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Appraising Research Evidence for Practice.

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Introduction

Appraising Research Evidence for Practice The purpose of this assignment is to acquire the pre-requisite skills necessary to critically appraise and review a body of research literature of my choice. I will give a rationale for my choice of topic and discuss the research strategy employed to find the evidence. While critically analysing the research, I will incorporate research theory, where appropriate, and also evaluate its potential benefit to evidence based practice. I am currently on practice at a young persons inpatient unit that admits children aged twelve to eighteen years of age. One illness, which I have found particularly interesting, and at times challenging is anorexia nervosa, due to its apparent physical and psychological complexity. I have never met any clients with this illness during my training, but soon came to realise how common the illness is among adolescents, particularly females. The onset of this disorder is seen most frequently in females between twelve to eighteen years of age and ranks third among common chronic disorders in adolescents, surpassed only by asthma and obesity (Muscari, 1998). Staff attitudes towards treatment of this disorder appear to differ, leading to inconsistencies. Hogarth (1991) feels this is partly due to professional's frustrations as the recovery process is slow, but she also states that there is a recognised need for development of knowledge in this area. It was with these factors in mind that I chose this area for my research subject, specifically treatment and management of anorexia nervosa. I carried out my literature search on a computer using electronic databases. I initially carried out a search on the Ovid database and requested hits from Cinahl 1982 to March 2000, Nursing Collection 1995 to March 2000 and Medline 1993 to Present. I used the titles 'anorexia nervosa' then limited the search to 'adolescents with anorexia nervosa'. The literature available in general was voluminous, however when I limited the search to 'research' and 'adolescents with anorexia nervosa' the available literature was limited on these databases and not particularly interesting. ...read more.

Middle

Therefore I am lead to assume that the purpose of the study is to gain a greater understanding of the ambivalence to enhance understanding during treatment. The design of the research so far had proved disappointing and lacking in information in areas, but despite these critical observations it still held my interest. Through their literature review the authors discuss how the 'trans-theoretical model of change' sprang from a study of common processes among different therapeutic approaches by Prochaska (1979), and was originally developed in smokers. However the authors did not discuss which disciplinary theory the model originated from. I have attempted to search the on-line databases to find information on the original study carried out by Prochaska in 1979, but could only find his later studies, which did not offer any theory either. Interestingly none of the studies I found by Prochaska give his professional title, so I logged on AskMe.com, which allows you to ask questions through e-mail to experts in different fields. The information I received informed me that James O Prochaska is a Director of Cancer Prevention Research Consortium and Professor of Clinical and Health Psychology at the University of Rhode Island, USA. I feel this information gives credence to his studies being mostly based on cancer and the cessation of smoking and gives validation to the model. The authors regarding the validity of the model make other references, but I observed that Prochaska was included in all of these. The authors cited no references in eating disorders and I as mentioned earlier, I also failed to find any similar research in anorexia nervosa when carrying out my own search. Thus suggesting to me that this is the first and possibly the only study of its kind addressing this particular topic. However the authors note that the trans-theoretical model has been applied in areas such as alcohol abuse and weight control, but did not elaborate further in relation to the strengths and weaknesses of these studies. ...read more.

Conclusion

They have also criticised the implicit reductionism in trying to break human action into measurable and casually linked components. However as the authors were assessing change and measuring processes and had predicted an association between two variables a quantitative method was still proved appropriate. I feel that lack of qualitative research in this area may be because the underlying psychological factors can be quite individualised and a qualitative piece may not prove generalisability to the client group as a whole. Also the methods of data collection may prove to be too intrusive for the clients. The interventions carried out on the unit I where I am working include individual therapy, cognitive therapy, family therapy and dairy work, which are carried out at different stages of change in the client's presentation. On comparing these interventions with the model, I felt that the model would be of little value without any psychological therapies. Most of the research into behavioural prediction and change models suggest that both cognitive and action oriented approaches are necessary to move people from precontemplation to contemplation. The findings of the papers indicate that a combination of cognitive and action strategies may be the most effective way to target individuals who have no intention of changing their behaviour (Bowen, et al, 1992, Carbonari, et al, 1996, Fava, et al, 1995, Goldberg, et al, 1992, Marcus and Simkin, 1994, Margetts, et, al, 1997). Swadi (2000) on discussing treatments for anorexia describes an exciting, new approach towards treatment that is based on Prochaska's theory of change and incorporates Miller and Rollnick's (1991) motivational enhancement interviewing. Swadi (2000) goes on to describe how this approach is particularly useful with resistant clients, such as adolescents, to increase their motivation to change behavioural patterns. Discovering this information allows me to conclude that that the research conducted by Treasure, et al (1996), can be used to inform nursing practice and allows areas for further development. Research is of little value unless it somehow influences the practice of nursing (Morrison, 1991). 3 1 ...read more.

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