title: Evaluating the efficiency and effectiveness of approaches to nasogastric tube insertion during trauma care.
abstract: BACKGROUND
  Numerous invasive, uncomfortable, and discomforting procedures are implemented almost routinely during trauma care. Previous research has shown that trauma care practitioners use comforting strategies during this care. Yet little is known of the effect of these comforting strategies on the effectiveness and efficiency of treatment.
  
  
  OBJECTIVE
  To evaluate the effect of the caregiver's approach on the efficient and effective completion of a discomforting procedure (nasogastric tube insertion) on conscious patients during trauma care.
  
  
  METHODS
  Ethology was used to analyze 32 attempts at nasogastric tube insertion from 193 videotaped trauma cases from 3 level I trauma centers in North America. Both qualitative and quantitative analytic techniques were used.
  
  
  RESULTS
  The practitioner's approach was associated with the outcome of the treatment. Overall, practitioners who balanced the technical aspects of the procedure with use of comforting strategies to minimize the patient's discomfort (the blended approach) were most efficient and most effective in completing this procedure. Practitioners who were most attentive to procedural technique (with little respect to patients' discomfort) or who were overly attentive to comforting strategies (termed the technical and affective approaches, respectively) took longer and/or were less successful at completing the procedure.
  
  
  CONCLUSIONS
  Four patterned, standardized approaches to care were found: technical, affective, blended, and mixed. This study has implications for further research into the effect of the practitioner's approach on the patient's behavioral state in trauma care.
authors.affiliation: International Institute for Qualitative Methodology, University of Alberta.
authors.forename: J M
authors.initials: JM
authors.lastname: Morse
authors.forename: J
authors.initials: J
authors.lastname: Penrod
authors.forename: C
authors.initials: C
authors.lastname: Kassab
authors.forename: C
authors.initials: C
authors.lastname: Dellasega
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D004526:Efficiency; D004638:Emergency Treatment / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania; D014741:Video Recording