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Running head: ADVANCING ADHERENCE TO THE CAFFEINE INTAKE GUIDELINES TO IMPROVE PRE – PREGNANCY, PREGNANCY, AND BIRTH OUTCOMES

Advancing Adherence to the Caffeine Intake Guidelines to Improve Pre – Pregnancy,

Pregnancy, and Birth Outcomes

Advancing Adherence to the Caffeine Intake Guidelines to Improve Pre – Pregnancy,
Pregnancy, and Birth Outcomes

Benedicte Mbui

Mount Mercy University

Nu 471

Audrey Sheller

03/31/2021

Pregnant women form a demographic that requires policies and guidelines that are critical in improving their public health and the next generation’s health (Li et al., 2015). Specifically, these policies involve reducing certain substances like toxins and drugs that have been identified as harmful to the child and the mother during gestation. These issues have become critical to the medical society. Therefore, it is critical to understand how change can be implemented to help women eliminate caffeine consumption and interventions that can promote healthy behavior—the risk of such substances to mothers’ fetuses and fertility warrants the need for intervention and change (Loomans et al., 2012). Although caffeine’s exact effects on the fetus remain primarily misunderstood, there is a need to impact change and ensure that women can understand the benefits and risks of caffeine consumption pre-pregnancy and during pregnancy. Caffeine remains one of the most consumed beverages by men and women alike. There are underlying effects of caffeine consumption that are becoming more apparent from recent studies and research. The effects may vary from one individual to the next. This paper, therefore, proposes an intervention set to help pregnant women eliminate caffeine consumption before and after pregnancy. It will include strategies to assist the patients in understanding the need for the change, involve all stakeholders, and ensure they are all trained and are on board with the program. The analysis will include the possible challenges and barriers that can affect change and the best ways to overcome them. Current studies on caffeine’s effect before and during pregnancies used the rodent model to examine the effects in pregnancy, the effects after birth, and the fetus’s growth. Prior research showed that limiting the amount of caffeine could lower the risk of complications. However, throughout the pregnancy, daily consumption of the recommended minimum can still cause issues. This report, therefore, focuses on the implementation of change in caffeine consumption in a health setting. It involves the patients, doctors, the medical staff, the nurses, and family members and friends.

PICO Question

Does changing the caffeine intake guidelines improve pre – pregnancy, pregnancy, and birth outcomes?

Supportive Evidence

This section investigates the evidence that relates to the effect of taking caffeine during prenatal and postnatal periods. The section will also aim to establish the research gaps that exist in the previous studies. Besides, this section will use the previous papers to validate this study. Additionally, it will also assess the effectiveness of this study on other environments and the precautions that ought to be taken to ensure that it is effective. Further, it will also critically evaluate the literature while pointing out the effects at each stage and the interventions to implement during the various stages. Finally, the section will highlight the findings that arise from the review of the existing literature.

Guillán-Fresco et al. (2020) indicate that caffeine belongs to a family of methylxanthines. Since caffeine comes from coffee, tea, and soda, then its consumption is high as preferred beverages. Caffeine is a natural alkaloid with no nutritional value and has various adverse effects, especially among pregnant women.

Effects of Caffeine Consumption at the Prenatal Stage

According to Qian et al. (2020), the various effect of caffeine consumption during the prenatal stage include intrauterine growth restriction, and miscarriage. Another risk is that despite causing miscarriage, it can cause the pregnancy to attach wrongly in the uterus. He indicates that continued consumption of caffeine during pregnancy dramatically increases the chances of the above conditions, among others Guillán-Fresco et al., (2020); (Galéra et al., 2016) indicates that consumption of caffeine influences the birth outcome as well as compromising the pregnancy. A cup of coffee contains 100mg of caffeine. Therefore, it was widely thought that consuming three cups a day is not likely to have any effect and was thus referred to as a safe dosage. However, further research has revealed more damning results not previously highlighted (Bakker et al., 2011). Other studies also show that the effect during the various stages of pregnancy contrary to what was widely thought. Studies show that the consumption of caffeinated products is almost 89% per day in the United States alone. Further, other than other drugs, consumption is not restricted in any way, with Africans and Asians consuming tea, and soda t increase caffeine levels while Americans and Europeans and drink coffee and soda (Galéra et al., 2016); (Guillán-Fresco et al. 2020). Either way, despite the caffeine’s high consumption rates, the effects are evident and adequate steps should be implemented to limit the impact of consuming it.

According to Loomans et al. (2012), for pregnant mothers, there are no caffeine levels that are considered safe. Many analysts suggest that consuming two cups of coffee has an equivalent of about 200mg, which is still not safe for both the unborn child and the mother. Responsible bodies ought to take decisive action to minimize the consumption of caffeine. First, an important step is to encourage caffeine consumers to go for alternative products. There are many alternative products whose consumption is guaranteed to offer vitamins and more health benefits such as vitamins. According to Bakker et al. (2011), since caffeine products do not have vitamins, there are better products with higher vitamins, which can be more helpful to such women. Therefore, even though caffeine products such as tea and coffee, which lack nutrition value, are preferred by many Americans, starting an initiative to encourage expectant mothers against it would help reduce the effects associated with caffeine consumption (Loomans et al., 2012). The alternative products such as fruit juices and milk are of higher nutritional value, and therefore, responsible bodies should encourage expectant women to consume such products over tea and coffee.

The other meaningful way to minimize caffeine consumption is to educate pregnant mothers about the possible effects of caffeine consumption. Most postnatal patients are not aware of the many consequences of consuming caffeine products and therefore consume them ignorantly (Bakker et al., 2011). Several training programs will help health care facilities cut down on the costs incurred in treating some advanced effects of consuming caffeine (Galéra et al., 2016). Taking such precautions will reduce miscarriage and other negative consequences that can be attributed to the consumption of caffeine.

Effects on Postnatal Consumption of Caffeine

Keeping to the findings of Guillán-Fresco et al. (2020), Mothers who consume high levels of caffeine bear children who are likely to develop impaired cognitive development. Sometimes, such children have a very low IQ. Additionally, Qian et al. (2020) demonstrate that in the model of rodents’ expectant mothers who consume high caffeine levels influence children’s brain development. Other studies show that even the lowest consumption of caffeine products influences the cognitive development of such children.

Obesity is another common problem with children born of mothers who had a high caffeine consumption during pregnancy. Guillán-Fresco et al. (2020) Explain that a high percentage of children born of mothers with a high caffeine consumption rate undergo childhood obesity. Several studies indicate that the mother’s caffeine consumption influences the weight of the child (Loomans et al., 2012). Obesity is a significant challenge in the United States that is responsible for high motility rate mothers ought to take action to ensure their children’s health. in addition to the caffeine consumption causing Obesity among children, it is also responsible for childhood acute lymphoblastic leukemia (Peacock et al., 2018). The childhood acute lymphoblastic leukemia condition is responsible for many childhood deaths, and mothers ought to reduce or eliminate caffeine consumption to save their children.

Another effect of consuming high levels of caffeine during child pregnancy is that it is responsible for children with low birth weight and small head circumference. According to Qian et al. (2020), several factors influence the birth weight of a child. These factors include heart disease, anemia, and childhood acute lymphoblastic leukemia. Childhood acute lymphoblastic leukemia has a high mortality rate of around 70%; therefore, mothers should stop consuming caffeine to stop exposing their children to the condition.

Interventions for Postnatal

Loomans et al. (2012) Indicate that consuming high levels of caffeine leads to impaired cognitive development. Therefore, mothers should desist from consuming or reduce the amount of caffeine intake. The reduction will lead to a decrease in the number of children affected by impaired cognitive development. Guillán-Fresco et al. (2020) Indicate that the mental development process begins before birth. Therefore, any force that influences such an approach should be altered before it affects the responsible person.

Obesity among children is still one of the most common killer conditions in the United States. As such, responsible parties should take proper initiative to ensure that the children born are free from any life-threatening condition (Loomans et al.., 2012); (Galéra et al., 2016). Additionally, implementing proper measures is critical to ensure that conditions such as do not affect the child later.

The small head circumference condition is at times an indication of a brain that is not fully developed. Additionally, when children are born underweight, they have to be put in an incubator until they are fully developed (Peacock et al., 2018). However, in some instances, these conditions can hurt the children and, in worst cases, result in death. Therefore, caffeine consumption during prenatal and postnatal stages should be discouraged to ensure that the children do not develop such possibly fatal conditions. Qian et al. (2020) indicate that in some instances have associated caffeine with heart conditional among children. Therefore, since several studies have demonstrated the adverse conditions influenced by mothers consuming caffeine during pregnancy, it is prudent to cease losing children at an instance.

In conclusion, the articles reviewed lay bare the effects of consuming caffeine on children. Some authors still indicate that taking small quantities has only limited effects on then the patient. The impact of postnatal and prenatal caffeine is quite prominent (Galéra et al., 2016). First, the postnatal stage’s impact includes impaired cognitive development, childhood acute lymphoblastic leukemia, Obesity among children, cancer, low birth weight, and small head circumference. These conditions can be easily altered if only mothers are responsible enough for their children. These conditions are fatal in some instances, meaning that they make the United States’ mortality rate remain high. On the other hand, the prenatal stage’s effects are that the combination of the impact in both stages indicates that caffeine consumption harms the children born by such mothers. Therefore, this review establishes that it is crucial to reduce caffeine consumption throughout the pregnancy cycle.

Implementation Potential

Many people are naturally resistant to change, and more so when it involves strong habits such as caffeine consumption. Therefore, to effectively implement change and eliminate caffeine consumption before and during pregnancy, there has to be an unfreezing stage. Since it is a challenge to eliminate consumption at once, there must be a plan to help the individual eliminate caffeine consumption gradually. The role of unfreezing is to create awareness and inform the woman that the current status quo is not the most suitable for conceiving and the child’s health (Li et al., 2015). This stage also involves informing the patient that the degree of acceptance and the current belief they hold on caffeine consumption can affect them and affect the outcome of the pregnancy.

At this stage of the implementation, the medical personnel involved in the intervention must educate the person. Understanding that the old way of thinking must be dealt with before undertaking the process of change and convincing the patient that there is a need for change is critical to eliminating caffeine (Modzelewska et al., 2019). There are many beliefs and arguments about caffeine, and therefore the woman may hold some of her own, so communication as a tool must be effectively implemented.

At the unfreezing stage of every intervention, communication is essential as the woman, the spouse, and other family members and the medical personnel have to work hand in hand to realize change. The role of communication is to point out the benefits of caffeine elimination and the need for imminent change. The more the woman and the family members understand more about the change, the more they will be more willing to accept it and work towards it (Jahanfar & Jaafar, 2015). The process of conceiving and during pregnancy is a delicate one, and therefore, as long as the family feels the urgency, they will be willing to cooperate and accept the change. To shift from a culture that a person is used to already and accept change requires an internal drive. Therefore, such drive for change has to originate from the top. That is the physicians. The medical team supporting the mother before and during pregnancy must set the intervention’s tone and the need for change (Rodda et al., 2020). Unless the medical team sets the best place for the practice, the chances of the patients following through are minimized.

Barriers to Change

Availing information is, therefore, the best way to raise the desire to change for the woman. The use of information and data is the perfect tool for nurses and doctors to convince patients to change. With tests and measurements, a physician can raise an issue to the woman at this stage of the intervention. This stage, therefore, involves consultations between the medical team and the patient (Hillier & Olander, 2017).

Caffeine elimination is challenging progress and promises to be difficult for the mother and the family. There are several barriers to change. These must be identified. For a person to prioritize caffeine elimination, there are specific barriers that they have to deal with and face. There is the fear of withdrawal which can be scary for a person, especially during pregnancy. Some people also justify their case that they are unable to concentrate without caffeine and the impossibility of stopping (Stoll et al., 2018). Fighting caffeine addiction is associated with relapses and challenges and may scare a person from attempting to quit.

Another barrier to eliminating caffeine is the social functions it plays in the lives of many people worldwide. Many people hold the idea that without regular caffeine, they are unable to concentrate and remain productive. Many people apply caffeine in employment settings, such as those who work extra hours (Jahanfar & Jaafar, 2015). A person may also associate caffeine with studying and working on assignments regularly and may fear that elimination might affect their routine.

A barrier to implementing change is that caffeine is consumed as a part of a ritual or routine. Many people have caffeine as an essential part of their daily activities and changing may affect their routine. The woman can also resist change if they use caffeine to deal with mental health complications such as lack of sleep and anxiety (Rodda et al., 2020). Caffeine can also be used in sports settings as a stimulant or gym works.

To achieve the change needed, there must be feedback on various people’s behavior, including family members and medical personnel. It is essential to explain whether caffeine consumption is an issue and a need to change (Hillier & Olander, 2017). There is a need to self-assess the woman to understand the extent of caffeine they consume and the degree of tolerance and dependence. The benefits and costs of the elimination must be assessed thoroughly by the patient, the medical team, and family members. It is critical to understand the severity of the withdrawal and the effects that women can face if she attempts to eliminate consumption (Chen et al., 2018). Understanding the quantity of caffeine consumption and how it affects health is a critical factor in making the right decision about the change.

The potential benefits of the change must be clear. These for the woman include better sleep, an increase in better health, more energy, and mental health. Caffeine consumption affects blood pressure and adrenaline functioning (Modzelewska et al., 2019). It also causes anxiety, panic attacks, and irritability. All healthcare personnel who work with the mother can instruct caffeine during pregnancy due to the possibility of surgical procedures, dental issues, and general health problems. There should be moderation which warrants the need for the implementation (Evatt et al., 2016). Lowering the consumption of coffee and related substances such as dairy and sugar can also have health effects and reduce the financial burden associated with the habit as reasons for change.

Development and Implementation

Training is critical to attaining the goals of the change among pregnant women. The primary source of information is from the medical team and professionals. Additional sources can provide information on external sources such as blogs, websites, and books (Modzelewska et al., 2019). All the intervention stakeholders must understand caffeine as a substance, strategies to change dependency, symptoms of caffeine deficiency. The process of training also involves the psychological burdens and effects of continuous consumption of caffeine. For a person to understand the need for the change, they have to be well versed in the substance’s knowledge (Rodda et al., 2020). People must understand whether the type of caffeine they consume is natural or has additional additives and the caffeine industry issues.

Further information and discussions during the training must include how coffee is metabolized in the body and how it differs when pregnant. Without a proper understanding of the scientific side, the patients can be resistant to change. It is also critical to understand the process of manufacturing and production. In the past, the urgency has been in limiting the consumption to an average minimum; however, there is a need to convince women that the best way to ensure the pregnancy’s best outcome is to eliminate consumption (Hillier & Olander, 2017).

Training Stakeholders

The patients and the staff must be trained on dealing with withdrawals and scenarios that can occur while quitting. The training should also involve discussions with other people who have gone through the same situation (Hashmi et al., 2016). The patients should talk to other women who went through pregnancy and had to eliminate their caffeine consumption. Hearing from the experiences of women in similar situations can assist in eliminating the barriers to change. They can get guidance from people who have dealt with withdrawal and managed to go through with the pregnancy until birth. Seeing the health benefits of the change to the baby and the mother can motivate other women to keep going (Jahanfar & Jaafar, 2015). The internet is a good source of information and case stories about people who have dealt with caffeine addiction during pregnancy.

This stage involves the actual change and move, which is the reality of the intervention. At this stage, the medical team must understand that many people struggle with accepting the new status quo. The patients can face fear and uncertainty, which can make overcoming a significant challenge. The more the patients are prepared to face the issue, it will be easier for them to complete it. Therefore support, education, and communication are critical between the doctors, the nurses, the patients, and families as they familiarize themselves with the change (Rodda et al., 2020). The nursing team must be fully aware of the change’s benefits and why it should be implemented.

The patients should be supported by all parties involved and taught to believe in themselves. It is accepting that they can achieve the goal of eliminating caffeine during pregnancy. The nurses must keep a positive mind and attitude. Their training can include a non-medical professional such as a dietician or psychologist. The patients can require remote counseling sessions and medical care, and nurses should understand natural supplements and medications to help with the withdrawal symptoms. Quitting caffeine is associated with muscle pain, depressive episodes, muscle pain, headaches, and other cases that can be alleviated by appropriate medication (Stoll et al., 2018). The medical personnel must also track the consumption of caffeine among the patients.

The patient’s feelings and thoughts must also be sourced to understand the changes in moos, anxiety, and energy. These factors are critical in understanding how their bodies respond to withdrawal. This stage must involve the support system, including the family, work colleagues, friends, and nurses who understand the change’s intention. Accountability is critical for success; therefore, the support system should be constantly involved as family and friends assist the patients in caffeine consumption (Jahanfar & Jaafar, 2015). The patients, however, reserve the decision on whether to continue with the process or if they choose to stop due to inability to avoid the barriers.

A strategy to ensure the change’s success includes withdrawal management in the initial days of caffeine elimination. All stakeholders must be trained and willing to deal with real-time scenarios rather than reverse the need. Well-being as a strategy can involve a range of approaches to improve patients’ general health based on factors such as diet and sleep. Although factors such as these are not directly related to caffeine elimination, some consumers believe that caffeine helps develop resilience and capabilities (Stoll et al., 2018). Controlling consumption must include substitutions, antecedents, and associations.

In managing the change process in a medical setting, the people who have to change must participate in all the change processes. The hospital setting must develop a team spirit and culture whereby everyone understands the intended change and its need. This way, the nurses, doctors, and patients can work towards attaining the same common goal. The common goal in this discussion is the elimination of caffeine consumption among pregnant women (Rodda et al., 2020). This vision must be well communicated to the patients and the staff, and family members.

The change’s specifics must be precise, with both the patients and the nurses treating each other with mutual respect. Achieving change at such a level requires a clear explanation of expectations as every stakeholder is evident on the role they play in the change, understands others’ role, and feels the collective sense of accountability for the process. In the implementation of change, individuals need to know how much change they are making, and this can be achieved through feedback from the nurses’ data throughout the period.

Evaluation

The intervention’s deliverables will seek to reduce and eliminate caffeine consumption among women pre-pregnancy and during pregnancy. One way that will be used to measure the success of the intervention is self-reported data collected via surveys. The nurses will periodically contact the women to report the progress on caffeine intake since the training on caffeine withdrawal. The surveys will be sent online and will ask questions regarding withdrawal from caffeine. The survey will also investigate whether the women have been able to withdraw successfully and manage the symptoms, caffeine substitutes that they are currently using, the effects of withdrawal, and how they are dealing with them, among others. The survey’s results will be data-savvy and coded and analyzed to present findings of the caffeine withdrawal and use before, during, and after the intervention. The second approach will be clinical and will seek to measure known outcomes of caffeine use that nurses are inherently duty-bound to measure and manage. These approaches will seek to explore the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of both the mother and the child, families, communities, and populations. Clinical data will be corrected to measure caffeine intake’s effect on all involved parties before, during, and after the intervention and launch of the Caffeine Intake Guideline. Among the clinical data that will be collected including fetal abnormalities, pregnancy complications such as miscarriages, fetal developmental issues, among other issues related to caffeine intake.

The surveys will be conducted every three months after the interventions are initiated. On the other hand, clinical data will be collected during pregnancy and pregnancy clinics that women attended periodically in local healthcare institutions. The target will be to affirm the abnormalities and defects that are related to caffeine intake are reduced by at least 55% in the first two years since the intervention and caffeine intake guidelines are put in place. Still, measurements will be taken in the long run to develop an intense database that can be used to affirm how the intervention works each financial year and identify areas of improvement. The proper budgeting and accounting measures will be put in place to measure the project budget and expenses on cost versus benefit analysis. Each quarter, the healthcare organization will present a financial report of the intervention program with clear information relating to investments in capital, expenses, and costs. These costs overall cost differences will be measure against the pre-existing accounts of budgets and expenses that have previously been spent on managing and treating caffeine-related complications and defects during pregnancies. The intention is to contain lower costs than the expenses on managing and treating caffeine-related defects while changing and improving both the mother and the child’s lives. Therefore, cost-benefit will be measured purely on accounting grounds using comparative analysis of costs and expenses before and during the interventions. The cost-benefit evaluation is in line with the principles and practices in healthcare, where cost-benefit analysis (CBA) involves comparing interventions and their consequences in whereby both costs and resulting benefits (health outcomes and others) are expressed in monetary terms.

Conclusion

It is critical to limit caffeine consumption during pregnancy due to the mother and the fetus’s potential harm. High levels of use are connected to complications for the baby and the mother. There have been limitations to the amount a pregnant person can consume in a day, but recent studies show that it can still lead to stillbirths and miscarriage. Therefore, with this information, there is a need to implement this report’s strategies to help reduce the risks of complications. The intervention must be carried out respectfully and understandably, as all parties should be willing to play their part. This report highlights the strategies that can be used to achieve the goals. It highlights the possibilities of carrying out the strategies and the perceived costs and benefits to the patients. It also highlights the functions and duties. All parties involved, families, friends, and healthcare service providers involved, must be trained to deal with the situations that arise and possible barriers. The barriers to change are also highlighted and accordingly dealt with the implementation of appropriate strategies. The process will collect data for the evaluation and refreezing stage of the implementation to understand and monitor the changes.

References

Bakker, R., Steegers, E. A., Hofman, A., & Jaddoe, V. W. (2011). Blood pressure in different gestational trimesters, fetal growth, and the risk of adverse birth outcomes: the generation R study. American journal of epidemiology, 174(7), 797-806.doi.org/10.1093/aje/kwr151

Chen, L. W., Fitzgerald, R., Murrin, C. M., Mehegan, J., Kelleher, C. C., Phillips, C. M., & Lifeways Cross Generation Cohort Study. (2018). Associations of maternal caffeine intake with birth outcomes: results from the Lifeways Cross Generation Cohort Study. The American journal of clinical nutrition, 108(6), 1301-1308.doi.org/10.1093/aje/kwr151

Evatt, D. P., Juliano, L. M., & Griffiths, R. R. (2016). A brief manualized treatment for problematic caffeine use: A randomized control trial. Journal of consulting and clinical psychology, 84(2), 113. https://psycnet.apa.org/fulltext/2015-48759-001.html

Galéra, C., Bernard, J. Y., van der Waerden, J., Bouvard, M. P., Lioret, S., Forhan, A., … & EDEN Mother-Child Cohort Study Group. (2016). Prenatal caffeine exposure and child IQ at age 5.5 years: the EDEN mother-child cohort. Biological psychiatry, 80(9), 720-726. doi.org/10.1016/j.biopsych.2015.08.034

Guillán-Fresco, M., Franco-Trepat, E., Alonso-Pérez, A., Jorge-Mora, A., López-Fagúndez, M., Pazos-Pérez, A., … & Gómez, R. (2020). Caffeine, a risk factor for osteoarthritis and longitudinal bone growth inhibition. Journal of clinical medicine, 9(4), 1163.

https://doi.org/10.3390/jcm9041163

Hashmi, A. M., Bhatia, S. K., Bhatia, S. K., & Khawaja, I. S. (2016). Insomnia during pregnancy: diagnosis and rational interventions. Pakistan journal of medical sciences, 32(4), 1030.

10.12669/pjms.324.10421

Hillier, S. E., & Olander, E. K. (2017). Women’s dietary changes before and during pregnancy: A systematic review. Midwifery, 49, 19-31.

doi.org/10.1016/j.midw.2017.01.014

Jahanfar, S., & Jaafar, S. H. (2015). Effects of restricted caffeine intake by mother on fetal, neonatal and pregnancy outcomes. Cochrane database of systematic reviews, (6). doi.org/10.1002/14651858.CD006965.pub4

Li, D. K., Ferber, J. R., & Odouli, R. (2015). Maternal caffeine intake during pregnancy and risk of obesity in offspring: a prospective cohort study. International Journal of Obesity, 39(4), 658-664. doi.org/10.1038/ijo.2014.196

Loomans, E. M., Hofland, L., Van der Stelt, O., Van der Wal, M. F., Koot, H. M., Van den Bergh, B. R., & Vrijkotte, T. G. (2012). Caffeine intake during pregnancy and risk of problem behavior in 5-to 6-year-old children. Pediatrics, 130(2), e305-e313.doi.org/10.1542/peds.2011-3361

Modzelewska, D., Bellocco, R., Elfvin, A., Brantsæter, A. L., Meltzer, H. M., Jacobsson, B., & Sengpiel, V. (2019). Caffeine exposure during pregnancy, small for gestational age birth and neonatal outcome–results from the Norwegian Mother and Child Cohort Study. BMC pregnancy and childbirth, 19(1), 1-11.doi.org/10.1186/s12884-019-2215-9

Peacock, A., Hutchinson, D., Wilson, J., McCormack, C., Bruno, R., Olsson, C. A…, & Mattick, R. P. (2018). Adherence to the caffeine intake guideline during pregnancy and birth outcomes: A prospective cohort study. Nutrients, 10(3), 319.doi.org/10.3390/nu10030319

Qian, J., Chen, Q., Ward, S. M., Duan, E., & Zhang, Y. (2020). Impacts of caffeine during pregnancy. Trends in Endocrinology & Metabolism, 31(3), 218-227. doi.org/10.1016/j.tem.2019.11.004

Rodda, S., Booth, N., McKean, J., Chung, A., Park, J. J., & Ware, P. (2020). Mechanisms for the reduction of caffeine consumption: What, how and why. Drug and Alcohol Dependence, 212, 108024.doi.org/10.1016/j.drugalcdep.2020.108024

Stoll, K., Swift, E. M., Fairbrother, N., Nethery, E., & Janssen, P. (2018). A systematic review of nonpharmacological prenatal interventions for pregnancy‐specific anxiety and fear of childbirth. Birth, 45(1), 7-18.doi.org/10.1111/birt.12316

Evidence Based Practice Paper Rubric

Student name: _____________________________________________________________________

Topic/Title of paper: ________________________________________________________________

Points: ________/1

points

Part one of the EBP paper:

First, identify a clinical problem

Then, find an evidence-based change in nursing practice to make improvement.

Find

background articles that describe the population and current situation (professional literature, within last 10 years). Literature reviews and meta-analyses may be used for background articles.

Find 5 supportive evidence articles. These must be original research articles that support your intervention. Professional literature, at least 3 pages long, original research studies within the last 10 years.
NO editorials or opinion articles.

First section of article is a review of each supportive evidence article, followed by a summary of that total research.

Part two of the EBP paper:

The next section is a plan to implement your intervention into a specific clinical unit. This plan should be specific and detailed enough that anyone could take it to the unit and actually make it happen as written. Must involve a change in nursing practice that will include nursing staff.

You are writing a clinical change in practice, NOT a research study! No control group. The change will be implemented for all eligible patients within the unit. You will collect data before and after the intervention to compare and determine if outcomes were met.

PICO worksheet must be submitted in the dropbox by the due date. If you are not sure if an article is appropriate please check with the professor prior to writing your EBP paper. Faculty will not approve articles submitted within 1 week of paper deadline.

Students are allowed one pre-read which must be submitted by no later than 1 week prior to the due date for the paper.

Critical Attributes

Excellent 100%-90%

Rare Errors

Satisfactory 89%-75%

Occasional Errors

Needs Improvement

74%-0%

Frequent Errors

Part 1:
I. Introduction and relevance to nursing practice

10 points

10-9 points

Describe the nursing problem and the specific setting where the problem exists.

Reference at least 2 background articles.

Identify the intervention or evidence-based guidelines that will be implemented to address the problem.

Include the clinical question in PICO format. 2 specific, measureable outcomes are identified.

8-5 points

Describes the problem but does not mention the specific setting where the problem exists.

Identifies only 1 background reference.

Identifies in vague terms the intervention that will be implemented.

Part of PICO question absent.

4-0 points

Problem not clearly stated and specific setting not mentioned.

No background articles referenced.

Intervention not mentioned in introduction.

PICO question not present or missing 2 or more components.

II. Supportive evidence

30 points

30-25 points

Five original relevant research articles referenced.

When referencing the articles:

Includes the author and year.

If using a direct quote also includes page number as well as the author and year. Every paragraph has a reference noted.

Each article is identified as to if qualitative or quantitative research, a brief summary of the article including sample size, how the research was conducted and how the intervention was measured. Includes the results including limitations. Discusses the quality of the study as it relates to intervention.

At the end of the supportive evidence section includes a summary of all articles. This section should synthesize information from the 7 articles and sources must be cited.

24-15 points

Four original relevant research articles referenced.

When referencing the articles:

Includes the author and year on most references.

If using a direct quote does not include page numbers as well as the author and year. Most paragraphs have a reference noted.

Most articles are identified as to if qualitative or quantitative research, a brief summary of the article including sample size, how the research was conducted and how they measured their intervention. Includes the results including limitations. Discusses the quality of the study as it relates to intervention.

At the end of the supportive evidence section summary of articles is vague or summarizes the problem but not the interventions in research.

14-0 points

Three or less original relevant research articles referenced.

When referencing the articles:

Includes the author and year on some or none of the references.

If using a direct quote does not include page numbers as well as the author and year. Most paragraphs not referenced

Some to none of the articles are identified as to if qualitative or quantitative research, a brief summary of the article including sample size, how the research was conducted and how they measured the intervention. Missing the results and/or the limitations. No discussion of the quality of the study or how it relates to the intervention. Or articles are not relevant to the intervention/problem identified.

Summary of supportive evidence section is missing.

Part 2

III Implementation potential (unfreezing)

20 points

20-16 points

Addresses transferability of the intervention or guidelines to the practice setting

Discusses the feasibility of implementing the intervention including the costs vs. benefits, the specific team who will lead the intervention and their roles.

Identifies barriers to implementing the intervention and solutions how these will be addressed

15-10points

Addresses transferability of the intervention or guidelines to the practice setting but fails to give specific information so reader can see feasibility of intervention.

Discusses implementing the intervention including the costs vs. benefits in a vague manner, Identifies the team but does not identify their role in the intervention implementation. Or the team is too large for the proposed change.

Identifies some barriers to implementing the intervention and limited solutions/how these will be addressed.

9-0 points

No transferability of the intervention or guidelines to the practice setting is addressed.

Discusses the feasibility of implementing the intervention in vague terms. Does not address the costs vs. benefits, the specific team who will lead the intervention and their roles.

Identifies only one or no barriers to implementing the intervention or fails to address possible solutions/how these will be addressed

IV Development and implementation (movement)

20 points

20-16 points

Discusses training and education of staff, patients, families, and any other relevant groups. Specifically identifies what the education will include and method of instruction (ie: written, role playing, video, etc.)

Describes an overall plan for implementing the intervention or guidelines in the practice setting in detail.

Identifies strategies for marketing the change as needed.

Client preference is identified and addressed if client wishes to opt out.

15-10 points

Discusses training and education of some but not all relevant people affected by the change. Education is vague and lacks detail or is the exact same for all groups involved or doesn’t include the method of instruction.

Overall plan for implementing the intervention or guidelines in the practice setting is vague and missing portions.

Limited strategies for marketing the change are included.

States client preference if chooses to opt out, but no strategies to address this included in paper.

9-0 points

No or limited discussion of training and education. Or education not addressed for all involved or doesn’t include the method of instruction.

Overall plan for implementing the intervention or guidelines in the practice setting is missing large portions or too vague to understand how the intervention would be implemented. Or the intervention chosen is not a nursing intervention but would require a doctor’s order or is a product.

No or minimal strategies for marketing the change are included.

Client preferences and strategies to address are not included.

V Evaluation (refreezing)

10 points

10-8 points

Describes how the intervention will be measured referring back to the expected outcomes in the PICO question.

Includes a guideline for the time frame for the intervention as well as includes a discussion of the timeline, the methods used to collect the data, including in the appendix a sample of the tool used if appropriate.

States who is responsible for collecting and analyzing data. Evaluation tool developed if necessary. Explains how costs vs benefits will be evaluated

7-5 points

Describes in vague terms how the intervention will be measured. Evaluations only part of the expected outcomes from the PICO question. No time frame for the intervention to be evaluated is included or how the intervention will be evaluated is vague and doesn’t adequately evaluate the expected outcomes.

No sample of the tool used if appropriate or evaluation tool not well-developed if necessary.

Explanation of how costs vs benefits vague.

4-0 points

Expected outcomes from PICO question not evaluated or evaluated in such vague terms hard to decipher what is being evaluated.

No evaluation tool identified or described.

Timeline for on-going evaluation not present. Explanation of how costs vs benefits absent

VI. Conclusion/Summary

10 points

10-9 points

Key points of the whole paper as well as the implementation summarized in a concise manner.

An overview of the research utilization or EBP project well-summarized

8-5 points

Summary is vague and doesn’t address either the research or the intervention that was discussed for implementation.

4-0 points

Unclear summary of intervention or introduces new information into the summary or no summary present.

Include this with part 1 of paper-should be emailed to professor

VII. Reference List

10 points

10-9 points

Uses at least five professional research articles. (articles that support the intervention for the specific problem)

At least two background references (these articles address/describe the problem that has led to the proposed suggested intervention)

Used APA formatting in the reference list

Only articles that are cited in the paper are included on the reference paper.

Research articles are from an approved country (USA, Canada, England, Sweden, Germany, Australia, Denmark, Ireland, Wales, Spain, Japan)

References are current (within last 5 – 10 years).

References are Primary sources.

8-5 points

Uses four professional research articles. (articles that support the intervention for the specific problem)

Only one background reference used (these articles address/describe the problem that has led to the proposed suggested intervention) or article is not a reference or an approved article.

Some APA formatting in the reference list.

Extra articles that are not cited in the paper are included on the reference paper or references are missing from the reference page.

Some articles are from a country not on the approved list (,Russia, some countries in South America, Africa, Iran, Iraq, Saudia Arabia, North or South Korea-unless prior approval given)

References are older than 10-15 years.

References are secondary sources.

4-0 points

Uses three or less professional research articles. (articles that support the intervention for the specific problem)

No background reference used (these articles address/describe the problem that has led to the proposed suggested intervention) or article is a lay article or not an approved article. Research is from a country not approved to use in paper.

Sources not cited using APA format in the reference list.

Articles/references are missing from the reference page.

All articles are from a country not approved (Russia, some countries in South America, Africa, Iran, Iraq, Saudia Arabia, North or South Korea-unless prior approval given)

References are older than 15 years.

References are secondary sources or lay sources.

Satisfactory 89%-75%

Occasional Errors

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	Category	Excellent 100%-90% Rare Errors		Needs Improvement 74%-0% Frequent Errors
CLARITY 5 Points APA pp. 65-70 GRAMMAR 5 Points APA pp.78-79,87-96, 106-114	Clear, concise sentences throughout the paper.	Clear, concise sentences throughout most of the paper.	Frequent unclear sentences.
Sentence structure is grammatically correct (e.g. avoids incomplete or run on sentences).	Occasional errors in sentence structure.	Frequent errors in sentence structure.
Referent of pronoun is clear. Singular noun (student) in agreement with pronoun (she or he).	Referent of pronoun is almost always clear. Singular noun (student) in agreement with pronoun (she or he).	Frequent unclear use of pronoun. Singular noun (student) used with plural pronoun (they).
Fully developed focused paragraphs that transition smoothly. Paragraphs are understood with first reading and are of appropriate length.	Occasional passage or paragraph unfocused, difficult to understand with first reading or of inappropriate length. Lack of transition in a few areas.	Many areas not understood with first reading. Paragraphs are frequently inappropriate in length and/or have more than one focus. Lack of transition in many areas.
Spells out abbreviations and acronyms with first use.	Occasional use of abbreviations and acronyms without spelling out on first use.	Frequent use of abbreviations and acronyms without spelling out on first use.
Rare errors in punctuation.	Occasional errors in punctuation.	Frequent errors in punctuation.
Rare errors in spelling.	Occasional errors in spelling.	Frequent errors in spelling.
Rare errors in capitalization.	Occasional errors in capitalization.	Frequent errors in capitalization.
Rare errors in use of numbers (spells numbers zero to nine and at beginning of sentence).	Occasional errors in use of number/words.	Frequent errors in use of numbers/words.
VOICE 5 Points APA pp.73-76	Writing consistently engages the reader, uses appropriate tone for audience.	Writing is clear and tone is appropriate for audience throughout most of paper.	The writing style is superficial, cursory, or oversimplified.
Writing reflects respect for client or participant and reader. Favors terms such as “person with diabetes” rather than “diabetic”.	Occasional use of language that labels persons.	Use of biased language that is patronizing or offensive.
Uses both first and third person voice appropriately. Uses active voice rather than passive voice. Avoids the use of ‘you’ or ‘your’.	Appropriate use of both first and third person voice with occasional errors. Uses active rather than passive voice.	Frequent errors in use of first or third person voice or passive over active voice.
Avoids use of potentially identifying information such as names, client initials, dates of care, institutions/units.	Uses unnecessary details such as client initials, institution or date.	Uses a combination of potentially identifying information such as names, client initials, dates and institution/unit.
	SCORE
APA ELEMENTS 10 Points	Uses appropriate format for paper including running head, title, page numbers, 12 font Times New Roman, spacing, margins and required headings (course specific). APA p. 23 and p. 62	Occasional errors in format for paper including running head, title, page numbers, font, Times New Roman, spacing, margins and headings (course specific).	Frequent errors in APA format.
Uses appropriate in-text citations. APA p. 92, pp. 112-114,	Occasional in-text citation errors.	Frequent errors in-text citations.
Meets reference page requirements. APA pp 174-179, 198-215	Occasional errors in reference page requirements.	Frequent errors in reference page requirements.
All sources cited in text are included on reference page. All sources on reference page are cited in the body of the paper.	Reference list is missing one source cited in the paper or includes one source that was not cited in the paper.	Reference list is missing more than one source cited in the paper and/or includes more than one source that was not cited in the paper.
Appropriate use of direct quotes (course specific).	Over-use of direct quotes.	Excessive use of direct quotes.