Evidence-Based Practice Nursing, Research Critiques & PICOT Statement Essay Assignment Papers

Evidence-Based Practice Nursing, Research Critiques & PICOT Statement Essay Assignment Papers

Prepare this assignment as a 1,750 word paper using the instructor feedback from the Topic 1, 2, and 3 assignments and the guidelines below.

PICOT Statement 

Revise the PICOT statement you wrote in the Topic 1 assignment.

Research Critiques

In the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions.


The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT statement.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT statement, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

Prepare this assignment according to the APA guidelines.

USE THIS TITLE AS Appropriate: 

Tittle of page, Introduction, PICOT Statement, Literature Review (Qualitative and Quantitative Review), Background, Methodology, Results of Findings, Ethical Considerations, Proposed Evidence-Based Practice Change, Conclusions. Evidence-Based Practice Nursing, Research Critiques & PICOT Statement Essay Assignment Papers.

Childhood Obesity- PICOT Statement and Literature Search

Overweight and obesity among children can be prevented, managed, and controlled using school-based interventions more effectively than non-school-based interventions within one year.

P- Population- Children with overweight and obesity

Mahmood, S., Perveen, T., Dino, A., Ibrahim, F., & Mehraj, J. (2014). Effectiveness of

school-based intervention programs in reducing prevalence of overweight. Indian

journal of community medicine: official publication of Indian Association of

Preventive & Social Medicine39(2), 87.

School-based interventions are increasingly being employed in Americans learning institutions to tackle the unending problem of childhood obesity. In this journal article, Mahmood et al. (2014) investigate the efficacy of utilizing school-based interventions to minimize high obesity prevalence among children. In order to achieve this objective, the researchers evaluated all published clinical trials that qualified for the study. The researchers excluded previous studies that entailed cost-effective evaluation of school-based interventions. Five trials comprised of 3900 school-going children were incorporated into the study. The average age of the students both boys and girls, was between 8 and 13 years. The meta-analysis revealed a statistical significance beneficial impact of school-based intervention initiatives on obesity status of school children. Individual assessments suggested efficacy of these school-based efforts to tackle childhood obesity. The researchers infer that school-based interventions are effective in deterring childhood obesity and overweight problem. According to Mahmood et al. (2014), childhood overweight and obesity is a global public health concern that is responsible for high morbidity and increase in the risk of cardiovascular disease, diabetes mellitus, and osteoarthritis. Considering the potential risks that childhood overweight and obesity pose to the American population, Mahmood et al. (2014) stress on the need to examine school-based interventions as a way to address the problem.

Amini, M., Djazayery, A., Majdzadeh, R., Taghdisi, M. H., & Jazayeri, S. (2015). Effect of

school-based interventions to control childhood obesity: a review of

reviews. International journal of preventive medicine6.

In this article, Amini et al. (2015) hold that eh efficacy of school-based interventions to prevent and manage overweight and obesity among school-going children has been a subject of debate among healthcare professionals. In view of that, Amini et al. (2015) conduct a critical review, meta-analysis, and examination of policy briefs and reports that target children and adolescents. This review included interventional studies that have a control group and sought to deter or reduce overweight and obesity in a school setting. Four key systematic reviews, alognside four meta-analyses were found to meet the eligibility criteria. As a result, they were incorporated into the review. The findings of the review suggested that the implementation of multi-component interventions does not necessarily improve the anthropometric outcomes. While intervention durations are critical determinant of the efficacy, researches aimed at evaluating the length of time needed were lacking. Furthermore, the researchers assert the need for interventional efforts for children in order to report any unwarranted mental or physical adverse impacts that stem from the intervention. The researchers also revealed that BMI is one of the most popular indicators utilized for assessing the childhood obesity prevention or treatment trials. Finally, Amini et al. (2015) recommend that future studies on school-based interventions should be done to prevent or control overweight or obesity.

Ickes, M. J., McMullen, J., Haider, T., & Sharma, M. (2014). Global school-based

childhood obesity interventions: a review. International journal of environmental

research and public health11(9), 8940-8961.

            Childhood obesity is a problem that has sparked a major global health crisis. According to Ickes et al. (2014), many school-based interventions have been developed and implemented to curb this growing crisis. In response to this phenomenon, Icke et al. (2014) undertake a comprehensive review that is aimed at comparing and contrasting the American and global school-based overweight and obesity prevention and management efforts. To complete this task, the researchers use five major databases. The selection methodology for these databases include primary research, overweight or obesity prevention interventions, school, based, and studies that were published between 2002 to 2013. In totality, approximately 20 interventions met the eligibility standards of inclusion. The research showed that the interventions that were implemented in the United States and globally led to the successful outcomes. These included positive changes in student’s BMI. However, the researchers observe that different approaches were utilized to attain success. This reinforces the fact that a one-size-fits-all approach is not necessary for impacting childhood obesity. Nonetheless, establishing on successful interventions in future school-based obesity management efforts should have the capacity to integrate culturally-specific interventional strategies. They should also seek to include an environmentally-friendly component that includes parents whenever possible.

Maatoug, J., Msakni, Z., Zammit, N., Bhiri, S., Harrabi, I., Boughammoura, L., &

Ghannem, H. (2015). Peer Reviewed: School-Based Intervention as a Component of

a Comprehensive Community Program for Overweight and Obesity Prevention,

Sousse, Tunisia, 2009–2014. Preventing chronic disease12.

In this article, Maatoug et al. (2015) argue that the task of combating childhood obesity at a tender age, through improvements of physical activities, nutritional interventions, and other behaviors, is instrumental to the prevention of more crucial health concerns in adulthood. Consequently, the researchers evaluate the efficacy of a school-based aspect of a community behavioral intervention on overweight and obesity rates among adolescents in Tunisia. Using a quasi-experimental school-based intervention method, Maatoug et al. (2015) include an intervention group and a control group located in Sousse Msaken. The intervention took three years, with information that pre-intervention gathered from 2009 to 2010 school year period. The researchers then undertook a descriptive evaluation and multivariate assessment to determine the impact of the intervention on risks of excess weight. The study findings suggested the existence of a major increase in fruits and vegetable intake by the intervention group. The intervention group also improved in terms of acquiring the normal weight category. There was also a decrease in students’ overweight population. This study suggests that the school-based interventions are protective measures to curb excessive weight gain for participating school-going children. Furthermore, the research indicates that school-based interventions are effective in increasing the pattern of healthy dietary habits and minimizing risks of excessive weight gains. It also sheds light on the significance of multidisciplinary approach to offer an environment that is conducive to healthy behaviors for children and adolescents.

Kothandan, S. K. (2014). School based interventions versus family-based interventions in

the treatment of childhood obesity-a systematic review. Archives of Public

Health72(1), 3.

            There has been a widespread debate among health professionals over whether school-based interventions work better than family-based approaches. In an effort to settle this impasse, Kothandan (2014) conducted a comprehensive review aimed at drawing comparison between school-based interventions and family-based interventions in the treatment, management, and control of childhood overweight and obesity. According to Kothandan (2014), the prevalence rates of childhood obesity, which has steadily increased in the last ten years, is currently regarded as a major public health concern. Current treatment options are often premised on two major models: school-and family-based strategies. Nonetheless, most studies have not yet drawn a major comparison between the two treatment options. Therefore, Kothandan (2014) conducted a database search of resources such as Medline, Pub med, and Science Direct with the view of executing the search for primary research papers in accordance with various inclusion criteria. The review also included randomized control trial and quasi-randomized controlled trials on the basis of family- and school-based interventions. The study identified 1231 studies, 13 of which met the researcher’s criteria. The research revealed that family-based interventions were ideal for children aged below 12, whereas school-based interventions worked for children aged between 12 and seventeen years for both long-term and short-term outcomes.

Gonzalez-Suarez, C., Worley, A., Grimmer-Somers, K., & Dones, V. (2009). School-based

interventions on childhood obesity: a meta-analysis. American journal of preventive

medicine37(5), 418-427.

Finally, Gonzalez-Suarez et al. (2009) argue that childhood obesity is a major predictor of chronic lifestyle diseases in adulthood. Therefore, the researchers explore the effectiveness of school-based programs in the prevention and management of childhood obesity. After conducting a comprehensive literature search, coupled with a meta-analysis for RCTs and clinical controlled trials on school-based interventions, the results indicated that the odds of participants’ being overweight and obese in the school-based programs compared with the control arm were significantly protective in the short-term. However, school-based interventions were effective in the long-run. Therefore, longer running initiatives were more effective than shorter programs. Evidence-Based Practice Nursing, Research Critiques & PICOT Statement Essay Assignment Papers.

Qualitative Research Critique and Ethical Considerations

Summary of the Study

            The study seeks to evaluate the efficacy of school-based programs in treating and managing overweight and obesity among children. Childhood obesity is increasingly becoming both national and global public health concern that has resulted in increased childhood morbidity and mortality. In particular, childhood obesity has catapulted the increase in health problems such as cardiovascular diseases, diabetes, as well as osteoarthritis later in adulthood (Mahmood et al. 2014). Schools can provide one of the most effective channels through which childhood obesity interventions can be directed. In this respect, policies, procedures, and guidelines have been passed in many nations and states for the implementation of school-based interventions. In the United States, many studies have recommended the utilization of school-based obesity management programs to address the unending crisis of childhood obesity.  In light of this concern, this study seeks to investigate the efficacy of school-based interventions in treating and managing childhood obesity. In particular, the study will also assess school methodologies such as incorporation of obesity education into the routine curriculum in minimizing the constantly-increasing cases of obese children population.

Method of Study

The study is also going to use qualitative design in order to examine the perception of children towards school-based obesity management initiatives. Previous studies conducted by Clarke et al. (2015) also sought to investigate the experiences and views of kids who went through school-based obesity management programs. This can help to improve knowledge and understanding of better ways to address the problem of childhood obesity within school settings. In order to provide a comprehensive finding that guides future clinical decision-making, the study will evaluate efficacy of school-based interventions with respect to many key areas. They include cost efficiency of school-based interventions, improvements in physical activities and healthy eating habits following interventions, as well as level of awareness among children on the dangers of childhood obesity and the ways in which it can be averted. Furthermore, effectiveness will be investigated through evaluation of body weight and BMI before and after the introductions of these interventions (Mahmood et al. 2014). Most significantly, cardiovascular fitness and other outcome measures will be investigated.  The target population and participants of the study will mainly be school-going children. Both boys and girls with an average age of between 8 and 16 years will be incorporated into the study.

Schools vary in the ways in which they utilize such interventions. For instance, some schools utilize planet health programs that incorporate the teacher training workshops, class lessons, physical education materials, and educational programs that emphasize on enhancing physical activities. These programs also seek to discourage sedentary lifestyles among school-going populations (Mahmood et al. 2014). Other initiatives often embrace strategies such as utilization of banners and logos on water bottles with the purpose of supporting healthy living, embracing healthy diets and discouraging the use of sugar-sweetened drinks. In some cases, schools ensure that children are enrolled in programs such as aerobics dance sessions.

One of the primary reasons for exploring this area of research is the fact that obesity among children is a risk indicator for future obesity during adulthood. This problem has been associated with adverse physical, socioeconomic and mental impacts such as risks for getting non-communicable diseases (Amini et al. 2015). In addition, school-going children face the risk of being socially stigmatized, leading to sadness and loneliness. Moreover, obese kids are most likely to involve themselves in high-risk behaviors as a result of negative stereotyping. Although an urgent intervention is needed to curb the worrying increase in overweight and obese populations, these steps must be informed by widely acknowledged collection of evidences to support positive health outcomes (Amini et al. 2015). The current body of evidence incorporates researches conducted that target their interventions in several contexts such as community centers, home, and schools. In particular, schools have taken the lead in being among the most suitable settings for obesity management since they are distinct in some elements.

Result of Study

The effectiveness and capability of school-oriented interventions to prevent obesity among school going children was subjected for review for a period more than 10 year. Reviews of reviews, meta-analysis, reports on children and adolescents, systematic reviews, and interventional studies were used.  During the study, four meta-analysis and four systematic reviews were selected for the review.  The results indicated that adoption of multifaceted   interventions did not significantly affect the anthropometric findings. Even though the duration for intervention is very useful in establishing effectiveness, there is no adequate studies that can appraise the duration. There is a significant difference between boys and girls on how they respond to school-based interventions.  Relying on an indicator such as the body mass index to determine obesity prevention among children was determined to seriously misleading. Non-targeted interventions were helpful in solving the issue among the general public as compared to targeted approaches.

How the Findings Might be Used in Nursing Practice

Nurses must utilize the best available evidences to support decision-making on the best way to address childhood obesity. Assessing the efficacy of school-based interventions have various implications for nursing practice (Wareing, 2018). The recommendations that seek to improve outcomes from school-based physical activity initiatives may be utilized by nurses to foster positive attitudes towards exercises among children and young adolescents. Nurses may also address these problems by raising the level of activities throughout the school day. In practical sense, knowledge on the importance of school-base interventions can shift the working environment of nurses, educators, and school staffs. Nurses can employ school-based programs by utilizing multidisciplinary approaches to obesity management such as encouraging parents and community members to participate in school-based initiatives (Wareing, 2018). There is also need for nurses to engage in advocacy and health communication campaigns among public health bodies collaborate with teachers, parents, and lobby groups in order to combat childhood obesity. Nurses can educate the school children and young adolescents about food choices.

In particular, school nurses have the skills to offer counseling to support weight-associated behavior change (Pbert et al. 2013). They are also easily accessible to children with no transport or costs. Thus, nurses can play an integral role in supporting students who suffer from overweight and obesity problems to gather a healthy lifestyle (Pbert et al 2013). The leveraging of current infrastructures and resources through capitalization on the placements of skilled healthcare providers within highly accessible school contexts has major public health importance in comparison with specialty clinics that face eh challenge of limited reach. This is partly because specialty clinics have constrained reach as a result of access and expenses o intensive resources needed, such as costs to the families in terms of transportation, copayments and time (Pbert et al. 2013). Thus, weight management and counseling interventions are practicable for school nurses in the delivery of high fidelity within the school health contexts.

Potential Ethical Implications

Childhood overweight and obesity studies are often carried out among vulnerable groups. A significant number of obese students also grapple with major mental challenges, such as anxiety, depression, ADHD, and emotional and eating problems. Combined with this challenge, obesity holds a social stigma that negatively affects children and their respective family members (Holm et al. 2014). In acknowledgment of this problem, discourses have emerged among health care professionals relating to the potential ethics for school-based interventions for treating childhood obesity, as well as the mechanistic clinical researches that seek to understand the pathophysiology of this health problem among students without directly aiming at minimizing overweight (Holm et al. 2014). Researchers must seriously consider if their protocols and procedures offer situations where they can empirically evaluate and prove their hypothesis while at the same time developing environments where children and their family members are free to make choices to enter the study (autonomy). Further, justice should be granted by granting all participants with benefits after taking part in such studies.

Another ethical issue relates to the manner in which obesity is communicated to members of the public. While the causes of childhood obesity are often publicized in simple ways, such as excessive energy comparison with energy use, this disease is complex. There are various factors that are associated with this health problem. These include socioeconomic indicators, level of education and awareness, and lifestyle. However, the causes of obesity go beyond these commonly talked about factors to include issues such as culture, media presence, as well as peer pressure. Therefore, in attempting to engage in advocacy campaigns to reduce obesity, nurses must not leave out important information that can generate positive health outcomes among children.



Amini, M., Djazayery, A., Majdzadeh, R., Taghdisi, M. H., & Jazayeri, S. (2015). Effect of

school-based interventions to control childhood obesity: a review of

reviews. International journal of preventive medicine6.

Clarke, J. L., Griffin, T. L., Lancashire, E. R., Adab, P., Parry, J. M., & Pallan, M. J. (2015).

Parent and child perceptions of school-based obesity prevention in England: a qualitative

study. BMC public health15(1), 1224.

Holm, J. C., Nowicka, P., Farpour-Lambert, N. J., O’Malley, G., Hassapidou, M., Weiss, R., &

Baker, J. L. (2014). The ethics of childhood obesity treatment-from the Childhood

Obesity Task Force (COTF) of European Association for the Study of Obesity

(EASO). Obesity facts7(4), 274-281.

Mahmood, S., Perveen, T., Dino, A., Ibrahim, F., & Mehraj, J. (2014). Effectiveness of

school-based intervention programs in reducing prevalence of overweight. Indian

journal of community medicine: official publication of Indian Association of

Preventive & Social Medicine39(2), 87.

Pbert, L., Druker, S., Gapinski, M. A., Gellar, L., Magner, R., Reed, G., … & Osganian, S.

(2013). A school nurse‐delivered intervention for overweight and obese

adolescents. Journal of School Health83(3), 182-193.

Wareing, A. (2018). School‐based physical activity programs for promoting physical activity and

fitness in children and adolescents aged 6 to 18. International journal of nursing

practice24(1). Evidence-Based Practice Nursing, Research Critiques & PICOT Statement Essay Assignment Papers

Qualitative Research Critique and Ethical Considerations

Summary of the Study

            In an article titled “Effect of school-based interventions to control childhood obesity: a review of reviews”, Amini et al. (2015) investigate the efficacy of school-based interventions in the prevention and management of overweight and obesity among school-going children for an eleven-year duration. Using systemic assessments, meta-analyses, reviews of reviews, and policy briefs, the researchers examine school-based obesity management programs that target children and young adolescents, including interventional studies that have control groups and sought to prevent or manage overweight and obesity within school contexts. Amini et al. (2015) found four systematic assessments and four meta-analyses that met the legibility and were incorporated into their review process. The results revealed that the implementation of multi-tiered interventions did not necessarily result in positive anthropometric outcomes. While the program durations serve as a crucial factor in influencing the efficacy of these interventions, there is a paucity of studies that sought to investigate the length of time needed for effective outcomes of these programs.

In view of the current variations between girls and boys in reacting to the aspects of the programs in tailoring school-based interventions, the dissimilarities should be taken into account, particularly aiming at children. These interventions can be more efficacious for vulnerable children populations. School-based initiatives for students should be able to report any unwanted or unexpected mental or physical negative impacts that stem from administering them to target populations. Body mass index was identified as one of the most widely utilized indicators for assessing the childhood obesity prevention or treatment trials. However, the researchers observe that overreliance on this metric as the only index for adiposity outcomes might prove misguiding. Moreover, there are very few studies that identify the mental theories and models of behavior change employed in school-based interventions. Therefore, Amini et al. (2015) propose for more studies that take into account psychological impacts of school-based interventions.

Method of Study

The main methods that were used to undertake the study included systemic reviews and meta-analyses. A meta-analysis can be defined as a form of survey in which previously prepared study reports, not humans, are subjects of the evaluation (McNabb, 2015). In this case, the meta-analysis has been used quantitatively by selecting a total of 61 materials for research. The meta-analyses method is an efficacious way of establishing the state of research findings on a specific subject, since it offers the researcher with the bigger picture as opposed to merely a simple discussion of a single or few parts of the issue or problem under investigation. In order to realize this objective, the researchers conducted a comprehensive literature search of previous works that were done from January 2001 to December 2011.

The main research databases that were utilized to select studies for research include PubMed, Cochraine, ProQuest, as well as Health Information Research Unit.  Other sources of research materials to be evaluated included policy briefs and reports that are widely used both locally and internationally (Amini et al. 2015). A total of 61 research materials were selected for comprehensive analysis. In order to identify appropriate studies, all titles and abstracts generated from the searches were evaluated by a reviewer. This was meant to determine the extent to which they met eligibility standards. Therefore, an assessment of the full textual contents was done by a team of reviewers. Any discrepancy or disagreements were addressed by constructive discussions until a consensus was attained. All the 61 articles selected were assessed against new selection criteria in separate ways.  One of the main benefits of this methodology is that it provides a holistic procedure for establishing a coding scheme and criteria for selecting studies. This may include reading study reports, coding the materials, and ensuring that they are subjected to a rigid statistical analysis (McNabb, 2015). This can impose a discipline on the research team that is normally missing in qualitative summarizations and comparative evaluations.

Results of the Study

In total one hundred and six papers were systematically evaluated. They included four systematic reviews and four-meta-analyses. During the first stage of the selection, three reports described as report were screened, which were filtered in the second stage of the selection process. Out of these reports, the researchers did not find any policy brief. Out of the our meta-analyses that were undertaken, one did not find the age ranges of participants incorporated in the studies., In some situations, some studies only took into account single strategies like physical activities or nutritional education for assessment of the studies. Further, others only sought to understand combined or multi-tiered strategies (Amini et al. 2015). A significant fraction of the reviews had quality assessments or a scoring system. The searches span for incorporated evaluations and meta-analyses ranged from 1966 to 2010. The systemic reviews and meta-analyses found that most studies were mainly undertaken in the United States and European nations. The outcomes of the reviews suggested that implementation of multi-component interventions did not necessarily improve the health outcomes. While implementation durations are a critical determinant of effectiveness, researches to examine the length of time needed were lacking. The researchers also found that more than half of the studies that were evaluated utilized body mass index as the measurement method for determining the outcomes of the interventions. Therefore, Amini et al. (2015) cautioned against overdependence on BMI as the sole method of assessing the efficacy of school-based interventions. Depending on it as the only metric for assessing adiposity outcomes can prove to be misleading. Most significantly, the researchers suggest the need to incorporate psychological impacts of interventions that seek to prevent and manage obesity among school-going children.

How the Findings can Be Used in nursing Practice

            For nursing practice, the study identifies school settings as some of the most powerful levels of interventions at which the problem of childhood obesity can be addressed. The study gives insights into how nurses can employ different strategies to curb childhood obesity. One of the issues that have been raised by the article is failure by previous studies to utilize multi-disciplinary and multi-tiered approaches to curb childhood obesity. For instance, most studies that have been evaluated by the research have only used few or single approaches, which generate minimal fruits. However, the article sheds light on the need for school-based interventions to move beyond use of only physical education to include dietary education and other practices.

Ethical Considerations

            All efforts that seek to reduce childhood obesity prevalence in schools must never overlook the potential ethical challenges that might emerge. One of the most commonly mentioned ethical issue is stigma. Health care professionals such as nurses and physicians must provide interventions that do not negatively brand overweight and obese people in negative ways (Garbarino & Sigman, 2010).  Instead, advocacy campaigns must be launched to discourage acts of bullying, verbal abuses, and discrimination against children who are overweight and obese. In some cases, nurses should embrace the best interest doctrine by examining strategies that work best for overweight and obese children. This may require engaging in extensive consultations with school heads, families, as well as the children themselves. The best interest policy is directly associated with the ethical premise of beneficence (Garbarino & Sigman, 2010).  Although conflicts may emerge when there are cases of disagreements on what works best for the child, there is need to take the most effective approach that has minimal potential risks to the patient.


Childhood obesity is one of the problems that continue to affect the United States and other developed countries. School-based interventions have proven to be some of the most effective strategies to eradicate this public health concern. However, this study suggests that the efficacy of school-based programs strongly depends on approaches that are used. Therefore, use of multi-tiered approaches that take into account elements such as physical education, dietary plans and education, and family-centered strategies promise to generate the desired health outcomes as opposed to using only a single strategy such as physical education alone.




Amini, M., Djazayery, A., Majdzadeh, R., Taghdisi, M. H., & Jazayeri, S. (2015). Effect of

school-based interventions to control childhood obesity: a review of

reviews. International Journal of Preventive Medicine6.

Garbarino, J., & Sigman, G. (Eds.). (2010). A child’s right to a healthy environment (Vol. 1).

New York:  Springer Science & Business Media.

McNabb, D. E. (2015). Research methods in public administration and nonprofit management.

London: Routledge. Evidence-Based Practice Nursing, Research Critiques & PICOT Statement Essay Assignment Papers

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