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Research Review
Accident and Emergency Nursing (2001) 9, 24–26 © 2001 Harcourt Publishers Ltd doi: 10.1054/ aaen.2000.0205, available online at http://www.idealibrary.com on
Research Review H. M. McClelland
This review examines some of the most recent research articles related to A&E practice. It provides an outline of the study and a comment on its relevance and appropriateness to the A&E environment. Giuliano KK, Giuliano A et al. (2000) ‘Temperature measurement in critically ill adults: a comparison of tympanic and oral methods.’ American Journal of Critical Care 9(4): 254–261
Heather M. McClelland, Sister in A&E, Leeds General Infirmary UK. Currently undertaking a MSc. Health Services Research and Health Technology Assessment. Manuscript Accepted: 11 October 2000
24
Background: Increasing use of tympanic thermometers is not supported by the literature as variation in their measurements is a continual concern. The study aimed to compare the variability of oral and tympanic thermometer readings against pulmonary artery (PA) measurements. Methods: A convenience sample of ITU patients with PA catheters in place was used. Temperature measurements were taken concurrently from two tympanic and one electronic oral thermometer, and compared against the PA reading. Each patient was entered into the study up to three times. Analysis of the data illustrates the mean differences in the readings from the reference point. Results: A total of 812 temperature measurements were taken; 203 with each instrument – 32 % of measurements were taken from febrile patients. The results show greater variability in both the tympanic thermometers than the oral device when compared to the PA catheter measurements. The Thermoscan Ear Pro 1 performed least well. Both the tympanic probes also underestimated temperatures in febrile patients. Comment: Well-presented account of the study with explicit details of the methodology and results. The use of Bland & Altman method for assessing the accuracy of clinical equipment useful in this study facilitating understanding of the data analysis. However, it is unclear how the sample size was derived or the rationale for using two tympanic devices in contrast to one oral
Accident and Emergency Nursing
(2001) 9, 24–26
thermometer. The researchers also highlighted concerns regarding the lack of data on hypothermic patients and recommended further work. In general, this is a useful report, addressing the concerns of many practitioners in relation to tympanic thermometry. Morse JM, Penrod J, Kassab C et al. 2000 ‘Evaluating the Efficiency and Effectiveness of Approaches to Nasogastric tube Insertion during Trauma Care.’ American Journal of Critical Care 9(5): 325–333 Objectives: To evaluate how efficiency (time to successful insertion), and effectiveness (successful insertion) are affected by the approaches used by caregivers on nasogastric (NG) tube insertion in conscious trauma patients. Methods: The videos of thirty-two NG tube insertion episodes during trauma were used and analysed both qualitatively, to decipher specific approaches, and quantitatively to derive associations between approaches used and outcome. Results: Inductive analysis of the tapes identified four approaches – technical, affective, blended and mixed. Deductively, no significant difference was found between outcome and approach used. However, the strongest association was shown between successful outcome and use of a blended approach, meeting both technical and affective needs of the procedure. Comment: Thorough, useful study exposing approaches to care utilised in all aspects of nursing. The mix of inductive/deductive analysis provided depth and an approach applicable to other areas of nursing research. The paper was clear in methodology and results but there was little indication for using the first/last insertion attempt as measurement of success. There was thorough discussion of threats to reliability and other factors affecting results. However, the sample size is small, and as such, there may have been potential in validating the qualitative findings on a larger group of trauma patients.
© 2001 Harcourt Publishers Ltd
Research Review
Kendrick KR, Baxi, SC, Smith RM 2000 ‘Usefulness of the modified 0–10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma.’ Journal of Emergency Nursing 26(3): 216–222 Objective: To identify if dyspnoeic patients can communicate their level of breathlessness with the modified Borg scale (MBS), and if subjective improvements as measured by MBS correlate with improvements in clinical signs – PEFR and SaO2. Methods: MBS assessed at triage for all patients presenting complaint of dyspnea, and diagnosed with asthma or COPD. Re- assessment of MBS 30 min after treatment. Data collected on other clinical and vital signs over time period. Results: 102 patients were identified with acute bronchospasm, 60 with COPD and 42 with asthma. Using Pearson’s correlation coeffient, both the asthma and COPD groups showed a significant negative correlation between PEFR and MBS scores, i.e. as peak flow improved the MBS decreased. The asthma group also showed significant negative correlation between MBS and SaO2, a result not identified in the COPD group. Comment: A potentially valuable paper for those of us not using any measure of dyspnea (in contrast to pain assessment). This could provide a significant outcome measurement tool for practice development. The article provides descriptive and visual explanations of methods and results, and a discussion section, which provides details on implementation and effects on practice. Helmer SD, Smith S, Dort JM et al. 2000 ‘Family Presence during Trauma Resuscitation: A Survey of AAST and ENA Members.’ The Journal of Trauma: Injury, Infection and Critical Care 48(6): 1015–1021 Objectives: To assess the opinions of American Association for the Surgery of Trauma (AAST) and Emergency Nurses Association (ENA) members to family presence (FP) during resuscitation. Methods: A survey of 18 questions was sent to all members of AAST and random sample of ENA members. Epidemiological details and Likert-scales to assess strength of opinion were utilised, and results were analysed using ANOVA and Chi-square.
© 2001 Harcourt Publishers Ltd
Results: There was a 43.4% response rate. AAST were significantly more likely to find FP during any part of resuscitation unacceptable, feeling it interferes with resuscitation and increases team stress. Significant difference was found in experiences of FP between AAST and ENA members. AAST members were more likely to be older, male and have greater trauma experience. Comment: There is a concern that this survey with a poor response rate and methodology may be used as evidence. There are no descriptions of the two groups, do we assume knowledge of the groups? Are we comparing like with like? It is inevitable that trauma surgeons have more experience of trauma than emergency nurses, as a group. The review of the literature is limited with extensive previous research and opinion on FP in resuscitation, especially in relation to medicine and paediatrics. This survey only highlights the dichotomy of opinion on a subject which the speciality should be working on as a team. Carlson KL, Broome M, Vessey JA 2000 ‘Using Distraction to Reduce Reported Pain, Fear and Behavioural Distress in Children and Adolescents: A Multisite Study.’ Journal of Specialist Paediatic Nurses 5(2): 75–85 Objectives: To examine the effectiveness of distraction in reducing behavioural distress, pain and fear in children undertaking venepuncture and cannulation. Methods: 384 children undergoing the procedures were randomized to either the intervention or the control group. The sample were stratified for age, into three groups: 4–7yrs; 8–12yrs; and 13–18yrs. The intervention consisted of the use of an Illusion Kaleidoscope as distraction, whereas the control group received standard care and information. Instruments were used to measure fear, pain and distress. The VAS-fear was administered to child, parent and nurse before and after the procedure. The other scoring devices, the Oucher (pain) and the Procedural Behavioural Rating Scale (distress) were administered after the procedure to the children only. Results: No significant difference was found between the intervention/control groups in any of the systems. There was significance found across the age groups in all devices, the younger group (4–7yrs) showing increased levels of pain, fear and distress. The authors highlight methodological problems that may have affected results.
Accident and Emergency Nursing
(2001) 9, 24–26
25
Research Review
Comment: This interesting study showed disappointing results for a concept which has long been perceived as successful in paediatric care. The review of the literature is extensive and balanced, the methodology explicit and the results well presented and discussed. There is a concern over the randomization process and the rationale
26
Accident and Emergency Nursing
(2001) 9, 24–26
for inclusion/exclusion criteria. It is also difficult to ascertain the validity of the scoring devices for the different groups of children/adolescents. How appropriate is the use of VAS in the youngest group? At the end there is a useful discussion at the end of the limitations of the study and problems, which may have effected the results.
© 2001 Harcourt Publishers Ltd
Research Review H. M. McClelland
This review examines some of the most recent research articles related to A&E practice. It provides an outline of the study and a comment on its relevance and appropriateness to the A&E environment. Giuliano KK, Giuliano A et al. (2000) ‘Temperature measurement in critically ill adults: a comparison of tympanic and oral methods.’ American Journal of Critical Care 9(4): 254–261
Heather M. McClelland, Sister in A&E, Leeds General Infirmary UK. Currently undertaking a MSc. Health Services Research and Health Technology Assessment. Manuscript Accepted: 11 October 2000
24
Background: Increasing use of tympanic thermometers is not supported by the literature as variation in their measurements is a continual concern. The study aimed to compare the variability of oral and tympanic thermometer readings against pulmonary artery (PA) measurements. Methods: A convenience sample of ITU patients with PA catheters in place was used. Temperature measurements were taken concurrently from two tympanic and one electronic oral thermometer, and compared against the PA reading. Each patient was entered into the study up to three times. Analysis of the data illustrates the mean differences in the readings from the reference point. Results: A total of 812 temperature measurements were taken; 203 with each instrument – 32 % of measurements were taken from febrile patients. The results show greater variability in both the tympanic thermometers than the oral device when compared to the PA catheter measurements. The Thermoscan Ear Pro 1 performed least well. Both the tympanic probes also underestimated temperatures in febrile patients. Comment: Well-presented account of the study with explicit details of the methodology and results. The use of Bland & Altman method for assessing the accuracy of clinical equipment useful in this study facilitating understanding of the data analysis. However, it is unclear how the sample size was derived or the rationale for using two tympanic devices in contrast to one oral
Accident and Emergency Nursing
(2001) 9, 24–26
thermometer. The researchers also highlighted concerns regarding the lack of data on hypothermic patients and recommended further work. In general, this is a useful report, addressing the concerns of many practitioners in relation to tympanic thermometry. Morse JM, Penrod J, Kassab C et al. 2000 ‘Evaluating the Efficiency and Effectiveness of Approaches to Nasogastric tube Insertion during Trauma Care.’ American Journal of Critical Care 9(5): 325–333 Objectives: To evaluate how efficiency (time to successful insertion), and effectiveness (successful insertion) are affected by the approaches used by caregivers on nasogastric (NG) tube insertion in conscious trauma patients. Methods: The videos of thirty-two NG tube insertion episodes during trauma were used and analysed both qualitatively, to decipher specific approaches, and quantitatively to derive associations between approaches used and outcome. Results: Inductive analysis of the tapes identified four approaches – technical, affective, blended and mixed. Deductively, no significant difference was found between outcome and approach used. However, the strongest association was shown between successful outcome and use of a blended approach, meeting both technical and affective needs of the procedure. Comment: Thorough, useful study exposing approaches to care utilised in all aspects of nursing. The mix of inductive/deductive analysis provided depth and an approach applicable to other areas of nursing research. The paper was clear in methodology and results but there was little indication for using the first/last insertion attempt as measurement of success. There was thorough discussion of threats to reliability and other factors affecting results. However, the sample size is small, and as such, there may have been potential in validating the qualitative findings on a larger group of trauma patients.
© 2001 Harcourt Publishers Ltd
Research Review
Kendrick KR, Baxi, SC, Smith RM 2000 ‘Usefulness of the modified 0–10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma.’ Journal of Emergency Nursing 26(3): 216–222 Objective: To identify if dyspnoeic patients can communicate their level of breathlessness with the modified Borg scale (MBS), and if subjective improvements as measured by MBS correlate with improvements in clinical signs – PEFR and SaO2. Methods: MBS assessed at triage for all patients presenting complaint of dyspnea, and diagnosed with asthma or COPD. Re- assessment of MBS 30 min after treatment. Data collected on other clinical and vital signs over time period. Results: 102 patients were identified with acute bronchospasm, 60 with COPD and 42 with asthma. Using Pearson’s correlation coeffient, both the asthma and COPD groups showed a significant negative correlation between PEFR and MBS scores, i.e. as peak flow improved the MBS decreased. The asthma group also showed significant negative correlation between MBS and SaO2, a result not identified in the COPD group. Comment: A potentially valuable paper for those of us not using any measure of dyspnea (in contrast to pain assessment). This could provide a significant outcome measurement tool for practice development. The article provides descriptive and visual explanations of methods and results, and a discussion section, which provides details on implementation and effects on practice. Helmer SD, Smith S, Dort JM et al. 2000 ‘Family Presence during Trauma Resuscitation: A Survey of AAST and ENA Members.’ The Journal of Trauma: Injury, Infection and Critical Care 48(6): 1015–1021 Objectives: To assess the opinions of American Association for the Surgery of Trauma (AAST) and Emergency Nurses Association (ENA) members to family presence (FP) during resuscitation. Methods: A survey of 18 questions was sent to all members of AAST and random sample of ENA members. Epidemiological details and Likert-scales to assess strength of opinion were utilised, and results were analysed using ANOVA and Chi-square.
© 2001 Harcourt Publishers Ltd
Results: There was a 43.4% response rate. AAST were significantly more likely to find FP during any part of resuscitation unacceptable, feeling it interferes with resuscitation and increases team stress. Significant difference was found in experiences of FP between AAST and ENA members. AAST members were more likely to be older, male and have greater trauma experience. Comment: There is a concern that this survey with a poor response rate and methodology may be used as evidence. There are no descriptions of the two groups, do we assume knowledge of the groups? Are we comparing like with like? It is inevitable that trauma surgeons have more experience of trauma than emergency nurses, as a group. The review of the literature is limited with extensive previous research and opinion on FP in resuscitation, especially in relation to medicine and paediatrics. This survey only highlights the dichotomy of opinion on a subject which the speciality should be working on as a team. Carlson KL, Broome M, Vessey JA 2000 ‘Using Distraction to Reduce Reported Pain, Fear and Behavioural Distress in Children and Adolescents: A Multisite Study.’ Journal of Specialist Paediatic Nurses 5(2): 75–85 Objectives: To examine the effectiveness of distraction in reducing behavioural distress, pain and fear in children undertaking venepuncture and cannulation. Methods: 384 children undergoing the procedures were randomized to either the intervention or the control group. The sample were stratified for age, into three groups: 4–7yrs; 8–12yrs; and 13–18yrs. The intervention consisted of the use of an Illusion Kaleidoscope as distraction, whereas the control group received standard care and information. Instruments were used to measure fear, pain and distress. The VAS-fear was administered to child, parent and nurse before and after the procedure. The other scoring devices, the Oucher (pain) and the Procedural Behavioural Rating Scale (distress) were administered after the procedure to the children only. Results: No significant difference was found between the intervention/control groups in any of the systems. There was significance found across the age groups in all devices, the younger group (4–7yrs) showing increased levels of pain, fear and distress. The authors highlight methodological problems that may have affected results.
Accident and Emergency Nursing
(2001) 9, 24–26
25
Research Review
Comment: This interesting study showed disappointing results for a concept which has long been perceived as successful in paediatric care. The review of the literature is extensive and balanced, the methodology explicit and the results well presented and discussed. There is a concern over the randomization process and the rationale
26
Accident and Emergency Nursing
(2001) 9, 24–26
for inclusion/exclusion criteria. It is also difficult to ascertain the validity of the scoring devices for the different groups of children/adolescents. How appropriate is the use of VAS in the youngest group? At the end there is a useful discussion at the end of the limitations of the study and problems, which may have effected the results.
© 2001 Harcourt Publishers Ltd