Evidence Based Practice in Nursing Essay

Article Critique

Introduction

Clinical nurses, especially those working in the intensive care unit (ICU), must be knowledgeable about measuring glucose values in an accurate, timely, and safe way. The BG monitoring is helpful in terms of either falling or rising values, adjustment of insulin, and managing the disease. Notably, research shows that even short hypoglycemia can result in profound brain dysfunction while prolonged severe hypoglycemia that causes the death of the brain (Saini, 2016). The main role of ICU nurses is to sustain BG values within a range of 130-180 mg/dL. This paper will, therefore, critically evaluate a study conducted on monitoring the BG values using first or second drops. The study under evaluation is on “First or second drop of blood in capillary glucose monitoring: Findings from a quantitative study” and was conducted by Palese, Fabbro, Casetta, & Mansutti (2016).

Research design

The research type of quantitative research design in this article was a comparative experimental research design. This design was appropriate because the objective of the study was to measure the differences between blood glucose (BG) measured in the first drops and second of capillary samples consecutively obtained from the same fingertip. The variables being examined in this experiment includes the first drops and second drops of capillary samples consecutively obtained from the same fingertip. The independent variable is the BG reported in the first drops, while the independent variable is the BG reported in the second drops. The author operationally defined the study variables used in this study. For instance, the authors define first drops as initial blood glucose (BG) measure of capillary samples obtained from the fingertip. The authors also define second drops as the blood glucose (BG) measure of capillary samples consecutively obtained from the same fingertip.

Sampling Plan

The population being studied was identified and described in detail. The population in this study included a consecutive sample with type 1 diabetes who attended their periodic follow-up in an Italian outpatient clinic in the morning, taking breakfast. The characteristics of the population included patients of age 14 years and above with normal body peripheral temperature to prevent vasoconstriction; those who washed their hands and had no suspected case of hypoglycemia; and were willing to participate in the study after having received information concerning the aims of the study and written consent. This study utilized a systematic sampling design in which the blood sample was gathered using standard procedures on all subjects to avoid any possible bias.

The sample design used in this study was the best because it made a comparison between the first drop and second drop easy and more convenient. For instance, the researchers considered the same hand and finger in all subjects and a gentle pressure applied in case there was difficulty in obtaining blood samples. Besides, the first and seconds drops were obtained using similar procedures. Moreover, the researchers used a sample size of 195 patients with type 1 diabetes. This sample was large enough because all eligible patients in this particular clinic participated in the study. As a result, the researchers did not conduct a power analysis. A power analysis is often performed before data collection to determine the smallest possible sample size that would be suitable to detect the effect of a particular test at the desired level of significance.

Data Collection

Data was collected using various means, including face-to-face interviews and other standard techniques. For instance, data concerning age, gender, and BG procedures adopted in everyday practice regarding measurement were gathered in face-to-face interviews. At the same time, the samples of BG were collected using standard experimental procedures. The data collection method was appropriate for the variables under the study because collecting blood glucose of capillary samples that were consecutively obtained from the same fingertip requires the researchers to perform systematic experiments to collect the uniform data from all the subjects to determine the correlation between the first and second drops. The face-to-face interviews were appropriate for this study to collect first-hand information from the participants without any distortion in the information. However, biophysiologic measures would be more appropriate because collecting information concerning the first drops and second drops require specialized technical instrument for their measurement. In this study, the specific instruments included a portable glucose meter and finger stick. However, the researchers did not attempt to describe these instruments and how they function.

Analysis of Data

In this study, the data were analyzed using SPSS software. The researchers assessed the averages, standard deviations, medians, frequencies, and proportions. The results showed that the average age of the participants was 57.7 years, with the majority (128) being males. Besides, the results showed that the majority of the participants had never received recommendations from healthcare practitioners concerning the drop to consider the first drop to obtain accurate BG measurements. Again, the results showed that the average and median differences between the first drop and second drop BG measurements were limited to about 3 mg/dL and 6 mg/dL, respectively, implying that the second drop had higher glucose values that were highly correlated, statistically different, but clinically comparable with the initial drop measured in the same finger a few seconds earlier. The BG from the first drop tended to be lower than in the second drop due to dilution with interstitial fluid. Additionally, there were no crossed groups between the first and second BG measurements.

These results were presented using graphs and tables showing descriptive statistics from the analysis. For instance, descriptive statistics of the blood glucose in the first and second drops of blood were presented in a table. Spearman’s Rho test was presented on a line graph. Information concerning statistical significance was presented. For instance, the results of the first hypothesis, that there were no distinctions between the first and second drops of blood, showed a strong correlation between the BG level reported in the first and second drops. The difference was statistically significant. However, the difference that emerged in the BG measurements between the first and second drops were not significantly impacted by the concentration of glucose, thereby, supporting the second hypothesis that “difference concentrations of glucose will not affect the differences between the first and the second drop of blood.

Discussion

This study had several limitations that could affect the results. For instance, there were no consistent guidelines available concerning whether to utilize the first or second drop in capillary BG testing in the home of ED settings. Besides, in their daily practice, patients and practitioners still appeared to be unsure and, as a result, had inconsistencies concerning the BG measurement procedure. For example, 72 percent of the nurse educators advised study participants to wash their hands using soap and water and to utilize the first drop of blood. In case it was not possible to wash hands, 52 percent of the nurse educators suggested that the second drop was more accurate, implying that they were not sure about the procedure. The other limitation is that the comparison between the first and second drops was made without the consideration of a gold standard measure like venous BG results, as is the case with previous studies. Besides, the drops were consecutive and not drawn from a second site or measured with different glucose meters, as is the case with previous studies. Moreover, the findings were limited to individuals with type 1 diabetes. Lastly, the evidence was also limited to date concerning the variability of the BG measurements between hand or finger sites of collection.

Further, the authors discussed the implication of this study for practice and future research. For instance, the findings in this study showed a relatively narrow clustering of glucose values around the median with no participant displaying evidence of significance biochemical hypoglycemia, implying that accurate detection of hypoglycemia is the most crucial glucose measurement task performed in the emergency room. This study, therefore, suggested that future research needs to address the full range of conditions that represents the complexity of care in the emergency department. This study has significant implications for emergency department nurses who have to routinely deal with the care of diabetes patients or patients that need BG measurement. As an ED nurse, this study can influence practice by providing the guidelines for BG measurement procedures using capillary blood to measure BG levels and give the best patient care accurately.

References

Brysbaert, M., & Stevens, M. (2018). Power analysis and effect size in mixed effects models: A tutorial. Journal of Cognition, 1(1).

Palese, A., Fabbro, E., Casetta, A., & Mansutti, I. (2016). First or second drop of blood in capillary glucose monitoring: Findings from a quantitative study. Journal of Emergency Nursing, 42(5), 420-426.

Saini, S., Kaur, S., Das, K., & Saini, V. (2016). Using the first drop of blood for monitoring blood glucose values in critically ill patients: An observational study. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 20(11), 658.