92318 Evidence for Nursing Assessment

92318 Evidence for Nursing Assessment

92318 Evidence for Nursing Assessment

Task 1 Development of a Research Question.

Clinical topic which is of interest for me is increasing frequency of childhood obesity patients and impact of this disorder on their health. This topic is of specific interest for me because i have been observing during my clinical duties in paediatric department as well as at my surroundings at residence that number of children below age of 14 years are showing an increasing trend of obesity and in a period of 2-3 years i personally observed some children in my locality who grew their weight exponentially. On the basis of this observation i did some research on subject and it became clearer to me that childhood obesity or overall obesity is one of the fastest growing problem globally and countries like USA, UK and Australia are most severely impacted by this development (Olsen, et al. 2009).

Evidence for Nursing Assessment

Further research also revealed that child hood obesity has its impact on psychology of a child and their development as well as their social inclusion becomes very difficult and they feel isolated and different from other children of their age. This limitation of children restricts their communication and interaction with their family members only and eventually they end up being depressed and subdued children with a very narrow social circle.

On the basis of this research my research question developed as
‘To identify and analyse the impact of child hood obesity on communication and interaction abilities in children of age range of 6-13 years”. 

PICO

PICO is the process of formulating a research question which will have following element in it. Here P stands for population, I stands for intervention, C stands for control and O stands for outcome. Now this research question can be redefined as per PICO standards as

  • Population:-population for this research study would be children of age range 6 to 14 years who are suffering from obesity or overweight. However this population would not be targeted alone as there would be requirement of inputs from their parents, caretakers and siblings as well to gain information about communication and interaction of children who is suffering from obesity. 
  • Intervention:-research would be a qualitative in nature and it will use both primary and secondary research approaches in it. Secondary research would be done through a literature review which will be exhaustive and use multiple research studies and journals on obesity. Primary research would be designed by using questionnaire as a tool for data collection from parents and guardians while children would be observed only for their communication and interaction skills (Bonfiglioli, et al. 2007). 
  • Control:-control would be the children group who belong to same age group and all of them are average or close to average on a BMI scale. They would be compared with the test group for better understanding (WHO, 2010).
  • Outcome:-outcome of this research project would be a better understanding of the impact of obesity on communication and interaction skills of a child. Obesity might be controlled in future but communication skills which are developed during formative year cannot be modified or changed easily in late years. Such research study would also help in developing intervention plans for obese children who will also include correction of their communication and social skills and this would also be included in the nursing and medical intervention plans. Parents and families can also be informed of such an aspect so that they can keep an observation on obese child and observe any changes in their speaking, listening, behaviour socially and make an early intervention (Carter, 2006).

Research Papers to Be Used

  • Bonfiglioli, C. et al. (2007) Obesity in the media; political hot potato or a human interest story? Australia journalism review 29 (1) 53-61
  • Olsen,  A. et al. (2009) Weighing it up: the missing social inequalities dimension in Australian obesity policy discourse, Health Promotion Journal of Australia 2009: 20 (3)
  • Carter, O.B.J., (2006). The weighty issue of Australian television food advertising and childhood obesity. Health Promotion Journal of Australia, 17, (1), 5 – 11.
  • WHO, (2010) “Obesity: Preventing and Managing the Global Epidemic,” WHO Technical Report Series no. 894 (Geneva: WHO, 2000).

These research papers and publications would form the major base of literature review and answer some of the research questions through secondary research only. 
Search Strategy

 

Search Strategy

1

Using search key words

2

obesity

3

Child hood

4

Psychology or mental health

5

Impact of obesity

6

Communication skills and mental health

7

Obesity and developmental effect

8

 

9

 

10

 

11

 

12

 

13

 

Task 2 Appraisal of a Qualitative Research Article

Qualitative research paper which is appraised for this task is one of the five prime resources indicated in research question. This research paper is published in year 2006 by Carter Owen and it is analysing the impact of food advertising on television in Australia and its role in rising cases of obesity in Australian Children.

This research paper is a qualitative research paper and it is assessing the impact made by television advertising on children and their eating habits. Author is of opinion that food advertisement should be heavily regulated and fast foods and fattening food products should be banned from advertising on television. This research paper also emphasized on the fact that there is a direct and clear link between obesity in Australian children and Australian television advertisement and author used a systematic review of literature and data analysis from various sources of reliable data like Australian bureau of statistics and Australian social trends etc (Hesse-Biber and Leavy, 2010).

This qualitative research paper is secondary in approach and they used literature review and secondary quantitative data from different sources to analyse the impact of advertisements on health of children. This is a appropriate choice of approach for this research paper because the target population for this project cannot be aligned for a primary research neither a longitudinal study can be done through primary research to assess the impact of advertisement from last 20 -30 years.

Research methodology which is used by the author in this research paper is A systematic review of current medical, public health, psychological and marketing research literature surrounding the topics of childhood obesity and television food advertising, with emphasis on Australian data.

Data analysis of research paper provided information that child hood obesity rate in Australia has tripled from year 1985 and it was also observed that consumption of energy dense food in Australia also tripled during this period. This indicates that a sudden surge in sales of energy dense food is the primary reason of obesity in Australian children population.

In this research paper author also ensured that all ethical and regulatory norms are followed and none of the research objectives should either have a negative impact on children or any other stake holders involved with research. Inclusion criteria of literature in this research project are very firm and they included only peer reviewed articles, literature published in reputed journals and data only from sources where it can be verified and have a strong credibility (Mitchell and Jolley, 2009).

CASP or critical appraisal of skills program carefully defines how to critically evaluate a research paper and identify its strong and weak points. On the basis of this appraisal it can be stated that strongest part of research paper is the contemporary topic and fresh perspective brought in by the author and using resources which can be verified by any reader any time easily. Another strong point of this research proposal is that it opens many new threads for research papers and it provides various opportunities which can be explored and a detailed knowledge about this aspect of obesity can be developed. One of the weak part of this research paper is there is no inclusion of primary research or data at any point in study and also other channels of advertisement like internet, social mediaand radio etc are not considered. Since there was a lack of data which provide sufficient support to hypothesis mentioned in research paper earlier final conclusion of research paper were as follows, There is robust evidence to suggest that television viewing and childhood obesity are related. However, the direction of causation and specific contribution of food advertising remains equivocal. In future more studies can be done to find out the direction of causation and specific contribution of food and advertisement. This paper was published in health promotion journal of Australia in year 2006 in volume 17th edition first (Gray, 2009).

Task 3

General Content Questions

1.    Describe the relationship between the two frameworks that underpin this subject: Tanner’s Model of Clinical Judgement and Evidence Based Practice (see figure above)? (150 words, 5 points)
Ans:-Both frameworks are strongly interlinked with each other and without proper adoption of clinical judgement and its applicability in real life practice, development of evidence based practice is not effective. An evidence based practice has to be modified according to the clinical requirements as well as there is a need to link evidence based practice with the environmental factors which can be done using Tanner’s model of clinical judgement. There are many variables in consideration while taking a clinical judgement and it can accentuate the effectiveness of evidence based practice if used properly (Raines, 2008).

2.    Describe why would you choose to access a qualitative research paper in particular? (50 words, 2 points)
Ans:-Research topic and area of research both are subjective in nature and it prudent to use qualitative research paper when a subjective phenomenon is researched. 

3.    Describe would you choose to access a quantitative research paper in particular? (50 words, 2 points)
Ans:- yes I would choose to access a quantitative research paper which will help me in gaining numerical data to support the qualitative research paper selected earlier.

4.    Describe the purpose of a systematic review compared with a single high quality randomised controlled trial? (50 words, 2 points)
Ans:- A systematic review is much better than a single high quality randomized controlled trial because their applicability in evidence based practice is much better and they help in capturing the entire development over a period of time rather than taking into consideration only what happened at a particular point of time (Spring & Hitchcock, 2009). 

Statistics Case Study

The figures below illustrate the results from a study that looked at the impact of oral morphine compared with placebo in managing refractory breathlessness. Patients treated with morphine reported an average improvement of 9.5mm (95% CI 7.4mm – 11.6mm, p = 0.006) when compared with those who received the placebo. Answer the following three (3) questions in relation to the case study:

parameter is in our confidence interval

5. Looking at the Figure 1 above, the mean difference is 9.5mm with a 95% confidence interval around that mean of7.4mm – 11.6mm, what does this tell you? (2 points)
Ans:-this tells us that it can be said with a 95 percent confidence that average improvement in a patient suffering from breathlessness when given morphine would be better. It also states that we are 95% confident that the true value of the parameter is in our confidence interval.

parameter is in our confidence interval

5.    Looking at the Figure 2 above, the p value is <0.05. What does this tell you? (2 points)
This means that the null hypothesis which was proposed in the research project is rejected by the data analysis. 

6.    Thinking of the overall results from this case study and the two figures, what do these results tell you about the effect of oral morphine compared with placebo in patients with refractory breathlessness? (2 points)
Ans:effect of oral morphine is definitely better than the placebo and it also indicates that the null hypothesis which stated that both placebo and morphine have similar effect is reject with a 95 percent confidence interval. 

Application of Research

Thinking broadly about the way you engage with evidence in your clinical practice, please answer the following questions:
8.    Thinking about your progression into a junior clinician, what resources would you access in the clinical area to help you decide best practice for your patients? (1.5 points)
Ans:-latest medical journals and research papers which are published with new findings and insights would be a preferred way to adopt evidence based practice. Similarly guidelines developed by governing body and council of each branch would also help in keeping treatment modalities updated. Regular attendance to the conferences and paper presentation where discussion on issues and latest development take place would also help in gaining a better understanding of new areas which are explored and included in medicine practice.

9.    What are some of the barriers to implementing new research findings into clinical practice? (1.5 points)
Heavy practice schedule, higher confidence level because of successful treatment and lack of motivation to attend conferences or read research papers are some fot he barriers. Even access to latest medical journals is also a barrier in many rural areas where physicians are practicing in isolation (Melnyk & Fineout-Overholt, 2011).

10.    Why do you think it is important for you to take this subject as preparation for your role as a junior clinician? (150 words, 5 points)
It is very important to take this subject because it provides a brief synopsis of the way evidence based practices are developed and included in clinical practice. Similarly there are some very strong models and framework studied in this subject for critical appraisal as well as using EBP in practice which can help in gaining better understanding of latest developments in medical field. This subject also helps in transition of a student into a junior clinician because it provides evidences supporting the fact that how important and critical decision of a clinician is and how it can be supported by a DSS or EBP. This subject also helps in developing a understanding of data analysis and making meaningful observations from these data analysis which will further strengthen the practice and EBP incorporation (Newhouse, et al 2007).

References

  • Bonfiglioli, C. et al. (2007) Obesity in the media; political hot potato or a human interest story? Australia journalism review 29 (1) 53-61
  • Olsen,  A. et al. (2009) Weighing it up: the missing social inequalities dimension in Australian obesity policy discourse, Health Promotion Journal of Australia 2009: 20 (3)
  • Carter, O.B.J., (2006). The weighty issue of Australian television food advertising and childhood obesity. Health Promotion Journal of Australia, 17, (1), 5 – 11.
  • Dixon, J. & Broom, D.H. (2007) The 7 deadly sins of Obesity. University of New South Wales Press Ltd. Sydney, Australia.
  • WHO, (2010) “Obesity: Preventing and Managing the Global Epidemic,” WHO Technical Report Series no. 894 (Geneva: WHO, 2000).