Case study 8 pages apa seven references less than five years

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Attached part I and instructtions

Part II Capstone


This is a continuation of the health promotion program proposal, part one, which you submitted previously. Please approach this assignment as an opportunity to integrate instructor feedback from part I and expand on ideas adhering to the components of the MAP-IT strategy. Include necessary levels of detail you feel appropriate to assure stakeholder buy-in.


You have already completed the steps 1-4. Make sure you revise this initial submission according to your instructor’s comments.

1. Describe the health problem. Using data and statistics support your claim that the issue you selected is a problem. What specifically will you address in your proposed health promotion program? Be sure your proposed outcome is realistic and measurable.

2. Describe the vulnerable population and setting. What are the risk factors that make this a vulnerable population? Use evidence to support the risk factors you have identified.

3. Provide a review of literature from scholarly journals of evidence-based interventions that address the problem. After completing a library search related to effective interventions for your chosen health promotion activity, you will write a review that evaluates the strengths and weaknesses of all the sources you have found. You might consult research texts for information on how to write a review of the literature found in your search.

4. Select an appropriate health promotion/disease prevention theoretical framework or conceptual model that would best serve as the framework guiding the proposal. Provide rationale for your selection which includes discussion of the concepts of the selected model

For this assignment add criteria 5-8 as detailed below: 

5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which include resources necessary, those involved, and feasibility for a nurse in an advanced role. Be certain to include a timeline. (2 to 4 paragraph. You may use bullets if appropriate).

6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach. (1 paragraph).

7. Provide a detailed plan for evaluation for each outcome. (1 paragraph). 

8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (1 paragraph). 

9. Conclude the paper with a Conclusion paragraph. Don’t type the word “Conclusion”. Here you will share your insights about this strategy and your expectations regarding achieving your goals. (1 paragraph). 

Paper Requirements 

Your assignment should be 7-8 pages (excluding title page, references, and appendices), following APA standards. 

Remember, your Proposal must be a scholarly paper demonstrating graduate school level writing and critical analysis of existing nursing knowledge about health promotion. 



Orlando Perez Cuba

Florida National university

Professor: Alexander Garcia

October 12, 2022


Osteoarthritis is a progressive joint condition where the structures gradually deteriorate. The cartilage and several other tissues in the joints deteriorate or undergo architectural restructuring, which leads to the development of osteoarthritis. Alternately, alterations in the tissue may be the cause of the degradation, which normally takes place progressively as time passes. It is the most prevalent form of arthritis and affects elderly persons more frequently (NIAMS, 2022). Each person is affected by the disease individually. Several people have quite minimal osteoarthritis, which has little impact on daily operations. Others experience severe discomfort and impairment as a result. Joint deterioration often occurs slowly over several years, however, in some persons it may increase abruptly.

Approximately 3.3 to 3.6% of people worldwide suffer from OA. It ranks as the 11th most disabling condition in the world, resulting in varied degrees of morbidity in 43 million individuals (Sen, & Hurley 2022). Even though just 60percent of the people over 65 in the United States experiences complaints, it is believed that 80% of this subgroup has radiological signs of OA. This is due to the fact that radiological OA occurs at approximately twice as frequently as clinical OA. Consequently, radiological alterations do not demonstrate that the client’s discomfort is due to OA. Osteoarthritis is the second most costly condition encountered in the United States in 2011, accounting for about 1 million hospital admissions at a total expense of roughly $15 billion. This piece is aimed at determining whether water exercises are more effective in alleviating osteoarthritic pain compared to land exercise.


The picot Question: In elderly patients suffering from osteoarthritis how does water exercise compared with land exercise influence in pain alleviation after two months?

The population that will be used is the elderly persons, particularly those above 65years. This is because osteoarthritis is more common in elderly patients. According to NIAMS (2022), osteoarthritis is an age-related disorder and therefore the elderly population is more susceptible. The proposed intervention is water exercise, also known as aquatic exercise. The current practice requires osteoarthritic patients to perform exercises, much of which is done on land, to reduce pain. Though this has produced some results, it is also key to investigate the impact that would be produced if such exercises were conducted in water. The results obtained will be compared to those obtained from osteoarthritic patients who perform exercise on land over a period of two months.

The vulnerable population

Social variables of health are those fiscal, interpersonal, and ecological elements that help elderly adults retain their fitness and well-being. These components include factors like getting enough access to healthful food, a reliable source of income, a secure home to live, and reachable, trustworthy conveyance (Pooler, & Srinivasan, 2018). Dealing with SDOH-related concerns increases a person’s risk for poor wellness, in addition to disease burden and mortality. SDOH factors significantly affect older people’s wellness and aging patterns, especially their ability to age comfortably and where they are. Economic constraints render these senior people from accessing quality care and eventually, their health deteriorate considerably (Fournier, n.d.)

Age is the most important risk factor for osteoarthritis. Unfortunately, nothing much can be done about it. This is because degeneration is a normal physiological process that happens during aging. Therefore, this degeneration also affects joints, leading to osteoarthritis. According Zamri et al., (2019), osteoarthritis was associated with increased joint use. Therefore, the type of work done by these elderly patients also matters in determining how soon one will develop osteoarthritis. Another risk factor associated with increased susceptibility to osteoarthritis is high body mass index. In the same study, it was found that obese patients were more likely to develop osteoarthritis particularly knee osteoarthritis. This was attributed to the excess weight bearing on the already degenerating joints, increasing the strain and consequently wear and tear.

Literature Review

Aquatic exercise is performed in water that is typically between 32 and 36 degrees Celsius. Aquatic workout might be extra advantageous for individuals with osteoarthritis compared to equivalent exercise on land, since the aspect of lukewarm water is presumed to lessen discomfort and rigidity of the joints and muscles and trigger relaxation response (Franco et al., 2017). Patients who have just completed their care for osteoarthritis of the knee or hip should consider participating in aquatic exercise as soon as possible. Immediately following the conclusion of their course of therapy, clients suffering from osteoarthritis of the knee and hip may find relief from their symptoms through participation in aquatic exercise.

Exercising in the water or aquatic therapy is a useful non-pharmacological intervention which helps lessen pain, improve joint and muscular mobility, which reduces muscle spasms and increases muscular strength (Khanjari, & Garooei, 2020). Because of the characteristics of water in producing resistance, easing, and lowering the strain on the afflicted joints, exercising in water has various benefits, including reduced injury and simpler learning. Knee joint arthritis complaints can be significantly improved by running in the water. Khanjari, & Garooei, (2020) conducted research on the effects of water jogging on patients with osteoarthritic knee, and found it very useful to means of alleviating pain in the victims

Other research work conducted have emerged suggesting that there the achievements of water exercise are no better than those of land exercise, claiming that it only increases physical function without any significant impact on the pain. In a systematic analysis that compared the effectiveness of land-based exercise (LBE) and aquatic exercise (AQE) in alleviating knee osteoarthritic pain, Dong et al., (2018) observed no statistically significant discrepancies across the two (land and water exercises) therapies over a brief period of time. In addition, the findings showed that AQE had minimal impact on pain control, QOL enhancement, and only marginal impact on physical function enhancement.

Exercise in the water is also linked to improved cognition, mood, and mobility. Aquatic workout can help patients who have received joint replacement therapy to feel more comfortable and improve their joints’ functioning. In a study by Kim et al., (2021), exercising in the water reduced overall and each WOMAC subcategory of discomfort, rigidity, and performance, which relieved the complaints of osteoarthritis. Following total knee arthroplasty, the overall WOMAC score dropped by 11, which is more than the minimal statistically significant change according to Kim et al., (2021). Individuals with osteoarthritis may benefit more from aquatic workout. Water’s buoyancy has less negative effects on the joints than land-based exercise, which may be quite painful for osteoarthritis individuals.

Exercise and athletic endeavors aid to prevent or postpone the need for another knee or hip replacement, which should only be performed in the very late stages of OA when extreme pain and disability are present. Aquatic exercise takes advantage of the weight-relieving qualities of water to relieve pain, make joints move more easily, improve physical function, lessen muscular stiffness, and relax muscles in OA patients. According to Zampogna et al., (2020), the risk of falling in the older adults is reduced in patient who perform water exercise, when compare to land exercise, owing to its ability to reduce joint stiffness and pain, which consequently improves physical performance.

Intense exercise improves general adaptability and joint function while also lowering discomfort and strengthening the muscles that encircle the knee joint. Numerous clinical recommendations recommend exercise as a first-line method of treating osteoarthritis complaints. Water-based exercise improves function temporarily but only minimally reduces discomfort. Patients with functionality or mobility issues are advised to use it. Land-based workout, particularly Tai Chi, has been shown to significantly improve pain and physical performance in KOA individuals compared to water exercise according to an article study by Kan et al., (2019)

The sources used n the literature review are not without limitations. For one several of them have not mentioned the intensity, type and the duration of either the land of water exercise, making the studies generalization difficulty. Other articles used had an increased risk of biasness, making the results less reliable. Most importantly, most of the article studied on knee osteoarthritis, raising a question on whether the same evidence could be used to address osteoarthritis of any other joint like hip joint, hence the results rendered ungeneralizable.


Following the results I obtained in the literature review above, it is concluded that for elderly individuals with osteoarthritis and those who are overweight, aquatic activities are very effective. The weight of the body is supported by the surges and buoyancy of the water, which lessens the stress on joints and the perceived pain’s severity during exercise. Warmer water’s temperature and pressure also ease tension, ease stress, lessen joint rigidity, and make mobility easier. Exercises in the water are also beneficial for building muscle strength. Therefore, the study proposes the use of water exercise to alleviate discomfort in elderly patients with osteoarthritis. This because it has multiple added advantages including boosting mood, and reducing depression. In addition, it could also helpful in reducing falls among the elderly.

Water exercise requires few resources, although it can be provided for a group of patients. For the intervention, the patients will need to have a preheated pool of water as the main resource. The next resource it the guidance, from a professional, on how to perform exercise, and which exercises to perform. Guided exercise provides the best results for the patient since it reduced the likelihood of performing irrelevant or even to some extent, dangerous exercises, like vigorous exercise on a body that can’t stand it. This intervention it expected to be conducted in withing the two-month research time.


Dong, R., Wu, Y., Xu, S., Zhang, L., Ying, J., Jin, H., Wang, P., Xiao, L., & Tong, P. (2018). Is aquatic exercise more effective than land-based exercise for knee osteoarthritis?. 
97(52), e13823.

Fournier, S. (n.d.). Texas Health and Human Services.

Franco, M. R., Morelhão, P. K., de Carvalho, A., & Pinto, R. Z. (2017). Aquatic exercise for the treatment of hip and knee osteoarthritis. 
Physical Therapy
97(7), 693-697.

Kan, H. S., Chan, P. K., Chiu, K. Y., Yan, C. H., Yeung, S. S., Ng, Y. L., … & Ho, T. (2019). Non-surgical treatment of knee osteoarthritis. 
Hong Kong Medical Journal
25(2), 127.

Khanjari, Y., & Garooei, R. (2020). The effect of a water jogging exercise course on older men with knee osteoarthritis. 
Exercise and Quality of Life
12(2), 31-35.

Kim, S., Hsu, F. C., Groban, L., Williamson, J., & Messier, S. (2021). A pilot study of aquatic prehabilitation in adults with knee osteoarthritis undergoing total knee arthroplasty–short term outcome. 
BMC Musculoskeletal Disorders
22(1), 1-11.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2022, June 8). NIAMS health information on osteoarthritis.

Pooler, J., & Srinivasan, M. (2018, September 7). Social determinants of health and the aging population. IMPAQ International.

Sen, R., & Hurley, J. A. (2022, May 1). Osteoarthritis – StatPearls – NCBI bookshelf. National Center for Biotechnology Information.

Song, J. A., & Oh, J. W. (2022). Effects of Aquatic Exercises for Patients with Osteoarthritis: Systematic Review with Meta-Analysis. 
Healthcare (Basel, Switzerland)
10(3), 560.

Zampogna, B., Papalia, R., Papalia, G. F., Campi, S., Vasta, S., Vorini, F., … & Denaro, V. (2020). The role of physical activity as conservative treatment for hip and knee osteoarthritis in older people: a systematic review and meta-analysis. 
Journal of clinical medicine
9(4), 1167.

Zamri, N. A. A., Harith, S., Yusoff, N. A. M., Hassan, N. M., & Qian Ong, Y. (2019). Prevalence, risk factors and primary prevention of osteoarthritis in Asia: A scoping review. 
Elderly Health Journal
5(1), 19-31.

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