Problem Statement/ Purpose
The study was based on the fact that the scales used for assessing the depth of sedation in critically ill children, especially for the ones who are subjected to neuromuscular blocking agents are not as reliable as they should have been. The researchers proposed the use of BIS or Bispectral Index monitoring along with the conventional sedation scale among the paediatric ICU patients who are intubated and are under ventilators. The study method included evaluation of 17 nurses working in the PICU unit. The BIS was implemented for a period of 8 weeks which was guided by a BIS sedation protocol, designed for this purpose. The measurements were based on a 15 point survey for the assessment of BIS perceptions among the nurses following first 4 BIS encounters. Comments given by the nurses and the project coordinators were recorded. The data obtained following the survey indicated that the nurses were somewhat reserved about the implementation of the BIS, but the qualitative data depicted that they valued the usefulness of BIS for the assessment of sedation depth among paediatric patients. As a result, after the study was completed, BIS was implemented as a regular practice in the hospital set up. After 1 year, it was observed that BIS implementation was being continued without any hassles. increased number of patients were being monitored on the BIS. However, well defined guidelines are required for implementing BIS monitoring on the patients who were not subjected to paralytic medications (Hawks, Brandon, & Uhl, 2013). The purpose of the study was clearly in line with the problem. The study design completely supports the aim of the study and the results validate the objective.
Literature Review
The literature used in this study dates back till 1997. It can be said that the literature is relatively old. Current literature should ideally include the studies conducted within the time span of last 5 years. In this paper, the studies as old as 19 years are also included. However, the literature review is completely relevant and apt for the study purpose. It includes all the different angles and observations that have been evident in the last few years in context with this particular study. The entire literature review is well summarized and adequately evaluated. The strong literature review provided with this study has proved to be a firm backbone which has given the entire study a concrete base. The literature review provided in the study do recognize the gaps in the knowledge we have, however, it does not do any good in terms of closing those gaps. The study only reemphasises the already known facts. It also ends with the same conclusion as earlier studies did. It did not added up anything new to the already available knowledge.
Design
The study is a qualitative one. The methodology included 17 nurses from the PICU unit of a Healthcare organization. The nurses were asked to implement BIS monitoring for the paediatric patients who were on ventilators following sedation. The BIS monitors were used along with the traditional sedation scale. The hypothesis stated that assessment of sedation depth among the paediatric patients would be easier to assess with the BIS. The study design is apt as per the purpose or statement of the study.
Method
The study included PICU patients who were ventilated and sedated. The methodology did not lead to any interruption in the ventilation mechanism of the patients, hence ensuring no harm to the human subjects.
The sample identified did complete justice to the basic purpose of the study. It included the nurses of PICU units. Being in the closest contact with the patients, these nurses were the best subjects for the study and would have been the best choice for the required answers the research wanted to arrive at.
The data collection method was kept simple, based on a questionnaire which the selected sample size of the nurses had to answer. As the answers to the questions were subjective, they can be considered as reliable and valid.
Study Procedure
The study procedure was realistic. A study procedure should be described in a way that it can be repeated by the reader at any point of time in a suitable setting. The procedure used in this study was well explained and suitable.
The independent variable in this study was the use of BIS monitoring. It was implemented consistently in the selected setting. The suggested tool was added along with the pre existing conventional assessment scale. The selected environment was the PICU unit of a health care organization. The environment was kept consistent throughout the study period of 8 weeks.
Data Analysis
The data analysis was done on the basis of the findings obtained through a prepared questionnaire. The analysis was further computed with the help of SPSS software.
Findings/ Results
The study suggested that implementation of BIS monitoring along with the traditional methods was helpful in assessing the sedation depth of paediatric patients. All the aspects of the problem statement were correctly addressed in the result section of the study. The findings of this study corroborate well with the findings of the previous studies. It further reconfirms the findings of the previously conducted studies.
Discussions
The study was further evaluated after one year. It was found that the implementation of BIS was well accepted in the health care organization and was being practiced adequately. The findings make complete sense as they correlate with the previous findings based on similar researches. The results cannot be generalized as they consider only the PICU patients subjected to paralytic drugs. The effect on non paralytic medications is yet to be ascertained. The study ends with discussion of the limitations. The small sample size was a limitation to the study. Thus, generalizability of the study is hampered to some extent.
Implications
Implications from practice and research were well presented and they were in flow with the findings directly.
References
Hawks, S., Brandon, D., & Uhl, T. (2013). Nurse perception of Bispectral Index monitoring as an adjunct to sedation scale assessment in the critically ill paediatric patient. Intensive And Critical Care Nursing, 29(1), 28-39. http://dx.doi.org/10.1016/j.iccn.2012.04.003
