Discuss about the Role of Evidence Based Nursing Research.
Nurses have a critical role to play in providing the best quality of care to patients struggling with life threatening problems. This proposal deals with the identification of the problem in nursing and explaining its relevance. Further, the paper includes a critical appraisal of a study conducted by Martin et al., (2014) and discusses the appropriate quality improvement approach to be applied to solve the identified problem.
Nutrition is an important factor in chronic disease management . In Australia, only half of the patients with chronic illness receive adequate nutrition care in primary health care setting. It was evident from a thorough literature review that practice nurses are not able to deliver nutrition-focused care. There is an ongoing debate about most efficient method of providing nutrition care to patients. The rationale for investigating this problem is due to the significant impact of food-related behavior on health condition.
This proposal aims to understand the barriers to nutrition care in Australia and factors influencing the PNs because “practice nursing” is a new and evolving profession in Australia. It is observed since 2004, that there is an increase in the role of PN in chronic disease management. Moreover, nutrition is the vital component of management and prevention of chronic illness. Consequently, this study aims to develop the strategy to enable PNs to provide adequate nutrition care.
It has been estimated by Martin et al., (2014) that majority of practice nurses in Australia perceive that nutrition-focused training is essential to ensure that their practices are effective in increasing adherence to nutritional recommendations for patients. This article by Martin et al., (2014) has been selected for understanding the attitude of the practice nurses in Australia, in providing nutrition care to the patients with chronic illness.
The study by Martin et al., (2014), has provided an abstract where the researcher has concisely summarized the aim, background, methodology and results obtained from the study. The researcher of this article has presented a clear introduction highlighting the identified problem related to nutrition care in Australia with facts. The literature provided in the introduction substantiates author’s argument. The review, in the beginning, explains the relevance of the problem and rationalizes the emphasis laid upon practice nurses. The researcher has set a stage for the study by listing all the factors indicating the need of PNs in delivering nutrition-focused care and the positive aspects. The author has chosen “practice nurses” as a target population of study. The paper provides an adequate and convincing justification for this purpose stating that this group of health professionals has not been able to deliver effective nutrition-focused care. Relevant articles have not been used to support the impact of inadequate nutrition care.
This is the first article exploring the attitude and skills of PNs in providing nutrition care for chronic disease management. Therefore, the author could explain the literature gap in this area. It was found by the author that patients perceive involvement of PN’s in managing chronic illness as sustainable and feasible. It was also found that a majority of the PNs failed to consider the nutritional aspect of patient care. Therefore, this helps in establishing a trend in the influencing factors of nursing attitude towards nutrition care. There is a lack of critical analysis of previous studies used in the literature review, which constitutes the drawback of the article. The literature synthesis in this article was sufficient to establish the problem. This study was relevant for an author, because, in Australia, there is a demand for PNs for delivering effective nutrition care. To fulfill this demand, the author found it essential to assess the attitudes, skills, and perceptions of the practices nurses in Australia. Overall, the literature was found to be relevant to the topic. The author has successfully carried out the progression formed by the review throughout the study.
In this study, the online cross-sectional survey has been used by the author selecting 181 Australian PNs as the sample population. The selected nurses have been working between February to April 2013 in a general practice setting. The survey was developed by LimeSurvey™ version 1.9. The article “Development of a measure of attitude toward nutrition in patient care” by McGaghie et al., (2001) appears to be seminal as this has been used by the author for developing the cross-sectional study.
The questionnaire (primary instrument) was designed in a manner that assists in examining the factors that influence nutrition care of PNs. To ensure the validity of the data collected, “Nutrition in Patient care Survey,’ tool has been used. McGaghie et al., (2001) as it has been found to be reliable in other studies, used the same. It was modified by adding additional questions to make it relevant to PNs. The questionnaire was divided into five sections containing 72 items to cover the broad spectrum of variables and measure nurses’ attitude with sufficient sensitivity. The articles were related to demographics, GP behaviour, perceptions of PNs on their role and responsibility towards the provision of nutrition care, promoting change to patients, and their view of continuing professional development (CPD) activities. The article does not discuss the sampling method, which is the other observed drawback. The author has calculated the descriptive statistic for each survey item. The author has tested the survey sample for its representation of PN workforce in Australia. Further, the author has explored the association of demographic characteristics between respondents and the responses to the survey item. The data collected was tested for statistical significance set at P < 0.05. Therefore, this ensures internal validity and reliability of the data. Data analysis was performed using the SPSS statistical software package version 19. Overall, the methodology is clearly laid out in this research paper. It acts as a template that can be replicated in future studies with sufficient ease.
Martin et al., (2014) has invited the nurses through “e-Newsletters of the major Australian practice nurse associations” briefly explaining the purpose of the research and assuring confidentiality of the matter which is considered to be the chief priority of ethics (Hartas, 2015). Thus, the researcher has upheld the rights of informed consent. It was declared in the paper that the “Griffith University Human Research Ethics Committee (Protocol Number PBH/08/13/HREC) approved the research, and there were no conflicts of interests.
The results revealed that 89% of the PNs perceive diet as an important factor to be addressed during chronic disease management. More than half of the PNs that is 61% were unsure if their practices have breached the compliance to nutritional recommendations of the patients and 98% of the PNs believe that the nutrition-focused training and education program would increase the effectiveness of their nutrition care. Further, the author has also identified that family commitment, lack of time, traveling issues, a high cost of activities as significant barriers that prevented CPD activities among the PNs. These results are a significant contribution to the literature since it indicates the lack of training being the crucial factor influencing the delivery of nutrition care. The result section is well presented with tabular charts to allow readers grab a clear understanding of the outcome. These findings are highly relevant for policy makers, health professionals, intending to develop the effective strategy for enhancing nutrition care.
The research has been relevant in identifying the factors affecting nutrition care among nurses. The results make a unique contribution as it is found that nurses have a positive attitude towards enhancing nutrition care, and they are seeking for education and training to obtain best outcomes. Therefore, it implies that delivering appropriate intervention addressing the issues and needs of the nurses will reduce the barriers. However, as a critique of the research article, I will recommend the researcher to conduct the qualitative assessment personally interviewing individual nurses and dieticians about their attitude in this problem area.
Currently, there is no data available regarding effective interventions being implemented in Australia to help dietitians or nurses in enhancing nutrition care. The training and education for improving nutrition care are likely to be implemented successfully for PNs to provide effective nutrition care for patients with chronic illness. The result obtained from Martin et al., (2014) will be exposed to the policy makers and health professionals to push for the training process. The training will be sustained if it is compatible with the hospital priorities. The program will be timely evaluated collecting feedback from the nurses and the patient to assess the merits, demerits and the success of the program in its execution and implementation. Positive feedback will indicate the effectiveness of the strategy. A project including the “unit team and implementation team” will be prepared to state plans for implementing the effective intervention for enhancing nutrition care. The team will reach consensus with developed questions such as –
Further, a structure will be prepared for implementing the training program. This includes evaluation of risks, scheduled protocols, the intervention that will deal with the issues and post-intervention assessment. The component of the program will be modified as per individual patient’s condition. It is anticipated that this strategy will be successful as nurses are positive in their attitude. Further, feedback will be utilized to enhance the desired outcomes.
References
Agarwal, E., Ferguson, M., Banks, M., Batterham, M., Bauer, J., Capra, S., & Isenring, E. (2012). Nutrition care practices in hospital wards: results from the Nutrition Care Day Survey 2010. Clinical nutrition, 31(6), 995-1001.
Ball, L., Desbrow, B., & Leveritt, M. (2014). An exploration of individuals’ preferences for nutrition care from Australian primary care health professionals. Australian Journal of Primary Health, 20(1), 113-120.
Beattie, E., O’Reilly, M., Strange, E., Franklin, S., & Isenring, E. (2014). How much do residential aged care staff members know about the nutritional needs of residents?. International journal of older people nursing, 9(1), 54-64.
Buxton, C., & Davies, A. (2013). Nutritional knowledge levels of nursing students in a tertiary institution: Lessons for curriculum planning. Nurse education in practice, 13(5), 355-360.
Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz, M. J., Mayer-Davis, E. J., … & Yancy, W. S. (2014). Nutrition therapy recommendations for the management of adults with diabetes. Diabetes care, 37(Supplement 1), S120-S143.
Franz, M. J., Powers, M. A., Leontos, C., Holzmeister, L. A., Kulkarni, K., Monk, A., … & Gradwell, E. (2010). The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults. Journal of the American Dietetic Association, 110(12), 1852-1889.
Hartas, D. (Ed.). (2015). Educational research and inquiry: Qualitative and quantitative approaches. Bloomsbury Publishing.
Kiss, C. M., Byham-Gray, L., Denmark, R., Loetscher, R., & Brody, R. A. (2012). The impact of implementation of a nutrition support algorithm on nutrition care outcomes in an intensive care unit. Nutrition in Clinical Practice, 27(6), 793-801.
Kris-Etherton, P. M., Akabas, S. R., Bales, C. W., Bistrian, B., Braun, L., Edwards, M. S., … & Pratt, C. A. (2014). The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. The American journal of clinical nutrition, 99(5), 1153S-1166S.
Martin, L., Leveritt, M. D., Desbrow, B., & Ball, L. E. (2014). The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease. Family practice,31(2), 201-208.
McGaghie, W. C., Van Horn, L., Fitzgibbon, M., Telser, A., Thompson, J. A., Kushner, R. F., & Prystowsky, J. B. (2001). Development of a measure of attitude toward nutrition in patient care. American journal of preventive medicine, 20(1), 15-20.
Schaller, C., & James, E. L. (2005). The nutritional knowledge of Australian nurses. Nurse Education Today, 25(5), 405-412.
Martin, L., Leveritt, M. D., Desbrow, B., & Ball, L. E. (2014). The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease. Family practice,31(2), 201-208.
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