Evidence Based Nursing Practice for Pediatric Patients and Involvement of Parents

This article discusses the role of parents in the care process of pediatric patients and the efficacy of involving them in the decision making process for vaccination against influenza. A systematic review was conducted and two research articles were selected for evidence based practice. The article also includes the evaluation of outcomes, validity, and reliability of the research.

Running head: EVIDENCE BASED NURSING PRACTICE
EVIDENCE BASED NURSING PRACTICE
Name of the Student
Name of the University
Author note

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Introduction
World Health Organisation mentions family as the milieu that provides children with
values, views, shapes the attitude of members and behavior to life and people around and
nurtures them which ultimately reflects in their health behavior (Coyne, 2015). Parents play an
important role in developing healthcare habits and maintaining the healthy and hygienic lifestyle
of every child and hence, their contribution is higher in any childhood development associated to
social, emotional and cognitive development (Alexander, Austin & Prasanth, 2018). Therefore,
in the healthcare process of children, parents could play an effective role as it becomes their duty
to communicate with the healthcare professionals so that they can take effective steps about the
interventions, their needs and also provides consent so that smooth and effective care process
could be delivered to the patient (King et al., 2015).
To understand and validate the role of parents in the care process of their children, their
role in the pediatric care process would be assessed by looking for evidences from recent
healthcare practices. In this aspect, a systematic review will be conducted and recent literature
articles related to the topic will be searched in the databases such as Pub Med and Cochrane and
Medline. Further, using inclusion and exclusion criteria, 2 articles will be collected. Further,
using the six steps of evidence based practice, the collected evidences and their application in the
healthcare process for children and parental input would be discussed and their outcome will be
addressed.
PICOT Question
Population Intervention Comparative Outcome Timeline
Pediatric Applying family Parents who do Improved patient Within 6 months

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patients from 0-
17 years
centered care by
involving
parents into the
decision making
of implementing
vaccine against
influenza
not involve in
the care process
or vaccination
process
condition for
children and
minimize their
risk of
developing
pneumonia
The question: Does involvement of parents in the decision making process for
vaccination against influenzaamong pediatric children help to minimize the risk of pneumonia
within 6 months, compared to children, whose parents do not take part in the decision making
process?
Systematic review
Systematic review is the research process, using which previous and recent research
articles are searched over several databases within which using several inclusion and exclusion
criteria several research and their findings are selected (Shamseer et al., 2015). These research
articles then are analyzed so that their application in the care process could be done and the
outcome assessed could be achieved in the care process (Moher et al., 2015).
In this evidence based practice, databases such as Pub Med and Cochrane were used to
search recent literature articles that contain evidences associated to the PICOT question of this
paper. The databases were searched with several key terms such as “family centered care
among pediatric patients”, “pediatric patients and their parents as a part of care process”,
“involving parents in the care process of children”, “adverse effects of not including parents
in the care process of children”. Further, these key terms were shuffled among each other and
connected using Boolean operators “And/Or” so that possible research articles could be

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collected. The total number of research articles obtained from Pub Med and Cochrane after
conducting the search was 845 and 134 respectively within which only 2 accurate and
appropriate research articles were included. The prisma chart of search strategy is as follows:

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Pub Med and Cochrane data bases were searches with specific key
words
Pediatric patients and their
parents as a part of care process
Family centered care
among pediatric patients
Involving parents in the
care process of children
Adverse effects of not including
parents in the care process of
children
Total 979 research articles were
found
Inclusion factor: English language,
presence of research method and
findings, peer reviewed articles,
published not before 2014.
Exclusion factor: language other than
English, absence of research method
and findings, no peer reviewed
articles, published before 2014 and
descriptive paper
Total 2 articles
were selected
(CREATED BY AUTHOR)
Systematic error: systematic error is the process which occurs due to the imperfect
calibration of measurement, imperfect method of observation and interference of the

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environment in the process (Macleod et al., 2015). Due to these errors and measurement
associated conditions, results are affected and divert the research in different direction. These
errors are difficult and hence, it becomes difficult for the research workers to understand the
systematic bias or error present in the research study (Roulston & Shelton, 2015). In this process
also systematic errors and bias will be observed and strategies will be implemented so that while
implementing evidences, the errors could not affect its reliability (Althubaiti, 2016). To reduce
the errors of the selected research articles, all the aspects that can increase the rate of systematic
errors would be discussed and then those errors would be removed and to balance the presence
statistical errors, calibration methods would be used (Macleod et al., 2015).
Evidence based practice (selected cases)
The research article which has been selected after the systematic review was by Coker et
al. (2016), and in this research the primary aim of the study was to understand the effect of
parent centered or family centered care in the care process for children belonging to low income
families. This study approach of this research article was discussing the new model, well child
care in which parents were provided with the charge of healthcare for the patients (Coker et al.,
2016). Total 251 children with their parents were included in the process and their selection in
the subject group and the target group was randomized to comply with the study design which
was randomized control trail. This study was selected as it provided with the comparison of
intervention group and non-intervention group through application of randomized control trial
(Coker et al., 2016).
Further the article also included, the treatment as usual and the parental problem solving
skill technique so that their involvement in the care process of their children could be

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implemented and then the efficacy of the care process could be assessed (Coker et al., 2016).
Hence, using systematic review, the article was able to apply both of these methods and assessed
their importance for the care process of the children with family centered care (Coker et al.,
2016).
Summary of the articles
The first research article by Coker et al. (2016) selected for this discussion. The primary
aim of this research was to understand the role of new care model Well child care or WCC which
includes parents of new born and toddlers requiring healthcare or vaccination associated care in
the process of their growth and development (Coker et al., 2016). Total 251 children and their
parents were included in the process and depending on that they were provided with four type of
educational and skill training such as parent coach in which they were provided with anticipatory
guidance, and understanding of behavioral guidance (Coker et al., 2016). Further, they were
provided with web based tool for their screening, healthcare associated messages, and finally a
brief of problem focused care so that they can comply with the care process for their children
(Coker et al., 2016). The control group on the other hand was not provided with any such
training or education so that comparison could be drawn. These families were low-income
families and hence, it was important for their children’s growth and development that they
become aware of the healthcare process and take active part in the process (Coker et al., 2016).
After conducting the study, the parents were assessed on the bases of several measures such as
anticipatory guidance, health information, psychosocial assessment and developmental screening
ability among the parents. However, the researchers did not found any significant difference
between the achievement of care of the child both in subject and control group (Coker et al.,
2016). However, it was seen that parents with WCC were more focused and aware of the aspects

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which could affect child’s health condition and hence, were able to apply preventive measures in
the process. Besides that, it also reduces their cost of healthcare as they were more focused on
the prevention of the diseases of their children (Coker et al., 2016).
The second research article by Palermo et al. (2016) was included in the study of
evidence based practice in which the primary aim of the researchers was to understand the
efficiency of problem solving skill training or PSST compared to the ‘treatment as usual’ so that
the effect of including parents in the care process for children could be assessed and compared
with the usual treatment procedure (Palermo et al.. 2016). This randomized control trail was
conducted on 61 parents and their 10 to 17 year old children and the outcome assessment were
done thrice, once prior to commencement of the process, second after 2 months of process and
final assessment after the completion of the process (Palermo et al., 2016). The efficacy and
efficiency of the process were assessed after assessing the parent’s retention skills, their
attendance in such sessions, and engagement of the care process for their children. After
completion of the study, it was found that parents, who attended the PSST training were satisfied
and completely involved in the pediatric care process and hence, making them understand the
complication of healthcare system was easier for the healthcare professionals (Palermo et al..
2016). On the other hand, parents on TAU group was not satisfied with their children’s treatment
and were not able to understand the complication of the care process due to which, the
acceptability of care among those parents were less than the PSST group (Palermo et al., 2016).
Application of evidence in care process
Both of these research articles included in the study were associated to the application of
parents in the care process of children and assessed the quality of care and achievement of health

8EVIDENCE BASED NURSING PRACTICE
if the parents were an active part of the care process. Despite the fact that both of these articles
did not discuss about the implementation of vaccines in the children for their health
improvement, both of these articles compares the involvement of parents with parents who are
not involved in the care process which increased its acceptability for this discussion.
The article by Palermo et al. (2016) mentions the PSST or problem solving skill training
for the parents whose children are admitted in the care facility as it was seen that after
application of this training, parents were more focused on the care process, were able to
understand the preventive measures and satisfied with the health improvement of their children.
Hence, this PSST training will be included in the care process for the parents for making them
understand the value of vaccination to save their children from diseases (Palermo et al., 2016).
The second article, whereas, mentioned about the application of well child care model as
through this, the parents, who belong to low income families were provided with healthcare and
preventive measures so that using those preventive measures the parents could maintain their
child’s health condition (Coker et al., 2016). Therefore, this skill should also be used in the
parent educational session for making them aware of the vaccination strategy and its importance
for the growth and development of children.
Evaluation of the outcomes, its validity and reliability
Evaluation of these strategies applied after the conduction of evidence based practice
should also be inclusive of parents and their ability to compliance of the care process. In this
aspect, parents who would be selected in the skill developmental or educational sessions prior to
include them in the care process, should be evaluated on the basis of their understanding of the
complete sessions (Heale & Twycross, 2015). Interviews and questionnaire should be an

9EVIDENCE BASED NURSING PRACTICE
appropriate and accurate evaluation process for the identification of the ability of the parents to
comply with the care process. After their feedback, all the results will be assessed statistically so
that accurate data regarding their understanding as well as the success of the evidence based
practice could be understood (Darawsheh, 2014).
Research reliability completely depends on the removal of study bias, calculation and
systematic error present in the included pares or conducted research (Koo & Li, 2016). In this
process, for the completion of the calculations and finding the success of the evidences collected
from the systematic review, statistical method would be selected so that negligent bias could be
eliminated from it and reliability of the process could be retained (Darawsheh, 2014). Further, in
this way, the validity of the evidences of family centered care for children could be achieved.
Both of these articles hence find its validity and reliability so that these interventions could be
applied in the healthcare processes to make the parents a part of care team and implement family
centered care in the process (Heale & Twycross, 2015).
Study bias of these researches
As mentioned in both of these research articles, researchers were aware of the effect of
study bias in reliability and validity of the research and hence, proper approach were selected for
all the calculations so that bias present in the study could be removed (Kelly, Fitzsimons &
Baker, 2016). In the article by Coker et al. (2016), the researchers implemented ‘intention to
treat’ analysis so that majority of study bias that could affect the reliability of the research could
be removed. These biases were associated to selective disenrollment from the intervention as
well as nondichotomous outcomes were measured in the scale of 0 to 100 that provided room for
accurate calculations. Thereby, removing the associated bias of the process. On the other hand,

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the study design of the process was directly involved with satisfactory level of parents after
receiving PSST training, hence no such study bias were present (Bengtsson, 2016).
Identification of the level of evidence
The level of evidence associated to both these researches was Level 1. As Silverwood et
al. (2015) mentions that level 1 evidences are selected from a systematic review and or a meta
analytical study and always are inclusive of evidence based clinical practice or randomized
control trail so that clear evidence of the subject intervention could be achieved. Therefore, the
articles selected for this evidence based practice contains level 1 evidence (Grosso et al., 2017).
Conclusion
In the modern age healthcare processes, it is important to implement patent centered or
family centered care as care process is not only associated to achievement of physiological
health, but also is associated to satisfactory mental health. In this aspect, while providing care to
a child, involvement of parent becomes necessary so that informed and family centered care
associated strategies could be implemented and consent from the parents regarding the care
process of the child could be obtained. This article discusses one such picot question in which
involvement of parents in the care process was compared with non-involvement of parent. To
obtain valid evidences from the recent research articles a detailed systematic review was
conducted so that accurate article with randomized control trail related to PICOT study could be
obtained. After that two research articles were selected and their detailed analysis were provided
in the process with details of their reliability, validity, present study bias and summary of the
care process were provided. Finally, the application of these evidences in present scenario with

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their reliability and validity was presented in this evidence based research paper, so that parents
could be involved in the care process of their child to increase the efficacy of the process.

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