Refinement of a Nursing Concern Into an Evidence-Based Practice: Formula vs. Human Milk During Infancy and Gastrointestinal Complications

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Refinement of a Nursing Concern Into an Evidence-Based Practice: Formula vs. Human Milk During Infancy and Gastrointestinal Complications

Words: 1428

Subject: Pediatrics

Table of Contents Evidence-Based Practice Overview Nursing Concern Selection PICOT Question and Literature Review Theoretical Framework Conclusion References Modern mothers pay much attention to the issue of infant feeding and the effects of malnutrition on young children and toddlers. In this paper, the area of interest that is chosen for the evidence-based practice (EBP) project is closely connected to this topic as the decision to evaluate the risks of gastrointestinal infections due to drinking formula or human milk is made. According to the investigations of the World Health Organization (2018), about 155 million children under 5 are stunted, 52 million are wasted, and 41 million are overweight or obese because of poorly organized nutrition. The Convention on the Rights of the Child states that every infant has the right to appropriate nutrition that should be promoted by parents or other caregivers (Moghaddam, Khademi, Abbasi, & Saeidi, 2015). This proposal is based on the recent research studies about infancy feeding and associated gastrointestinal complications and the theory of planned behavior to get prepared for future EBP within the frames of a PICOT question to compare the effects of drinking formula or milk.

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Evidence-Based Practice Overview There are many ways to improve the level of knowledge about a particular topic and make certain contributions to the chosen field. Family nurse practitioners, as well as other nurses and medical employees, have to understand the differences between such concepts as research and EBP. The research aims to generate new knowledge or evaluate the existing information relying on a theory when EBP is about translating the already gathered evidence and its application to clinical decision-making (Conner, 2014). In both cases, specific research questions should be asked. Still, compared to conducting research where answers and descriptions are usually enough, EBP researchers should be ready to use their findings in clinical expertise and personal work. Regarding the basics of the chosen approach, this EBP project may contribute to professional nursing in a variety of ways. This method helps to make certain conclusions in a short period. For example, Bartle and Harvey (2017) explain that evidence proves that as soon as formula milk is introduced, the reduction of breastfeeding may be possible. Such MSN Program specialty as a family nurse practitioner can benefit from the EBP project because it focuses on the improvement of infant well-being, caretakers’ literacy in feeding, and even the relationships between parents (Wahyutri, Jasmawati, Dharma, & Ratnawati, 2017). The investigations of Yin et al. (2014) introduce low health literacy as the main reason why formula feeding prevails over milk feeding. Finally, EBP can be used to understand what steps should be taken to prevent health complications such as obesity, gastritis, and heart problems (Appleton et al., 2018; Moghaddam et al., 2015). These evaluations are necessary to promote changes and develop future research regarding the chosen practice setting and available resources. Nursing Concern Selection Nursing concerns are based on current problems patients and the staff may face when healthcare services are offered. In this project, the problem of infant feeding will be discussed to understand what contributions nurses can make to improve the health of young children and toddlers and identify time frames for possible interventions. O’Sullivan, Farver, and Smilowitz (2015) state that the work of the gastrointestinal system depends on human milk and protein concentrations in the body. Though it is not known how exactly the introduction of formula may impact the gastrointestinal tract, breastfeeding duration is usually promoted (O’Sullivan et al., 2015). Each case of gastrointestinal infection in a toddler has its specific characteristics, and the task of a nurse is not to search for shortages or mistakes but to gather the material and make conclusions. In the setting where I have to work for a considerable period, the cases of gastrointestinal complications are not frequent. As a rule, mothers admit their lack of knowledge of feeding and ask a nurse for a brief, helpful course. Therefore, nurses and parents (mothers in particular) are defined as the main stakeholders of the chosen concern and take responsibility for the consequences of their interventions. It is integral to evaluate all options and understand the difference between formula and human milk feeding to clarify if parental choice may determine health complications among their children.

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The attention to health conditions of a mother as the main source of human milk and the quality of formulas chosen should be paid. Therefore, the purpose statement of this EBP proposal is to clarify if toddlers suffer from gastrointestinal infections because their parents or caregivers choose formula feeding instead of breastfeeding. PICOT Question and Literature Review The main PICOT question of this project is as follows: “In toddlers (P/T), does drinking formula during infancy (I) compared to drinking human milk during infancy (C) increase the risk of gastrointestinal complications/infections (O)? This question should be answered as a result of gathering the material using a mixed-research method within the frames of the EBP project. The expected outcomes will be useful for the future practice setting because they can help to recognize the main cause of the existing problem and discuss the solutions that may be offered. Mothers can choose formula feeding because of personal or health-related issues. Breastfeeding remains to be a social, ethical, and psychological concern for many mothers. Therefore the purpose of conducting a literature review is not only to gather the material about the benefits and threats of formula feeding compared to breastfeeding but also to distinguish the conditions under which such a decision is made. The work on the chosen EBP project and the creation of the literature review will be developed in several stages. First, it is necessary to identify the databases which are credible for this type of work. As a family nurse practitioner, I have already dealt with such databases as Medscape, Sage Publications, PLOS, and PubMed. These sources can be used to gather enough material from case studies, direct interventions, and evidence-based reviews. To facilitate this search, such key-terms as “formula feeding”, “milk feeding” or “breastfeeding”, “gastrointestinal infection”, and “nursing” will be used alone and in groups. It is possible to improve research and add such minor search phrases as “nutrition knowledge”, “parental attitude”, and “child health”. All these terms are appropriate for the study and meet the demands of the EBP. Along with online databases, the investigation of credible organizations is advisable. The projects of the Centers for Disease Control and Prevention (CDC), WHO, Pediatric Nutrition, and the Association of Pediatric Gastroenterology and Nutrition Nurses can improve the results of research. Theoretical Framework The choice of a theoretical framework is a crucial step for any proposal. The necessity to refine a nursing concept is not an easy task, and the awareness of a special theory can facilitate the task and guide a researcher. The theory of planned behavior (TPB) is the chosen background for future study. Bartle and Harvey (2017) admit that this theory, as well as Bandura’s social cognitive theory or the theory of reasoned action, helps to quantify the cognitive and psychological factors of infant feeding. Caregiver’s behavior may be determined by the intention of a person to take a step to promote the child’s well-being. This theory has its pros and cons that may define the investigation of infant feeding and its effects on gastrointestinal infections. According to the TPB, an intention is the core issue that represents a combination of attitudes and norms that build human behavior (Bartle & Harvey, 2017). The choice of this theoretical framework is not always supported by all researchers because of the difficulty to falsify it and its problematic validity.

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However, its authors Martin Fishbein and Icek Ajzen introduced a clear formula according to which a behavioral intention (BI) may be identified through the relationships between attitudes toward behaviors (AB), subjective norms (SN), and weights (W): BI = AB*W1+ SN*W2. This formula can help to unit qualitative and quantitative information and identify if the choice of feeding is the reason for gastrointestinal complications in toddlers. Conclusion In general, the investigation of the connection between feeding and gastrointestinal infections with the help of evidence-based practice and the theory of planned behavior has positive outcomes in nursing. First, it should help the changes that may be recommended for nurses who aim at reducing the risks for children whose parents prefer formula feeding to breastfeed. Second, this project aims at evaluating the differences between the two types of feeding and the conditions under which parents make their final decisions. Finally, the chosen PICOT, literature, and theory prove that this nursing concern is urgent in modern nursing, and family nurse practitioners should take the necessary steps and find a solution to gastrointestinal infection reduction. References Appleton, J., Laws, R., Russell, C. G., Fowler, C., Campbell, K. J., & Denney-Wilson, E. (2018). Infant formula feeding practices and the role of advice and support: An exploratory qualitative study. BMC Pediatrics, 18(1), 12-23. Bartle, N. C., & Harvey, K. (2017). Explaining infant feeding: The role of previous personal and vicarious experience on attitudes, subjective norms, self‐efficacy, and breastfeeding outcomes. British Journal of Health Psychology, 22(4), 763-785. Conner, B. T. (2014). Differentiating research, evidence-based practice, and quality improvement. American Nurse Today, 9(6). Web. Moghaddam, H. T., Khodaee, G. H., Abbasi M. A., & Saeidi, M. (2015). Infant and young children feeding: A key area to improve child health. International Journal of Pediatrics, 3(6.1), 1083-1092. O’Sullivan, A., Farver, M., & Smilowitz, J. T. (2015). The influence of early infant-feeding practices on the intestinal microbiome and body composition in infants. Nutrition and Metabolic Insights, 8(1), 1-9.

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Wahyutri, E., Jasmawati, M., Dharma, K. K., & Ratnawati, M. (2017). The effect of infant feeding planning education on nutrition and breastfeeding knowledge, mother’s attitude, and husband’s support to expectant mother. Journal of Nursing Education and Practice, 8(1), 87-93. World Health Organization. (2018). Infant and young child feeding. Web. Yin, H. S., Sanders, L. M., Rothman, R. L., Shustak, R., Eden, S. K., Shintani, A., … Perrin, E. M. (2014). Parent health literacy and “obesogenic” feeding and physical activity-related infant care behaviors. The Journal of Pediatrics, 164(3), 577-583.

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