NuRS21010 Understanding Evidence-Based Nursing Practice

Concept	Terms	Boolean Operator	Hits
Population: Childhood	Childhood, young people, children, child, youth.	(Childhood obesity or young people or children or child or your ) and health promotion or cognitive behavioural therapy	38
Intervention: health promotion	Health, promotion,	(Childhood obesity or young people or children or child or your ) and health promotion or cognitive behavioural therapy	21
Comparison: Cognitive Behavioural Therapy	CBT, behavioural, behavioural	(Childhood obesity or young people or children or child or your ) and health promotion or (cognitive behavioural therapy or CBT )	17
Outcome: obesity	Obese, weight gain.	(Childhood or young people or children or child or youth ) and ( obesity or obese or weight gain) and health promotion or (cognitive behavioural therapy or CBT )	11

Which is more effective in reducing childhood obesity health promotion or Cognitive behavioural therapy?

Concept	Terms	Truncate	Hits
Population: Childhood	Childhood, young people, children, child, youth.	Child* obesity health promotion or cognitive behavioural therapy	26
Intervention: Nurse led health promotion	Health, promotion,	Child* obesity and health promotion and cognitive behavioural therapy	15
Comparison: Cognitive Behavioural Therapy	CBT, behavioural, behavioural	Child* obesity health promotion or cognitive behaviour* tharap?	10

The first part of my essay will be based on the evaluation on my question this will include looking at the strengths, weaknesses and how I could improve it if I were to do it again.

I wanted to research the question: which is more effective in reducing childhood obesity, health promotion or Cognitive behavioural therapy? As I find the topic childhood obesity really fascinating especially with the current national epidemic of childhood obesity. This made me realise that it’s a concerning health issue so I wanted to explore the possible interventions which were available for those suffering from childhood obesity. To do this I compared one of the most common interventions (health promotion) to one of the emerging interventions being used to treat childhood obesity (cognitive behavioural therapy). I used the CINHAL database for my literature search as it provides indexing of the top nursing and allied health literature (CINHAL, 2013) and offers information relevant to my question.

When researching I used truncation I decided to truncate the terms in my research question as I wanted to collect the information which was relevant to my question rather than irrelevant data, as it did not correlate to my question. This worked as each time I truncated I was able to gather data which related to my research question so this was beneficial mechanism when gathering relevant data.

A research mechanism which I used was the Boolean operator to help me find appropriate literature. Boolean operators utilise the terms: “and”, “or” and “not” to restrict, increase, or narrow searches depending on Boolean logic, which describes how Boolean operators manipulates large sets of data (Barker et al 2011).Boolean operators link keywords and phrases this informs the search engine how to interpret the search, which helps identify the results the researcher is looking for (Barker et al 2011). By utilizing the Boolean operator it helped narrow my search and provided me with the literature which was relevant to my research question. Because at first when I researched I got a lot of hits but a majority if the literature was irrelevant and therefore not required, but by using the boolean operator it allowed me to access specific literature for my research question.

I think I could have improved my research question by making my research question more specific for instance instead of childhood obesity which is a very large age group I could have narrowed it down to teenagers. As this will give me a sense of direction when looking for supporting literature as it’s a specific age group this can be supported by Sackett (2000) who sates that by asking a precise question you can look for specific knowledge for chosen research topic.

Whereas with my current question I have a lot to cover as it looks at childhood obesity which is a broad age group, which makes it difficult gathering supporting literature. Another weakness is that although I gathered literature for my research question a majority of it was applicable to health promotion interventions in comparison to cognitive behavioural therapy in relation to childhood obesity. So to alter this I think I would have compared health promotional techniques to non-health promotion health techniques. This will ensure I get a balance of supporting literature between the comparisons, as there was little literature for cognitive behavioural therapy.

This part of the essay will critically appraise intervention for ineffective airway clearance in asthmatic children: a controlled and randomised clinical trial (Lima et al, 2013). The CASP tool (Guyatt et al 1993) will be used to achieve this.

1. Was the question clear?

The population that was studied was 42 asthmatic children age < 36 months. The applied treatments consisted of actions linked to change of positioning and stimulation of cough. The outcome of the research is the effectiveness of interventions for ineffective airway clearance (IAC) in asthmatic children (Lima et al, 2013). From this it is appropriate to say that the study asks a clearly focused question. It’s vital that research questions are clear. The question must emphasis the topic of interest and be presented in such a way that someone who is not an proficient in that field will recognise why the research was carried out (Blaikie, 2009).

2. Was this a randomised controlled trial?

The study used a randomised clinical trial (RCT). A RCT is where partakers are randomly allotted to one or more control groups this is determined by the number of interventions (Parahoo, 2006). Randomisation means allocating applicants to experimental or control groups at random so that partakers have an equal likelihood of being placed in either group (Lang, 1997). This eradicates selection bias and offers equilibrium amid recognised and unidentified confounding factors to make a control group similar to the treatment group (Akbong, 2005).

The method was apt for the question being researched as Machin & Fayers, (2010) states that RCT’s are the principal mode for defining the comparative efficacy and safety of substitute medical devices, interventions or treatments. This method is apt for the research as the question aimed to analyse the effectiveness of an intervention for the nursing diagnosis of ineffective airway clearance in asthmatic children. The study used this method to verify the effect of asthmatic of an intervention for asthmatic children. Lawrence et al (2010) RCTs are the finest for trials determining the impact of health interventions, they’re very robust and systematic for critiquing the efficiency of health interventions. Though there is a risk of bias when there are errors in the strategy and organisation of a trial (Akobeng, 2005).

3.Were participants allocated to intervention group and control groups?

The partakers were aptly allocated to intervention and control groups. As participants were allocated to groups via generating an algorithm of random numbers through the use of the R software (Lima et al, 2013). The inclusion criteria in the study were asthma identified by a doctor, based on assessment and physical existence defining features and linked factors termed in the NANDA international taxonomy age < 36 months. Participants with other illnesses were excluded (Lima et al, 2013). By using the NANDA international taxonomy indicates the study used stratification method to help allot the children into groups. The NANDA international taxonomy is a nursing board which offers paradigms for nursing diagnoses (NANDA, 2012). The intervention group had participants with a higher weight and age values in contrast to the control group. Randomisation can eradicate selection bias, but doesn’t promise that both the intervention and control group will be parallel in relation to key features of applicants (Chia, 2000).In research, vital prognostic factors are acknowledged prior to research. To ensure the intervention and control groups are alike a distinct block of randomisation lists for different mixtures of prognostic elements is made. This is stratified block sampling or stratification (Akobeng, 2005).

4. Were participants and staff blind to participants study group?

The team member who did the randomisation did not partake in the interventions or the outcome evaluation. This shows that the study used blinding which is vital as there is a threat in RCTs exploring the benefits of one intervention over an alternative as it can impact outcomes, causing influenced results. Blinding trials reduces bias, blinding refers to the exercise of stopping partakers, health professionals, and those gathering and examining data from knowing who is in the experimental group and who is in the control group, to avert them from being influenced by such knowledge (Day, 2000). Studies show that by blinding patients and health professionals avoids bias. Trials which didn’t blind bore more estimates of treatment effects than trials in which authors conveyed blinding (odds ratios overstated, by 17%) (Schulz &Grimes, 2002).

5. Were all participants accounted in conclusion?

All the participants in the study group were followed up for its conclusion. The participants in the control group did not get the option to be in the intervention group or vice versa.

6 .Were participants in all groups followed up and data collection in the same way?

All the participants were followed up in the study

.

The effect of the intervention was evaluated at a single moment, due to the obstruction of secretion as it reversed quickly and linked to working with other professionals (Lima et al, 2013).

7. Did the study have enough participants to minimise the chance of play?

The study used chi-squared test for power calculation. The test aims to test the hypothesis of no association between two or multiple groups, criteria and population (West, 2008). The chi test found P=0.061, statically significance was assumed at P < 0.05. (Lima et al, 2013). When looking for p-calculation the following should be considered: the size of the sample, the parameters of the substitute and null hypothesis i.e. how they differ, the significance or confidence level and the distribution of the parameter to be valued (Olbricht &Wong) .

8. What is the main result?

The study found an improvement in obstructive symptoms in those who took the intervention offered, with great alterations in the displays of choking and adventitious breath sounds. The generalisations may be limited as children in the intervention group show higher values for age and weight. The group also consisted of children under the age of 36 months thus likely to have asthma attacks (Lima et al, 2013). This may question the validity of the results found. The study also found there was little research in this topic making it challenging when trying to compare findings with other research (Lima et al, 2013). The study uses a small sample as there are only 42 participants in the study, so not really representative. Akobeng, (2005) argues that when a study uses a small sample of participants in it can be difficult identify the real variances of results found from both the intervention and control group. The study highlights the need for research on airway clearance techniques to assess the effectiveness of its use. The findings suggest studies to offer planned interventions during hospitalization to determine the link between the intervention and a decreased in the duration of hospital stay (Lima et al, 2013).

9. How precise are these results?

The study used Mann–Whitney test uses the findings of the t-test to identify variances amid two groups of habitually distributed population (Burns & Grove, 2005). The Mann Whitney test found that after the intervention, the intervention group showed greater improvement than the control group for the indicators of choking (16.83 vs. 26.17, P = 0.007) and adventitious breath sounds (16.4 vs. 26.6, P = 0.005). This illustrates that the detected variance between the groups is doubtful to have happened by chance hence the null hypothesises rejected due to no variance and the other hypothesis as there is an actual variance in the intervention group is taken into account (Akobeng, 2005).

10. Were all vital outcomes considered so the results can be applied?

The participants in the study are classified as asthmatic it doesn’t specify the type of asthma they have. Knowing they type of asthma they had i.e. chronic or acute asthma is beneficial as will illustrate if there is a different effect on a patient with certain type of asthma. For instance Schechter (2007) found that airway clearance therapy has little or no effect on acute asthma, so techniques used in this study may not be applicable for those with acute asthma. Airway clearance techniques requires training in order for patient or carers to carry it out correctly, this may be an issue for some as they may not have the funding or money for training.

In relation to parents and carers airway clearance techniques may be a barrier for them when implementing it to their child. As airway clearance techniques require equipment and considerable amount of time (Walsh et al, 2011) to carry out in order to ensure that it is carried out correctly and effectively on child. This can be an issue for parents and carers especially if they don’t have the time due to other issues such as work or taking care of other children.

According Pryor (2009) to policy makers and health care professionals in the UK, are less likely to utilise the intervention of airway clearance in asthma patients due to the uncertainty of the effectiveness of its usage in asthma patients this is also because of little research available on this topic. The study itself also mentions the lack of research available on airway clearance Walsh et al, (2011) techniques for asthma (Lima et al, 2013). Also found although airway clearance techniques have progressed over the years there is little research to illustrate the effectiveness of airway clearance techniques amid the child population who have asthma (Walsh et al, 2011).

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