Emergency Care of Children and Adults with Head Injury - Essay Example

? Nursing Research Critique: Emergency Care of Children and Adults with Head Injury Presented Research Critique: Emergency Care of Children and Adults with Head Injury Purpose of the study The purpose of the study is to establish the appropriate emergency care of children and adults with head injuries. In particular, the study is concerned with assessment mechanisms and critical indicators or ‘red flags’ that helps health practitioners to properly diagnose the injury properly, carry out early head injury management and offer right emergency and proper discharge. The study is important in that the number of head injury casualties in casualty departments and minor units continues to rise. Early and proper emergency care is important as it helps to reduce potential disability and death risks. The objectives of this study were as follows; i. To identify the signs and symptoms (‘red flag mechanisms’) of severe head injury in children and adults ii. To establish levels of head injuries and categories of skull fractures iii. To establish the importance of computed tomography, after care following head injury and proper discharge. iv. To identify common causes of head injuries in children and adults v. To establish history taking techniques and their interrelations with inter-cerebral head damage and bleeding The study faces limitation due to possibility of researcher/ nurse bias when assessing injuries through history taking. The study has not provided a razor sharp research design but the flow of the report structure helps to determine it. Research design for any study involves specifying the methods and procedures under which the study will be conducted thus giving it direction. The study employed descriptive research design which involves describing a phenomenon with a view to answering some research or health questions. The data about a phenomenon is obtained through use of questionnaires or observational guides and monitoring equipment (Taylor, Kermode and Roberts, 2006). The study through the research design seeks to describe the three categories of head injuries that include minor, moderate and severe. Under each condition the research has tried to clearly establish the diagnostics tests that should be carried out. For example, the study has specified mechanisms for establishing severity of the injury, history taking steps and observational features to look for. In advanced cases of injury the study has documented how Computed Tomography (CT) scanning can be applied. The research design also provides a framework for understanding the anatomy of the skull bones, how to carry out physical examination and care and advice needed during and after treatment and discharge. The study has discussed two theoretical frameworks at length that are used in physical examination of casualties with head injuries. First, Glasgow Coma Scale (GCS) theoretical framework has been discussed. The framework is suitable as it helps to standardize the assessment levels of consciousness in patients with atraumatic head injuries. The framework also helps to predict severity of the injury and any intra-cerebral bleeding. Normally, the higher the score, the less is the risk. Second theoretical framework is Alert Voice Pain Unresponsive (AVPU) model used to measure consciousness level using AVPU tool. The method is easier and less time consuming. The tool helps to establish whether the patient is [A] Alert, responsive to [V]voice and [P]Pain or [U]unresponsive. Both frameworks support the research study in that GCS helps to establish severity of the injury in a more standardized manner and AVPU helps to establish consciousness level which is critical in deciding whether to do CT scanning. In summary, both frameworks help to classify the head injuries as minor, moderate or severe. AVPU has however been contested for its reliability to establish changes in consciousness. Organization of literature search is well done and flowing. The study starts by giving an introduction on head injuries and statistics in UK and in major casualty departments. The study then goes on to discuss the anatomy of human skull and the differences between adult and children bone structure. The process of CT scanning and history taking for patients with head injuries, mechanisms of identifying signs and symptoms and red flags as well as care needed have also been discussed. After, this, the study then discusses the physical examination and how to categorize the levels of skull fractures. The study then discusses how care for adults and children during and after treatment and discharge. Finally, advice during discharge and conclusion of the study findings come last. In summary, literature is well organized from general to specifics. Gerrish and Lacey (2010) defined target population as ‘the total population that forms the focus of the study.’ Target population for the study is adults and children patients with various forms of head injuries. The study presents protection of human subjects and informed consents in various ways. Protection of human subjects is presented by providing clear guides for early management of emergency head injuries to avoid potential risks of disability or death. During discharge giving a written advice is preferred as well as specifying sign and symptoms that would make a patient to re-attend hospital as well as activities to avoid. Telephone contacts and inquiry on home status is also needed. Informed consent is presented in giving advice, recommendation for scanning and response during physical examination. Sampling method employed in this study involve patients with minor, moderate and severe head injuries. Sampling has also been made based on levels of fracture like depressed, linear, basal and diastatic. The sampling design is reflective of the study research design and validity as it explains all the forms of head injuries and their levels. Internal validity which is concerned with minimizing the effects of extraneous factors is reflected through critical history taking to understand other factors that might influence injuries. External validity which focuses on degree to which results from a study can be generalized is reflected is on the use of GCS and AVPU and the shortcoming of the latter in measuring and capturing changes in consciousness (Tappen, 2011). Independent and dependent variables have not been vividly identified. However, reading through the study, independent variables include causes of head injuries while dependents variables include consciousness and injury levels and signs and symptoms from head injuries. Data collection was done using observational guides to observe consciousness, eye and motor responses. CT scanning and was used to objectively measure severe cases of injury. Measurement level for most of data obtained is nominal and ordinal as only categories and assigning of values has been done. Validity of results has been discussed in paragraph seven. Reliability of results involves consistency, dependability and ability to be replicated. Since the study was done in a scientific manner where some theoretical frameworks and CT scanning machines were used, its possible achieve such results under any other conditions and therefore possible to generalize. Assessment of the injuries involves use of human beings and machines and human beings can introduce subjectivity bias which compromises reliability. The results of this study are generalizable because a representative sample was selected comprising of children and adults with various levels of head injuries. Use of GCS to measure severity of injuries means results are standardized and can therefore be replicated. However, since some assessment is done by nurses through observation researcher or nurse bias can affect the results limiting their ability to be generalized. In conclusion, the study provides a solid basis upon which nurses and health practitioners can learn on how to assess, diagnose and manage emergency head injuries in children and adults. Particularly, the study provides signs and symptoms to look for, history taking techniques and advice and precautions to give patients during discharge to avoid deterioration of injuries and setbacks in recovery. References Gerrish, K., & Lacey, A. (2010). The research process in nursing (6th ed.). West Susses: Wiley-Blackwell Publishing Limited. Tappen, R. M. (2011). Advanced nursing research: From theory to practical. London: Jones & Bartlett Learning Taylor, B., Kermode, S., & Roberts, A. (2006). Research in nursing and health care: Evidence for practice (3rd ed.). Sydney: Thompson Publishing Read More