EDUCATION

From Capstone to Community:

Translating a Capstone
Project to a Community
Setting as a Component of a
Comprehensive Program to
Address Childhood Obesity
Courtney E. Reinisch, DNP, APRN, DCC
Rachel Lyons, DNP, CPNP-PC/AC, DCC, CEN
Margaret Quinn, DNP, CPNP, CNE
Sarah Kelly, PhD, RN
Rutgers, The State University of New Jersey

Across the nation, doctor of nursing practice programs require a final project for partial completion
of the degree. What happens to these projects after the degree is conferred? This article seeks to
describe how a group of nursing faculty used a capstone project to address the needs of the local
community in an underserved inner city middle school to have physical and nutrition education
curriculum introduced. A completed capstone project served as a framework for the physical activ-
ity component of a health and fitness curriculum. The overall program goal was to serve as a child-
hood obesity intervention by increasing student’s active time and improving nutrition behaviors.
For this article, the needs assessment, partnership, and translation of a capstone project will be
described.

Keywords: capstone project; translation; community-based project; childhood obesity prevention

Doctor of nursing practice (DNP) programs require
a final project for partial completion of the degree.
According to the American Association of Colleges
of Nursing (AACN, 2006), the student in a practice-
focused program carries out a practice application
“final DNP project.” What happens to these projects
after the degree is conferred? Perhaps some proj-
ects continue if a workplace quality improvement or
an evidence-based practice guideline is developed.
Other projects may end completely when the student
graduates. This article seeks to describe how the trans-
lation of a capstone project serves as a part of an in-
novative solution to assist in meeting the needs of an
urban middle school.
Rutgers University College of Nursing faculty part-
nered with an underserved inner city middle school to
address the needs for physical and nutrition education as
a school-based obesity prevention. A needs assessment of
a Newark, New Jersey, middle school by Rutgers College
of Nursing faculty revealed that students did not receive

160 Clinical Scholars Review, Volume 8, Number 2, 2015 © Springer Publishing Company
http://dx.doi.org/10.1891/1939-2095.8.2.160
any physical or nutrition education because of limited
resources and the focus of the schools charter. The build-
ing that houses the school does not have a gymnasium
nor is there an outdoor open space for activity. A team
that included faculty with expertise in family health, pe-
diatric health, public health, and vulnerable youth was
created to develop a project that would address access to
healthy behaviors, such as nutrition and physical activity.
Each member of the team contributed to the overall
project and served as co-investigators.
Background
The epidemic of childhood obesity has been viewed by
many as a multifaceted public health concern. Factors
contributing to this epidemic may include poor infant
feeding practices; genetics; environment; socioeconomic
status; increase in sedentary behaviors; decrease in activ-
ity, including a decrease in school-based physical educa-
tion programs; and the basic phenomenon of overeating
(Centers for Disease Control and Prevention [CDC],
2012). Because schoolchildren spend most of their non-
home time at school, school interventions provide the
opportunity for exercise, healthy eating patterns, and to
encourage healthy lifestyles.
In New Jersey, 14.2% of adolescents were overweight
(85th and ,95th percentiles for body mass index
[BMI] by age and gender) and 10.3% were obese (95th
percentile BMI by age and gender; CDC, 2012). Physi-
cal activity levels totaled at least 60 min for only 21.3%
of the adolescents per day; 18.3% did not participate in
at least 60 min of physical activity on any day (CDC,
2012). Poverty, violence, urban dwelling, and a dearth of
available healthy food choices all contribute to the in-
creased risk and reality of childhood obesity in Newark,
New Jersey. Lack of opportunity and access for physical
activity is associated with higher levels of obesity, which
can increase morbidity and mortality (Lee, 2009).
The New Jersey Childhood Obesity Study found
that Newark children are much more likely to be over-
weight or obese compared to their national counterparts,
with more than twice the rate of obesity in children of
Newark versus the rest of the country. Most of Newark
children do not meet recommendations for vegetable
consumption and frequently consume energy dense
foods such as fast food, sugar-sweetened beverages, and
sweet and salty snacks (Brownlee et al., 2010). These
children also do not meet the recommendations for
being physically active for 60 min each day. A large pro-
portion spends more than 2 hr a day watching television,
From Capstone to Community
using the computer, and playing sedentary video games
(Biddiss & Irwin, 2010). Almost half of children do
not walk or bike to school, and many do not use the
sidewalks, parks, and exercise facilities available in their
neighborhoods because of safety concerns. Attractive
alternatives must be found to encourage exercise and
promote healthy behaviors in the urban environment.
This initiative replicated a DNP project by one of
the faculty team members, whose project incorporated
active video games as a fitness alternative in physical ed-
ucation class. Because this school had limited resources
and no dedicated gymnasium space, the project was
appropriate for implementation in this environment.
Components of the original capstone project included
curriculum development and pre- and postintervention
evaluations. Results during the original pilot interven-
tion were noteworthy for an increase in active time in
physical education class comparing active video gaming
(AVG) to traditional sports games. It was also noted
that at home play of AVG significantly increased, which
supports activity outside of the school environment
(Quinn, 2013). As the curriculum templates from the
initial project met state and national standards for phys-
ical education, they were used with the author’s permis-
sion in this school setting.
School budget constraints and a decrease in after
school activities require creative solutions to address the
obesity epidemic. Incorporating systems that connect
students with technology may enhance class participa-
tion for students at all skill levels. Often, children re-
port participation in group activity when it is fun. Most
children are familiar with video games, using that plat-
form as an active one can be healthy as well as enjoyable.
This is more apt to garner participation in the long term
(Biddiss & Irwin, 2010). Video games may be viewed as
one cause of childhood obesity epidemic; however, these
systems are fun and familiar to students and can be used
as part of the solution for the obesity crisis (Quinn,
2013). Educational efforts that incorporate technology
may be effective with students who are technologically
savvy. Incorporating a familiar and enjoyable AVG sys-
tem into the school curriculum for physical activity may
be a cost-effective option to enhance exercise participa-
tion and energy expenditure by students (Quinn, 2013).
Implementation and Evaluation Measures
The primary goal of this project was to augment students’
physical activity and nutritional education at a Newark
area middle school for an academic semester (Table 1).
161
TABLE 1. Project Aims and Objectives experiential nutrition education in partnership with
community-based partners. There were 44 students who
Project Aims Project Objectives
are engaged in biweekly 30 min of AVG for 6 weeks and
1. Implement biweekly 1. Encourage students to engage 30 min per week of nutrition education for 6 weeks. See
active video gaming pro- in recommended levels of daily
gram for middle school activity.
Table 2 for measurements and timing of data collection
students for 6 weeks. conducted by nursing faculty and students.
2. Implement weekly 2. Incorporate a technology-based
experiential nutritional physical education initiative Outcomes
education for middle that aligns with New Jersey
school students. Core Curriculum Standards. Four nursing faculty were able to successfully replicate
3. Implement an evidence-based and implement an AVG physical education program to
nutritional education program an urban middle school for less than $3,000 in equip-
for students to enhance their
ment and supplies. The cost of this component of the
nutritional behaviors.
overall program calculates to be approximately $5 per
4. Evaluate the effectiveness of
the physical activity and nutri- student per session. The cost will continue to decline
tional educational programs. based on continued usage of the equipment already
purchased. These programs will aide in the ability to
continue to provide an opportunity for physical activity
All fifth-grade students enrolled in Greater Newark using a train the trainer model.
Charter School (GNCS; N 5 44) in Newark, New Jer- The original capstone project was enhanced to in-
sey, were included in this physical and nutrition educa- clude a nutrition component to encourage healthy
tion program. The program took place twice weekly for behaviors. A community-based partnership was estab-
30 min at each session for the exercise component in a lished between the College of Nursing and Rutgers
multipurpose room. Inclusion criteria for these students Expanded Food and Nutrition Program (EFNEP) to
were enrollment in the GNCS school program, paren- deliver the nutrition education. EFNEP provides nu-
tal consent for participation, and adolescent assent. No tritional education using community-based peer educa-
student was deemed ineligible based on race or ethnicity. tors, using a curriculum that is targeted for low-income
The program received exempt status from the institu- families and children with a goal of increasing school
tional review board at Rutgers University and was ap- age child awareness on the nutritional value of food.
proved by the charter school administration. Ultimately, this encourages increased consumption of
A nonrandomized convenience sample was used healthful options and discourages the intake of highly
for this program. Phase 1 was composed of the AVG refined food products (Rutgers, 2013).
physical activity program based on the capstone Because all the students in the charter school qualify
project–developed curriculum. Phase 2 involved weekly for reduced or free lunch programming, the nutrition

TABLE 2. Data Collected by College of Nursing Faculty and Honors Undergraduate Nursing Student

Measurement Instruments Timing of Measures

Demographic data Age, gender, race, Start of program (T0)

education level 12 weeks of program (T1)
At 16-week program which is 4 weeks
postimplementation (T2)
Nutritional status BMI (height and weight) Youth Risk Behavior Start of program (T0)
Survey (YRBS); 12 weeks of program (T1)
items related to body
At 16-week program which is 4 weeks
image and nutrition.
postimplementation (T2)
Physical activity Self-reported measures YRBS items related to Start of program (T0)
of active time physical activity 12 weeks of program (T1)
At 16-week program which is 4 weeks
postimplementation (T2)

Note. BMI 5 body mass index.

162 Reinisch et al.

education program is available at no cost, which also
increases viability for continuation of the program. A
field trip to Whole Foods Market was arranged for the
entire fifth grade. Whole Foods is an international food
market chain, which boasts a “natural and organic food
experience” and was chosen because the corporation
fosters a Whole Kids Foundation, which encourages
partnerships with local teachers and school districts
(Whole Foods, 2013). Whole Foods provides education
to its constituents at no cost as part of its mission and
vision. The faculty did spend $350 for student, teacher,
and chaperone transportation making the cost $7 per
student for this valuable experience.
Limitations
As with any project, there were limitations to this
initiative. There were scheduling challenges as the
school changed their calendar to address other academic
and administrative needs. The program length was lim-
ited to 6 weeks and the content of the Just Dance vid-
eos became repetitive. The inclusion of caregivers and
school staff was not direct, which can limit the overall
effectiveness of maintaining healthy behavior long term.
Future Implications
Significant student and faculty effort is put forth into
the DNP capstone experience. Translating these proj-
ects into meaningful community initiative is worth-
while. This case demonstrates a faculty effort to address
a community need by replicating and enhancing a cap-
stone project. A capstone project using AVG and ca-
pacity building community partnership with EFNEP
allowed for physical and nutrition education to occur.
Forming partnerships between a college of nursing fac-
ulty and a community-based charter school also allows
for service-based education opportunity for students.
As more students graduate from DNP programs,
the resources and efforts put forth to improve patient
care, systems of care, quality, and safety should be ex-
amined for continuation or expansion. Graduates of
DNP programs practice includes direct patient care and
care of a panel of patients or a target population, a set
of populations, or a broad community (AACN, 2006).
From Capstone to Community
These scholarly projects focus on translating research
into the practice setting. A goal of this process is more
rapid dissemination of research into practice. Graduates
of DNP programs will be prepared for the translation
of new science into practice (AACN, 2006). Significant
student and faculty resources are used in developing and
implementing the scholarly DNP project. These efforts
should not go dormant when the student graduates.
Integrating these projects into clinical settings support
and improve patient care, which makes DNP programs
sustainable and relevant moving forward.
References
American Association of Colleges of Nursing. (2006). The
essentials of doctoral education for advanced nursing practice.
Retrieved from http://www.aacn.nche.edu/publications/
position/DNPEssentials.pdf
Biddiss, E., & Irwin, J. (2010). Active video games to pro-
mote physical activity in children and youth. Archives of
Pediatric Adolescent Medicine, 164, 664–672.
Brownlee, S., Ohri-Vachaspati, P., Lloyd, K., Yedidia, M.,
Gaboda, D., & Chou, J. (2010). New Jersey Childhood
Obesity Survey. Retrieved from http://www.cshp.rutgers
.edu/Downloads/8650.pdf
Centers for Disease Control and Prevention. (2012). New
Jersey: State nutrition, physical activity, and obesity pro-
file. Retrieved from http://www.cdc.gov/obesity/state
programs/fundedstates/pdf/New-Jersey-State-Profile.pdf
Lee, Y. S. (2009). Consequences of childhood obesity. Annals
of the Academy of Medicine, 38, 75–81.
Quinn, M. (2013). Introduction of active video gaming into
the middle school curriculum as a school based childhood
obesity intervention. Journal of Pediatric Health Care,
27(1), 3–12.
Rutgers New Jersey Agricultural Experiment Station. (2013).
Expanded Food and Nutrition Program (EFNEP). Coope-
rative Extension of Essex County. Retrieved from http://
essex.njaes.rutgers.edu/
Whole Foods (2013). Whole Kids Foundation. Retrieved from
www.wholefoodsmarket.com
Correspondence regarding this article should be directed to
Courtney E. Reinisch, DNP, APRN, DCC, Rutgers, The State
University of New Jersey, School of Nursing, 65 Bergen St.,
Rm 11-04, Newark, NJ 07107. E-mail: courtney.reinisch@
rutgers.edu
163