The Imprtance of Evidence Base Practice

According to the case study if weight loss could be achieved then the health risks associated with obesity could be reversed. Even moderate weight loss of 10 per cent would reduce health risks which include Diabetes, Hyperlipidaemia, Hypertension and Sleep Apnoea. Also if 15-20 per cent of body weight could be lost in the first year of diagnosis, then this could reverse the increase of mortality rate caused by the health risks associated with obesity (Kirk 2003).The question is, what are the best available treatments to tackle obesity? The assignment will explain the benefits and challengers of finding evidence to answer the question, both in Nursing Practice and for studies. The assignment will also explain how the search process was conducted to locate and retrieve evidence to answer the question. The evidence that was gathered in the search process is appraised and summarised then a conclusion given on the findings. Finally a conclusion will be given regarding how useful the process was towards the understanding and the need to support evidence based practice (EBP).

In Nursing Practice, finding the answer to this question involves using (EBP). The ability to use (EBP) is an essential and important approach to the delivery of health and social care. (EBP) is using the best available evidence, to deliver the best possible care, using one’s best clinical judgement whilst taking into account a patient’s preference. Two important elements of using (EBP) in Nursing practice are that it leads to positive patient outcomes and it allows one to justify, give a clear account of and rational of the care being given, as being a professional one is accountable for one’s actions (Aveyard, Sharpe 2009). The Nursing and Midwifery Council (NMC 2008) declare that as a professional one is personally accountable and must be able to justify all actions used in practice. The ability to use (EBP) in studies is also important, as being able to answer the question and explain in an assignment what evidence was found, what care will be given and why it will be given, will then be put into practice when a student is in a clinical setting.

Patients will expect a student to understand and explain to the patient why the patient is receiving that care in a particular way. This will become increasingly important as the student will gain experience and eventually be the one using (EBP), planning and making decisions relating to the care of patients (Aveyard, Sharpe 2009). Another benefit of using (EBP) in studies is that it prepares students to be good consumers of research. Using (EBP) enables students to research and appraise evidence that is relevant to specific questions, both in studies and clinical settings. The ability to research for studies gives students an advantage when going into clinical settings, as this knowledge to research will assist organisations to improve patient outcomes (Layman, Eve L 2008). Jolley (2010, p19) believes that:

Research in Nursing is essential because Nursing will never be content with what it knows and what it can do. Nursing will always strive to make things better.

However it is important that the evidence used to answer questions, in Nursing Practice and for studies, is up to date and relevant. It would not be good practice to give a patient treatment that is out of date. Finding evidence from a reputable source is also an important factor, as anyone can upload material onto the web and it may or may not be well researched. Evidence found may not always be the best source of evidence in some cases, as there may be instances where research has been done but the data is not relevant to the question or the patient. In order to overcome these challenges all literature and information needs to be critically appraised by filtering and looking at its applicability, validity and reliability in order to find the best evidence (Brown 2012). A search process was conducted using the library gateway to answer the question.

This involved using a systematic approach to locate and retrieve evidence. In order to find the relevant literature search limits were implemented to identify and locate the widest range and most relevant literature relating to the question. (See appendix 1.The search process). However, although search limits were in place, the search produced thousands of results. Owing to the enormous amount of information it was an impossible task to read every article that was published on the topic. The evidence that was chosen was evaluated and critically appraised by looking at its applicability, validity and reliability in order to find the best evidence. In order to evaluate the literature the use of the CASP tool was used (SHU 2012). The evidence that was chosen looked at three effective treatments to tackle obesity: lifestyle modification, drugs and bariatric surgery.

Lifestyle changes have three major components to treat obesity, which include diet, exercise and behaviour modification. Behaviour approaches for obesity treatment are based on the assumption that eating and exercise are learned behaviours and by modifying these behaviours, body weight can be lost. However the important predictor of success in behaviour modification is attendance and adherence to self-monitor diet and exercise. If these predictors are discontinued then body weight is likely to be regained. Diets that reduce the total energy intake by 500 calories per day result in a weight loss of one pound per week and have shown an 8 per cent loss in body weight over 6 months. However, dieting alone may only produce weight loss in the short term, so in order to keep the weight off will require making physical exercise a permanent part of a person’s lifestyle. Physical exercise on its own can lead to less than 3 per cent body weight loss; however, when combined with dieting it can lead to greater weight loss. Lifestyle interventions are the most cost-effective means to reduce weight and represent the first step in the treatment of obesity (Burke, Wang 2011).

Three drugs are currently licensed in the UK for treating obesity and are available on the National Health Service. These are Orlistat, Sibutramine and Rimonabant. These drugs have all been shown to produce greater weight loss than lifestyle interventions in clinical trials and, importantly, to help with weight maintenance once weight loss has been achieved. Success rates of achieving weight loss goals of 5 to10% are generally two to three times greater than lifestyle interventions. These drugs have been associated with improving risk factors, such as Dyslipidaemia, Hypertension and Diabetes. However at present, it is not known whether any of these drug treatments are clinically or economically cost-effective as there is little evidence or published data. Only Orlistat has published clinical trial data supporting effectiveness beyond 2 years (Wilding 2007).

Bariatric surgery treatments are currently only recommended for patients with severe obesity that have not been able to lose weight after trying other available treatments. Bariatric surgery results in long term reduction of energy intake and is associated with increased physical activity, which in turn helps with weight management. The weight lost through Bariatric treatment improved or resolved Diabetes, Hyperlipidaemia, Hypertension and Sleep Apnoea in half of the patients. However, complications after bariatric surgery are common and many patients are re-hospitalised during the first year, which could be costly. However, although the initial procedure and the treatment of complications are expensive, the medication costs to treat the health conditions a patient had before surgery decreases considerably in half of the patients after Bariatric surgery and have concluded that it is cost effective (Thompson et al. 2007).

The evidence concludes that lifestyle interventions treatments are long term and require attendance and adherence to self-monitor diet and exercise in order not to regain weight. Lifestyle interventions treatments produce the least weight loss however it is the most cost-effective treatment used.

Drug treatments have produce greater weight loss than lifestyle interventions and help with weight maintenance once weight loss has been achieved. Drug treatments also improve the risk factors associated with obesity, however at present, it is not known whether all drug treatments are cost-effective as there is little evidence or published data.

Bariatric surgery treatments also produce greater weight loss than lifestyle interventions and also help with weight maintenance once weight loss has been achieved. Bariatric surgery treatments also produce effective long term outcomes that improve or resolve the risk factors associated with obesity. Bariatric treatments have concluded that it is a cost effective procedure however, treatments are only available if the patient is severely over weight and other treatments have failed to help with weight loss.

Therefore it seems that all available treatments have a positive effect on reducing a patient’s weight and lowering the health risks associated with obesity. However, to decide which treatment to use, one’s best clinical judgement needs to be used with reference to a patient’s preference. All patients are individual and therefore need to be assessed to determine the best possible treatment that would be the most effective. It could also be suggested that research needs to be on going in order to keep finding the most effective treatments to tackle obesity.

In conclusion, the process of using (EBP) to answer the question for the assignment allowed one to understand the importance of using a systematic approach to locate, retrieve and appraise evidence in order to find the best available evidence.( EBP) is used to deliver the best possible care, which in turn produces better patient outcomes. Therefore the ability to use (EBP), in studies, will become increasingly important when one is a qualified Nurse.

REFERENCE LIST

AVEYARD, HELEN & SHARP, PAM (2009). A beginner’s guide to evidence based practice in health and social care. Maidenhead, Open University Press. BROWN, SARAH JO (2012). Evidence Based Nursing. Second Edition, London, Jones & Bartlett Learning, LLC. BURKE, LORA, E & WANG, JING (2011).Treatment strategies for overweight and obesity. [Online]. Journal of Nursing Scholarship, 43 (2), 368-375. Article from Wiley online library last accessed 19th November 2012 at: http://onlinelibrary.wiley.com/ JOLLEY, JEREMY (2010). Introducing research and evidence-based practice for Nurses. Essex, Pearson Education Limited. KIRK, SARA (2003). Diet and weight management. Nursing Standard 17, 47-53. LAYMEN, EVE, L (2008). Implementing evidence-based nursing practice. [Online]. Nurse leader, 6 (1), 15-22. Article from science direct last accessed 10th November 2012 at: http://ac.els-cdn.com/ NURSING AND MIDWIFERY COUNCIL (2008). The code:
standards of conduct, performance and ethics for nurses and midwives. [Online].Last accessed 09/11/2012at: http://www.nmc-uk.org/Nurses-and-midwives/Standards-and-guidance1/The-code/The-code-in-full/ THOMPSON, WARREN, G (2007).Treatment of obesity. [Online]. Mayo Clinic Proceedings, 82 (1), 93-102. Article from Nursing/Academic edition last accessed 19th November 2012 at: http://web.ebscohost.com/ SHU (2012). How do you evaluate the results? (Adapted CASP). [online].Last accessed 11th November 2012 at: https://shuspace.shu.ac.uk/webapps/portal/ WILDING, J, P, H (2007).Treatment strategies for obesity. [Online]. Obesity reviews, 8 (1), 137-144. Article from Wiley online library last accessed 16th November 2012 at: http://onlinelibrary.wiley.com/

Appendix 1.
The search process.

Information source (i.e. library search or internurse)| Keywords| Search limits (exclusions/inclusion criteria, for example date, population, discipline)| No. of results| SHU Library Gateway Search| ‘’Obesity Treatments’’ OR ‘’Tackling Obesity’’ AND Obes* AND Treat*| Limit to articles from peer-reviewed publications, Published 2007- present, Exclude newspaper articles| 207,952| CINAHLDatabase| Same as above| English Language,Limit to articles from peer-reviewed publications, Published 2007- present| 138| Internurse Database| Same as above| All Journals,Published 2007- present| Over 500 results(Only Displaying 500)| Cochraine Library| Same as above | None| 603|

Google| Same as above| None| 43,900,000|