Purpose of the Study
The study offers the background that patients in the ICU often have conditions that compromise eye protection mechanisms resulting in dry eye and other ocular surface disorders. This can lead to discomfort or even damage to the patient’s eye. Nursing interventions can be effective in preventing or minimizing the effects of this condition. The study seeks to explore which would be most effective in an ICU setting, using liquid artificial tears or artificial tears gel.
Research & Design
The study design was a randomized controlled trial. It used a double-blind approach with two unique parallel groups. In this type of design, neither researchers nor patients know which group they are in. This helps to achieve objectivity and determine more accurately the most effective means of preventing dry eye, as the objective of this study states.
Sample
The initial study population consisted of 546 patients admitted to the ICU, with the final sample consisting of 140 patients, 60 in each group. Patients were in an ICU unit of a large tertiary care hospital in Brazil. Patients had to meet the criteria of being aged 18 and older and lacking the diagnosis of the dried eye upon admission to the ICU. Furthermore, they received mechanical ventilation, had to have a blink rate of less than 5 per minute, or have a score of 7 or lower on a Glasgow Coma Scale. Patients with a diagnosis of brain death or those located in the ICU for less than 48 hours were excluded.
Data Collection
The researchers collected data in the course of 5 days since it takes an average of 3-5 days for dry eye to develop. Nurses used the intervention substance, and afterward, an assistant removed the substance using a specialized solution so that the observer researcher remained blind to the group the patient was in. On five consecutive days, a researcher conducted an ocular assessment using the Schirmer test (tear volume) and the fluorescein eye stain test (evaluates cornea for abnormalities).
Data Analysis
Standard data analysis and statistical tests were used in this study. Two researchers separately entered the data into a software program, where it was extracted to another program after being checked for consistency. Using the R-3.2.3 software, researchers ran basic statistical tests of standard deviation, frequency, and central tendency. Variables were then analyzed using the Fisher exact test, Mann-Whitney test, and the Shapiro-Wilk test.
Limitations
One of the limitations identified by the researchers is that the interventions were delivered twice a day based on the researcher’s routine, which does not correlate with traditional clinical guidelines of administering dry eye treatment whenever necessary. This potentially influences the outcomes and implications for clinical practice since the solution administered routinely can have a more profound and regular effect than ones administered upon need, which can be highly random.
Findings/Discussion
The researchers found that dry eye was present in 21% of participants in the group for liquid artificial tears and only 9% in those with artificial tears gel used. It was interesting to consider that the gel is more effective in practice as one would assume it is not as well or as natural a moisturizer as a liquid solution.
Reading Research Literature
It is very important for a healthcare professional to consistently read and learn through research literature. It provides a foundation for evidence-based practice one could implement or advocate for in the workplace. Research literature helps to consider aspects of practice and avoid making critical errors. By completing this worksheet, it was learned that studies are complex and highly consisting of following standard scientific methods that ensure the quality of research and avoidance of biases.
Reference
De Araujo, D. D., Silva, D. V. A., Rodrigues, C. A. O., Silva, P. O., Macieira, T. G. R., & Chianca, T. C. M. (2019). Effectiveness of nursing interventions to prevent dry eye in critically ill patients. American Journal of Critical Care, 28(4), 299-306. Web.