Running head: REFLECTION PAPER: ETCO2 MONITORING 1

Reflection Paper: ETCO2 Monitoring in Post-Operative Day 1 Patients

Amy Johns
Ferris State University

REFLECTION PAPER-ETCO2 MONITORING 2

Abstract
This paper is a review of the reference sources used for the article entitled, Evidence-Based
Practice Project: Use of EtCO2 Monitoring by Policy in Post-Operative Day 1 Patients Using a
PCA or with OSA, a paper written by a BSN student at Ferris State University in the context of
facilitating a transition into professional nursing. It is a critical examination of the research and
reference sources used to develop the knowledge of a beginner-level nurse in the use of end-tidal
CO2 monitoring in post-operative patients who are using patient controlled analgesia or who
have a diagnosis of obstructive sleep apnea. These reference sources will be critiqued for their
professional and scholarly nature, credibility, and relevance to the profession of nursing and to
the development of quality, evidence-based nursing practice.


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Reflection Paper: ETCO2 Monitoring in Post-Operative Day 1 Patients
The purpose of this paper is to critically examine and evaluate the quality of the many
aspects of medical research as they relate to nursing practice. It is the goal of this paper to
develop insight into the critical use of professional knowledge for the development of quality,
evidence-based nursing practice for individual nurses, but also to establish the professional
credibility of nursing which, as a profession, is in its infancy (Nieswiadomy, 2012, p. 5). For
this paper, the sources for a prior research assignment will be analyzed for their quality,
credibility and relevance to nursing. Another goal of this paper is to practice professional
writing skills for submission and feedback (Ferris State University, 2013).
Review
Research studies and publications widely vary in their quality and their professional
appropriateness. There is unlimited access to vast amounts of data which may or may not be
proven or backed by credible scientific methodology. An understanding of what constitutes a
credible or scholarly source of valid information is crucial.
Knowledge is disseminated in many ways but journal articles are prevalent in a literature
review. Several things can be indicators of an article that is a trustworthy source of information.
A peer-reviewed article is one that has been submitted to a panel of professional peers for
review and discussion in advance of publication (Nieswiadomy, 2012, p. 265). Research
sources should be scholarly and studies should undertaken with proper method and for the
purposes of advancing the knowledge base of a profession (Nieswiadomy, 2012, p. 4). Studies
produced with the biases of financial or professional reward or without proper methodology are
to be avoided. Of the different methodologies, research studies can be qualitative or quantitative
in scope. Quantitative research is tightly controlled, rigid in the scope of limiting for factors that
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may introduce other sources of uncertainty or reasons for variability in outcome. This allows for
valid assumptions to be made which enable broad generalization of a limited study. Qualitative
research is more subjective in nature, focusing on the skillful gathering and insightful
interpretation of experiential data (Nieswiadomy, 2012, p. 15). Knowledge of the different
elements of research and the informed usage of those elements is essential for professional
development.
Article One
One of the articles used to study ETCO2 monitoring in post-operative patients was
entitled, Does end tidal CO2 monitoring during emergency department procedural sedation and
analgesia with propofol decrease the incidence of hypoxic events? A randomized, controlled
trial. This is an article found in the journal Annals of Emergency Medicine and was authored by
Kenneth Deitch, DO, Jim Miner, MD, Carl R. Chudnofsky, MD, Paul Dominici, MD, and Daniel
Latta, BS. It is a quantitative research study in which hypoxia was measured in emergency
department patients to which propofol was administered. The article concluded that the
incidence of hypoxia was lowered when patients had ETCO2 monitoring added to the standard
monitoring (Deitch, Miner, Chudnofsky, Dominici, & Latta, 2009).
The journal Annals of Emergency Medicine is a peer-reviewed, well-respected medical
journal. It has an impact factor of 4.28 (Elsevier, 2013). It was written by four physicians in
association with the Departments of Emergency Medicine at Albert Einstein Medical Center in
Philadelphia, Pennsylvania and Hennepin County Medical Center in Minneapolis, Minnesota
(Deitch, et al., 2009).
Although this is a very credible source, it is borrowed knowledge, written by
physicians in an emergency room setting. The goal of research was to provide sources to
REFLECTION PAPER-ETCO2 MONITORING 5

contribute to evidence-based nursing practice on an acute care, med/surg floor. This article only
does so indirectly.
Article Two
Another source was an abstract of article entitled, End-tidal carbon dioxide monitoring
in patient controlled analgesia in the journal Respiratory Care by Thomas McCarter, MD,
FACP, Zakir Shaik, MD, Keith Scarfo, DO, MS and Laura J.Thompson, RT(R), MBA. It is a
study of patients receiving patient-controlled analgesia who were monitored by pulse oximetry
and end-tidal capnography. Results state that ETCO2 monitoring alerted compromised
respiratory status earlier that pulse oximetry in a total of ten patients in a five-month period and
may have prevented serious consequences (Carter, Shaik, Scarfo, & Thompson, 2007).
This source is an abstract and as such, does not state the exact number of participants and
methodology. It is published in Respiratory Care, a peer-reviewed journal with impact factor of
2.01 (Researchgate, 2013b). The authors include three physicians and a respiratory therapist.
This abstract indirectly provides solid research for improving evidence-based nursing practice,
but does so with borrowed knowledge once again.
Article Three
This source is an article called, End-Tidal Carbon Dioxide Monitoring found in the
journal Critical Care Nurse and authored by Robert E. St. John, RN, RRT, MSN. It is not a
research study, but is a comprehensive, instructional article written by a nurse for use by nurses
in a critical care setting. Critical Care Nurse is a peer-reviewed journal specific to nursing. It
has an impact factor of 2.498 (Researchgate, 2013a).
While this article is significant to nursing in that it was written by a nurse and published
in a nursing journal, it does not provide quantitative research evidence in the text of the article
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pertaining to the value of ETCO2 monitoring on patients using patient-controlled analgesia. It
does, however, provide good information that is relevant specifically to improving evidence-
based nursing practice on a med/surg. floor.
Reflection
After examining these articles, I feel that all three are quality articles from credible
sources (peer-reviewed, scholarly, well-respected) and are relevant to the subject and goal of the
original paper. They would be (and have been) useful in guiding practice decisions for a
med/surg. nurse working with patients receiving patient-controlled analgesia. The use of quality
sources as well as those who have been authored by and for nurses is important for many
reasons. The technical responsibility of nurses is increasing, calling for nurses to be better
informed and more accountable in all aspects of the interventions they perform and medications
they administer to their patients. Nurses need to be able to justify and defend the choices they
make with regard to the treatment of their patients.
Nursing as a profession also needs to establish its own base of knowledge to justify its
existence as an independent entity. Nursings unique contributions to the field of medicine
include honesty and high ethical standards (Nieswiadomy, 2012, p. 5). These are crucial, albeit
subjective. Nurses need to be ready to prove themselves academically savvy and proficient at all
the quantitative, objective methods of the science of medicine to demonstrate credibility and
competence, especially in our professions formative period.

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References
Deitch, K., Miner, J., Chudnofsky, C., Dominici, P., & Latta, D. (2010). Does end tidal CO2
monitoring during emergency department procedural sedation and analgesia with
propofol decrease the incidence of hypoxic events? A randomized, controlled trial.
Annals of Emergency Medicine, 55(3), 258-264. doi:http://0-
dx.doi.org.libcat.ferris.edu/10.1016/j.annemergmed.2009.07.030
Elsevier, (2013). Annals of Emergency Medicine. [Website]. Retrieved from
http://www.journals.elsevier.com/annals-of-emergency-medicine/
Ferris State University, (2013). NURS 350 Syllabus. Retrieved from
https://fsulearn.ferris.edu/bbcswebdav/pid-374681-dt-content-rid-
1983640_1/courses/XLIST_80303.201308/NURS350%20syllabus%20Fall2013.Ursuy%
283%29.pdf
McCarter, T., Shaik, Z., Scarfo, K., Laura, T. (2007). End-tidal carbon dioxide monitoring in
patient-controlled analgesia. Respiratory Care. [Abstract]. Retrieved from
http://www.rcjournal.com/abstracts/2007/?id=aarc07_12
Nieswiadomy, R.M., (2012). Foundations in Nursing Research. Upper Saddle River, New
Jersey: Pearson.
Researchgate, (2013a). Critical Care Nurse. [Website]. Retrieved from
http://www.researchgate.net/journal/1940-8250_Critical_Care_Nurse
Researchgate, (2013b). Respiratory Care (RESP CARE). [Website]. Retrieved from
http://www.researchgate.net/journal/0020-1324_Respiratory_care
St. John, R.E., (2003). End-Tidal Carbon Dioxide Monitoring. Critical Care Nurse. 23(4), 83-88.
Retrievedfrom http://ccn.aacnjournals.org/content/23/4/83.full