The role of nurses in the management of Obesity The case study provided regarding diet and weight management has led me to explore the role of a nurse specifically during the management of obesity. The investigation aims to determine how a nurse can intervene and control obesity. The research generally looks at the role of the nurse in managing a patient that is clinically classed as obese. Obesity is calculated using BMI measurements (appendix 1). Limitations to this investigation from a personal perspective are that I haven’t yet practised as a nurse so I can’t use reflection on my own practise as a learning tool.
Taking this into consideration I have sourced my information with the use of secondary research methods, thus meaning the summary and synthesis of existing research already available to me via published articles, books and other relevant resources. As you will see as you read on the value of knowledge and evidence to professional practise is critical. The main reason why you need to base your professional practice on the best available evidence is explained by Aveyard and Sharp (2009, p6), “…… t enables us to deliver the best possible patient/client care rather than out of date practice’’. Aveyard and Sharp (2009, p7) goes on to say that “evidence based practice is practice that is supported by clear reasoning, taking into account the patient or clients preferences using your own judgement”. This description is backed up by Sackett et al (1996, p71-72) who described EBP as, “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patient/clients”.
Gray (1997,p9) emphasized a focus on patient values describing EBP as , “an approach to decision making in which the clinician uses the best evidence available in consultation with the patient, to decide upon the option which suits the patient best. The NMC code of Conduct (2008) foregrounds the importance of evidence based practice in professional development and requires that all nurses should be accomplished in practicing evidence based care.
After reading various journal articles and books on EBP I have discovered that it is about integrating individual clinical expertise, for example your own proficiency and expertise, along with the best external evidence and also taking in mind the best interests for the patient. It is of high importance to use current best evidence, according to Greenhalgh and Donald (2000) without current best evidence, “practise risks becoming rapidly out of date, to the detriment of the patients”. Ultimately EBP is the formalization of the care process that the best clinicians have practiced for generations.
The contribution of EBP to clinical practice is the delivery of high quality, cost effective and quality care (Aveyard and Sharp, 2009). Challenges surrounding EBP are a nurses experience, for example new nurses may be a little anxious of their new surroundings and unable to utilize all their newly learnt skills. According to Ferguson and Day (2007), “access to evidence in nursing practice is often challenging due to time constraints, difficulties in interpreting the disparate research reports on particular issues, or lack of up-to-date print-based resources or Internet connections on nursing units”.
The main tool applied during my research process was Library Gateway which can be accessed via Shu space. Library Gateway enables you to access a large number of information resources and search tools. The main resource I used is Library Search, which can find results from books, full text journals and many other sources, and return them in one integrated list. The other Gateway tools include Subject Guides, help pages for referencing, the Video, Images and Audio guide and a list of subject databases.
Textbooks provide good background information and offer an excellent starting point for more in-depth research, the information provided is not normally rapidly changing and it must be remembered that it may be out of date. Journal articles contain current information and research. They provide detailed reports of the methodology and results of laboratory research, case series reports, clinical trials, program evaluation, and other kinds of research studies. Journal articles focus on finding solutions to specific health care problems. The Internet is not always the best place to look for professional-level information.
While it can be easily searched and you get a lot of what you find in full-text, the quality of the health care information found can be questionable. It is important to look at trusted authorities online, however the internet can be useful for looking into a patient’s perspective, for example a patient may explain their worries and experiences in an online chat forum which is always an interesting insight. The tables that follow details the databases used and the search criteria applied. Each database offers a different value of evidence. It is important to consider the following factors when looking t text documents regardless whether it a book, journal, article or online….. Who wrote it, why it was written and when it was produced (SHU 2012). Once you have found a source that is deemed suitable it is then important to consider if the study was original, was the design of the study sensible, has systematic bias been avoided or minimised, was assessment ‘blind’, were preliminary statistical questions addressed (Greenhalgh, 2010). After summing up these points the methodological quality will have been accurately assessed and providing no flaws or faults are found it can be deemed accurate and reliable information.
Table 1. Databases used; Database| Details| SHU Library Search| SHU Library Search searches for academic journal and newspaper articles, books,videos, maps and much more from a single search bar. It searches the SHU library catalogue, full text journals and other linked databases. It is limited to content subscribed to by SHU. | Internurse| Internurse is the online archive of peer reviewed nursing articles published by MA healthcare Ltd. It draws together articles from 13 high quality journals. | Table 2. Search Strategy;
Database| Keywords| Rationale| Criteria| No. of results| Search terms used in Library Search and Internurse| Nurs* AND manag* AND obes*| The word nurse/nurses/nursing and manage/managing/management and obese/obesity| 2008 to 2012English languageNo country specified. Type of publication: Peer reviewed journals and books | 32| You can search as far back as 2004 using Inter-nurse. For the chosen subject area I decided to concentrate my research more specifically on more recent research as I found I was bombarded with information when I looked as far back as 2004.
This has allowed me to look at more recent publications which I feel is highly important in a profession where health care routines are often being changed and improved. Once I had narrowed down the search I was able to pick journals, articles and books which I felt where most appropriate by reading the abstract to get a more in depth overview of what would be best for my topic. Obesity can lead to the onset of several complications, which with the intervention of nurses could be prevented, these complications are highlighted in appendix 2.
Maggi Banning (2005) states that there is an ever increasing need for the evolvement of a nursing role as an obesity nurse specialist. She claims the nursing profession needs to step up and prepare for obesity management. The National Obesity Forum provides an ‘Obesity Care Pathway Toolkit’. It strengthens the need for the use of EBP by claiming weight management should ‘…. be based on best evidence, where ever possible’. It also states the following, “It is essential that services be developed in consultation with the users and people who will be delivering them, working together as a multi-disciplinary group.
Training on weight management control, healthy eating and increasing physical activity to health professionals is necessary to ensure consistent, accurate and up to date messages are given to patients at all times. Currently, very few NHS weight management services are monitored or audited, this will be a must in the future and needs to be built in at the planning stage. The feedback will result in improved services to patients. ” Changes in eating habits and activity levels are thought to lie at the heart of obesity (Wadden et al, 2002).
As a nurse will get to see their patients everyday it is the ideal opportunity for them to advise patients on healthy eating and provide encouragement for increased levels of activity. Drummond (2002) identified that communication between the nurse and patient is important as some patients may be self conscious or body-conscious. For example certain terms should be avoided such as ‘sport’ or ‘exercise’ which may have negative associations for patients, a higher level of activity and ‘avoiding sedentary pursuits should be emphasised’.
Body weight is considered a sensitive issue for most people so it is vital that healthcare professionals handle the subject of weight loss with sensitivity. Crogan (2006) emphasized that it is important that nurses establish an open approach to communication when addressing issues relating to obesity. I feel a multi-component intervention would be the best way for nurses to manage obesity. It should include behaviour change strategies to increase peoples physical activity levels or to decrease inactivity levels, improve eating behaviour and the quality of the persons diet and aim to reduce energy intake.
According to (Sheehan and Yin, 2006) nurses constitute a political force in health policy, because they are situated in a wide range of settings. This is backed up by Bennett 2007 who states, ‘Nurses in the primary care setting are uniquely placed to support patients to make the necessary changes’. Nurses need to have an understanding of the patients multiple needs and to collaborate with other members of the health team to discuss personalized holistic care issues.
Chrystalleni and Christiana (2010) have recognised that “the aetiology of obesity is multi-factorial, and dietary factors that relate or are responsible for the development of obesity are complex and still not understood”. As they define development of obesity to not be understood I feel this is a large limitation and therefore requires constant comparison of current techniques used in managing obesity along with any current evidence that has arisen through trustworthy practice research. In conclusion, the role of a nurse in managing an obese patient should involve discussing the weight issues and the severity on the patient’s health.
As supported by Green et al (2000) this will enable the nurse to gain insight into the magnitude of the problem and to negotiate realistic goals in terms of weight loss and to support and provide dietary advice which is acceptable for the individual. Nurses should consider each patient holistically and use appropriate language in order to encourage and not offend. As encouraged by the national obesity forum patient selection should be active rather than passive, with opportunistic screening rather than reliance exclusively on self-referral.
The nurse should discuss ways in which a negative energy balance is achievable. References AVEYARD, Helen and SHARP, Pam (2009). A beginners guide to evidence based practice in health and social care,. Open University Press, McGraw-Hill. BENNET D (2007). Nurses at the cutting edge of obesity. Practise Nursing. 18,9,454-458. CHRYSTALLENI, Lazarou, CHRISTIANA, Kouta (2010). The role of nurses in the prevention and management of obesity. [online]. 19 (10) 641-647. Journal from British Journal of Nursing last accessed 12th November 2012 at http://www. internurse. om CROGAN E (2006). A bio-behavioural approach to obesity. Practise nursing. 17, 9, 439-442. DRUMMOND S (2002). The management of obesity. Nursing Standard. 16(48), 47-52. GRAY J. A. M (1977). Evidence-based Healthcare. Churchill Livingstone, Newyork, USA. GREENHALGH, T & DONALD,A (2000). Evidence based health care work book: Understanding research for individual and group learning. London, BMJ Books. Last accessed 16th November 2012. GREENHALGH, Trisha (2010). How to read a paper: the basics of evidence based medicine. [online]. London, BMJ Books.
Book from Library Gateway last accessed 12thNovember 2012 at: http://library. shu. ac. uk FERGUSON, Linda & RENE, Day (2007)Challenges for new nurses in evidence-based practice. [online]. Journal of Nursing Management. 15(1), 107-113. Last accessed 15th November at: http://onlinelibrary. wiley. com. lcproxy. shu. ac. uk/doi/10. 1111/j. 1365-2934. 2006. 00638. x/full JOLLEY, Jeremy (2010). Introduction to evidence based practice for nurses. Harlow. Pearson Education. MAGGI, Banning. The management of obesity: the role of the specialist nurse. online]. 14 140. Journal from British Journal of Nursing last accessed 12th November 2012 at http://www. internurse. com Nursing & Midwifery Council (2008). The code: standards of conduct, performance and ethics for nurses and midwives. Nursing & Midwifery Council. London. SACKETT, D. L. , et al. (1996). Evidence based medicine: what it is and what it isn’t. British Medical Journal, 312,71-72. Sheffield Hallam University (2012). Evaluation: Why evaluate. [online] Last accessed November 2012 at http://infoskills. shu. ac. k/skills/evaluation. html SHEEHAN NC, YIN L (2006). Childhood obesity: nursing policy implications. J Pediatr Nurs 21(4): 308-10, Last accessed November 2012 at http://www. who. int World Health Organisation (2005). Obesity and Overweight: Factsheet. [online] Last accessed 12th November 2012 at http://www. who. int/en Appendix 1. (WHO 1995) BMI (kg/m2) Category of Obesity 18. 5–24. 9 Normal weight 25. 0–29. 9 Grade I obesity 30. 0–39. 9 Grade II obesity ;40. 0 Grade III obesity
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