Overcoming Barriers and Increasing Confidence of Providers and Nurses in Addressing Overweight and Obesity

Abstract

<p>The purpose of this DNP project was to improve weight loss management by decreasing barriers and increasing health care provider and nurse confidence in addressing overweight and obesity with patients. The project took place at a Midwest Veterans Affairs (VA) facility. The project director (PD) sent a recruitment email to health care providers and nurses working at the primary care clinics. The 13 individuals who agreed to participate completed an anonymous online pre-intervention survey to assess perceived barriers to and level of confidence in addressing overweight and obesity. <br /> The PD developed and presented a 30 minute educational session for participants. The educational program incorporated both the Transtheoretical Model of Change (TTM) and the Modified 5As of behavioral counseling (Ask, Assess, Advise, Agree, Assist). Staff members who participated in this quality improvement project were educated on strategies to overcome barriers to addressing obesity, use of the 5As in obesity management, attending to stage of readiness for change, and incorporation of motivational interviewing (MI) into patient discussions. After completion of the educational program, participants completed a post-intervention survey using the same questions as the pre-intervention survey. <br />A patient education folder was made available to health care providers and nurses to provide to patients who were overweight or obese. Additionally, a clinical reminder was created in the computerized patient record to prompt participants to consider stage of readiness for change, Modified 5As, MI, and to offer patients the educational folder. <br />Data from the pre and post-intervention surveys were analyzed to determine if perceived barriers decreased and self-confidence improved. Data from chart audits were analyzed to see if more patients were provided weight loss information. Confidence of nurses/providers did increase after the intervention based on Pre-test/Post-test results. Pre-test confidence score compared to post-test confidence score showed a Wilcoxon p value of 0.033. Decreasing barriers was not found to be statistically significant. 150 charts were reviewed pre and post-intervention of participants, and there was increased discussion of weight management after the educational session. Limitations of the project included a short time-frame, limited staffing, and time constraints. In conclusion, utilization of the TTM, MI and 5As in educational programs of nurses/providers to increase confidence may lead to increased discussion of weight management with patients.</p>