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**files (1)** – ## NUR670Wk5Responses.pdf **## NUR670Wk5Responses.pdf** Nakiba Nelson Interpreting the Results of the Literature Review Introduction Psychiatric-Mental Health Nurse Practitioners (PMHNPs) make clinical decisions based on their interpretation of the evidence, which is a crucial part o…
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Nakiba Nelson
Interpreting the Results of the Literature Review
Introduction
Psychiatric-Mental Health Nurse Practitioners (PMHNPs) make
clinical decisions based on their interpretation of the evidence, which is
a crucial part of evidence-based practice (EBP). A literature review finds
existing research, but interpreting the findings necessitates a critical
evaluation of methodological quality, consistency of findings, practice
application, and consequences for patient outcomes. For complicated
mental illnesses like schizophrenia, where interventions must target
long-term recovery, treatment adherence, and community reintegration
in addition to symptom management, this distinction is especially
crucial. For adults with schizophrenia spectrum illnesses who are
frequently hospitalized, the chosen PICO question assesses whether
Assertive Community Treatment (ACT) yields better results than normal
outpatient psychiatric care.
Comparing Literature Summarization and Interpretation
Interpreting search results and summarizing the literature are
essentially distinct activities. A literature overview describes research
designs, interventions, populations, and outcomes to objectively
aggregate the results of various studies. However, interpretation
necessitates higher-order analysis that assesses the overall strength of the
evidence, finds patterns and contradictions, takes bias into account, and
assesses the findings' clinical importance (Melnyk & Fineout-Overholt,
2023).
Interpretation transforms research findings into useful clinical
knowledge for PMHNPs. Instead of just stating that ACT lowers
hospitalization rates, interpretation takes into account whether the results
are repeatable across healthcare systems, whether patient characteristics
or resource availability may affect effectiveness, and whether the
evidence is rigorous enough to support implementation in practice. This
analytical method enables tailored psychiatric care and enhances
evidence-based decision-making.
Process Used to Interpret the Search Results
The interpretation process began with a comprehensive search of
PubMed, CINAHL Complete, PsycINFO, the Cochrane Library, and
Google Scholar using combinations of the
keywords schizophrenia, Assertive Community Treatment, ACT
team, Flexible Assertive Community Treatment
(FACT), rehospitalization, medication adherence, and community
functioning. Following duplicate removal and screening, only peer-
reviewed studies published between 2021 and 2026 that directly
addressed the PICO question were retained for critical appraisal.
The methodological quality, study design, sample characteristics,
intervention, outcome measures, and potential sources of bias were all
taken into consideration. These designs offer more robust evidence than
descriptive or opinion-based articles, systematic reviews, randomized
controlled trials, and longitudinal cohort studies were given more weight
(Dang et al., 2022). To ascertain whether the results could be logically
extended to community psychiatric settings where PMHNPs work,
studies were also evaluated for external validity.
Interpretation extended beyond individual study outcomes by
examining consistency across the body of evidence. Rather than relying
on isolated findings, conclusions were based on recurring themes
identified in multiple investigations evaluating ACT or Flexible
Assertive Community Treatment programs.
Interpretation of Findings and Clinical Significance
The literature consistently demonstrated that ACT is associated with
meaningful reductions in psychiatric rehospitalization among adults with
schizophrenia spectrum disorders. Multidisciplinary care teams that
provide intensive community-based outreach, case management, and
crisis intervention appear to reduce relapses and prevent avoidable
inpatient admissions by addressing barriers to treatment before
psychiatric deterioration occurs (Tholen et al., 2024).
Similarly, the evidence indicates that ACT improves medication
adherence and continuity of care. This finding is clinically significant
because medication nonadherence remains one of the strongest
predictors of psychotic relapse and recurrent hospitalization. Frequent
patient contact, coordinated medication management, psychoeducation,
and collaboration among team members contribute to sustained
treatment engagement and improved adherence (Hird et al., 2024).
An additional theme emerging from the literature is the positive
effect of ACT on community functioning and recovery-oriented
outcomes. Studies reported improvements in housing stability, social
participation, outpatient engagement, and quality of life, reflecting a
shift from symptom-focused care toward holistic recovery. For
PMHNPs, these findings reinforce the importance of integrating
psychosocial interventions and community resources into
comprehensive treatment planning rather than relying exclusively on
pharmacotherapy (Killaspy, 2023).
Implications for Advanced Psychiatric Nursing Practice
The evidence synthesized through this literature review supports
ACT as an effective, evidence-based intervention for individuals with
schizophrenia who experience repeated psychiatric hospitalizations and
difficulty engaging in conventional outpatient services. From a PMHNP
perspective, these findings support timely referral to ACT programs,
interdisciplinary collaboration, and advocacy for community-based
treatment models that promote sustained recovery.
Moreover, interpretation highlights the broader role of PMHNPs as
leaders in translating research into practice. By critically appraising
evidence rather than merely summarizing findings, PMHNPs can
develop treatment plans that improve medication adherence, reduce
healthcare utilization, and enhance functional recovery while addressing
social determinants of health. This evidence-based approach aligns with
recovery-oriented psychiatric care and supports long-term patient
stability.
Conclusion
Summarizing literature vs interpreting search results is key to
evidence-based psychiatry. Summarization describes research, whereas
interpretation critiques its quality, consistency, and clinical relevance.
The collective evidence suggests that Assertive Community Treatment
reduces rehospitalization, improves medication adherence, and improves
community functioning in adults with schizophrenia spectrum disorders
compared to standard outpatient psychiatric care. These findings
strongly recommend introducing ACT into comprehensive PMHNP
practice while researching implementation techniques and patient-
centered outcomes.
Mario Forbes
Abstract
Introduction/Background
Rational clinical decision making is a key component in advanced
practice psychiatric nursing in which evidence-based practice is used.
The PICO framework helps psychiatric mental health nurse practitioners
(PMHNPs) to create focused and precise clinical questions and conduct
a systematic review of the empirical literature. Evidence collection is
essential but there are specific skills required to summaries a literature
search and to interpret the results. The distinction between describing
findings versus critically assessing the quality of data, bias and clinical
transferability will help to ensure that PMHNPs can confidently
incorporate remote treatment modalities into psychiatric care.
Purpose
This inquiry is to test and clarify the differences between
summarizing the literature review and interpreting the results of the
search in evidence-based practice. The review is guided by the following
PICO question: In adults with depression and anxiety disorders (P), does
tele-health Cognitive Behavioral Therapy (CBT) and tele-group
psychotherapy (I), compared to traditional face-to-face psychotherapy
(C), increase treatment engagement and decrease anxiety and depression
symptoms (O)? The aim is to create a methodological framework that
PMHNPs can use to critically examine, evaluate, and implement tele-
health research findings in safe clinical practice.
Methods/Search Strategy
The research methodology was integrative review. Integrative
review was used as research methodology to find research which is
related. Detailed literature searches were conducted in the large
databases such as PubMed, CINAHL, PsycINFO, and Google Scholar.
Targeted keywords and Boolean operators used in the search process
included: “Telehealth AND depression,” “Telepsychiatry AND anxiety,”
“Online group psychotherapy,” “Telehealth-CBT,” “virtual or mental
health treatment,” and “Telehealth AND psychiatric care.” Title and
abstract screening were used to exclude studies that were not relevant to
tele-health modalities, advanced nursing practice, and measurable
psychiatric outcomes. Full-text reviews were conducted of the research
designs found in the evidence pyramid. Clinical studies (adults with
anxiety, depression, insomnia, and/or PTSD) using tele-psychology were
selected and literature without clear mental health measures or not
related to psychiatric care was excluded.
Results
The search resulted in various sources of literature at different
levels of evidence. Systematic reviews and meta-analyses were used to
demonstrate that online group psychotherapy and delivery models using
tele-health systems have similar reductions in symptoms and increased
treatment accessibility as face-to-face therapies at high levels of
evidence (Andrews et al., 2024; Kelber et al., 2025; Krzyzaniak et al.,
2024). Structured protocols with evidence of clinical intervention and
feasibility study were identified in the middle tier, such as CBT-I for
brain tumor patients and military veteran populations (Arizmendi et al.,
2023; Loughan et al., 2024). Intermediate evidence included descriptive
scoping and narrative reviews that provided general narratives of
implementation success in rural and low-income settings (Beheshti et al.,
2022; Butzner & Cuffee, 2021; Sultana & Pagán, 2023). Importantly,
structural problems like digital privacy vulnerabilities and connectivity
concerns were found in remote provider environments (Houser et al.,
2023) in systematic reviews.
Synthesis of Evidence
The findings from the synthesis of the data illustrate the difference
between data description and critical appraisal, yet they also show that
they are complementary. A literature review yielded a consistent profile
of the narrative: tele-health modalities are consistently linked to
improvements in care access for underserved, rural, and low-income
populations and do not negatively impact symptom control (Butzner &
Cuffee, 2021; Sultana & Pagán, 2023). The search results, however,
needed more methodological critique, though. Top-tier systematic
reviews minimized bias to show the efficacy of a treatment over the
broader population level (Andrews et al., 2024; Krzyzaniak et al., 2024),
while analysis of mid-tier clinical trials revealed population-specific
gaps to ensure that positive results from highly specific populations
(e.g., veterans, oncology patients) were carefully evaluated before
general application to the general adult psychiatric population
(Arizmendi et al., 2023; Loughan et al., 2024). Furthermore,
interpretation illuminated key clinical challenges, including the potential
for breaches of patient confidentiality and the limitations of descriptive
summaries in capturing technological aspects of SDoH (Houser et al.,
2023).
Implications for Practice
Knowing the difference between summarizing and interpreting
evidence enables PMHNPs to deliver interventions remotely with
greater clinical accuracy. Telehealth CBT and Tele group psychotherapy
is a very reliable method for increasing patient engagement and
decreasing anxiety and depression symptoms. APPs can confidently use
these tools to improve healthcare equity among the rural and low-
income populations. When developing the tele-health protocols,
however, PMHNPs should be proactive in incorporating risk-mitigation
strategies for data privacy, internet reliability and the unique socio-
demographic requirements of the patient population to maximize clinical
outcomes.
Introduction
An important aspect of psychiatric mental health nursing is the role
of evidence-based practice, which enables psychiatric mental health
nurse practitioners (PMHNPs) to make rational clinical decisions based
on the latest scientific research. PICOS are used to generate a focused
clinical question, which facilitates searching the literature for evidence
and enhance clinician outcomes. Following the process of selecting a
PICO question, this question has been chosen:
Does tele-health CBT (I) and tele group psychotherapy (I)
compared to face-to-face psychotherapy (C) increase treatment
engagement and decrease anxiety and depression symptoms (O) among
adults with depression and anxiety disorders?
There are some steps that need to be taken when conducting a
literature review, such as: Summarizing the literature; Interpreting search
results. These processes are interconnected but have different functions
in evidence-based research. These differences can help PMHNPs assess
research results and use evidence-based interventions in psychiatric
practice.
Comparing Summarizing the Literature Review and Interpreting
Search Results
Literature review summarization is a process of organizing and
presenting of the main results of selected research studies. The goal of
the literature review is to make it easy to see the evidence that pertains
to the PICO question. This process involves recognizing themes, sharing
similarities and differences between studies, and summarizing key study
findings regarding patient outcomes, interventions, and clinical
implications.
A literature review summary is brief description of the findings of
the studies. Andrews et al. (2024), for instance, demonstrated that online
group psychotherapy enhanced patient engagement and treatment access
within mental health care services. Likewise, Krzyzaniak et al. (2024)
found that interventions for anxiety disorders via tele-health were as
effective as in-person psychotherapy. The results of these findings could
be summarized to show that tele-health interventions can help enhance
psychiatric treatment availability while maintaining positive treatment
outcomes.
Summarizing the literature also includes the ability to detect
patterns in several studies. Several of the articles selected in this study,
for instance, indicated that telehealth strategies enhanced access to care
for underserved groups such as rural areas and low-income individuals
(Butzner & Cuffee, 2021; Sultana & Pagán, 2023). The literature review
is summarized to structure this information into a discussion that can be
used for supporting the PICO question.
Interpreting the search results takes a different approach, however,
in which critical interpretation of the meaning, quality, reliability and
clinical relevance of the evidence retrieved during the literature search
are required. Interpretation is more than just reporting the results of a
study. Rather, it is geared toward critiquing the evidence in relation to
the PICO question and the ability to translate the findings into
psychiatric nursing practice.
PMHNPs need to be able to assess the rigor of evidence, limitations
within research studies, and relevance of the interventions to the clinical
situation. Systematic reviews and meta-analyses, for instance, as
conducted by Andrews et al. (2024) and Kelber et al. (2025), bring
together several studies and lower the risk of bias to provide stronger
evidence. The narrative review and descriptive study, on the other hand,
can be of assistance to give background information; however, they are
less strong.
Also, when you are interpreting the results of the search, you are
interpreting whether the results from the studies are relevant to the
patient population that you have identified in your PICO question.
Arizmendi et al. (2023) employed a sample of military veterans
receiving CBT-I interventions via tele-health. The results of these studies
indicate that tele-health interventions are effective, but it remains to be
seen if the results can be applied to larger populations of individuals
with anxiety and depression disorders.
In general, the literature review is summarized by describing the
results of the research, and the interpretation of search results is
described by the analysis of the meaning, reliability and clinical
relevance of the results of the searched literature.
The steps taken to make sense of search results. The way in which
the search results have been interpreted.
The results from the searches were interpreted using several steps in
the process for the selected PICO question. A thorough literature review
was completed on databases including PubMed, CINAHL, PsycINFO
and Google Scholar. To find relevant studies pertaining to tele-health
psychotherapy, depression, anxiety, and cognitive behavioral therapy,
keywords and Boolean operators were used.
Title and abstracts of studies were then screened to see if articles
were relevant to the PICO question. The articles were chosen for full
text review if they focused on tele-health interventions, online
psychotherapy, CBT, depression, anxiety, PTSD and treatment outcome.
Research not related to psychiatric treatment or failing to have any
measurable mental health outcomes was not included.
The next step was to assess the quality of the information and the
strength of the evidence presented in each of the studies using the
evidence pyramid. Systematic reviews and meta-analyses were regarded
as the highest quality evidence, as they were derived by combining
results from several research studies. Andrews et al. (2024), Kelber et al.
(2025), and Krzyzaniak et al. (2024) gave high-level evidence on the
effectiveness of tele-health as a means to deliver mental health
treatment.
Evidence quality was evaluated and findings from each study were
compared to notice any common themes and consistent findings
throughout the studies. Several studies showed that tele-health
interventions had positive outcomes on access to psychiatric care,
treatment adherence, and symptom management for individuals with
anxiety and depression. The study by Beheshti et al. (2022) and Butzner
and Cuffee (2021) highlighted the role of tele-health in making
healthcare more accessible to underserved populations. Positive results
have also been found with CBT interventions delivered via tele-health
by Loughan et al. (2024) and Arizmendi et al. (2023).
The last part of the search results interpretation was to consider the
limitations and the practical implications regarding PMHNP practice.
Some studies raised issues of patient privacy, technical issues, and
internet connectivity. Houser et al. (2023) noted potential privacy and
security concerns of tele services, particularly regarding the protection
of patient confidentiality during psychiatric care sessions with a virtual
provider.
Conclusion
The ability to summarize what was found in the literature and to
interpret the results of the search are important parts of evidence-based
psychiatric research. Summarizing literature involves organizing and
describing the research findings and interpreting search results involves
critically evaluating the reliability, interpretation, and clinical relevance
of the literature. This search process that was used for the selected PICO
question involved the following: a database search, screening articles,
evaluating levels of evidence, comparing findings, and analyzing the
clinical implications. These actions enable PMHNPs to implement
evidence-based interventions that will enhance patient outcomes, make
treatment more available, and facilitate quality psychiatric treatment via
tele-health.
**## NUR670Wk5Responses.pdf**
Nakiba Nelson
Interpreting the Results of the Literature Review
Introduction
Psychiatric-Mental Health Nurse Practitioners (PMHNPs) make
clinical decisions based on their interpretation of the evidence, which is
a crucial part of evidence-based practice (EBP). A literature review finds
existing research, but interpreting the findings necessitates a critical
evaluation of methodological quality, consistency of findings, practice
application, and consequences for patient outcomes. For complicated
mental illnesses like schizophrenia, where interventions must target
long-term recovery, treatment adherence, and community reintegration
in addition to symptom management, this distinction is especially
crucial. For adults with schizophrenia spectrum illnesses who are
frequently hospitalized, the chosen PICO question assesses whether
Assertive Community Treatment (ACT) yields better results than normal
outpatient psychiatric care.
Comparing Literature Summarization and Interpretation
Interpreting search results and summarizing the literature are
essentially distinct activities. A literature overview describes research
designs, interventions, populations, and outcomes to objectively
aggregate the results of various studies. However, interpretation
necessitates higher-order analysis that assesses the overall strength of the
evidence, finds patterns and contradictions, takes bias into account, and
assesses the findings' clinical importance (Melnyk & Fineout-Overholt,
2023).
Interpretation transforms research findings into useful clinical
knowledge for PMHNPs. Instead of just stating that ACT lowers
hospitalization rates, interpretation takes into account whether the results
are repeatable across healthcare systems, whether patient characteristics
or resource availability may affect effectiveness, and whether the
evidence is rigorous enough to support implementation in practice. This
analytical method enables tailored psychiatric care and enhances
evidence-based decision-making.
Process Used to Interpret the Search Results
The interpretation process began with a comprehensive search of
PubMed, CINAHL Complete, PsycINFO, the Cochrane Library, and
Google Scholar using combinations of the
keywords schizophrenia, Assertive Community Treatment, ACT
team, Flexible Assertive Community Treatment
(FACT), rehospitalization, medication adherence, and community
functioning. Following duplicate removal and screening, only peer-
reviewed studies published between 2021 and 2026 that directly
addressed the PICO question were retained for critical appraisal.
The methodological quality, study design, sample characteristics,
intervention, outcome measures, and potential sources of bias were all
taken into consideration. These designs offer more robust evidence than
descriptive or opinion-based articles, systematic reviews, randomized
controlled trials, and longitudinal cohort studies were given more weight
(Dang et al., 2022). To ascertain whether the results could be logically
extended to community psychiatric settings where PMHNPs work,
studies were also evaluated for external validity.
Interpretation extended beyond individual study outcomes by
examining consistency across the body of evidence. Rather than relying
on isolated findings, conclusions were based on recurring themes
identified in multiple investigations evaluating ACT or Flexible
Assertive Community Treatment programs.
Interpretation of Findings and Clinical Significance
The literature consistently demonstrated that ACT is associated with
meaningful reductions in psychiatric rehospitalization among adults with
schizophrenia spectrum disorders. Multidisciplinary care teams that
provide intensive community-based outreach, case management, and
crisis intervention appear to reduce relapses and prevent avoidable
inpatient admissions by addressing barriers to treatment before
psychiatric deterioration occurs (Tholen et al., 2024).
Similarly, the evidence indicates that ACT improves medication
adherence and continuity of care. This finding is clinically significant
because medication nonadherence remains one of the strongest
predictors of psychotic relapse and recurrent hospitalization. Frequent
patient contact, coordinated medication management, psychoeducation,
and collaboration among team members contribute to sustained
treatment engagement and improved adherence (Hird et al., 2024).
An additional theme emerging from the literature is the positive
effect of ACT on community functioning and recovery-oriented
outcomes. Studies reported improvements in housing stability, social
participation, outpatient engagement, and quality of life, reflecting a
shift from symptom-focused care toward holistic recovery. For
PMHNPs, these findings reinforce the importance of integrating
psychosocial interventions and community resources into
comprehensive treatment planning rather than relying exclusively on
pharmacotherapy (Killaspy, 2023).
Implications for Advanced Psychiatric Nursing Practice
The evidence synthesized through this literature review supports
ACT as an effective, evidence-based intervention for individuals with
schizophrenia who experience repeated psychiatric hospitalizations and
difficulty engaging in conventional outpatient services. From a PMHNP
perspective, these findings support timely referral to ACT programs,
interdisciplinary collaboration, and advocacy for community-based
treatment models that promote sustained recovery.
Moreover, interpretation highlights the broader role of PMHNPs as
leaders in translating research into practice. By critically appraising
evidence rather than merely summarizing findings, PMHNPs can
develop treatment plans that improve medication adherence, reduce
healthcare utilization, and enhance functional recovery while addressing
social determinants of health. This evidence-based approach aligns with
recovery-oriented psychiatric care and supports long-term patient
stability.
Conclusion
Summarizing literature vs interpreting search results is key to
evidence-based psychiatry. Summarization describes research, whereas
interpretation critiques its quality, consistency, and clinical relevance.
The collective evidence suggests that Assertive Community Treatment
reduces rehospitalization, improves medication adherence, and improves
community functioning in adults with schizophrenia spectrum disorders
compared to standard outpatient psychiatric care. These findings
strongly recommend introducing ACT into comprehensive PMHNP
practice while researching implementation techniques and patient-
centered outcomes.
Mario Forbes
Abstract
Introduction/Background
Rational clinical decision making is a key component in advanced
practice psychiatric nursing in which evidence-based practice is used.
The PICO framework helps psychiatric mental health nurse practitioners
(PMHNPs) to create focused and precise clinical questions and conduct
a systematic review of the empirical literature. Evidence collection is
essential but there are specific skills required to summaries a literature
search and to interpret the results. The distinction between describing
findings versus critically assessing the quality of data, bias and clinical
transferability will help to ensure that PMHNPs can confidently
incorporate remote treatment modalities into psychiatric care.
Purpose
This inquiry is to test and clarify the differences between
summarizing the literature review and interpreting the results of the
search in evidence-based practice. The review is guided by the following
PICO question: In adults with depression and anxiety disorders (P), does
tele-health Cognitive Behavioral Therapy (CBT) and tele-group
psychotherapy (I), compared to traditional face-to-face psychotherapy
(C), increase treatment engagement and decrease anxiety and depression
symptoms (O)? The aim is to create a methodological framework that
PMHNPs can use to critically examine, evaluate, and implement tele-
health research findings in safe clinical practice.
Methods/Search Strategy
The research methodology was integrative review. Integrative
review was used as research methodology to find research which is
related. Detailed literature searches were conducted in the large
databases such as PubMed, CINAHL, PsycINFO, and Google Scholar.
Targeted keywords and Boolean operators used in the search process
included: “Telehealth AND depression,” “Telepsychiatry AND anxiety,”
“Online group psychotherapy,” “Telehealth-CBT,” “virtual or mental
health treatment,” and “Telehealth AND psychiatric care.” Title and
abstract screening were used to exclude studies that were not relevant to
tele-health modalities, advanced nursing practice, and measurable
psychiatric outcomes. Full-text reviews were conducted of the research
designs found in the evidence pyramid. Clinical studies (adults with
anxiety, depression, insomnia, and/or PTSD) using tele-psychology were
selected and literature without clear mental health measures or not
related to psychiatric care was excluded.
Results
The search resulted in various sources of literature at different
levels of evidence. Systematic reviews and meta-analyses were used to
demonstrate that online group psychotherapy and delivery models using
tele-health systems have similar reductions in symptoms and increased
treatment accessibility as face-to-face therapies at high levels of
evidence (Andrews et al., 2024; Kelber et al., 2025; Krzyzaniak et al.,
2024). Structured protocols with evidence of clinical intervention and
feasibility study were identified in the middle tier, such as CBT-I for
brain tumor patients and military veteran populations (Arizmendi et al.,
2023; Loughan et al., 2024). Intermediate evidence included descriptive
scoping and narrative reviews that provided general narratives of
implementation success in rural and low-income settings (Beheshti et al.,
2022; Butzner & Cuffee, 2021; Sultana & Pagán, 2023). Importantly,
structural problems like digital privacy vulnerabilities and connectivity
concerns were found in remote provider environments (Houser et al.,
2023) in systematic reviews.
Synthesis of Evidence
The findings from the synthesis of the data illustrate the difference
between data description and critical appraisal, yet they also show that
they are complementary. A literature review yielded a consistent profile
of the narrative: tele-health modalities are consistently linked to
improvements in care access for underserved, rural, and low-income
populations and do not negatively impact symptom control (Butzner &
Cuffee, 2021; Sultana & Pagán, 2023). The search results, however,
needed more methodological critique, though. Top-tier systematic
reviews minimized bias to show the efficacy of a treatment over the
broader population level (Andrews et al., 2024; Krzyzaniak et al., 2024),
while analysis of mid-tier clinical trials revealed population-specific
gaps to ensure that positive results from highly specific populations
(e.g., veterans, oncology patients) were carefully evaluated before
general application to the general adult psychiatric population
(Arizmendi et al., 2023; Loughan et al., 2024). Furthermore,
interpretation illuminated key clinical challenges, including the potential
for breaches of patient confidentiality and the limitations of descriptive
summaries in capturing technological aspects of SDoH (Houser et al.,
2023).
Implications for Practice
Knowing the difference between summarizing and interpreting
evidence enables PMHNPs to deliver interventions remotely with
greater clinical accuracy. Telehealth CBT and Tele group psychotherapy
is a very reliable method for increasing patient engagement and
decreasing anxiety and depression symptoms. APPs can confidently use
these tools to improve healthcare equity among the rural and low-
income populations. When developing the tele-health protocols,
however, PMHNPs should be proactive in incorporating risk-mitigation
strategies for data privacy, internet reliability and the unique socio-
demographic requirements of the patient population to maximize clinical
outcomes.
Introduction
An important aspect of psychiatric mental health nursing is the role
of evidence-based practice, which enables psychiatric mental health
nurse practitioners (PMHNPs) to make rational clinical decisions based
on the latest scientific research. PICOS are used to generate a focused
clinical question, which facilitates searching the literature for evidence
and enhance clinician outcomes. Following the process of selecting a
PICO question, this question has been chosen:
Does tele-health CBT (I) and tele group psychotherapy (I)
compared to face-to-face psychotherapy (C) increase treatment
engagement and decrease anxiety and depression symptoms (O) among
adults with depression and anxiety disorders?
There are some steps that need to be taken when conducting a
literature review, such as: Summarizing the literature; Interpreting search
results. These processes are interconnected but have different functions
in evidence-based research. These differences can help PMHNPs assess
research results and use evidence-based interventions in psychiatric
practice.
Comparing Summarizing the Literature Review and Interpreting
Search Results
Literature review summarization is a process of organizing and
presenting of the main results of selected research studies. The goal of
the literature review is to make it easy to see the evidence that pertains
to the PICO question. This process involves recognizing themes, sharing
similarities and differences between studies, and summarizing key study
findings regarding patient outcomes, interventions, and clinical
implications.
A literature review summary is brief description of the findings of
the studies. Andrews et al. (2024), for instance, demonstrated that online
group psychotherapy enhanced patient engagement and treatment access
within mental health care services. Likewise, Krzyzaniak et al. (2024)
found that interventions for anxiety disorders via tele-health were as
effective as in-person psychotherapy. The results of these findings could
be summarized to show that tele-health interventions can help enhance
psychiatric treatment availability while maintaining positive treatment
outcomes.
Summarizing the literature also includes the ability to detect
patterns in several studies. Several of the articles selected in this study,
for instance, indicated that telehealth strategies enhanced access to care
for underserved groups such as rural areas and low-income individuals
(Butzner & Cuffee, 2021; Sultana & Pagán, 2023). The literature review
is summarized to structure this information into a discussion that can be
used for supporting the PICO question.
Interpreting the search results takes a different approach, however,
in which critical interpretation of the meaning, quality, reliability and
clinical relevance of the evidence retrieved during the literature search
are required. Interpretation is more than just reporting the results of a
study. Rather, it is geared toward critiquing the evidence in relation to
the PICO question and the ability to translate the findings into
psychiatric nursing practice.
PMHNPs need to be able to assess the rigor of evidence, limitations
within research studies, and relevance of the interventions to the clinical
situation. Systematic reviews and meta-analyses, for instance, as
conducted by Andrews et al. (2024) and Kelber et al. (2025), bring
together several studies and lower the risk of bias to provide stronger
evidence. The narrative review and descriptive study, on the other hand,
can be of assistance to give background information; however, they are
less strong.
Also, when you are interpreting the results of the search, you are
interpreting whether the results from the studies are relevant to the
patient population that you have identified in your PICO question.
Arizmendi et al. (2023) employed a sample of military veterans
receiving CBT-I interventions via tele-health. The results of these studies
indicate that tele-health interventions are effective, but it remains to be
seen if the results can be applied to larger populations of individuals
with anxiety and depression disorders.
In general, the literature review is summarized by describing the
results of the research, and the interpretation of search results is
described by the analysis of the meaning, reliability and clinical
relevance of the results of the searched literature.
The steps taken to make sense of search results. The way in which
the search results have been interpreted.
The results from the searches were interpreted using several steps in
the process for the selected PICO question. A thorough literature review
was completed on databases including PubMed, CINAHL, PsycINFO
and Google Scholar. To find relevant studies pertaining to tele-health
psychotherapy, depression, anxiety, and cognitive behavioral therapy,
keywords and Boolean operators were used.
Title and abstracts of studies were then screened to see if articles
were relevant to the PICO question. The articles were chosen for full
text review if they focused on tele-health interventions, online
psychotherapy, CBT, depression, anxiety, PTSD and treatment outcome.
Research not related to psychiatric treatment or failing to have any
measurable mental health outcomes was not included.
The next step was to assess the quality of the information and the
strength of the evidence presented in each of the studies using the
evidence pyramid. Systematic reviews and meta-analyses were regarded
as the highest quality evidence, as they were derived by combining
results from several research studies. Andrews et al. (2024), Kelber et al.
(2025), and Krzyzaniak et al. (2024) gave high-level evidence on the
effectiveness of tele-health as a means to deliver mental health
treatment.
Evidence quality was evaluated and findings from each study were
compared to notice any common themes and consistent findings
throughout the studies. Several studies showed that tele-health
interventions had positive outcomes on access to psychiatric care,
treatment adherence, and symptom management for individuals with
anxiety and depression. The study by Beheshti et al. (2022) and Butzner
and Cuffee (2021) highlighted the role of tele-health in making
healthcare more accessible to underserved populations. Positive results
have also been found with CBT interventions delivered via tele-health
by Loughan et al. (2024) and Arizmendi et al. (2023).
The last part of the search results interpretation was to consider the
limitations and the practical implications regarding PMHNP practice.
Some studies raised issues of patient privacy, technical issues, and
internet connectivity. Houser et al. (2023) noted potential privacy and
security concerns of tele services, particularly regarding the protection
of patient confidentiality during psychiatric care sessions with a virtual
provider.
Conclusion
The ability to summarize what was found in the literature and to
interpret the results of the search are important parts of evidence-based
psychiatric research. Summarizing literature involves organizing and
describing the research findings and interpreting search results involves
critically evaluating the reliability, interpretation, and clinical relevance
of the literature. This search process that was used for the selected PICO
question involved the following: a database search, screening articles,
evaluating levels of evidence, comparing findings, and analyzing the
clinical implications. These actions enable PMHNPs to implement
evidence-based interventions that will enhance patient outcomes, make
treatment more available, and facilitate quality psychiatric treatment via
tele-health.
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1. Select a health problem that primarily affects the pediatric population. SCARLETT FEVER 2. Provide information about the incidence, prevalence, and pathophysiology of the disease/disorder to the cellular level.
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**files (1)** – ## EstablishingtheMissionPhilosophyandGoalsofanOrganization.docx **## EstablishingtheMissionPhilosophyandGoalsofanOrganization.docx** **_Establishing the Mission, Philosophy and Goals of an Organization_** **Purpose:** The purpose of this assignment is to understand the meaning and p…
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**## EstablishingtheMissionPhilosophyandGoalsofanOrganization.docx**
**_Establishing the Mission, Philosophy and Goals of an Organization_**
**Purpose:**
The purpose of this assignment is to understand the meaning and purpose of organizational mission statements, philosophies and goals. It is essential to know about an organization when proposing and developing a project plan or deciding if your personal philosophy is compatible with their values.
**Instructions:**
**Part A:** Create a mission statement, organizational philosophy, nursing service philosophy, goals, and objectives for a fictitious organization.
**Part B:** Based on the videos in
[Module 2 Lecture Materials & Resources A](https://stu.instructure.com/courses/54940/pages/module-2-lecture-materials-and-resources-a), explain the importance of nursing leaders having financial literacy and competence in the business aspects of healthcare (regarding reimbursement and keeping costs to a minimum).
**Submission Requirements:**
· The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
· The paper should be formatted per current APA and 3-5 pages in length, excluding the title, abstract and references page. Incorporate a minimum of 5 current (published within last five years)
_scholarly journal articles_ or
_primary legal sources_(statutes, court opinions) within your work.
· Your submission will be assessed through Turnitin.
**Grading Rubric**
Your assignment will be graded according to the grading rubric.
**Essay/Paper Rubric**
| | | |
| — | — | — |
| Essay/Paper Rubric |
| **Criteria** | **Ratings** | **Points** |
| **Identification of Main Issues/Problems** | **Distinguished**<br>Identifies and demonstrates a sophisticated understanding of the issues/problems.<br>**4 to >3 pts**<br>**Excellent**<br>Identifies and demonstrates an accomplished understanding of most issues/problems.<br>**3 to >2 pts**<br>**Fair**<br>Identifies and demonstrates an acceptable understanding of most issues/problems.<br>**2 to >0 pts**<br>**Poor**<br>Identifies and demonstrates an unacceptable understanding of most issues/problems. Or nothing was submitted.<br>**0 pts** | /4 pts |
| **Analysis and Evaluation of Issues/Problems** | **Distinguished**<br>Presents an insightful, thorough analysis and evaluation of issues/problems.<br>**4 to >3 pts**<br>**Excellent**<br>Presents a thorough analysis and evaluation of most of the issues/problems.<br>**3 to >2 pts**<br>**Fair**<br>Presents a superficial or incomplete analysis and evaluation of issues/problems.<br>**2 to >0 pts**<br>**Poor**<br>Presents unacceptable analysis and evaluation of issues/problems. Or nothing was submitted.<br>**0 pts** | /4 pts |
| **Demonstrates a Conceptual Understanding** | **Distinguished**<br>Provides thorough, competent, and interpretive responses to all issues/problems, and shows a high level of conceptual understanding.<br>**4 to >3 pts**<br>**Excellent**<br>Provides competent and interpretive responses to all issues/problems, and shows a moderate level of conceptual understanding.<br>**3 to >2 pts**<br>**Fair**<br>Provides competent responses to all issues/problems, but lacks interpretation and a moderate level of conceptual understanding.<br>**2 to >0 pts**<br>**Poor**<br>Provides an unacceptable response to all issues/problems, and lacks interpretation and a moderate level of conceptual understanding. Or nothing was submitted.<br>**0 pts** | /4 pts |
| **Use of Citations to Course Readings and Additional Research/Literature** | **Distinguished**<br>Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing.<br>**4 to >3 pts**<br>**Excellent**<br>Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.<br>**3 to >2 pts**<br>**Fair**<br>Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.<br>**2 to >0 pts**<br>**Poor**<br>Ineffectively uses the literature and other resources to inform their work. Unacceptable use of citations and extended referencing. Or nothing was submitted.<br>**0 pts** | /4 pts |
| **Writing Mechanics and APA Formatting Guidelines** | **Distinguished**<br>Demonstrates a high level of clarity, precision, and attention to detail. APA style is correct and writing is free of grammar and spelling errors.<br>**4 to >3 pts**<br>**Excellent**<br>Demonstrates a high level of clarity. APA style and writing mechanics need more precision and attention to detail.<br>**3 to >2 pts**<br>**Fair**<br>Demonstrates a moderate level of clarity. APA style and writing mechanics need more precision and attention to detail.<br>**2 to >0 pts**<br>**Poor**<br>Demonstrates issues in writing and communicating clearly. APA style and writing mechanics need serious attention. Or nothing was submitted.<br>**0 pts** | /4 pts |
**## EstablishingtheMissionPhilosophyandGoalsofanOrganization.docx**
**_Establishing the Mission, Philosophy and Goals of an Organization_**
**Purpose:**
The purpose of this assignment is to understand the meaning and purpose of organizational mission statements, philosophies and goals. It is essential to know about an organization when proposing and developing a project plan or deciding if your personal philosophy is compatible with their values.
**Instructions:**
**Part A:** Create a mission statement, organizational philosophy, nursing service philosophy, goals, and objectives for a fictitious organization.
**Part B:** Based on the videos in
[Module 2 Lecture Materials & Resources A](https://stu.instructure.com/courses/54940/pages/module-2-lecture-materials-and-resources-a), explain the importance of nursing leaders having financial literacy and competence in the business aspects of healthcare (regarding reimbursement and keeping costs to a minimum).
**Submission Requirements:**
· The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
· The paper should be formatted per current APA and 3-5 pages in length, excluding the title, abstract and references page. Incorporate a minimum of 5 current (published within last five years)
_scholarly journal articles_ or
_primary legal sources_(statutes, court opinions) within your work.
· Your submission will be assessed through Turnitin.
**Grading Rubric**
Your assignment will be graded according to the grading rubric.
**Essay/Paper Rubric**
| | | |
| — | — | — |
| Essay/Paper Rubric |
| **Criteria** | **Ratings** | **Points** |
| **Identification of Main Issues/Problems** | **Distinguished**<br>Identifies and demonstrates a sophisticated understanding of the issues/problems.<br>**4 to >3 pts**<br>**Excellent**<br>Identifies and demonstrates an accomplished understanding of most issues/problems.<br>**3 to >2 pts**<br>**Fair**<br>Identifies and demonstrates an acceptable understanding of most issues/problems.<br>**2 to >0 pts**<br>**Poor**<br>Identifies and demonstrates an unacceptable understanding of most issues/problems. Or nothing was submitted.<br>**0 pts** | /4 pts |
| **Analysis and Evaluation of Issues/Problems** | **Distinguished**<br>Presents an insightful, thorough analysis and evaluation of issues/problems.<br>**4 to >3 pts**<br>**Excellent**<br>Presents a thorough analysis and evaluation of most of the issues/problems.<br>**3 to >2 pts**<br>**Fair**<br>Presents a superficial or incomplete analysis and evaluation of issues/problems.<br>**2 to >0 pts**<br>**Poor**<br>Presents unacceptable analysis and evaluation of issues/problems. Or nothing was submitted.<br>**0 pts** | /4 pts |
| **Demonstrates a Conceptual Understanding** | **Distinguished**<br>Provides thorough, competent, and interpretive responses to all issues/problems, and shows a high level of conceptual understanding.<br>**4 to >3 pts**<br>**Excellent**<br>Provides competent and interpretive responses to all issues/problems, and shows a moderate level of conceptual understanding.<br>**3 to >2 pts**<br>**Fair**<br>Provides competent responses to all issues/problems, but lacks interpretation and a moderate level of conceptual understanding.<br>**2 to >0 pts**<br>**Poor**<br>Provides an unacceptable response to all issues/problems, and lacks interpretation and a moderate level of conceptual understanding. Or nothing was submitted.<br>**0 pts** | /4 pts |
| **Use of Citations to Course Readings and Additional Research/Literature** | **Distinguished**<br>Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing.<br>**4 to >3 pts**<br>**Excellent**<br>Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.<br>**3 to >2 pts**<br>**Fair**<br>Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.<br>**2 to >0 pts**<br>**Poor**<br>Ineffectively uses the literature and other resources to inform their work. Unacceptable use of citations and extended referencing. Or nothing was submitted.<br>**0 pts** | /4 pts |
| **Writing Mechanics and APA Formatting Guidelines** | **Distinguished**<br>Demonstrates a high level of clarity, precision, and attention to detail. APA style is correct and writing is free of grammar and spelling errors.<br>**4 to >3 pts**<br>**Excellent**<br>Demonstrates a high level of clarity. APA style and writing mechanics need more precision and attention to detail.<br>**3 to >2 pts**<br>**Fair**<br>Demonstrates a moderate level of clarity. APA style and writing mechanics need more precision and attention to detail.<br>**2 to >0 pts**<br>**Poor**<br>Demonstrates issues in writing and communicating clearly. APA style and writing mechanics need serious attention. Or nothing was submitted.<br>**0 pts** | /4 pts |
As advanced practice nurses how can we begin to eliminate disparities in rural underserved areas? Posts are a minimum of 300 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and a minimum of 3 references.
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Posts are a minimum of 300 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and a minimum of 3 references.
**files (3)** – ## SMARTGoal.docx – ## HealthPromotionProposalPart14.docx – HealthPromotionpart2.docx **## SMARTGoal.docx** 1 7 **SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County** Mirlenys Diaz Florida National University Health Promotion & Role Development in Adv. Nursing Pra…
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**## SMARTGoal.docx**
1
7
**SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County**
Mirlenys Diaz
Florida National University
Health Promotion & Role Development in Adv. Nursing Practice-
Dr. Nora Hernandez-Pupo
June 11, 2026
**SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County**
Adult obesity is a major public health concern in the United States, notably in susceptible communities such as Miami-Dade County. Obesity is a risk factor for hypertension, type 2 diabetes mellitus, cardiovascular disease, stroke and some malignancies Recent national data indicate that adult obesity is still relatively prevalent, with 40.3% of people in the United States classed as obese during August 2021 through August 2023 (Emmerich et al., 2024). This is particularly relevant for low-income Hispanic adults, where social determinants of health, including food insecurity, limited access to healthy foods, transportation barriers, low health literacy, and decreased access to safe environments for physical activity, may negatively influence weight management (Washington et al., 2023). Therefore, a culturally relevant nurse-led health promotion intervention is needed to improve the obesity-related markers in this community.
This plan has the SMART aim of: Low-income Hispanic adults with obesity in Miami-Dade County who participate in a nurse-led health promotion program will have an average of 3%-5% reduction in body weight within 12 weeks, show improvement in BMI trends, increase moderate physical activity to at least 150 minutes per week, and improve nutrition knowledge scores by 20%. The outcomes will be measured by weekly weight tracking, activity logs, and pre/post nutrition questionnaires. The objective is SMART in that it describes the population, the intervention, the outcomes, the methods of measurement and the period of assessment.
Specific
It is specific since the target population is low-income Hispanics with obesity in Miami-Dade County. The intervention will be a 12-week, nurse-leaded intervention including culturally appropriate nutrition teaching, physical activity counseling, weekly weight monitoring and motivational support. This cohort was chosen because Hispanic people in low-income regions may face more difficulties in preventing and managing obesity, such as food instability, limited access to preventive care, and environmental factors that hinder healthy lifestyle habits (Washington et al., 2023). What is the role of nurse-led education in improving obesity outcomes in low-income Hispanic adults? This is a very important question in graduate level. Nurse-led education may improve results by increasing understanding of the hazards of obesity, enhancing self-management skills and promoting realistic behavior change. Furthermore, a community health worker intervention using motivational interviewing found positive changes in weight-related outcomes among Hispanic adults (Brown et al., 2022), which supports the use of culturally relevant counseling in this approach.
Measurable
The aim is measurable . It contains clear signals to monitor progress. Primary objectives will be body weight, BMI trends, weekly minutes of physical activity and nutrition knowledge scores. Body weight will be measured weekly and trends in BMI from baseline to week 12 will be investigated. Physical activity will be monitored using activity diaries by participants and nutrition knowledge will be assessed using pre and after intervention questionnaires. The second question at the graduate level is: What are the best measured outcomes that show short-term progress in obesity management? Clinical and behavioural change (e.g. body weight, BMI, waist circumference, physical activity levels and dietary knowledge) are useful markers. The use of measurable outcomes in this health promotion program is confirmed by the findings of Zeb et al. (2024), who found improvement in body weight, BMI and waist circumference in community-based obesity treatments.
Achievable
The target is achievable because the expected results are realistic to achieve within a 12-week period. A reasonable target for a short-term health promotion strategy that does not involve unsafe or excessive eating habits is an average weight loss of 3% to 5% body weight. The method will focus on making little changes to lifestyle, such adopting healthier food choices, controlling portion sizes, walking more, or doing moderate activity, and assessing yourself often. Practical strategies that can be utilized in a community setting include weekly education sessions, activity records, nutrition questionnaires and weight monitoring. Motivational interviewing also allows participants to uncover personal barriers, increase self-confidence, and generate realistic action plans. The technique suits the specified group. Brown et al. (2022) revealed that motivated interviewing helps in obesity-related behavior change in Hispanic adults.
Relevant
This purpose is relevant because it is directly related to the promotion of health, prevention of chronic diseases and advanced nursing practice. Advanced practice nurses are trained to evaluate health risks, educate patients, coordinate care, and advocate for vulnerable populations. This intervention has particular relevance in Miami-Dade County, where many low-income Hispanic residents may face cultural, economic and environmental barriers to healthy living. The Health Belief Model supports this hypothesis. The model explains how perceived vulnerability, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy influence health behavior. Training based on the Health Belief Model and social support increased physical activity among overweight women (Faghih et al., 2024). Therefore, this approach can allow the nurse to help the participants to identify the dangers of obesity and to adopt healthy practices.
Time-Bound
The goal has a time frame since it will be finished and evaluated in 12 weeks. Week 1 will include a baseline measurement of body weight, BMI, activity level and dietary information.
Weeks 2-11 Participants will get weekly teaching, counseling and monitoring. The last data collection will be in week 12 and outcomes will be compared to base line A third graduate level concern is how can advanced practice nurses help in maintaining lifestyle change after the 12-week intervention has been completed? Instructing participants on setting personal goals, tracking weight and activity, planning affordable meals, utilizing community resources, and following through with care will help participants reach their sustainability goals.
At the conclusion of this study, it is confirmed that obesity among low-income Hispanic adults in Miami-Dade County is a local public health issue that requires prioritized action. This group is constrained by social environmental barriers. The culturally adapted, nurse-led SMART goal intervention proposed in this study is clear, measurable, and evidence-based, and can turn generalized public health concerns into actionable, on-the-ground efforts. Led and implemented by advanced practice nurses through health education, motivational support, and continuous assessment, this intervention is expected to improve weight-related outcomes and support the development of long-term healthy behaviors.
**References**
Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2022). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing.
_American journal of health promotion : AJHP_,
_36_(2), 259–268.
[https://doi.org/10.1177/08901171211049679](https://doi.org/10.1177/08901171211049679)
Emmerich, S. D., Fryar, C. D., Stierman, B., & Ogden, C. L. (2024).
_Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023_. National Center for Health Statistics.
[https://doi.org/10.15620/cdc/159281](https://doi.org/10.15620/cdc/159281)
Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.
_Frontiers in public health_,
_12_, 1250152.
[https://doi.org/10.3389/fpubh.2024.1250152](https://doi.org/10.3389/fpubh.2024.1250152)
Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in access and quality of obesity care.
_Gastroenterology Clinics of North America, 52_(2), 429–441.
[https://doi.org/10.1016/j.gtc.2023.02.003](https://doi.org/10.1016/j.gtc.2023.02.003)
Zeb, A., Sivarajan Froelicher, E., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis.
_Iranian journal of nursing and midwifery research_,
_29_(1), 16–22. https://doi.org/10.4103/ijnmr.ijnmr_120_22
**## HealthPromotionProposalPart14.docx**
2
**Adult Obesity in Miami-Dade County**
Mirlenys Diaz
Florida National University
Health Promotion & Role Development in Adv. Nursing Practice-
Dr. Nora Hernandez-Pupo
May 30, 2026
**Adult Obesity in Miami-Dade County**
Obesity in adults is a major public health problem in Miami-Dade County and the United States. During August 2021 through August 2023, the prevalence of obesity among adults in the United States reached 40.3%, with no significant difference between men and women, and prevalence was higher among adults aged 40 to 59 compared to other age groups (Emmerich et al., 2024). Nationwide, in 2023, all states and territories in the United States had an obesity prevalence of more than 20% with the South reporting obesity prevalence of 35% (CDC, 2024). This burden is particularly high in low-income, Hispanic communities, such as the communities throughout Miami Dade County, Florida, which are affected by multiple structural inequities that increase the risk of chronic disease. The proposed health promotion program will consist of a structured 12-week nutrition education and physical activity counseling program in the community with a measurable goal of decreasing mean Body Mass Index (BMI) by 5% of adult Hispanic residents of Miami Dade County at the end of the intervention.
Globally, obesity continues to be a major public health concern. In 2022, 1 in 8 people worldwide were living with obesity, and approximately 890 million adults had obesity (World Health Organization, 2025). In the United States, adult obesity prevalence reached 40.3% during August 2021 through August 2023 (Emmerich et al., 2024). Locally, Miami-Dade County reported that 61.9% of adults were overweight or obese during 2017–2019, showing the continued need for community-based obesity prevention strategies in this population (Miami-Dade Matters, n.d.).
**Vulnerable Population**
Low-income Hispanic adults living in Miami-Dade County is the vulnerable population for this proposal. Socio-economic, cultural and environmental factors contribute to this population's increased risk of obesity. Minority families, specifically non-Hispanic African American and Hispanic families, are more likely to experience food insecurity, which makes it difficult to adhere to a particular diet, and low-income minority families face a number of other challenges such as chronic stress and poor access to quality foods, including vegetables, fruits and lean meats (Washington et al., 2023). In addition to these structural disadvantages, there are also poor access to physical activity resources. Low-income families may not have access to safe spaces for physical activity or may have transportation barriers that limit access to grocery stores with healthier food options, while financial insecurity can have a negative effect on health behaviors.
Another set of risk factors are those associated with access to health care and acculturation stress. Risk factors that contribute to the obesity disparities within Hispanic communities include low high school completion rates, low employment rates, higher rates of food insecurity, higher availability of poor-quality foods, low availability of convenient physical activity spaces, targeted marketing of poor food choices, and low access to healthcare providers or community-based organizations to support self-management (Levi et al., 2020). The combination of these vulnerabilities makes low-income Hispanic adults in Miami-Dade one of the most vulnerable populations for obesity and related comorbidities, and therefore a population in need of targeted, culturally competent health promotion efforts.
**Review of Literature**
Interventions that include culturally appropriate education, physical activity promotion, and motivational interviewing have been shown to have measurable impacts on BMI and body fat percentage in low-income Hispanic adults with obesity. Brown et al. (2022) performed a quasi-experimental study to determine if Hispanic adults who participated in the Healthy Fit intervention with supplemental motivational interviewing (MI) had more significant reductions in body composition than those who received the standard intervention. Of the 656 baseline participants, intervention participants had 2.13 times higher odds of weight loss and 2.59 times higher odds of decreased body fat percentage, and the average amount of weight lost for the MI group was 1.23 kg over 12 months. The study found that a community health worker approach that incorporates MI is a viable, cost-effective strategy for incremental change in diet and physical activity behavior in Hispanic communities, thus establishing a solid evidence base for replication in Miami-Dade.
Zeb et al. (2024) reviewed the literature on community-based obesity interventions and their effects on body weight, BMI, and waist circumference. The study validated that obesity prevention and management can be achieved by healthy diet, exercise and lifestyle modification provided by community-based programs. Structured community programs with multiple behavior change components were consistently found to have positive effects on BMI and waist circumference, supporting the proposed design of intervention for the target population in Miami-Dade County.
**Strengths and Weaknesses of Sources**
There are several strengths and limitations in the literature reviewed for this proposal. The strengths of the Brown et al. (2022) study are that it was conducted specifically with a Hispanic adult population, employed a validated intervention framework (Healthy Fit), and reported very precise and measurable outcomes on BMI and Body Fat Percentage at a 12-month follow-up. However, because of its quasi-experimental design, causal inferences are limited, and there is a high attrition rate of 46%, which may limit the generalizability of the findings.
The Zeb et al. (2024) meta-analysis is more generalizable since it incorporates several community-based studies, but its inclusion of international studies also leads to some differences in socioeconomic and healthcare systems that may not apply to a Miami-Dade community. Despite the limitations, however, both sources are peer reviewed, published in reputable indexed journals and offer empirical data, well identified methodologies, and sampling procedures that meet rigorous standards of scientific credibility and applicability to the proposed health promotion program.
**Theoretical Framework**
The Health Belief Model (HBM) is chosen as the guiding theoretical framework for this health promotion proposal. The HBM proposes that individuals are more likely to engage in health-promoting behaviors when they perceive themselves as susceptible to a condition, believe the condition is serious, perceive benefits to taking action, and experience few barriers to doing so.The HBM can be used as a framework to guide the design of health promotion and disease prevention interventions by identifying the factors that influence behavioral intentions for weight management in adults (Vo & Le, 2025). Its constructs reflect the challenges that low-income Hispanic adults experience in Miami-Dade, including low perceived susceptibility for obesity-related comorbidities and high structural barriers to healthy behavior.
Using the HBM, the proposed program will address perceived susceptibility through targeted health screening, perceived severity through diabetes and cardiovascular risk education, perceived benefits through culturally appropriate nutrition and exercise, and barriers through transportation assistance and Spanish language resources. Interventions informed by the HBM that involve social support and education have been shown to have a considerable positive impact on physical activity and weight-related outcomes for overweight adults (Faghih et al., 2024). The HBM therefore offers a sound and action-oriented approach to design, implement and assess this community-based obesity program in Miami-Dade County.
**References**
Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2021). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing.
_American Journal of Health Promotion_,
_36_(2), 089011712110496. https://doi.org/10.1177/08901171211049679
CDC. (2024, September 12).
_New CDC Data Show Adult Obesity Prevalence Remains High_. CDC Newsroom. https://www.cdc.gov/media/releases/2024/p0912-adult-obesity.html
Emmerich, S., Fryar, C., Stierman, B., & Ogden, C. (2024). Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023.
_Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023_,
_508_(508). https://doi.org/10.15620/cdc/159281
Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.
_Frontiers in Public Health_,
_12_(12). https://doi.org/10.3389/fpubh.2024.1250152
Petersen, R., Pan, L., & Blanck, H. M. (2020). Racial and Ethnic Disparities in Adult Obesity in the United States: CDC’s Tracking to Inform State and Local Action.
_Preventing Chronic Disease_,
_16_(16). https://doi.org/10.5888/pcd16.180579
Vo, T. T., & Le, Q.-D. (2025). Application of the health belief model to study weight management behavioral intentions among adults in Ho Chi Minh City, Vietnam: a cross-sectional study.
_BMC Public Health_,
_25_(1). https://doi.org/10.1186/s12889-025-23637-9
Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in Access and Quality of Obesity Care.
_Disparities in Access and Quality of Obesity Care_,
_52_(2), 429–441. https://doi.org/10.1016/j.gtc.2023.02.003
Zeb, A., Froelicher, E. S., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis.
_Iranian Journal of Nursing and Midwifery Research_,
_29_(1), 16. https://doi.org/10.4103/ijnmr.ijnmr_120_22
**HealthPromotionpart2.docx**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/healthpromotionpart2-docx-10565539)
**HealthPromotionpart2.docx**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/healthpromotionpart2-docx-10565539)
**## SMARTGoal.docx**
1
7
**SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County**
Mirlenys Diaz
Florida National University
Health Promotion & Role Development in Adv. Nursing Practice-
Dr. Nora Hernandez-Pupo
June 11, 2026
**SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County**
Adult obesity is a major public health concern in the United States, notably in susceptible communities such as Miami-Dade County. Obesity is a risk factor for hypertension, type 2 diabetes mellitus, cardiovascular disease, stroke and some malignancies Recent national data indicate that adult obesity is still relatively prevalent, with 40.3% of people in the United States classed as obese during August 2021 through August 2023 (Emmerich et al., 2024). This is particularly relevant for low-income Hispanic adults, where social determinants of health, including food insecurity, limited access to healthy foods, transportation barriers, low health literacy, and decreased access to safe environments for physical activity, may negatively influence weight management (Washington et al., 2023). Therefore, a culturally relevant nurse-led health promotion intervention is needed to improve the obesity-related markers in this community.
This plan has the SMART aim of: Low-income Hispanic adults with obesity in Miami-Dade County who participate in a nurse-led health promotion program will have an average of 3%-5% reduction in body weight within 12 weeks, show improvement in BMI trends, increase moderate physical activity to at least 150 minutes per week, and improve nutrition knowledge scores by 20%. The outcomes will be measured by weekly weight tracking, activity logs, and pre/post nutrition questionnaires. The objective is SMART in that it describes the population, the intervention, the outcomes, the methods of measurement and the period of assessment.
Specific
It is specific since the target population is low-income Hispanics with obesity in Miami-Dade County. The intervention will be a 12-week, nurse-leaded intervention including culturally appropriate nutrition teaching, physical activity counseling, weekly weight monitoring and motivational support. This cohort was chosen because Hispanic people in low-income regions may face more difficulties in preventing and managing obesity, such as food instability, limited access to preventive care, and environmental factors that hinder healthy lifestyle habits (Washington et al., 2023). What is the role of nurse-led education in improving obesity outcomes in low-income Hispanic adults? This is a very important question in graduate level. Nurse-led education may improve results by increasing understanding of the hazards of obesity, enhancing self-management skills and promoting realistic behavior change. Furthermore, a community health worker intervention using motivational interviewing found positive changes in weight-related outcomes among Hispanic adults (Brown et al., 2022), which supports the use of culturally relevant counseling in this approach.
Measurable
The aim is measurable . It contains clear signals to monitor progress. Primary objectives will be body weight, BMI trends, weekly minutes of physical activity and nutrition knowledge scores. Body weight will be measured weekly and trends in BMI from baseline to week 12 will be investigated. Physical activity will be monitored using activity diaries by participants and nutrition knowledge will be assessed using pre and after intervention questionnaires. The second question at the graduate level is: What are the best measured outcomes that show short-term progress in obesity management? Clinical and behavioural change (e.g. body weight, BMI, waist circumference, physical activity levels and dietary knowledge) are useful markers. The use of measurable outcomes in this health promotion program is confirmed by the findings of Zeb et al. (2024), who found improvement in body weight, BMI and waist circumference in community-based obesity treatments.
Achievable
The target is achievable because the expected results are realistic to achieve within a 12-week period. A reasonable target for a short-term health promotion strategy that does not involve unsafe or excessive eating habits is an average weight loss of 3% to 5% body weight. The method will focus on making little changes to lifestyle, such adopting healthier food choices, controlling portion sizes, walking more, or doing moderate activity, and assessing yourself often. Practical strategies that can be utilized in a community setting include weekly education sessions, activity records, nutrition questionnaires and weight monitoring. Motivational interviewing also allows participants to uncover personal barriers, increase self-confidence, and generate realistic action plans. The technique suits the specified group. Brown et al. (2022) revealed that motivated interviewing helps in obesity-related behavior change in Hispanic adults.
Relevant
This purpose is relevant because it is directly related to the promotion of health, prevention of chronic diseases and advanced nursing practice. Advanced practice nurses are trained to evaluate health risks, educate patients, coordinate care, and advocate for vulnerable populations. This intervention has particular relevance in Miami-Dade County, where many low-income Hispanic residents may face cultural, economic and environmental barriers to healthy living. The Health Belief Model supports this hypothesis. The model explains how perceived vulnerability, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy influence health behavior. Training based on the Health Belief Model and social support increased physical activity among overweight women (Faghih et al., 2024). Therefore, this approach can allow the nurse to help the participants to identify the dangers of obesity and to adopt healthy practices.
Time-Bound
The goal has a time frame since it will be finished and evaluated in 12 weeks. Week 1 will include a baseline measurement of body weight, BMI, activity level and dietary information.
Weeks 2-11 Participants will get weekly teaching, counseling and monitoring. The last data collection will be in week 12 and outcomes will be compared to base line A third graduate level concern is how can advanced practice nurses help in maintaining lifestyle change after the 12-week intervention has been completed? Instructing participants on setting personal goals, tracking weight and activity, planning affordable meals, utilizing community resources, and following through with care will help participants reach their sustainability goals.
At the conclusion of this study, it is confirmed that obesity among low-income Hispanic adults in Miami-Dade County is a local public health issue that requires prioritized action. This group is constrained by social environmental barriers. The culturally adapted, nurse-led SMART goal intervention proposed in this study is clear, measurable, and evidence-based, and can turn generalized public health concerns into actionable, on-the-ground efforts. Led and implemented by advanced practice nurses through health education, motivational support, and continuous assessment, this intervention is expected to improve weight-related outcomes and support the development of long-term healthy behaviors.
**References**
Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2022). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing.
_American journal of health promotion : AJHP_,
_36_(2), 259–268.
[https://doi.org/10.1177/08901171211049679](https://doi.org/10.1177/08901171211049679)
Emmerich, S. D., Fryar, C. D., Stierman, B., & Ogden, C. L. (2024).
_Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023_. National Center for Health Statistics.
[https://doi.org/10.15620/cdc/159281](https://doi.org/10.15620/cdc/159281)
Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.
_Frontiers in public health_,
_12_, 1250152.
[https://doi.org/10.3389/fpubh.2024.1250152](https://doi.org/10.3389/fpubh.2024.1250152)
Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in access and quality of obesity care.
_Gastroenterology Clinics of North America, 52_(2), 429–441.
[https://doi.org/10.1016/j.gtc.2023.02.003](https://doi.org/10.1016/j.gtc.2023.02.003)
Zeb, A., Sivarajan Froelicher, E., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis.
_Iranian journal of nursing and midwifery research_,
_29_(1), 16–22. https://doi.org/10.4103/ijnmr.ijnmr_120_22
**## HealthPromotionProposalPart14.docx**
2
**Adult Obesity in Miami-Dade County**
Mirlenys Diaz
Florida National University
Health Promotion & Role Development in Adv. Nursing Practice-
Dr. Nora Hernandez-Pupo
May 30, 2026
**Adult Obesity in Miami-Dade County**
Obesity in adults is a major public health problem in Miami-Dade County and the United States. During August 2021 through August 2023, the prevalence of obesity among adults in the United States reached 40.3%, with no significant difference between men and women, and prevalence was higher among adults aged 40 to 59 compared to other age groups (Emmerich et al., 2024). Nationwide, in 2023, all states and territories in the United States had an obesity prevalence of more than 20% with the South reporting obesity prevalence of 35% (CDC, 2024). This burden is particularly high in low-income, Hispanic communities, such as the communities throughout Miami Dade County, Florida, which are affected by multiple structural inequities that increase the risk of chronic disease. The proposed health promotion program will consist of a structured 12-week nutrition education and physical activity counseling program in the community with a measurable goal of decreasing mean Body Mass Index (BMI) by 5% of adult Hispanic residents of Miami Dade County at the end of the intervention.
Globally, obesity continues to be a major public health concern. In 2022, 1 in 8 people worldwide were living with obesity, and approximately 890 million adults had obesity (World Health Organization, 2025). In the United States, adult obesity prevalence reached 40.3% during August 2021 through August 2023 (Emmerich et al., 2024). Locally, Miami-Dade County reported that 61.9% of adults were overweight or obese during 2017–2019, showing the continued need for community-based obesity prevention strategies in this population (Miami-Dade Matters, n.d.).
**Vulnerable Population**
Low-income Hispanic adults living in Miami-Dade County is the vulnerable population for this proposal. Socio-economic, cultural and environmental factors contribute to this population's increased risk of obesity. Minority families, specifically non-Hispanic African American and Hispanic families, are more likely to experience food insecurity, which makes it difficult to adhere to a particular diet, and low-income minority families face a number of other challenges such as chronic stress and poor access to quality foods, including vegetables, fruits and lean meats (Washington et al., 2023). In addition to these structural disadvantages, there are also poor access to physical activity resources. Low-income families may not have access to safe spaces for physical activity or may have transportation barriers that limit access to grocery stores with healthier food options, while financial insecurity can have a negative effect on health behaviors.
Another set of risk factors are those associated with access to health care and acculturation stress. Risk factors that contribute to the obesity disparities within Hispanic communities include low high school completion rates, low employment rates, higher rates of food insecurity, higher availability of poor-quality foods, low availability of convenient physical activity spaces, targeted marketing of poor food choices, and low access to healthcare providers or community-based organizations to support self-management (Levi et al., 2020). The combination of these vulnerabilities makes low-income Hispanic adults in Miami-Dade one of the most vulnerable populations for obesity and related comorbidities, and therefore a population in need of targeted, culturally competent health promotion efforts.
**Review of Literature**
Interventions that include culturally appropriate education, physical activity promotion, and motivational interviewing have been shown to have measurable impacts on BMI and body fat percentage in low-income Hispanic adults with obesity. Brown et al. (2022) performed a quasi-experimental study to determine if Hispanic adults who participated in the Healthy Fit intervention with supplemental motivational interviewing (MI) had more significant reductions in body composition than those who received the standard intervention. Of the 656 baseline participants, intervention participants had 2.13 times higher odds of weight loss and 2.59 times higher odds of decreased body fat percentage, and the average amount of weight lost for the MI group was 1.23 kg over 12 months. The study found that a community health worker approach that incorporates MI is a viable, cost-effective strategy for incremental change in diet and physical activity behavior in Hispanic communities, thus establishing a solid evidence base for replication in Miami-Dade.
Zeb et al. (2024) reviewed the literature on community-based obesity interventions and their effects on body weight, BMI, and waist circumference. The study validated that obesity prevention and management can be achieved by healthy diet, exercise and lifestyle modification provided by community-based programs. Structured community programs with multiple behavior change components were consistently found to have positive effects on BMI and waist circumference, supporting the proposed design of intervention for the target population in Miami-Dade County.
**Strengths and Weaknesses of Sources**
There are several strengths and limitations in the literature reviewed for this proposal. The strengths of the Brown et al. (2022) study are that it was conducted specifically with a Hispanic adult population, employed a validated intervention framework (Healthy Fit), and reported very precise and measurable outcomes on BMI and Body Fat Percentage at a 12-month follow-up. However, because of its quasi-experimental design, causal inferences are limited, and there is a high attrition rate of 46%, which may limit the generalizability of the findings.
The Zeb et al. (2024) meta-analysis is more generalizable since it incorporates several community-based studies, but its inclusion of international studies also leads to some differences in socioeconomic and healthcare systems that may not apply to a Miami-Dade community. Despite the limitations, however, both sources are peer reviewed, published in reputable indexed journals and offer empirical data, well identified methodologies, and sampling procedures that meet rigorous standards of scientific credibility and applicability to the proposed health promotion program.
**Theoretical Framework**
The Health Belief Model (HBM) is chosen as the guiding theoretical framework for this health promotion proposal. The HBM proposes that individuals are more likely to engage in health-promoting behaviors when they perceive themselves as susceptible to a condition, believe the condition is serious, perceive benefits to taking action, and experience few barriers to doing so.The HBM can be used as a framework to guide the design of health promotion and disease prevention interventions by identifying the factors that influence behavioral intentions for weight management in adults (Vo & Le, 2025). Its constructs reflect the challenges that low-income Hispanic adults experience in Miami-Dade, including low perceived susceptibility for obesity-related comorbidities and high structural barriers to healthy behavior.
Using the HBM, the proposed program will address perceived susceptibility through targeted health screening, perceived severity through diabetes and cardiovascular risk education, perceived benefits through culturally appropriate nutrition and exercise, and barriers through transportation assistance and Spanish language resources. Interventions informed by the HBM that involve social support and education have been shown to have a considerable positive impact on physical activity and weight-related outcomes for overweight adults (Faghih et al., 2024). The HBM therefore offers a sound and action-oriented approach to design, implement and assess this community-based obesity program in Miami-Dade County.
**References**
Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2021). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing.
_American Journal of Health Promotion_,
_36_(2), 089011712110496. https://doi.org/10.1177/08901171211049679
CDC. (2024, September 12).
_New CDC Data Show Adult Obesity Prevalence Remains High_. CDC Newsroom. https://www.cdc.gov/media/releases/2024/p0912-adult-obesity.html
Emmerich, S., Fryar, C., Stierman, B., & Ogden, C. (2024). Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023.
_Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023_,
_508_(508). https://doi.org/10.15620/cdc/159281
Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.
_Frontiers in Public Health_,
_12_(12). https://doi.org/10.3389/fpubh.2024.1250152
Petersen, R., Pan, L., & Blanck, H. M. (2020). Racial and Ethnic Disparities in Adult Obesity in the United States: CDC’s Tracking to Inform State and Local Action.
_Preventing Chronic Disease_,
_16_(16). https://doi.org/10.5888/pcd16.180579
Vo, T. T., & Le, Q.-D. (2025). Application of the health belief model to study weight management behavioral intentions among adults in Ho Chi Minh City, Vietnam: a cross-sectional study.
_BMC Public Health_,
_25_(1). https://doi.org/10.1186/s12889-025-23637-9
Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in Access and Quality of Obesity Care.
_Disparities in Access and Quality of Obesity Care_,
_52_(2), 429–441. https://doi.org/10.1016/j.gtc.2023.02.003
Zeb, A., Froelicher, E. S., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis.
_Iranian Journal of Nursing and Midwifery Research_,
_29_(1), 16. https://doi.org/10.4103/ijnmr.ijnmr_120_22
**HealthPromotionpart2.docx**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/healthpromotionpart2-docx-10565539)
**## SMARTGoal.docx**
1
7
**SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County**
Mirlenys Diaz
Florida National University
Health Promotion & Role Development in Adv. Nursing Practice-
Dr. Nora Hernandez-Pupo
June 11, 2026
**SMART Goal for Improving Adult Obesity Indicators in Miami-Dade County**
Adult obesity is a major public health concern in the United States, notably in susceptible communities such as Miami-Dade County. Obesity is a risk factor for hypertension, type 2 diabetes mellitus, cardiovascular disease, stroke and some malignancies Recent national data indicate that adult obesity is still relatively prevalent, with 40.3% of people in the United States classed as obese during August 2021 through August 2023 (Emmerich et al., 2024). This is particularly relevant for low-income Hispanic adults, where social determinants of health, including food insecurity, limited access to healthy foods, transportation barriers, low health literacy, and decreased access to safe environments for physical activity, may negatively influence weight management (Washington et al., 2023). Therefore, a culturally relevant nurse-led health promotion intervention is needed to improve the obesity-related markers in this community.
This plan has the SMART aim of: Low-income Hispanic adults with obesity in Miami-Dade County who participate in a nurse-led health promotion program will have an average of 3%-5% reduction in body weight within 12 weeks, show improvement in BMI trends, increase moderate physical activity to at least 150 minutes per week, and improve nutrition knowledge scores by 20%. The outcomes will be measured by weekly weight tracking, activity logs, and pre/post nutrition questionnaires. The objective is SMART in that it describes the population, the intervention, the outcomes, the methods of measurement and the period of assessment.
Specific
It is specific since the target population is low-income Hispanics with obesity in Miami-Dade County. The intervention will be a 12-week, nurse-leaded intervention including culturally appropriate nutrition teaching, physical activity counseling, weekly weight monitoring and motivational support. This cohort was chosen because Hispanic people in low-income regions may face more difficulties in preventing and managing obesity, such as food instability, limited access to preventive care, and environmental factors that hinder healthy lifestyle habits (Washington et al., 2023). What is the role of nurse-led education in improving obesity outcomes in low-income Hispanic adults? This is a very important question in graduate level. Nurse-led education may improve results by increasing understanding of the hazards of obesity, enhancing self-management skills and promoting realistic behavior change. Furthermore, a community health worker intervention using motivational interviewing found positive changes in weight-related outcomes among Hispanic adults (Brown et al., 2022), which supports the use of culturally relevant counseling in this approach.
Measurable
The aim is measurable . It contains clear signals to monitor progress. Primary objectives will be body weight, BMI trends, weekly minutes of physical activity and nutrition knowledge scores. Body weight will be measured weekly and trends in BMI from baseline to week 12 will be investigated. Physical activity will be monitored using activity diaries by participants and nutrition knowledge will be assessed using pre and after intervention questionnaires. The second question at the graduate level is: What are the best measured outcomes that show short-term progress in obesity management? Clinical and behavioural change (e.g. body weight, BMI, waist circumference, physical activity levels and dietary knowledge) are useful markers. The use of measurable outcomes in this health promotion program is confirmed by the findings of Zeb et al. (2024), who found improvement in body weight, BMI and waist circumference in community-based obesity treatments.
Achievable
The target is achievable because the expected results are realistic to achieve within a 12-week period. A reasonable target for a short-term health promotion strategy that does not involve unsafe or excessive eating habits is an average weight loss of 3% to 5% body weight. The method will focus on making little changes to lifestyle, such adopting healthier food choices, controlling portion sizes, walking more, or doing moderate activity, and assessing yourself often. Practical strategies that can be utilized in a community setting include weekly education sessions, activity records, nutrition questionnaires and weight monitoring. Motivational interviewing also allows participants to uncover personal barriers, increase self-confidence, and generate realistic action plans. The technique suits the specified group. Brown et al. (2022) revealed that motivated interviewing helps in obesity-related behavior change in Hispanic adults.
Relevant
This purpose is relevant because it is directly related to the promotion of health, prevention of chronic diseases and advanced nursing practice. Advanced practice nurses are trained to evaluate health risks, educate patients, coordinate care, and advocate for vulnerable populations. This intervention has particular relevance in Miami-Dade County, where many low-income Hispanic residents may face cultural, economic and environmental barriers to healthy living. The Health Belief Model supports this hypothesis. The model explains how perceived vulnerability, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy influence health behavior. Training based on the Health Belief Model and social support increased physical activity among overweight women (Faghih et al., 2024). Therefore, this approach can allow the nurse to help the participants to identify the dangers of obesity and to adopt healthy practices.
Time-Bound
The goal has a time frame since it will be finished and evaluated in 12 weeks. Week 1 will include a baseline measurement of body weight, BMI, activity level and dietary information.
Weeks 2-11 Participants will get weekly teaching, counseling and monitoring. The last data collection will be in week 12 and outcomes will be compared to base line A third graduate level concern is how can advanced practice nurses help in maintaining lifestyle change after the 12-week intervention has been completed? Instructing participants on setting personal goals, tracking weight and activity, planning affordable meals, utilizing community resources, and following through with care will help participants reach their sustainability goals.
At the conclusion of this study, it is confirmed that obesity among low-income Hispanic adults in Miami-Dade County is a local public health issue that requires prioritized action. This group is constrained by social environmental barriers. The culturally adapted, nurse-led SMART goal intervention proposed in this study is clear, measurable, and evidence-based, and can turn generalized public health concerns into actionable, on-the-ground efforts. Led and implemented by advanced practice nurses through health education, motivational support, and continuous assessment, this intervention is expected to improve weight-related outcomes and support the development of long-term healthy behaviors.
**References**
Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2022). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing.
_American journal of health promotion : AJHP_,
_36_(2), 259–268.
[https://doi.org/10.1177/08901171211049679](https://doi.org/10.1177/08901171211049679)
Emmerich, S. D., Fryar, C. D., Stierman, B., & Ogden, C. L. (2024).
_Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023_. National Center for Health Statistics.
[https://doi.org/10.15620/cdc/159281](https://doi.org/10.15620/cdc/159281)
Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.
_Frontiers in public health_,
_12_, 1250152.
[https://doi.org/10.3389/fpubh.2024.1250152](https://doi.org/10.3389/fpubh.2024.1250152)
Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in access and quality of obesity care.
_Gastroenterology Clinics of North America, 52_(2), 429–441.
[https://doi.org/10.1016/j.gtc.2023.02.003](https://doi.org/10.1016/j.gtc.2023.02.003)
Zeb, A., Sivarajan Froelicher, E., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis.
_Iranian journal of nursing and midwifery research_,
_29_(1), 16–22. https://doi.org/10.4103/ijnmr.ijnmr_120_22
**## HealthPromotionProposalPart14.docx**
2
**Adult Obesity in Miami-Dade County**
Mirlenys Diaz
Florida National University
Health Promotion & Role Development in Adv. Nursing Practice-
Dr. Nora Hernandez-Pupo
May 30, 2026
**Adult Obesity in Miami-Dade County**
Obesity in adults is a major public health problem in Miami-Dade County and the United States. During August 2021 through August 2023, the prevalence of obesity among adults in the United States reached 40.3%, with no significant difference between men and women, and prevalence was higher among adults aged 40 to 59 compared to other age groups (Emmerich et al., 2024). Nationwide, in 2023, all states and territories in the United States had an obesity prevalence of more than 20% with the South reporting obesity prevalence of 35% (CDC, 2024). This burden is particularly high in low-income, Hispanic communities, such as the communities throughout Miami Dade County, Florida, which are affected by multiple structural inequities that increase the risk of chronic disease. The proposed health promotion program will consist of a structured 12-week nutrition education and physical activity counseling program in the community with a measurable goal of decreasing mean Body Mass Index (BMI) by 5% of adult Hispanic residents of Miami Dade County at the end of the intervention.
Globally, obesity continues to be a major public health concern. In 2022, 1 in 8 people worldwide were living with obesity, and approximately 890 million adults had obesity (World Health Organization, 2025). In the United States, adult obesity prevalence reached 40.3% during August 2021 through August 2023 (Emmerich et al., 2024). Locally, Miami-Dade County reported that 61.9% of adults were overweight or obese during 2017–2019, showing the continued need for community-based obesity prevention strategies in this population (Miami-Dade Matters, n.d.).
**Vulnerable Population**
Low-income Hispanic adults living in Miami-Dade County is the vulnerable population for this proposal. Socio-economic, cultural and environmental factors contribute to this population's increased risk of obesity. Minority families, specifically non-Hispanic African American and Hispanic families, are more likely to experience food insecurity, which makes it difficult to adhere to a particular diet, and low-income minority families face a number of other challenges such as chronic stress and poor access to quality foods, including vegetables, fruits and lean meats (Washington et al., 2023). In addition to these structural disadvantages, there are also poor access to physical activity resources. Low-income families may not have access to safe spaces for physical activity or may have transportation barriers that limit access to grocery stores with healthier food options, while financial insecurity can have a negative effect on health behaviors.
Another set of risk factors are those associated with access to health care and acculturation stress. Risk factors that contribute to the obesity disparities within Hispanic communities include low high school completion rates, low employment rates, higher rates of food insecurity, higher availability of poor-quality foods, low availability of convenient physical activity spaces, targeted marketing of poor food choices, and low access to healthcare providers or community-based organizations to support self-management (Levi et al., 2020). The combination of these vulnerabilities makes low-income Hispanic adults in Miami-Dade one of the most vulnerable populations for obesity and related comorbidities, and therefore a population in need of targeted, culturally competent health promotion efforts.
**Review of Literature**
Interventions that include culturally appropriate education, physical activity promotion, and motivational interviewing have been shown to have measurable impacts on BMI and body fat percentage in low-income Hispanic adults with obesity. Brown et al. (2022) performed a quasi-experimental study to determine if Hispanic adults who participated in the Healthy Fit intervention with supplemental motivational interviewing (MI) had more significant reductions in body composition than those who received the standard intervention. Of the 656 baseline participants, intervention participants had 2.13 times higher odds of weight loss and 2.59 times higher odds of decreased body fat percentage, and the average amount of weight lost for the MI group was 1.23 kg over 12 months. The study found that a community health worker approach that incorporates MI is a viable, cost-effective strategy for incremental change in diet and physical activity behavior in Hispanic communities, thus establishing a solid evidence base for replication in Miami-Dade.
Zeb et al. (2024) reviewed the literature on community-based obesity interventions and their effects on body weight, BMI, and waist circumference. The study validated that obesity prevention and management can be achieved by healthy diet, exercise and lifestyle modification provided by community-based programs. Structured community programs with multiple behavior change components were consistently found to have positive effects on BMI and waist circumference, supporting the proposed design of intervention for the target population in Miami-Dade County.
**Strengths and Weaknesses of Sources**
There are several strengths and limitations in the literature reviewed for this proposal. The strengths of the Brown et al. (2022) study are that it was conducted specifically with a Hispanic adult population, employed a validated intervention framework (Healthy Fit), and reported very precise and measurable outcomes on BMI and Body Fat Percentage at a 12-month follow-up. However, because of its quasi-experimental design, causal inferences are limited, and there is a high attrition rate of 46%, which may limit the generalizability of the findings.
The Zeb et al. (2024) meta-analysis is more generalizable since it incorporates several community-based studies, but its inclusion of international studies also leads to some differences in socioeconomic and healthcare systems that may not apply to a Miami-Dade community. Despite the limitations, however, both sources are peer reviewed, published in reputable indexed journals and offer empirical data, well identified methodologies, and sampling procedures that meet rigorous standards of scientific credibility and applicability to the proposed health promotion program.
**Theoretical Framework**
The Health Belief Model (HBM) is chosen as the guiding theoretical framework for this health promotion proposal. The HBM proposes that individuals are more likely to engage in health-promoting behaviors when they perceive themselves as susceptible to a condition, believe the condition is serious, perceive benefits to taking action, and experience few barriers to doing so.The HBM can be used as a framework to guide the design of health promotion and disease prevention interventions by identifying the factors that influence behavioral intentions for weight management in adults (Vo & Le, 2025). Its constructs reflect the challenges that low-income Hispanic adults experience in Miami-Dade, including low perceived susceptibility for obesity-related comorbidities and high structural barriers to healthy behavior.
Using the HBM, the proposed program will address perceived susceptibility through targeted health screening, perceived severity through diabetes and cardiovascular risk education, perceived benefits through culturally appropriate nutrition and exercise, and barriers through transportation assistance and Spanish language resources. Interventions informed by the HBM that involve social support and education have been shown to have a considerable positive impact on physical activity and weight-related outcomes for overweight adults (Faghih et al., 2024). The HBM therefore offers a sound and action-oriented approach to design, implement and assess this community-based obesity program in Miami-Dade County.
**References**
Brown, L. D., Vasquez, D., Lopez, D. I., & Portillo, E. M. (2021). Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing.
_American Journal of Health Promotion_,
_36_(2), 089011712110496. https://doi.org/10.1177/08901171211049679
CDC. (2024, September 12).
_New CDC Data Show Adult Obesity Prevalence Remains High_. CDC Newsroom. https://www.cdc.gov/media/releases/2024/p0912-adult-obesity.html
Emmerich, S., Fryar, C., Stierman, B., & Ogden, C. (2024). Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023.
_Obesity and Severe Obesity Prevalence in Adults: United States, August 2021–August 2023_,
_508_(508). https://doi.org/10.15620/cdc/159281
Faghih, M., Kaveh, M. H., Nazari, M., Khademi, K., & Hasanzadeh, J. (2024). Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.
_Frontiers in Public Health_,
_12_(12). https://doi.org/10.3389/fpubh.2024.1250152
Petersen, R., Pan, L., & Blanck, H. M. (2020). Racial and Ethnic Disparities in Adult Obesity in the United States: CDC’s Tracking to Inform State and Local Action.
_Preventing Chronic Disease_,
_16_(16). https://doi.org/10.5888/pcd16.180579
Vo, T. T., & Le, Q.-D. (2025). Application of the health belief model to study weight management behavioral intentions among adults in Ho Chi Minh City, Vietnam: a cross-sectional study.
_BMC Public Health_,
_25_(1). https://doi.org/10.1186/s12889-025-23637-9
Washington, T. B., Johnson, V. R., Kendrick, K., Ibrahim, A. A., Tu, L., Sun, K., & Stanford, F. C. (2023). Disparities in Access and Quality of Obesity Care.
_Disparities in Access and Quality of Obesity Care_,
_52_(2), 429–441. https://doi.org/10.1016/j.gtc.2023.02.003
Zeb, A., Froelicher, E. S., Pienaar, A. J., & Dhamani, K. (2024). Effectiveness of Community-based Obesity Intervention for Body Weight, Body Mass Index, and Waist Circumference: Meta-analysis.
_Iranian Journal of Nursing and Midwifery Research_,
_29_(1), 16. https://doi.org/10.4103/ijnmr.ijnmr_120_22
**HealthPromotionpart2.docx**
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**files (3)** – ## FinalCapstone.docx – ## CapstoneProject1.docx – Capstonepart2.docx **## FinalCapstone.docx** Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm 1.Implementation/Conclusion – Implement the change you are proposing- This should be a cohesive paper and continuation…
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– ## FinalCapstone.docx
– ## CapstoneProject1.docx
– Capstonepart2.docx
**## FinalCapstone.docx**
Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm
1.Implementation/Conclusion
– Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.
2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.
3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.
-Timeline should be presented as a chart or essay format.* Do not use bullet points.
*Do not use direct implementation of Human Subjects in your proposal. This requires IRB
approval and CITI training which we will not use for this Capstone.
4. How would you evaluate the change process?
-The change must be measurable before and after the implementation.
-How would you measure or evaluate? Is there a tool to measure?
5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?
6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.
-How will you present the information to your stakeholders? Include cost and budget.
OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.
-Use appropriate APA 7th Ed. format
-Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be minimum 3-4 pages long (not including the title and reference page).
-The final Capstone project should be a minimum of 8 pages.
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written in the 3rd person.
CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
Implementation of
the practice change
20 Points
Thoroughly
presented the
change proposal.
Included setting,
time frame,
population,
stakeholders, Pros
and cons/barriers.
20
Briefly presented
the change
proposal. Briefly
Included setting,
time frame,
stakeholders. Pros
and cons.
15
Vaguely presented
the change
proposal. Vaguely
Included setting,
time frame,
stakeholders, Pros
and cons.
10
Did not present the
change proposal.
0
Change proposal
was measured and
realistic.
20 Points
Thoroughly used an
appropriate
measurement tool.
Provided realistic
outcomes.
Discussed how it
will be used and
implemented.
20
Briefly used an
appropriate
measurement tool.
Provided realistic
outcomes.
15
Vaguely used an
appropriate
measurement tool.
Provided realistic
outcomes.
10
Did not use an
appropriate
measurement tool.
Provided realistic
outcomes.
0
Depth of
Discussion and
Cohesiveness
20 Points
Thoroughly, In-
depth discussion
and elaboration in
all sections of the
paper. Follows
criteria provided in
addition to
leadership,
management,
budget and
statistics.
20
Briefly, In-depth
discussion and
elaboration in most
sections of the
paper.
15
Vaguely, In-depth
discussion and
elaboration in most
sections of the
paper.
10
Did not use In-
depth discussion
and elaboration in
most sections of
the paper.
0
Conclusion
25 Points
Thoroughly, Ties
together
information from all
sources of Part I,
II,III. Followed
feedback and
comments given
from faculty.
25
Briefly, Ties
together
information from all
sources of Part I,
II,III
20
Vaguely, Ties
together
information from all
sources of Part I,
II,III
15
Does not Tie
together
information from all
sources of Part I,
II,III
0
Spelling and
Grammar
5 points
Fewer than 5
grammatical,
spelling,
capitalization, or
punctuation errors.
More than 5 but
fewer than 10
grammatical,
spelling,
More than 10
grammatical,
spelling,
capitalization &
punctuation errors
An unacceptable
number of spelling
and/or grammar
mistakes.
Required word
count has been
met.
5
capitalization &
punctuation errors
Required word
count is 25 words
below the minimum
required count.
4
Required word
count is 50 words
below the minimum
required count.
3
Required word
count is more than
50 words below the
minimum required
count.
0
Sources
5 points
Over 5 current
sources, of which
at least 3 are peer-
review journal
articles or scholarly
books. Sources
include both
general background
sources and
specialized
sources. Special-
interest sources
and popular
literature and
acknowledged as
such if they are
cited. All websites
utilized are
authoritative.
5
5 current sources,
of which at least 2
are peer-review
journal articles or
scholarly books. All
websites utilized
are authoritative.
4
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books. All
websites utilized
are credible.
3
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books.
Not all websites
utilized are credible,
and/or sources are
not current.
0
Citations
5 points
Fewer than 5
incomplete
citations and/or
quotations, and
APA format errors
5
More than 5 but
fewer than 10
incomplete
citations and/or
quotations, and
APA format errors.
4
More than 10
incomplete
citations and/or
quotations, or APA
format errors.
3
The citation style is
inconsistent or
incorrect. It does
not cite sources
**## CapstoneProject1.docx**
2
**Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County**
Anisleidy Alvarez
Florida National University
MSN Capstone Project-DAX-DL01
Dr. Carmen Lazo
May 23, 2026
**Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County**
Anxiety disorders are among the most common conditions among adult patients in the United States and are poorly treated in primary care. The National Center for Health Statistics reports that in 2022, about one in five of adults aged 18 and older had symptoms of anxiety, with the highest rates found in younger adults and in people living in lower-income households (Terlizzi & Zablotsky, 2024). It's not only an individual problem as anxiety also creates significant health care expenses. Anxiety disorders collectively cost the United States healthcare system tens of billions of dollars per year, with increased emergency department visits, unnecessary specialist referrals, and diminished workforce productivity (Banushi et al., 2023).
Even with this high prevalence, mild anxiety is often underdiagnosed and is not adequately treated in primary care, where most persons with anxiety symptoms seek care. Mild anxiety patients who do not receive treatment are at great risk of the symptoms escalating to more severe anxiety, poor functioning and more frequent use of emergency services. Poor anxiety regulation also has a negative impact on treatment adherence of comorbid physical conditions, increasing healthcare utilization and costs.
The purpose of this capstone project is to evaluate whether a nurse-led 2-minute deep breathing educational intervention improves self-reported anxiety symptoms among adults with mild anxiety symptoms receiving care in a community primary care clinic in Miami-Dade County over an eight-week period. The proposed intervention aims to provide a simple, low-cost, evidence-based strategy that promotes self-management and improves emotional well-being in a vulnerable population.
**PICOT**
The prevalence of mild anxiety is a topic of increasing clinical interest in outpatient primary care, especially in diverse, urban communities where care for mental health is scarce. The following PICOT question guides this capstone project:
_In adult patients presenting with mild anxiety symptoms in a community primary care clinic in Miami-Dade County (P), does teaching a 2-minute nurse-led deep breathing exercise (I), compared to no structured breathing intervention (C), reduce self-reported anxiety levels (O) over eight weeks (T)?_
The population includes adults 18 years and older with mild anxiety symptoms presenting to primary care clinics in Miami-Dade County. This population often has limited access to mental health specialists and limited structured anxiety management during regular clinic visits.
The intervention is a brief 2-minute-deep breathing technique to be taught by the nurse to each patient at the clinic visit, combined with an instructional card to be printed and given to the patient for practicing at home. Controlled breathing is effective at engaging the Parasympathetic Nervous System (PNS) which reduces the physiological stress response and self-reported anxiety (Magnon et al., 2021). The comparison is standard care, which means routine clinical management without any structured breathing instruction.
The expected outcome is improvement in patient-reported anxiety symptoms following implementation of the nurse-led intervention. When available, Patient-reported symptom improvement may be discussed during routine follow-up visits as part of standard patient care. May be used as part of standard clinical assessment to monitor symptom improvement. Studies have shown that brief, structured breathwork exercises show significant decrease in physiological arousal and increase of mood compared to control conditions (Balban et al., 2023). The eight weeks is a reasonable amount of time to observe regular practice effects and is convenient in a capstone course that is structured on a semester basis.
**Vulnerable Population and Setting**
The target population for this intervention includes adults with mild anxiety symptoms receiving care in community primary care clinics in Miami-Dade County, Florida. This population often experiences multiple social and healthcare barriers that may contribute to delayed recognition and treatment of anxiety symptoms. Many adults receiving care in community clinics may have coexisting chronic conditions, limited access to mental health specialists, and limited exposure to structured behavioral health interventions during routine primary care visits. As a result, primary care settings frequently serve as the first and sometimes only point of access for individuals seeking support for mental health concerns.
Miami-Dade County has a population that is one of the most culturally and linguistically diverse in the United States, with over 70% of the county's residents identifying as Hispanic and/or Latino (U.S Census Bureau, 2025). The stigma attached to mental health, low mental health literacy and a preference for physical explanations of distress over psychiatric explanations are commonly mentioned as cultural factors hindering help-seeking in this population (Forcén et al., 2023). Structural factors are also constraints to receiving mental health treatment: language, insurance status, cost of treatment, and transportation. The evidence shows that Hispanic and Latino adults are much less likely than adults of other races and ethnicities to receive mental health care, despite having clinically meaningful symptoms (Forcén et al., 2023).
Anxiety disorders affect nearly one in five adults nationwide and is one of the most underdiagnosed conditions in primary care, with studies showing that only approximately 20% of affected patients receive appropriate treatment (Banushi et al., 2023; National Institute of Mental Health, 2024). Social determinants of health add to vulnerability in Miami-Dade and further increase this gap. A stressful urban environment, the economic instability, stressors related to immigration, and social isolation make the situation ripe for anxiety symptoms to continue and intensify without some degree of intervention. A straightforward, low cost, culturally appropriate approach, like deep breathing led by nurses, is therefore clinically appropriate and highly needed for this population.
**Proposal and Intervention Plan**
The proposed intervention is a 2-minute-deep breathing exercise taught to each adult patients with mild anxiety symptoms by a trained nurse during his or her usual primary care clinic in a community clinic in Miami-Dade County. The intervention includes instruction on slow diaphragmatic breathing with controlled inhalation and prolonged exhalation, an approach shown to promote relaxation and reduce anxiety-related physiological arousal through activation of the parasympathetic nervous system .The educational session is delivered individually by the nurse at the point of care and requires minimal time to implement during routine patient education. Patients will also receive a bilingual educational handout to encourage continued practice of the breathing technique at home. (Magnon et al., 2021).
The resources required for implementation are minimal and include printed bilingual instruction cards, a standardized nurse teaching script, and a brief staff orientation session. It does not require a special setup or extra space and is very easy to do in a busy outpatient clinic.
The proposed intervention is low-cost and feasible for implementation in a community primary care clinic. Resources required include printed bilingual educational handouts for patients, estimated at approximately $50 to $75, and a brief staff orientation session incorporated into regular nursing meetings without additional staffing expenses. Because the intervention is integrated into routine patient education, no additional personnel or specialized equipment are required. The low-cost nature of this intervention supports feasibility within an eight-week academic semester timeline.
Involved in the intervention are bedside registered nurses teaching, Advanced practice nurses managing the intervention and adherence to the protocol, and the primary care physicians who identify patients during clinic visits. Clinic administrative staff support scheduling and patient education coordination and scheduling support.
The implementation timeline takes place in three phases. In week 1 and 2 staff education takes place, and all patient materials are prepared and printed. From week 3 to 6, the nurses teach deep breathing techniques to patients during their routine clinic visits, and the patients practice deep breathing at home with the deep breathing instruction card. During weeks 7 and 8, nurses will reinforce patient education and encourage continued use of the deep breathing technique during routine follow-up visits.
**Theoretical Framework**
This capstone project is largely based on Dorothea Orem's Self-Care Deficit Nursing Theory. Nurses in Orem's framework are educators who recognize the patient's deficits in self-care and fill that gap with knowledge and skills so that the patient can maintain his or her health independently. According to Bekaert (2025) health education is a component of nursing, which is built upon Orem's theory, in which the nurse assists individuals in meeting their self-care needs by demonstrating and facilitating their ability to cope with stress and manage their emotional state. The 2-minute-deep breathing exercise directly targets the patient's self-care deficit by offering a practical and repeatable tool that patients can use independently to help with mild anxiety symptoms outside of the clinic and at the end of the intervention period.
The intervention is implemented at the organizational level in the clinic, using Kurt Lewin's Change Theory. Lewin's model has three stages; Unfreezing, Change and Refreezing. In unfreezing, clinic staff are taught about the high prevalence of undiagnosed and unmanaged anxiety and the evidence supporting brief breathing techniques. The deep breathing teaching educational approach is introduced into regular nursing practice during the change phase. During the refreezing stage, the nurse-led deep breathing educational approach may become incorporated into routine patient education for adults with mild anxiety symptoms, supporting sustainability beyond the capstone timeline. Lewin's model is one of the most commonly used models in nurse-led change in healthcare organizations as it provides a simple structure to help guide complex changes to practice (Harrison et al., 2021). Combined, Orem's and Lewin's models guarantee the patient-centered and organizationally sustainable nature of the intervention. Orem leads direct patient care and Lewin leads institutional change for sustaining it.
**Conclusion**
Mild anxiety symptoms in people within primary care settings are prevalent, sometimes overlooked, and linked to diminished quality of life and heightened healthcare usage, especially among vulnerable groups facing obstacles to mental healthcare access. In culturally diverse areas like Miami-Dade County, socioeconomic determinants of health, such as restricted access to behavioral healthcare, linguistic obstacles, economic instability, and mental health stigma, may lead to postponed treatment and exacerbated symptoms. This capstone project suggests a nurse-led, 2-minute deep breathing educational intervention as a viable, cost-effective, and evidence-based approach to assist adults with mild anxiety symptoms in a community primary care clinic in Miami-Dade County. The intervention, principally informed by Orem’s Self-Care Deficit Nursing Theory and reinforced by Lewin’s Change Theory, fosters patient self-management and facilitates integration into standard nursing practice. The proposed intervention is pragmatic, achievable within an eight-week academic timeframe, and possesses the capacity to enhance patient-reported anxiety symptoms while promoting overall emotional well-being. Educational interventions in primary care may enhance quality of life and mitigate the course of anxiety symptoms when implemented early in treatment.
**References**
Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal.
_Cell Reports Medicine_,
_4_(1), 1–15. https://doi.org/10.1016/j.xcrm.2022.100895
Banushi, B., Brendle, M., Ragnhildstveit, A., Murphy, T., Moore, C., Egberts, J., & Robison, R. (2023). Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review.
_Brain Sciences_,
_13_(2), 256. https://doi.org/10.3390/brainsci13020256
Bekaert, S. (2025). Repositioning health education as a core nursing function: a commentary.
_Journal of Research in Nursing_. https://doi.org/10.1177/17449871251358627
Forcén, F. E., Flórez, M. C. V., Medina, R. B., Zambrano, J., Pérez, J. H., Rodríguez, A. M., & Santos, L. H. (2023). Deconstructing cultural aspects of mental health care in Hispanic/Latinx people.
_Psychiatric Annals_,
_53_(3), 127–132. https://doi.org/10.3928/00485713-20230215-02
Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where Do Models for Change management, Improvement and Implementation meet? a Systematic Review of the Applications of Change Management Models in Healthcare.
_Journal of Healthcare Leadership_,
_13_(2), 85–108. https://doi.org/10.2147/JHL.S289176
Magnon, V., Dutheil, F., & Vallet, G. T. (2021). Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults.
_Scientific Reports_,
_11_(1). https://doi.org/10.1038/s41598-021-98736-9
National Institute of Mental Health. (2024).
_Any Anxiety Disorder_. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
Terlizzi, E. P., & Zablotsky, B. (2024). Symptoms of Anxiety and Depression Among Adults: United States, 2019 and 2022.
_National Health Statistics Reports_,
_213_, CS353885. https://doi.org/10.15620/cdc/64018
U.S Census Bureau. (2025).
_QuickFacts: Miami-Dade County, Florida_. Census Bureau QuickFacts; United States Census Bureau. https://www.census.gov/quickfacts/fact/table/miamidadecountyflorida/BZA115223
**Capstonepart2.docx**
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**Capstonepart2.docx**
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**## FinalCapstone.docx**
Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm
1.Implementation/Conclusion
– Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.
2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.
3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.
-Timeline should be presented as a chart or essay format.* Do not use bullet points.
*Do not use direct implementation of Human Subjects in your proposal. This requires IRB
approval and CITI training which we will not use for this Capstone.
4. How would you evaluate the change process?
-The change must be measurable before and after the implementation.
-How would you measure or evaluate? Is there a tool to measure?
5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?
6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.
-How will you present the information to your stakeholders? Include cost and budget.
OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.
-Use appropriate APA 7th Ed. format
-Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be minimum 3-4 pages long (not including the title and reference page).
-The final Capstone project should be a minimum of 8 pages.
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written in the 3rd person.
CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
Implementation of
the practice change
20 Points
Thoroughly
presented the
change proposal.
Included setting,
time frame,
population,
stakeholders, Pros
and cons/barriers.
20
Briefly presented
the change
proposal. Briefly
Included setting,
time frame,
stakeholders. Pros
and cons.
15
Vaguely presented
the change
proposal. Vaguely
Included setting,
time frame,
stakeholders, Pros
and cons.
10
Did not present the
change proposal.
0
Change proposal
was measured and
realistic.
20 Points
Thoroughly used an
appropriate
measurement tool.
Provided realistic
outcomes.
Discussed how it
will be used and
implemented.
20
Briefly used an
appropriate
measurement tool.
Provided realistic
outcomes.
15
Vaguely used an
appropriate
measurement tool.
Provided realistic
outcomes.
10
Did not use an
appropriate
measurement tool.
Provided realistic
outcomes.
0
Depth of
Discussion and
Cohesiveness
20 Points
Thoroughly, In-
depth discussion
and elaboration in
all sections of the
paper. Follows
criteria provided in
addition to
leadership,
management,
budget and
statistics.
20
Briefly, In-depth
discussion and
elaboration in most
sections of the
paper.
15
Vaguely, In-depth
discussion and
elaboration in most
sections of the
paper.
10
Did not use In-
depth discussion
and elaboration in
most sections of
the paper.
0
Conclusion
25 Points
Thoroughly, Ties
together
information from all
sources of Part I,
II,III. Followed
feedback and
comments given
from faculty.
25
Briefly, Ties
together
information from all
sources of Part I,
II,III
20
Vaguely, Ties
together
information from all
sources of Part I,
II,III
15
Does not Tie
together
information from all
sources of Part I,
II,III
0
Spelling and
Grammar
5 points
Fewer than 5
grammatical,
spelling,
capitalization, or
punctuation errors.
More than 5 but
fewer than 10
grammatical,
spelling,
More than 10
grammatical,
spelling,
capitalization &
punctuation errors
An unacceptable
number of spelling
and/or grammar
mistakes.
Required word
count has been
met.
5
capitalization &
punctuation errors
Required word
count is 25 words
below the minimum
required count.
4
Required word
count is 50 words
below the minimum
required count.
3
Required word
count is more than
50 words below the
minimum required
count.
0
Sources
5 points
Over 5 current
sources, of which
at least 3 are peer-
review journal
articles or scholarly
books. Sources
include both
general background
sources and
specialized
sources. Special-
interest sources
and popular
literature and
acknowledged as
such if they are
cited. All websites
utilized are
authoritative.
5
5 current sources,
of which at least 2
are peer-review
journal articles or
scholarly books. All
websites utilized
are authoritative.
4
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books. All
websites utilized
are credible.
3
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books.
Not all websites
utilized are credible,
and/or sources are
not current.
0
Citations
5 points
Fewer than 5
incomplete
citations and/or
quotations, and
APA format errors
5
More than 5 but
fewer than 10
incomplete
citations and/or
quotations, and
APA format errors.
4
More than 10
incomplete
citations and/or
quotations, or APA
format errors.
3
The citation style is
inconsistent or
incorrect. It does
not cite sources
**## CapstoneProject1.docx**
2
**Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County**
Anisleidy Alvarez
Florida National University
MSN Capstone Project-DAX-DL01
Dr. Carmen Lazo
May 23, 2026
**Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County**
Anxiety disorders are among the most common conditions among adult patients in the United States and are poorly treated in primary care. The National Center for Health Statistics reports that in 2022, about one in five of adults aged 18 and older had symptoms of anxiety, with the highest rates found in younger adults and in people living in lower-income households (Terlizzi & Zablotsky, 2024). It's not only an individual problem as anxiety also creates significant health care expenses. Anxiety disorders collectively cost the United States healthcare system tens of billions of dollars per year, with increased emergency department visits, unnecessary specialist referrals, and diminished workforce productivity (Banushi et al., 2023).
Even with this high prevalence, mild anxiety is often underdiagnosed and is not adequately treated in primary care, where most persons with anxiety symptoms seek care. Mild anxiety patients who do not receive treatment are at great risk of the symptoms escalating to more severe anxiety, poor functioning and more frequent use of emergency services. Poor anxiety regulation also has a negative impact on treatment adherence of comorbid physical conditions, increasing healthcare utilization and costs.
The purpose of this capstone project is to evaluate whether a nurse-led 2-minute deep breathing educational intervention improves self-reported anxiety symptoms among adults with mild anxiety symptoms receiving care in a community primary care clinic in Miami-Dade County over an eight-week period. The proposed intervention aims to provide a simple, low-cost, evidence-based strategy that promotes self-management and improves emotional well-being in a vulnerable population.
**PICOT**
The prevalence of mild anxiety is a topic of increasing clinical interest in outpatient primary care, especially in diverse, urban communities where care for mental health is scarce. The following PICOT question guides this capstone project:
_In adult patients presenting with mild anxiety symptoms in a community primary care clinic in Miami-Dade County (P), does teaching a 2-minute nurse-led deep breathing exercise (I), compared to no structured breathing intervention (C), reduce self-reported anxiety levels (O) over eight weeks (T)?_
The population includes adults 18 years and older with mild anxiety symptoms presenting to primary care clinics in Miami-Dade County. This population often has limited access to mental health specialists and limited structured anxiety management during regular clinic visits.
The intervention is a brief 2-minute-deep breathing technique to be taught by the nurse to each patient at the clinic visit, combined with an instructional card to be printed and given to the patient for practicing at home. Controlled breathing is effective at engaging the Parasympathetic Nervous System (PNS) which reduces the physiological stress response and self-reported anxiety (Magnon et al., 2021). The comparison is standard care, which means routine clinical management without any structured breathing instruction.
The expected outcome is improvement in patient-reported anxiety symptoms following implementation of the nurse-led intervention. When available, Patient-reported symptom improvement may be discussed during routine follow-up visits as part of standard patient care. May be used as part of standard clinical assessment to monitor symptom improvement. Studies have shown that brief, structured breathwork exercises show significant decrease in physiological arousal and increase of mood compared to control conditions (Balban et al., 2023). The eight weeks is a reasonable amount of time to observe regular practice effects and is convenient in a capstone course that is structured on a semester basis.
**Vulnerable Population and Setting**
The target population for this intervention includes adults with mild anxiety symptoms receiving care in community primary care clinics in Miami-Dade County, Florida. This population often experiences multiple social and healthcare barriers that may contribute to delayed recognition and treatment of anxiety symptoms. Many adults receiving care in community clinics may have coexisting chronic conditions, limited access to mental health specialists, and limited exposure to structured behavioral health interventions during routine primary care visits. As a result, primary care settings frequently serve as the first and sometimes only point of access for individuals seeking support for mental health concerns.
Miami-Dade County has a population that is one of the most culturally and linguistically diverse in the United States, with over 70% of the county's residents identifying as Hispanic and/or Latino (U.S Census Bureau, 2025). The stigma attached to mental health, low mental health literacy and a preference for physical explanations of distress over psychiatric explanations are commonly mentioned as cultural factors hindering help-seeking in this population (Forcén et al., 2023). Structural factors are also constraints to receiving mental health treatment: language, insurance status, cost of treatment, and transportation. The evidence shows that Hispanic and Latino adults are much less likely than adults of other races and ethnicities to receive mental health care, despite having clinically meaningful symptoms (Forcén et al., 2023).
Anxiety disorders affect nearly one in five adults nationwide and is one of the most underdiagnosed conditions in primary care, with studies showing that only approximately 20% of affected patients receive appropriate treatment (Banushi et al., 2023; National Institute of Mental Health, 2024). Social determinants of health add to vulnerability in Miami-Dade and further increase this gap. A stressful urban environment, the economic instability, stressors related to immigration, and social isolation make the situation ripe for anxiety symptoms to continue and intensify without some degree of intervention. A straightforward, low cost, culturally appropriate approach, like deep breathing led by nurses, is therefore clinically appropriate and highly needed for this population.
**Proposal and Intervention Plan**
The proposed intervention is a 2-minute-deep breathing exercise taught to each adult patients with mild anxiety symptoms by a trained nurse during his or her usual primary care clinic in a community clinic in Miami-Dade County. The intervention includes instruction on slow diaphragmatic breathing with controlled inhalation and prolonged exhalation, an approach shown to promote relaxation and reduce anxiety-related physiological arousal through activation of the parasympathetic nervous system .The educational session is delivered individually by the nurse at the point of care and requires minimal time to implement during routine patient education. Patients will also receive a bilingual educational handout to encourage continued practice of the breathing technique at home. (Magnon et al., 2021).
The resources required for implementation are minimal and include printed bilingual instruction cards, a standardized nurse teaching script, and a brief staff orientation session. It does not require a special setup or extra space and is very easy to do in a busy outpatient clinic.
The proposed intervention is low-cost and feasible for implementation in a community primary care clinic. Resources required include printed bilingual educational handouts for patients, estimated at approximately $50 to $75, and a brief staff orientation session incorporated into regular nursing meetings without additional staffing expenses. Because the intervention is integrated into routine patient education, no additional personnel or specialized equipment are required. The low-cost nature of this intervention supports feasibility within an eight-week academic semester timeline.
Involved in the intervention are bedside registered nurses teaching, Advanced practice nurses managing the intervention and adherence to the protocol, and the primary care physicians who identify patients during clinic visits. Clinic administrative staff support scheduling and patient education coordination and scheduling support.
The implementation timeline takes place in three phases. In week 1 and 2 staff education takes place, and all patient materials are prepared and printed. From week 3 to 6, the nurses teach deep breathing techniques to patients during their routine clinic visits, and the patients practice deep breathing at home with the deep breathing instruction card. During weeks 7 and 8, nurses will reinforce patient education and encourage continued use of the deep breathing technique during routine follow-up visits.
**Theoretical Framework**
This capstone project is largely based on Dorothea Orem's Self-Care Deficit Nursing Theory. Nurses in Orem's framework are educators who recognize the patient's deficits in self-care and fill that gap with knowledge and skills so that the patient can maintain his or her health independently. According to Bekaert (2025) health education is a component of nursing, which is built upon Orem's theory, in which the nurse assists individuals in meeting their self-care needs by demonstrating and facilitating their ability to cope with stress and manage their emotional state. The 2-minute-deep breathing exercise directly targets the patient's self-care deficit by offering a practical and repeatable tool that patients can use independently to help with mild anxiety symptoms outside of the clinic and at the end of the intervention period.
The intervention is implemented at the organizational level in the clinic, using Kurt Lewin's Change Theory. Lewin's model has three stages; Unfreezing, Change and Refreezing. In unfreezing, clinic staff are taught about the high prevalence of undiagnosed and unmanaged anxiety and the evidence supporting brief breathing techniques. The deep breathing teaching educational approach is introduced into regular nursing practice during the change phase. During the refreezing stage, the nurse-led deep breathing educational approach may become incorporated into routine patient education for adults with mild anxiety symptoms, supporting sustainability beyond the capstone timeline. Lewin's model is one of the most commonly used models in nurse-led change in healthcare organizations as it provides a simple structure to help guide complex changes to practice (Harrison et al., 2021). Combined, Orem's and Lewin's models guarantee the patient-centered and organizationally sustainable nature of the intervention. Orem leads direct patient care and Lewin leads institutional change for sustaining it.
**Conclusion**
Mild anxiety symptoms in people within primary care settings are prevalent, sometimes overlooked, and linked to diminished quality of life and heightened healthcare usage, especially among vulnerable groups facing obstacles to mental healthcare access. In culturally diverse areas like Miami-Dade County, socioeconomic determinants of health, such as restricted access to behavioral healthcare, linguistic obstacles, economic instability, and mental health stigma, may lead to postponed treatment and exacerbated symptoms. This capstone project suggests a nurse-led, 2-minute deep breathing educational intervention as a viable, cost-effective, and evidence-based approach to assist adults with mild anxiety symptoms in a community primary care clinic in Miami-Dade County. The intervention, principally informed by Orem’s Self-Care Deficit Nursing Theory and reinforced by Lewin’s Change Theory, fosters patient self-management and facilitates integration into standard nursing practice. The proposed intervention is pragmatic, achievable within an eight-week academic timeframe, and possesses the capacity to enhance patient-reported anxiety symptoms while promoting overall emotional well-being. Educational interventions in primary care may enhance quality of life and mitigate the course of anxiety symptoms when implemented early in treatment.
**References**
Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal.
_Cell Reports Medicine_,
_4_(1), 1–15. https://doi.org/10.1016/j.xcrm.2022.100895
Banushi, B., Brendle, M., Ragnhildstveit, A., Murphy, T., Moore, C., Egberts, J., & Robison, R. (2023). Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review.
_Brain Sciences_,
_13_(2), 256. https://doi.org/10.3390/brainsci13020256
Bekaert, S. (2025). Repositioning health education as a core nursing function: a commentary.
_Journal of Research in Nursing_. https://doi.org/10.1177/17449871251358627
Forcén, F. E., Flórez, M. C. V., Medina, R. B., Zambrano, J., Pérez, J. H., Rodríguez, A. M., & Santos, L. H. (2023). Deconstructing cultural aspects of mental health care in Hispanic/Latinx people.
_Psychiatric Annals_,
_53_(3), 127–132. https://doi.org/10.3928/00485713-20230215-02
Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where Do Models for Change management, Improvement and Implementation meet? a Systematic Review of the Applications of Change Management Models in Healthcare.
_Journal of Healthcare Leadership_,
_13_(2), 85–108. https://doi.org/10.2147/JHL.S289176
Magnon, V., Dutheil, F., & Vallet, G. T. (2021). Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults.
_Scientific Reports_,
_11_(1). https://doi.org/10.1038/s41598-021-98736-9
National Institute of Mental Health. (2024).
_Any Anxiety Disorder_. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
Terlizzi, E. P., & Zablotsky, B. (2024). Symptoms of Anxiety and Depression Among Adults: United States, 2019 and 2022.
_National Health Statistics Reports_,
_213_, CS353885. https://doi.org/10.15620/cdc/64018
U.S Census Bureau. (2025).
_QuickFacts: Miami-Dade County, Florida_. Census Bureau QuickFacts; United States Census Bureau. https://www.census.gov/quickfacts/fact/table/miamidadecountyflorida/BZA115223
**Capstonepart2.docx**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/capstonepart2-docx-10565529)
**## FinalCapstone.docx**
Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm
1.Implementation/Conclusion
– Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.
2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.
3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.
-Timeline should be presented as a chart or essay format.* Do not use bullet points.
*Do not use direct implementation of Human Subjects in your proposal. This requires IRB
approval and CITI training which we will not use for this Capstone.
4. How would you evaluate the change process?
-The change must be measurable before and after the implementation.
-How would you measure or evaluate? Is there a tool to measure?
5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?
6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.
-How will you present the information to your stakeholders? Include cost and budget.
OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.
-Use appropriate APA 7th Ed. format
-Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be minimum 3-4 pages long (not including the title and reference page).
-The final Capstone project should be a minimum of 8 pages.
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written in the 3rd person.
CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
Implementation of
the practice change
20 Points
Thoroughly
presented the
change proposal.
Included setting,
time frame,
population,
stakeholders, Pros
and cons/barriers.
20
Briefly presented
the change
proposal. Briefly
Included setting,
time frame,
stakeholders. Pros
and cons.
15
Vaguely presented
the change
proposal. Vaguely
Included setting,
time frame,
stakeholders, Pros
and cons.
10
Did not present the
change proposal.
0
Change proposal
was measured and
realistic.
20 Points
Thoroughly used an
appropriate
measurement tool.
Provided realistic
outcomes.
Discussed how it
will be used and
implemented.
20
Briefly used an
appropriate
measurement tool.
Provided realistic
outcomes.
15
Vaguely used an
appropriate
measurement tool.
Provided realistic
outcomes.
10
Did not use an
appropriate
measurement tool.
Provided realistic
outcomes.
0
Depth of
Discussion and
Cohesiveness
20 Points
Thoroughly, In-
depth discussion
and elaboration in
all sections of the
paper. Follows
criteria provided in
addition to
leadership,
management,
budget and
statistics.
20
Briefly, In-depth
discussion and
elaboration in most
sections of the
paper.
15
Vaguely, In-depth
discussion and
elaboration in most
sections of the
paper.
10
Did not use In-
depth discussion
and elaboration in
most sections of
the paper.
0
Conclusion
25 Points
Thoroughly, Ties
together
information from all
sources of Part I,
II,III. Followed
feedback and
comments given
from faculty.
25
Briefly, Ties
together
information from all
sources of Part I,
II,III
20
Vaguely, Ties
together
information from all
sources of Part I,
II,III
15
Does not Tie
together
information from all
sources of Part I,
II,III
0
Spelling and
Grammar
5 points
Fewer than 5
grammatical,
spelling,
capitalization, or
punctuation errors.
More than 5 but
fewer than 10
grammatical,
spelling,
More than 10
grammatical,
spelling,
capitalization &
punctuation errors
An unacceptable
number of spelling
and/or grammar
mistakes.
Required word
count has been
met.
5
capitalization &
punctuation errors
Required word
count is 25 words
below the minimum
required count.
4
Required word
count is 50 words
below the minimum
required count.
3
Required word
count is more than
50 words below the
minimum required
count.
0
Sources
5 points
Over 5 current
sources, of which
at least 3 are peer-
review journal
articles or scholarly
books. Sources
include both
general background
sources and
specialized
sources. Special-
interest sources
and popular
literature and
acknowledged as
such if they are
cited. All websites
utilized are
authoritative.
5
5 current sources,
of which at least 2
are peer-review
journal articles or
scholarly books. All
websites utilized
are authoritative.
4
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books. All
websites utilized
are credible.
3
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books.
Not all websites
utilized are credible,
and/or sources are
not current.
0
Citations
5 points
Fewer than 5
incomplete
citations and/or
quotations, and
APA format errors
5
More than 5 but
fewer than 10
incomplete
citations and/or
quotations, and
APA format errors.
4
More than 10
incomplete
citations and/or
quotations, or APA
format errors.
3
The citation style is
inconsistent or
incorrect. It does
not cite sources
**## CapstoneProject1.docx**
2
**Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County**
Anisleidy Alvarez
Florida National University
MSN Capstone Project-DAX-DL01
Dr. Carmen Lazo
May 23, 2026
**Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County**
Anxiety disorders are among the most common conditions among adult patients in the United States and are poorly treated in primary care. The National Center for Health Statistics reports that in 2022, about one in five of adults aged 18 and older had symptoms of anxiety, with the highest rates found in younger adults and in people living in lower-income households (Terlizzi & Zablotsky, 2024). It's not only an individual problem as anxiety also creates significant health care expenses. Anxiety disorders collectively cost the United States healthcare system tens of billions of dollars per year, with increased emergency department visits, unnecessary specialist referrals, and diminished workforce productivity (Banushi et al., 2023).
Even with this high prevalence, mild anxiety is often underdiagnosed and is not adequately treated in primary care, where most persons with anxiety symptoms seek care. Mild anxiety patients who do not receive treatment are at great risk of the symptoms escalating to more severe anxiety, poor functioning and more frequent use of emergency services. Poor anxiety regulation also has a negative impact on treatment adherence of comorbid physical conditions, increasing healthcare utilization and costs.
The purpose of this capstone project is to evaluate whether a nurse-led 2-minute deep breathing educational intervention improves self-reported anxiety symptoms among adults with mild anxiety symptoms receiving care in a community primary care clinic in Miami-Dade County over an eight-week period. The proposed intervention aims to provide a simple, low-cost, evidence-based strategy that promotes self-management and improves emotional well-being in a vulnerable population.
**PICOT**
The prevalence of mild anxiety is a topic of increasing clinical interest in outpatient primary care, especially in diverse, urban communities where care for mental health is scarce. The following PICOT question guides this capstone project:
_In adult patients presenting with mild anxiety symptoms in a community primary care clinic in Miami-Dade County (P), does teaching a 2-minute nurse-led deep breathing exercise (I), compared to no structured breathing intervention (C), reduce self-reported anxiety levels (O) over eight weeks (T)?_
The population includes adults 18 years and older with mild anxiety symptoms presenting to primary care clinics in Miami-Dade County. This population often has limited access to mental health specialists and limited structured anxiety management during regular clinic visits.
The intervention is a brief 2-minute-deep breathing technique to be taught by the nurse to each patient at the clinic visit, combined with an instructional card to be printed and given to the patient for practicing at home. Controlled breathing is effective at engaging the Parasympathetic Nervous System (PNS) which reduces the physiological stress response and self-reported anxiety (Magnon et al., 2021). The comparison is standard care, which means routine clinical management without any structured breathing instruction.
The expected outcome is improvement in patient-reported anxiety symptoms following implementation of the nurse-led intervention. When available, Patient-reported symptom improvement may be discussed during routine follow-up visits as part of standard patient care. May be used as part of standard clinical assessment to monitor symptom improvement. Studies have shown that brief, structured breathwork exercises show significant decrease in physiological arousal and increase of mood compared to control conditions (Balban et al., 2023). The eight weeks is a reasonable amount of time to observe regular practice effects and is convenient in a capstone course that is structured on a semester basis.
**Vulnerable Population and Setting**
The target population for this intervention includes adults with mild anxiety symptoms receiving care in community primary care clinics in Miami-Dade County, Florida. This population often experiences multiple social and healthcare barriers that may contribute to delayed recognition and treatment of anxiety symptoms. Many adults receiving care in community clinics may have coexisting chronic conditions, limited access to mental health specialists, and limited exposure to structured behavioral health interventions during routine primary care visits. As a result, primary care settings frequently serve as the first and sometimes only point of access for individuals seeking support for mental health concerns.
Miami-Dade County has a population that is one of the most culturally and linguistically diverse in the United States, with over 70% of the county's residents identifying as Hispanic and/or Latino (U.S Census Bureau, 2025). The stigma attached to mental health, low mental health literacy and a preference for physical explanations of distress over psychiatric explanations are commonly mentioned as cultural factors hindering help-seeking in this population (Forcén et al., 2023). Structural factors are also constraints to receiving mental health treatment: language, insurance status, cost of treatment, and transportation. The evidence shows that Hispanic and Latino adults are much less likely than adults of other races and ethnicities to receive mental health care, despite having clinically meaningful symptoms (Forcén et al., 2023).
Anxiety disorders affect nearly one in five adults nationwide and is one of the most underdiagnosed conditions in primary care, with studies showing that only approximately 20% of affected patients receive appropriate treatment (Banushi et al., 2023; National Institute of Mental Health, 2024). Social determinants of health add to vulnerability in Miami-Dade and further increase this gap. A stressful urban environment, the economic instability, stressors related to immigration, and social isolation make the situation ripe for anxiety symptoms to continue and intensify without some degree of intervention. A straightforward, low cost, culturally appropriate approach, like deep breathing led by nurses, is therefore clinically appropriate and highly needed for this population.
**Proposal and Intervention Plan**
The proposed intervention is a 2-minute-deep breathing exercise taught to each adult patients with mild anxiety symptoms by a trained nurse during his or her usual primary care clinic in a community clinic in Miami-Dade County. The intervention includes instruction on slow diaphragmatic breathing with controlled inhalation and prolonged exhalation, an approach shown to promote relaxation and reduce anxiety-related physiological arousal through activation of the parasympathetic nervous system .The educational session is delivered individually by the nurse at the point of care and requires minimal time to implement during routine patient education. Patients will also receive a bilingual educational handout to encourage continued practice of the breathing technique at home. (Magnon et al., 2021).
The resources required for implementation are minimal and include printed bilingual instruction cards, a standardized nurse teaching script, and a brief staff orientation session. It does not require a special setup or extra space and is very easy to do in a busy outpatient clinic.
The proposed intervention is low-cost and feasible for implementation in a community primary care clinic. Resources required include printed bilingual educational handouts for patients, estimated at approximately $50 to $75, and a brief staff orientation session incorporated into regular nursing meetings without additional staffing expenses. Because the intervention is integrated into routine patient education, no additional personnel or specialized equipment are required. The low-cost nature of this intervention supports feasibility within an eight-week academic semester timeline.
Involved in the intervention are bedside registered nurses teaching, Advanced practice nurses managing the intervention and adherence to the protocol, and the primary care physicians who identify patients during clinic visits. Clinic administrative staff support scheduling and patient education coordination and scheduling support.
The implementation timeline takes place in three phases. In week 1 and 2 staff education takes place, and all patient materials are prepared and printed. From week 3 to 6, the nurses teach deep breathing techniques to patients during their routine clinic visits, and the patients practice deep breathing at home with the deep breathing instruction card. During weeks 7 and 8, nurses will reinforce patient education and encourage continued use of the deep breathing technique during routine follow-up visits.
**Theoretical Framework**
This capstone project is largely based on Dorothea Orem's Self-Care Deficit Nursing Theory. Nurses in Orem's framework are educators who recognize the patient's deficits in self-care and fill that gap with knowledge and skills so that the patient can maintain his or her health independently. According to Bekaert (2025) health education is a component of nursing, which is built upon Orem's theory, in which the nurse assists individuals in meeting their self-care needs by demonstrating and facilitating their ability to cope with stress and manage their emotional state. The 2-minute-deep breathing exercise directly targets the patient's self-care deficit by offering a practical and repeatable tool that patients can use independently to help with mild anxiety symptoms outside of the clinic and at the end of the intervention period.
The intervention is implemented at the organizational level in the clinic, using Kurt Lewin's Change Theory. Lewin's model has three stages; Unfreezing, Change and Refreezing. In unfreezing, clinic staff are taught about the high prevalence of undiagnosed and unmanaged anxiety and the evidence supporting brief breathing techniques. The deep breathing teaching educational approach is introduced into regular nursing practice during the change phase. During the refreezing stage, the nurse-led deep breathing educational approach may become incorporated into routine patient education for adults with mild anxiety symptoms, supporting sustainability beyond the capstone timeline. Lewin's model is one of the most commonly used models in nurse-led change in healthcare organizations as it provides a simple structure to help guide complex changes to practice (Harrison et al., 2021). Combined, Orem's and Lewin's models guarantee the patient-centered and organizationally sustainable nature of the intervention. Orem leads direct patient care and Lewin leads institutional change for sustaining it.
**Conclusion**
Mild anxiety symptoms in people within primary care settings are prevalent, sometimes overlooked, and linked to diminished quality of life and heightened healthcare usage, especially among vulnerable groups facing obstacles to mental healthcare access. In culturally diverse areas like Miami-Dade County, socioeconomic determinants of health, such as restricted access to behavioral healthcare, linguistic obstacles, economic instability, and mental health stigma, may lead to postponed treatment and exacerbated symptoms. This capstone project suggests a nurse-led, 2-minute deep breathing educational intervention as a viable, cost-effective, and evidence-based approach to assist adults with mild anxiety symptoms in a community primary care clinic in Miami-Dade County. The intervention, principally informed by Orem’s Self-Care Deficit Nursing Theory and reinforced by Lewin’s Change Theory, fosters patient self-management and facilitates integration into standard nursing practice. The proposed intervention is pragmatic, achievable within an eight-week academic timeframe, and possesses the capacity to enhance patient-reported anxiety symptoms while promoting overall emotional well-being. Educational interventions in primary care may enhance quality of life and mitigate the course of anxiety symptoms when implemented early in treatment.
**References**
Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal.
_Cell Reports Medicine_,
_4_(1), 1–15. https://doi.org/10.1016/j.xcrm.2022.100895
Banushi, B., Brendle, M., Ragnhildstveit, A., Murphy, T., Moore, C., Egberts, J., & Robison, R. (2023). Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review.
_Brain Sciences_,
_13_(2), 256. https://doi.org/10.3390/brainsci13020256
Bekaert, S. (2025). Repositioning health education as a core nursing function: a commentary.
_Journal of Research in Nursing_. https://doi.org/10.1177/17449871251358627
Forcén, F. E., Flórez, M. C. V., Medina, R. B., Zambrano, J., Pérez, J. H., Rodríguez, A. M., & Santos, L. H. (2023). Deconstructing cultural aspects of mental health care in Hispanic/Latinx people.
_Psychiatric Annals_,
_53_(3), 127–132. https://doi.org/10.3928/00485713-20230215-02
Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where Do Models for Change management, Improvement and Implementation meet? a Systematic Review of the Applications of Change Management Models in Healthcare.
_Journal of Healthcare Leadership_,
_13_(2), 85–108. https://doi.org/10.2147/JHL.S289176
Magnon, V., Dutheil, F., & Vallet, G. T. (2021). Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults.
_Scientific Reports_,
_11_(1). https://doi.org/10.1038/s41598-021-98736-9
National Institute of Mental Health. (2024).
_Any Anxiety Disorder_. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
Terlizzi, E. P., & Zablotsky, B. (2024). Symptoms of Anxiety and Depression Among Adults: United States, 2019 and 2022.
_National Health Statistics Reports_,
_213_, CS353885. https://doi.org/10.15620/cdc/64018
U.S Census Bureau. (2025).
_QuickFacts: Miami-Dade County, Florida_. Census Bureau QuickFacts; United States Census Bureau. https://www.census.gov/quickfacts/fact/table/miamidadecountyflorida/BZA115223
**Capstonepart2.docx**
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**files (3)** – ## FinalCapstone.docx – ## MSN_Capstone_Part1_Revised1.docx – Capstonepart2.docx **## FinalCapstone.docx** Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm 1.Implementation/Conclusion – Implement the change you are proposing- This should be a cohesive paper an…
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– ## FinalCapstone.docx
– ## MSN_Capstone_Part1_Revised1.docx
– Capstonepart2.docx
**## FinalCapstone.docx**
Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm
1.Implementation/Conclusion
– Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.
2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.
3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.
-Timeline should be presented as a chart or essay format.* Do not use bullet points.
*Do not use direct implementation of Human Subjects in your proposal. This requires IRB
approval and CITI training which we will not use for this Capstone.
4. How would you evaluate the change process?
-The change must be measurable before and after the implementation.
-How would you measure or evaluate? Is there a tool to measure?
5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?
6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.
-How will you present the information to your stakeholders? Include cost and budget.
OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.
-Use appropriate APA 7th Ed. format
-Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be minimum 3-4 pages long (not including the title and reference page).
-The final Capstone project should be a minimum of 8 pages.
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written in the 3rd person.
CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
Implementation of
the practice change
20 Points
Thoroughly
presented the
change proposal.
Included setting,
time frame,
population,
stakeholders, Pros
and cons/barriers.
20
Briefly presented
the change
proposal. Briefly
Included setting,
time frame,
stakeholders. Pros
and cons.
15
Vaguely presented
the change
proposal. Vaguely
Included setting,
time frame,
stakeholders, Pros
and cons.
10
Did not present the
change proposal.
0
Change proposal
was measured and
realistic.
20 Points
Thoroughly used an
appropriate
measurement tool.
Provided realistic
outcomes.
Discussed how it
will be used and
implemented.
20
Briefly used an
appropriate
measurement tool.
Provided realistic
outcomes.
15
Vaguely used an
appropriate
measurement tool.
Provided realistic
outcomes.
10
Did not use an
appropriate
measurement tool.
Provided realistic
outcomes.
0
Depth of
Discussion and
Cohesiveness
20 Points
Thoroughly, In-
depth discussion
and elaboration in
all sections of the
paper. Follows
criteria provided in
addition to
leadership,
management,
budget and
statistics.
20
Briefly, In-depth
discussion and
elaboration in most
sections of the
paper.
15
Vaguely, In-depth
discussion and
elaboration in most
sections of the
paper.
10
Did not use In-
depth discussion
and elaboration in
most sections of
the paper.
0
Conclusion
25 Points
Thoroughly, Ties
together
information from all
sources of Part I,
II,III. Followed
feedback and
comments given
from faculty.
25
Briefly, Ties
together
information from all
sources of Part I,
II,III
20
Vaguely, Ties
together
information from all
sources of Part I,
II,III
15
Does not Tie
together
information from all
sources of Part I,
II,III
0
Spelling and
Grammar
5 points
Fewer than 5
grammatical,
spelling,
capitalization, or
punctuation errors.
More than 5 but
fewer than 10
grammatical,
spelling,
More than 10
grammatical,
spelling,
capitalization &
punctuation errors
An unacceptable
number of spelling
and/or grammar
mistakes.
Required word
count has been
met.
5
capitalization &
punctuation errors
Required word
count is 25 words
below the minimum
required count.
4
Required word
count is 50 words
below the minimum
required count.
3
Required word
count is more than
50 words below the
minimum required
count.
0
Sources
5 points
Over 5 current
sources, of which
at least 3 are peer-
review journal
articles or scholarly
books. Sources
include both
general background
sources and
specialized
sources. Special-
interest sources
and popular
literature and
acknowledged as
such if they are
cited. All websites
utilized are
authoritative.
5
5 current sources,
of which at least 2
are peer-review
journal articles or
scholarly books. All
websites utilized
are authoritative.
4
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books. All
websites utilized
are credible.
3
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books.
Not all websites
utilized are credible,
and/or sources are
not current.
0
Citations
5 points
Fewer than 5
incomplete
citations and/or
quotations, and
APA format errors
5
More than 5 but
fewer than 10
incomplete
citations and/or
quotations, and
APA format errors.
4
More than 10
incomplete
citations and/or
quotations, or APA
format errors.
3
The citation style is
inconsistent or
incorrect. It does
not cite sources
**## MSN_Capstone_Part1_Revised1.docx**
1
**Reducing Muscle Stiffness Through a Brief Stretching Intervention:** **A Capstone PICOT Proposal**
Alex De Cardenas
Florida National University
MSN Capstone Project-DAX-DL01
Dr. Carmen Lazo
May 21, 2026
**Abstract**
Mild muscle stiffness is a common musculoskeletal issue that is seen a community-based primary care clinic in Miami-Dade County, Florida and is associated with working-age and older adults, often related to physical inactivity, prolonged postures at work and sedentary lifestyles. Although these conditions are common and have significant health service utilization and cost (likely in the United States, over $200 billion per year for all musculoskeletal conditions), self-management interventions are underutilized in community and primary care settings. This culminating proposal is an evidence-based program to decrease self-reported muscle stiffness through education and implementation of a short five minute stretching routine daily and is nurse-led. The target population for this study is adults in Miami-Dade County, FL who visit primary care providers and/or community health services and are experiencing mild muscle stiffness. The intervention will be assessed with a numeric stiffness rating scale at baseline and week 8. This program is designed to increase the self-efficacy of patients, minimize need for analgesic medications, minimize avoidable use of healthcare resources and optimize functional quality of life for a socioeconomically diverse and vulnerable patient population based on Dorothea Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence Based Practice.
Keywords:
_muscle stiffness, stretching, self-care, nurse-led education, primary care, community health, Miami-Dade_
**Reducing Muscle Stiffness Through a Brief Stretching Intervention:** **A Capstone PICOT Proposal**
Muscle stiffness is an increasingly common but undertreated health problem in adults in community and primary care practices. Muscle stiffness is often linked to sedentary lifestyle and unhealthy occupational postures, as well as physical inactivity, and is not only a problem for mobility but also for comfort and functional status (Zvetkova et al., 2023). While it's not a serious health condition, ongoing stiffness can be a significant quality-of-life problem and can over time lead to increased use of healthcare and a loss of independence. Musculoskeletal conditions, such as muscle, tendon, and connective tissue related to stiffness, impact the lives of about 126.6 million Americans annually with over $213 billion in treatment expenses, lost wages and economic burden (United States Bone and Joint Initiative, 2021). These statistics emphasize the need for strategies that prevent and intervene early in the course of musculoskeletal issues to prevent them from becoming chronic and expensive.
Miami-Dade County is a uniquely burdened area for MS complaints at the local level. Florida is one of the highest states for musculoskeletal-related visits to the emergency department and primary care providers, and many of these visits are due to work-related musculoskeletal disorders among service-sector and manual labor employees (Florida Department of Health, 2022). These factors combine to decrease the chances residents have for timely, organized musculoskeletal care, with the Miami-Dade County uninsured rate estimated at about 19%, compared to the national average of 9.2% (U.S. Census Bureau, 2023). Uncontrolled muscle stiffness in this population comes with direct costs (such as increased consumption of pain medications) and indirect costs (such as unnecessary clinic visits, loss of working time, and exacerbated chronic pain problems). Minimally costly and specialized equipment-free nurse-led interventions, which are evidence-based and fiscally-sound, are strategies to reduce this burden.
The aim of this proposed program is to determine if a nurse-led structured 5-minute daily stretching education program can significantly decrease muscle stiffness in adults over an 8 week period in a primary care or community health care setting. The expected results are clinically relevant decreases in stiffness scores (measured by patient-reported outcomes) at the end of the eight-week intervention period. The importance of this program is not just to reducing unnecessary clinic visits, but also less use of analgesic medicines and long-term functional health of a vulnerable adult population.
**PICOT**
In adults with mild muscle stiffness (P), does teaching a simple five-minute daily stretching routine (I), compared to usual care without structured stretching education (C), reduce self-reported muscle stiffness (O) over eight weeks (T)?
The population of this project is adults with mild muscle stiffness, who are commonly seen in primary and community health services. This population includes individuals who are working age who have sedentary work, those who are older who have lower levels of physical activity and those who have discomfort in their musculoskeletal system, which is in early stages. Chronic musculoskeletal pain or stiffness is reported by about 54 million adults in the United States, and prevalence is higher among older people and those who are sedentary in their occupations (Theis et al., 2021). Low access to physical therapy, low health literacy, and lack of guidance on self-management strategies (Çimen, 2023) make this population vulnerable.
Proposed intervention is a five-minute, standardized, nurse delivered stretching program done at the end of the visit with emphasis on major muscle groups that tend to become stiff when injured, such as the neck, shoulders, lower back and lower extremities. Systematic reviews provide evidence of the significant benefits of regular static and dynamic stretching programs, including decreases in musculoskeletal pain severity, range of motion, and perceived muscle stiffness in adults. (Behm et al., 2023) The briefness of the routine is deliberate because shorter structured exercise programs have been shown to have greater sustained patient adherence versus longer programs that utilize equipment or gym access.
The comparison intervention is usually care plus verbal advice or referring to physical therapy for self-management training, but not providing a formal self-management program. There is a consistent body of evidence of less enduring improvement in musculoskeletal symptoms associated with passive care approaches compared to active, patient-centerd approaches like structured exercise or stretching education (Behm et al. 2023). The project is expected to yield statistically and clinically meaningful improvement of self-reported muscle stiffness scores (measured by a validated Numeric Rating Scale) at the end of the 8 weeks when compared to the baseline score. The eight-week duration is long enough to establish a pattern of stretching and to demonstrate measurable changes in muscle physiology such as increased tissue extensibility and decreased resting muscle tension (Zvetkova et al., 2023).
**Vulnerable Population and Setting**
The target population for this project are adults (ages 18) who live in Miami-Dade County, Florida, and present to their primary care clinics or community health centers with complaints of mild muscle stiffness. Miami-Dade is a diverse urban area with a concentration of population where most residents have sedentary service jobs and earn low wages in manual jobs. The two occupations are related to high levels of musculoskeletal complaints from the static position and repetitive motion patterns (Çimen, 2023). The occupational dimension of musculoskeletal disorder occurrence in and susceptibility of workers is demonstrated by the fact that service and manual labor workers make up a disproportionate share of the estimated 544,900 reported cases of MSDs that result in days away from work annually in the United States (BLS, 2022).
The musculoskeletal burden of this population is heavily influenced by social determinants of health. Around 19% of Miami-Dade County residents do not have health insurance, which reduces their access to specialist musculoskeletal care, physical therapy referrals, and preventive health services (U.S. Census Bureau, 2023). Low income also makes it harder to join gyms, get ergonomic workstations, and access evidence-based self-care resources. Difficulty with language may impede seeking help and compliance to health guidelines in Spanish-speaking and Haitian Creole-speaking populations. In addition, long work hours and caregiving duties limit physical activity time which also contributes to stiffness and functional decline. Cultural and low barrier approaches to addressing social disadvantage are essential for these compounded social disadvantage groups (Zvetkova et al., 2023).
Unless stiffness is treated early, it's likely to become a chronic pain problem, to result in reduced range of motion, and to be a fall risk, especially for older individuals in this group. In Miami-Dade, chronic musculoskeletal pain has been linked to emergency department visits that have an average cost of $1,389 per visit, while a structured nurse-led primary care intervention has average costs of about $120 per visit, indicating the cost-effectiveness of early preventive programming (Florida Department of Health, 2022). The differences highlight the need for proactive nursing interventions based in the community as a clinical priority and also a cost-effective approach to the healthcare system in Miami Dade.
**Proposal**
The proposed intervention is a nurse-led patient education program that will be delivered in a primary care or community health clinic in Miami-Dade County. If adults are identified on a regular basis in clinics for having mild muscle stiffness, a trained registered nurse or advanced practice registered nurse will provide a structured 15-minute educational session where the patient will be taught a standardized 5-minute stretching exercise. The routine concentrates on the cervical spine, shoulders, thoracic back, lumbar spine, hip flexors and hamstrings, each stretch being bilaterally performed for 30-60 seconds. A laminated take home reference card with illustrated instructions will be provided for patients to use independently each day. The evidence supports this educational approach, as Galmarini et al., (2024) showed that self-directed stretching programs that are supplemented with visual instructional materials are more likely to lead to improved patient adherence and musculoskeletal outcomes than verbal instruction alone.
The resources needed for implementation are the printed patient education materials, an area in the clinical setting for demonstration and nurse time of 20 minutes per patient encounter. The estimated cost of the intervention is $15-$25, per patient, which is very practical in resource-limited community settings (Theis et al., 2021). Multilingual patient materials in English, Spanish and Haitian Creole will be developed to meet the language needs of Miami-Dade's diverse population and ensure equitable access to the intervention. Furthermore, the short duration of the routine and its ease of implementation will contribute to patient compliance.In addition, the routine is brief and straightforward, making it easier to implement.
The program will take a total of 10 weeks: 2 weeks of staff training and program preparation, 8 weeks of open enrolment of patients and delivery of the intervention, and 8 weeks concurrently for outcome assessments, with a standardized numeric stiffness rating scale used at baseline and week 8. Advanced practice nurse overseeing program will review outcome data at 4 weeks to determine the progress that has been made and to discuss any challenges to adherence as needed (Behm et al., 2023). If the 8-week outcome data show statistical difference in stiffness scores, presentation will be made to clinic leadership for further consideration of wider program implementation.
**Theoretical Framework**
This Capstone project is designed and implemented through a pair of complementary frameworks: Dorothea Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice. These frameworks offer a clear and comprehensive basis for patient-centered education and for integrating evidence in clinical practice.
In accordance with Orem's Self-Care Deficit Nursing Theory, patients have a natural ability for self-care and nursing can support, educate, and empower patients when their self-care ability falls short of their therapeutic needs (Tanaka, 2022). The five-minute stretching exercise is a self-care behavior and this theory can be directly applied to the proposed intervention. There is a lack of structured knowledge among adults in case of mild muscle stiffness, which can be compensated by nursing education and leads to a lack of self-care. The role of the nurse in this project is an educative-supportive role as the nurse provides patients with the knowledge, skill, and motivation to perform the daily stretches alone. The preventive focus of the intervention is also understood through Orem's framework; in doing so, the skills needed to successfully implement self-care behavior are introduced, thereby decreasing reliance on healthcare services and decreasing the accumulation of health deficits over time.
The Iowa Model of Evidence-Based Practice offers a systematic approach to moving from evidence to practice. Based on the Iowa Model, Cullen et al. (2022) offer practitioners guidance for problem identification, evidence appraisal, pilot implementation, and outcome evaluation. Muscle Stiffness is determined as a clinically relevant trigger of practice change in this Capstone project. Systematic reviews and RCTs published and supporting stretching interventions are appraised and included in intervention design. A standardised 5 minute routine is rehearsed in the clinic and the patient's outcome is formally assessed at 8 weeks. When outcomes data show positive results, the model can be used to share the results and to consider the broader implementation at the healthcare organization level. This is a well-structured intervention that is theory driven, operationally astute, and can produce transferable clinical knowledge.
Conclusion
In conclusion, this capstone proposal addresses mild muscle stiffness as an important but often underrecognized musculoskeletal concern among adults in Miami-Dade County. The proposed nurse-led five-minute daily stretching intervention is realistic, low-cost, and appropriate for implementation in a community-based primary care clinic setting. By using patient education, self-care support, and a simple daily routine, the project promotes prevention and early management before muscle stiffness progresses into chronic pain, decreased mobility, or higher health care utilization. The intervention is supported by Orem’s Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice because it empowers patients to participate actively in their own care while allowing nurses to lead an evidence-based practice change. Overall, this project has the potential to improve self-reported muscle stiffness, increase patient self-efficacy, and support better functional outcomes in a vulnerable adult population.
**References**
Behm, D. G., Alizadeh, S., Daneshjoo, A., Anvar, S. H., Graham, A., Zahiri, A., & Konrad, A. (2023). Acute effects of various stretching techniques on range of motion: A systematic review with meta-analysis.
_Sports Medicine-Open, 9_(1), 107. https://doi.org/10.1186/s40798-023-00652-x
Bureau of Labor Statistics. (2022).
_Employer-reported workplace injuries and illnesses — 2021._ U.S. Department of Labor. https://www.bls.gov/news.release/osh.nr0.htm
Çimen, O. (2023). The efficiency of ergonomics, active break and stretching exercise program in office workers with chronic neck and back pain.
_Deneysel ve Klinik Tıp Dergisi, 40_(2), 329–332. https://dergipark.org.tr/en/pub/omujecm/issue/79274/1282408
Cullen, L., Hanrahan, K., Farrington, M., Tucker, S., & Edmonds, S. (2022).
_Evidence-based practice in action: Comprehensive strategies, tools, and tips from University of Iowa Hospitals & Clinics._ Sigma Theta Tau.
Florida Department of Health. (2022).
_Florida musculoskeletal health data and statistics._ https://www.floridahealth.gov
Theis, K. A., Murphy, L. B., Guglielmo, D., Boring, M. A., Okoro, C. A., Duca, L. M., & Barbour, K. E. (2021). Prevalence of arthritis and arthritis-attributable activity limitation — United States, 2016–2018.
_Morbidity and Mortality Weekly Report, 70_(40), 1401–1407.
[https://doi.org/10.15585/mmwr.mm7040a2](https://doi.org/10.15585/mmwr.mm7040a2)
Galmarini, E., Marciano, L., & Schulz, P. J. (2024). The effectiveness of visual-based interventions on health literacy in health care: A systematic review and meta-analysis.
_BMC Health Services Research_,
_24_(1), 1–10. https://doi.org/10.1186/s12913-024-11138-1
Tanaka, M. (2022). Orem's nursing self-care deficit theory: A theoretical analysis focusing on its philosophical and sociological foundation.
_Nursing Forum, 57_(3), 480–485. https://doi.org/10.1111/nuf.12696
U.S. Census Bureau. (2023).
_American Community Survey: Health insurance coverage in the United States._ https://www.census.gov/topics/health/health-insurance.html
United States Bone and Joint Initiative. (2021).
_The burden of musculoskeletal diseases in the United States: Prevalence, societal and economic cost (4th ed.)._ https://www.bmus-ors.org/
Zvetkova, E., Koytchev, E., Ivanov, I., Ranchev, S., & Antonov, A. (2023). Biomechanical, healing and therapeutic effects of stretching: A comprehensive review.
_Applied Sciences, 13_(15), 8596. https://doi.org/10.3390/app13158596
**Capstonepart2.docx**
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**## FinalCapstone.docx**
Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm
1.Implementation/Conclusion
– Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.
2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.
3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.
-Timeline should be presented as a chart or essay format.* Do not use bullet points.
*Do not use direct implementation of Human Subjects in your proposal. This requires IRB
approval and CITI training which we will not use for this Capstone.
4. How would you evaluate the change process?
-The change must be measurable before and after the implementation.
-How would you measure or evaluate? Is there a tool to measure?
5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?
6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.
-How will you present the information to your stakeholders? Include cost and budget.
OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.
-Use appropriate APA 7th Ed. format
-Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be minimum 3-4 pages long (not including the title and reference page).
-The final Capstone project should be a minimum of 8 pages.
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written in the 3rd person.
CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
Implementation of
the practice change
20 Points
Thoroughly
presented the
change proposal.
Included setting,
time frame,
population,
stakeholders, Pros
and cons/barriers.
20
Briefly presented
the change
proposal. Briefly
Included setting,
time frame,
stakeholders. Pros
and cons.
15
Vaguely presented
the change
proposal. Vaguely
Included setting,
time frame,
stakeholders, Pros
and cons.
10
Did not present the
change proposal.
0
Change proposal
was measured and
realistic.
20 Points
Thoroughly used an
appropriate
measurement tool.
Provided realistic
outcomes.
Discussed how it
will be used and
implemented.
20
Briefly used an
appropriate
measurement tool.
Provided realistic
outcomes.
15
Vaguely used an
appropriate
measurement tool.
Provided realistic
outcomes.
10
Did not use an
appropriate
measurement tool.
Provided realistic
outcomes.
0
Depth of
Discussion and
Cohesiveness
20 Points
Thoroughly, In-
depth discussion
and elaboration in
all sections of the
paper. Follows
criteria provided in
addition to
leadership,
management,
budget and
statistics.
20
Briefly, In-depth
discussion and
elaboration in most
sections of the
paper.
15
Vaguely, In-depth
discussion and
elaboration in most
sections of the
paper.
10
Did not use In-
depth discussion
and elaboration in
most sections of
the paper.
0
Conclusion
25 Points
Thoroughly, Ties
together
information from all
sources of Part I,
II,III. Followed
feedback and
comments given
from faculty.
25
Briefly, Ties
together
information from all
sources of Part I,
II,III
20
Vaguely, Ties
together
information from all
sources of Part I,
II,III
15
Does not Tie
together
information from all
sources of Part I,
II,III
0
Spelling and
Grammar
5 points
Fewer than 5
grammatical,
spelling,
capitalization, or
punctuation errors.
More than 5 but
fewer than 10
grammatical,
spelling,
More than 10
grammatical,
spelling,
capitalization &
punctuation errors
An unacceptable
number of spelling
and/or grammar
mistakes.
Required word
count has been
met.
5
capitalization &
punctuation errors
Required word
count is 25 words
below the minimum
required count.
4
Required word
count is 50 words
below the minimum
required count.
3
Required word
count is more than
50 words below the
minimum required
count.
0
Sources
5 points
Over 5 current
sources, of which
at least 3 are peer-
review journal
articles or scholarly
books. Sources
include both
general background
sources and
specialized
sources. Special-
interest sources
and popular
literature and
acknowledged as
such if they are
cited. All websites
utilized are
authoritative.
5
5 current sources,
of which at least 2
are peer-review
journal articles or
scholarly books. All
websites utilized
are authoritative.
4
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books. All
websites utilized
are credible.
3
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books.
Not all websites
utilized are credible,
and/or sources are
not current.
0
Citations
5 points
Fewer than 5
incomplete
citations and/or
quotations, and
APA format errors
5
More than 5 but
fewer than 10
incomplete
citations and/or
quotations, and
APA format errors.
4
More than 10
incomplete
citations and/or
quotations, or APA
format errors.
3
The citation style is
inconsistent or
incorrect. It does
not cite sources
**## MSN_Capstone_Part1_Revised1.docx**
1
**Reducing Muscle Stiffness Through a Brief Stretching Intervention:** **A Capstone PICOT Proposal**
Alex De Cardenas
Florida National University
MSN Capstone Project-DAX-DL01
Dr. Carmen Lazo
May 21, 2026
**Abstract**
Mild muscle stiffness is a common musculoskeletal issue that is seen a community-based primary care clinic in Miami-Dade County, Florida and is associated with working-age and older adults, often related to physical inactivity, prolonged postures at work and sedentary lifestyles. Although these conditions are common and have significant health service utilization and cost (likely in the United States, over $200 billion per year for all musculoskeletal conditions), self-management interventions are underutilized in community and primary care settings. This culminating proposal is an evidence-based program to decrease self-reported muscle stiffness through education and implementation of a short five minute stretching routine daily and is nurse-led. The target population for this study is adults in Miami-Dade County, FL who visit primary care providers and/or community health services and are experiencing mild muscle stiffness. The intervention will be assessed with a numeric stiffness rating scale at baseline and week 8. This program is designed to increase the self-efficacy of patients, minimize need for analgesic medications, minimize avoidable use of healthcare resources and optimize functional quality of life for a socioeconomically diverse and vulnerable patient population based on Dorothea Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence Based Practice.
Keywords:
_muscle stiffness, stretching, self-care, nurse-led education, primary care, community health, Miami-Dade_
**Reducing Muscle Stiffness Through a Brief Stretching Intervention:** **A Capstone PICOT Proposal**
Muscle stiffness is an increasingly common but undertreated health problem in adults in community and primary care practices. Muscle stiffness is often linked to sedentary lifestyle and unhealthy occupational postures, as well as physical inactivity, and is not only a problem for mobility but also for comfort and functional status (Zvetkova et al., 2023). While it's not a serious health condition, ongoing stiffness can be a significant quality-of-life problem and can over time lead to increased use of healthcare and a loss of independence. Musculoskeletal conditions, such as muscle, tendon, and connective tissue related to stiffness, impact the lives of about 126.6 million Americans annually with over $213 billion in treatment expenses, lost wages and economic burden (United States Bone and Joint Initiative, 2021). These statistics emphasize the need for strategies that prevent and intervene early in the course of musculoskeletal issues to prevent them from becoming chronic and expensive.
Miami-Dade County is a uniquely burdened area for MS complaints at the local level. Florida is one of the highest states for musculoskeletal-related visits to the emergency department and primary care providers, and many of these visits are due to work-related musculoskeletal disorders among service-sector and manual labor employees (Florida Department of Health, 2022). These factors combine to decrease the chances residents have for timely, organized musculoskeletal care, with the Miami-Dade County uninsured rate estimated at about 19%, compared to the national average of 9.2% (U.S. Census Bureau, 2023). Uncontrolled muscle stiffness in this population comes with direct costs (such as increased consumption of pain medications) and indirect costs (such as unnecessary clinic visits, loss of working time, and exacerbated chronic pain problems). Minimally costly and specialized equipment-free nurse-led interventions, which are evidence-based and fiscally-sound, are strategies to reduce this burden.
The aim of this proposed program is to determine if a nurse-led structured 5-minute daily stretching education program can significantly decrease muscle stiffness in adults over an 8 week period in a primary care or community health care setting. The expected results are clinically relevant decreases in stiffness scores (measured by patient-reported outcomes) at the end of the eight-week intervention period. The importance of this program is not just to reducing unnecessary clinic visits, but also less use of analgesic medicines and long-term functional health of a vulnerable adult population.
**PICOT**
In adults with mild muscle stiffness (P), does teaching a simple five-minute daily stretching routine (I), compared to usual care without structured stretching education (C), reduce self-reported muscle stiffness (O) over eight weeks (T)?
The population of this project is adults with mild muscle stiffness, who are commonly seen in primary and community health services. This population includes individuals who are working age who have sedentary work, those who are older who have lower levels of physical activity and those who have discomfort in their musculoskeletal system, which is in early stages. Chronic musculoskeletal pain or stiffness is reported by about 54 million adults in the United States, and prevalence is higher among older people and those who are sedentary in their occupations (Theis et al., 2021). Low access to physical therapy, low health literacy, and lack of guidance on self-management strategies (Çimen, 2023) make this population vulnerable.
Proposed intervention is a five-minute, standardized, nurse delivered stretching program done at the end of the visit with emphasis on major muscle groups that tend to become stiff when injured, such as the neck, shoulders, lower back and lower extremities. Systematic reviews provide evidence of the significant benefits of regular static and dynamic stretching programs, including decreases in musculoskeletal pain severity, range of motion, and perceived muscle stiffness in adults. (Behm et al., 2023) The briefness of the routine is deliberate because shorter structured exercise programs have been shown to have greater sustained patient adherence versus longer programs that utilize equipment or gym access.
The comparison intervention is usually care plus verbal advice or referring to physical therapy for self-management training, but not providing a formal self-management program. There is a consistent body of evidence of less enduring improvement in musculoskeletal symptoms associated with passive care approaches compared to active, patient-centerd approaches like structured exercise or stretching education (Behm et al. 2023). The project is expected to yield statistically and clinically meaningful improvement of self-reported muscle stiffness scores (measured by a validated Numeric Rating Scale) at the end of the 8 weeks when compared to the baseline score. The eight-week duration is long enough to establish a pattern of stretching and to demonstrate measurable changes in muscle physiology such as increased tissue extensibility and decreased resting muscle tension (Zvetkova et al., 2023).
**Vulnerable Population and Setting**
The target population for this project are adults (ages 18) who live in Miami-Dade County, Florida, and present to their primary care clinics or community health centers with complaints of mild muscle stiffness. Miami-Dade is a diverse urban area with a concentration of population where most residents have sedentary service jobs and earn low wages in manual jobs. The two occupations are related to high levels of musculoskeletal complaints from the static position and repetitive motion patterns (Çimen, 2023). The occupational dimension of musculoskeletal disorder occurrence in and susceptibility of workers is demonstrated by the fact that service and manual labor workers make up a disproportionate share of the estimated 544,900 reported cases of MSDs that result in days away from work annually in the United States (BLS, 2022).
The musculoskeletal burden of this population is heavily influenced by social determinants of health. Around 19% of Miami-Dade County residents do not have health insurance, which reduces their access to specialist musculoskeletal care, physical therapy referrals, and preventive health services (U.S. Census Bureau, 2023). Low income also makes it harder to join gyms, get ergonomic workstations, and access evidence-based self-care resources. Difficulty with language may impede seeking help and compliance to health guidelines in Spanish-speaking and Haitian Creole-speaking populations. In addition, long work hours and caregiving duties limit physical activity time which also contributes to stiffness and functional decline. Cultural and low barrier approaches to addressing social disadvantage are essential for these compounded social disadvantage groups (Zvetkova et al., 2023).
Unless stiffness is treated early, it's likely to become a chronic pain problem, to result in reduced range of motion, and to be a fall risk, especially for older individuals in this group. In Miami-Dade, chronic musculoskeletal pain has been linked to emergency department visits that have an average cost of $1,389 per visit, while a structured nurse-led primary care intervention has average costs of about $120 per visit, indicating the cost-effectiveness of early preventive programming (Florida Department of Health, 2022). The differences highlight the need for proactive nursing interventions based in the community as a clinical priority and also a cost-effective approach to the healthcare system in Miami Dade.
**Proposal**
The proposed intervention is a nurse-led patient education program that will be delivered in a primary care or community health clinic in Miami-Dade County. If adults are identified on a regular basis in clinics for having mild muscle stiffness, a trained registered nurse or advanced practice registered nurse will provide a structured 15-minute educational session where the patient will be taught a standardized 5-minute stretching exercise. The routine concentrates on the cervical spine, shoulders, thoracic back, lumbar spine, hip flexors and hamstrings, each stretch being bilaterally performed for 30-60 seconds. A laminated take home reference card with illustrated instructions will be provided for patients to use independently each day. The evidence supports this educational approach, as Galmarini et al., (2024) showed that self-directed stretching programs that are supplemented with visual instructional materials are more likely to lead to improved patient adherence and musculoskeletal outcomes than verbal instruction alone.
The resources needed for implementation are the printed patient education materials, an area in the clinical setting for demonstration and nurse time of 20 minutes per patient encounter. The estimated cost of the intervention is $15-$25, per patient, which is very practical in resource-limited community settings (Theis et al., 2021). Multilingual patient materials in English, Spanish and Haitian Creole will be developed to meet the language needs of Miami-Dade's diverse population and ensure equitable access to the intervention. Furthermore, the short duration of the routine and its ease of implementation will contribute to patient compliance.In addition, the routine is brief and straightforward, making it easier to implement.
The program will take a total of 10 weeks: 2 weeks of staff training and program preparation, 8 weeks of open enrolment of patients and delivery of the intervention, and 8 weeks concurrently for outcome assessments, with a standardized numeric stiffness rating scale used at baseline and week 8. Advanced practice nurse overseeing program will review outcome data at 4 weeks to determine the progress that has been made and to discuss any challenges to adherence as needed (Behm et al., 2023). If the 8-week outcome data show statistical difference in stiffness scores, presentation will be made to clinic leadership for further consideration of wider program implementation.
**Theoretical Framework**
This Capstone project is designed and implemented through a pair of complementary frameworks: Dorothea Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice. These frameworks offer a clear and comprehensive basis for patient-centered education and for integrating evidence in clinical practice.
In accordance with Orem's Self-Care Deficit Nursing Theory, patients have a natural ability for self-care and nursing can support, educate, and empower patients when their self-care ability falls short of their therapeutic needs (Tanaka, 2022). The five-minute stretching exercise is a self-care behavior and this theory can be directly applied to the proposed intervention. There is a lack of structured knowledge among adults in case of mild muscle stiffness, which can be compensated by nursing education and leads to a lack of self-care. The role of the nurse in this project is an educative-supportive role as the nurse provides patients with the knowledge, skill, and motivation to perform the daily stretches alone. The preventive focus of the intervention is also understood through Orem's framework; in doing so, the skills needed to successfully implement self-care behavior are introduced, thereby decreasing reliance on healthcare services and decreasing the accumulation of health deficits over time.
The Iowa Model of Evidence-Based Practice offers a systematic approach to moving from evidence to practice. Based on the Iowa Model, Cullen et al. (2022) offer practitioners guidance for problem identification, evidence appraisal, pilot implementation, and outcome evaluation. Muscle Stiffness is determined as a clinically relevant trigger of practice change in this Capstone project. Systematic reviews and RCTs published and supporting stretching interventions are appraised and included in intervention design. A standardised 5 minute routine is rehearsed in the clinic and the patient's outcome is formally assessed at 8 weeks. When outcomes data show positive results, the model can be used to share the results and to consider the broader implementation at the healthcare organization level. This is a well-structured intervention that is theory driven, operationally astute, and can produce transferable clinical knowledge.
Conclusion
In conclusion, this capstone proposal addresses mild muscle stiffness as an important but often underrecognized musculoskeletal concern among adults in Miami-Dade County. The proposed nurse-led five-minute daily stretching intervention is realistic, low-cost, and appropriate for implementation in a community-based primary care clinic setting. By using patient education, self-care support, and a simple daily routine, the project promotes prevention and early management before muscle stiffness progresses into chronic pain, decreased mobility, or higher health care utilization. The intervention is supported by Orem’s Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice because it empowers patients to participate actively in their own care while allowing nurses to lead an evidence-based practice change. Overall, this project has the potential to improve self-reported muscle stiffness, increase patient self-efficacy, and support better functional outcomes in a vulnerable adult population.
**References**
Behm, D. G., Alizadeh, S., Daneshjoo, A., Anvar, S. H., Graham, A., Zahiri, A., & Konrad, A. (2023). Acute effects of various stretching techniques on range of motion: A systematic review with meta-analysis.
_Sports Medicine-Open, 9_(1), 107. https://doi.org/10.1186/s40798-023-00652-x
Bureau of Labor Statistics. (2022).
_Employer-reported workplace injuries and illnesses — 2021._ U.S. Department of Labor. https://www.bls.gov/news.release/osh.nr0.htm
Çimen, O. (2023). The efficiency of ergonomics, active break and stretching exercise program in office workers with chronic neck and back pain.
_Deneysel ve Klinik Tıp Dergisi, 40_(2), 329–332. https://dergipark.org.tr/en/pub/omujecm/issue/79274/1282408
Cullen, L., Hanrahan, K., Farrington, M., Tucker, S., & Edmonds, S. (2022).
_Evidence-based practice in action: Comprehensive strategies, tools, and tips from University of Iowa Hospitals & Clinics._ Sigma Theta Tau.
Florida Department of Health. (2022).
_Florida musculoskeletal health data and statistics._ https://www.floridahealth.gov
Theis, K. A., Murphy, L. B., Guglielmo, D., Boring, M. A., Okoro, C. A., Duca, L. M., & Barbour, K. E. (2021). Prevalence of arthritis and arthritis-attributable activity limitation — United States, 2016–2018.
_Morbidity and Mortality Weekly Report, 70_(40), 1401–1407.
[https://doi.org/10.15585/mmwr.mm7040a2](https://doi.org/10.15585/mmwr.mm7040a2)
Galmarini, E., Marciano, L., & Schulz, P. J. (2024). The effectiveness of visual-based interventions on health literacy in health care: A systematic review and meta-analysis.
_BMC Health Services Research_,
_24_(1), 1–10. https://doi.org/10.1186/s12913-024-11138-1
Tanaka, M. (2022). Orem's nursing self-care deficit theory: A theoretical analysis focusing on its philosophical and sociological foundation.
_Nursing Forum, 57_(3), 480–485. https://doi.org/10.1111/nuf.12696
U.S. Census Bureau. (2023).
_American Community Survey: Health insurance coverage in the United States._ https://www.census.gov/topics/health/health-insurance.html
United States Bone and Joint Initiative. (2021).
_The burden of musculoskeletal diseases in the United States: Prevalence, societal and economic cost (4th ed.)._ https://www.bmus-ors.org/
Zvetkova, E., Koytchev, E., Ivanov, I., Ranchev, S., & Antonov, A. (2023). Biomechanical, healing and therapeutic effects of stretching: A comprehensive review.
_Applied Sciences, 13_(15), 8596. https://doi.org/10.3390/app13158596
**Capstonepart2.docx**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/capstonepart2-docx-10565507)
**## FinalCapstone.docx**
Final Capstone: Part I, II, III Cohesively Due 10/18/2025 by 11:59pm
1.Implementation/Conclusion
– Implement the change you are proposing- This should be a cohesive paper and continuation of Part I and Part II. Present as a cohesive paper to include Part I, II, III as per APA essay format.
2. Describe the practice change and setting clearly; is it in the community, organizational, clinic setting? Be detailed about the reason why you are seeking change.
3. Discuss how you would implement and assess the change; this should include time frame, setting (be specific), participants, barriers, external and internal factors.
-Timeline should be presented as a chart or essay format.* Do not use bullet points.
*Do not use direct implementation of Human Subjects in your proposal. This requires IRB
approval and CITI training which we will not use for this Capstone.
4. How would you evaluate the change process?
-The change must be measurable before and after the implementation.
-How would you measure or evaluate? Is there a tool to measure?
5. The literature review must support your change and implementation. Use leadership qualities and skills that will be utilized for successful completion of the project. What leasdership/management skills will you use?
6. Discuss who will be invited to the proposal: who are the stakeholders? Be specific about why you chose the team and what each of their role will be.
-How will you present the information to your stakeholders? Include cost and budget.
OVERALL: The conclusion should have your Part I, II, II all put together in a thorough APA format.
-Use appropriate APA 7th Ed. format
-Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be minimum 3-4 pages long (not including the title and reference page).
-The final Capstone project should be a minimum of 8 pages.
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written in the 3rd person.
CRITERIA OUTSTANDING VERY GOOD GOOD UNACCEPTABLE
Implementation of
the practice change
20 Points
Thoroughly
presented the
change proposal.
Included setting,
time frame,
population,
stakeholders, Pros
and cons/barriers.
20
Briefly presented
the change
proposal. Briefly
Included setting,
time frame,
stakeholders. Pros
and cons.
15
Vaguely presented
the change
proposal. Vaguely
Included setting,
time frame,
stakeholders, Pros
and cons.
10
Did not present the
change proposal.
0
Change proposal
was measured and
realistic.
20 Points
Thoroughly used an
appropriate
measurement tool.
Provided realistic
outcomes.
Discussed how it
will be used and
implemented.
20
Briefly used an
appropriate
measurement tool.
Provided realistic
outcomes.
15
Vaguely used an
appropriate
measurement tool.
Provided realistic
outcomes.
10
Did not use an
appropriate
measurement tool.
Provided realistic
outcomes.
0
Depth of
Discussion and
Cohesiveness
20 Points
Thoroughly, In-
depth discussion
and elaboration in
all sections of the
paper. Follows
criteria provided in
addition to
leadership,
management,
budget and
statistics.
20
Briefly, In-depth
discussion and
elaboration in most
sections of the
paper.
15
Vaguely, In-depth
discussion and
elaboration in most
sections of the
paper.
10
Did not use In-
depth discussion
and elaboration in
most sections of
the paper.
0
Conclusion
25 Points
Thoroughly, Ties
together
information from all
sources of Part I,
II,III. Followed
feedback and
comments given
from faculty.
25
Briefly, Ties
together
information from all
sources of Part I,
II,III
20
Vaguely, Ties
together
information from all
sources of Part I,
II,III
15
Does not Tie
together
information from all
sources of Part I,
II,III
0
Spelling and
Grammar
5 points
Fewer than 5
grammatical,
spelling,
capitalization, or
punctuation errors.
More than 5 but
fewer than 10
grammatical,
spelling,
More than 10
grammatical,
spelling,
capitalization &
punctuation errors
An unacceptable
number of spelling
and/or grammar
mistakes.
Required word
count has been
met.
5
capitalization &
punctuation errors
Required word
count is 25 words
below the minimum
required count.
4
Required word
count is 50 words
below the minimum
required count.
3
Required word
count is more than
50 words below the
minimum required
count.
0
Sources
5 points
Over 5 current
sources, of which
at least 3 are peer-
review journal
articles or scholarly
books. Sources
include both
general background
sources and
specialized
sources. Special-
interest sources
and popular
literature and
acknowledged as
such if they are
cited. All websites
utilized are
authoritative.
5
5 current sources,
of which at least 2
are peer-review
journal articles or
scholarly books. All
websites utilized
are authoritative.
4
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books. All
websites utilized
are credible.
3
Fewer than 5
current sources or
fewer than 2 of 5
are peer-reviewed
journal articles or
scholarly books.
Not all websites
utilized are credible,
and/or sources are
not current.
0
Citations
5 points
Fewer than 5
incomplete
citations and/or
quotations, and
APA format errors
5
More than 5 but
fewer than 10
incomplete
citations and/or
quotations, and
APA format errors.
4
More than 10
incomplete
citations and/or
quotations, or APA
format errors.
3
The citation style is
inconsistent or
incorrect. It does
not cite sources
**## MSN_Capstone_Part1_Revised1.docx**
1
**Reducing Muscle Stiffness Through a Brief Stretching Intervention:** **A Capstone PICOT Proposal**
Alex De Cardenas
Florida National University
MSN Capstone Project-DAX-DL01
Dr. Carmen Lazo
May 21, 2026
**Abstract**
Mild muscle stiffness is a common musculoskeletal issue that is seen a community-based primary care clinic in Miami-Dade County, Florida and is associated with working-age and older adults, often related to physical inactivity, prolonged postures at work and sedentary lifestyles. Although these conditions are common and have significant health service utilization and cost (likely in the United States, over $200 billion per year for all musculoskeletal conditions), self-management interventions are underutilized in community and primary care settings. This culminating proposal is an evidence-based program to decrease self-reported muscle stiffness through education and implementation of a short five minute stretching routine daily and is nurse-led. The target population for this study is adults in Miami-Dade County, FL who visit primary care providers and/or community health services and are experiencing mild muscle stiffness. The intervention will be assessed with a numeric stiffness rating scale at baseline and week 8. This program is designed to increase the self-efficacy of patients, minimize need for analgesic medications, minimize avoidable use of healthcare resources and optimize functional quality of life for a socioeconomically diverse and vulnerable patient population based on Dorothea Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence Based Practice.
Keywords:
_muscle stiffness, stretching, self-care, nurse-led education, primary care, community health, Miami-Dade_
**Reducing Muscle Stiffness Through a Brief Stretching Intervention:** **A Capstone PICOT Proposal**
Muscle stiffness is an increasingly common but undertreated health problem in adults in community and primary care practices. Muscle stiffness is often linked to sedentary lifestyle and unhealthy occupational postures, as well as physical inactivity, and is not only a problem for mobility but also for comfort and functional status (Zvetkova et al., 2023). While it's not a serious health condition, ongoing stiffness can be a significant quality-of-life problem and can over time lead to increased use of healthcare and a loss of independence. Musculoskeletal conditions, such as muscle, tendon, and connective tissue related to stiffness, impact the lives of about 126.6 million Americans annually with over $213 billion in treatment expenses, lost wages and economic burden (United States Bone and Joint Initiative, 2021). These statistics emphasize the need for strategies that prevent and intervene early in the course of musculoskeletal issues to prevent them from becoming chronic and expensive.
Miami-Dade County is a uniquely burdened area for MS complaints at the local level. Florida is one of the highest states for musculoskeletal-related visits to the emergency department and primary care providers, and many of these visits are due to work-related musculoskeletal disorders among service-sector and manual labor employees (Florida Department of Health, 2022). These factors combine to decrease the chances residents have for timely, organized musculoskeletal care, with the Miami-Dade County uninsured rate estimated at about 19%, compared to the national average of 9.2% (U.S. Census Bureau, 2023). Uncontrolled muscle stiffness in this population comes with direct costs (such as increased consumption of pain medications) and indirect costs (such as unnecessary clinic visits, loss of working time, and exacerbated chronic pain problems). Minimally costly and specialized equipment-free nurse-led interventions, which are evidence-based and fiscally-sound, are strategies to reduce this burden.
The aim of this proposed program is to determine if a nurse-led structured 5-minute daily stretching education program can significantly decrease muscle stiffness in adults over an 8 week period in a primary care or community health care setting. The expected results are clinically relevant decreases in stiffness scores (measured by patient-reported outcomes) at the end of the eight-week intervention period. The importance of this program is not just to reducing unnecessary clinic visits, but also less use of analgesic medicines and long-term functional health of a vulnerable adult population.
**PICOT**
In adults with mild muscle stiffness (P), does teaching a simple five-minute daily stretching routine (I), compared to usual care without structured stretching education (C), reduce self-reported muscle stiffness (O) over eight weeks (T)?
The population of this project is adults with mild muscle stiffness, who are commonly seen in primary and community health services. This population includes individuals who are working age who have sedentary work, those who are older who have lower levels of physical activity and those who have discomfort in their musculoskeletal system, which is in early stages. Chronic musculoskeletal pain or stiffness is reported by about 54 million adults in the United States, and prevalence is higher among older people and those who are sedentary in their occupations (Theis et al., 2021). Low access to physical therapy, low health literacy, and lack of guidance on self-management strategies (Çimen, 2023) make this population vulnerable.
Proposed intervention is a five-minute, standardized, nurse delivered stretching program done at the end of the visit with emphasis on major muscle groups that tend to become stiff when injured, such as the neck, shoulders, lower back and lower extremities. Systematic reviews provide evidence of the significant benefits of regular static and dynamic stretching programs, including decreases in musculoskeletal pain severity, range of motion, and perceived muscle stiffness in adults. (Behm et al., 2023) The briefness of the routine is deliberate because shorter structured exercise programs have been shown to have greater sustained patient adherence versus longer programs that utilize equipment or gym access.
The comparison intervention is usually care plus verbal advice or referring to physical therapy for self-management training, but not providing a formal self-management program. There is a consistent body of evidence of less enduring improvement in musculoskeletal symptoms associated with passive care approaches compared to active, patient-centerd approaches like structured exercise or stretching education (Behm et al. 2023). The project is expected to yield statistically and clinically meaningful improvement of self-reported muscle stiffness scores (measured by a validated Numeric Rating Scale) at the end of the 8 weeks when compared to the baseline score. The eight-week duration is long enough to establish a pattern of stretching and to demonstrate measurable changes in muscle physiology such as increased tissue extensibility and decreased resting muscle tension (Zvetkova et al., 2023).
**Vulnerable Population and Setting**
The target population for this project are adults (ages 18) who live in Miami-Dade County, Florida, and present to their primary care clinics or community health centers with complaints of mild muscle stiffness. Miami-Dade is a diverse urban area with a concentration of population where most residents have sedentary service jobs and earn low wages in manual jobs. The two occupations are related to high levels of musculoskeletal complaints from the static position and repetitive motion patterns (Çimen, 2023). The occupational dimension of musculoskeletal disorder occurrence in and susceptibility of workers is demonstrated by the fact that service and manual labor workers make up a disproportionate share of the estimated 544,900 reported cases of MSDs that result in days away from work annually in the United States (BLS, 2022).
The musculoskeletal burden of this population is heavily influenced by social determinants of health. Around 19% of Miami-Dade County residents do not have health insurance, which reduces their access to specialist musculoskeletal care, physical therapy referrals, and preventive health services (U.S. Census Bureau, 2023). Low income also makes it harder to join gyms, get ergonomic workstations, and access evidence-based self-care resources. Difficulty with language may impede seeking help and compliance to health guidelines in Spanish-speaking and Haitian Creole-speaking populations. In addition, long work hours and caregiving duties limit physical activity time which also contributes to stiffness and functional decline. Cultural and low barrier approaches to addressing social disadvantage are essential for these compounded social disadvantage groups (Zvetkova et al., 2023).
Unless stiffness is treated early, it's likely to become a chronic pain problem, to result in reduced range of motion, and to be a fall risk, especially for older individuals in this group. In Miami-Dade, chronic musculoskeletal pain has been linked to emergency department visits that have an average cost of $1,389 per visit, while a structured nurse-led primary care intervention has average costs of about $120 per visit, indicating the cost-effectiveness of early preventive programming (Florida Department of Health, 2022). The differences highlight the need for proactive nursing interventions based in the community as a clinical priority and also a cost-effective approach to the healthcare system in Miami Dade.
**Proposal**
The proposed intervention is a nurse-led patient education program that will be delivered in a primary care or community health clinic in Miami-Dade County. If adults are identified on a regular basis in clinics for having mild muscle stiffness, a trained registered nurse or advanced practice registered nurse will provide a structured 15-minute educational session where the patient will be taught a standardized 5-minute stretching exercise. The routine concentrates on the cervical spine, shoulders, thoracic back, lumbar spine, hip flexors and hamstrings, each stretch being bilaterally performed for 30-60 seconds. A laminated take home reference card with illustrated instructions will be provided for patients to use independently each day. The evidence supports this educational approach, as Galmarini et al., (2024) showed that self-directed stretching programs that are supplemented with visual instructional materials are more likely to lead to improved patient adherence and musculoskeletal outcomes than verbal instruction alone.
The resources needed for implementation are the printed patient education materials, an area in the clinical setting for demonstration and nurse time of 20 minutes per patient encounter. The estimated cost of the intervention is $15-$25, per patient, which is very practical in resource-limited community settings (Theis et al., 2021). Multilingual patient materials in English, Spanish and Haitian Creole will be developed to meet the language needs of Miami-Dade's diverse population and ensure equitable access to the intervention. Furthermore, the short duration of the routine and its ease of implementation will contribute to patient compliance.In addition, the routine is brief and straightforward, making it easier to implement.
The program will take a total of 10 weeks: 2 weeks of staff training and program preparation, 8 weeks of open enrolment of patients and delivery of the intervention, and 8 weeks concurrently for outcome assessments, with a standardized numeric stiffness rating scale used at baseline and week 8. Advanced practice nurse overseeing program will review outcome data at 4 weeks to determine the progress that has been made and to discuss any challenges to adherence as needed (Behm et al., 2023). If the 8-week outcome data show statistical difference in stiffness scores, presentation will be made to clinic leadership for further consideration of wider program implementation.
**Theoretical Framework**
This Capstone project is designed and implemented through a pair of complementary frameworks: Dorothea Orem's Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice. These frameworks offer a clear and comprehensive basis for patient-centered education and for integrating evidence in clinical practice.
In accordance with Orem's Self-Care Deficit Nursing Theory, patients have a natural ability for self-care and nursing can support, educate, and empower patients when their self-care ability falls short of their therapeutic needs (Tanaka, 2022). The five-minute stretching exercise is a self-care behavior and this theory can be directly applied to the proposed intervention. There is a lack of structured knowledge among adults in case of mild muscle stiffness, which can be compensated by nursing education and leads to a lack of self-care. The role of the nurse in this project is an educative-supportive role as the nurse provides patients with the knowledge, skill, and motivation to perform the daily stretches alone. The preventive focus of the intervention is also understood through Orem's framework; in doing so, the skills needed to successfully implement self-care behavior are introduced, thereby decreasing reliance on healthcare services and decreasing the accumulation of health deficits over time.
The Iowa Model of Evidence-Based Practice offers a systematic approach to moving from evidence to practice. Based on the Iowa Model, Cullen et al. (2022) offer practitioners guidance for problem identification, evidence appraisal, pilot implementation, and outcome evaluation. Muscle Stiffness is determined as a clinically relevant trigger of practice change in this Capstone project. Systematic reviews and RCTs published and supporting stretching interventions are appraised and included in intervention design. A standardised 5 minute routine is rehearsed in the clinic and the patient's outcome is formally assessed at 8 weeks. When outcomes data show positive results, the model can be used to share the results and to consider the broader implementation at the healthcare organization level. This is a well-structured intervention that is theory driven, operationally astute, and can produce transferable clinical knowledge.
Conclusion
In conclusion, this capstone proposal addresses mild muscle stiffness as an important but often underrecognized musculoskeletal concern among adults in Miami-Dade County. The proposed nurse-led five-minute daily stretching intervention is realistic, low-cost, and appropriate for implementation in a community-based primary care clinic setting. By using patient education, self-care support, and a simple daily routine, the project promotes prevention and early management before muscle stiffness progresses into chronic pain, decreased mobility, or higher health care utilization. The intervention is supported by Orem’s Self-Care Deficit Nursing Theory and the Iowa Model of Evidence-Based Practice because it empowers patients to participate actively in their own care while allowing nurses to lead an evidence-based practice change. Overall, this project has the potential to improve self-reported muscle stiffness, increase patient self-efficacy, and support better functional outcomes in a vulnerable adult population.
**References**
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