Evidenced Based Practice
Group Presentation
Chris Bookheimer
Michelle Rowe
Sandy Saylor
Jackie Tiefenthal
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“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).
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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
By Julie L. Lohse, RN, MSN
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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.
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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.
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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.
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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.
Jeremy A. Kelley, MSN, RN, CRNP
Roy Ann Sherrod, DSN, RN, CNE, CNL
Patsy Smyth, DSN, RN
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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
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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 selfmotivated 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)
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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
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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
Girls on the Move
Program to Increase
Physical Activity Participation
Authors: Lorraine B. Robbins, Kimberlee A. Gretebeck, Anamaria S. Kazanis
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).
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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
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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).
“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).
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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
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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 selfmanagement.
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This study emphasizes the fact that healthcare 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.
“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).
“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).
“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
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“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).
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“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)
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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.