Table of Contents
- Main Issues Being Researched Regarding Physical Assessment and Diagnosis
- Elements of the Review
- Validity of the Results of the Systematic Review
- Final Results
- Application to Practice as Either a Practicing or a Registered Nurse
- The Funder of the Review
- Strengths and Limitations of the Review
- Objective Accomplished
- Critical Thoughts of the Review and Its Implementation into the Work of APRNs or Registered Nurses
- Related Nursing essays
Main Issues Being Researched Regarding Physical Assessment and Diagnosis
The systematic review by Armstrong et al. (2016) had the primary objective of highlighting the significance of conducting a targeted physical examination in the course of pediatric visits focusing on weight management. The main issue being researched regarding physical assessment and diagnosis relates to the physical examination findings that are specific to children as well as adolescents who suffer from obesity. The researchers focused on defining the findings including the prevalence of each physical examination aspect among pediatric patients having obesity. In addition, the review provides a discussion on the relevance and significance of the findings, describing the known techniques used in the assessment of severity, and reviewing evidence concerning the need for supplementary evaluation. The review was motivated by the high prevalence of obesity among adolescents and children in the US (17 percent) irrespective of the recent declines (Ogden, Carroll, Kit, & Flegal, 2012).
Elements of the Review
Validity of the Results of the Systematic Review
The results of systematic review are valid. Armstrong et al. (2016) satisfied the requirements of ensuring valid findings outlined by Bronson & Davis (2011), Eden, Levit, Berg, & Morton (2011), and Gough, Oliver, & Thomas (2012). First, their systematic review tackled a sensible issue. Secondly, the authors conducted a search that is exhaustive and detailed, and comprised of relevant studies. It can be attributed to the fact that the authors searched for the appropriate bibliographic databases and outlined the search strategy that they adopted. The selection criteria used by the researchers have also been outlined. The review findings are also valid due to the similar results of various studies included in the review. A key validity issue cited by Armstrong et al. (2016) is that the quality of the evidence of the studies included in the review was low. Overall, the findings of the review are valid.
The final findings of the systematic review by Armstrong et al. (2016) is that providers are recommended to use the BMI when screening for obesity. In addition, the results highlight the importance of discussing the weight status with the children and their parents, as well as providing activity and dietary counselling. Moreover, the findings reveal that a targeted and comprehensive physical assessment can help the clinician in determining the severity including the need for additional treatment or assessment of comorbid conditions. The findings of the physical examination can also help the clinician in detecting and treating health conditions that might result in inactivity and disability in future. Moreover, the authors show that physical assessment is a non-invasive mechanism that can be used as a follow-up of progression co-comorbidities that are weight-related, and can be of significant help to families with respect to understanding the impacts of being overweight on the health of child.
Application to Practice as Either a Practicing or a Registered Nurse
The findings of systematic review by Armstrong et al. (2016) can be applied by either a practicing or a registered nurse. It is due to the fact that the authors present the known techniques that can be used by clinicians to evaluate the severity of various physical elements under examination. Essentially, the findings of the review emphasize the significance of conducting a targeted physical examination for pediatric patients during weight management visits, which is a key finding that can be applied in primary care, especially in the prevention of weight-related issues (Cunningham, Kramer, & Narayan, 2014; Guinhouya, 2012; Gupta, Goel, Shah, & Misra, 2012; Wang, et al., 2015). Some of the physical evaluation elements covered in the review include hypertension, elevated heart rate, height velocity changes, papilledema, dental caries, adenotonsillar hypertrophy and wide neck, gynecomastia, cervicodorsal hump, scoliosis, and gait among others. For each of these physical elements, the authors describe the techniques that can be used in the assessment of their severity. Another important finding that can be applied in clinical practice relates to the use of BMI when screening for obesity. This finding is consistent with other results reported in the literature (Baidal & Taveras, 2012; Lakshman, Elks, & Ong, 2012). In addition, the findings underscore the importance of clinicians discussing weight status with children and their parents, and providing activity and dietary counselling – all of which can be applied by nurses in the primary prevention and management of obesity.
The Funder of the Review
Armstrong et al. (2016) declared no external funding for their research. They also point out that they do not have any pertinent financial relationships that require disclosure. Thus, it can be inferred that the authors funded the research on their own.
Strengths and Limitations of the Review
The systematic review by Armstrong et al. (2016) has a number of strengths. The first strength is that it has a clearly stated aim. In this respect, the researchers clearly stated that the aim of their research is to alert clinicians to the results of findings as well as to offer a framework for the management of the conditions discovered during the physical examinations. The authors also caution that their review is not geared towards providing screening recommendations. The second strength of the systematic review stems from the methodological rigor adopted in the review. In this respect, Armstrong et al. (2016) specified the literature search strategy as well as the selection criteria. In addition, the authors demonstrate substantial effort aimed at searching all the pertinent research. Essentially, their methodology can be reproduced.
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Despite these strengths, the systematic review also has several weaknesses. The first weakness that the authors acknowledged stems from the low quality of evidence present in the articles included for review. In this regard, Armstrong et al. (2016) point out that the bulk of the published studies are observational; therefore, tend to be associative instead of predictive. The second weakness in the review emanates from the selection bias wherein the researchers purposely selected physical assessment findings they considered most prevalent and those that are most likely to have an impact on clinical decision making. Furthermore, details regarding the decision-making process, such as independent examination of studies, the number of reviewers involved, and the resolution of disagreements among reviewers, are not presented. Another potential weakness is that the authors did not provide adequate details of the individual studies included in the review; thus, it is relatively difficult to determine the appropriateness of the conclusions derived by the authors. The authors could have improved their review by providing a table summarizing the design as well as the findings of individual research studies, or outlining a narrative description of the research studies.
The objective of the review was accomplished. As mentioned earlier, the review sought to alert clinicians regarding the presence of physical findings as well as to outline a framework that can be used to manage the conditions that have been discovered during the physical examination. The findings of the review indicated the physical assessment findings observed among adolescents and children having obesity and the techniques that clinicians can utilize for assessing these conditions. The authors also used their findings to present recommendations for conducting comprehensive and targeted physical assessments.
Critical Thoughts of the Review and Its Implementation into the Work of APRNs or Registered Nurses
In sum, the findings of the review are valid and tackle an important and timely issue – obesity among adolescents and children. Nurses should play a crucial role in the primary prevention and management of obesity (Bohman, Ghaderi, & Rasmussen, 2014; Rabbitt & Coyne, 2012; Robinson, Denney‐Wilson, Laws, & Harris, 2013). Against such backdrop, the systematic review by Armstrong et al. (2016) is a valuable resource for nurses working towards addressing the obesity menace. The review outlines practical recommendations that nurses can adopt to help deal with pediatric obesity such as using BMI for obesity screening, activity counselling, and dietary counselling.