Assessing the Knowledge of Nurse Practitioners about ...

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Assessing the Knowledge of Nurse Practitioners about ...

  1. 1. 1111 Assessing the Knowledge ofAssessing the Knowledge of Nurse Practitioners aboutNurse Practitioners about Childhood ObesityChildhood Obesity David Summerfield, BSN, CNOR, RNFADavid Summerfield, BSN, CNOR, RNFA A Project Submitted to the University of North Carolina Wilmington in Partial Fulfillment Of the Requirements for the Degree of Masters of Science in Nursing
  2. 2. 2222 IntroductionIntroduction  Prevalence of overweight children hasPrevalence of overweight children has increased to almost 19 % in the U.S. andincreased to almost 19 % in the U.S. and 30% in NC30% in NC (1)(1)  The health consequences related toThe health consequences related to childhood obesity are numerouschildhood obesity are numerous (2,3,4)(2,3,4)  400,000 deaths a year are the result of400,000 deaths a year are the result of diseases linked to poor diet and lowdiseases linked to poor diet and low activity levelsactivity levels (5)(5)
  3. 3. 33 INTRODUCTION Overweight adolescents have a 70 percent chance of becoming overweight or obese adults. (6)
  4. 4. 4444 IntroductionIntroduction  Obesity is costlyObesity is costly  $2.1 billion a year in NC$2.1 billion a year in NC  Over $117 billion a year in the U.SOver $117 billion a year in the U.S (7)(7)  How can NPs decrease morbidityHow can NPs decrease morbidity associated with childhood obesity?associated with childhood obesity?
  5. 5. 55 Purpose  Examine the knowledge NPs have about childhood obesity.  Determine if NPs are following the AAP recommendations when evaluating overweight or obese children.
  6. 6. 6666 RecommendationsRecommendations  Prevention of Pediatric OverweightPrevention of Pediatric Overweight and Obesity , 2003, Americanand Obesity , 2003, American Academy of PediatricsAcademy of Pediatrics (8)(8)  Proposes strategies for earlyProposes strategies for early identification of excessive weight gainidentification of excessive weight gain by using body mass index, for dietaryby using body mass index, for dietary and physical activity interventions, andand physical activity interventions, and for advocacy and research.for advocacy and research.
  7. 7. 77 Recommendations  Calculate and plot BMI once a year on all children and adolescents.  Use change in BMI to identify rate of excessive weight gain relative to linear growth.  Encourage parents and caregivers to promote healthy eating patterns.  Routinely promote physical activity.  Recommend limitation of television and video time to a maximum of 2 hours per day.
  8. 8. Body Mass Index  Is derived from commonly available data—weight and height  The ratio of weight in kilograms to the square of height in meters.  Correlates well with more accurate measures of body fatness  At risk of overweight = BMI between 85th and 95th percentile for age  Overweight/Obese = BMI => 95th percentile for age
  9. 9. 99 Literature Review  Larsen, L., Mandleco, B., Williams, M., & Tiedeman, M. (2006). Childhood obesity: Prevention practices of nurse practitioners. Journal of the American Academy of Nurse Practitioners, 18, 70-79. (9)
  10. 10. 1010 Literature Review  Barlow, S., Dietz, W., Klish, W., & Trowbridge, F. (2002). Medical evaluation of overweight children and adolescents: Reports from Pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics, 110, 222-228. (10)
  11. 11. 11111111 Materials and MethodsMaterials and Methods  A cross-sectional survey of NPs in the U.S.A cross-sectional survey of NPs in the U.S. was used.was used.  Approval from the UNCW InstitutionalApproval from the UNCW Institutional Review Board (IRB) was obtained.Review Board (IRB) was obtained.  Survey was posted on the internet.Survey was posted on the internet.  The survey was a 25 item self-administeredThe survey was a 25 item self-administered questionnaire.questionnaire.  Inclusion criteriaInclusion criteria  SPSS softwareSPSS software
  12. 12. 12121212 ResultsResults  47 surveys completed, 45 were included47 surveys completed, 45 were included  4 male and 41 female respondents4 male and 41 female respondents  Median age was 45.6 years (range = 24 toMedian age was 45.6 years (range = 24 to 68)68)  Median length of practice was 8.7 yearsMedian length of practice was 8.7 years (range 1 to 35)(range 1 to 35)  Family practice (22), Pediatric practice (12)Family practice (22), Pediatric practice (12) and other types of practices (11)and other types of practices (11)
  13. 13. 13131313 ResultsResults  78%78% admitted toadmitted to being awarebeing aware of the AAPof the AAP guidelinesguidelines Aware of Guidelines Not Aware of the Guidelines 35 10
  14. 14. 14141414 ResultsResults  51% report51% report adhering toadhering to the guidelinesthe guidelines either often oreither often or alwaysalways Adherent to guidelines Not adherent to guidelines 23 22
  15. 15. 15151515 ResultsResults  78% use78% use BMI toBMI to identifyidentify overweightoverweight or obeseor obese childrenchildren General Appearance Weight for Height BMI 3 7 35
  16. 16. 16161616 ResultsResults  A one-way AVOVAA one-way AVOVA reveals a trendreveals a trend toward differencestoward differences between NPs inbetween NPs in family and pediatricfamily and pediatric practices andpractices and adherence toadherence to guidelines(F(2)=2.7guidelines(F(2)=2.7 8, p<.07)8, p<.07) 0 2 4 6 8 10 12 14 NPs in a Family practice setting NPs in a Pediatric practice setting NPs in all other practices Adhere Do not adhere
  17. 17. 1717 ResultsResults  91% always or often encourage healthy eating patterns Encourages Healthy Eating Patterns Does not encourage 41 4
  18. 18. 1818 ResultsResults  84% promote physical activity and recommend limiting TV and video time Recommend Physical activity and limiting TV/ Video time Do not recommend 38 7
  19. 19. 1919 ResultsResults  93% are comfortable talking with family/pt about obesity.  Only 42% felt their recommendations were effective.  60% list the family as the biggest barrier.  Other barriers: low activity levels, expensive food, lifestyle, fast food, and TV/video time
  20. 20. 20202020 ConclusionsConclusions  The NPs in this sample need toThe NPs in this sample need to become more familiar with the AAPbecome more familiar with the AAP recommendations.recommendations.  Because NPs are not following theBecause NPs are not following the recommendations children may not berecommendations children may not be getting properly evaluated.getting properly evaluated.  The barriers to proper evaluation mustThe barriers to proper evaluation must be overcome.be overcome.
  21. 21. Interventions  There needs to be local, state, andThere needs to be local, state, and national level CMEs to help educatenational level CMEs to help educate NPs on how to evaluate the pediatricNPs on how to evaluate the pediatric population for overweight and obesity.population for overweight and obesity.  Utilize cost effective programsUtilize cost effective programs (H.E.A.T.)(H.E.A.T.) (11)(11)  Use an algorithm.Use an algorithm.
  22. 22. 22222222 AlgorithmAlgorithm (12)
  23. 23. 23232323 Future ResearchFuture Research  Studying the best way to implementStudying the best way to implement the guidelines to improve compliancethe guidelines to improve compliance  Determine why NPs in family practiceDetermine why NPs in family practice do not follow the guidelines as well asdo not follow the guidelines as well as NPs in a pediatric practiceNPs in a pediatric practice  Determining what the barriers toDetermining what the barriers to implementing the guidelines are andimplementing the guidelines are and how can we overcome themhow can we overcome them
  24. 24. 2424 Limitations  Small sample size  Voluntary, online survey
  25. 25. References 1.1. Obesity and Overweight: Childhood Overweight.Obesity and Overweight: Childhood Overweight. (May 22,(May 22, 2007). Retrieved May 29, 2007, from2007). Retrieved May 29, 2007, from http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/index.hhttp://www.cdc.gov/nccdphp/dnpa/obesity/childhood/index.h tmtm 2.2. Harbaugh, B. I., Jordan-Welch, B., Bounds, W., & Blom, L.Harbaugh, B. I., Jordan-Welch, B., Bounds, W., & Blom, L. (2007).(2007). Nurses and Families Rising to the Challenge ofNurses and Families Rising to the Challenge of Overweight Children.Overweight Children. The Nurse Practitioner, 32The Nurse Practitioner, 32(3), 31-35.(3), 31-35. 3.3. Ribeiro, J., Guerra, S., Oliveira, J., Anderson, L., Duarte, JRibeiro, J., Guerra, S., Oliveira, J., Anderson, L., Duarte, J & Mota, J. (2004). Body fatness and clustering of& Mota, J. (2004). Body fatness and clustering of cardiovascular disease risk factor in Portuguese childrencardiovascular disease risk factor in Portuguese children and adolescents.and adolescents. American Journal of Human BiologyAmerican Journal of Human Biology,, 16,16, 556-562.556-562.
  26. 26. References 4. Poussa, M., Schlenzka, D., & Yrjonen, T. (2003). Body mass index and slipped capital femoral Epiphysis. British Journal of Pediatric Orthopedics, 12, 369- 371. 5. CDC, MMWR, 2004 6. Torgan, C. (2002). Childhood obesity on the rise. The NIH Word on Health. Downloaded from: http://www.nih.gov/news/WordonHealth/jun2002/chilhnoodobesity. htm Accessed: April 15, 2008. 7. www.surgeongeneral.gov/topics/obesity/calltoaction/fact_glance.htm 8. AAP policy statement (2003). Prevention of Pediatric Overweight and Obesity. Accessed from http://aappolicy.aappublications.org/cgi/content/full/pediatric s;112/2/424 on April 12, 2007
  27. 27. References 9. Larsen, L., Mandleco, B., Williams, M., & Tiedeman, M. (2006). Childhood obesity: Prevention practices of nurse practitioners. Journal of the American Academy of Nurse Practitioners, 18, 70- 79. 10. Barlow, S., Dietz, W., Klish, W., & Trowbridge, F. (2002). Medical evaluation of overweight children and adolescents: Reports from Pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics, 110, 222-228. 11. H.E.A.T. program, NAPNAP. http://www.napnap.org/index_home.cfm 12.12. Algorithm for screening procedureAlgorithm for screening procedure http://www.cdc.gov/nccdphp/dnpa/growthcharts/training/mohttp://www.cdc.gov/nccdphp/dnpa/growthcharts/training/mo dules/module3/text/page3b.htmdules/module3/text/page3b.htm

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