Childhood obesity is rapidly becoming a public health disaster. The increasing rates of overweight and obese children and teens in the developed countries demonstrates that lack or inadequacy in interventions is the cause of the growing trend of type II diabetes, and other chronic ailments in children and teens. According to Mohamed (2015), the rates of overweight and obese children and teens in the U.S. has tripled from below 10% to over 30% between 1980 and 2010 (Mohamed, 2015). The extent of increment is further discouraging based on the claims by Sheldon and colleagues that demonstrate that since 2013, the rates increased from one child in every ten children to one in every six in 2015 (Sheldon, Lyn, Bracci & Phillips, 2015). Scholars demonstrate that obesity was the primary cause of the chronic ailments in youths and children.
The studies discussed the need for developing health programs that would mitigate the rates of obesity and ensure that nurses and other health practitioners should develop the advocacy promotions. The notion that the health practitioners understand the issues more than the legislature does, makes them the best people to engage in health policymaking. However, Lanier (2017) argues that the current crop of nursing practitioners separate and avoid any engagement with politics. According to Shariff (2014), in a country such as the U.S. politics is a fundamental factor of policymaking hence the need to adopt a political stance similar to the Florence Nightingale, whose vision transformed the nursing and health policies.
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Thesis
This study focuses on developing a health advocacy campaign to solve the childhood obesity. Therefore, the paper focuses on evaluating and integrating ethical codes as a guideline in formulating the ideal program to mitigate the obesity problem.
Paper Arrangement
The next chapter summaries the 7th, 8th, and 9th provisions of the ANA Code of Ethics in relation to advocacy for population health. The summary provides the background of understanding the expectations and requirement of nursing practitioners in advocating for reform programs that would reduce and change the growing concerns of childhood obesity.
The third section includes the use of the ANA Code of Ethics to help formulate the best advocacy campaign and considering their application and consideration of lobbying laws based on the location of the campaign. The fourth section evaluates the ethical concerns of the introducing the campaign and special ethical challenges of the population the program intends to address. The section address the ethical dilemmas that may jeopardize the formulation and efficiency of the program and the different solutions to eliminate such challenges. The last chapter summarizes all the key issues discussed in the paper.
Summary of ANA Code of Ethics
Ethics are fundamental in enhancing moral behavior and actions of any person. The American Nursing Association (ANA) Code of Ethics provide the guidelines of how nursing practitioners should behave and undertake their responsibilities. Since the Florence Nightingale vision, different policies and code of conduct developed to ensure that the nurses are always ethical even in the challenging moments. These codes influence the moral duties of the practitioners towards serving to save lives at all cost. The ANA Code of Ethics of 2017, contains nine provisions, however, this study focuses on the last three due to their connection and applicability in advocacy of public health.
Provision 7
The provision states that nurses in all settings and roles should advance their profession through scholarly inquiry and research to enable the generation of nursing and health policies and to improve the professional standards (Schroeter, Flowers, Davidson & Wicklin, 2017). It contains three subsections that are important to achieve the entirety of the provision as defined above.
The first subsection describes the roles of NPs to contribute through scholarly inquiry and research. It demonstrates that the diseases and technological changes among other changes in the health sector and provision require constant advancement in knowledge. The strategies to increase their knowledge that is vital in improving the healthcare efficiency and understanding new conditions is through experiments. During scientific or clinical experiments the NPs can participate as volunteers or may use humans or animals as the participators of the experiments, therefore, they must maintain high ethical standards during such experiments to enhance validity, reliability and ensure the safety of the participants (Schroeter, Flowers, Davidson & Wicklin, 2017). The experiments or nursing researches should employ the national and international ethical standards to enhance benefits, responsibilities, legitimacy, and integration with the community consultation.
The second category dictates on the need to develop, maintain and implement professional practice standards. The provision understands that the nursing profession is a hectic and complex career, which would result in trying to decrease the workload through unethical practices. Therefore, the guideline calls on the executives and educators to provide a conducive environment for the NPs to utilize their skills and increase their knowledge (Schroeter, Flowers, Davidson & Wicklin, 2017). Educators should equip the students with the skills to improve their moral standards and ensure self-regulation.
Lastly, the provision understands the key to improving health reforms is through including nurses in policymaking. Therefore, it states that the NPs should contribute through nursing and health policy development. The nurses should be role models and mentors towards leadership and policymaking to improve the healthcare provisions (Schroeter, Flowers, Davidson & Wicklin, 2017). Hence, the need of the nursing organizations, senior members or experienced and educators to instill leadership qualities and skills to the nursing students.
Provision 8
This provision calls on nurses to collaborate with other health professionals and the public in their bid to protect human rights, reduce health disparities and promote diplomacy (Schroeter, Flowers, Davidson & Wicklin, 2017). The provision is divided into four sections as discussed below.
The first section is the belief and understanding that health is a universal right. The role of nurses and other health professionals is to ensure that every patient receives the best available healthcare. Therefore, issues such as race, gender, socio-cultural and political differences should not result in decreasing the healthcare quality or accessibility (Schroeter, Flowers, Davidson & Wicklin, 2017). The guideline eliminates the issues of discrimination and enhances patient-based service delivery.
Once acknowledging that health is universal human right the nurses should collaborate this acknowledgment with health diplomacy. Health diplomacy according to the ANA includes the engagement in community-based healthcare services, welfare and reducing the social health determinants such as poverty and sanitation (Schroeter, Flowers, Davidson & Wicklin, 2017). It is under this category that nurses are encouraged to collaborate with the other professionals and the community to limit all the cases of human rights violations.
The third category stipulates that the nurse obligation is to advance health, human rights and reduce disparities. The section is similar to second but it focuses on improving the structural, institutional and social equalities. The elimination of unjust and discriminative processes or structures while educating the community through different organizations and groups improves the access and quality of healthcare delivery.
Lastly, the complexity and extreme issues may result in competing moral claims, for instance, treating a prisoner the same way as he or she treats any other patient and sticking to the ANA codes of providing the best quality healthcare to all persons. This issue is difficult to understand since some people may review it as amoral to save the life of a murderer shot in a shootout. Therefore, this code stipulates that in all conditions, the most important role for the nurse is to save lives and eradicate inequalities at all cost (Schroeter, Flowers, Davidson & Wicklin, 2017). The nurse should always weigh all issues before acting to help preserve human dignity to all groups of people.
Provision 9
This provision calls on the collective integration of the nurses in their professional organizations. It dictates that the organizations and collective power should enhance nursing values, integrate principles of social justice and maintain the nursing integrity as a profession and for the nurses.
The first category describes the articulation and assertion of values of individual nurses through their professional organizations. The collectivity instills bargaining power that is vital in formulating the ideas and values of nurses. The solidarity brought about by forming and joining organizations increases the power to influence the social justice (Schroeter, Flowers, Davidson & Wicklin, 2017). The other section expounds on the need for inter-organization and international organizations to facilitate the power of the nurses that helps improve social justice.
The last two subsections detail the need for integrating social justice through collective lobbying to influence the policymakers and government agencies to address the social determinant of health (Schroeter, Flowers, Davidson & Wicklin, 2017). The integration of social justice and health policy means that the nurses through their organizations should engage in solving the political, social and environmental issues that affect the local, national and international community.
Employing the ANA Code of Ethics to Formulate the Advocacy Program
As earlier stated, the last three provisions discussed above describes and obligates the NPs to promote public health. The obligations provided in Provision 7 expounds on the nurses’ obligations to advance their knowledge. The need to advance knowledge on childhood obesity through reading scholarly articles and performing clinical experiments to determine the different mitigation strategies resulted in separating the strategies that would work to mitigate obesity in children and teens. Provision 8 expounds on the healthcare provision by maintaining ethical standards even in extreme and contradicting situations. Whereas Provision 9 addresses the issue of nursing collectivity in nursing and inter-profession, organizations that help influence policymaking (Schroeter, Flowers, Davidson & Wicklin, 2017). Therefore, the provisions encouraged the study and experimentation of the issue and the compilation of the following literature review was possible.
Literature Review
According to Bhadoria and his colleagues, the rapid increment of childhood obesity is caused by the unhealthy lifestyles, socio-cultural inadequacies and the decline in physical activities (Bhadoria et al., 2015). The article defined and illustrated the different definitions of overweight and obesity and the lifestyle changes increasing the rates of obesity, which influences the risk of type II diabetes and other chronic ailments. The article further describes the issues such as socio-cultural issues for example; the use of sweet and unhealthy foods as rewards to children makes such foods too valuable and difficult to change the mindset of the children thus developing into habits (Bhadoria et al., 2015). Mohamed (2015) concurs with these arguments by demonstrating the unhealthy dietary, inactivity, and socio-cultural issues that influence obesity.
The two studies further established the physical, emotional and psychological health effects of obesity in children and teens. It was evident that obesity is the main cause of type II obesity, which is among the core chronic ailments affecting and increasing the healthcare budget. The stereotyping and stigmatization of obese teens was a major cause of an eating disorder, anti-social behaviors, and stress. It was evident that stigmatization and low self-esteem increased the chances of such teens or children remaining indoors watching television and playing video games because they did not have friends or were bullied. Social media and the internet makes it difficult for obese children to interact with people on the social platforms due to the stigmatization and cyberbullying (Bhadoria et al., 2015). These studies among others provided the basic understanding of the causes and impacts of childhood obesity.
Scholars in the bid of mitigating the rising trends of obesity in children experimented on different mitigating strategies. For instance, Lee and Thompson reviewed different studies that used menus, calories labels, and the physical exercises needed to burn the calories. The study utilized the three valuables to determine the effects of menus without labels, menus with calories labels and menus with both calories and exercises needed (Lee & Thompson, 2016). The study depicted that menu labeling had no effects on the choice of food and snacks ordered by the students. It was evident that the arguments on introducing menu labeling would yield little or no results in mitigating obesity.
However, Houston’s systematic review demonstrated that inadequate knowledge of obesity among most civilians hindered their health care seeking. The study demonstrated that educating people, promoting nutrition and physical exercises reduced obesity and overweight among the participants (Houston, 2013). The moderate and intensive training had the greatest positive impacts, as the participants were able to reduce weight. Studies in Yoga and other types of exercises demonstrate that introducing physical exercises and dietary change from fast food to homemade healthy food would result in the reduction of weight and body fats while motivating the adoption of healthy lifestyles.
The studies above provided the background and clinical experiments on how to solve the vice but such experiments did not discuss the way to develop the advocacy program that will fulfill provision 8 on improving the societal health conditions. Based on this provision, it is important to choose the marginalized community that has little knowledge and access to healthcare to establish the campaign. The program will borrow from provision 9 that directs the engagement in collectivity in professional nursing organizations. These organizations help in lobby sittings that influence the policymakers. However, Lanier (2017) and Shariff (2014) demonstrated that NPs in the 21st century tend to distance themselves away from politics. The studies analyzed the disturbing exclusion of nurses in health policymaking due to their increased condemnation of politics as a dirty game. Lanier (2017) portrayed that the NPs disassociation with politics is too high that some of the practitioners do not know their senators or local politicians, which compounds the issue of integrating with them and proposing changes that would improve health care.
However, the study demonstrated that collaborating in nursing organizations helps nurses to engage in policymaking through their collective power and the organization playing the vital role of lobbyists. It further demonstrated that through such organizations nurses could pursue politics and win political sits when the organizations sponsor their political goals (Lanier, 2017). Other scholars depicted that workload and workplace structures inhibit the engagement of politics for the practicing nurses. The studies portrayed that experience and structures that mentored nurses’ leadership enhanced collectively organization and engagement in politics through voting and health policymaking.
Ethical Dilemma
The literature review summarized the fundamental issues and challenges of developing an advocacy program. However, using the community-based dissemination of the Logan Healthy Living Program (LHLP) as translated by Goode, Owen, Reeves, and Eakin (2012), is possible to use the Optimal Health Program (OHP) and National Health Diabetes Prevention Program (DPP). LHLP is an old community-based propagation that medical and health organizations use to advocate for changes that enable behavioral changes. The translation demonstrated the need to use the four approaches or 4 A’s that include assessment, advice, assistance, and arranging (Goode, Owen, Reeves, and Eakin, 2012). The assessment of the situations based on the target population must include evaluation thus requires the inputs of the population through feedback from the children and teens. Children below the age of 7 years are likely to have little or no feedback; therefore, involving their parents or guardians is instrumental in identifying the forces leading to the unhealthy lifestyles and inactivity (Goode, Owen, Reeves, and Eakin, 2012). Advice includes counseling and providing guidelines that influence the changes in lifestyles while providing help and motivation to adopt the healthy dietary and physical activities through assistance. The counselors and nursing practitioners assist in the formulation of schedules and setting goals on the personalization of activities rather than utilizing generalized ideas. Past studies show that follow up is vital to ensure that even after the experiments the participants are willing to continue on the healthy lifestyles with lack of follow up showing a relapse or setbacks to earlier unhealthy habits.
The program is set to focus on primary and high school in the outcast of New York. Hispanics who are more likely to seek traditional medicine than accessing modern treatment dominate the area’s population. Therefore, it is clear that trying to convince parents of overweight children to participate in the experiment is challenging mainly due to the limited knowledge on obesity. The study needs to use churches to engage in community education on obesity as a public problem that requires immediate solutions. However, the ethical dilemma may arise from creating fear rather than showing the need for the community to learn. Fear strategies tend to work in motivating people to seek medication but based on nursing codes of ethics, undertaking such an action is immoral.
Clinicians should not be force people to engage in public programs. Forcing people to engage in clinical experience also violates human rights as detailed in the Fourteenth Amendment and diminishes the national and international experiment guidelines (Schroeter, Flowers, Davidson & Wicklin, 2017). The NPs need to initiate the obesity conversation through the churches to reach the Hispanic community mainly the parents to ensure that they support the introduction of extra-curriculum activities in schools and contribute to home-based contributions (Vine, Hargreaves, Briefel & Orfield, 2013). Using the church and schools to educate the parents and children to educate the issues of nutrition and physical exercises can result in condemning fast food culture that would increase risks of prosecution from the various snack and fast food companies. Engaging in such a battle is challenging with the risks of being a complete failure.
Therefore, the NPs must employ the knowledge and experience to focus on healthy dietary without attacking the fast food companies during their sessions. Approaching teens can be challenging hence the need to introduce similar extra-curriculum activities and enrolling the overweight and obese teens in high school. Once enrolled in introducing a social media chatting blog for these participants. The sharing of photos and engaging in talent competitions within the groups makes the participants motivated and enhance their self-esteem. However, such motivation strategies can be limiting in the long-term hence the need to broaden the scope and techniques to ensure that the parents, teens, and children stay motivated. Through social awareness and using the inter-organizational connections, the NPs can approach the different sporting teams such as NFL or NBA to offer tours at their franchises and tickets for the two or three participants that demonstrate the dedication of reducing their weight.
Lastly, the call for insurance companies to provide specific coverage for obesity treatment. The NPs should ensure that no increase in premium in the current medical coverage (Sommers et al., 2014). The move is quite difficult but it provides an opportunity for the parents to be determined to enhance home-based dietary and encouraging their children outdoor sports or other physical exercises such as yoga. The NPs through the organizations engage in lobbying thus influence the New York Council to make the regulation to all New York insurance companies (Rask et al., 2013). The nursing organization will use its influence and collective bargaining and monetary power to realize these goals. Once the Mayor signs the bill to law, it is the role of the nurses and the health centers to ensure that the insurance companies pay for such services for all the obese children. The organizations can also influence the budget disbursement to ensure that the State invest in the advocacy campaign and funds to treat the obesity problem.
Conclusion
The formulation of working advocacy program is a challenging task due to the multiple issues such as ethics, failure in policies to support the programs, monetary issues and using a strategy that fails to enhance lifestyle changes. The paper demonstrated that the last three ANA Code of Ethics equips the nurses with the platform to pursue such advocacy programs while using the nursing and inter-profession organizations that help influence the policymakers. The study demonstrated that employing the LHLP strategy provides flexibility to suit different types of population and allowing integrated methods with everybody in the community. The advocacy program broadened the fight against childhood obesity by including everyone from children, teens, parents, leaders, and sporting organizations. The move results in accountability and long-term goals, which is important to eradicate the obesity problem.
References
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