Head-Of-Bed Positioning Is an Important

Head-of-Bed positioning is an important factor in preventing pneumonia due to aspiration in patients receiving mechanical ventilation. Current guidelines recommend positioning the head at an angle of 30-45 degrees to prevent pneumonia. Yet, many nurses do not follow this guideline consistently. Research conducted by Lyerla, LeRouge, & Cooke et al. (2010) explored the reasons for failure to adhere to this guideline. The following is a critique of their article, published in the American Journal of Critical Care on this topic.

The title of the article is "A Nursing Clinical Decision Support System and Potential Predictors of Head-of-Bed Position for Patients Receiving Mechanical Ventilation." First of all, this is a quite lengthy title and one must wonder if a shorter title would have been clearer. The article addressed two important issues; the reasons behind the failure of nurses to adhere to the set guidelines and the affectiveness of a software intervention (CDSS) to improve nursing adherence to the recommended guidelines for patients on mechanical ventilation. The second observation about the title, is that research addressed these two issues in the opposite order presented in the title. Perhaps a better title would be, "Improving Nurse Adherence to Guidelines For Patients on Mechanical Ventilation." This title is more in alignment with the stated purpose of the research study.

The objective of the study is to improve nurse adherence to guidelines regarding head-of-bed positioning in patients receiving mechanical ventilation in order to prevent serious and potentially life threatening complications in this group of patients. Nurse adherence to prescribed guidelines is essential for improving patient outcomes. The results of this study have serious implications for both nurses and the patients whom they serve.

The introductory paragraph of the article highlights the importance of the research through presenting the statistical impact of Ventilator-associated pneumonia (VAP). The purpose and importance of the study are made clear in the opening paragraph of the article. The article contained no apparent errors of fact or interpretation. The guidelines used as the basis for the study and the software are industry standards and were utilized in the manner for which they were designed. Prior to the study, the researcher consulted pertinent literature on both the head-of-bed elevation standard and the Clinical Decision Support System. The sources used were authoritative and relevant. The information presented by the author is in agreement with other research in this clinical area of study (Frederich, Sud, & Sud et al. (2008); Williams, Chan & Kelly (2008).

The author placed considerable emphasis on nurse characteristics, which were not even mentioned as an objective of the study. They seem to have been added into the methodology without justification. The objective of the study addressed patient characteristics, but not nurse characteristics. This added in another variable that was not part of the original research study. Patient characteristics and the affect of the CDSS were discussed sufficiently, as were the limitations of the study. The authors provided enough details of the study to be replicated by other researchers. The authors were careful to make certain that they were objective in the ability to apply the results to different sample populations and paid particular attention to the limitations of the study.