Running head: CLINICAL QUESTION PAPER: PICOT 1

Clinical Question Paper: PICOT

Whitney Ayers

Ferris State University

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Abstract

The profession of nursing requires registered nurses to write clinical questions. The PICOT

format is utilized by nurses to formulate these types of questions. This paper reviews three

research articles based around the topic of childhood obesity and the effects that parents may

have on their children’s weight. The first article is a cross-sectional study used to clarify the

relationship between ineffective parenting and childhood obesity using different dimension of

family functioning. This study found that because parents of obese children are more likely to

have their own weight problems, they may model ineffective lifestyle patterns. The second is a

systematic review focused on whether parents are using portion control when feeding their

children, and whether education and training on portion control could have an effect on parents

feeding strategies. The results were positive effects of portion control on the energy intake of

children, and parents accurately estimating portion sizes after education. The final article was a

cross-sectional descriptive study that explored different parenting styles and other potential

family and social indicators of an obese or weight-promoting family environment. This study

found that parents with moderate control had more concern about their children’s weight and had

better knowledge of nutrition when compared to parents with strict control. The significance of

using sound evidence is discussed as it relates to the profession and standards of nursing, as well

as quality and safety.

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Clinical Question Paper: PICOT

Nursing research is an important fundamental of the nursing profession. The skills and

practice of nurses are built around the proper research and evidence to recommend the most

efficient, safest, and most cost effective way to complete each task. If nurses follow the

guidelines set for each task, it will help to ensure nurse safety, patient safety, and high patient

quality of care. “Nurses interpret research findings and use evidence-based research to support

nursing decisions. The purpose of this assignment is to reflect how nursing knowledge is

disseminated for use in personal and professional practice” (Singleterry, (2014), pg.7). This

paper will discuss different parenting strategies and techniques and the relationship they have on

their children’s weight.

Clinical Question

Childhood obesity has become a growing problem in today’s society in America

(Williams et al., 2012). Williams and his colleges go on to say that children may not realize the

harmful effects that being overweight can have on their health in their future years. This not only

affects their physical health, but their emotional health as well. Bullying in schools and self-

esteem issues are just a few hurdles that overweight children may have to deal with. If these

children continue to gain weight as they age, they may be putting themselves at risk for

developing numerous conditions that may be prevented with weight loss (Williams et al., 2012).

A question that may be asked is who is causing these children to become overweight? This

question will be examined further throughout this paper.

Nursing practice requires that practicing registered nurses write clinical questions for

specific clinical problems. According to Nieswiadomy (2012), the acronym PICOT is used to

help format these types of clinical questions. This format was developed in 2005 by Fineout-
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Overholt and Johnson (282). The “P” in PICOT stands for the patient or population, the “I”, for

the intervention or interest area, the “C” for the comparison intervention or current practice, the

“O” for the outcome desired, and the “T” for the time to achieve each outcomes (Nieswiadomy,

2012).

The clinical question being asked and discussed in this paper is as follows. Does

parental obesity play a role in their children’s body mass index (BMI) in the ages between five

and twelve years of age? The answer to this question could be significant in finding a way to

decrease the number of overweight children. Do the parental eating and activity patterns impact

the weight of their children? It is the job of the nurse to educate patients and their families about

information that may be beneficial to their health. This clinical question may be especially

helpful in certain programs that deal with children’s health. An example of one of these

programs would be the women, infant, children (WIC) program offered in Michigan to monitor

the health status of the community’s children (United States Department of Agriculture Food and

Nutrition Service, 2014). Children are the future and if nothing is done to stop the uphill trend of

childhood obesity, America may be looking at a future of chronic diseases and condition, many

of which could have been prevented (Williams et al., 2012). Today’s parents and all adults in

general need to set a good example for children so they can learn and grow in a healthy

environment. This will help to improve the quality and safety of the future generation.

Methodology

The Ferris State University database was used to search for research articles on the topic

of childhood obesity. The CINAHL database was used to search for articles that meet the criteria

of childhood obesity. The key search terms used were obesity, obese, BMI, overweight, parents,

parent, guardian, children, child, and youth. The advanced search tool was used to narrow the
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articles to only peer reviewed, nursing research. A total of 330 articles were found that meet this

search criteria. The search was then narrowed even further by changing the date of publication to

2010 or newer. This search resulted in 140 articles. Next, the articles that did not research the

parental effects of children’s weight were removed, which left 33 articles to choose from. From

this list of 33 articles, three were chosen to critique and discuss in further detail.

As future nurses it is important to know how to research topics specific to nursing. This

will ensure that the research is within the nursing scope of practice. This paper uses only nursing

research to address whether or not parental weight correlates to the weight of their children. The

articles used are within the scope of nursing practice and may be used to help educate the public

about childhood obesity. Using research designed around nursing practices will ensure that the

information being used is at the level of practicing nurses and not beyond the scope of practice of

a registered nurse.

There are different levels of evidence that can be used in nursing research. These levels

of evidence promote the use of evidenced based practice in the nursing role. Using evidenced

based research within the profession of nursing will help to ensure the nursing profession to

continue to grow and develop. These levels of evidence help to promote patient quality and

safety in everyday nursing practice. The Quality and Safety Education for Nurses (QSEN) model

will be used in this paper to explain the levels of evidence used in the research that was done.

Level I evidence is the highest quality evidence according to the QSEN model, this level of

evidence was searched for when reviewing articles.

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Discussion of Literature

Article one

The first article that was reviewed for this paper deals with whether parents are using

effective parenting strategies with their obese children (Morawska & West, 2012). This article is

nursing research because the article is written by two registered nurses and the topic is dealing

with an important topic in nursing education. Ethical clearance for this study was obtained from

the University of Queensland and the National Health and Medical Research Council guidelines.

The problem in this article is clearly stated and is as follows. Overweight and obesity in children

is becoming a significant problem, and up to a third of children are classified as overweight or

obese. Evidence is showing that parents play a critical role in their children’s dietary and activity

patterns. The literature is appropriate for this type of study although a systematic review would

be helpful. This is a cross-sectional study used to clarify the relationship between ineffective

parenting and childhood obesity using different dimension of family functioning. According to

QSEN this is a level five, level of evidence.

The sample for this study was 62 families with children between the ages of four through

the age of eleven (Williams et al., 2012). A phone interview was completed to assess the

eligibility of each family. In the healthy weight group, target child must be between the ages of

four through eleven, parents must describe the children’s body size as healthy, and the child must

not be on any medications that affect growth or weight control, and must not have a

developmental delay or disability. In the obese weight group the children had to be between the

ages of four through eleven, parents must describe their child’s body size as obese, and the

parents had to agree to a 12 week intervention. These children could not be taking any

medications that affected growth or weight control, and must not have any developmental delays
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or disabilities. The families were matched by sex, age, and family type. Nominal measurement

was used in this study in order to match families with the variables of sex and family type.

Interval measurement was used to place families into groups based on age. This level of

measurement was also used to measure weight status as well as parental and child behavior

status. The lifestyle behavior checklist and the parenting scale were used to determine parenting

strategies as well as the children’s lifestyle behaviors. This is the appropriate levels of

measurement to use in this study. The results of this study state that children and parents in the

obese group tended to have larger body sizes and a higher percentage of body fat than children

and parents in the healthy group. The parents in the healthy group tended to have a body mass

index (BMI) that fell within a healthy weight range, and most parents in the obese group had

BMI’s that fell in the overweight or obese range. Also parents in the obese group had a higher

percentage of children with behavior problems, lifestyle behavior problems, and peer problems,

when compared to the children in the healthy group.

According to Morawska and West (2012) the conclusion of this article was that because

parents of obese children are more likely to have their own weight problems, they may model

ineffective lifestyle patterns. Also their knowledge of effective strategies to control their

children’s weight, and implementing lifestyle changes to promote a healthy BMI may not be as

effective. This is important information for nurses to know when educating patients on childhood

obesity. This information may change the approach that needs to be used, and may even address

the weight problems of the entire family and not just the child.

Article two

The second article that was reviewed was focused around whether parents are using

portion control when feeding their children (Small et al. 2013). This article also examines
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whether education and training parents on portion control could have an effect on the rising

obesity problem. This article is nursing research because many of the authors are nurses and this

topic deals with nursing in relation to education. This article is a systematic review which looked

at nine different research articles. The purpose of this study was to examine findings regarding

the food portion sizes for young children, and finding evidence regarding the effects of educating

adults to estimate portion sizes. The general sample in these studies included children from age

two through age eleven. There is no specific sample because this is a review of nine different

studies. There is also no specific level of measure in this type of study because it involves many

different studies and reviews the results of the combined study.

The QSEN level of evidence for this article is a level I (Cronenwett et al., 2007). This is

the highest quality of evidence defined by QSEN. The results of this systematic review showed

that there was a positive effect of portion size on the energy intake of children. Also the ability of

parents to accurately estimate the portion sizes for their children improved following education

and training. Recommendation for this study would be to offer all children the same food

because a limitation of this study was the variety of food was unknown. This is important

information for nurses to communicate to patients and their families when educating them about

their weight.

Article three

The third and final article reviewed was a pilot study, the purpose of the study was to

explore parenting style and other potential family and social indicators of an obese or weight-

promoting family environment (Riesch et al., 2013). This article is nursing research because it is

written by nurses and the information deals with nursing practice. This study was approved by

the institutional review board. This was a cross-sectional descriptive study about parents and
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their children between nine and eighteen years of age. The sample for this study was twenty-

eight parents and their children. The children had to be between the age of nine through the age

of eighteen, and English speaking. They also must be diagnosed as overweight by a health care

provider.

The data was collected using a variety of methods. Parenting style was scored using the

parental acceptance –rejection questionnaire (Riesch et al., 2013). The parental method was

scored using the 29-item family activity and eating habits questionnaire. These are an example of

ratio levels of measure because the information can be ranked into specific groups and there is an

absolute zero. This study also had interval data using the weight of each study participant. This

study found that parents with moderate control had more concern about their children’s weight

and had better knowledge of nutrition when compared to parents with strict control. This study

could be significant to nursing because if it is known how parenting styles effect the weight of

their children, nurses could properly educate patients and their families about family dynamics

and their relationship to weight.

Significance to Nursing

It is important to research topics that are related to the type of work that nurses preform

on a daily basis. Education it one of the top nursing priorities that is set for each patient that

receives care, and nurses need to be knowledgeable in order to properly teach. This topic is so

important to the future of the healthcare system, and if nothing is done to stop this trend toward

obesity in the younger generation, the healthcare system may suffer. Educating parents and the

children of each community about proper diets, different parenting styles, and the negative

effects that childhood obesity may have on their health and the health of their children might be

what it will take to change this obesity epidemic.

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In researching ways to help educate patients and their families, it is essential that the

research used is quality evidence. In order for the nursing profession to continue to grow and

develop, evidence based research should be utilized in practice. The American Nurses

Association (ANA) has set standards in which all nurses are expected to follow (American

Nurses Association [ANA], 2010). Standard nine states that evidence based practice should be

used to guide nursing practice. The research found should be communicated to other members of

the healthcare team so the best practice is always being utilized. Standard ten of the ANA is

communication, not only with patients and their families, but also with the other members of the

healthcare team (ANA, 2010). Nurses are lifelong learners, the skills and practice will change

many times. Communication will help to ensure that all members of the healthcare team are on

the same page, and the patient will receive high quality healthcare.

Patients trust nurses to give them the best advice that is out there, and using evidence

based nursing practice every day will help keep patients safe, as well as delivery high quality

care. According to QSEN, evidence-based practice” integrates best current evidence with clinical

expertise and patient/family preferences and values for delivery of optimal health care”

(Cronenwett et al., 2007, table 3).

It is also important for nurses to remember that not all patients learn the same way, what

work for one person may not work for everyone. Nurses need to learn how to adapt the care they

give around each patient and develop a plan of care that is unique to them. QSEN defines

patient-centered care as” recognize the patient or designee as the source of control and full

partner in providing compassionate and coordinated care based on respect for patient’s

preferences, values, and needs” (Cronenwett et al., 2007, table 1). Encouraging patients to get

involved in their own care and developing care based around their abilities will help the patient
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feel they are in control of their care, which will increase the quality of care they receive. This

will help the profession of nursing continue to grow and develop while forever expanding

knowledge and practice.

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References

American Nurses Association. (2010). Nursing scope and standards of practice. In .Silver Spring,

MD: American Nurses Association

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., ... Warren, J.

(2007). Quality and Safety Education for Nurses. Nursing Outlook, 55(3), 122-131.

Morawska, A., & West, F. (2012). Do parents of obese children use ineffective parenting

strategies? Journal of Child Health Care, 17(4), 375-386.

http://dx.doi.org/10.1177/1367493512462263

Nieswiadomy, R. M. (2012). Foundations of Nursing Research (6th ed.). Upper Saddle River,

NJ: Pearson Education.

Riesch, S., Lyles, A., Brown, R., Perez, O., Kotula, K., & Sass-DeRuyter, S. (2013). Modifiable

Family FactorsAmong Treatment-SeekingFamilies of Children With High Body Mass

Index: Report of a Pilot Study. Journal of Pediatric Health Care, 27(4), 255-266.

http://dx.doi.org/10.1016/j.pedhc.2011.11.006

Singleterry. (2014). NURS 350 Nursing Research [syllabus].

Small, L., Lane, H., Vaughan, L., Melnyk, B., & McBurnett, D. (2013). A Systematic Review of

the Evidence: The Effects of Portion Size Manipulation with Children and Portion

Education/Traning Interventions on Dietary Intake with Adults. Sigma Theta Tau

International, 69-81.

United States Department of Agriculture Food and Nutrition Service. (2014).

http://www.fns.usda.gov/wic/women-infants-and-children-wic

Williams, N., Fournier, J., Coday, M., Richey, P., Tylavsky, F., & Hare, M. (2012, August).

Body esteem, peer difficulties and perceptions of physical health in overweight and obese
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urban children aged 5 to 7 years. Child: Care, Health and Development, 39(6), 825-834.

http://dx.doi.org/DOI: 10.1111/j.1365-2214.2012.01401