Evidence-Based Practice
Translation of Research in Evidence-Based Practice
Nursing involves men and women who are willing to help the patients with their skills like health maintenance, recovery of ill or injured people and the treatment. They develop a care plan for the patient sometimes in collaboration with the physicists or therapists. This paper discusses the current nursing practice in which I am involved and needs to be changed.
Identification of a Current Nursing Practice Requiring Change
Description of the Current Nursing Practice
Children of all age groups are facing a grave problem these days: obesity.
Childhood obesity is a major risk factor for future health problems, in addition to being a significant public health problem, given the evidence available in research literature. Literature properly documents the risk factors and multi-related factors associated with childhood obesity and overweight that threatens public health.
According to the Centers for Disease Control and Prevention (CDC), children above the 85th percentile body mass index (BMI) risk being overweight, defining it as above the sex-, BMI at or age-specific 95th percentile BMI cut points sourced from the CDC Growth Charts developed in 2000. Childhood overweight prevalence data for ages 6 to 19 years is provided by the National Center for Health Statistics (NCHS) Chartbook, Health, United States (2007), and based on various national studies conducted between 1960s and 2004. Data for race and ethnic subgroups are available from the 80s to 2004. Within each subgroup, prevalence in childhood overweight has increased steadily over the years since the 80s to 2004 (CDC, 2007).
Childhood overweight is even more common in younger children. (Nelson, Chiasson, & Ford, 2004) studies are increasingly documenting evidence of increased overweight prevalence in children aged two to three years. According to Patrick & Nicklas, 2005, overweight prevalence in children of 4 to 5 years rose from 5% to 10.4% since 1976 to 2000. Overweight children of 4 years have a 20% risk of overweight issues persisting into adulthood whereas that of teenagers stands at 80% (Thorpe et al., 2004). Overweight prevalence is greater in 4-year-olds than their younger counterparts. This indicates that overweight prevention efforts should begin early in childhood (Walker & Avis, 1999).
Obesity presents further risks to health problems. It has been demonstrated that childhood obesity prompts biomarket development for critical health conditions later in life. For instance, Hispanic children are predisposed to type 2 diabetes due to overweight or obesity and genetic susceptibility (Neufeld, et al., 1998). According to Poston et al. (2003), Mexican-American have an increased chance of developing serious atherogenic body fat distribution patterns and weight gain in upper parts of the body due to obesity. Obese children also risk developing joint problems, asthma, elevated cholesterol, anxiety and depression. Severe to moderate overweight can lead to psychosocial and physical effects like increased growth in puberty followed by stunted growth, obstructive apnea, early onset of puberty in females, hyperlipidemia, gall bladder disease, pancreatitis, polycystic ovary syndrome, hypertension and long-term cardiovascular damages (Barlow and the Expert Committee, 2007). According to Myers & Vargas (2000) in an epidemiologic Bogalusa Study that took 20 years, a major heart disease, atherosclerosis, has its roots in early childhood. Endurance performance and poorer development of the gross motors are also associated to childhood obesity (Graf et al., 2004).
According to Action for Healthy Kids (2004), absenteeism and decreased scholastic performance have also been associated to childhood obesity in various studies. Strauss (2000) relates overweight in children to mental-health-related conditions. According to Strauss, obese children with decreasing self-esteem experience loneliness, sadness, nervousness and have a higher likelihood of using substances like alcohol and cigarettes compared to their obese counterparts with increasing self-esteem.
Obesity considered as a chronic disease when the weight-gain reaches dangerously increased level, which becomes risky for the health. The raised body mass becomes dangerous for children and some schools are now looking into this matter with concern. They are sending notices to the parents to take care of their child's diet, and within the schools, the management is trying to take help of nurses so that their intervention might prove helpful in reducing child obesity. An effective strategy needs to be formulated to alleviate the effects of obesity in children and some steps have been taken for that purpose. The strategy involves contact with children and parents on their dietary and general health education, and increased activities for them (Clark, 2004, p. 29). It is well understood that strategy implementation of this problem needs intervention of the health professionals, such as school nurses. In recent studies, four researches were probed to measure the reduction in child obesity due to nurse intervention, out of which only two show positive results in intervention groups as compared to control groups (Berkowitz & Borchard, 2009, p. 4).
Weight management interventions in adolescents were studied so that efficacy of the school nurses weight management could be investigated (Pbert et al., 2013, p. 182). Six high schools were taken as a sample, from where eighty-four obese adolescents were selected. They were in grade 9 to 11 and were asked to complete behavioral and psychological assessments. A two-month and two three-month follow ups were recorded and it was revealed that nurse intervention helped in controlling their weight. It improved their weight as the obese adolescents were able to control their cola intake and fast foods once in a week, which showed health betterments.
Another study was undertaken to observe the effects of providing education on weight management among children, adolescents and their parents along with reducing BMI index. The foundation of this project was Primary Care Healthy Choices Intervention Program for Overweight and Obese School-aged Children and their Parents (Jenike, 2013, p. 15). Remote methods were used to increase their knowledge about healthy nutrition and physical activity. A seven-week, one group pre-/post-test design was used for this purpose. The results showed that that project was informative for the children and their parents via remote methods such as telephone counseling. A decreased BMI percentile was observed along with increased information regarding physical activity and healthy diet benefits.
Why the Practice Needs Change
The current practice needs to be changed since dramatic increase in children weight becomes perilous for their health. Most of the reasons for child obesity include lack of exercise and less time spent on physical activities. Today, children are more into using laptops and video games rather than going out and playing in the open play grounds with their friends. Even if the children decide to hang out, they do that at one of their friend's place and arrange competitions on their video games. A small example of this lack of physical activity is proved by the study indicating that less than five percent of school children now go to school via cycling as compared to more than 80% around twenty years ago (Clark, 2004, p. 29).
School nurses or those that work in hospitals or other health units should be able perform their primary health care tasks, such as weight management in obese children in order to reduce weight after treatment of 3 months or more.
The various treatment stages of childhood obesity represent a progressive rise in the level of counseling, supervision and intervention. Nurses and other clinicians involved in the treatment interventions have reported several obstacles to obesity treatment in children. These barriers include: lack of clinician time, support services, available treatment skills and clinician knowledge. Reimbursement for obesity-related management services is typically poor. According to a study on a tertiary weight management program, obesity treatment only receives reimbursement at a rate of 11%. As a result, related programs are forced to seek significant financial support from external parties for long-term viability. The variation in reimbursement among various programs was reported to range from 0% to 100% (Story et al., 2002; Tershakovec et al., 1999). These clearly explain why there's a need for change in this nursing practice.
Nurses should be able to use their critical thinking skills for better diagnosis and devising of treatment plans. A weight management program could be devised by the nurses to see if the weight in obese children is controlled or not and how much change is observed, if any. It can then be compared to no nurse intervention so that a clear comparison can be made between nurse intervention for weight management and no intervention at all. Secondly, a three-month check would ensure the effect of a particular intervention strategy.
Part B: Identification of Key Stakeholders That Are Part of the Change
The key stakeholders that would be the part of change are nurses, doctors (physicians, therapists etc.), top management of the health care unit or hospital, school management, and parents and children.
Role of Each Stakeholder
Nurses
The role of nurses would be to give full care to the obese children with their expert thinking skills and knowledge of the field. The roles of nurses in childhood obesity include, but are not limited to the following:
Advocating for governments to increase physical activity in obese children
Engaging families in prevention efforts and activities geared towards managing childhood obesity.
Encouraging parenting styles that facilitate enhanced physical activity in obese children while minimizing sedentary behaviors
Encouraging parental modeling to promote healthy choice of diets
Prevention, early detection and effective treatment of childhood obesity
Participation in health education and promotion programs
Provision of appropriate nutritional advice to parents, the general public and even policy-makers (Sheehan and Yin, 2006)
Doctors
The doctors would help and assist the nurses in completing their task that the nurses help the patients in collaboration with the physicians or therapist. Doctors provide the following services in obesity management programs:
Education of and partnering with parents to monitor progress and offer recommended treatments
Provision of patient-centered treatments
Diagnosis and carrying out of tests
Coordination of childhood obesity treatments and provision of appropriate drug prescriptions
Therapists
Therapists help deliver treatments based on therapies such as obesity behavioral therapy that entails exercise, nutrition and counseling. Exercise specialists and behavioral counselors help with modifications of behaviors or habits and physical activity, respectively.
Dietitians
Dietitians help develop customized diets that suit the unique needs of each obese child for fast recovery. They work together with the nurses to advice parents on the best healthy styles and diets for their obese children.
Top Management of Healthcare Units
The top management also have a role to play in childhood obesity interventions, giving the nurses the autonomy for effective weight management and loss; they could make policies that are in accordance with the requirements of such change. The management ensures that the nurses have all the resources needed to get obese patients proper treatment. They are also the decision-makers in all matters related to nursing practice in the organization (Sheehan and Yin, 2006).
School Management
Since children spend most of their time in school, teachers and other students need to be involved in a school-based program run by the school management. The school management can make policies and give support to the nurses for the implementation of an effective weight management program. The school management can take part in nutritional education, improvement of healthy behaviors and promotion of positive changes in children's dietary habits (Sheehan and Yin, 2006).
Parents
Children need the support of their parents and families at large to make healthy behavioral choices. Parents are take charge of family-based programs for successful prevention and treatment of childhood obesity. They are the children's role models and offer confirmatory conditions to help children make the right choices regarding their health. Based on family functioning management and adoption of the right parenting styles, parents help foster healthy lifestyles and habits in their children (Sheehan and Yin, 2006).
Obese Children
Finally, the children would be the ones who would be benefitted from the change, in the form of better uninterrupted treatment from the nurses without any delays in fulfilling tasks along with the parents who would be satisfied with their child's progress in losing weight and leading a better and healthier lifestyle (Sheehan and Yin, 2006).
Part C: Evidence-Based Critique Table
Implications
The study would help in developing of data for the improvement of nursing practices and assist weight management practices throughout the state by adopting a multifaceted approach to treatment.
For future implications, the study can serve as a source to improve the nursing practice in weight management and the need for realizing the change in weight.
The findings can be used to learn how weight loss can be discussed with the patients and theie parents, eliminating yany negative consequences as well.
Data for childhood obesity could be obtained and more effective strategies could be formulated for building policies for better child health in future.
The study can help in weight loss via primary health care practices and devising in supporting treatments for the problem.
Study Limitations
The boy in the case study initially experienced little progress mainly with tracking and physical activity.
of results.
Anthropometric index lacked in some studies.
The study focused more on clinical beliefs rather than social and moral ones and some literature materials were out-of-date.
absence of theoretical concepts.
None mentioned
Clinical doctors might be giving advice for management for weight but not documenting it.
Results
The study successfully determined that a multi-faceted approach to physical activity and nutrition patterns with a focus on environmental and family factors can significantly impact treatment outcomes.
efficacy theory along with perceived skills, training, education and advocacy improve weight management practices.
School-based programs have long-term impacts on a large target group of obese children.
was to broach the patients who needed weight managed routine-wise. Nurses were confused about their roles.
Nurses need to develop advocacy skills, collaborative leadership skills and social marketing skills for policy and behavioral change intervention to better help prevent and manage childhood obesity.
negative consequences, time and resources for such sensitive topic.
Family-based multidisciplinary cognitive behavioral treatment in obese children was determined to be effective in managing childhood obesity.
children.
Interventions for weight management were required mostly for women, older individuals and those with deprivations.
Intervention and outcome measures
The child successfully gained confidence, changed his poor health behaviors and lost 70lb, confirming the success of a multifaceted approach in treating childhood obesity.
management practices was observed.
High quality clinical trials were selected for use in the study.
were analyzed by a thematic approach.
Content and thematic analyses were used to analyze the interviews.
Questionnaires for quality of life, clinical and biomedical data and cardiovascular tests for fitness were used to measure outcomes.
community, play and hospital based.
Interventions for body weight managements, advice, referrals, and drugs were included. Outcome measures were rate of body weight management and time to intervene.
Level/design/subjects
Electronic search-based study. The study presents a case study of a 16-year-old boy diagnosed with seizure disorder and put on a multidisciplinary weight management program.
social variables and professional weight management practices.
An electronic search was conducted in PubMed, MEDLINE, ISI Web of Science and Scopus Scientific databases. High quality clinical trials made up 70 of the 105 search yields of obese children not more than 18 years.
two local health board areas.
Use of qualitative study with the help of Theoretical Domains Framework (TDF). A sample of 34 health practitioners was taken.
A randomized clinical trial made of 40 obese children was used.
Academic Search Premier from the year 1999 to 2011.
An electronic search was conducted in PubMed, MEDLINE, ISI Web of Science and Scopus patients was selected, aging 30-100 years.
Study Objectives
The study was purposed to address the need to adopt a multidisciplinary approach to managing childhood obesity through nutrition analysis and management.
performance of Registered Nurses (RNs) related to weight management.
The study reviewed various strategies used and challenges encountered in controlling childhood obesity.
and to determine barriers in achieving their goals.
The study advocates for childhood obesity prevention by calling on nursing practitioners to take action.
obstacles in broach the topic of weight in common practice.
The study assesses the effect of a multidisciplinary treatment approach for childhood obesity based on cognitive behavioral therapy.
governmental actions for addressing this challenge.
The study reviews community- and clinical- based treatment interventions for childhood obesity as a way of improving the role of primary care in the nursing practice.
primary health care patients.
Author/Year
Ross, M. M., Kolbash, S., Cohen, G. M., & Skelton, J. A. (2010). Multidisciplinary Treatment of Pediatric Obesity: Nutrition Evaluation and Management. Nutrition in Clinical Practice?: Official Publication of the American Society for Parenteral and Enteral Nutrition, 25(4), 327-334. http://doi.org/10.1177/0884533610373771
Kelishadi, R., & Azizi-Soleiman, F. (2014). Controlling childhood obesity: A systematic review on strategies and challenges. Journal of Research in Medical Sciences?: The Official Journal of Isfahan University of Medical Sciences, 19(10), 993-1008.
Berkowitz, B., Borchard, M., (January 31, 2009) "Advocating for the Prevention of Childhood Obesity: A Call to Action for Nursing" OJIN: The Online Journal of Issues in Nursing Vol. 14, No. 1. Manuscript 2.2004 Aug; 114(2):e154-9.
O'
Vos RC, Wit JM, Pijl H, Kruyff CC, Houdijk EC. Trials. 2011 May 6; 12:110. Epub 2011 May 6.
Vine M, Hargreaves MB, Briefel RR, Orfield C. J Obes. 2013; 2013:172035. Epub 2013 Apr 28.
Evidence Strengths of Each Chosen Source
Evidence / Domains
Study limitations
Directness
Consistency
Precision
Reporting bias
Ross, M. M., Kolbash, S., Cohen, G. M., & Skelton, J. A. (2010). Multidisciplinary Treatment of Pediatric Obesity: Nutrition Evaluation and Management. Nutrition in Clinical Practice?: Official Publication of the American Society for Parenteral and Enteral Nutrition, 25(4), 327-334. http://doi.org/10.1177/0884533610373771
Low
Direct
Highly Consistent
Precise
Not Detected
Kelishadi, R., & Azizi-Soleiman, F. (2014). Controlling childhood obesity: A systematic review on strategies and challenges. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, 19(10), 993-1008.
Low
Direct
Highly Consistent
Precise
Not Detected
Berkowitz, B., Borchard, M., (January 31, 2009) "Advocating for the Prevention of Childhood Obesity: A Call to Action for Nursing" OJIN: The Online Journal of Issues in Nursing Vol. 14, No. 1. Manuscript 2.
Low
Direct
Highly Consistent
Precise
Not Detected
Vos RC, Wit JM, Pijl H, Kruyff CC, Houdijk EC. Trials. 2011 May 6; 12:110. Epub 2011 May 6.
Low
Direct
Consistent
Precise
Undetected Not Detected
Vine M, Hargreaves MB, Briefel RR, Orfield C. J Obes. 2013; 2013:172035. Epub 2013 Apr 28.
Low
Direct
Consistent
Precise
Not Detected
Evidence Hierarchy of Each Chosen Source
Evidence / Level
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7
Strength*
Ross, M. M., Kolbash, S., Cohen, G. M., & Skelton, J. A. (2010). Multidisciplinary Treatment of Pediatric Obesity: Nutrition Evaluation and Management. Nutrition in Clinical Practice: Official Publication of the American Society for Parenteral and Enteral Nutrition, 25(4), 327-334. http://doi.org/10.1177/0884533610373771
A Kelishadi, R., & Azizi-Soleiman, F. (2014). Controlling childhood obesity: A systematic review on strategies and challenges. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, 19(10), 993-1008.
A Berkowitz, B., Borchard, M., (January 31, 2009) "Advocating for the Prevention of Childhood Obesity: A Call to Action for Nursing" OJIN: The Online Journal of Issues in Nursing Vol. 14, No. 1. Manuscript 2.
A Vos RC, Wit JM, Pijl H, Kruyff CC, Houdijk EC. Trials. 2011 May 6; 12:110. Epub 2011 May 6.
A Vine M, Hargreaves MB, Briefel RR, Orfield C. J Obes. 2013; 2013:172035. Epub 2013 Apr 28.
A *Strength of Recommendation:
A: Good evidence to support the recommendation
B: Fair evidence to support recommendation
C: Insufficient evidence to recommend for or against a recommendation
D: Fair evidence to support the recommendation of excluded intervention
E: Good evidence to support the recommendation of excluded intervention.
Part D: Developing Evidence Summary
Title of Evidence/Source 1:
Multidisciplinary Treatment of Pediatric Obesity: Nutrition Evaluation and Management
There's rapid evolution of methods used to assess and treat pediatric obesity. The condition has been attributed to an imbalance the intake and expenditure of calories. Obesity calls for comprehensive patient, environmental, familial, cultural and genetic factor evaluation to enable clinicians come up with successful interventions. Due to the difficulty of quantitative assessment of caloric nutrition intake and the fact that it's time consuming, it should only be used in isolated settings like research environments or in case initial management approaches have been futile. Alternatively, providers need to identify dietary behaviors or patterns associated with obesity and promise change. Interventions should be tailored by clinicians with family and patient motivations being considered, as well as their preparedness to change. Step-by-step increase in treatment plans are currently featured in guideline recommendations, with multidisciplinary treatments teams for patients in need of intense interventions. Multidisciplinary level providers should use their expertise through team work to come up with a comprehensive management plan. This article reviews existing pediatric obesity evaluation and treatment recommendations with a focus on assessment of patient nutrition made inclusive in the multidisciplinary team.
Title of Evidence/Source 2:
Controlling Childhood Obesity: A Systemic Review on Strategies and Challenges
Today, childhood obesity epidemic is not just common in the developed world, but has become a serious global health issue. The World Health Organization (WHO) estimates 43 million children below the age of 5 to be overweight and by 2020, over 60% of diseases worldwide will be related to obesity. Childhood obesity is related to both long- and short- term health problems like hypertension, fatty liver disease, cardiovascular diseases, low self-esteem, orthopedic problems, etc. The condition can lower life expectancy by 2 to 5 years. Furthermore, the ever-increasing cases of obesity have a huge impact on the global economy. The environment and genes are the major causes of overweight in both children and adults. However, since gene defects take time to showcase their phenotype, the obesogenic environment is more responsible for causing obesity.
Primary or primordial pediatrics obesity prevention and development of healthy lifestyle behaviors from childhood are recommended to help reduce global obesity epidemic levels.
Various effective childhood obesity prevention and control interventions are recommended for application in different settings. Physical activity behaviors and specific eating are recommended by experts through counseling. Clinic-, community-, family-, school- and after-school- programs have been used by researchers to try and manage obesity. Most of these interventions had positive outcomes in children aged 6 to 12 years based on the Cochrane review of programs for preventing obesity. Population-based approaches for teenagers and interventions targeting children might not just make sense economically but are also useful. This research is aimed at a systemic review of the impacts of different interventions based on clinics and communities on childhood obesity control, including a recommendation for future interventions.
Title of Evidence/Source 3:
Advocating for the Prevention of Childhood Obesity: A Call to Action for Nursing
The authors of this article offer a background discussion on obesity in children, an examination of the different contributory-factor to overweight issues and obesity in children, literature review of different childhood obesity prevention strategies and interventions and the skills nurses require to prevent obesity in children. A family-based approach to changing dietary habits of children from a young age, early childhood interventions for overweight prevention before development of poor dietary habits, and importance of community involvement and support are covered under the literature review. Based on the findings, nurses are advised to develop advocacy, social marketing and collaborative leadership skills required to prevent obesity in children.
Title of Evidence/Source 4:
The Effect of Family-based Multidisciplinary Cognitive Behavioral Treatment in Children with Obesity: A Study Protocol for a Randomized Controlled Trial
The Netherlands has witnesses a rapid increase in childhood obesity prevalence over the last 30 years. Environmental factors have majorly been attributed to the trend. Some risk factors for childhood obesity are low social economic statuses and parental overweight. Impaired social and cognitive development and low self-esteem are some negative consequences of childhood obesity. Since obese children have a high risk of becoming obese adults, they have a high chance of developing type 2 diabetes mellitus, cardiovascular diseases, psychosocial problems, etc. Moreover, obese children have impaired secretion of gastrointestinal hormones responsible for appetite, and food digestion, and absorption. Lifestyle changes for reduction of weight by altering health risks are the most prevalent childhood obesity treatment options. This study is aimed at evaluating the impact of family-based multidisciplinary lifestyle intervention with a focus on cognitive behavioral therapy. The treatment is purposed to develop weight loss and stabilization in the long-term, reductions of negative effects associated with obesity and enhancement of self-image through cognitive behavioral therapies and lifestyle changes.
Title of Evidence/Source 5:
Expanding the Role of Primary Care in the Prevention and Treatment of Childhood Obesity: A Review of Clinic- and Community- Based Recommendations and Interventions
There's a need to extend the role of primary care in clinical settings as it has been used traditionally by pediatric providers to evaluate and treat childhood obesity and related health conditions. This article reviews literature published from 2005 to 2012 to offer instances of functions primary care providers can play to deliver successful prevention and treatment of obesity in children in community and clinical settings. It also analyzes evidence of critical characteristics, strategies or factors in successful intervention models based on communities. 96 articles were selected for evidence collection on how providers of primary care can prevent and treat obesity in children successfully through primary care coordination efforts and connections to resources for preventing and treating obesity in communities. The most promising interventions and accompanying recommendations published within the last 10 years on the American Academy of Pediatrics, the Institute of Medicine and other health companies were collected and nine ways in which primary care providers can promote childhood obesity prevention and treatment based on community- and clinical- based efforts were identified. These include: promotion of healthy lifestyles, evaluation and monitoring of patient weight status, development of clinician skills, treatment, development of clinical infrastructure, community health education, community program referrals, advocacy of policies, and promotion of multi-sector community initiatives.
Part E: Recommendation of a Specific Best Practice
A multidisciplinary intervention or staged approach to treatment is recommended.
In 2007, the American Association of Pediatrics recommended a staged approach for childhood obesity management and treatment. The initiation of treatment at the first stage depends on a child's BMI percentile, age and success history of initial treatment ages. Patients need counseling on ways of preventing obesity during all well-child visits irrespective of a child's BMI. Primary care physicians or related healthcare providers (with the right skills in behavioral counseling and weight management) are responsible for the provision of stage 1 and 2 treatments in clinical settings. Stages 3 and 4 occur in other treatment settings like communities and schools (Spear et al., 2007).
Many multi-component multidisciplinary programs were developed in 2005. This saw the United States Preventive Services Task Force (USPSTF) release new recommendations with regards to childhood and teenage obesity screening and treatment (Skelton et al., 2008; Nemet et al., 2005; Whitlock et al., 2010). The USPSTF found sufficient evidence that obese adolescents and children can improve their weight status within 1 year through high (up to 75 hours) multidisciplinary behavioral interventions to moderate interventions (treatment lasting 26 hours to 75 hours). Based on BMI, lower intensity interventions in clinical settings lasting a maximum of 25 hours yielded inconsistent and insignificant benefits. The data indicates the need for intensified treatment levels and a staged treatment approach in the prevention and management of overweight in children. A tertiary weight management team working within provided protocols and having expertise in managing overweight in children is the only one allowed to use medications, replacement of meals, diets with very low calories, bariatric surgery and diet and activity counseling as additional treatment options of childhood obesity (Barlow, 2007).
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