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Quantitative Critique of Tracheal Suctioning Study
- 1. QUANTITATIVE CRITICAL ANALYSIS JESSICA CLARK UNIVERSITY OF PHOENIX PREPARED FOR NUR 443, TAUGHT BY HECTOR VIZOSO
- 2. Tracheal Suctioning in Children with Chronic Tracheostomies: A Pilot Study Applying Suction Both While Inserting and Removing the Catheter (McClean, 2012)
- 3. PHASES OF QUANTITATIVE RESEARCH CRITIQUE • Phase 1- Comprehension • Phase 2-Critique • Phase 3- Analysis • Phase 4- Evaluation (Burns & Grove, 2011)
- 4. QUANTITATIVE RESEARCH CRITIQUE PHASE 1 COMPREHENSION • Abstract Review • Literature review, Problem, and Purpose American Thoracic Society (ATS) Recommendation American Association for Respiratory Care (AARC) Recommendation Suction upon insertion and removal of the catheter Suction only when removing the catheter
- 5. QUANTITATIVE RESEARCH CRITIQUE PHASE 1 COMPREHENSION • Variables • Methods • Criteria • Independent Variables: Methods of suctioning tracheostomies • Dependent Variables: Heart rate, oxygen saturation, amount of secretions
- 6. QUANTITATIVE RESEARCH CRITIQUE PHASE 1 COMPREHENSION • Procedures • Analysis
- 7. QUANTITATIVE RESEARCH CRITIQUE PHASE 1 COMPREHENSION • Author Interpretation • Limitations and Recommendations
- 8. QUANTITATIVE RESEARCH CRITIQUE PHASES 2 & 3 COMPARISON AND ANALYSIS • Research problem and purpose • Literature Review • Framework and Design
- 9. QUANTITATIVE RESEARCH CRITIQUE PHASES 2 & 3 COMPARISON AND ANALYSIS • Bias • Measurements • Sample, Population, and Setting
- 10. QUANTITATIVE RESEARCH CRITIQUE PHASES 2 & 3 COMPARISON AND ANALYSIS • Observations and Data Collection • Interpretation of Findings
- 11. QUANTITATIVE RESEARCH CRITIQUE PHASE 4- EVALUATION
- 12. REFERENCES • Burns, N., & Grove, S. K., (2011). Understanding nursing research. Building an evidenced-based practice (5th ed.). Retrieved from The University of Phoenix eBook Collection. • Cleveland Clinic. (2014). Treatments & procedures. Retrieved from http://my.clevelandclinic.org/health/treatments_and_procedures/hic-tracheal-suction-guidelines • Johns Hopkins Medicine. (n.d.). Suctioning. Retrieved from http://www.hopkinsmedicine.org/tracheostomy/living/suctioning.html • McClean, E. B. (2012, February) Tracheal suctioning in children with chronic tracheostomies: A pilot study applying suction both while inserting and removing the catheter. Journal of Pediatric Nursing, 27(1), 50-54. doi 10.1016/j.pedn.2010.11.007 • Sherman, J. M., Davis, S., Albamonte-Petrick, S., Chatburn, R. L., Fitton, • C., Green, C., et al. (2000). Care of the child with a chronic tracheostomy. American Respiratory Critical Care Medicine, 161(1), 297−308. Retrieved from http://www.atsjournals.org/doi/full/10.1164/ajrccm.161.1.ats1- 00#.VGWfmclHgc4 • Schuttleworth, M. (2014) Within subject design. Retrieved from https://explorable.com/within-subject-design
Editor's Notes
- Hello, My name is Jessica Clark. I am going to discuss the phases of quantitative research critique.
- I have chosen the article Tracheal Suctioning in Children with Chronic Tracheostomies: A Pilot Study Applying Suction Both While Inserting and Removing the Catheter (McClean, 2012).
- The phases of quantitative research critique are: Phase 1- Comprehension Phase 2-Critique Phase 3- Analysis Phase 4- Evaluation (Burns & Grove, 2011)
- Abstract The comprehension phase of McClean’s (2012) article begins with the abstract. The abstract clearly discussed the purpose: to compare the efficiency of tracheal secretion removal using two contrasting methods of tracheal suctioning. The abstract did not state the specific design but did elude to a quasi-experimental approach to the pilot study using 18 children with chronic tracheostomies. The conclusion clearly stated that one method produced a greater amount of secretions than the other, without compromising oxygenation and perfusion, as evidenced by statistical analysis. Literature Review, Problem, and Purpose McClean (2012) discussed the limited research involved in protocol development related to children with chronic tracheostomies. The various guidelines from different entities addressed aspects such as instillation of saline and length of time a child should be suctioned. McClean (2012) focused her study on the recommendation of when suction should be applied according to the American Thoracic Society (ATS) and the American Association for Respiratory Care (AARC). McClean (2012) provided the specific guidelines stated by the respective entities and explained how they differ in recommendations of removing tracheal secretions without causing undue harm (Sherman, 2000; Bond, 2003; Carroll, 1994 as cited in McClean 2012).
- Variables The independent variables are the two different methods of suctioning: suction applied only upon removal of the suction catheter and suction applied upon insertion and removal of the catheter. The dependent variables are the measures of heart rates, oxygen saturation, and the amount of secretions removed. Other variables such as gender, race, the reason for having a tracheostomy, reason for hospitalization, type brand and size of the tracheostomy tube were also noted (McClean, 2012). Methods The methods section described the use of a repeated measures within-subjects design. This means that there were no groups or randomization assigned, although the order of which technique was performed first was randomized. The same 18 children received the same treatments separated by 90 minutes. The sampling method was convenience sampling and recruitment of 18 children occurred over two years. Informed consent was given to both parents and participants per hospital policy. Children and adolescents were given opportunity to decline study involvement. Four families chose not to participate. Institutional review board approval was obtained from the children’s hospital where the study occurred. Criteria Inclusion criteria examined age, hospital status, chronic tracheostomy status (beyond the first tracheostomy tube change), and either Spanish or English speaking. Children were excluded from the study if they were known cardiac patients, had outpatient status, a hematocrit less than 25%, mechanically ventilated, or any other type of intubation (McClean, 2012).
- Procedures McClean (2012) used direct measurements of oxygen saturation, heart rate, and amount of secretions as the methods of measurement. The same diaper scale was used to determine the amount of secretions obtained by individual suction techniques and recorded in grams. A consistent procedure of patient positioning and pre-measured saline for clearing the suction catheter was used. The techniques were performed a substantial amount of time apart to allow the patient to return to baseline. Analysis Statistical analysis was performed using statistical software. A paired t test (level of significance p=.05) was used to compare the variables (McClean, 2012).
- Interpretation The author interpreted the findings as the method that applied suction upon both insertion and withdrawal of the catheter provided more effective secretion removal with minimal difference in oxygen saturation. Limitations and Recommendations McClean identified limitations as small sample size. McClean (2012) states that additional studies are necessary because of the unknown effect of the ATS method in patients with cardiac diagnosis. McClean also recommends investigation of the reason for heart rate increase five minutes after suctioning using the AARC method. McClean recommends following the ATS method of suctioning while inserting and removing the catheter.
- PHASE 2 & 3 Comparison and Analysis Burns and Grove (2011) recommend theses phases to be completed together. Research problem and purpose McClean (2012) addressed a problem I have personally experienced in my practice as a pediatric home health nurse. I consistently work with children who have chronic tracheostomies. The agency I work for cannot come to a consensus for policy and procedure of tracheostomy suctioning. The problem and purpose are realistic, and the outcome of McClean’s 2012 pilot study proves the need for further evaluation of the subject. Literature Review McClean (2012) explained that there is limited research in this area. The ATS and AARC have different views on the procedure of tracheal suctioning. McClean (2012) explained the differences and chose a focused topic to analyze. Framework and Design The study framework was clear and appropriate. An advantage of the repeated measures within-subjects design is that minimal participants are necessary. A disadvantage would be if the study took place over a longer period of time; then retention of participants could be compromised (Schuttleworth, 2014). Since that was not the case, the repeated measures within-subjects design was appropriate for the pilot study. The design allowed the researcher to compare the direct measures obtained.
- Bias Possible researcher bias was limited. McClean (2012) discussed training and verifying the training of three experienced medical-surgical registered nurses in the techniques to collect data. Measurements The explanation of data collection was consistent. However, the author did not state the length of time that the catheter was inserted into the tracheostomy for suctioning. Recommended suction time varies from 5 to10 seconds (Cleveland Clinic, 2014; Johns Hopkins Medicine, n.d.; Sherman et al., 2000). In my experience, multiple suction attempts have been necessary to effectively clear secretions. In the study, there was no mention that this did or did not occur. If it did occur and it was not reported. The results of the study could become skewed. Sample, Population, and Setting The decision of which treatment the child would receive first was determined by randomization prior to subject recruitment. However, 10 of the participants received one recommendation first, while 8 received the other recommendation first. The groups were not exactly equal. McClean (2012) determined the power analysis of the sample size to be 0.52 with a significance level of .05. This could lead to a type II error. The parents and children had the option to decline participation, and informed consent was given per hospital policy. The setting of a children’s hospital is an adequate and controllable environment for the study. Nothing unethical could be identified within this study.
- Observations and Data Collection The researcher cited Sherman,( 2000) Bond, (2003); Carroll, (1994) for the statement “The goal of tracheal suctioning is maximal secretion removal with minimal hypoxia and tissue damage” (p. 50). The body’s natural reaction to trauma is to increase the heart rate. Therefore, it was appropriate of McClean (2012) to include heart rate as a variable. Hypoxia can occur when the airway is compromised, such as when tracheal suctioning is performed. Heart rate and hypoxia can be assessed with the use of a pulse oximeter. The measurement methods were clearly defined. The results were provided in table 3 of the article. Interpretation of Findings McClean (2012) described that the heart rate and oxygen saturation was not significantly different in the first three readings of the procedure, but in the fourth reading, heart rate was significantly higher after “method A”, but “method A” was not defined. After consulting table 3 containing all of the results, method A is the AARC method of only applying suction when removing the catheter. The researcher identified this as an area of concern and recommends further evaluation of its occurrence. Also, McClean (2012) identified that her study excluded cardiac patients and a large number of children with chronic tracheostomy status also have cardiac conditions, and further studies should include these patients. I agree with both of these recommendations. The only part of McClean’s methodology I did not understand was when the data collection of participants occurred compared to when they were approached for participation in the study. It is unclear if the parents were solicited when their child was admitted from the emergency room or at other times before or during the course of hospital stay.
- Phase 4 Evaluation Overall, McClean’s (2012) study had valid findings that reflect what I have experienced in my three and a half years of practice in this area. As a pilot study with promising results, larger studies may be performed to help standardize the procedure of tracheostomy suctioning. The findings certainly have clinical significance, regardless of what statistical significance revealed.
- This concludes my presentation of quantitative critical analysis.