Effectiveness of an Aspiration Risk-Reduction Protocol - Assignment Example

Nursing October 13, Effectiveness of an Aspiration Risk-Reduction Protocol (Metheny, N., Davis-Jackson, J., & Stewart, B. (2010). ‘Effectiveness of an Aspiration Risk-Reduction Protocol’. Nursing Research, 59(1), 18-25. Retrieved October 13, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/20010041 1. Classification of the study The classification of the study is experimental. This was a quasi-experimental design meaning that variables are manipulated and a control group is involved. Quasi research is actually research that is influenced by the research group in order to note and observe the consequences (Experimental Research, 2012). Quasi experiments use the same methods of analysis though the major difference between these and true experiments are the scores and outcomes prepared are not based on the outcome of groups formed through a random assignment (Behi, and Nolan, 1996, p1079). Their design means their outcomes and results are less powerful or influential in confirming casual relationships though these studies are much more common in nursing and provide a very valuable tool for Nurses. Quasi experimental designs are especially useful when it is almost an impossibility ‘to have the necessary control, manipulation and randomization for the true group experimental designs, (Behi, and Nolan, 1996, p1081). 2. Problem statement and purpose of the study The problem statement of the study is that the ‘aspiration of gastric contents predisposes tube-fed patients to pneumonia,’ (Metheny, Davis-Jackson, & Stewart, 2010, p 18). The protection of the airway is then compromised by other factors such as induced sedation, poor health and illness. The aim of the study is to determine if elevating the head of the bed to 30% in these patients, the use of the small bowel as the feeding tube site and though it was not able to be implemented the further aim of the study was to test the implementation of an algorithm in patients with one or more gastric residual volumes of greater than or equal to 250 ml to determine their rate of aspiration. 3. Summary of key points in the literary review section Previous studies have shown the physician prescribed orders for head of bed elevation are useful in maintaining a low backrest position. Previous CDC recommendation’s based on research recommends that head of bed elevation to 30% reduces risk for aspiration pneumonia. Other studies and literature have shown that aspiration is much more likely when patients are in the supine position. Studies concerning small bowel feeding and aspirations have been conflicting. One study showed that overall those patients fed through the stomach do more frequently have micro-aspiration when fed beyond the pylorus. One failed study did not provide any statistics about the degree of aspiration in patients fed in different potions of the small bowel. A study concerning the algorithm approach in patients with high gastric content volume, though recommended and suggested was not found or able to be utilized in this experiment. 4. Two examples of past studies cited in the article One previous study mention was ‘Effect of Post Pyloric Feeding on Gastro-esophageal Regurgitation and Pulmonary Micro-aspiration, (Heyland, Drover, Macdonald, Novak, F & Lam, 2001)’ Findings of this study showed that patients fed beyond the pylorus have less micro-aspirations. A second study referenced in the article was ‘Optimizing the Benefits and Minimizing the Risks of Enteral Nutrition inn the Critically Ill: Role of Small Bowel Feeding, (Heyland, Drover, Dhaliwal, & Greenwood, 2002). Findings were that a small bowel feeding site did reduce the likelihood of gastro-esophageal reflux. 5. Study framework The study framework is a collection of previous finding and research results combined with current and unknown date organized in such a way as to provide clinicians with new data or to support previously suggested research date. The framework is guided by the purpose of the study and the intended outcomes. 6. Identify objective of the study The objective was to evaluate three interventions to reduce the risk of aspiration in critically ill and mechanically ventilated patients. 7. Independent and dependent variables The variables used were the usual care group of 329 patients and 139 patients in the AARP group. The independent variables were the two treatment conditions of the AARP group which were usual care and the AARP which consisted of admission to one of the five ICU’s at the study site, age of at least 18, informed consent, mechanical ventilation, and a medical order for blind insertion of feeding tube at bedside. Usual care was defined as the absence of symptomatic means of reducing risk for aspiration pneumonia. The dependent variable group consisted at that time of patients with no head of bed elevation orders, nurse placement of small bowel feeding tube, or the initiation of an approach for high gastric residual volume. 8. Identify the research design Both patients groups were cared for in the same ICU with the same primary outcomes of interest. A secondary outcome that was used was the length of hospital stay, length in ICU and time on mechanical ventilation. Measurements were the frequency of aspiration and incidence of pneumonia. 9. Was the independent variable manipulated? The independent was not manipulated as it was usual care and the AARP which included the absence of symptomatic means of reducing risk for aspiration pneumonia. 10. Target populations Target populations include those at high risk for aspiration and pneumonia due to compromised health, mechanical ventilation and high gastric residual volumes. 11. Identify the sample and sampling technique The sample and sampling technique was well defined due to the nature of the study. The sample was chosen from those who were in the ICU, mechanically ventilated, tube fed. Those who had previously placed tubes were eliminated. 12. Data collection methods used Chart review collected hospital resources such as length of stay, ICU length of time and time on ventilator. Hourly backrest angles were taken by Nurses using digital readouts that were located on the patient’s beds giving the head of bed elevation. X ray was used to determine tube placement immediately following. Tubing length was also measured and recorded from the exit site. The PH and appearance of any fluid aspirated from the tube was also recorded. Syringes were used to measure residual volumes every four hours by Nurses. The Glasgow Coma scale was used by Nurses to assess patient’s level of consciousness every four hours and the Vancouver Interaction and Calmness scale was used to assess levels of sedation. Demographics were obtained in the patient charts. 13. Describe instruments and variable being measured Aspiration was shown to be lower in the AARP group by the measurement of a lower mean amount of tracheal secretions. Pneumonia occurred in less than one fifth of the AARO group compared to the usual care group and these patients were in the hospital an average of two days less. Their amount of time in ICU was 1.9 days less and spent 1.5 fewer days on mechanical ventilation. !4. Were instruments used reliable and valid? Yes, I believe so as they were consistent with every patient in the group and measured consistently in the same way among the patients in the AARP group. The same factors were assessed to collect and analyze data and patients in the group were all of the same characteristics. 15. Descriptive statistics used in the study A descriptive statistic is used to explain the basic features of date included in a study. They are considered to be simple short summaries about the data and measures used and present what the data shows (Trochin, 2006). Those used in this study were the expression that two of the three AARP components were successful. 16. Identify statistics used to answer research questions Head of bed elevation was significantly higher in the AARP group, and a small bowel feeding site was obtained in 72% of the AARP patients. Elevated head of bed is shown to be a preventative for pneumonia and aspiration and distal small bowl feeding is associated with less aspiration. 17. Were the results significant? How do you know? The result were significant and I am able to determine this because they are supportive of other studies along these same lines which provides further evidence for changes in standards of care across the patient continuum. Because they concur with other studies cited in the article as well as in the articles reference list it is with high confidence that you can rely on these results. 18. Summarize what the study found and relate to the objective The study concluded that AARP patients had better outcomes overall as evidenced by the collected data and that as suggested in the objective the outcomes were improved. 19. Study limitations? There was a 28 month time lapse between the usual end of care phase and the beginning of the AARP phase. During that time changes could have happened that would have contributed to some of the outcomes. 20. Can the results of this study be generalized? No, the sample size was relatively small, the patients were extremely specific and the sample population does not represent the larger population as a whole. They can be generalized as far as creating new treatment protocols for these groups of patients to improve outcomes with much more studies in the same area. Because many studies have been done in this area especially since this article I believe they can be generalized to this particular population only. References Metheny, N., Davis-Jackson, J., & Stewart, B. (2010). Effectiveness of an Aspiration Risk-Reduction Protocol. Nursing Research, 59(1), 18-25. Retrieved October 13, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/20010041 Experimental Research. (2012). Experimental Research. - A Guide to Scientific Experiments. Retrieved October 13, 2012, from http://www.experiment-resources.com/experimental-research.html Behi, R., & Nolan, M. (1996). Research. Quasi-experimental research designs. British Journal Of Nursing, 5(17), 1079-1081. Available at http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?vid=11&hid=124&sid=ad617051-7d9f-4dc9-a12e-441fcd968aee%40sessionmgr110 Heyland, D., Drover, J., Macdonald, S., Novak, F., & Lam, M. (2001). Effect of Post Pyloric Feeding on Gastro esophageal Regurgitation and Pulmonary Micro aspiration. Critical Care Medicine, 29(8), 1495-1501. Heyland, D., Drover, J., Dhaliwal, R., & Greenwood, J. (2002). Optimizing the Benefits and Minimizing the Risks of Enteral Nutrition inn the Critically Ill: Role of Small Bowel Feeding. Journal of Parenteral and Enteral Nutrition, 26(6), S51-S55. Trochin, W. (2006). Descriptive Statistics. Descriptive Statistics. Retrieved October 13, 2012, from http://www.socialresearchmethods.net/kb/statdesc.php Read More