Clinical Question Paper: PICOT

Clinical Question Paper: PICOT

Abstract

The profession of nursing requires registered nurses to write clinical questions. The PICOT format is utilized by nurses to formulate these types of questions. This paper reviews three research articles based around the topic of childhood obesity and the effects that parents may have on their children’s weight. The first article is a cross-sectional study used to clarify the relationship between ineffective parenting and childhood obesity using different dimension of family functioning. This study found that because parents of obese children are more likely to have their own weight problems, they may model ineffective lifestyle patterns. The second is a systematic review focused on whether parents are using portion control when feeding their children, and whether education and training on portion control could have an effect on parents feeding strategies. The results were positive effects of portion control on the energy intake of children, and parents accurately estimating portion sizes after education.  The final article was a cross-sectional descriptive study that explored different parenting styles and other potential family and social indicators of an obese or weight-promoting family environment. This study found that parents with moderate control had more concern about their children’s weight and had better knowledge of nutrition when compared to parents with strict control. The significance of using sound evidence is discussed as it relates to the profession and standards of nursing, as well as quality and safety.

Clinical Question Paper: PICOT

Nursing research is an important fundamental of the nursing profession. The skills and practice of nurses are built around the proper research and evidence to recommend the most efficient, safest, and most cost effective way to complete each task. If nurses follow the guidelines set for each task, it will help to ensure nurse safety, patient safety, and high patient quality of care. “Nurses interpret research findings and use evidence-based research to support nursing decisions. The purpose of this assignment is to reflect how nursing knowledge is disseminated for use in personal and professional practice” (Singleterry, (2014), pg.7). This paper will discuss different parenting strategies and techniques and the relationship they have on their children’s weight.

Clinical Question

Childhood obesity has become a growing problem in today’s society in America (Williams et al., 2012). Williams and his colleges go on to say that children may not realize the harmful effects that being overweight can have on their health in their future years. This not only affects their physical health, but their emotional health as well. Bullying in schools and self-esteem issues are just a few hurdles that overweight children may have to deal with. If these children continue to gain weight as they age, they may be putting themselves at risk for developing numerous conditions that may be prevented with weight loss (Williams et al., 2012). A question that may be asked is who is causing these children to become overweight?  This question will be examined further throughout this paper.

Nursing practice requires that practicing registered nurses write clinical questions for specific clinical problems. According to Nieswiadomy (2012), the acronym PICOT is used to help format these types of clinical questions. This format was developed in 2005 by Fineout-Overholt and Johnson (282). The “P” in PICOT stands for the patient or population, the “I”, for the intervention or interest area, the “C” for the comparison intervention or current practice, the “O” for the outcome desired, and the “T” for the time to achieve each outcomes (Nieswiadomy, 2012).

The clinical question being asked and discussed in this paper is as follows. Does parental obesity play a role in their children’s body mass index (BMI) in the ages between five and twelve years of age?  The answer to this question could be significant in finding a way to decrease the number of overweight children. Do the parental eating and activity patterns impact the weight of their children? It is the job of the nurse to educate patients and their families about information that may be beneficial to their health. This clinical question may be especially helpful in certain programs that deal with children’s health. An example of one of these programs would be the women, infant, children (WIC) program offered in Michigan to monitor the health status of the community’s children (United States Department of Agriculture Food and Nutrition Service, 2014).  Children are the future and if nothing is done to stop the uphill trend of childhood obesity, America may be looking at a future of chronic diseases and condition, many of which could have been prevented (Williams et al., 2012).  Today’s parents and all adults in general need to set a good example for children so they can learn and grow in a healthy environment. This will help to improve the quality and safety of the future generation.

Methodology

            The Ferris State University database was used to search for research articles on the topic of childhood obesity. The CINAHL database was used to search for articles that meet the criteria of childhood obesity. The key search terms used were obesity, obese, BMI, overweight, parents, parent, guardian, children, child, and youth. The advanced search tool was used to narrow the articles to only peer reviewed, nursing research. A total of 330 articles were found that meet this search criteria. The search was then narrowed even further by changing the date of publication to 2010 or newer. This search resulted in 140 articles. Next, the articles that did not research the parental effects of children’s weight were removed, which left 33 articles to choose from. From this list of 33 articles, three were chosen to critique and discuss in further detail.

As future nurses it is important to know how to research topics specific to nursing. This will ensure that the research is within the nursing scope of practice. This paper uses only nursing research to address whether or not parental weight correlates to the weight of their children. The articles used are within the scope of nursing practice and may be used to help educate the public about childhood obesity. Using research designed around nursing practices will ensure that the information being used is at the level of practicing nurses and not beyond the scope of practice of a registered nurse.

There are different levels of evidence that can be used in nursing research. These levels of evidence promote the use of evidenced based practice in the nursing role.  Using evidenced based research within the profession of nursing will help to ensure the nursing profession to continue to grow and develop. These levels of evidence help to promote patient quality and safety in everyday nursing practice. The Quality and Safety Education for Nurses (QSEN) model will be used in this paper to explain the levels of evidence used in the research that was done. Level I evidence is the highest quality evidence according to the QSEN model, this level of evidence was searched for when reviewing articles.

Discussion of Literature

Article one

The first article that was reviewed for this paper deals with whether parents are using effective parenting strategies with their obese children (Morawska & West, 2012). This article is nursing research because the article is written by two registered nurses and the topic is dealing with an important topic in nursing education. Ethical clearance for this study was obtained from the University of Queensland and the National Health and Medical Research Council guidelines. The problem in this article is clearly stated and is as follows. Overweight and obesity in children is becoming a significant problem, and up to a third of children are classified as overweight or obese. Evidence is showing that parents play a critical role in their children’s dietary and activity patterns. The literature is appropriate for this type of study although a systematic review would be helpful. This is a cross-sectional study used to clarify the relationship between ineffective parenting and childhood obesity using different dimension of family functioning. According to QSEN this is a level five, level of evidence.

The sample for this study was 62 families with children between the ages of four through the age of eleven (Williams et al., 2012).  A phone interview was completed to assess the eligibility of each family. In the healthy weight group, target child must be between the ages of four through eleven, parents must describe the children’s body size as healthy, and the child must not be on any medications that affect growth or weight control, and must not have a developmental delay or disability.  In the obese weight group the children had to be between the ages of four through eleven, parents must describe their child’s body size as obese, and the parents had to agree to a 12 week intervention. These children could not be taking any medications that affected growth or weight control, and must not have any developmental delays or disabilities. The families were matched by sex, age, and family type. Nominal measurement was used in this study in order to match families with the variables of sex and family type. Interval measurement was used to place families into groups based on age. This level of measurement was also used to measure weight status as well as parental and child behavior status. The lifestyle behavior checklist and the parenting scale were used to determine parenting strategies as well as the children’s lifestyle behaviors. This is the appropriate levels of measurement to use in this study. The results of this study state that children and parents in the obese group tended to have larger body sizes and a higher percentage of body fat than children and parents in the healthy group. The parents in the healthy group tended to have a body mass index (BMI) that fell within a healthy weight range, and most parents in the obese group had BMI’s that fell in the overweight or obese range. Also parents in the obese group had a higher percentage of children with behavior problems, lifestyle behavior problems, and peer problems, when compared to the children in the healthy group.

According to Morawska and West (2012) the conclusion of this article was that because parents of obese children are more likely to have their own weight problems, they may model ineffective lifestyle patterns. Also their knowledge of effective strategies to control their children’s weight, and implementing lifestyle changes to promote a healthy BMI may not be as effective. This is important information for nurses to know when educating patients on childhood obesity. This information may change the approach that needs to be used, and may even address the weight problems of the entire family and not just the child.

Article two

The second article that was reviewed was focused around whether parents are using portion control when feeding their children (Small et al. 2013). This article also examines whether education and training parents on portion control could have an effect on the rising obesity problem. This article is nursing research because many of the authors are nurses and this topic deals with nursing in relation to education. This article is a systematic review which looked at nine different research articles. The purpose of this study was to examine findings regarding the food portion sizes for young children, and finding evidence regarding the effects of educating adults to estimate portion sizes. The general sample in these studies included children from age two through age eleven.  There is no specific sample because this is a review of nine different studies. There is also no specific level of measure in this type of study because it involves many different studies and reviews the results of the combined study.

The QSEN level of evidence for this article is a level I (Cronenwett et al., 2007). This is the highest quality of evidence defined by QSEN. The results of this systematic review showed that there was a positive effect of portion size on the energy intake of children. Also the ability of parents to accurately estimate the portion sizes for their children improved following education and training. Recommendation for this study would be to offer all children the same food because a limitation of this study was the variety of food was unknown. This is important information for nurses to communicate to patients and their families when educating them about their weight.

Article three

The third and final article reviewed was a pilot study, the purpose of the study was to explore parenting style and other potential family and social indicators of an obese or weight-promoting family environment (Riesch et al., 2013). This article is nursing research because it is written by nurses and the information deals with nursing practice. This study was approved by the institutional review board. This was a cross-sectional descriptive study about parents and their children between nine and eighteen years of age. The sample for this study was twenty-eight parents and their children. The children had to be between the age of nine through the age of eighteen, and English speaking. They also must be diagnosed as overweight by a health care provider.

The data was collected using a variety of methods. Parenting style was scored using the parental acceptance –rejection questionnaire (Riesch et al., 2013). The parental method was scored using the 29-item family activity and eating habits questionnaire. These are an example of ratio levels of measure because the information can be ranked into specific groups and there is an absolute zero. This study also had interval data using the weight of each study participant.  This study found that parents with moderate control had more concern about their children’s weight and had better knowledge of nutrition when compared to parents with strict control. This study could be significant to nursing because if it is known how parenting styles effect the weight of their children, nurses could properly educate patients and their families about family dynamics and their relationship to weight.

Significance to Nursing

            It is important to research topics that are related to the type of work that nurses preform on a daily basis. Education it one of the top nursing priorities that is set for each patient that receives care, and nurses need to be knowledgeable in order to properly teach. This topic is so important to the future of the healthcare system, and if nothing is done to stop this trend toward obesity in the younger generation, the healthcare system may suffer. Educating parents and the children of each community about proper diets, different parenting styles, and the negative effects that childhood obesity may have on their health and the health of their children might be what it will take to change this obesity epidemic.

In researching ways to help educate patients and their families, it is essential that the research used is quality evidence. In order for the nursing profession to continue to grow and develop, evidence based research should be utilized in practice. The American Nurses Association (ANA) has set standards in which all nurses are expected to follow (American Nurses Association [ANA], 2010). Standard nine states that evidence based practice should be used to guide nursing practice. The research found should be communicated to other members of the healthcare team so the best practice is always being utilized. Standard ten of the ANA is communication, not only with patients and their families, but also with the other members of the healthcare team (ANA, 2010). Nurses are lifelong learners, the skills and practice will change many times. Communication will help to ensure that all members of the healthcare team are on the same page, and the patient will receive high quality healthcare.

Patients trust nurses to give them the best advice that is out there, and using evidence based nursing practice every day will help keep patients safe, as well as delivery high quality care. According to QSEN, evidence-based practice” integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care” (Cronenwett et al., 2007, table 3).

It is also important for nurses to remember that not all patients learn the same way, what work for one person may not work for everyone. Nurses need to learn how to adapt the care they give around each patient and develop a plan of care that is unique to them. QSEN defines patient-centered care as” recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs” (Cronenwett et al., 2007, table 1). Encouraging patients to get involved in their own care and developing care based around their abilities will help the patient feel they are in control of their care, which will increase the quality of care they receive. This will help the profession of nursing continue to grow and develop while forever expanding knowledge and practice.

References

American Nurses Association. (2010). Nursing scope and standards of practice. In .Silver Spring, MD: American Nurses Association

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., … Warren, J. (2007). Quality and Safety Education for Nurses. Nursing Outlook, 55(3), 122-131.

Morawska, A., & West, F. (2012). Do parents of obese children use ineffective parenting strategies? Journal of Child Health Care, 17(4), 375-386. http://dx.doi.org/10.1177/1367493512462263

Nieswiadomy, R. M. (2012). Foundations of Nursing Research (6th ed.). Upper Saddle River, NJ: Pearson Education.

Riesch, S., Lyles, A., Brown, R., Perez, O., Kotula, K., & Sass-DeRuyter, S. (2013). Modifiable Family FactorsAmong Treatment-SeekingFamilies of Children With High Body Mass Index: Report of a Pilot Study. Journal of Pediatric Health Care, 27(4), 255-266. http://dx.doi.org/10.1016/j.pedhc.2011.11.006

Singleterry. (2014). NURS 350 Nursing Research [syllabus].

Small, L., Lane, H., Vaughan, L., Melnyk, B., & McBurnett, D. (2013). A Systematic Review of the Evidence: The Effects of Portion Size Manipulation with Children and Portion Education/Traning Interventions on Dietary Intake with Adults. Sigma Theta Tau International, 69-81.

United States Department of Agriculture Food and Nutrition Service. (2014). http://www.fns.usda.gov/wic/women-infants-and-children-wic

Williams, N., Fournier, J., Coday, M., Richey, P., Tylavsky, F., & Hare, M. (2012, August). Body esteem, peer difficulties and perceptions of physical health in overweight and obese urban children aged 5 to 7 years. Child: Care, Health and Development, 39(6), 825-834. http://dx.doi.org/DOI: 10.1111/j.1365-2214.2012.01401