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Benchmark – Part B: Population Health Research and PICOT

Benchmark – Part B: Population Health Research and PICOT

The prevalence of childhood obesity continues to raise a serious public health concern. The development of the condition is significantly influenced by poor parental practices; parents tend to give their children inappropriate food which eventually puts them at high risk of developing childhood obesity. The prevalence of obesity among the children is higher among the minority ethnic groups including the African Americans and Latin Americans. According to the federal government statistics, the prevalence of childhood obesity among the Latin American children is 25.8% and this is slightly higher than the rate recorded for the African American children (“State of Childhood Obesity”, n.d.). Therefore, exploring effective measures to address and reduce childhood obesity among the Latin Americans is significantly essential.

Nurses remain at the core of effective care provision and a growing profession because of its evolution. The need for advanced education and training, ensures that nurses are well positioned to deliver care in a transforming health industry. Today, professional nursing entails specialization and scopes of practice based on one’s clinical skills, capabilities, and competencies. The use of innovative care models and evidence-based practice implores nurses to advance their education, focus on patient care, and work in teams to enhance quality and delivery of patient care (Graebe & Chappell, 2019). The purpose of this essay is to evaluate contemporary nursing practice and evaluate how it has changed over time and its position today in health care system.

Methodology

The study involves literature review where a total of five articles were reviewed. The selection of the articles was based on their relevance to the research topic. The key search words included ‘pediatric obesity, childhood obesity, Culturally Tailored, Family Centered and Behavioral Intervention.’ A total of 25 articles were retrieved in the initial search; this was filtered to 5 articles based on the clinical research appraisal guidelines.

Literature Review

The study conducted by Falbe, Cadiz, Tantoco, Thompson, & Madsen, (2015) explored the effectiveness of culturally tailored obesity interventions among Latino children. The study involved testing the impact of the family-centered culturally tailored obesity on the body mass index as well as determining the cardiovascular risks among the Latino children. A randomized control trial study design was utilized whereby a population of 55 parent-child dyads was given an active and healthy family or the contemporary care waits for the list-control condition. The selection of the dyads was based on their ability to speak Spanish and provided that they took care of children aged between 5 and 12 years. The active and healthy families’ interventions were given for 10 weeks. The results indicated that children receiving the AHF intervention recorded a significant reduction in the BMI and also exhibited a relative improvement compared to the control in terms of blood pressure, triglycerides level and fasting blood measures. Falbe et al. (2015) concluded that AHF interventions were more effective in the management and prevention of childhood obesity among Latino children. The findings from the study are relevant in exploring the PICOT in the current study. AHF is among the family interventions that have been proposed in the current study that could help reduce body mass index.

Further, Smith, et al., (2018) explored the impact of the family-centered intervention for pediatric obesity in the primary care setting. Pediatric obesity is a major public health concern that is associated with early mortality, cancer, and cardiovascular diseases. Slight changes in the dietary intake, body mass index (BMI) and physical activities can significantly reduce the risks associated with the development of cardiovascular conditions. According to the study, family-based behavioral interventions have been underutilized in the management and prevention of obesity among children. The study employed a randomized control trial where the effectiveness of the Family Check-Up 4 Health programs were evaluated. A total of 350 families with children aged between 6 and 12 years were recruited in the study. The children were identified as overweight. The population characterized by multi-ethnic groups including the Latinos, African Americans, and the American Indians.

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Findings from the study are important and effective in the implementation of programs that prevent excess weight gain and thus relevant in this study Smith, et al. (2018) concluded the FCU4Health program was effective in helping reduce childhood obesity. The purpose of the current study is to explore and develop effective evidence-based approaches that can be used to manage and reduce the incidences of childhood obesity among Latin children. In as much as there are existing approaches used in the prevention of childhood obesity, developing superior measures would be more beneficial and effective in reducing the incidences of childhood obesity and the associated burden (Smith, et al., 2018). Primary care is promising in enhancing the parenting behaviors associated with children’s health. Considering that children spent most of their time with the parents and only interact with the healthcare providers occasionally, employing the family-based interventions are more effective in promoting the beneficial outcomes and preventing the development of obesity. The Family Check-Up 4 Health is an enhancement from the conventional family check-up interventions (Smith, et al., 2018).

According to Barkin, et al. (2018), behavioral-based interventions are essential in reducing the BMI trajectories among the Latino pres-school aged children. A randomized clinical trial was employed in exploring the role of behavioral control programs in reducing obesity among the underserved Latin American children (Barkin, et al., 2018). A multi-component behavioral intervention was developed and the growth trajectories of the children monitored among children aged between 3 and 5 years in a 36 months’ program. In the clinical trial, a total sample population of 610 patient-child pair was used from the Latino and other underserved communities. The enrollment into the program took place between August 2012 and May 2014 with the follow-up running up to June 2017. The intervention in the study involved a 36-month family-based and community-centered program characterized by 12 weekly sessions of skill building and then 9 months of coaching and telephone calls. The main outcome measure in the study was the BMI trajectory over 36 months. The study findings indicated that the intervention was effective in lowering the mean caloric intake and thus would significantly reduce the risk of developing obesity (Barkin, et al., 2018).  However, there was no a conclusive reporting on whether the multi-component behavioral intervention changed the BMI trajectory or not; therefore, this would require further research to come up with a conclusive answer to the question (Barkin, et al., 2018). The findings from the study form the baseline and background for exploring the role of Culturally Tailored, Family Centered Behavioral Intervention in preventing obesity among Latin American children. Childhood obesity is mainly associated with poor dietary intake. Therefore, teaching parents on the best feeding habits would help save their children from obesity and other nutritionally-related diseases and disorders.

While obesity impacts all ethnic groups, the Latinos and African American are the most affected groups. Therefore, the study conducted by Suarez-Balcazar, Friesema & Lukyanova (2014), explored the evidence in the cultural competent measures in addressing and preventing obesity among the pediatrics. The study involved a literature review where over 80 articles describing the successful interventions were reviewed. Furthermore, the study highlighted that obesity interventions are complex and require a lot of strategies. In reducing childhood obesity, measures should be developed to promote healthy eating and regular physical exercises among the children. The study emphasized the importance of cultural-competency as a major strategy that can be adapted to reduce childhood obesity. The study findings provide useful insights that will guide the scope of the current study in exploring the study problem. The incidences of childhood obesity are alarming and thus urgent and effective interventions are needed to address the public health concern.

In addition, the study conducted by Volger, Radler & Rothpletz-Puglia (2018) explored the rate of obesity among the pre-school children and how developed family and cultural-based interventions would be used to reduce them. The study involved a scoping review conducted according to the Askey and O’Malley’s framework in providing an overview of the types and cost-effectiveness of the prevention measures. A total of 34 studies were reviewed. The findings indicated that interventions targeting behavioral change and interpersonal health-level were effective in reducing the rates of childhood obesity among the targeted populations.

The findings from the analyzed studies indicate that adopting Culturally Tailored, Family Centered Behavioral Intervention would significantly improve the health promotion outcomes targeting reduction of childhood obesity among the Latin Americans. In all case, the engagement of any of the intervention would result in improved positive outcomes as compared to the conventional individual interventions. However, the study time-frame for each case differed significantly with some taking up to 36 months while others even taking a shorter time. The current study aims at exploring the role of the interventions in reducing childhood obesity among the Latin American children within a period of six months. By building on the already existing studies, the current findings will be reliable and can be used to develop recommendations for addressing the issue.

 

 

References

Barkin, S. L., Herman, W. J., Sommer, E. C., Martin, N. C., Buchowski, M. S., Schlundt, D., … & Truesdale, K. P. (2018). Effect of a behavioral intervention for underserved preschool-age children on change in body mass index: a randomized clinical trial. Jama320(5), 450-460.

Falbe, J., Cadiz, A. A., Tantoco, N. K., Thompson, H. R., & Madsen, K. A. (2015). Active and healthy families: a randomized controlled trial of culturally tailored obesity intervention for Latino children. Academic Pediatrics15(4), 386-395.

Smith, J. D., Berkel, C., Jordan, N., Atkins, D. C., Narayanan, S. S., Gallo, C., … & Meachum, M. K. (2018). An individually tailored family-centered intervention for pediatric obesity in primary care: study protocol of a randomized type II hybrid effectiveness–implementation trial (Raising Healthy Children study). Implementation Science13(1), 11.

Suarez-Balcazar, Y., Friesema, J., & Lukyanova, V. (2014). Culturally competent interventions to address obesity among African American and Latino children and youth. Occupational therapy in health care27(2), 113-128.

The state of childhood obesity – the state of obesity. (n.d.). Retrieved from. https://www.stateofobesity.org/childhood/

Volger, S., Radler, D. R., & Rothpletz-Puglia, P. (2018). Early childhood obesity prevention efforts through a life course health development perspective: A scoping review. PloS one13(12), e0209787.

 

Stress refers to a physiological and psychological and response to unwelcoming experiences usually referred to as stressors. A person’s stress threshold is determined by the source of stress, individual characteristics, past experiences, and coping skills. Sources of stress are grouped into four: social stressors, the physical environment, physiological, and psychological, which exist in diverse occupational settings (Kaburi et al., 2019). This paper seeks to explore the prevalence of occupational stress among nurses, including the factors that may influence population health management for nurses, and propose a potential solution to solve this health issue.

Population Description, Including Demographics and Health Concerns

According to the American Association of Colleges of Nursing (AACN), nursing is the largest healthcare profession in the U.S, with over 3.8 million registered nurses (RNs) countrywide. Besides, 84.5% of licensed RNs are employed in nursing (AACN, 2019). There are approximately 122,000 RNs in my state, North Carolina. The federal government estimates that more than 200,000 new RN positions will be formed annually from 2016-2026 (AACN, 2019). Approximately 58% of RNs work in general medical and surgical healthcare facilities and are the primary providers of hospital patient care providing the largest part of the country’s long-term care.

Occupational stress is an acknowledged health concern among nurses. A relationship of various factors in the work environment causes occupational stress among nurses. The key factors among these are high workloads, understaffing, high demand for administrative accountability, working in a physically and emotionally exhausting environment, insufficient autonomy during decision making, and lack of cooperation from patients and their families (Kaburi et al., 2019). Furthermore, strained working relationships between nurses and other health professionals, lack of support by the management, and the high degree of knowledge and skill required, are associated with occupational stress (Veda & Roy, 2020). Nurses’ stress is aggravated by the need to respond immediately in an emergency, the necessity for continuous attention to details of patient care, and lack of time to take a break.

Synthesis of Nursing Science, Determinants of Health, and Epidemiologic, Genomic, and Genetic Data in the Management of Population Health

Nursing science can influence the management of occupational stress among nurses by researching evidence-based strategies to prevent or alleviate stress in the nursing profession. Besides, nurses can identify stressors in their working environment and examine strategies that can be implemented to mitigate these stressors (Veda & Roy, 2020). Nursing science can impact stress management by nurses providing health promotion to other nurses on stress-management techniques to reduce the impact of stress on their health and quality of patient care.

Determinants of health that may impact management of this issue include income and working environment. Keykaleh et al. (2018) explain that a major cause of stress among nurses is the stressful working conditions. These factors include long working hours, high workload, dissatisfaction with wages and benefits, and working overtime. The factors can negatively impact occupational stress management among nurses since they alleviate psychological stress, resulting in poor mental health outcomes. The lack of social support from patients, relatives, and other health providers also affects the management of the condition because they intensify the stress.

Epidemiologic, genomic, and genetic data influence the occurrence of occupational stress among nurses and its management. According to Kakemam et al. (2019), epidemiologic factors that impact occurrence and management of occupational stress among nurses include female gender, being married, increased work hours, and working in general wards, emergency, and teaching hospitals. Consequently, stress may be more severe among female and married nurses and those working in the mentioned clinical settings. Meier et al. (2019) found that PDE4B genetic variants are associated with anxiety and stress-related disorders. Nurses with this genetic variant may thus be more vulnerable to occupation stress, and their management may be more complicated than those without the variant.

Potential Solution and PICOT Statement

Occupational stress among nurses is associated with far-reaching consequences both for nurses and their patients. According to Starc (2018), stress can have a considerable effect on nurses and their capacity to carry out tasks and, in particular, low concentration levels, poor decision making, decreased motivation, apathy, and anxiety. Therefore, it is crucial to identify a solution to mitigate or reduce occupational stress among nurses. My proposed potential solution is educating nurses on stress-management strategies. The proposal seeks to enable nurses to handle stressful work situations effectively with no effects on their mental health.  Starc (2018) explains that there are numerous stress and burnout prevention measures, strategies, and techniques, which facilitate people to modify their perception, attitudes, and behaviors to protect their health and wellbeing. The most common ones are cognitive restructuring, time management, constructive monologue, assertiveness training, social support, coaching, and supervision.

PICOT Statement: In registered nurses (P), does online education on stress-management strategies (I), compared to no intervention (C), reduce the prevalence of occupational stress (O) within 6 months (T)?

How the Solution Incorporates Health Policies and Goals That Support Health Care Equity for the Population of Focus

The proposed potential solution supports the Healthy People 2020 goal of improving mental health through prevention and promoting access to appropriate, quality mental health services. Health education on stress-management strategies is a mental health prevention intervention that improves their mental wellbeing. The proposal aligns with objective MHMD-4.2 to reduce the percentage of adults aged 18 years and above who experience major depressive episodes. Nurses with occupational stress are vulnerable to depression, which can lead to suicide. The proposal will lower the risk of nurses developing depressive disorders secondary to occupation stress and ultimately reduce the incidence of suicide by nurses.

Conclusion

Occupational stress is prevalent in the nursing profession. It is thought to result from an imbalance between workplace stressors and a person’s coping abilities, resulting in negative health outcomes. It is attributed to poor working conditions, high job demands, poor communications with patients and other providers, and an exhausting work environment. The consequences of occupational stress among nurses are poor quality of patient care, undesirable disease outcomes, and increased healthcare costs. Nurses’ mental health is also affected as stress puts them at risk of anxiety and depressive disorders. My proposed solution to address the occupational stress menace is to educate nurses on stress management strategies that they can employ to mitigate or reduce stress levels, thus promoting their mental wellbeing.

 

 

 

References

Kaburi, B. B., Bio, F. Y., Kubio, C., Ameme, D. K., Kenu, E., Sackey, S. O., & Afari, E. A. (2019). Psychological working conditions and predictors of occupational stress among nurses, Salaga Government Hospital, Ghana, 2016. The Pan African Medical Journal33. https://doi.org/10.11604/pamj.2019.33.320.16147]

Kakemam, E., Raeissi, P., Raoofi, S., Soltani, A., Sokhanvar, M., Visentin, D. C., & Cleary, M. (2019). Occupational stress and associated risk factors among nurses: a cross-sectional study. Contemporary Nurse55(2-3), 237-249. doi: 10.1080/10376178.2019.1647791.

Keykaleh, M. S., Safarpour, H., Yousefian, S., Faghisolouk, F., Mohammadi, E., & Ghomian, Z. (2018). The Relationship between Nurse’s Job Stress and Patient Safety. Macedonian journal of medical sciences, 6(11), 2228–2232. https://doi.org/10.3889/oamjms.2018.351

Meier, S. M., Trontti, K., Purves, K. L., Als, T. D., Grove, J., Laine, M., … & Mors, O. (2019). Genetic variants associated with anxiety and stress-related disorders: a genome-wide association study and mouse model study. JAMA Psychiatry, 76(9), 924-932. https://doi.org/10.1001/jamapsychiatry.2019.1119

Starc, J. (2018). Stress factors among nurses at the primary and secondary level of public sector health care: The case of Slovenia. Macedonian journal of medical sciences6(2), 416–422. https://doi.org/10.3889/oamjms.2018.100

The American Association of Colleges of Nursing. (2019, April). AACN fact sheet – Nursing. The American Association of Colleges of Nursing (AACN). https://www.aacnnursing.org/news-Information/fact-sheets/nursing-fact-sheet

Veda, A., & Roy, R. (2020). Occupational Stress Among Nurses: A Factorial Study with Special Reference to Indore City. Journal of Health Management22(1), 67-77. https://doi.org/10.1177/0972063420908392