Assignment Prompt & Instructions
**files (2)**
– ## capstoneintrucction.docx
– ## CapstonePartIPICOTAssignmentfeedback.pdf
**## capstoneintrucction.docx**
How will you be able to avoid IRB approval since you are proposing weight measurements and medical recommendations?
How can you gurantee safe exercises for all patients? DId you find research on why APRNs are suitable to lead the Capstone?
Missing Conclusion paragraph.
Capstone Part II: Review of Literature
**CAPSTONE: PART II due 10/4/2025 by 11:59pm**
1. Review of Literature:
– Review and discuss literature: Synthesize at least 10 primary research studies and/or systematic reviews; do not include summary articles. This section is all about the scientific evidence rather than someone else's opinion of the evidence. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. This is a synthesis rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.
2. Analyze and apply knowledge directly to your PICOT- The studies that you cite in this section must relate directly to your PICOT question.
3. Provide precise body of evidence for your Practice Change- Include Nurses as leaders in this project, statistics, cost, impact on healthcare.
4. Discuss objectives for your practice change, Why is change necessary?
5. Discuss where the problem exists, why it exists, what is the preposition for change. Include information from your PICOT.
6. Apply all that is relevant to the problem. For example: Pros vs Cons, current state of problem
NOTE: It should not reflect your opinion, but rather Evidence Based Practice should be applied
-After completing a literature search on interventions addressing your chosen health problem, write a review that evaluates the strengths and weaknesses of all the sources you have found, compare anc constrast.
-Use appropriate APA 7th Ed. Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be minimum 4-6 pages long (not including the title and reference page).
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written APA in the 3rd person.
**Rubric Capstone II.docx**
1. Integration of Knowledge — 25 points
Thoroughly select and present an appropriate evidence-based practice intervention for the identified health problem and proposed change. Clearly explain how the evidence supports the intervention.
2. Topic Focus — 25 points
Choose a health problem narrow enough for the assignment’s scope. Include a clear topic statement that provides direction for the paper. Maintain a consistent focus, develop thoughtful insights, and support the discussion with cited evidence.
3. Depth of Discussion and Cohesiveness — 25 points
Provide an in-depth discussion throughout the paper. Integrate information from all sources and demonstrate an understanding of the relationships among their findings. Ensure that ideas flow logically from one issue to the next. The rubric specifically requires the paper’s body to flow without headings.
4. Spelling and Grammar — Category Listed as 10 Points
Meet the required word count and include fewer than five grammatical, spelling, capitalization, or punctuation errors. Carefully proofread the paper before submission.
5. Sources — 10 points
Use at least six current sources, including at least three peer-reviewed journal articles or scholarly books. Include both general background information and specialized evidence. All websites must be authoritative. Identify special-interest sources or popular literature appropriately if used.
6. Citations — 5 points
Follow APA formatting consistently, with fewer than five errors involving citations, quotations, or formatting. Ensure that in-text citations and reference entries are complete and accurate.
Scoring clarification: The spelling and grammar category is labeled as worth 10 points, but the Outstanding column awards 8 points. This discrepancy should be clarified with the instructor.
**## CapstonePartIPICOTAssignmentfeedback.pdf**
1
Capstone Part I: PICOT Assignment
Erika Brito
Florida National University
MSN Capstone Project
Dr. Carmen Lazo
September 18, 2026
2
Introduction and Significance of the Practice Problem
Obesity is a serious chronic disease problem that has negative consequences for physical
and social health, health-care utilization, and health-care costs. The disease is linked to
cardiovascular disease, decreased physical functioning, musculoskeletal complications, certain
cancers, Type 2 diabetes and hypertension (CDC 2025). Across the nation, 40.3% of U.S. adults
were at risk of having obesity, with 9.4% having severe obesity during August 2021-2023
(Emmerich et al., 2024). CDC surveillance data also show that Hispanic adults are impacted; at
least 35% of adult Hispanics are obese in 33 geographic areas for which there is adequate data
for 2022–2024 (CDC, 2024). The results highlight the need for interventions aimed at weight
management that are culturally and linguistically accessible.
Obesity also has significant economic impacts. Health care for obesity is expensive for
patients and the health care system. In 2019 dollars, adults with obesity had $1,861 more in
annual medical expenses than adults with healthy weight. Excess costs for adults suffering for
severe obesity were $3,097 per person. This represents almost $173 billion in 2019 dollars
(CDC, 2024) in medical costs. Additionally, Cawley et al. (2021) further showed that the burden
of obesity to direct medical costs in the United States is substantial. Although a reliable obesity-
specific healthcare cost for ZIP code 33012 is not available, local socioeconomic conditions
justify examining the issue in this population. Hialeah is mostly Hispanic, and culturally
responsive care is relevant to the proposed project because there is a large Hispanic population
within ZIP code 33012.
The intervention that is being proposed is bi-lingual nurse led, 12-week-long nutrition,
portion control, physical activity, and realistic weight management education. The purpose is to
determine whether the intervention produces measurable weight loss among low-income
3
Hispanic adults with obesity receiving care in a community primary care clinic in Hialeah. The
proposed outcome is a change in body weight from baseline to the completion of 12 weeks. This
objective is measurable and realistic for a semester-long quality improvement project.
PICOT Question
The PICOT question is: In low-income Hispanic adults between 18 and 64 years of age
with obesity who receive primary care at a community clinic in Hialeah, Miami-Dade County
(P), how does a nurse-led bilingual education program addressing healthy nutrition and physical
activity (I), compared with participants’ baseline weight before the intervention (C), affect
weight loss (O) over 12 weeks (T)?
The population will consist of adults 18 to 64 years of age who self-identify as Hispanic,
have a BMI of at least 30 kg/m², receive care at the selected community clinic, and meet the
clinic’s income-related eligibility criteria. The intervention will consist of structured nurse-led
education provided in English and Spanish. Education will address affordable healthy food
selection, portion control, culturally familiar foods, increased physical activity, goal setting, and
strategies for overcoming common barriers. The comparison will use each participant’s baseline
weight as the preintervention reference point. Although this is not a separate control group, the
preintervention measurement will allow the project to determine whether weight changes occur
following implementation. The outcome will be change in weight measured in pounds or
kilograms, with measurements collected at baseline and during follow-up. The intervention will
continue for 12 weeks.
Vulnerable Population and Setting
The population selected would be the low-income Hispanic adults with obesity getting
primary care in the City of Hialeah, specifically in the 33012 ZIP code. The population is
4
vulnerable because obesity risk and weight-management behaviors are influenced by
socioeconomic conditions, access to nutritious foods, transportation, health education, language,
and opportunities for physical activity. A study of Latinx adults in Florida found that financial
constraints, not having access to nutritious food, and a lack of culturally sensitive education were
significant obstacles to preventing obesity and diabetes (Martin et al., 2022). Social determinants
of health are strongly associated with obesity, and cumulative socioeconomic disadvantage can
increase obesity risk and severity (Philip et al., 2025).
Local data should be used with caution. In 2023, there were approximately 30.9% adults
in the Hialeah community considered obese with a 95% confidence interval from 26.2% to
35.9%, in 2017. Thus, any estimate available locally should not be read as implying that Hialeah
has a greater obesity prevalence than the United States as a whole. Instead, the proposed project
will focus specifically on a clinically identified high-risk population of low-income Hispanic
adults with BMI of at least 30 kg/m². A baseline review of deidentified clinic data will determine
the number and percentage of eligible patients and provide a clinic-specific measure of need.
Change is important because obesity can negatively influence physical mobility,
emotional health, risk for chronic disease and health care usage. The population may also
experience difficulty following conventional weight-management programs when educational
materials do not reflect cultural foods, language preferences, family practices, or financial
realities. According to Garcia et al. (2026), culturally tailored interventions among Hispanic
populations frequently feature bilingual delivery, culturally adapted food choices, peer and
family support, and adjusted educational materials.
Evidence-Based Intervention and Literature Review
5
Research shows the efficacy of interventions that incorporate nutrition, physical exercise,
behavior modification, and follow-up. In addition, nurses are in the best position to conduct such
interventions as the role of primary care nurses encompasses assessment, education, goal setting,
monitoring, supportive care, and follow-up (Piwowarczyk et al., 2024). Nurses are involved in
education, counseling, psychological support, health advocacy, and intervention for obesity
management.Cultural adaptation is especially relevant to the proposed population. A recent
systematic review of behavioral weight-management interventions for Hispanic men found that
interventions frequently incorporated linguistic access and social or family support. Reported
weight changes ranged from weight gain to losses of approximately 6.3 kg (Flaxman et al.,
2024). Research involving Hispanic women also demonstrates benefits from culturally tailored
lifestyle interventions. When programs use bilingual and bicultural delivery, culturally modified
materials, traditional Hispanic foods, and peer participation (Garcia et al., 2026).
The proposed intervention will therefore avoid presenting weight management as a
simple matter of individual choice. Instead, nurses will assess barriers and work with participants
to establish achievable goals. Nutrition education will include affordable food substitutions and
portion control rather than requiring expensive specialty foods. Physical activity education will
focus on practical exercises that can be done safely in the participant’s environment. Follow-up
sessions each week will help maintain the activity, recognize barriers, and motivate the
individual to continue being active.
This approach is feasible for the advanced practice nurse because it can easily be
included in the daily routine of primary care services without any specialized and costly
equipment. The necessary resources are: bilingual educational brochures, weight scales, BMI
calculators, forms, educational materials, and about 15 to 30 minutes each session. The estimated
6
project budget can remain modest, consisting primarily of printing, educational materials, staff
preparation, and participant tracking. The clinic can establish an initial project budget of
approximately $300 to $500, depending on existing equipment and printing resources. No
additional medication or specialized technology is required.
Implementation Timeline
The project will take place within 16 weeks. In weeks 1 and 2, the APRN will get
organizational approval for the project, recruit the eligible participants, analyze baseline data
from the clinics and develop bilingual materials. In week 3, staff and participant recruitment will
be done. From weeks 4 to 15, there will be the 12-week intervention program. Week 16 will
involve final weight measurement, data analysis, evaluation of outcomes, and preparation of
recommendations for continued practice. The primary outcome will be the difference between
baseline weight and weight at 12 weeks.
Theoretical Nursing Framework
The theoretical framework that supports the project is Pender’s Health Promotion Model.
This model focuses on individual attributes and experiences, perceived benefits and barriers,
self-efficacy, interpersonal influences, situational influences, and commitment to act (Rojas-
Torres et al., 2025). The above concepts can easily apply to the chosen target population as
Hispanic adults living below the poverty line might face such barriers as economic, cultural,
linguistic, environmental, and motivational barriers to healthy behavior.
In the case of this project, the nurse will use the above model by assessing the perceived
barriers, confidence, culture food preference, readiness for change, and available resources of the
participants. Then, the education will be tailored according to the above assessment results. The
individuals will set weekly nutritional and physical activity goals, monitor their weight, and get
7
encouragement from the nurse. The model therefore connects the population’s needs with the
intervention and expected outcome.
Lewin’s Change Theory will provide a complementary framework for implementing the
practice change. The unfreezing stage will involve reviewing baseline obesity data, educating
staff, and explaining the need for improved weight-management support. The changing stage
will involve implementation of the bilingual 12-week intervention, participant education, goal
setting, weight monitoring, and follow-up. The refreezing stage will involve reviewing outcomes
and determining whether successful educational procedures can become part of routine clinic
practice. Change models can support structured preparation, implementation, stakeholder
engagement, and sustainability in healthcare improvement.
8
References
Cawley, J. (2021). Direct medical costs of obesity in the United States and the most populous
states. Journal of Managed Care & Specialty Pharmacy, 27(3), 354–366.
https://doi.org/10.18553/jmcp.2021.20410
CDC. (2024). Adult obesity prevalence maps. CDC. https://www.cdc.gov/obesity/data-and-
statistics/adult-obesity-prevalence-maps.html
CDC. (2025, January 28). High blood pressure facts. High Blood Pressure.
https://www.cdc.gov/high-blood-pressure/data-research/facts-stats/index.html
Centers for Disease Control and Prevention. (2024, May 14). Adult obesity facts. CDC.
https://www.cdc.gov/obesity/adult-obesity-facts/index.html
Emmerich, S., Fryar, C., Stierman, B., & Ogden, C. L. (2024, September). Obesity and severe
obesity prevalence in adults: United States, August 2021–August 2023. CDC. CDC.Gov.
https://www.cdc.gov/nchs/products/databriefs/db508.htm
Flaxman, H. R., Hernandez, N. G., Critelli, B., Chong, B. K., Sadowska, K., Pain, K., &
Gonzalez, C. J. (2024). Behavioral weight management interventions for hispanic men in
the United States: A systematic review. American Journal of Men’s Health, 18(5).
https://doi.org/10.1177/15579883241290344
Garcia, A. V., Falls, E., Dodge, E., & Aboul-Enein, B. H. (2026). The impact of culture in weight
loss intervention effectiveness among hispanic American women with overweight or
obesity: A systematic scoping review. Hispanic Health Care International : The Official
Journal of the National Association of Hispanic Nurses, 24(3), 153–171. PubMed
Central. https://doi.org/10.1177/15404153251383131
9
Martin, M. P., Obioha, C. U., Gaikwad, S., Padron-Monedero, A., Pino, M. J. Del, Curtis, D., &
Villalba, K. (2022). Perceptions, awareness, and barriers to care regarding obesity and
diabetes among latinx in Miami and Escambia, Florida: A qualitative geographical
comparative study. Journal of Global Health Reports, 6, e2022003.
https://doi.org/10.29392/001c.30829
Philip, J., Hagan, K., Shahid, I., Chang, R., Prakash, S., Friedman, M., Titus, A., Harun Kundi,
Amin, Z., Javed, U., Avenatti, E., Sadeer Al-Kindi, Nasir, K., & Javed, Z. (2025).
Unfavorable social determinants of health and obesity. JACC Advances, 4(11), 102154–
102154. https://doi.org/10.1016/j.jacadv.2025.102154
Piwowarczyk, E., MacPhee, M., & Howe, J. (2024). Nurses’ role in obesity management in
adults in primary healthcare settings worldwide: A scoping review. Healthcare, 12(17),
1700. https://doi.org/10.3390/healthcare12171700
Rojas-Torres, I. L., Garizábalo Dávila, C. M., Ruidíaz Gómez, K. S., Fernández Aragón, S. P.,
Perea-Rojas, D. M., Rodelo Olmos, G. M., & Liñán Meléndez, N. I. (2025).
Effectiveness of Nola Pender’s health promotion model: A comprehensive approach for
enhancing healthy behaviors and quality of life in adults. International Journal of
Environmental Research and Public Health, 22(10), 1506.
https://doi.org/10.3390/ijerph22101506
**## CapstonePartIPICOTAssignmentfeedback.pdf**
1
Capstone Part I: PICOT Assignment
Erika Brito
Florida National University
MSN Capstone Project
Dr. Carmen Lazo
September 18, 2026
2
Introduction and Significance of the Practice Problem
Obesity is a serious chronic disease problem that has negative consequences for physical
and social health, health-care utilization, and health-care costs. The disease is linked to
cardiovascular disease, decreased physical functioning, musculoskeletal complications, certain
cancers, Type 2 diabetes and hypertension (CDC 2025). Across the nation, 40.3% of U.S. adults
were at risk of having obesity, with 9.4% having severe obesity during August 2021-2023
(Emmerich et al., 2024). CDC surveillance data also show that Hispanic adults are impacted; at
least 35% of adult Hispanics are obese in 33 geographic areas for which there is adequate data
for 2022–2024 (CDC, 2024). The results highlight the need for interventions aimed at weight
management that are culturally and linguistically accessible.
Obesity also has significant economic impacts. Health care for obesity is expensive for
patients and the health care system. In 2019 dollars, adults with obesity had $1,861 more in
annual medical expenses than adults with healthy weight. Excess costs for adults suffering for
severe obesity were $3,097 per person. This represents almost $173 billion in 2019 dollars
(CDC, 2024) in medical costs. Additionally, Cawley et al. (2021) further showed that the burden
of obesity to direct medical costs in the United States is substantial. Although a reliable obesity-
specific healthcare cost for ZIP code 33012 is not available, local socioeconomic conditions
justify examining the issue in this population. Hialeah is mostly Hispanic, and culturally
responsive care is relevant to the proposed project because there is a large Hispanic population
within ZIP code 33012.
The intervention that is being proposed is bi-lingual nurse led, 12-week-long nutrition,
portion control, physical activity, and realistic weight management education. The purpose is to
determine whether the intervention produces measurable weight loss among low-income
3
Hispanic adults with obesity receiving care in a community primary care clinic in Hialeah. The
proposed outcome is a change in body weight from baseline to the completion of 12 weeks. This
objective is measurable and realistic for a semester-long quality improvement project.
PICOT Question
The PICOT question is: In low-income Hispanic adults between 18 and 64 years of age
with obesity who receive primary care at a community clinic in Hialeah, Miami-Dade County
(P), how does a nurse-led bilingual education program addressing healthy nutrition and physical
activity (I), compared with participants’ baseline weight before the intervention (C), affect
weight loss (O) over 12 weeks (T)?
The population will consist of adults 18 to 64 years of age who self-identify as Hispanic,
have a BMI of at least 30 kg/m², receive care at the selected community clinic, and meet the
clinic’s income-related eligibility criteria. The intervention will consist of structured nurse-led
education provided in English and Spanish. Education will address affordable healthy food
selection, portion control, culturally familiar foods, increased physical activity, goal setting, and
strategies for overcoming common barriers. The comparison will use each participant’s baseline
weight as the preintervention reference point. Although this is not a separate control group, the
preintervention measurement will allow the project to determine whether weight changes occur
following implementation. The outcome will be change in weight measured in pounds or
kilograms, with measurements collected at baseline and during follow-up. The intervention will
continue for 12 weeks.
Vulnerable Population and Setting
The population selected would be the low-income Hispanic adults with obesity getting
primary care in the City of Hialeah, specifically in the 33012 ZIP code. The population is
4
vulnerable because obesity risk and weight-management behaviors are influenced by
socioeconomic conditions, access to nutritious foods, transportation, health education, language,
and opportunities for physical activity. A study of Latinx adults in Florida found that financial
constraints, not having access to nutritious food, and a lack of culturally sensitive education were
significant obstacles to preventing obesity and diabetes (Martin et al., 2022). Social determinants
of health are strongly associated with obesity, and cumulative socioeconomic disadvantage can
increase obesity risk and severity (Philip et al., 2025).
Local data should be used with caution. In 2023, there were approximately 30.9% adults
in the Hialeah community considered obese with a 95% confidence interval from 26.2% to
35.9%, in 2017. Thus, any estimate available locally should not be read as implying that Hialeah
has a greater obesity prevalence than the United States as a whole. Instead, the proposed project
will focus specifically on a clinically identified high-risk population of low-income Hispanic
adults with BMI of at least 30 kg/m². A baseline review of deidentified clinic data will determine
the number and percentage of eligible patients and provide a clinic-specific measure of need.
Change is important because obesity can negatively influence physical mobility,
emotional health, risk for chronic disease and health care usage. The population may also
experience difficulty following conventional weight-management programs when educational
materials do not reflect cultural foods, language preferences, family practices, or financial
realities. According to Garcia et al. (2026), culturally tailored interventions among Hispanic
populations frequently feature bilingual delivery, culturally adapted food choices, peer and
family support, and adjusted educational materials.
Evidence-Based Intervention and Literature Review
5
Research shows the efficacy of interventions that incorporate nutrition, physical exercise,
behavior modification, and follow-up. In addition, nurses are in the best position to conduct such
interventions as the role of primary care nurses encompasses assessment, education, goal setting,
monitoring, supportive care, and follow-up (Piwowarczyk et al., 2024). Nurses are involved in
education, counseling, psychological support, health advocacy, and intervention for obesity
management.Cultural adaptation is especially relevant to the proposed population. A recent
systematic review of behavioral weight-management interventions for Hispanic men found that
interventions frequently incorporated linguistic access and social or family support. Reported
weight changes ranged from weight gain to losses of approximately 6.3 kg (Flaxman et al.,
2024). Research involving Hispanic women also demonstrates benefits from culturally tailored
lifestyle interventions. When programs use bilingual and bicultural delivery, culturally modified
materials, traditional Hispanic foods, and peer participation (Garcia et al., 2026).
The proposed intervention will therefore avoid presenting weight management as a
simple matter of individual choice. Instead, nurses will assess barriers and work with participants
to establish achievable goals. Nutrition education will include affordable food substitutions and
portion control rather than requiring expensive specialty foods. Physical activity education will
focus on practical exercises that can be done safely in the participant’s environment. Follow-up
sessions each week will help maintain the activity, recognize barriers, and motivate the
individual to continue being active.
This approach is feasible for the advanced practice nurse because it can easily be
included in the daily routine of primary care services without any specialized and costly
equipment. The necessary resources are: bilingual educational brochures, weight scales, BMI
calculators, forms, educational materials, and about 15 to 30 minutes each session. The estimated
6
project budget can remain modest, consisting primarily of printing, educational materials, staff
preparation, and participant tracking. The clinic can establish an initial project budget of
approximately $300 to $500, depending on existing equipment and printing resources. No
additional medication or specialized technology is required.
Implementation Timeline
The project will take place within 16 weeks. In weeks 1 and 2, the APRN will get
organizational approval for the project, recruit the eligible participants, analyze baseline data
from the clinics and develop bilingual materials. In week 3, staff and participant recruitment will
be done. From weeks 4 to 15, there will be the 12-week intervention program. Week 16 will
involve final weight measurement, data analysis, evaluation of outcomes, and preparation of
recommendations for continued practice. The primary outcome will be the difference between
baseline weight and weight at 12 weeks.
Theoretical Nursing Framework
The theoretical framework that supports the project is Pender’s Health Promotion Model.
This model focuses on individual attributes and experiences, perceived benefits and barriers,
self-efficacy, interpersonal influences, situational influences, and commitment to act (Rojas-
Torres et al., 2025). The above concepts can easily apply to the chosen target population as
Hispanic adults living below the poverty line might face such barriers as economic, cultural,
linguistic, environmental, and motivational barriers to healthy behavior.
In the case of this project, the nurse will use the above model by assessing the perceived
barriers, confidence, culture food preference, readiness for change, and available resources of the
participants. Then, the education will be tailored according to the above assessment results. The
individuals will set weekly nutritional and physical activity goals, monitor their weight, and get
7
encouragement from the nurse. The model therefore connects the population’s needs with the
intervention and expected outcome.
Lewin’s Change Theory will provide a complementary framework for implementing the
practice change. The unfreezing stage will involve reviewing baseline obesity data, educating
staff, and explaining the need for improved weight-management support. The changing stage
will involve implementation of the bilingual 12-week intervention, participant education, goal
setting, weight monitoring, and follow-up. The refreezing stage will involve reviewing outcomes
and determining whether successful educational procedures can become part of routine clinic
practice. Change models can support structured preparation, implementation, stakeholder
engagement, and sustainability in healthcare improvement.
8
References
Cawley, J. (2021). Direct medical costs of obesity in the United States and the most populous
states. Journal of Managed Care & Specialty Pharmacy, 27(3), 354–366.
https://doi.org/10.18553/jmcp.2021.20410
CDC. (2024). Adult obesity prevalence maps. CDC. https://www.cdc.gov/obesity/data-and-
statistics/adult-obesity-prevalence-maps.html
CDC. (2025, January 28). High blood pressure facts. High Blood Pressure.
https://www.cdc.gov/high-blood-pressure/data-research/facts-stats/index.html
Centers for Disease Control and Prevention. (2024, May 14). Adult obesity facts. CDC.
https://www.cdc.gov/obesity/adult-obesity-facts/index.html
Emmerich, S., Fryar, C., Stierman, B., & Ogden, C. L. (2024, September). Obesity and severe
obesity prevalence in adults: United States, August 2021–August 2023. CDC. CDC.Gov.
https://www.cdc.gov/nchs/products/databriefs/db508.htm
Flaxman, H. R., Hernandez, N. G., Critelli, B., Chong, B. K., Sadowska, K., Pain, K., &
Gonzalez, C. J. (2024). Behavioral weight management interventions for hispanic men in
the United States: A systematic review. American Journal of Men’s Health, 18(5).
https://doi.org/10.1177/15579883241290344
Garcia, A. V., Falls, E., Dodge, E., & Aboul-Enein, B. H. (2026). The impact of culture in weight
loss intervention effectiveness among hispanic American women with overweight or
obesity: A systematic scoping review. Hispanic Health Care International : The Official
Journal of the National Association of Hispanic Nurses, 24(3), 153–171. PubMed
Central. https://doi.org/10.1177/15404153251383131
9
Martin, M. P., Obioha, C. U., Gaikwad, S., Padron-Monedero, A., Pino, M. J. Del, Curtis, D., &
Villalba, K. (2022). Perceptions, awareness, and barriers to care regarding obesity and
diabetes among latinx in Miami and Escambia, Florida: A qualitative geographical
comparative study. Journal of Global Health Reports, 6, e2022003.
https://doi.org/10.29392/001c.30829
Philip, J., Hagan, K., Shahid, I., Chang, R., Prakash, S., Friedman, M., Titus, A., Harun Kundi,
Amin, Z., Javed, U., Avenatti, E., Sadeer Al-Kindi, Nasir, K., & Javed, Z. (2025).
Unfavorable social determinants of health and obesity. JACC Advances, 4(11), 102154–
102154. https://doi.org/10.1016/j.jacadv.2025.102154
Piwowarczyk, E., MacPhee, M., & Howe, J. (2024). Nurses’ role in obesity management in
adults in primary healthcare settings worldwide: A scoping review. Healthcare, 12(17),
1700. https://doi.org/10.3390/healthcare12171700
Rojas-Torres, I. L., Garizábalo Dávila, C. M., Ruidíaz Gómez, K. S., Fernández Aragón, S. P.,
Perea-Rojas, D. M., Rodelo Olmos, G. M., & Liñán Meléndez, N. I. (2025).
Effectiveness of Nola Pender’s health promotion model: A comprehensive approach for
enhancing healthy behaviors and quality of life in adults. International Journal of
Environmental Research and Public Health, 22(10), 1506.
https://doi.org/10.3390/ijerph22101506
**## capstoneintrucction.docx**
How will you be able to avoid IRB approval since you are proposing weight measurements and medical recommendations?
How can you gurantee safe exercises for all patients? DId you find research on why APRNs are suitable to lead the Capstone?
Missing Conclusion paragraph.
Capstone Part II: Review of Literature
**CAPSTONE: PART II due 10/4/2025 by 11:59pm**
1. Review of Literature:
– Review and discuss literature: Synthesize at least 10 primary research studies and/or systematic reviews; do not include summary articles. This section is all about the scientific evidence rather than someone else's opinion of the evidence. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. This is a synthesis rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.
2. Analyze and apply knowledge directly to your PICOT- The studies that you cite in this section must relate directly to your PICOT question.
3. Provide precise body of evidence for your Practice Change- Include Nurses as leaders in this project, statistics, cost, impact on healthcare.
4. Discuss objectives for your practice change, Why is change necessary?
5. Discuss where the problem exists, why it exists, what is the preposition for change. Include information from your PICOT.
6. Apply all that is relevant to the problem. For example: Pros vs Cons, current state of problem
NOTE: It should not reflect your opinion, but rather Evidence Based Practice should be applied
-After completing a literature search on interventions addressing your chosen health problem, write a review that evaluates the strengths and weaknesses of all the sources you have found, compare anc constrast.
-Use appropriate APA 7th Ed. Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be minimum 4-6 pages long (not including the title and reference page).
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written APA in the 3rd person.
**Rubric Capstone II.docx**
1. Integration of Knowledge — 25 points
Thoroughly select and present an appropriate evidence-based practice intervention for the identified health problem and proposed change. Clearly explain how the evidence supports the intervention.
2. Topic Focus — 25 points
Choose a health problem narrow enough for the assignment’s scope. Include a clear topic statement that provides direction for the paper. Maintain a consistent focus, develop thoughtful insights, and support the discussion with cited evidence.
3. Depth of Discussion and Cohesiveness — 25 points
Provide an in-depth discussion throughout the paper. Integrate information from all sources and demonstrate an understanding of the relationships among their findings. Ensure that ideas flow logically from one issue to the next. The rubric specifically requires the paper’s body to flow without headings.
4. Spelling and Grammar — Category Listed as 10 Points
Meet the required word count and include fewer than five grammatical, spelling, capitalization, or punctuation errors. Carefully proofread the paper before submission.
5. Sources — 10 points
Use at least six current sources, including at least three peer-reviewed journal articles or scholarly books. Include both general background information and specialized evidence. All websites must be authoritative. Identify special-interest sources or popular literature appropriately if used.
6. Citations — 5 points
Follow APA formatting consistently, with fewer than five errors involving citations, quotations, or formatting. Ensure that in-text citations and reference entries are complete and accurate.
Scoring clarification: The spelling and grammar category is labeled as worth 10 points, but the Outstanding column awards 8 points. This discrepancy should be clarified with the instructor.
**## CapstonePartIPICOTAssignmentfeedback.pdf**
1
Capstone Part I: PICOT Assignment
Erika Brito
Florida National University
MSN Capstone Project
Dr. Carmen Lazo
September 18, 2026
2
Introduction and Significance of the Practice Problem
Obesity is a serious chronic disease problem that has negative consequences for physical
and social health, health-care utilization, and health-care costs. The disease is linked to
cardiovascular disease, decreased physical functioning, musculoskeletal complications, certain
cancers, Type 2 diabetes and hypertension (CDC 2025). Across the nation, 40.3% of U.S. adults
were at risk of having obesity, with 9.4% having severe obesity during August 2021-2023
(Emmerich et al., 2024). CDC surveillance data also show that Hispanic adults are impacted; at
least 35% of adult Hispanics are obese in 33 geographic areas for which there is adequate data
for 2022–2024 (CDC, 2024). The results highlight the need for interventions aimed at weight
management that are culturally and linguistically accessible.
Obesity also has significant economic impacts. Health care for obesity is expensive for
patients and the health care system. In 2019 dollars, adults with obesity had $1,861 more in
annual medical expenses than adults with healthy weight. Excess costs for adults suffering for
severe obesity were $3,097 per person. This represents almost $173 billion in 2019 dollars
(CDC, 2024) in medical costs. Additionally, Cawley et al. (2021) further showed that the burden
of obesity to direct medical costs in the United States is substantial. Although a reliable obesity-
specific healthcare cost for ZIP code 33012 is not available, local socioeconomic conditions
justify examining the issue in this population. Hialeah is mostly Hispanic, and culturally
responsive care is relevant to the proposed project because there is a large Hispanic population
within ZIP code 33012.
The intervention that is being proposed is bi-lingual nurse led, 12-week-long nutrition,
portion control, physical activity, and realistic weight management education. The purpose is to
determine whether the intervention produces measurable weight loss among low-income
3
Hispanic adults with obesity receiving care in a community primary care clinic in Hialeah. The
proposed outcome is a change in body weight from baseline to the completion of 12 weeks. This
objective is measurable and realistic for a semester-long quality improvement project.
PICOT Question
The PICOT question is: In low-income Hispanic adults between 18 and 64 years of age
with obesity who receive primary care at a community clinic in Hialeah, Miami-Dade County
(P), how does a nurse-led bilingual education program addressing healthy nutrition and physical
activity (I), compared with participants’ baseline weight before the intervention (C), affect
weight loss (O) over 12 weeks (T)?
The population will consist of adults 18 to 64 years of age who self-identify as Hispanic,
have a BMI of at least 30 kg/m², receive care at the selected community clinic, and meet the
clinic’s income-related eligibility criteria. The intervention will consist of structured nurse-led
education provided in English and Spanish. Education will address affordable healthy food
selection, portion control, culturally familiar foods, increased physical activity, goal setting, and
strategies for overcoming common barriers. The comparison will use each participant’s baseline
weight as the preintervention reference point. Although this is not a separate control group, the
preintervention measurement will allow the project to determine whether weight changes occur
following implementation. The outcome will be change in weight measured in pounds or
kilograms, with measurements collected at baseline and during follow-up. The intervention will
continue for 12 weeks.
Vulnerable Population and Setting
The population selected would be the low-income Hispanic adults with obesity getting
primary care in the City of Hialeah, specifically in the 33012 ZIP code. The population is
4
vulnerable because obesity risk and weight-management behaviors are influenced by
socioeconomic conditions, access to nutritious foods, transportation, health education, language,
and opportunities for physical activity. A study of Latinx adults in Florida found that financial
constraints, not having access to nutritious food, and a lack of culturally sensitive education were
significant obstacles to preventing obesity and diabetes (Martin et al., 2022). Social determinants
of health are strongly associated with obesity, and cumulative socioeconomic disadvantage can
increase obesity risk and severity (Philip et al., 2025).
Local data should be used with caution. In 2023, there were approximately 30.9% adults
in the Hialeah community considered obese with a 95% confidence interval from 26.2% to
35.9%, in 2017. Thus, any estimate available locally should not be read as implying that Hialeah
has a greater obesity prevalence than the United States as a whole. Instead, the proposed project
will focus specifically on a clinically identified high-risk population of low-income Hispanic
adults with BMI of at least 30 kg/m². A baseline review of deidentified clinic data will determine
the number and percentage of eligible patients and provide a clinic-specific measure of need.
Change is important because obesity can negatively influence physical mobility,
emotional health, risk for chronic disease and health care usage. The population may also
experience difficulty following conventional weight-management programs when educational
materials do not reflect cultural foods, language preferences, family practices, or financial
realities. According to Garcia et al. (2026), culturally tailored interventions among Hispanic
populations frequently feature bilingual delivery, culturally adapted food choices, peer and
family support, and adjusted educational materials.
Evidence-Based Intervention and Literature Review
5
Research shows the efficacy of interventions that incorporate nutrition, physical exercise,
behavior modification, and follow-up. In addition, nurses are in the best position to conduct such
interventions as the role of primary care nurses encompasses assessment, education, goal setting,
monitoring, supportive care, and follow-up (Piwowarczyk et al., 2024). Nurses are involved in
education, counseling, psychological support, health advocacy, and intervention for obesity
management.Cultural adaptation is especially relevant to the proposed population. A recent
systematic review of behavioral weight-management interventions for Hispanic men found that
interventions frequently incorporated linguistic access and social or family support. Reported
weight changes ranged from weight gain to losses of approximately 6.3 kg (Flaxman et al.,
2024). Research involving Hispanic women also demonstrates benefits from culturally tailored
lifestyle interventions. When programs use bilingual and bicultural delivery, culturally modified
materials, traditional Hispanic foods, and peer participation (Garcia et al., 2026).
The proposed intervention will therefore avoid presenting weight management as a
simple matter of individual choice. Instead, nurses will assess barriers and work with participants
to establish achievable goals. Nutrition education will include affordable food substitutions and
portion control rather than requiring expensive specialty foods. Physical activity education will
focus on practical exercises that can be done safely in the participant’s environment. Follow-up
sessions each week will help maintain the activity, recognize barriers, and motivate the
individual to continue being active.
This approach is feasible for the advanced practice nurse because it can easily be
included in the daily routine of primary care services without any specialized and costly
equipment. The necessary resources are: bilingual educational brochures, weight scales, BMI
calculators, forms, educational materials, and about 15 to 30 minutes each session. The estimated
6
project budget can remain modest, consisting primarily of printing, educational materials, staff
preparation, and participant tracking. The clinic can establish an initial project budget of
approximately $300 to $500, depending on existing equipment and printing resources. No
additional medication or specialized technology is required.
Implementation Timeline
The project will take place within 16 weeks. In weeks 1 and 2, the APRN will get
organizational approval for the project, recruit the eligible participants, analyze baseline data
from the clinics and develop bilingual materials. In week 3, staff and participant recruitment will
be done. From weeks 4 to 15, there will be the 12-week intervention program. Week 16 will
involve final weight measurement, data analysis, evaluation of outcomes, and preparation of
recommendations for continued practice. The primary outcome will be the difference between
baseline weight and weight at 12 weeks.
Theoretical Nursing Framework
The theoretical framework that supports the project is Pender’s Health Promotion Model.
This model focuses on individual attributes and experiences, perceived benefits and barriers,
self-efficacy, interpersonal influences, situational influences, and commitment to act (Rojas-
Torres et al., 2025). The above concepts can easily apply to the chosen target population as
Hispanic adults living below the poverty line might face such barriers as economic, cultural,
linguistic, environmental, and motivational barriers to healthy behavior.
In the case of this project, the nurse will use the above model by assessing the perceived
barriers, confidence, culture food preference, readiness for change, and available resources of the
participants. Then, the education will be tailored according to the above assessment results. The
individuals will set weekly nutritional and physical activity goals, monitor their weight, and get
7
encouragement from the nurse. The model therefore connects the population’s needs with the
intervention and expected outcome.
Lewin’s Change Theory will provide a complementary framework for implementing the
practice change. The unfreezing stage will involve reviewing baseline obesity data, educating
staff, and explaining the need for improved weight-management support. The changing stage
will involve implementation of the bilingual 12-week intervention, participant education, goal
setting, weight monitoring, and follow-up. The refreezing stage will involve reviewing outcomes
and determining whether successful educational procedures can become part of routine clinic
practice. Change models can support structured preparation, implementation, stakeholder
engagement, and sustainability in healthcare improvement.
8
References
Cawley, J. (2021). Direct medical costs of obesity in the United States and the most populous
states. Journal of Managed Care & Specialty Pharmacy, 27(3), 354–366.
https://doi.org/10.18553/jmcp.2021.20410
CDC. (2024). Adult obesity prevalence maps. CDC. https://www.cdc.gov/obesity/data-and-
statistics/adult-obesity-prevalence-maps.html
CDC. (2025, January 28). High blood pressure facts. High Blood Pressure.
https://www.cdc.gov/high-blood-pressure/data-research/facts-stats/index.html
Centers for Disease Control and Prevention. (2024, May 14). Adult obesity facts. CDC.
https://www.cdc.gov/obesity/adult-obesity-facts/index.html
Emmerich, S., Fryar, C., Stierman, B., & Ogden, C. L. (2024, September). Obesity and severe
obesity prevalence in adults: United States, August 2021–August 2023. CDC. CDC.Gov.
https://www.cdc.gov/nchs/products/databriefs/db508.htm
Flaxman, H. R., Hernandez, N. G., Critelli, B., Chong, B. K., Sadowska, K., Pain, K., &
Gonzalez, C. J. (2024). Behavioral weight management interventions for hispanic men in
the United States: A systematic review. American Journal of Men’s Health, 18(5).
https://doi.org/10.1177/15579883241290344
Garcia, A. V., Falls, E., Dodge, E., & Aboul-Enein, B. H. (2026). The impact of culture in weight
loss intervention effectiveness among hispanic American women with overweight or
obesity: A systematic scoping review. Hispanic Health Care International : The Official
Journal of the National Association of Hispanic Nurses, 24(3), 153–171. PubMed
Central. https://doi.org/10.1177/15404153251383131
9
Martin, M. P., Obioha, C. U., Gaikwad, S., Padron-Monedero, A., Pino, M. J. Del, Curtis, D., &
Villalba, K. (2022). Perceptions, awareness, and barriers to care regarding obesity and
diabetes among latinx in Miami and Escambia, Florida: A qualitative geographical
comparative study. Journal of Global Health Reports, 6, e2022003.
https://doi.org/10.29392/001c.30829
Philip, J., Hagan, K., Shahid, I., Chang, R., Prakash, S., Friedman, M., Titus, A., Harun Kundi,
Amin, Z., Javed, U., Avenatti, E., Sadeer Al-Kindi, Nasir, K., & Javed, Z. (2025).
Unfavorable social determinants of health and obesity. JACC Advances, 4(11), 102154–
102154. https://doi.org/10.1016/j.jacadv.2025.102154
Piwowarczyk, E., MacPhee, M., & Howe, J. (2024). Nurses’ role in obesity management in
adults in primary healthcare settings worldwide: A scoping review. Healthcare, 12(17),
1700. https://doi.org/10.3390/healthcare12171700
Rojas-Torres, I. L., Garizábalo Dávila, C. M., Ruidíaz Gómez, K. S., Fernández Aragón, S. P.,
Perea-Rojas, D. M., Rodelo Olmos, G. M., & Liñán Meléndez, N. I. (2025).
Effectiveness of Nola Pender’s health promotion model: A comprehensive approach for
enhancing healthy behaviors and quality of life in adults. International Journal of
Environmental Research and Public Health, 22(10), 1506.
https://doi.org/10.3390/ijerph22101506
**## capstoneintrucction.docx**
How will you be able to avoid IRB approval since you are proposing weight measurements and medical recommendations?
How can you gurantee safe exercises for all patients? DId you find research on why APRNs are suitable to lead the Capstone?
Missing Conclusion paragraph.
Capstone Part II: Review of Literature
**CAPSTONE: PART II due 10/4/2025 by 11:59pm**
1. Review of Literature:
– Review and discuss literature: Synthesize at least 10 primary research studies and/or systematic reviews; do not include summary articles. This section is all about the scientific evidence rather than someone else's opinion of the evidence. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. This is a synthesis rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.
2. Analyze and apply knowledge directly to your PICOT- The studies that you cite in this section must relate directly to your PICOT question.
3. Provide precise body of evidence for your Practice Change- Include Nurses as leaders in this project, statistics, cost, impact on healthcare.
4. Discuss objectives for your practice change, Why is change necessary?
5. Discuss where the problem exists, why it exists, what is the preposition for change. Include information from your PICOT.
6. Apply all that is relevant to the problem. For example: Pros vs Cons, current state of problem
NOTE: It should not reflect your opinion, but rather Evidence Based Practice should be applied
-After completing a literature search on interventions addressing your chosen health problem, write a review that evaluates the strengths and weaknesses of all the sources you have found, compare anc constrast.
-Use appropriate APA 7th Ed. Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be minimum 4-6 pages long (not including the title and reference page).
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written APA in the 3rd person.
**Rubric Capstone II.docx**
1. Integration of Knowledge — 25 points
Thoroughly select and present an appropriate evidence-based practice intervention for the identified health problem and proposed change. Clearly explain how the evidence supports the intervention.
2. Topic Focus — 25 points
Choose a health problem narrow enough for the assignment’s scope. Include a clear topic statement that provides direction for the paper. Maintain a consistent focus, develop thoughtful insights, and support the discussion with cited evidence.
3. Depth of Discussion and Cohesiveness — 25 points
Provide an in-depth discussion throughout the paper. Integrate information from all sources and demonstrate an understanding of the relationships among their findings. Ensure that ideas flow logically from one issue to the next. The rubric specifically requires the paper’s body to flow without headings.
4. Spelling and Grammar — Category Listed as 10 Points
Meet the required word count and include fewer than five grammatical, spelling, capitalization, or punctuation errors. Carefully proofread the paper before submission.
5. Sources — 10 points
Use at least six current sources, including at least three peer-reviewed journal articles or scholarly books. Include both general background information and specialized evidence. All websites must be authoritative. Identify special-interest sources or popular literature appropriately if used.
6. Citations — 5 points
Follow APA formatting consistently, with fewer than five errors involving citations, quotations, or formatting. Ensure that in-text citations and reference entries are complete and accurate.
Scoring clarification: The spelling and grammar category is labeled as worth 10 points, but the Outstanding column awards 8 points. This discrepancy should be clarified with the instructor.
**## CapstonePartIPICOTAssignmentfeedback.pdf**
1
Capstone Part I: PICOT Assignment
Erika Brito
Florida National University
MSN Capstone Project
Dr. Carmen Lazo
September 18, 2026
2
Introduction and Significance of the Practice Problem
Obesity is a serious chronic disease problem that has negative consequences for physical
and social health, health-care utilization, and health-care costs. The disease is linked to
cardiovascular disease, decreased physical functioning, musculoskeletal complications, certain
cancers, Type 2 diabetes and hypertension (CDC 2025). Across the nation, 40.3% of U.S. adults
were at risk of having obesity, with 9.4% having severe obesity during August 2021-2023
(Emmerich et al., 2024). CDC surveillance data also show that Hispanic adults are impacted; at
least 35% of adult Hispanics are obese in 33 geographic areas for which there is adequate data
for 2022–2024 (CDC, 2024). The results highlight the need for interventions aimed at weight
management that are culturally and linguistically accessible.
Obesity also has significant economic impacts. Health care for obesity is expensive for
patients and the health care system. In 2019 dollars, adults with obesity had $1,861 more in
annual medical expenses than adults with healthy weight. Excess costs for adults suffering for
severe obesity were $3,097 per person. This represents almost $173 billion in 2019 dollars
(CDC, 2024) in medical costs. Additionally, Cawley et al. (2021) further showed that the burden
of obesity to direct medical costs in the United States is substantial. Although a reliable obesity-
specific healthcare cost for ZIP code 33012 is not available, local socioeconomic conditions
justify examining the issue in this population. Hialeah is mostly Hispanic, and culturally
responsive care is relevant to the proposed project because there is a large Hispanic population
within ZIP code 33012.
The intervention that is being proposed is bi-lingual nurse led, 12-week-long nutrition,
portion control, physical activity, and realistic weight management education. The purpose is to
determine whether the intervention produces measurable weight loss among low-income
3
Hispanic adults with obesity receiving care in a community primary care clinic in Hialeah. The
proposed outcome is a change in body weight from baseline to the completion of 12 weeks. This
objective is measurable and realistic for a semester-long quality improvement project.
PICOT Question
The PICOT question is: In low-income Hispanic adults between 18 and 64 years of age
with obesity who receive primary care at a community clinic in Hialeah, Miami-Dade County
(P), how does a nurse-led bilingual education program addressing healthy nutrition and physical
activity (I), compared with participants’ baseline weight before the intervention (C), affect
weight loss (O) over 12 weeks (T)?
The population will consist of adults 18 to 64 years of age who self-identify as Hispanic,
have a BMI of at least 30 kg/m², receive care at the selected community clinic, and meet the
clinic’s income-related eligibility criteria. The intervention will consist of structured nurse-led
education provided in English and Spanish. Education will address affordable healthy food
selection, portion control, culturally familiar foods, increased physical activity, goal setting, and
strategies for overcoming common barriers. The comparison will use each participant’s baseline
weight as the preintervention reference point. Although this is not a separate control group, the
preintervention measurement will allow the project to determine whether weight changes occur
following implementation. The outcome will be change in weight measured in pounds or
kilograms, with measurements collected at baseline and during follow-up. The intervention will
continue for 12 weeks.
Vulnerable Population and Setting
The population selected would be the low-income Hispanic adults with obesity getting
primary care in the City of Hialeah, specifically in the 33012 ZIP code. The population is
4
vulnerable because obesity risk and weight-management behaviors are influenced by
socioeconomic conditions, access to nutritious foods, transportation, health education, language,
and opportunities for physical activity. A study of Latinx adults in Florida found that financial
constraints, not having access to nutritious food, and a lack of culturally sensitive education were
significant obstacles to preventing obesity and diabetes (Martin et al., 2022). Social determinants
of health are strongly associated with obesity, and cumulative socioeconomic disadvantage can
increase obesity risk and severity (Philip et al., 2025).
Local data should be used with caution. In 2023, there were approximately 30.9% adults
in the Hialeah community considered obese with a 95% confidence interval from 26.2% to
35.9%, in 2017. Thus, any estimate available locally should not be read as implying that Hialeah
has a greater obesity prevalence than the United States as a whole. Instead, the proposed project
will focus specifically on a clinically identified high-risk population of low-income Hispanic
adults with BMI of at least 30 kg/m². A baseline review of deidentified clinic data will determine
the number and percentage of eligible patients and provide a clinic-specific measure of need.
Change is important because obesity can negatively influence physical mobility,
emotional health, risk for chronic disease and health care usage. The population may also
experience difficulty following conventional weight-management programs when educational
materials do not reflect cultural foods, language preferences, family practices, or financial
realities. According to Garcia et al. (2026), culturally tailored interventions among Hispanic
populations frequently feature bilingual delivery, culturally adapted food choices, peer and
family support, and adjusted educational materials.
Evidence-Based Intervention and Literature Review
5
Research shows the efficacy of interventions that incorporate nutrition, physical exercise,
behavior modification, and follow-up. In addition, nurses are in the best position to conduct such
interventions as the role of primary care nurses encompasses assessment, education, goal setting,
monitoring, supportive care, and follow-up (Piwowarczyk et al., 2024). Nurses are involved in
education, counseling, psychological support, health advocacy, and intervention for obesity
management.Cultural adaptation is especially relevant to the proposed population. A recent
systematic review of behavioral weight-management interventions for Hispanic men found that
interventions frequently incorporated linguistic access and social or family support. Reported
weight changes ranged from weight gain to losses of approximately 6.3 kg (Flaxman et al.,
2024). Research involving Hispanic women also demonstrates benefits from culturally tailored
lifestyle interventions. When programs use bilingual and bicultural delivery, culturally modified
materials, traditional Hispanic foods, and peer participation (Garcia et al., 2026).
The proposed intervention will therefore avoid presenting weight management as a
simple matter of individual choice. Instead, nurses will assess barriers and work with participants
to establish achievable goals. Nutrition education will include affordable food substitutions and
portion control rather than requiring expensive specialty foods. Physical activity education will
focus on practical exercises that can be done safely in the participant’s environment. Follow-up
sessions each week will help maintain the activity, recognize barriers, and motivate the
individual to continue being active.
This approach is feasible for the advanced practice nurse because it can easily be
included in the daily routine of primary care services without any specialized and costly
equipment. The necessary resources are: bilingual educational brochures, weight scales, BMI
calculators, forms, educational materials, and about 15 to 30 minutes each session. The estimated
6
project budget can remain modest, consisting primarily of printing, educational materials, staff
preparation, and participant tracking. The clinic can establish an initial project budget of
approximately $300 to $500, depending on existing equipment and printing resources. No
additional medication or specialized technology is required.
Implementation Timeline
The project will take place within 16 weeks. In weeks 1 and 2, the APRN will get
organizational approval for the project, recruit the eligible participants, analyze baseline data
from the clinics and develop bilingual materials. In week 3, staff and participant recruitment will
be done. From weeks 4 to 15, there will be the 12-week intervention program. Week 16 will
involve final weight measurement, data analysis, evaluation of outcomes, and preparation of
recommendations for continued practice. The primary outcome will be the difference between
baseline weight and weight at 12 weeks.
Theoretical Nursing Framework
The theoretical framework that supports the project is Pender’s Health Promotion Model.
This model focuses on individual attributes and experiences, perceived benefits and barriers,
self-efficacy, interpersonal influences, situational influences, and commitment to act (Rojas-
Torres et al., 2025). The above concepts can easily apply to the chosen target population as
Hispanic adults living below the poverty line might face such barriers as economic, cultural,
linguistic, environmental, and motivational barriers to healthy behavior.
In the case of this project, the nurse will use the above model by assessing the perceived
barriers, confidence, culture food preference, readiness for change, and available resources of the
participants. Then, the education will be tailored according to the above assessment results. The
individuals will set weekly nutritional and physical activity goals, monitor their weight, and get
7
encouragement from the nurse. The model therefore connects the population’s needs with the
intervention and expected outcome.
Lewin’s Change Theory will provide a complementary framework for implementing the
practice change. The unfreezing stage will involve reviewing baseline obesity data, educating
staff, and explaining the need for improved weight-management support. The changing stage
will involve implementation of the bilingual 12-week intervention, participant education, goal
setting, weight monitoring, and follow-up. The refreezing stage will involve reviewing outcomes
and determining whether successful educational procedures can become part of routine clinic
practice. Change models can support structured preparation, implementation, stakeholder
engagement, and sustainability in healthcare improvement.
8
References
Cawley, J. (2021). Direct medical costs of obesity in the United States and the most populous
states. Journal of Managed Care & Specialty Pharmacy, 27(3), 354–366.
https://doi.org/10.18553/jmcp.2021.20410
CDC. (2024). Adult obesity prevalence maps. CDC. https://www.cdc.gov/obesity/data-and-
statistics/adult-obesity-prevalence-maps.html
CDC. (2025, January 28). High blood pressure facts. High Blood Pressure.
https://www.cdc.gov/high-blood-pressure/data-research/facts-stats/index.html
Centers for Disease Control and Prevention. (2024, May 14). Adult obesity facts. CDC.
https://www.cdc.gov/obesity/adult-obesity-facts/index.html
Emmerich, S., Fryar, C., Stierman, B., & Ogden, C. L. (2024, September). Obesity and severe
obesity prevalence in adults: United States, August 2021–August 2023. CDC. CDC.Gov.
https://www.cdc.gov/nchs/products/databriefs/db508.htm
Flaxman, H. R., Hernandez, N. G., Critelli, B., Chong, B. K., Sadowska, K., Pain, K., &
Gonzalez, C. J. (2024). Behavioral weight management interventions for hispanic men in
the United States: A systematic review. American Journal of Men’s Health, 18(5).
https://doi.org/10.1177/15579883241290344
Garcia, A. V., Falls, E., Dodge, E., & Aboul-Enein, B. H. (2026). The impact of culture in weight
loss intervention effectiveness among hispanic American women with overweight or
obesity: A systematic scoping review. Hispanic Health Care International : The Official
Journal of the National Association of Hispanic Nurses, 24(3), 153–171. PubMed
Central. https://doi.org/10.1177/15404153251383131
9
Martin, M. P., Obioha, C. U., Gaikwad, S., Padron-Monedero, A., Pino, M. J. Del, Curtis, D., &
Villalba, K. (2022). Perceptions, awareness, and barriers to care regarding obesity and
diabetes among latinx in Miami and Escambia, Florida: A qualitative geographical
comparative study. Journal of Global Health Reports, 6, e2022003.
https://doi.org/10.29392/001c.30829
Philip, J., Hagan, K., Shahid, I., Chang, R., Prakash, S., Friedman, M., Titus, A., Harun Kundi,
Amin, Z., Javed, U., Avenatti, E., Sadeer Al-Kindi, Nasir, K., & Javed, Z. (2025).
Unfavorable social determinants of health and obesity. JACC Advances, 4(11), 102154–
102154. https://doi.org/10.1016/j.jacadv.2025.102154
Piwowarczyk, E., MacPhee, M., & Howe, J. (2024). Nurses’ role in obesity management in
adults in primary healthcare settings worldwide: A scoping review. Healthcare, 12(17),
1700. https://doi.org/10.3390/healthcare12171700
Rojas-Torres, I. L., Garizábalo Dávila, C. M., Ruidíaz Gómez, K. S., Fernández Aragón, S. P.,
Perea-Rojas, D. M., Rodelo Olmos, G. M., & Liñán Meléndez, N. I. (2025).
Effectiveness of Nola Pender’s health promotion model: A comprehensive approach for
enhancing healthy behaviors and quality of life in adults. International Journal of
Environmental Research and Public Health, 22(10), 1506.
https://doi.org/10.3390/ijerph22101506