https://doi.org/10.4081/qrmh.2020.9077
A focused ethnography of how endoscopy practitioners utilize capnography in sedated patients
Submitted: 3 May 2020
Accepted: 14 September 2020
Published: 30 October 2020
Accepted: 14 September 2020
Abstract Views: 1081
PDF: 372
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The literature shows that respiratory complications are common with sedation. Given the inherent risk, capnography monitoring is recommended whenever sedation is administered. We aimed to explore sedation practitioners’ behavior patterns and perceptions regarding capnography monitoring during endoscopy sedation and examine how capnography influenced clinical decision making when assessing respiration. We conducted a focused ethnography with triangulated observations and semi-structured interviews, and we purposively sampled and recruited five sedation practitioners as participants at a hospital in Saudi Arabia. Through data analysis, we identified representative themes and found cultural differences between anesthesia practitioners and nurses when using capnography during sedation. Anesthesia practitioners linked safety and the use of capnography to maintain adequate respiration, while nurses believed capnography was a secondary supportive monitor to patient observation and assessment. Findings also captured the unique cultures and values of each professional group to be associated with the varying perceptions. We also identified several factors facilitating and barring adequate utilization of capnography. In conclusion, professional culture, hospital policy, knowledge and previous experience with capnography guided the monitoring practice of endoscopy practitioners when assessing respiration during sedation.
Adams L, Butas S, Spurlock Jr D. Capnography (ETCO2), respiratory depression, and nursing interventions in moderately sedated adults undergoing transesophageal echocardiography (TEE). J Perianesth Nurs 2015;30:14-22.
DOI: https://doi.org/10.1016/j.jopan.2013.07.009
Vaessen HH, Knape JT. Considerable variability of procedural sedation and analgesia practices for gastrointestinal endoscopic procedures in Europe. Clin Endosc 2016;49:47.
DOI: https://doi.org/10.5946/ce.2016.49.1.47
Joint Commission. Pain assessment and management standards for hospital: requirement, rationale, reference. a complimentary publication of the joint commission. [Internet]. 2017 [cited 2018 Dec 02]. Available from: https://www.jointcommission.org/assets/1/18/R3_Report_Issue_11_Pain_Assessment_8_25_17_FINAL.pdf
European Board of Anaesthesiology. Recommendations for minimal monitoring during Anaesthesia and Recovery. [Internet]. 2011 [cited 2018 April 20]. Available from: http://www.eba-uems.eu/resources/PDFS/safety-guidelines/EBA-Minimal-monitor.pdf
American Society of Anaesthesiology. Standards for basic anesthetic monitoring: American Society of Anesthesiologists. [Internet]. 2010 [cited 2018 April 27]. Available at: https://www.asahq.org/standards-and-guidelines/standards-for-basic-anesthetic-monitoring
Kodali BS. Capnography outside the operating rooms. Anesthesiology 2013;118:192-201.
DOI: https://doi.org/10.1097/ALN.0b013e318278c8b6
Beitz A, Riphaus A, Meining A, et al. Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: a randomized, controlled study (ColoCap Study). Am J Gastroenterol 2012;107:1205-12.
DOI: https://doi.org/10.1038/ajg.2012.136
Barnett S, Hung A, Tsao R, et al. Capnographic monitoring of moderate sedation during low-risk screening colonoscopy does not improve safety or patient satisfaction: a prospective cohort study. Am J Gastroenterol 2016;111:388-94.
DOI: https://doi.org/10.1038/ajg.2016.2
Klare P, Reiter J, Meining A, et al. Capnographic monitoring of midazolam and propofol sedation during ERCP: a randomized controlled study (EndoBreath Study). Endoscopy 2016;48:42-50.
Egan E. Introducing capnography monitoring into an endoscopy service. Gastroenterol Nurs 2016;14:37-43.
DOI: https://doi.org/10.12968/gasn.2016.14.4.37
Langhan ML, Kurtz JC, Schaeffer P, et al. Experiences with capnography in acute care settings: a mixed-methods analysis of clinical staff. J Crit Care 2014;29:1035-40.
DOI: https://doi.org/10.1016/j.jcrc.2014.06.021
Brewer J. Ethnography. UK; McGraw-Hill Education; 2000.
Richards L, Morse JM. Readme first for a user's guide to qualitative methods. Sage; 2012.
Patton MQ. Qualitative research & evaluation methods: Integrating theory and practice. Sage; 2014.
Roper JM, Shapira J. Ethnography in nursing research. Sage; 2000.
DOI: https://doi.org/10.4135/9781483328294
Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins; 2014.
Urquhart C. Observation research techniques. Journal of EAHIL 2015;11:29-31.
Fetterman DM. Ethnography: Step-by-step. SAGE; 2019.
Bryman A. Social research methods. Oxford university press; 2016.
Creswell JW, Creswell JD. Research design: Qualitative, quantitative, and mixed methods approaches. Sage; 2017.
Renz SM, Carrington JM, Badger TA. Two strategies for qualitative content analysis: An intramethod approach to triangulation. Qual Health Res 2018;28:824-31.
DOI: https://doi.org/10.1177/1049732317753586
Cardiff University. Guidance for managing research data and records. [Internet]. 2018 [Cited 2018 Dec 15]. Available from: https://www.cardiff.ac.uk/__data/assets/pdf_file/0004/937021/Research-Integrity-and-Governance-Code-of-Practice-v3-PDF.pdf
Act DP. Data protection act 1998, c. 29. B. [Cited 2018 Dec 20]. Available from: http://www.legislation.gov.uk/ukpga/1998/29/pdfs/ukpga_19980029_en.pdf
Ryan GW, Bernard HR. Techniques to identify themes. Field methods 2003;15:85-109.
DOI: https://doi.org/10.1177/1525822X02239569
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77-101.
DOI: https://doi.org/10.1191/1478088706qp063oa
Gale NK, Heath G, Cameron E, et al. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 2013;13:117.
DOI: https://doi.org/10.1186/1471-2288-13-117
Tattersall A. Who, What, Where, When, Why: Using the 5 Ws to communicate your research. Impact of Social Sciences Blog; 2015 [Cited 2019 Jan 15]. Available from: http://eprints.lse.ac.uk/70619/1/blogs.lse.ac.uk-Who%20What%20Where%20When%20Why%20Using%20the%205%20Ws%20to%20communicate%20your%20research.pdf
Sheckley B, Kehrhahn M, Bell S, Grenier R. Trio: an emerging model of adult professional learning. Proceedings of the 49th Annual Adult Education Research Conference; 2008, University of Missouri, St. Louis.
Feng X, Bobay K, Weiss M. Patient safety culture in nursing: a dimensional concept analysis. J Adv Nurs 2008 Aug;63:310-9.
DOI: https://doi.org/10.1111/j.1365-2648.2008.04728.x
Kiekkas P, Stefanopoulos N, Konstantinou E, et al. Development and psychometric evaluation of an instrument for the assessment of nurses’ knowledge on capnography. Collegian 2016;23:39-46.
DOI: https://doi.org/10.1016/j.colegn.2014.09.010
Clark CL, Weavind LM, Nelson SE, et al. Nursing attitudes towards continuous capnographic monitoring of floor patients. BMJ Open Qual 2018;7:e000416.
DOI: https://doi.org/10.1136/bmjoq-2018-000416
Iyer NS, Koziel JR, Langhan ML. A qualitative evaluation of capnography use in paediatric sedation: perceptions, practice and barriers. J Clin Nurs 2015;24:2231-8.
DOI: https://doi.org/10.1111/jocn.12848
Langhan ML, Shabanova V, Li FY, et al. A randomized controlled trial of capnography during sedation in a pediatric emergency setting. Am J Emerg Med 2015;33:25-30.
DOI: https://doi.org/10.1016/j.ajem.2014.09.050
Benner P. From novice to expert. Menlo Park; 1984.
DOI: https://doi.org/10.1097/00000446-198412000-00027
Kerslake I, Kelly F. Uses of capnography in the critical care unit. BJA Educ 2017;17:178-83.
DOI: https://doi.org/10.1093/bjaed/mkw062
Applegate RL, II JL, Malkin M, et al. Advanced monitoring is associated with fewer alarm events during planned moderate procedure-related sedation: a 2-part pilot trial. Anesth Analg 2016;122:1070.
DOI: https://doi.org/10.1213/ANE.0000000000001160
Siebig S, Kuhls S, Imhoff M, et al. Intensive care unit alarms—How many do we need?. J Crit Care Med 2010;38:451-6.
DOI: https://doi.org/10.1097/CCM.0b013e3181cb0888
Sowan AK, Tarriela AF, Gomez TM, et al. Nurses' perceptions and practices toward clinical alarms in a transplant cardiac intensive care unit: Exploring key issues leading to alarm fatigue. JMIR Hum Factors 2015;2:e3.
DOI: https://doi.org/10.2196/humanfactors.4196
Gottlieb KT, Banerjee S, Barth BA, et al. Monitoring equipment for endoscopy. Gastrointest Endosc 2013;77:175-80.
DOI: https://doi.org/10.1016/j.gie.2012.09.028
Maddox RR, Williams CK. Clinical experience with capnography monitoring for PCA patients. APSF Newsletter. 2012;26(3).
How to Cite
Aldossary, Deemah Nassir, and Sherran Milton. 2020. “A Focused Ethnography of How Endoscopy Practitioners Utilize Capnography in Sedated Patients”. Qualitative Research in Medicine and Healthcare 4 (2). https://doi.org/10.4081/qrmh.2020.9077.
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