From A Local Perspective, How Does The Practice Problem Impa ✓ Solved

From a local perspective, how does the practice problem impact

From a local perspective, how does the practice problem impact nurses, nursing care, healthcare organizations, and the quality of care being provided? Identify the local key stakeholders related to the selected practice problem. Describe one approach used at your unique setting to address this problem. From your perspective, is this intervention effective in addressing the problem? Why or why not? If this practice problem is not addressed at your workplace, propose an intervention that could be implemented on a local scale to address the problem.

Paper For Above Instructions

Introduction and local context

In Skagit County, Washington, obesity has been identified as a pressing local health concern with implications for pregnancy outcomes and general health. Although the precise prevalence data shift over time, regional health metrics indicate that a substantial portion of adults in rural and semi-rural settings struggle with obesity, which amplifies risks during pregnancy and complicates obstetric care. Obesity is associated with higher rates of gestational diabetes, hypertensive disorders, cesarean delivery, preeclampsia, and postpartum complications, all of which strain nursing staff and healthcare systems (IHME, 2020; WHO, 2021; CDC, 2023). In obstetric settings, obesity increases risks such as cesarean delivery, delivery complications, and maternal–fetal morbidity, creating a need for targeted local strategies to support high‑risk pregnancies (ACOG, 2022; BJOG, 2021). The local health system must balance patient safety, quality of care, and workforce sustainability while addressing social determinants that hinder consistent care from rural communities to access nutrition and prenatal services (CDC, 2023; Rural Health Journal, 2023).

Impact on nurses, nursing care, and organizational quality

Obesity complicates routine nursing tasks—mobilization, positioning, wound care, and infection prevention—requiring additional staff time and careful safety considerations. Studies at similar scales show increased nursing workload when caring for patients with obesity, contributing to burnout, reduced morale, and higher risk for adverse events if staffing does not scale with patient needs (Nursing Management and related contemporary reviews, 2020–2023). Locally, nurse-to-patient ratios on medical–surgical units can become strained when a sizable subset of patients requires disproportionate time and resources, potentially compromising quality of care for other patients and contributing to higher risk of falls, medication errors, and delayed interventions (IHME, 2020; Rural Health Journal, 2022). These dynamics affect patient outcomes, staff satisfaction, and hospital financial performance through potential increase in complications and possible litigation costs when care is not optimal or timely.

Local stakeholders

Key local stakeholders include patients and families, bedside nurses and other clinicians, nurse managers and administrators, obstetric service leaders, primary care and nutrition staff, social workers, transportation and public health resources, and hospital governing bodies. Community leaders, local policymakers, clinics, and nonprofit organizations also influence resource allocation and education campaigns. Engaging these groups fosters coordinated care, supports adherence to nutrition and weight‑management recommendations, and helps align hospital practice with population health goals (Folta et al., 2015; WHO, 2021). In rural settings, transportation barriers and access to nutrition counseling frequently mediate the effectiveness of any in‑hospital plan, underscoring the need for local partnerships and patient navigation supports (CDC, 2023; Rural Health Journal, 2023).

Current local approach to address the problem

At the local setting level, an integrated obstetric care approach has been implemented to address obesity in pregnancy. This includes early pregnancy BMI assessment (early in the first prenatal visit, around 8 weeks gestation), counseling on appropriate weight gain during pregnancy, and a referral pathway to a nutritionist or dietitian when obesity is identified. In addition, providers initiate screening for glucose intolerance and thyroid function (TSH) in high‑risk patients and prompt the updating of problem lists to flag high‑risk pregnancy status. This approach aims to deliver timely education, coordinate multidisciplinary care, and tailor nutrition plans to individual needs. While some patients engage readily with nutrition services and adopt healthier dietary patterns during pregnancy, others encounter barriers such as transportation, time, and limited access to follow‑up care in rural contexts (Cochrane et al., 2019; Hahler, 2002; IHME, 2020). The effectiveness of this approach appears mixed, with improved engagement among motivated patients but inconsistent uptake among those facing social determinants of health challenges (CDC, 2023; PLOS ONE, 2023).

Effectiveness of the current approach

Overall, the current local strategy shows promise in raising awareness and initiating pharmacologic and dietary referrals early in pregnancy, which can positively influence pregnancy outcomes for motivated patients. However, several factors limit effectiveness: transportation barriers that hinder attendance at nutrition appointments in rural areas; variability in patient adherence to nutrition guidance; and staffing limitations that constrain follow-up and case management. Research from similar settings indicates that without robust staffing, transportation support, and ongoing patient navigation, obesity management during pregnancy remains partially effective at best (J Rural Health, 2022; JMIR, 2024). A cautious assessment suggests that the approach is beneficial for some patients but insufficient for addressing the full scope of local needs without additional, comprehensive interventions (ACOG, 2022; BJOG, 2021).

Proposed local intervention if not already addressed

If the current workplace does not fully address the problem, a multi-faceted local intervention could be implemented to strengthen outcomes. Proposed components include: (1) a multidisciplinary obesity in pregnancy program housed within the obstetric service, integrating obstetricians, nurses, dietitians, social workers, and a care coordinator; (2) expanded navigation services to assist with transportation, appointment scheduling, and access to rural telehealth nutrition counseling; (3) tele-nutrition and remote monitoring using secure mobile health tools to track weight gain, dietary intake, and physical activity; (4) group prenatal care models focused on weight management education and peer support; (5) targeted community partnerships with local gyms, farmers' markets, and WIC programs to encourage healthy lifestyle behaviors outside the clinic; and (6) a continuous quality improvement (CQI) initiative with clear metrics and feedback loops. This program would aim to reduce obstetric complications, improve patient satisfaction, and enhance nurse capacity by distributing workload more evenly and providing early, proactive support for high‑risk pregnancies (PLOS ONE, 2023; JMIR, 2024; BJOG, 2021; IHME, 2020).

Implementation considerations and potential outcomes

Implementation would require administrative support, funding for staff and telehealth infrastructure, and robust data collection for monitoring outcomes. Potential outcomes include reductions in gestational diabetes, hypertensive disorders, and cesarean rates, as well as improved maternal and neonatal health indicators. It would also aim to reduce nurse burnout by aligning staffing with patient needs and by providing dedicated case management for high‑risk pregnancies. Success would depend on addressing social determinants of health, ensuring reliable transportation, and maintaining strong community partnerships. Evaluation metrics could include maternal weight gain within guideline ranges, rates of prenatal nutrition counseling attendance, incidence of pregnancy complications, patient-reported satisfaction, and nurse staffing indices (CDC, 2023; WHO, 2021; BMJ, 2020; JMIR, 2024).

Conclusion

Addressing obesity in pregnancy at a local level requires a comprehensive, multilevel approach that engages clinicians, administrators, and the broader community. While existing strategies can positively influence care, enduring improvements depend on expanding access to nutrition services, overcoming transportation barriers, and aligning staffing with patient needs. A local obesity‑in‑pregnancy program that integrates nutrition, care coordination, telehealth, and community partnerships holds promise for reducing adverse outcomes and sustaining high‑quality nursing care in a rural setting. Ongoing evaluation and stakeholder engagement will be essential to adapt the program to evolving local needs and resources.

References

1. Institute for Health Metrics and Evaluation. (2020). US health data and obesity metrics. IHME.
2. Centers for Disease Control and Prevention. (2023). Obesity facts and pregnancy considerations. CDC.
3. World Health Organization. (2021). Obesity and overweight: key facts. WHO.
4. American College of Obstetricians and Gynecologists. (2022). Obesity in pregnancy: clinical guidance. ACOG.
5. British Journal of Obstetrics and Gynecology. (2021). Maternal obesity and pregnancy outcomes: a comprehensive review. BJOG.
6. PLOS ONE. (2023). Interventions to reduce obesity in pregnancy: systematic review. PLOS ONE.
7. Journal of Rural Health. (2022). Obesity in pregnancy in rural settings: care challenges and outcomes. J Rural Health.
8. JMIR mHealth and uHealth. (2024). Mobile health interventions for weight management in pregnancy. JMIR MHealth UHealth.
9. Obstetrics and Gynecology (The Green Journal). (2020). Obesity in pregnancy and obstetric outcomes: a meta-analysis. Obstet Gynecol.
10. Nursing Management. (2021). Nursing workload and patient outcomes in obesity care: a systematic review. Nurs Manage.