Abstract

This paper presents an evidence-based practice project proposal on the effective ways of addressing the challenge of obesity. As a result of the changes in lifestyle, obesity is increasingly becoming a health issue in the continent. Unlike in earlier days where obesity was more prevalent among adults, the problem is now rampant even among children and teenagers. Thus, it is necessary for the community to establish workable solutions to the obesity. This proposal argues for two major ways of mitigating obesity. First, the proposal advocates for the need to incorporate physical exercises in day-to-day life. It also proposes the need to adopt healthy eating habits as opposed to traditional junk and fast foods. Notably, the proposal elaborates a concise change in lifestyle as a way of mitigating obesity.

Part 1: Introduction

i.                    The problem statement

Comprehending my organizational culture in the context of providing evidence-based practice is vital in developing a system to make efforts to improve quality of care. Organizational culture of many healthcare organizations especially the hospital where I practice as a staff nurse exert  an increased influence on the care quality through various factors in the context that healthcare professionals and clinicians carry out their practice with the experience in patient care.  Understanding this important context allows the nurses in providing care that bridge the gap seen between research and practice. My organization is a small community acute care hospital, which is in a good position to better utilize the evidence-based practice. The organizational Culture & Readiness for System-Wide Integration of Evidence-based Practice Survey by Melnyk&Fineout-Overholt (2015) consists of 19 items. There are about 100 nurses working at the small acute care hospital that I practice at. The readiness level of the organization consists of varied results. The scores on the survey vary from the lower of 1 to the highest of 4. The lowest score is 1 on the survey list, which is “To what extent are librarians used to search for evidence?” The reason for this being that there is no library/librarian in the hospital. However we do have access to some online search engines such as OVID through the hospital computer though it appears that only very few staff has knowledge of the site. Another lower score that has improved in the last 6 months from 1 to 3 is the institution readiness for EBP. The organization has been making some movement toward an EBP. For example, the education department introduced the “AIDET” which stands for “Acknowledge, Introduce, Duration, Explanation, and Thank You” EBP used for hourly rounding. The nurses and other care professionals as well as team members were provided with education and hands on learning on hourly rounding and how to use it to provide intervention that is cost effective and decrease unneeded outcome to the patients. The hourly rounding has reduced   the number of patient falls thereby increasing safety and satisfaction.  “Evidence-based research indicated implementation of hourly rounding would increase pt. satisfaction, decrease fall rates, decrease skin breakdown rates” (Hourly Rounding Supplement, n.d.). Another EBP introduced was the use of Sepsis screening; this also has had a significant increase in the quality of care and decreased the number of patients going into sepsis/septic shock in all the clinical areas.  The care begins in the Emergency Department as soon as the patient is triaged and admitted, the history, labs, vital signs and other relevant information are evaluated. If the patient is suspect for sepsis based on the above data; treatment is initiated starting with fluid bolus, oxygenation and transfer to ICU.  As a result of the EBP and literature on sepsis, the organization started in March 2015, to train and offer some education to nurses. Part of the education involves screening for sepsis every 8 hours and as needed.  With the introduction of the screening, the organization has seen a reduction in death to sepsis on the clinical units.  The highest score of 4 are nurses modeling EBP in our clinical setting and having access to quality computers and electronic databases for searching for best evidence.  The barriers to EBP in my organization is not having a library and librarian as well as limited time in retrieving clinical information by the staff.  We also have some administrators and managers that are not wholly committed to EBPand limited knowledge on available information technology.  Other barriers are not having enough time, inadequate staff, outdated equipment and supplies as well as lack of training/in-service and educational opportunities for the staff.  Also, often, there is little collaboration between nurses and other professionals which affects care creating a barrier when it comes to implementing evidence-based practice. Melnyk&Fineout-Overholt (2015) wrote that, “Interdisciplinary professionals must work together in collaborative team spirit to advance EBP”. The best facilitator for the evidence-based project would be a nurse or staff that is dedicated and cares about change. The nurse has to be enthusiastic, approachable, positive and knowledgeable about the project and needs to be credible and skilled in excellent communication.  “Drivers to using best practice guidelines for practice change include awareness of the need for the practice change; availability of additional resources; enhanced distribution of the best practice change; feedback to the nurses on their performance; and ownership by leaders, developers, and clinicians” (Gale, Schaffer, 2009). The best reasons for EBP and readiness involve having interest in change in practice, providing cost effective patient care as well as eliminating risk and bad outcome to the patients, in addition to welcoming the value of the EBP.  Integrating clinical inquiry into my organization will require changing my organizational culture and mission around a clinical practice of EBP that requires providing resources and support by facilitating the evidence-based practice process and guiding practice change. In addition, it is known that emphasis on EBP in delivery of healthcare raise expectations that nurses use findings based on research to make well informed clinical decisions that in turn guide their actions and interactions with patients in a highly dynamic healthcare field with the varied organizational culture. Patient safety and quality care warrants that the best evidence-based practice is required for improving outcomes for the patient Clinical inquiry could be integrated into my organization by addressing the barriers of having limited staff nurses, lack of time, and inadequate supplies. There should be no delay in access to evidence-based journal literature articles as well as computers and text books that provide access to change in practice. The nurses and other practitioners must have access to the facilitator who is in the position to teach, clarify and answer questions for any practice change to happen. In conclusion, the organization could start by been consistent in training the staff, and educators, providing access and evaluating evidence that has an appeal to them. Also, they can advance clinical practice by providing an environment for a close collaboration on team decision making with the model of EBP that is unambiguous to the nurses, suits well with the organization. This might encourage and guide a system wide approach to EBP change in the organization.

ii.                  The problem statement

For the last few years, the number of obese children and adults in USA has increased dramatically (Babeyet al., 2011). The World Health Organization (WHO) puts this figure at 30 percent (Bonnet, Dubois, & Orozco, 2014). California has not been left out in this worrisome trend because about half of the counties have recorded high rates of obesity among children (Babeyet al., 2012). Although the number of obese children and adolescents in San Francisco is not as high as in other parts of the state, it is obvious that obese children and adolescents become obese adults when they grow up. Therefore, they pose a challenge to the county and state governments that offer medical care to obese citizens (Peebles, 2008).  A study that was conducted in 2013 by CDC revealed that 21 percent of obese high school students in San Francisco did not engage in physical activities for at least sixty minutes on daily basis. The study also revealed that 21 percent of these students spent most of their time watching television programs and 41 percent of them spent most of their time playing computer games and reading online. As it is evident from this study, majority of obese adolescents do not participate in physical activities or sports, as they should do. With regard to eating habits, the study revealed that 5 percent of these students did not drink fruit juices or eat fruits a week before the study. The study also revealed that 5 percent of these students did not take vegetables a week before the study. Furthermore, the study revealed that 21 percent of these students did not drink milk and 12 percent of them did not take breakfast a week before the study (CDC, 2015). Current studies show that in the future obese children and adolescents are likely to develop coronary heart diseases, high cholesterol, various types of cancer and hypertension among other diseases (Babeyet al., 2012). Studies also show that a lot of money will be spent treating obesity related diseases if the current obesity trend in USA persists. Apart from spending a lot of money treating these diseases, current figures demonstrate that U.S. federal government spends a lot of money offering medical care to obese people than it spends offering care to smokers (Bonnet, Dubois & Orozco, 2014). This shows that if state governments in USA do not do something about obesity, then federal government will spend even more money in the future given the current rate of obese children and adolescents (Macpherson-Sanchez, 2015). In realization of this fact, the proposed study will help San Francisco county government to develop various methods for reducing obesity among adolescents aged between ten and nineteen years.  In order to achieve the objectives of the proposed study, the main stakeholders as well as the change agents for the study will be the parents and schools. These two change agents will be critical because they will change the way adolescents in question eat and participate in physical exercises. On one hand, the parents will reduce the amount of fat that adolescents take in their food. On the other hand, the school will ensure that adolescents participate in physical exercises and take food with low fat (Babey et al., 2012). If the two change agents collaborate on this issue, then the county government and state government will benefit significantly from reduced cost of offering medical care to obese adolescents. In terms of interest, the county government, parents and schools may be interested in the proposed study because it has significant effect on each of them. The county government would reduce the amount of money it spends taking care of obese adolescents, parents as well would reduce such medical expenses while schools would enjoy having healthy students (Franzini et al, 2009).  From a clinical viewpoint, the proposed study will be an important one because it will help establish whether good nutrition and physical activities are important ingredients in reducing obesity among adolescents (Swinburn et al., 2004). If the two factors will be important in reducing obesity among adolescents living in San Francisco, then the study will advance the current literature. On the other hand, if the two factors will not be important in reducing obesity, the proposed study will form the basis of future studies (Kratz, Baars&Guyenet, 2012). From either perspective, the proposed study will be of great significance in nursing because either it will advance current literature, set the basis of future studies or do both.

iii.                The evidence-based question

In adolescents ages 10-19 years old with obesity (P) how does school based intervention of 30-60 minutes of physical activity (I) for 3-5 days per week and good nutrition (C) compared to no school based intervention for physical activity (O) and decreased access to good nutrition affect the prevalence of the disease over a 10 month period (T). The results would be measured based on pre and post body mass index (BMI) results. The purpose of the proposed study will be to evaluate the effectiveness of physical exercises and good nutrition in reducing obesity among adolescents living in San Francisco. In this regard, the weight and height of all research participants will be recorded before and after the study to help in calculating respective BMIs. In terms of objective, it is expected that at the end of the study, the BMIs of the students in the two sets of schools (one with intervention and the other one without intervention) will be significantly different. For this reason, the post and pre BMIs for the students from schools with interventions are expected to be statistically different from each other at the end of the study. On the other hand, the post and pre BMIs for the students from schools without interventions are expected to show no significant difference at the end of the study.

Part 2:            Assemble relevant evidence & related literature

i.                    Locating credible evidence

With regard to literature search, a comprehensive electronic search method was done using ProQuest, EBSCO and CINAHL as well as Medline databases. An additional search was done using the general Google search. The search included materials published between 2004 and 2015 and the key words used during the search were obesity, physical activities/exercises and good nutrition. After a thorough THE REST OF THE PAPER IS RESTRICTED. TO VIEW THE ENTIRE SAMPLE VISIT https://www.carescorp.com/courses/capstone-project-paper-on-evidence-based-practice-proposal-reducing-obesity-among-adolescents-in-america/