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Running Head: Clinical Question Paper: Picot 1
Running Head: Clinical Question Paper: Picot 1
Whitney Ayers
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
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
Clinical Question
(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
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-
CLINICAL QUESTION PAPER: PICOT 4
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
CLINICAL QUESTION PAPER: PICOT 5
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
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
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
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
CLINICAL QUESTION PAPER: PICOT 7
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,
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
CLINICAL QUESTION PAPER: PICOT 8
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
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
CLINICAL QUESTION PAPER: PICOT 9
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
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
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”
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
CLINICAL QUESTION PAPER: PICOT 11
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
References
American Nurses Association. (2010). Nursing scope and standards of practice. In .Silver Spring,
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
http://dx.doi.org/10.1177/1367493512462263
Nieswiadomy, R. M. (2012). Foundations of Nursing Research (6th ed.). Upper Saddle River,
Riesch, S., Lyles, A., Brown, R., Perez, O., Kotula, K., & Sass-DeRuyter, S. (2013). Modifiable
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
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
International, 69-81.
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
CLINICAL QUESTION PAPER: PICOT 13
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