Analyzing Translation of Research in Evidence Based Practice

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. It is 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. 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

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 doctors would help and assist the nurses in completing their task that the nurses help the patients in collaboration with the physicians or therapist. The top management could help in intervention and 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 school management can make policies and give support to the nurses for the implementation of an effective weight management program. 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.

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.

For future implications, the study can serve as a source to improve nurse language 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 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

Sample of nurses was selected form one university; unexplained variance persisted; more research needed for validity of results.

Interviews present the risk of reporting bias as nurses might present themselves as good practitioners.

The study focused more on clinical beliefs rather than social and moral ones; absence of theoretical concepts.

None mentioned

Clinical doctors might be giving advice for management for weight but not documenting it.

Results

Self-efficacy theory helped in predicting the weight management practices both directly sand positively. It was also revealed that self-efficacy theory along with perceived skills, training, education and advocacy improve weight management practices.

The nurse mentioned two roles they had to play: one was providing obesity management and the other was to broach the patients who needed weight managed routine-wise. Nurses were confused about their roles.

Three barriers were identified: limited understanding of the topic, negative consequences, time and resources for such sensitive topic.

Intervention programs faced challenges of funds and stigmatization of obese children.

Interventions for weight management were required mostly for women, older individuals and those with deprivations.

Intervention and outcome measures

The response rate of the survey was 71.4%. A moderate level of weight management practices was observed.

Audio recorders were used to document the interviews and were analyzed by a thematic approach.

Content and thematic analyses were used to analyze the interviews.

Interventions were family0-baseds, school-based, 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

A questionnaire was designed for a sample of 588 RNs based on socio-demographic variables, psycho-social variables and professional weight management practices.

Qualitative semi-structured interviews were used with a sample of 18 nurses in 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.

Search from the databases of CINAHL, MEDLINE, ERIC and Academic Search Premier from the year 1999 to 2011.

A cohort sample of 91-413 overweight patients was selected, aging 30-100 years.

Study objectives

The purpose of this study was to observe self-efficacy theory-based representation in comprehending the performance of Registered Nurses (RNs) related to weight management.

To explore how good practice nurses are in managing obesity with their primary care practices and to determine barriers in achieving their goals.

To investigate the general practitioners' and primary care nurses' apprehended obstacles in broach the topic of weight in common practice.

To identify various factors affecting childhood obesity, interventions and governmental actions for addressing this challenge.

Studying access to interventions for weight management for obese UK primary health care patients.

Author/year

Zhu, D.Q., Norman, I.J., & While, A.E. (2013)

Phillips, K., Wood, F., & Kinnersley, P. (2014)

Blackburn, M., Stathi, A., Keogh, E., & Eccleston, C. (2015)

Karnik, S. & Kanekar, A. (2012)

Booth, H.P., Prevost, A.T., & Gulliford, M.C. (2015)

Evidence Strengths of Each Chosen Source

Evidence / Domains

Study limitations

Directness

Consistency

Precision

Reporting bias

Zhu, D.Q., Norman, I.J., & While, A.E. (2013)

Medium

Indirect

Consistent

Precise

Suspected

Phillips, K., Wood, F., & Kinnersley, P. (2014)

Medium

Indirect

Consistent

Precise

Suspected

Blackburn, M., Stathi, A., Keogh, E., & Eccleston, C. (2015)

Low

Indirect

Consistent

Precise

Suspected

Karnik, S. & Kanekar, A. (2012)

None

Direct

Consistent

Precise

Undetected

Booth, H.P., Prevost, A.T., & Gulliford, M.C. (2015)

Medium

Direct

Consistent

Precise

Suspected

Evidence Hierarchy of Each Chosen Source

Evidence / Level

Level 1

Level 2

Level 3

Level 4

Level 5

Level 6

Level 7

Strength*

Zhu, D.Q., Norman, I.J., & While, A.E. (2013)

A Phillips, K., Wood, F., & Kinnersley, P. (2014)

Blackburn, M., Stathi, A., Keogh, E., & Eccleston, C. (2015)

Karnik, S. & Kanekar, A. (2012)

Booth, H.P., Prevost, A.T., & Gulliford, M.C. (2015)

*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: Nurses' self-efficacy and practices relating to weight management of adult patients: a path analysis.

The authors of this source mentioned that health professional proves to be a useful means in weight management, especially when it comes to nurse practitioners. This study helped in examining the self-efficacy theory in understanding the role of nurses in weight management. A self-report questionnaire was used for collecting data from 588 nurses and the results revealed that self-efficacy directly and positively related to weight management. Moreover, there was full or partial relationship between perceived barriers, professional role and identity and the skills of the nurse for this purpose. In fact, perceived skills were the most correlated factor with self-efficacy in the study.

Title of evidence/source 2: Tackling obesity: the challenge of obesity management practice nurses in primary care.

The authors of this research wanted to investigate how practice nurses manage obesity and what barriers are involved while doing so in primary health care. A qualitative semi-structured interview study design was used and conducted among 18 nurses from two local health boards. The results showed that nurses were involved in two roles: one was providing obesity management and the other was to broach the topic to healthy but overweight patients. They were confused about which role should be adopted and what approach should be chosen for that purpose.

Title of evidence/source 3: Raising the topic of weight in general practice: perspectives of GPs primary care nurses.

The authors focused on exploring general practitioners' (GPs) and primary care nurses' perceived barriers for the purpose of raising the topic to the obesity patients. A qualitative design study was used including 34 semi-structured interviews. Content and thematic analyses were used for the analysis. The results showed that there were three main barriers: limited understanding of the topic, concern about its negative repercussions, and requiring time and resources for raising the topic. These barriers were restricting the nurses to raise the topic to their patients and constraining their 10 minutes' consultation.

Title of evidence/source 4: Childhood obesity: a global public health crisis.

The authors of this study wanted to address numerous factors that affected childhood obesity and the governmental actions taken to face this challenge. The study entailed review of literature collected from databases of ERIC, CINAHL, and MEDLINE etc. The results showed that interventions were from the family, school, community, play and hospital. Financial challenges hinder effective interventions, especially from the schools in order to devise a healthy diet educational plan. Government's policies might help in alleviating the problem and its effects.

Title of evidence/source 5: Access to weight reduction interventions for overweight and obese patients in UK primary care: population-based cohort study.

The authors wanted to explore the access to weight management interventions for overweight people in primary care. A cohort of 91-413 overweight patients aging from 30 to 100 years was selected for the purpose of this study. The results showed that overweight patients had no track management system for their weight. The results showed that weight management was more accessed through women and older individuals.

Part E: Recommendation of a Specific Best Practice

The specific best practice based on the summary could be intervention of nurses for weight management in obese children. This would help the children when nurses' practitioners would track their weight, give them diet plans and advice physical activities for them. An established, and commonly accepted interval for ascertaining sustainable change is three months from the onset of the interventions. This duration helps the NP's to gain important insights into the efficacy of the measures deployed to control, and subsequently, reduce obesity it is believed. This would assist in losing their weight and that would save them from many chronic diseases later in their lives, leading to the relief for their parents as well. Several types of interventions can be implemented, such as:

i. It is learnt that nurse interventions for children and adolescents have showed signs of improvement in child weight management; however, in few cases, children are not able to follow physical activity plans and do not show signs of weight reductions. For them, pharmacotherapy can be suggested. It is a medical care that involves medications for weight control along with some other relevant therapies.

ii. Another radical decision for those children who do not show reduced weight symptoms can undergo a bariatric surgery, which is recommended by only 1% of the U.S. surgeons. Performing this controversial surgery on children or adolescents involves several lengthy procedures but if a serious obesity case is observed, then this decision can be made.

iii. The most convenient and feasible form of nurse intervention is the weight management plan devised by the nurse practitioner (NP). The NP would track the child's weight, his blood pressure, and other vital characteristics of his health to record his health data for diagnosis of suitable weight management plan. He would then be given a diet plan along with some healthy physical activities to be carried out daily. The nurse would be able to monitor his health daily, so that weekly and ultimately, monthly tracking of his weight changes, if any, could be gauged. The focus of the NP would be to assess the progress in three-month intervals.

iv. Nurses can make use of telephone counseling and arranging weekly meetings with the parents to help them understand the severity of the problem and assist them in reducing the weight of their children successfully.

Part F: Identification of Practice Change Model for the Implementation of Proposed Practice Change

A CETEP (Clinical Excellence Through Evidence-Based Practice) model would be helpful for implementing a practice change (see Figure 1). It would serve as a critical appraisal-based model for carrying out the proposed change. With the help of this model, firstly, a group of people would be assigned to disseminate information using bulletin-board (Sparger et al., 2012, p 14), for example, within the schools. The model defines some steps for implementation; initially, the clinical practice question should be defined (Collins et al., 2007), which is nurse intervention for weight management of obese children at least for three months to observe any weight reductions and health improvements in children as compared to no nurse intervention at all; next step is to assess the critical appraisal components, which can include research about the identified problem, national guidelines for reducing obesity in children, child health factor related to obesity, his history and preferences, and clinical setting factors such as expertise and knowledge of the nurse, safety issues, ethical implications etc.; planning the implementation, which entails steps for carrying out the plan for weight management such as recommendations presented above; evaluating the practice change in the form of monitoring techniques in the form of weekly and monthly tracking of the weight, following of the diet plan, improvement in physical activity etc.