Research and commentary

Nursing assessment of an infant with bronchiolitis

The type of information nurses need to undertake assessments of an infants with bronchiolitis, and how this information is gathered and evaluated.

Davies C, Waters D, Marshall A (2017) The nursing assessment of an infant with bronchiolitis. Journal of Child Health Care. 2, 12, 181-190. 

Bronchiolitis
Picture: Alamy

Aim

To ascertain what type of information nurses need to undertake assessments of an infants with bronchiolitis, and how this information is gathered and evaluated.

Methods

The research design for this qualitative study was naturalistic enquiry. The sample was ten registered nurses working in a children’s unit in Australia, all with a minimum of 12 months’ clinical experience.

Participants and parents gave their consent to the study.

There were two data-collection methods: ‘think aloud’, in which participants explained their actions as they undertook nursing care, and retrospective, which involved interviewing participants within 24 hours of them undertaking care.

To answer all parts of the research question, a combination of thematic and content analysis was used. The resulting data were then checked for accuracy with the participants.

Findings

Three key themes were identified:

  • Understanding the impact of illness. As well as recording details on physical signs, it was deemed important to gain information on changes, such as irritability, from the parents.
  • Digging deeper – identifying subtle changes. Parents can pick up subtle changes, especially improvements in the condition, and so consultations with them contributed to assessments.
  • Contextual decision making. Participants considered that the best judgements were made after accumulation and interpretation of a variety of information so making sense of the information, including that which appeared insignificant, was regarded as important.

Conclusion

This study describes the role of nurses who care for infants with bronchiolitis while obtaining, interpreting and acting on information about them and their condition. It also describes the importance of parental knowledge and its contribution to nursing assessments, and ways that nurses can work in partnership with parents in this important aspect of care delivery. 

Liaising with families from the beginning helps infants with bronchiolitis 

The incidence of bronchiolitis continues to rise. Green et al (2016) explain how, in England, the number of hospital admissions for this acute illness increased by an average of 1.8% between 2004 to 2011. It is recognised that caring for infants with bronchiolitis each winter is a significant part of paediatric healthcare provision.

This study demonstrates the importance of detailed nursing assessments of infants with the condition. An important part of these assessment processes is the use of scoring systems (Naddy 2012) to detect deteriorating children as early as possible and maximise their chances of good outcomes.

Broom (2007) explains how a nursing assessment should be centred on the child while promoting family-centred care. This study provides guidance to the different ways in which parents can be involved in such care and offer their views on their children’s condition.

Kelsall-Knight (2012) explains the importance of supporting families through information giving and emotional support, and suggest that involving families from the beginning of the assessment process can contribute towards forming a true partnership.  

Broom (2007) explains how assessment should not be viewed as a task but as a fluid and dynamic process that is re-evaluated and takes into account all relevant factors.

This study contributes towards a body of knowledge on the complexity of undertaking nursing assessments that can aid the detection of early deterioration while ensuring the needs of children and families are met.


References

  • Broom M (2007) Exploring the assessment process. Paediatric Nursing. 9, 4, 22-25.
  • Green C, Yeates D, Goldacre A et al (2016) Admission to hospital for bronchiolitis in England: trends over five decades, geographical variation and association with perinatal characteristics and subsequent asthma. Archives of Diseases in Childhood. 101, 140-160.
  • Kelsall-Knight (2012) Clinical assessment and management of a child with bronchiolitis. Nursing Children and Young People. 24, 8, 29-34.
  • Naddy C (2012) The impact of paediatric early warning systems. Nursing Children and Young People. 24, 8, 14-17.

 

Compiled by Theresa Pengelly, senior lecturer in children and young people’s nursing, Coventry University on behalf of the RCN’s Research in Child Health Community

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