Article Critique

At this time, based on the evidence available, a recommendation for a change to the
policy that all temperatures must be taken rectally for infants birth to 24 months of age cannot
be made. This statement is based on (Bahorski et al., 2012) comparing rectal and temporal
temperature measures from a peer-reviewed journal (Journal of Pediatric Nursing, 2014). The
main subject of the study was to find a less invasive yet efficacious method to obtain
temperatures in pediatric patients other than rectally. The Purpose of the study was to determine
if there is a difference between temperature readings using a temporal artery thermometers or
rectal thermometers on pediatric patients. Based on discrepancies found in the literature
reviewed for the study and the endorsement of the Society of Pediatric Nurses to use TAT, a
need was found to conduct the study of the problem to find a less invasive, yet accurate method
to obtain pediatric/infant temperatures other than rectally. The sample population consisted of
47 pediatric patients between 3 and 36 months of age from three different units (emergency
department, pediatric ICU, and pediatric outpatient center) of a large, not-for-profit regional
hospital in the southeast. The study was of comparative single-group design with low level D
evidence support based on the American Association of Critical-Care Nurses (AACN) scale
(Armola et al., 2009). Statistical analyses used were the Levenes test, for equal variances, the t
test for equality of means, Pearsons r, and Spearmans rho. The use of temperature in this study
is interval level measurement which is an appropriate use of the t test along with the Pearsons r
and Spearmans rho since this shows a correlation between the two measurements taken. Based
on the original question, are there differences between readings using a temporal artery and
rectal thermometer, the results clearly show no statistically significant difference between the
readings, but the graphs represented a different picture. The graphs do not represent an accurate
correlation between the two thermometers. In fact, they show a significant difference in
readings. The data analysis results are consistent with an earlier study from 2004, but
contradictive with several other studies reviewed. At face value, the results seem valid, but
threats to validity need to be considered. Instrumentation, both thermometers were calibrated by
employees of the testing hospital, and used by hospital staff trained to conduct the study.
Selection bias, most test subjects came from the emergency department with a chief complaint or
diagnosis of fever alone.
The results of this study only confirm the results of one other previous study. Changing
policy based on this study alone could result in injury or death to a pediatric patient.
Temperature is an indication of infection (Braun & Anderson, 2011), and to use unproven
technique and equipment would borderline on malicious behavior by a medical professional.
Based on this study, a recommendation for change to the current policy that all
temperatures must be taken rectally for infants birth to 24 months of age cannot be made at this
time. With the limitations and need for further investigation proven by this study, a need for a
less invasive yet accurate technique is still needed.

References
Armola, R. R., Bourgault, A. M., Halm, M. A., Board, R. M., Bucher, L., Harrington, L., ...
Medina, J. (2009, August). AACN Levels of Evidence: Whats New? Critical Care
Nurse, 29(4), 70-73. Retrieved from
http://www.mc.vanderbilt.edu/documents/CAPNAH/files/Evidence%20Levels%20by%2
0AACN.pdf
Bahorski, J., Repasky, T., Ranner, D., Fields, A., Jackson, M., Moultry, L., ... Sandell, M.
(2012). Temperature Measurement in Pediatrics: A Comparison of the Rectal Method
Versus the Temporal Artery Method. Journal of Pediatric Nursing, 27, 243-247.
http://dx.doi.org/10.1016/j.pedn.2010.12.015
Braun, C. A., & Anderson, C. M. (2011). Pathophysiology A Clinical Approach (2nd ed.).
Nieswiadomy, R. M. (2012). Foundations of Nursing Research (6th ed.). Upper Saddle River,
NJ: Pearson Education.