Evidenced Based Practice Group Presentation Chris Bookheimer Michelle Rowe Sandy Saylor

1. Evidenced Based Practice Group Presentation Chris Bookheimer Michelle Rowe Sandy Saylor Jackie Tiefenthal

2. Health Promotion Model • “The HPM was proposed as a framework for integrating nursing and behavioral science perspectives on factors that influence health behaviors” (Wills, 2007) • “The major concepts of the HPM are individual characteristics and experiences (prior related behavior and personal factors), behavior-specific cognitions and affect (perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences, and situational influences), and behavior outcomes (commitment to a plan of action, immediate competing demands and preferences, and health-promoting behavior)” (Wills).

3. Practice Areas/Topics • Promoting participation: Evaluation of a health promotion program for low income seniors • Testing the barriers to healthy eating scale • Diet and exercise in low-income culturally diverse middle school students • Early detection of type 2 diabetes among older African Americans • A bicycle safety education program for parents of young children • Effectiveness of a tailored intervention to increase factory workers’ use of hearing protection • An explanatory model of variables influencing health promotion behaviors in smoking and nonsmoking college students • Balanced analgesia after hysterectomy: The effect on outcomes • Promoting the mental health of elderly African Americans: A case illustration • Barriers and facilitators of self-reported physical activity in cardiac patients • Wills, (2007), p. 249

4. A Bicycle Safety Education Program for Parents of Young Children By Julie L. Lohse, RN, MSN

5. The Study • 1st and 2nd grade parents from 3 schools were given Bicycle Helmet Questionnaires (BHQ) • 2 of the schools provided the parents with the BHQ after exposure to bicycle safety program the 3rd school sent it home a week in advance of the safety program. • The findings indicated that exposure to a school-based bicycle safety educational program made a significant difference in parent knowledge levels about bicycle accident and injury information and in correct bicycle helmet placement and fit. • Parents who are knowledgeable about injury and accident statistics were more inclined to encourage helmet use in their children.

6. The Framework • This framework used in this study was useful to investigated biopsychosocial processes that motivate individual to participate in behaviors that enhance health. • Health Promotion behaviors increase the level of well-being in an individual and will be performed only if they have intrinsic value to that individual (Pender, 1996). • Interpersonal influences – are defined as the beliefs and attitudes of others that have a direct impact on health care behavior. • Role modeling of bicycle helmet use by parents and sibling has been found to encourage bicycle helmet use in children. • Situational influences - such as educational programs and bicycle helmet legislation give cues to action to trigger the behavior of wearing bike helmets. • For success interventions that encourage commitment to action need to be included like encouraging a positive perception of bicycle helmet use, and providing cues to action such as legislation and education.

7. Limitations of the Study • It was assumed that parents would give honest answers and not socially correct answers. • It was assumed that children were previously exposed to some form of bicycle safety education, and also that the children would share this information learned with their parents.

8. Credibility of the Study • Education programs combined with legislation increase the use of helmets. • Legislation decreases peer pressure about bicycle helmets because all children would be required to wear helmets. • Teaching strategies should incorporate the importance of wearing bike helmets as a health promoting behavior as soon as the child learns to ride a bike. • Most children are injured when falling from their bikes and hitting fixed objects such as curbs and trees. It was found that 70% of bicyclists injured hit the road with their head first. • Bike riders at greatest risk are between the ages of 5 – 14.

9. Coronary Artery Disease and Smoking Cessation Intervention by Primary Care Providers in a Rural Clinic Jeremy A. Kelley, MSN, RN, CRNP Roy Ann Sherrod, DSN, RN, CNE, CNL Patsy Smyth, DSN, RN

10. The Study • 250 males and females • Patient’s with a history of CAD and smoking • 150 patient’s charts • Smoking cessation = immediate and long term benefits, namely reduction in the chance of symptom recurrence and death • Educate patient’s that smoking is a MODIFIABLE risk factor, and cessation can improve health status, regardless of current state • Modifying lifestyle choices, educating on lifestyle modifications and benefits

11. The Findings • Some patient’s need the continuing push to stress the importance of and assist them to make the changes. • If patient’s are not motivated and self-motivated at that, this study will not be successful • Limited resources • Limited patient’s that fit the profile for the study • Primary Care Providers may only see patient’s once a year (limited interaction time)

12. Framework • Based on Nola J. Pender’s Health Promotion Model • Influencing factors: individual characteristics and experiences that include prior related behaviors and personal factors • Personal Factors : biological (race, gender), psychological (self-esteem, self motivation), and sociocultural (educational level, socioeconomic status) • Interpersonal Influences (behaviors, beliefs, attitude) • In this study, the PCP (interpersonal influence) provides the pressure to smoking cessation and the influence for compliance with healthy behaviors • Pender’s HPM addresses many of these factors from the patient’s perspective by accounting for various characteristics, determining why one person may quit smoking while another will not

13. Limitations/Credibility • Small scale • Not generalizable (one location was studied) • Access to charts only – no interaction with patient’s • Only 150 charts met the criteria for the study • No assessments on the quality of smoking cessation therapy or the primary care givers role • Study was only for one year • Data collection tool was developed by the researcher and no validity or reliability for its usefulness was established

14. Girls on the Move Program to Increase Physical Activity Participation Authors: Lorraine B. Robbins, Kimberlee A. Gretebeck, Anamaria S. Kazanis

15. The Study The premise of the study was to address “serious health risks” associated with less than adequate physical activity in young girls who have “sedentary lifestyles” (Nursing Research, 2006). The objective was to find out if physical activity would increase by using an “individualized physical activity program plus nurse counseling intervention” (Nursing Research).

16. Method Used for Study • 77 girls in grades 6th through 8th grade from two separate schools • Pretest and post test control group design • Randomly assigned to a control or intervention group • Physical activity list given to each participant in intervention group • Individual feedback and counseling used • Telephone calls and mailings to intervention group

17. Findings/Results • No clear findings were identified between the two groups after one and twelve weeks • Only significant finding was that intervention group had a greater “social support” (Nursing Research, 2006).

18. How HPM Framed This Study “The Health promotion model (HPM; Pender, Murdaugh, & Parsons, 2002) and the Transtheoretical Model (TTM; Prochaska & DiClemente, 1984) were integrated to individually tailor the Girls on the Move intervention” (Nursing Research, 2006).

19. Limitations of the Study • Short time frame utilized • Self reported physical activity • Size of study group • Randomization was used incorrectly • Nurse practitioners assigned to study group were not “observed directly nor audiotaped” (Nursing Research, 2006) thus continuity may not have been followed

20. Diabetes Empowerment related to Pender’s Health Promotion Model: A meta-synthesisAuthor: A. Y. K. Ho, I. Berggren, E. Dahlborg-Lyckhage

21. The Study • The goal of this research was to discover a deeper understanding of what clients perceive as being important in an effective empowerment strategy for diabetes self-management.

22. Framework of Study • This study emphasizes the fact that health-care professionals need to understand and address modifiable behavior-specific variables. The study suggests that an effective empowerment strategy would be to use activity-related affect, as well as interpersonal and situational influences, as a means of facilitating and enhancing clients’ health-promoting behaviors.

23. Why the need for the study “Despite different empowerment approaches and modern monitoring devices, many people still experience difficulties related to diabetes self-management. For this reason, a large number of studies on facilitating client empowerment has been conducted. However, despite a substantial quantity of empirical research, as well as meta-synthesis on clients’ experiences of diabetes and diabetes care, there is still a gap in the knowledge regarding effective empowerment strategies” (Ho, 2010).

24. Limitations of Study “The quality of meta-synthesis is strongly dependent on the author’s skills, knowledge, and experience. As a result there might be a bias in the selection of articles, and the analysis and translation of the metaphors, which could affect the outcome of the synthesis” (Ho, 2010).

25. Findings of Study “Four central metaphors emerged as important for revealing the factors that influenced effective empowerment” (Ho, 2010) -trust in nurses’ competence and awareness -striving for control -a desire to share experiences -nurses’ attitudes and ability to personalize

26. Research StudiesImplications for Practice • “Commitment must be made to the ongoing nature of building knowledge and basing practice on evidence of efficacy” (Kearney, 2008) • “A professional nurse should be an active consumer of nursing research, promoting use of current and valid scientific knowledge and identifying the questions to be addressed in further research” (Kearney).

27. Critical Reflection • “Research supports our knowledge base and answers questions of clinical concern” (Kearney, 2008, p. 104) • Nursing research utilizes theory to substantiate evidence based outcomes • “Theory guides practice, but current knowledge and practice must be based on evidence of efficacy rather than intuition, tradition, or past practice” (Kearney, p. 104)

28. References • Robbins, L., Gretebeck, K., Kazanis, A., & Pender, N. (2006). Girls on the move program to increase physical activity participation. Nursing Research, 55(3), 206-216. • Kearney-Nunnery, R. (2008). Advancing your career concepts of professional nursing. Philadelphia, PA: F.A. Davis Company. • McEwen, M., & Wills, E. (2007). Theoretical basis for nursing second edition. Philadelphia, PA: Lippincott Williams & Wilkins. • Ho, A., Berggren, I., & Dahlborg-Lyckhage, E. (2010). Diabetes empowerment related to pender. Nursing & Health Sciences, 12. doi: 10.1111/j.1442-2018.2010.00517.x • Kelley, JA., Sherrod, RA., Smyth, P.  (2009).  Coronary artery disease and smoking cessation intervention by promary care providers in rural clinic: Online Journal of Rural Nursing and Health Care Fall 2009; 9(2), 82-94. • Lohse, J. L. (2003, April). A bicycle safety education program for parents of young children. The Journal of School Nursing, 19(2), 100-110.