Clare Davies

MPhil (Nursing) candidate

The Use of Respiratory Assessment Tools in the Nursing Evaluation of Infants with Bronchiolitis


Supervisors: Andrea Marshall and Donna Waters


Bronchiolitis is the most common severe respiratory infection of infancy. The major causative organism, RSV (Respiratory Syncytial Virus), infects virtually all infants by the age of two years, with around 40% developing involvement of the lower respiratory tract. American studies have estimated that 120,000 infants require hospitalisation with RSV infection each year and more than 200 infants die (1,2). Although no estimates on costs to healthcare exist in Australia, estimated US annual costs are $390 million (3). Clinical trials of pharmacological agents and other therapies have failed to conclude that any of these treatments are effective (4–8). Expert consensus is that supportive care therapies are the main line of management for infants with bronchiolitis (9–11) although there is little research investigating these therapies.

What complicates the evaluation of both pharmacological and supportive therapies is the subjective nature of respiratory assessments in infants with bronchiolitis. It is also recognised that the components of assessment and their relative importance vary amongst health professionals, and that different care providers may focus on different aspects of clinical examination leading to differences in the assessment of respiratory status (12,13). While many tools have been developed to assess the efficacy of pharmacological clinical trials in infants with bronchiolitis, their reliability and validity have rarely been assessed (13,14). In addition, data on the clinical utility of these tools is lacking, indicating an apparent gap between their use in research and in practice.

Aim

The aim of this study is to:

  • Ascertain whether there is a reliable and valid assessment tool for assessing infants with bronchiolitis.
  • Determine whether this assessment tool has utility for nurses in the clinical setting.
Methodology

A sequential, mixed methods design will be used for this study. A mixed methods approach will allow for the selection of an assessment tool for bronchiolitis that measures functional domains that are relevant to the target population ie. paediatric nurses, in the most accessible and inclusive way.

Significance

A tool that could be used to assess nursing care strategies in a research setting, and that is useful in everyday clinical situations, could help to inform nursing practice and assist in developing a systematic way for nurses and other health professionals to assess and manage infants with bronchiolitis. It is proposed that in order to evaluate the utility of the so far under-researched supportive care strategies used whilst nursing infants with bronchiolitis, and for nurses to effectively evaluated their nursing care in the clinical setting in order to guide their practice, a valid and reliable clinical tool that has utility for nursing practice is needed.