4. Does the framework help you identify variables that you would like to measure and what are those variables?

Framework Paper Grading Criteria

RUBRIC

Framework Paper

PICOT Question

In overweight adults with hypertension (P), does educating them on long-term weight management techniques (I) compared to no further education (C) result in weight loss maintenance (O) for six months (T)?

Background of the Problem

            There is a rapidly increasing prevalence of weight gain and obesity in many countries worldwide. Almost 604 million adults (12%), with an uncertainty interval of 592.9 to 615.6, have been found to suffer from obesity in 2015. Females are more likely to suffer from obesity than males in all age brackets. An individual’s risk peaks between 60 to 64 years-old in women and 50 to 54 years-old in men. Studies have also shown that obesity is highest in early adulthood, and there is no significant change from 1980 to 2015 (GBD 2015 Obesity Collaborators, 2017).

Studies suggest a rise in the body-weight index (BMI) is one of the principal factors contributing to the rising index of chronic diseases, such as those related to the cardiovascular, endocrine, musculoskeletal, neurological, and renal systems. Moreover, obesity is also associated with the increased prevalence of malignancies (GBD 2015 Obesity Collaborators, 2017). The diseases implicated include hypertension, diabetes, stroke, and cancers involving the breast, endometrium, and colon. Obesity also has a lifetime impact on finances. The National Health and Nutrition Examination Survey in the United States analyzed the data from 2011 to 2012. Results revealed an estimated amount of $147 to $210 billion was spent annually on obesity-related Medicare expenses (Mendy et al., 2017).

Failure to control the obesity epidemic will lead to higher mortalities and morbidities in future generations. Therefore, various weight loss management techniques have been proposed to reduce the global burden of the disease. Data suggest that around 5 to 10% of the individual’s present weight loss leads to a significant improvement of health-related outcomes. Furthermore, a greater percentage of weight loss is beneficial in clinically diagnosed dyslipidemia, hypertension, and hyperglycemia. In non-alcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA), a minimum of 10% weight reduction is advised to achieve better health outcomes (Fruh, 2017).

Weight management strategies include food choice modification, exercise, and caloric counting. Among these, physical activity has shown a significant improvement in weight reduction. To maintain ideal body weight, a balance between daily energy expenditure and daily caloric intake must be achieved. A high level of physical activity significantly moderates weight gain, especially in women. The study by Hankinson et al. and the Finnish Twin Cohort, as mentioned in Wilkund (2016), revealed that consistent physical activity is associated with less weight gain than consistent inactivity. Furthermore, the Finnish Twin Cohort reported that the differences in body composition, such as weight, BMI, and visceral fat, between twins, are more likely due to physical activity differences rather than genetic predisposition (Wilkund, 2016).

Currently, reports have shown that nurses face a challenge in caring for overweight and obese patients secondary to the lack of knowledge and training, resulting in a widespread misunderstanding. Nurses need to modify care strategies based on the needs of the patients. Over time, the numbers of more extensive and heavier patients are rising. Physical size intervenes with the necessary procedures, irrespective of the clinical care setting. Complications may also arise secondary to increased physical size and weight due to difficulties in movement, transfers, or physical examination. Examples of complications include difficulty maintaining skin integrity due to a higher frequency of skin erosions in obese patients. Also, they are predisposed to moisture accumulation, particularly in the intertriginous zones, which may lead to pathogen accumulation, leading to skin breakdown. They may also require more frequent monitoring of wounds than non-obese patients due to insufficient blood supply secondary to increased adipose tissue (Foroozesh et al., 2017).

Based on the mentioned global health and burden of obesity, this research investigates the differences in weight loss maintenance using long-term weight management techniques versus non-education over six months.

References

Foroozesh, R., Sadati, L., Nosrati, S., Karami, S., Beyrami, A., & Fasihi, T. (2017). Challenges in nursing care of morbidly obese patients: Nurses’ viewpoints. Journal of Minimally Invasive Surgical Sciences, 6(2). https://doi.org/10.5812/minsurgery.12040.

Fruh, S. M. (2017). Obesity: Risk factors, complications, and strategies for sustainable long‐term weight management. Journal of the American Association of Nurse Practitioners, 29(S1), S3-S14. https://doi.org/10.1002/2327-6924.12510

GBD 2015 Obesity Collaborators. (2017). Health effects of overweight and obesity in 195 countries over 25 years. New England Journal of Medicine, 377(1), 13-27. https://doi.org/10.1056/NEJMoa1614362

Mendy, V. L., Vargas, R., Cannon-Smith, G., & Payton, M. (2017). Overweight, Obesity, and Extreme Obesity Among Mississippi Adults, 2001-2010 and 2011-2015. Preventing chronic disease, 14, E49. https://doi.org/10.5888/pcd14.160554

Wiklund, P. (2016). The role of physical activity and exercise in obesity and weight management: Time for critical appraisal. Journal of Sport and Health Science, 5(2), 151-154. https://doi.org/10.1016/j.jshs.2016.04.001