METHODOLOGY
The objective of this chapter is to define nursing research, analyse methods of research and outline methodological process used to find articles on which to base this extended literature review. In this hypothesis, the reason for literature review is to ascertain whether or not gastric banding is an effective treatment for obesity in young adults as measured by physical functioning.

The research process is the step-by-step procedure of developing research paper (Boje, 2001). It normally consists of following stages: detection of the research problem; preparation of search plan; searching and assessing the literature; data collection and evaluation; formulating a research design; and presenting the research findings (Cormack, 1996). The ability of nurses and other health care professionals to locate and identify existing literature on a relevant topic is an essential nursing skill (Burns & Grove, 2003). The sources where they can gain and expand research knowledge from may include personal or specialist experiences and clinical procedures and guidelines (Eccles & Mason, 2001). Before they can be made assessable to health care workers, guidelines and procedures are required to go through rigorous process of dissemination, before they can be made assessable to health care workers to be used in practice (Craig & Smith, 2007). Some of the organisations responsible for underwriting and implementation of clinical guidelines into clinical practice are: the National Institute for Health and Clinical Excellence (NICE), NHS Evidence and the Joanna Briggs Institute (JBI), the Cochrane Collaboration and the Scottish Intercollegiate Guidelines Network (SIGN), (Cohen et al, 2008).

Cain (1999) described research as the analytical evaluation into and study of existing resources in order to ascertain facts and reach new conclusions. Polit & Beck (2004) further defined nursing research as a systematic analysis intended to develop the knowledge about issues that are important to nursing profession and nursing practice. Furthermore, Burns & Grove (2001) stressed that it is important to develop and refine the knowledge because it can improve the clinical practice. Similarly, Minichiello et al (2004) further supported this and emphasised that nursing practitioners need to be capable of understanding a research report and evaluate the quality of that research.
To guarantee reliability and authenticity of all research, it is recommended that researchers should have an audit trail to allow any future investigator to be able to replicate the study (Koch, 2006). For example, many critics are averse to accept the reliability of qualitative research; therefore researchers should provide necessary details to demonstrate that findings are not their own inclination, but true conclusions (Silverman, 2001).
Research evidence can appear in various forms and differs in quality and superiority, which means that certain types of research can uncover stronger evidence than others. This is known as the “hierarchy of evidence” or “hierarchy of reliability” (Summerskill, 2000). Model of hierarchy of evidence can be used as a guide when reflecting on the effectiveness of evidence based nursing practice (EBNP, 2015). Harbour & Miller, (2001) ascertained that systematic reviews and combined findings from independent studies, also known as meta-analysis, are ordinarily at the top of the hierarchy of evidence; followed by RCT’s (Randomised Control Trials), Case Reports, and Cohort studies (Appendix 3). Johnston (2005) further emphasised that the higher a methodology appears in the hierarchy, the more likely the outcomes signify unbiased authenticity and validity.
However, Cook et al (1998) argues that the hierarchy of evidence, which is so important in EBNP, may not always be correct and in fact can be complex and confusing to read (EBNP, 2015). This effectively can have undesirable effect on the nurses as caregivers, if they don’t entirely understand what they are reading.

The main methods of literature research are qualitative and quantitative research. Qualitative research is a systematic process, which is mainly used to describe life experiences, feelings and beliefs (Polit & Beck, 2006). This type of data collection commonly uses individual interviews, group discussions or partaking in small group sizes. Contrastingly, quantitative research is about quantifying the results to provide evidence, and subsequently producing values that can be changed into usable statistics (Gerrish & Lacey, 2006). Quantitative data collection techniques include online studies, telephone or face-to-face discussions and paper surveys. This type of data collection methods are much more organized and better controlled than qualitative, because findings are conclusive and usually descriptive in nature as opposed to qualitative which cannot be used to make generalizations (Chen & Hirschheim, 2004).

The topic of the effectiveness of gastric band surgery was chosen because preliminary search revealed that growing numbers of cases of obesity amongst young people and adolescents, has made it into a serious and alarming social problem (Laird et al, 1999). WHO (2003) stressed that presently, obesity is possibly the biggest and most worrying health crisis facing the world. Young people are tomorrow’s adults and their health and wellbeing is a vital issue for a healthy nation. One just needs to consider: diabetes mellitus, hypertension, coronary heart and artery disease, hyperlipidemia, and progressive joint disease. These are just some of the life threatening diseases, which are directly weight-related (Flegal et al, 1998).

Gastric band surgery has become increasingly popular, amongst young people, male and female, as a way to reduce the negative effects of obesity (Kral 1995; Brownell et al, 2007). Although, this subject has not been researched excessively, some research has been done to establish if this type of surgery is to be used as a future treatment for patients with severe and complex obesity, that has not responded to other non-invasive therapies (NHS, 2013). Frighteningly, some researchers have indicated that some types of gastric band surgeries may become the most common broad-spectrum surgical procedure performed in the next decade or so (Schauer et al, 2003).

The next step, in this literature review, was data collection and analysis, which describes the way that relevant information will be collected to answer the research question (Gerrish & Lacey, 2006). Additional description of data analysis, was given by Macleod Clark & Hockey (1989) cited by Cormack (2000) where is stated that research is an attempt to expand on what is already known through a systematic analysis, the research process.
The subject of effectiveness of gastric band surgery was researched using systematic literature review (Seaman 1987). The main objective of systematic review is, firstly to find relevant published evidence, establish the quality of study, select reports for inclusion, synthesise findings and conclusions in a balanced way and lastly to interpret outcomes and provide a well-adjusted and unbiased summery (Dubben & Beck-Bornholdt, 2005). Neale (1997) went further and titled it as a type of review that uses existing primary research for secondary data analysis, outlining common themes and results.
Brewer and Hunter (1989) claim that the most significant consideration in a literature review is the relevance of the sources to the topic researched. Therefore, to refine the research topic, a PICO model was applied which helps to break down the question into Population, Intervention, Comparison and Outcome (Cochrane Library, 2015).
Literature review and data analysis was conducted using databases selected from Buckinghamshire New University, library search. They were: the British Nursing Index, Internurse, CINAHL, Medline, Royal College of Nursing, PsycArticles, Ovid, PsycInfo, PubMed and Cochrane Controlled Trials. These databases were used because they encompass wide range of nursing journals, online or in paper form, and all directly related to nursing and nursing practice.

In order to effectively carry out this review, mixed methods research methodology was used. This type of approach combines the strength of both quantitative and qualitative research and promotes accuracy and clarity of findings (Creswell, 2008). Analysis and evaluation of the available articles was guided by the significance of the title, followed by the content of the abstract to prevent being deviated away from the purpose and aim of the study. The search words were devised from the original question to guarantee that it was answered correctly (Johnson et al, 2004). Initially, the time limit applied was five years, which was later extended to ten years. This was labelled as inclusion and exclusion criteria.

The search words used were: “gastric band surgery”; “gastric band” “and” “obesity”; “effectiveness of gastric band surgery”; “obese young people” “and” “surgery”; “surgical treatments for obesity”; “young patients” “and” “gastric band”; “effectiveness” “and” “complications of gastric band”; “nursing role in bariatric nursing” and “young women” “and” “bariatric surgery”.

All searches executed were set for English language and all articles searched were published in peer-reviewed journals. In addition, articles were selected based on significance and status of final result to the patient. Equally, inclusion criteria included randomized controlled trials (RCT), cohort studies, and studies that included patient oriented outcomes. Exclusion criteria included children under the age of sixteen that had no comorbid conditions, previous Cochrane reviews, and previous student published systematic reviews (Table 1). Inclusion criteria | Exclusion criteria | * Peer reviewed articles * English language * 2005-2015 * Age: 16-35 yrs. * Any gender * Any race * Randomized controlled trials (RCT) * Cohort studies * Case reports * Patients that have failed to reduce and maintain weight loss through behavioural therapy * Post-op complications | * Articles without outcome data * Adolescents younger than 14 yrs. * Previous Cochrane studies * Student published systematic reviews * Those who have had previous gastric band surgery | Table 1.

The first search was conducted using “gastric band surgery” and it produced 859 hits, however only 4 were in peer-reviewed journals. The abstracts of all 4 articles were read and one article was selected “Patients’ perception of the nursing contribution to gastric band surgery” by Pfeil, (2013). This was chosen because it met the key search terms for the chosen topic and also unearthed additional information about the concept of caring. The other 3 articles were excluded because the author was not a nurse researcher, as Walrath et al, (2012) highlighted that nurse researchers are one of the best-qualified groups for clinical outcomes research, and can make a significant contribution to the transfer of knowledge to the wider nursing community.
A second search was initiated using “gastric band surgery and young people”, producing 8 hits, and again, only 4 were peer reviewed. After reading abstracts of all 4 articles, one article was selected “Bariatric surgery in severely obese adolescents: single-centre experience” by Sachdev et al, (2014). This article was chosen because it was directly related to the original question while other 3 were very brief and were not related to the subject.

A third search was conducted using “gastric band surgery and obesity” producing 259 hits. Out of these 139 were peer reviewed. Further limitation was added to include “females” only and it produced 18 articles. Abstracts were all read and two articles were selected: “Mycobacterium abscessus peritonitis associated with laparoscopic gastric banding” by Hakami et al, (2013) and “Young adult woman’s experiences of body image after bariatric surgery: a descriptive phenomenological study” by Jensen et al, (2014). These were chosen because, again, there were relevant to the chosen topic and the others were excluded because of dissimilarities in relevant information.
Qualitative research occurs in natural (rather than experimental) settings and produces text-based data through open-ended discussions and observations.

A final search, using “bariatric surgery effectiveness and complications”, yielded 259 hits. Out of these, 137 were peer reviewed. It was than decided to add a key words “patient’s experiences’ which resulted in 87 hits, but only 17 were peer reviewed. All abstracts were read and from this yield further three articles were chosen: “Single incision laparoscopic adjustable gastric band: technique, feasibility, safety and learning curve” by Osborne et al, (2012); “Effects of Gastric Bypass Surgery in Patients With Type 2 Diabetes and Only Mild Obesity”, by Ricardo et al, (2012) and “Bariatric surgery in severely obese adolescents: a single-centre experience” by Sachdev et al, (2014).

To make this literature review more controllable, an additional table was generated, which included study type, number of participants involved, their age and emerging themes (Appendix 4). Bostrum and Suter (1993) further supports this expressing that this will help in linking findings and help form better discussions. As this is an appraisal of all aspects of gastric band surgeries, both quantitative and qualitative articles have been integrated as well as case reports. A critical analysis of the 6 articles chosen is now given in the following chapters as recommended by Hart (1998). Word count 2002.