Guide to Creating an Outline Purpose Use this document as.docx

Guide to Creating an Outline
Purpose: Use this document as a resource and guide for creating
effective outlines according to APA 6th
edition style guidelines.
Outline Formatting:
1. For first-level headings, use Roman numerals (I, II, III, etc.)
and present the information using all
uppercase letters.
2. For secondary headings, begin with a capital letter and
present the information using upper and
lowercase letters.
3. For tertiary headings, start with Arabic numerals and present
the information using upper and
lowercase letters.
4. Create parallel wording for headings and subheadings
(secondary and tertiary headings). For instance,
if the first heading starts with a noun, the second heading must
also start with a noun.
5. Include more general information in the first-level headings,
while more specific information in the
secondary and tertiary headings.

6. Use double spacing in the outline.
7. Refine the outline by filling in other appropriate details to
make it more precise.
Sample Outline:
I. INTERNAL AND EXTERNAL STAKEHOLDERS
INVOLVING IN THE DEICSION
A. Internal stakeholders
1. Employees
2. Physicians
B. External stakeholders
II. IMPACTS TO VARIOUS STAKEHOLDERS OF
ACQUIRING A CT UNIT
III. INTERNAL AND EXTERNAL FACTORS IMPACTING
THE DECISION -MAKING
A. Internal factors
1. Financial stability
2. Leadership and management
B. External factors
Reference
Purdue Online Writing Lab. (2014). Developing an outline.

Retrieved from
https://owl.english.purdue.edu/owl/resource/544/1/
Last reviewed: June 2016
Anatomy or system affected: Abdomen, blood vessels,
circulatory system, endocrine system, gastrointestinal system,
heart, intestines, joints, psychic-emotional system, respiratory
system, stomach
Definition: A condition in which the body carries excessive and
unhealthy amounts of fat tissue, leading the individual to weigh
in excess of 20 percent more than his or her ideal weight
Causes and Symptoms
Obesity is a condition in which the body accumulates an
abnormally large amount of adipose tissue, or fat. It is a
multifactorial, chronic disease that is rapidly increasing and
having devastating effects on health worldwide, especially in
high- and middle-income countries. Overweight and obesity are
linked to more deaths around the globe than underweight, and
obesity is a major risk factor for cardiovascular disease,
diabetes, musculoskeletal disorders such as osteoarthritis, and
some cancers. The disease has social, cultural, genetic,
metabolic, behavioral, and psychological components. People
who are obese also face stigma and discrimination in work and
social settings. Obesity is preventable. Obesity and overweight
are the second leading cause of preventable deaths in the United
States.
Silhouettes and waist circumferences representing normal,
overweight, and obese. Public domain, via Wikimedia Commons
Because it is not practical to measure body fat content directly
but it is easy to measure weight and height, the body mass index
(BMI), which correlates closely with body fat, is often used to

identify and quantify obesity.
Being overweight and being obese are not the same condition. A
BMI for an adult of 25 to 29.9 is considered to be overweight. A
BMI of 30 to 34.9 is considered obese class I, a BMI of 35 to
39.9 is considered obese class II, and a BMI of 40 or more is
obese class III. DWorldwide, obesity has doubled between 1980
and 2015. More than 39 percent adults worldwide were
overweight and 13 percent were obese in 2014. The US Centers
for Disease Control and Prevention (CDC) reported that more
than one-third (34.9 percent) of American adults were obese in
2015, with non-Hispanic black Americans having the highest
obesity rate of 47.8 percent of the population. Hispanic and
non-Hispanic white Americans followed with 42.5 percent and
32.6 percent, respectively. Non-Hispanic Asian Americans had
the lowest incidence of obesity with 10.8 percent of that
population reportedly obese. The CDC further reported that
obesity was highest among adults between the ages of forty and
fifty-nine.
The CDC also estimated that the annual cost of obesity in the
United States at $147 billion in 2008 US dollars. The Patient
Protection and Affordable Care Act of 2010 listed obesity
screening and counseling among the preventative services that
all new group health plans and individual market plans under
the act are required to provide without patient cost sharing.
Being overweight and obese significantly increases disease risk
for type 2 diabetes, hypertension, and cardiovascular disease
relative to normal weight individuals, particularly for
individuals with a waist circumference greater than 102
centimeters (40 inches) for men and 88 centimeters (35 inches)
for women.
An important function of adipose tissue is to store energy. If the
intake of energy in the form of food calories is greater than the
expenditure of energy, then the excess calories are stored,
mainly in the adipose tissue, with a resulting weight gain.
Expenditure of energy depends largely on the resting metabolic
rate or resting energy expenditure, defined as the calories used

each day to maintain normal body metabolism. Additional
calories are expended by exercise or other activity. Because of
this simple relationship between energy intake, energy
utilization, and energy storage, weight gain can occur only
when there is increased caloric intake, decreased caloric
expenditure, or both.
Genetic factors appear to be important in determining the
presence or absence of obesity. Body weight tends to be similar
in close relatives, especially in identical twins, who share the
same genetic makeup. The extent to which genetic factors affect
food intake, hunger levels, activity level, or metabolic processes
is not known. Eating a healthy diet and exercising can
counteract genetics-related obesity risk.
One theory holds that each individual has a “set point” that
determines body weight. When food intake is decreased sharply,
experiments have shown less weight loss than predicted by the
caloric deficit, suggesting that the body has slowed its
metabolic rate, thus minimizing the deviation from the original
weight. Many believe that physiologic regulation of body
weight, which tends to maintain a preferred weight for each
individual, explains some of the difficulty in treating obesity.
However, it is possible to lower one's set point, especially when
weight loss occurs slowly over the long term. The discovery and
role of leptin in regulating weight helps to explain this apparent
set point of weight for each individual. Nevertheless, as long as
a caloric deficit is maintained over the long term, weight loss
will occur. Some studies support losing no more than 10 percent
of one's body weight and then maintaining that 10 percent
weight loss for six months or more before losing more weight.
Small, sustainable changes in one's daily habits and diet can
help maintain weight loss over the lifetime.
There are other causes of obesity as well. Producing lesions in
the hypothalamus, a part of the brain, can make animals eat
excessively and become obese, and rare cases of obesity in
humans are attributable to disease of the hypothalamus. In
hypothyroidism, a condition in which the thyroid gland

produces too little thyroid hormone, the metabolic rate is
slowed, which may cause a mild gain in weight that can be
offset by reduced caloric intake. In Cushing’s syndrome, which
is caused by excessive amounts of the adrenal hormone cortisol
or by drugs that act like cortisol, there is an accumulation of
excessive fat in the face and trunk, which disappears when the
disease is cured or the drug is stopped. Weight gain has also
occurred with the use of other drugs, including some
antidepressants and tranquilizers.
The main factor causing obesity is excessive food intake in
relation to physical activity. However, it has been difficult to
prove that overweight people eat more than slender people do.
This may be the case because it is very difficult to measure food
intake under normal conditions, and obese individuals tend to
underestimate their food intake when dietary histories are taken.
Many health problems are associated with obesity. Overweight
and obesity are major risk factors for the development of non-
insulin-dependent diabetes mellitus, and manifestations of the
disease commonly improve or disappear if the individual
succeeds in losing weight. Hypertension (high blood pressure)
is more common with obesity, and weight loss may lower the
blood pressure enough to lessen or avoid the need for
medication. Arteriosclerosis, or “hardening of the arteries,” is
more prevalent in obese persons and causes an increased risk
for heart attacks and strokes. Certain forms of cancer are more
prevalent with obesity: cancer of the colon, rectum, and prostate
in men and cancer of the uterus, gallbladder, ovary, and breast
in women. Severe obesity can cause difficulties in breathing,
with sleepiness resulting from inadequate oxygen delivery to
the tissues and sometimes from interruption of sleep due to
apnea at night. In addition, conditions such as arthritis may be
worsened by the additional strain that excess weight places on
weight-bearing parts of the body.
The distribution of excess adipose tissue differs among
individuals. Two main patterns have been described: android
obesity (more commonly affecting men), in which fat

accumulates mainly in the abdomen and upper body; and gynoid
obesity (more common in women), in which fat accumulates
mainly in the hips, thighs, and lower body. This distinction has
received much attention because persons with android obesity
are more likely to suffer from diabetes, hypertension, and
cardiovascular disease. The closest association with these
diseases is seen when sensitive measurements of abdominal
visceral fat mass are made with computed tomography (CT)
scanning. A simple measurement of the waist circumference
compared with the hip circumference—the waist-to-hip ratio—
can also be used to identify those obese individuals at greater
risk for diabetes and cardiovascular disease.
Treatment and Therapy
Many obese people are highly motivated to lose weight because
of the common perception that a slim body build is more
attractive than an obese one. Many other overweight individuals
desire to lose weight because of health problems related to
obesity. As a result, the human and financial resources devoted
to weight loss efforts are extensive.
The only measures useful in the treatment of obesity are those
that decrease the intake or absorption of calories or those that
increase the expenditure of calories. The basis for any long-
term weight management program is a low-calorie diet. The
average daily calorie requirement depends on a person's age,
height, weight, and activity level and varies whether one is
trying to lose, maintain, or gain weight. It is helpful to calculate
one's basal metabolic weight (BMR), which is an estimate of a
person's daily energy expenditure at absolute rest based on one's
gender, weight, height, and age. A person's BMR is then
multiplied by a factor depending on average daily activity level
to estimate their total daily energy expenditure (TDEE).
Decreasing an individual’s caloric intake below his or her
TDEE, usually by 250 to 1,000 calories per day, will result in
weight loss, provided that energy expenditure does not also
decrease. A caloric deficit of 500 calories per day will result in
one pound (0.45 kilograms) of weight loss per week. The Mayo

Clinic recommends a balanced diet with 20 percent to 35
percent of one's daily calories derived from fat, which is
considerably less fat than is found in the typical American diet.
Many unbalanced diets, or “fad diets,” have enjoyed periods of
popularity. Rice diets, low-carbohydrate diets, vegetable diets,
and other special diets may produce rapid weight loss, but long-
term persistence with an unbalanced diet is rare and any lost
weight is often regained. Counting calories and maintaining a
caloric deficit tends to be a more sustainable approach to weight
loss than avoiding particular foods.
Many patients fail to lose weight with low-calorie diets. More
severe calorie restriction can be achieved with very-low-calorie
diets that provide only 400 to 800 calories daily. This level of
caloric restriction is unsafe in the long term. Nutrients should
be supplemented with vitamins and minerals. These
requirements can be met with special formula diets under
careful medical supervision. Such a program is recommended
for severely obese patients who are otherwise healthy enough to
tolerate this degree of caloric restriction.
Because most people find it difficult to lower their calorie
intake, behavioral management programs may be combined with
dietary restrictions. Dieters can be taught techniques for self-
monitoring of food intake, such as keeping a daily log of meals
and exercise, which will increase the awareness of eating
behavior as well as point out ways in which that behavior can
be modified. There are techniques for reducing exposure to food
and the stimuli associated with eating, such as keeping food out
of sight, keeping food handling and preparation to a minimum,
and eliminating the occasions when food is eaten out of habit or
as part of a social routine. Increasing the social support of
friends and family for weight-losing behavior and for
reinforcement of compliance with dietary restrictions can be
helpful. Interestingly, the “diet merry-go-round” or “yo-yo
diets” that many overweight and obese individuals experience—
restricting their caloric intake until a weight goal is achieved
and then ending the diet only to resume overeating and regain

the weight lost—often results in higher weight. Over time, such
a pattern can “cycle” the individual to a dangerously high
weight. Such individuals tend to experience more success if
they can adjust their long-range eating behavior to moderate,
rather than restrictive, intake of food. Many physicians would
prefer to see their obese patients remain relatively stable in
weight, reducing their weight slowly over time, to avoid
physical stress and ensure success.
Because obesity is caused by an excess of calorie intake over
calorie expenditure, another approach to weight loss is to
increase energy utilization by increasing physical activity.
Some studies have shown that overweight individuals are less
active than their nonobese counterparts. This fact could
contribute to their obesity, since less energy utilization results
in more energy available for storage as fat. Decreased activity
could also be a result of obesity, since a heavier person must do
more work, by carrying more pounds, than a nonobese person
who walks or climbs the same distance.
Each pound of fat contains energy equal to about 3,500 calories.
If an obese person expends 350 extra calories each day by
walking briskly for one hour, it will take ten days for this
activity to result in the loss of one pound. In a year, this
increased calorie expenditure would result in a thirty-six-pound
weight loss. More vigorous exercise, such as running,
swimming, or calisthenics, would lead to more rapid weight
loss, but it might not be advisable for every person because of
the increased prevalence of certain health problems in obese
individuals, such as heart disease, hypertension, and
musculoskeletal disorders. For this reason, any exercise
program that involves vigorous physical activity should be
undertaken following medical consultation.
Exercise as part of a weight-loss program has additional
benefits. The function of the cardiovascular system may be
improved, and muscles may be strengthened. Exercise will lead
to loss of adipose tissue and gain in lean body mass as weight is
lost, a change in body composition that is beneficial to overall

health. Although some fear that physical activity will lead to an
increase in appetite, exercise is a beneficial supplement to
calorie restriction.
Medications that decrease appetite are occasionally used to help
people comply with a low-calorie diet. Some appetite
suppressants act like adrenaline and may cause such side effects
as nervousness, irritability, and increased heart rate and blood
pressure. Other drugs may stimulate serotonin, a chemical
transmitter in the central nervous system that decreases appetite
and may cause drowsiness as a side effect. The use of these
medications is controversial because of their side effects and
their limited effectiveness in promoting weight loss.
Several surgical procedures, collectively referred to as bariatric
surgery, have been used to treat severe obesity that has impaired
the patient’s health and has resisted other treatment. The
operation now most commonly performed is vertical banded
gastroplasty, which creates a small pouch in the stomach with a
narrow outlet through which all food must pass. This procedure
decreases the effective volume of the stomach, causing fullness
and nausea if more than small amounts of solid food are eaten.
Patients have lost about half of their excess weight after one
and one-half to two years, but some weight may be regained
after this period. Gastroplasty has produced fewer serious
complications than an older form of treatment, no longer done,
called intestinal bypass. Care must be taken to avoid certain
foods that might cause blockage of the narrowed opening from
the surgically created stomach pouch, and the benefit of the
operation can be overcome by eating soft or liquid foods, which
can be consumed in large quantities. The long-term benefit of
this procedure is being evaluated, but a significant number of
obese patients with diabetes essentially cured their diabetes
mellitus after having the surgery and losing weight.
Perspective and Prospects
Fat has several important functions in the human body. It serves
as a cushion for the body frame and internal organs, it provides
insulation against heat loss, and it is a storage site for energy.

Fat stores energy very efficiently since it contains
approximately nine calories per gram, compared with
approximately four calories per gram in protein and
carbohydrate. The presence of reserve stores of energy in the
form of fat is particularly important when regular food intake is
interrupted and the body becomes dependent on its fat deposits
to maintain a source of fuel for daily metabolism and physical
activity.
In affluent societies, however, where food is abundant and
modern conveniences greatly reduce the need for physical
exertion, many people tend to accumulate excessive amounts of
fat, since energy that is taken in but not utilized is stored in the
adipose tissue. In the early twenty-first century, health officials
were concerned by findings that showed one in every fifty
Americans were “extremely obese,” meaning their BMI
measured at least 50 and they were at least one hundred pounds
overweight. This number had quadrupled since the 1980s.
Obesity is a critical public health problem because it increases
the risk of diabetes, hypertension, cardiovascular disease, and
other illnesses. Also, many overweight men and women are
distressed by the effects of their weight on their social
interactions and self-image, and, despite laws, face
discrimination in workplace settings.
Unfortunately, the results of weight-loss efforts must be
sustained over the long term, which can be difficult and
discouraging. Programs utilizing low-calorie diets, behavior
modification, exercise, and sometimes appetite-suppressing
drugs usually lead to a weight loss of ten to thirty pounds or
more over a period of several weeks or months. The problem is
that after a year or more, the great majority of dieters have
reverted to old habits and regained the lost weight. It appears
that the maintenance of a low-calorie diet and an increase in
physical activity require a degree of commitment and
willingness to endure inconvenience, self-deprivation, and
physical sensations of hunger that many people can accept for
short periods of time but struggle to sustain. There are

exceptions—many people do succeed in maintaining long-term
weight loss—but many dieters return to or surpass their original
weight.
Overweight and obese individuals who desire to lose weight
should identify the modifications in their diet and lifestyle that
would be most beneficial and should attempt, with medical
supervision, to initiate and maintain the behavior needed to
bring about permanent weight loss.
In 2006, in an effort to reduce the incidence rate of obesity in
the United States, the Alliance for a Healthier Generation, the
William J. Clinton Foundation, and the American Heart
Association announced an agreement to fight childhood obesity.
Five leading food manufacturers vowed to reformulate their
products in order to provide more nutritious choices for children
in schools. In 2010 President Barack Obama and First Lady
Michelle Obama each announced further initiatives to help
prevent childhood obesity.
Bibliography
Björntorp, Per, ed. International Textbook of Obesity.
Chichester: Wiley, 2002. Print.
Brethauer, S. A., et al. "Can Diabetes Be Surgically Cured?
Long-Term Metabolic Effects of Bariatric Surgery in Obese
Patients with Type 2 Diabetes Mellitus." Annals of Surgery
258.4 (2013): 628–37. Print.
Brownell, Kelly D., and Katherine Battle Horgen. Food Fight:
The Inside Story of America’s Obesity Crisis and What We Can
Do About It. New York: McGraw-Hill, 2004. Print.
Cespedes, Andrea. "The Average American Daily Caloric
Intake." Livestrong. Demand Media, 30 May 2014. Web. 28
Aug. 2014.
Finkelstein, Eric A., et al. "Annual Medical Spending
Attributable to Obesity: Payer-and Service-Specific Estimates."
Health Affairs 28.5 (2009): w822–31. Print.
Hassink, Sandra Gibson, ed. A Parent's Guide to Childhood
Obesity: A Road Map to Health. Elk Grove Village: Amer.
Acad. of Pediatrics, 2006. Print.

"Healthy Lifestyle: Nutrition and Healthy Eating." Mayo Clinic.
Mayo Foundation for Medical Education and Research, 5 Apr.
2014. Web. 26 Aug. 2014.
Koplan, Jeffrey P., Catharyn T. Liverman, and Vivica I. Kraak,
eds. Preventing Childhood Obesity: Health in the Balance.
Washington, D.C.: Natl. Academies P, 2005. Print.
Masters, Ryan K., et al. "The Impact of Obesity on US
Mortality Levels: The Importance of Age and Cohort Factors in
Population Estimates." Amer. Jour. of Public Health 103.10
(2013): 1895–1901. Print.
"Obesity." MedlinePlus. US Natl. Library of Medicine, 11 May
2016. Web. 12 May 2016.
"Obesity and Overweight." World Health Organization. WHO,
Jan. 2015. Web. 6 Aug. 2015.
Ogden, Cynthia L., et al. "Prevalence of Childhood and Adult
Obesity in the United States, 2011–2012." Jour. of the Amer.
Medical Assn. 311.8 (2014): 806–14. Print.
"Overweight and Obesity." Centers for Disease Control and
Prevention. CDC, 19 June 2015. Web. 6 Aug. 2015.
Saltiel, Alan R. "New Therapeutic Approaches for the
Treatment of Obesity." Science Translational Medicine 8.323
(2016): 323. Web.
Wadden, Thomas A., and Albert J. Stunkard, eds. Handbook of
Obesity Treatment. Rev. ed. New York: Guilford, 2004. Print.
Waters, Elizabeth, et al. "Interventions for Preventing Obesity
in Children." Sao Paulo Medical Jour." 132.2 (2014): 128–29.
Print.
Winslow, Ron. "Losing Prospects: New Procedures Hope to
Treat Obesity without the Risks of Bariatric Surgery." Wall
Street Journal. Dow Jones, 8 Apr. 2013. Web. 28 Aug. 2014.
Derived from: "Obesity." Magill's Medical Guide, Sixth Edition.
Salem Press. 2010.

Final Paper
Ashford General Hospital Proposal
Ashford General Hospital is a 263-bed regional hospital located
in California, serving its community for
more than 50 years. The hospital maintains the only 24-hour
emergency department in the area and an
"extended hours" urgent care clinic. Similar to other hospitals
in the United States, Ashford General
Hospital is encountering a nursing shortage. Sixty-eight percent
of the nursing staff is over the age of 45,
facing retirement. The retention rate on nurses is 61%,
compared to 65% nationwide. Many of the
nursing staff find the work too physically demanding and have a
feeling of emotional burn -out as well.
In the past two years, the hospital has used both per diem nurses
and traveling nurses who sign short -
term contracts to fill individual shifts and accommodate short-
term staffing needs arising from staff
vacations or medical leaves. This has not only driven up
personnel costs but also resulted in lower
scores on patient satisfaction surveys. Ashford General Hospital
faces significant challenges in nurs e
staffing ahead as it grapples with these issues, and the hospital
board is very concerned. They know

there must be some changes made in order to prevent a major
financial and human resources crisis in
the future. As the newly hired CEO, you are asked to present a
proposal in the next board meeting.
For your Final Paper, you will create a 10 to 15 page proposal
(excluding title and reference pages) for
the Ashford General Hospital Board of Directors. In your
proposal, you will:
Include an executive summary.
Research and describe solutions implemented at five other
hospitals in the US that were dealing with
these same issues.
Based on your research, describe two solutions that are the most
viable for Ashford General Hospital to
implement within the next two years.
Create a total of two stakeholder group analyses for two
solutions you select. Each analysis should
include at least five stakeholder groups involved (e.g. patients,
hospital executive administration,
accounting, Human Resources (HR), marketing, third-party
payers, etc.). As part of your analysis, address
the following questions:
Who is impacted?
What change processes may be required?

What fiscal impact would occur?
What are the ethical, legal, and diversity risk factors involved?
Based upon the stakeholder group analyses, recommend the best
solution for Ashford General Hospital
with detailed justification. Explain why you feel it is the most
viable and appropriate solution given the
financial impact, HR issues, and interpersonal dynamics of
hospital personnel, cultural shift, and change
management.
To prepare your board proposal, including the textbook, utilize
at least 10-to-12 scholarly and/or peer-
reviewed sources that were published within the past five years,
as well as hospital or foundation
websites. All sources must be cited according to APA style as
outlined in the Ashford Writing Center.
Writing the Final Paper
The Final Paper:
Must be 10-to-15 double-spaced pages (excluding title page and
references page) in length, and
formatted according to APA style as outlined in the Ashford
Writing Center.
Must include a title page with the following:

Title of paper
Student’s name
Course name and number
Instructor’s name
Date submitted
Must include an executive summary.
Must begin with an introductory paragraph that has a succinct
thesis statement.
Must address the topic of the paper with critical thought.
Must end with a conclusion that reaffirms your thesis.
Including the textbook, must utilize a minimum of 10 to 12
scholarly and/or peer-reviewed sources that
were published within the past five years, as well as hospital or
foundation websites. Must document all
sources in APA style, as outlined in the Ashford Writing
Center.
Must document all sources in APA style, as outlined in the
Writing Center.
Must include a separate reference page, formatted according to
APA style as outlined in the Writing
Center.

Carefully review the Grading Rubric for the criteria that will be
used to evaluate your assignment.
Proofreading Your Draft
Prior to submitting your Final Paper to WayPoint, use
Grammarly to proofread your draft. A final draft
should be complete, well-developed, refined, and error-free. It
is important to proofread your work for
grammar, punctuation, and sentence structure before submitting
it. A final draft must always represent
your very best work. Grammarly is one tool that can help you
identify errors and learn from your
mistakes during the proofreading process.

Guide to Creating an Outline Purpose Use this document as.docx

Recommended

Recommended

More Related Content

Similar to Guide to Creating an Outline Purpose Use this document as.docx

Similar to Guide to Creating an Outline Purpose Use this document as.docx (14)

More from whittemorelucilla

More from whittemorelucilla (20)

Recently uploaded

Recently uploaded (20)

Guide to Creating an Outline Purpose Use this document as.docx