Explain the Rational for your Decision Making to your Situation of Uncertainty

Solution Code: 1EDD

Question: Public Health Assignment

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Assessment task 2:

Evidence selection and critical appraisal using CASP Objective(s): This assessment task addresses subject learning objective(s): A, B, C, D, E, F and G This assessment task contributes to the development of graduate attribute(s): 1.0, 3.0 and 4.0 Weight: 40%

Task: This assessment builds on assessment 1. Students should use their feedback provided from assessment 1 to refine and strengthen their searchable question to address clinical uncertainty, search terms and search strategy. Assessment 1 should be refined and resubmitted to form the beginning of this assessment using the template provided.

PART 1: Students are to develop a question to address the area of uncertainty, and demonstrate their ability to use the PICO or PS framework, and document a systematic method to search literature. Students should complete the worksheet provided and document their searchable question, key search

terms, and evidence of their database search (i.e. using Medline or CINAHL).

PART 2: Students are required to select ONE article that best addresses their clinical uncertainty. (This paper may be a Randomised Controlled Trial, a qualitative article or a systematic review article). Students should appraise this selected paper using the relevant CASP tool for critical appraisal. A detailed critical appraisal is required of the selected paper.

PART 3: Following appraisal, students are required to provide a short answer to address the following questions. What are some of the barriers and enablers to you implementing evidence based practice in your workplace? 1. Provide a short summary of the important information that relates to your clinical question, explain the rational for your decision making to your situation of uncertainty.

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Solution:Public Health

According to Adams and Galanes (2011), Evidence-Based Practice (EBP) approach has clear benefits and is a globally accepted approach towards consistency and quality of care. However, there are several barriers and enablers to its implementation at the workplace. Inadequate research resource at the workplace is one of the major barriers to implementing EBP. While there may be the willingness to use nursing skills in equipping and helping teenagers on matters that relate to teenage pregnancy, the workplace does not have the necessary resources needed to build the capacity of the staff on issues that deal with teenage pregnancies. As such, the staff only use the knowledge they acquired from their college training to address teenage pregnancy issues. Unfortunately, college knowledge alone is not adequate since the dynamism of teenage issues needs continuous knowledge acquisition. To this end, the unavailability of the resource material acts as a barrier to the implementation of the EBP. Another barrier to implementing EBP is intimidation by senior staff. In most instances, there are perceptions that nurses do not have limited authority and lack the power to make decisions and changes in their practice setting (French, 2005). A work environment that rarely supports or values EBP is another barrier to implementing EBP at the workplace. Although the management is well aware of the importance of EBP at the work environment, very little has been done at my workplace to make this a reality. The administration has been hesitant to support any EBP initiatives. As such, the hesitation of the administration in supporting all initiatives towards EBP is a significant barrier. Lack of time is another barrier to the implementation of evidence-based practice at the workplace. It is unfortunate that in most instances the workplace does not have the sufficient number of staff to handle all the patient needs. To this end, the few staff at the workplace are often overworked, leading to extreme burnout (Adams & Galanes, 2011). As such, it becomes difficult to have sufficient time in to implement evidence-based practice at the center. According to experts, an evidence-based practice can be best achieved if the persons concerned have ample time at their disposal in handling the issues raised. Medical experts point out that if the staff are forced to participate in evidence-based practice in the absence of sufficient time, there are high chances that the result obtained will be marked with huge errors since the concerned persons will be doing this under duress and in a rush to meet their other work-related obligations. French (2005) notes that although there are barriers to implementing evidence-based practice in the workplace, there are also enablers to implementing EBP. A major enabler to the implementation of EBP is the availability of the necessary and appropriate resources for the nurses. Capacity building is another enabler towards implementing evidence-based practice. According to experts, it is increasingly difficult for healthcare staff to handle issues without having the proper capacity. Given the dynamic manner in which teenage pregnancies are being interpreted, there in an urgent need for the nurses to be well equipped in addressing this societal challenge. Teenage pregnancy is a challenge that the society is currently facing, and the impact of this challenge cannot be underestimated (Adams & Galanes, 2011). Although both genders of teenagers have unique challenges courtesy of their age, pregnancy matters seriously affect the females in this age group. Unfortunately, not many healthcare institutions support or have in place evidence-based practices. As such, nurses in most of the healthcare facilities can only provide basic healthcare support without having anything more to offer to this highly dynamic age group. In order for the nursing fraternity to provide the best healthcare to the teenagers, there is the need for them to be well equipped and be always involved in evidence-based practices. Such approaches will help in dealing with the rising teenage pregnancies in the community. The assignment is based on the details found in the link attached below, which best describes the PICO question, “teen pregnancy is prevented by school based sex education compared to school based abstinence education”. Quantitative Pico Table

Population	Intervention	Comparison	Outcome
The main population that the study focused on are teenage girls aged 13-19 who suffer from unexpected pregnancies	The proposed intervention for the challenge is school based sex education offered by qualified nurses.	The teens with unexpected pregnancy are compared to those who have been educated on abstinence but still attend school	It is expected that after extensive education and guidance by the nurses, there will be an increase in unintended teen pregnancy in school going teenagers.
Other terms to be used. Teen pregnancy	Other terms to be used. Sex education in the family under trained nurses.	Other terms to be used. Teens sexual abstinence in school.	Other terms to be used. Contraceptive use

CASP TOOL SECTION A Screening questions Did the trial address a clearly focused issue? YES. The study focused in addressing teenagers, who were the specific target group that the research intended to study. Particular effort was directed in understanding pregnancy in teenagers. Was the assignment of patients to treatment randomized? YES. The assignment was carried out on teenage girls living in a boarding school. The choice of dealing with students in a boarding school was deliberate to capture a particular group. Were all the patients who entered the trial properly accounted for at its conclusion? YES. Having all the participants of the study in the same location made it easier to account properly for all the participants. It must be appreciated that the trial was not stopped early since there was the need for the study to handle all aspects of the research with the target group. Detailed Questions Were the patients, health workers and study personnel ‘blind’ to treatment? YES. All the study personnel in the research were blind to the issues under study. However, the participating group were well informed of the study primary objective. As such, they were ready and willing to give the correct responses to the questions raised. Were the groups similar at the start of the trial? YES. In order to come out with a convincing conclusion on the issue of teenage pregnancy, there was the need to have participants of the same age. The only slight difference was that some male teenagers were also involved to capture their opinion on the subject of research. Aside from the experimental intervention were the groups treated equally? YES. In such research, where confidential details are needed, it is only fair to treat all the participating groups fairly. Failure to this will lead to negative perceptions that may end up forcing some participants giving false information. Selecting a specific group that operates from a given location made it easier in treating them equally (Courtney & McCutcheon, 2010). The deliberate focus on the target group was to avoid instances in which different participants living in different localities expecting to be treated differently. SECTION B How large was the treatment effect? Considerably large. Since the research intended to capture a relatively sensitive issue, there was the need to consider a large participant pool. Matters of teenage pregnancies continue to be a challenge to many communities. As such, getting finer details on how the teenage pregnancies can be addressed needs a relatively large group of target participants. From the onset, it was the outcomes of the research that were intended to be measured were information based. The focus of the study was on unexpected pregnancy, unplanned pregnancy, education in family planning and delayed information of sexual matters to teenagers (Courtney & McCutcheon, 2010). It was expected that once these key points are clearly specified to the participants, it would be easy to collect all the necessary and correct answers. From the data collected, it was evidently clear that the issue of teenage pregnancy is a harsh societal reality. Unfortunately, very little effort seems to be focused on this issue since many people in society would rather address the matter in hushed tones. Having clearly outlined the primary outcome, the collection of data became much easier. According to the data collected from the study, a sizeable percentage of the participants, especially the teenage girls admitted that teenage pregnancy is a challenge to them. According to the collected data, most of the teenagers fall into the trap of teenage pregnancy through different approaches (Levin & Feldman, 2012). The need to belong to a given teen group, the need to look fashionable, the need to look mature, and in some instance the act of rebelling from parents or guardians are some of the reasons given by the teenage girls. How precise was the estimate of the treatment effect? Very High. According to experts, for any research to have validation, there must be some element of confidentiality (Levin & Feldman, 2012). From the onset of the study, every participant was reassured of the levels of confidentiality of the research. In creating a very high level of confidentiality, the target research group was able to open up and give genuine answers to the questions raised. The high levels of confidence exhibited by the target group courtesy of the confidentiality of the research helped in reducing the amount of time spent on the project. It can be argued that the high level of confidence by the target group helped the researcher in meeting a considerable number of participants since little time was spent in building the confidence of individual participants. SECTION C: Will the results help locally? Can the results be applied in your context? (or to the local population?) Yes. The results of the research can be applied directly to the local population. Since the study concentrated on the issue of teenage pregnancy in education centers, the results obtained will come in handy for such institutions in addressing this societal reality. Available information from education experts indicates that a sizeable number of teenagers drop out of school due to pregnancy (Courtney & McCutcheon, 2010). Unfortunately, for a long time, the society has taken the issue of teenage pregnancy as a norm rather than the exception. As such, the community has created a narrative that permits this practice. However, the results from research illustrate a different trend. Most of the teenagers fall victim of this challenge for more reasons than what society has been taught to understand. It can be argued that all the results obtained in the research can be used the local population in bringing awareness on the detriments of teenage pregnancies. According to the results, it is evidently clear that the local populace is missing the input of such refined details in matters that relate to teenage pregnancies. By applying the results of the research, the local community will be able to help their teenage girls avoid early pregnancies, which has the potential of affecting their entire life (Levin & Feldman, 2012). Were all clinically important outcomes considered? YES. Although all researches intend to capture many aspects, there are possibilities of missing some elements that may affect the outcomes. From the onset, the study aimed to capture all issuers related to pregnancy in school going teenagers. The projected questions were specific to avoid any instances of assumptions and errors. The responses from the other teenagers who are not school going form an aspect of information that would have been important to be seen in this research. Unfortunately, this has not been captured in this research. The input of that category of persons would help in establishing and forming a convincing conclusion on the matters that relate to teenage pregnancies not only to school going teenagers but teenagers at large (Malloch & Porter-O'Grady, 2010). Considerable amount of information and reaction from parents with teenagers is another aspect or piece of information that would have been important to be seen in the outcome of this research. It is fair to note that parents or guardians play a critical role in the lives of their children. To this end, the information they would have provided of their argument about teenage pregnancy would have been important (Malloch & Porter-O'Grady, 2010). The input of educators or the teachers who spend a considerable amount of time with the teenagers is another piece of information that would have been important to be seen in this research. Since the data collected was on teenage girls who are school going, it would be fair to hear from their teachers. Available information indicates teachers spend considerable time with learners. As such, the teachers have an idea on the character and operations of the learners. To this end, the teachers’ contributions or information would go a long way in illustrating school based circumstances that the target group may not have enumerated in their answering. While the teenagers may look for all reasons to justify events that lead to teenage pregnancy, the teachers may have a varied opinion that may affect the final decisions reached it the research. Although several pieces of information that would have been necessary to be seen in the data captured in this research, it is worth noting that the information would not affect the decision reached. One aspect is fundamental while considering all the factors around teenage pregnancies; the responses of the teenagers to the issues leading to early pregnancies (Levin & Feldman, 2012). Are the benefits worth the harms and costs? YES. In considering the subject under consideration, it is fair to appreciate that the benefits are worth the harms and the costs of the research. As argued earlier, the issue of teenage pregnancy remains a big challenge that society continues to handle. It is unfortunate that there are certain categories of persons within the community who consistently blame the teenagers for the predicament of teenage pregnancies. However, such individuals fail to appreciate that a myriad of factors that contributes towards teenage pregnancy. To this end, evidence-based research such as this one comes in handy and provides the factual data that can be used by the whole community in addressing this menace (Malloch & Porter-O'Grady, 2010). Although the benefits are worth the harms and costs of this research, it is imperative to note that consistency also plays a fundamental role in achieving the correct results from evidence-based research. To this end, a lot of sacrifice and commitment was put in place to realize the results of this study. According to family experts, the teens are an integral part of society that needs to be properly guided (Levin & Feldman, 2012). Any society or community that fails in directing its teenagers will most surely have to deal with the adverse impacts of teen life. In particular communities, teen pregnancy was considered as an abomination and often led to the girl being alienated by the family or excommunicated from the community. However, the results of evidence-based researches can be used in educating the general populace on the best possible approaches that communities can use in averting this menace. Besides, the results of such an evidence-based research can be used as a teaching aid or reference point, which can be used either by the teaching fraternity or by the society in helping the pregnant teenagers cope with pregnancy. The outcomes of the research are a clear indication that teen pregnancy does not only occur in poor neighborhood institutions of learning but also affects the affluent. As such, it is the responsibility of every member of the society regardless of their status, religion or gender to work together as a community in addressing teen pregnancy (Courtney & McCutcheon, 2010). In addition, healthcare providers, especially the nursing fraternity should be at the forefront in using their knowledge and skills in championing a course that discourages teen pregnancy. Further, there is the need for the concerned government agencies to avail more resources towards capacity building of the whole populace on matters that relates to teen pregnancy. Community that fails in addressing the issue of teen pregnancy should be ready to deal with other societal challenges that are brought about by teen pregnancies.

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