Assignment: Evidence-Based Project, Part 4: Recommending an Evidence-Based Practice Change
The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.
In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.
To Prepare:
Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
Consider the best method of disseminating the results of your presentation to an audience.
The Assignment: (Evidence-Based Project)
Part 4: Recommending an Evidence-Based Practice Change
Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following:
Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
Add a lessons learned section that includes the following:
A summary of the critical appraisal of the peer-reviewed articles you previously submitted
An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)
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Evaluation Table

Use this document to complete the evaluation table requirement of the Module Assessment, Part A: Critical Appraisal of Research

Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Article #4

Kim, Y., Cubbin, C., & Oh, S. (2019). A systematic review of neighbourhood economic context on child obesity and obesity‐related behaviours. Obesity reviews, 20(3), 420-431.

Sirico, F., Bianco, A., D’Alicandro, G., Castaldo, C., Montagnani, S., Spera, R., … & Nurzynska, D. (2018). Effects of physical exercise on adiponectin, leptin, and inflammatory markers in childhood obesity: systematic review and metaanalysis. Childhood Obesity, 14(4), 207-217. Taylor, R. W., Gray, A. R., Heath, A. L. M., Galland, B. C., Lawrence, J., Sayers, R., … & Taylor, B. J. (2018). Sleep, nutrition, and physical activity interventions to prevent obesity in infancy: follow-up of the Prevention of Overweight in Infancy (POI) randomized controlled trial at ages 3.5 and 5 y. The American journal of clinical nutrition, 108(2), 228-236. Mora-Gonzalez, J., Esteban-Cornejo, I., Cadenas-Sanchez, C., Migueles, J. H., MolinaGarcia, P., Rodriguez-Ayllon, M., … & Ortega, F. B. (2019). Physical fitness, physical activity, and the executive function in children with overweight and obesity. The Journal of pediatrics, 208, 50-56.
Evidence Level *
(I, II, or III)
Level 1 Level 1 Level 1 Level 1
Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

The study did not have a conceptual framework

The study did not have a conceptual framework

The study did not have a conceptual framework

The study did not have a conceptual framework
Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).
Mixed method
Systematic review with meta-analysis of controlled randomized trials
Randomized controlled trial
Cross-sectional study
Sample/Setting

The number and characteristics of
patients, attrition rate, etc.

39 studies

250 participants in 7 trials

802 women

100 children with overweight and obesity
Major Variables Studied

List and define dependent and independent variables
Independent variable is neighborhood economic context

Dependent variable is child obesity and obesity-related behaviors
Independent variable is physical Exercise

Dependent variable is childhood obesity
Independent variables are sleep, nutrition, and physical activity interventions

Dependent variable is overweight in Infancy
Independent variables are physical fitness, physical activity, and the executive function in children

Dependent variable is overweight and obesity
Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).
60% showed an inverse association between higher neighborhood economic status and obesity
7 trials with a total of 250 participants among children up to 18 years.
802 women (86% European, 48% primiparous) were rrecruited with a 58 percent response rate.
100 children with overweight and obesity (10.1 ± 1.1 years old; 58.0% boys)
Data Analysis Statistical or
Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data). Of the analyzed studies 60% indicated an inverse relationship between higher economic status and obesity, while 33% and 14% showed positive relationship between higher economic status and healthy diet and physical exercise. without lifestyle changes, physical exercise triggers reduction in leptin [standardized mean difference (SMD) −1.13; 95% confidence interval (95%CI): −1.89 to −0.37; I2 = 79.9%] and interleukin-6 (SMD −0.84; 95%CI: −1.45 to −0.23, I2 = 0.9%) and an increase in adiponectin plasma concentration (SMD 0.69; 95%CI: 0.02–1.35; I2 = 74.3%). Children under the Sleep intervention had significantly lower BMI z scores at age 3.5 y (−0.24; 95% CI: −0.38, −0.10) and at age 5 y (−0.23; 95% CI: −0.38, −0.07) than children who did not Handgrip strength was positively related to planning ability (P = .025). The study did not find relationship between physical activity and sedentary time with executive function (P ≥ .05).
Findings and Recommendations

General findings and recommendations of the research The study finds positive relationship between various moderators and neighborhood-related obesity Physical exercise improved the inflammatory state in children with obesity Brief sleep intervention in infancy reduced the risk of obesity at 2 years
Cardiorespiratory fitness is related to indicators of cognitive flexibility
Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?
The research is worthy since it demonstrates the relationship between various moderators and obesity.

The study examined 39 studies and 60 percent had a positive outcome

The study examined a small number of studies.

The study can be used in practice to unlock the moderators causing obesity.
The study shows that physical exercise improved the inflammatory state in children with obesity. However, it is unclear if the effect can lower the risk of cardiovascular and metabolic disease.

The risk associated with the implementation is the unclear relationship between the variables.
The research is worth since it offers insights into a friendly option of sleep intervention which is doable by children below 5 years.

Out of the 802 women recruited, the study had a retention rate of 77 percent at 3.5 years

The results cannot be applied across different ethnic groups due to the limited participants

One of the risks associated with the implementation is that the study is not conclusive since it recommends need for further investigation

It is difficult to implement by forcing children to sleep more hours yet they need time to play.
The study is relevant since it adds knowledge to the study on obesity by exploring physical fitness and executive function

The study had cross-sectional study design which is effective in measuring physical fitness and physical activity with executive function

The study had only 100 participants, a number which is relatively low

The risks associated include difficult in accurately assessing muscular strength, speed agility, and cardiorespiratory fitness

The study findings can be used in the practice to assess risk of obesity

Key findings

The study finds that gender, age, race/ethnicity, individual-level economic status, rurality and social connectedness are moderators in neighborhood-obesity association Physical exercise improved the inflammatory state in children with obesity
A conventional intervention had unexpected adverse long-term weight results.
Cognitive flexibility is associated with fitness

Outcomes

Gender, age, race/ethnicity, individual-level economic status, rurality and social connectedness are moderators in neighborhood-obesity association It is unclear if the intervention can reduce the risk of cardiovascular and metabolic disease in adulthood. Brief sleep intervention in infancy reduced the risk of obesity at 2 years
Cardiorespiratory fitness is related to indicators of cognitive flexibility
General Notes/Comments

Societies should address the factors causing abortion

Children with obesity can attract health benefits from physical exercise. Sleep intervention may have positive long-lasting results and should be investigated.
Children should remain physically fit and maintain cognitive flexibility to reduce the risk of overweight or obesity.

Part B
Critical Appraisal Tool
Critical appraisal is an essential process in the academic field to establish the credibility and trustworthiness of research. Establishing credibility and using the information to change the nursing practice is vital. One of the best practices identified in the research studies is using physical activity to reduce the risk of obesity. Obesity in America starts at a tender age. Research shows an increase in the number of children with the condition, unlike the previous years (Mora-Gonzalez et al., 2019). It is thus vital to integrate physical exercise in the therapeutic management of obesity and overweight. Nurses have a duty to educate parents and children about the need for physical exercise. Physical exercise is critical in burning the excess fat stored in muscles leading to unnecessary weight.
Physical exercise leads to body fitness and reduces the risk of obesity. The research shows that neighborhoods with affluent families regularly go out jogging or running to keep fit (Kim et al., 2019). It is unlike low-income families that do not have time or knowledge about the importance of exercising. Physical exercise should be coupled with eating healthy meals. Children should avoid junk food or foods with excess fat. Eating vegetables is essential to address the risk of obesity.
The proposal recommends that nurses educate parents and children to exercise regularly. Schools should take up the matter and ensure they subject the learners to physical exercise. It is essential for children coming to the clinic to undergo a BMI test to assess if their height, weight, and body are aligned. The focus is to use preventive measures to reduce the occurrence of obesity among children and cultivate a habit of physical exercise.

References
Mora-Gonzalez, J., Esteban-Cornejo, I., Cadenas-Sanchez, C., Migueles, J. H., MolinaGarcia, P., Rodriguez-Ayllon, M., … & Ortega, F. B. (2019). Physical fitness, physical activity, and the executive function in children with overweight and obesity. The Journal of pediatrics, 208, 50-56.
Kim, Y., Cubbin, C., & Oh, S. (2019). A systematic review of neighbourhood economic context on child obesity and obesity‐related behaviours. Obesity reviews, 20(3), 420-431.
_________________________________________________________
Based on the four peer-reviewed articles I critically appraised in Module 4, related to my clinical topic of interest and PICOT, I have identified an opportunity for change within my healthcare organization. My topic of interest is childhood obesity and my PICOT question is: How does a neighborhood economic context affect child obesity and obesity-related behaviors in low-income areas?
The current problem or opportunity for change that I have identified is the high prevalence of childhood obesity in low-income areas. The circumstances surrounding the need for change include the increasing rates of childhood obesity and the health consequences that come with it, such as diabetes and heart disease. The scope of the issue is significant as it affects not only the children and their families but also the healthcare system and society as a whole. The stakeholders involved include parents, children, healthcare providers, community organizations, and policymakers. The risks associated with change implementation in general include resistance to change and lack of resources.
The evidence-based idea for a change in practice that I am proposing is to implement a community-based program that focuses on promoting healthy behaviors in low-income areas. This program would include education on healthy eating and physical activity, as well as access to affordable and healthy food options. This approach is supported by the evidence from the systematic review by Kim, Cubbin, and Oh (2019) which found that neighborhood economic context plays a significant role in child obesity and obesity-related behaviors.
My plan for knowledge transfer of this change includes creating knowledge through the implementation of the program, dissemination of the results through presentations at conferences and publications in peer-reviewed journals, and organizational adoption and implementation through partnerships with community organizations and policymakers. I will disseminate the results of my project to an audience through a combination of oral presentations and written publications. I have selected this dissemination strategy because it will reach a wide audience and allow for the results to be shared with both the scientific community and the general public.
The measurable outcomes I hope to achieve with the implementation of this evidence-based change include a reduction in the prevalence of childhood obesity in low-income areas, an improvement in the health outcomes of children and their families, and a reduction in healthcare costs.
In my lessons learned section, I will summarize the critical appraisal of the peer-reviewed articles I previously submitted. I will explain what I learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template, such as the importance of considering the study design and the potential biases in the research. Overall, I have learned that implementing an evidence-based approach to decision making is crucial in improving healthcare outcomes and addressing complex health issues such as childhood obesity.

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Evidence-Based Project
Recommending an Evidence-Based Practice Change

Introduction
• Obesity has been increasing among children and adolescents in many countries. According to the World Health Organization, the global prevalence of obesity in children and adolescents increased from 4.2% in 1990 to 5.6% in 2010 among boys, and from 5.0% to 5.5% among girls.
• The prevalence of obesity among children and adolescents aged 5–19 years was 11.3% in 2016. The prevalence of obesity is highest in the WHO Region of the Americas, at 22.2% in 2016, and lowest in the WHO South-East Asia Region, at 3.0% in 2016.
Background
• Its culture is one of innovation and continuous improvement, constantly seeking new ways to improve the quality of care and the patient experience.
• The organization is open to new ideas and is willing to invest in new technologies and processes, it has a strong commitment to evidencebased practice and is always looking for ways to improve the quality of care.
Problem identification
• The prevalance of obesity and the lack of activity and understanding of its causes in children is a concern.
• The scope of the issue is that obesity is a global epidemic and is rising at an alarming rate.
• The stakeholders involved are the children, their families, the healthcare providers, and the government.
• The risks associated with change implementation are the lack of knowledge and understanding of the causes of obesity, the lack of resources to implement change, and the lack of motivation to change.
Problem statement
• The healthcare providers should discuss the importance of sleep with parents of overweight and obese children. This change is based on the article by Taylor et al. (2018). The intervention group in a randomized controlled trial had significantly lower body mass index (BMI) z-scores at 3.5 and 5 years of age.
• According to Sirico et al. (2018) physical exercise can help to reduce the levels of adiponectin, leptin, and inflammatory markers in childhood obesity.
• This suggests that interventions that focus on increasing physical activity levels in children with obesity may help to improve their health by reducing levels of adiponectin, leptin, and inflammation.
Information dissemination
• The first step in knowledge transfer is knowledge creation.
• This involves taking the research findings and translating them into a form that can be used by practitioners.
• The second step is dissemination.
• The third step is organizational adoption and implementation.
• This is the process of incorporating the knowledge into the organization and making it part of the culture.
Results
• The most effective method will be through a presentation at a conference since it allows the audience to see the results of the project and ask questions about the project.
• Additionally, the results of the project will be published in a peerreviewed journal where the audience can view the results of the project and read the comments of the reviewers.
• These results will also be disseminated through a webinar.
Scope
The measurable outcomes that I hope to achieve with the implementation of this evidence-based change are:
• Increased physical activity levels in children with overweight and obesity
• Improved executive function in children with overweight and obesity
• Reduced adiposity in children with overweight and obesity
• Improved sleep quality in children with overweight and obesity
Critical appraisal
• “The critical appraisal of the four peer-reviewed articles showed that physical activity can help to reduce body mass index (BMI) and waist circumference in children” (Mora-Gonzalez et al., 2019).
• The articles also indicate that physical activity can help to improve executive function in children with obesity.
Critical appraisal
• The Critical Appraisal Tool Worksheet Template provides a framework for critically appraising the evidence to determine its strengths and weaknesses.
• This process allows the evidence to be evaluated in a systematic way, which leads to a better understanding of the quality of the evidence and its applicability to the clinical question.
References
• Kim, Y., Cubbin, C., & Oh, S. (2019). A systematic review of neighbourhood economic context on child obesity and obesity‐related behaviours. Obesity reviews, 20(3), 420-431.
• Sirico, F., Bianco, A., D’Alicandro, G., Castaldo, C., Montagnani, S., Spera, R., … & Nurzynska, D. (2018). Effects of physical exercise on adiponectin, leptin, and inflammatory markers in childhood obesity: systematic review and metaanalysis. Childhood Obesity, 14(4), 207-217.
• Taylor, R. W., Gray, A. R., Heath, A. L. M., Galland, B. C., Lawrence, J., Sayers, R., … & Taylor, B. J. (2018). Sleep, nutrition, and physical activity interventions to prevent obesity in infancy: follow-up of the Prevention of Overweight in Infancy (POI) randomized controlled trial at ages 3.5 and 5 y. The American journal of clinical nutrition, 108(2), 228236.
• Mora-Gonzalez, J., Esteban-Cornejo, I., Cadenas-Sanchez, C., Migueles, J. H.,
MolinaGarcia, P., Rodriguez-Ayllon, M., … & Ortega, F. B. (2019). Physical fitness, physical activity, and the executive function in children with overweight and obesity. The Journal of pediatrics, 208, 50-56.

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