Among a variety of issues that are a deep concern for modern health care professionals, obesity and overweight are frequently considered the most challenging. In this paper, childhood obesity prevention strategies will be studied in both quantitative and qualitative perspectives as combination of these approaches is the most effective in terms of epistemology.
The problem of overweight and obesity is one of the key concerns for health care professionals in the present time. When it comes to obesity prevention strategies in adult population, many researchers emphasize the significance of healthy eating habits and exercises since childhood. Therefore, strategies to prevent pediatric obesity are developed by the World Health Organization (WHO) and other health care programs on international, national, and local levels. The crucial aspect of childhood obesity discussed in nursing literature is that pediatric obesity is a risk factor for the future health problems (Berkowitz & Borchard, 2009). The surveys demonstrate that children overweight is met in no younger than 4 years old children with a tendency to persist in adulthood, which emphasizes the necessity of obesity prevention strategies in early childhood (Agency for Healthcare Research and Quality, 2013). Moreover, the data witness that the prevalence of overweight among 4-5 years old children increased from 5% to 10.4% between 1976 and 2000 (Berkowitz & Borchard, 2009; Nelson & Ford, 2004). According to the statistics offered by the WHO, 170 million children worldwide are estimated to be overweight and obese (The WHO, 2012, p. 13). Taking into account medical, psychological, and social effects of obesity on the quality of children’s lives, the WHO resolution called “The Global Strategy on Diet, Physical Activity and Health” states that pediatric obesity is the most serious public health challenge of the 21st century. Overweight children are at high risk of diabetes II, anxiety, depression, asthma, joint problems, cardiovascular system damages, as well as mental health issues including decreasing self-esteem, tendency to drink alcohol and smoke, high rates of sadness and nervousness (Berkowitz & Borchard, 2009).
The researchers emphasize asking the right questions to study pediatric obesity, as “they drive the research methods, subject selections, and data analyses in nurse researchers' quests to develop knowledge that hopefully will improve patient outcomes” (Beyea & Nicoll, 1997, p. 323). Taking into account the features of pediatric obesity prevention strategies, it is worth applying both qualitative and quantitative philosophy of nursing. Essentially, to investigate various manifestations of the phenomenon of interest, it is worth using quantitative approach. It should be primal because it allows processing the phenomenon statistically. It is impossible to study pediatric obesity prevention strategies without quantitative phase as the precise and objective data for making further conclusions are essential advantage of this type of nursing philosophy. Precisely measured effects and phenomena are the base for the entire study of the issue, as it works with empirical material. Initial acquisition with pediatric obesity phenomenon requires consideration of numerous factors, expressed through numbers. In addition, the quantitative research held with consideration of the investigation methods in nursing allows reaching objectivity and the truth.
However, quantitative research strategy in nursing regarding childhood obesity is not my philosophy of nursing yet. Instead of choosing among two distinct strategies, it is worth taking into consideration the results of humanity research. These results show that contemporary scientific discourses are marked by multidimensionality and combination of approaches that used to have no connection before. In other words, recent scientific researchers in different field state that contemporary scientists are focused on interdisciplinary approaches that make it possible to discover new aspects of common things. Though the researchers mention “irreconcilable conflict between the quantitative and qualitative paradigms” (Boyd, 1993, p. 66) and attempt to avoid illogical compromise recognizing the conflict, the proponents of each paradigm should applaud the existence and opportunities of each paradigm. Therefore, my philosophy of nursing does not end up quantitative strategy. I think that quantitative research is incomplete until the qualitative strategy is not applied after it. Qualitative approach allows viewing the phenomenon of childhood obesity from the perspectives of historiography, grounded theory, ethnography, and phenomenology. Qualitative methods make it possible to view the phenomenon of childhood obesity prevention as a lived experience, which means understanding the meaning of some issues (Beyea & Nicoll, 1997, p. 323). For instance, I think that it is possible to describe the phenomenon as lived experience and its connection with its environment via phenomenology. Furthermore, I believe that every proficient nurse applies phenomenological method because it helps to comprehend the experience of the patients via observations and interviewing. It is worth paying special attention to philosophical foundations of qualitative research and, especially, phenomenological point of view. Perspective of phenomenological psychology in nursing “focuses on phenomena as they appear and recognizes that reality is subjective and a matter of appearances for us in our social world” (Boyd, 1993, p. 66). Subjectivity means that the world is real through individual contact with the world and its interpretation. Therefore, the uniqueness of human experience is an essential component of my nursing philosophy.
Apart from statistical data, indexes, and graphs, my investigation of pediatric obesity strategies includes communication with patients and consideration of their individual experiences. When the term ‘philosophy’ is used, meta-view and meta-position are required, for it means standing above quantitative approaches and generalizing findings of quantitative research to find the most essential components. It signifies that nursing practice should become combination of theoretical knowledge gained by quantitative researchers and qualitative approach to adjust the emotional contact with each patient. For instance, Foss and Ellfsen confirm that qualitative and quantitative approaches in nursing may be combined by means of method triangulation (2002, p. 242). These researchers also confirm that the use of quantitative and qualitative methods combined together is increasing. It is worth agreeing with the authors who approve using epistemology that reflects multiplicity of contemporary nursing research (Foss & Ellfsen, 2002, p. 242). My epistemological position acknowledges both approaches to nursing research, thus, ranking research approaches in hierarchical order and in different values is not needed. As reality is complex and diverse with nursing practice and research as its parts, alternative epistemological position that embraces both quantitative and qualitative approaches is ontologically motivated. I realize that qualitative and quantitative approaches are distinct epistemological positions, though their combination allows investigating the phenomenon from new perspectives. The comprehensive and valid picture of strategies that prevent from childhood obesity is possible if different sources of knowledge are combined, not ranked.
It is necessary to discuss the fundamental patterns of knowing in nursing offered by Barbara Carper (1978). Via the analysis of the syntactical and conceptual structure of nursing knowledge, the author identifies four patters. In accordance with logical type of meaning, she distinguishes empirics, esthetics, ethics, and personal knowledge. Empiric pattern articulates the critical need for knowledge of the empirical world to organize it in systematical laws and theories so that it could be explained, described, and predicted. Nursing science represents new perspectives for treating common illness in a different way, viewing health as something more than absence of diseases. According to Carper, “health as something that normally ranges along a continuum has led to attempts to observe, describe, and classify variations of health, or levels of wellness, as expressions of a human being’s relationship to the internal and external environments” (1978, p. 24). Today science of nursing includes the aspects of natural history stage and stage of deductively formulated theory, the task of which is to describe the phenomenon by observations. Nevertheless, contemporary nursing literature is focused on inventing rather than describing or analyzing. The first fundamental pattern of knowing is empirical knowledge that comes from external sources and may be verified and formulated discursively. In my practice, I will use empirical pattern by studying human behavior via scientific methods.
Another pattern of knowledge is esthetic component that describes unrationalized experience. Esthetic meanings can be distinguished from scientific ones, as esthetic is expressive, whereas science is descriptive or formal. Esthetic pattern includes empathy that may be defined as capacity to experience the feelings of another person. Thus, emphatic acquaintance is the source that allows getting knowledge from particular and individual experience of the others. Experienced nurse becomes skilled in empathizing and is capable to reach understanding from alternative modes of reality. As the nurse understands the feelings of patients, she will be able to provide effective and satisfying nursing care due to a larger repertoire of choices in designing (Carper, 1978, p. 27). Thus, esthetic pattern may be formulated as the perception of particular experiences that may be distinguished from abstracted universals, which is the recognition of unique particular experience of the patient. I will apply this pattern by attempting not to use emotional connection with the patient so that he/she could freely share his/her feelings, which would be beneficial for healing.
The next fundamental pattern is personal knowledge that appears to be the most problematic due to the difficulties in teaching and mastering. As nursing is an interpersonal process that involves interactions, transactions, and relationship between the patient and the nurse, it significantly effects a sick patient coping with his/her illness. The term ‘therapeutic use of self’ means that nurses’ self may be beneficial for the patient. Hence, the task for the nurse is to develop personal knowledge about individual’s self and to treat the patient as to his/her personality rather than an object of care via reflection (Johns, 1995). When two personalities interact to promote wellbeing of each other, healing becomes essential replacement of viewing patient as a client-object. Personal knowledge and recognition of self may be called the most complicated task ever; nevertheless, reflection would help me to deepen my knowledge of self and improve my practice. Development of reflective practice, supported by Johns (1995) and Heath (1998) exceeds the limits of science and provides philosophical level of interaction with the patients.
The final fundamental pattern of knowledge is ethics that embraces moral aspects of nursing practice. Ethic pattern is crucial for nursing activity, as it is grounded on philosophical position towards definitions of good, bad, right, wrong, and desired. Ethical component is irreplaceable component of any relationships, but it is transformed in nursing because of special status of the patient. The nurse providing care and healing and the patient are both worth being respected and treated as ends, not means, though the nurse should recognize that patient needs help due to the health problems and that her task is to promote health according to the principles of humanism and morality. I realize that nursing is a caring profession that is extremely important for the society and that promotes health, life, and the good. Thus, my practice should be comprehended as a way to increase wellbeing of every patient who needs my care.
In conclusion, it is worth stating that childhood obesity prevention studies will be investigated the most effectively via the combination of quantitative and qualitative methods despite initial conflict of these paradigms. As the issue of obesity prevention is recognized by numerous researchers and authoritative healthcare organizations, the solution of this problem demands application of different patterns of knowledge. Nursing practice aimed to solve this problem should be a combination of the pattern of empirical research, esthetic experience, personal knowledge, and ethics. These components will be effective and promoting healing only if they are combined to improve the position of both nurse and patient.