Nursing Research Study:
Evaluation of Linear Measurement and Growth Plotting in an Inpatient Pediatric Setting
Student
Grand Canyon University
NRS433V
July 11, 2010

Nursing Research Study Summary The heights and weights of children can be key indicators of normal growth and development for each child and should be done routinely in a variety of patient care settings. The purpose of this paper is to provide a summary on the recent article in the Journal of Pediatric Nursing, Evaluation of Linear Measurement and Growth Plotting in an Inpatient Setting (Lipman, Euler, Markowitz, & Ratcliffe, 2009), in which nursing researchers documented an evaluation of the processes of obtaining measurement in their urban children’s hospital.
Background
The issue of a lack of properly done and routine measurements in pediatrics has been the topic of many studies done in the settings of pediatric and family practice offices. Inpatient admissions offer a unique opportunity to assess the growth of children. The purpose of the study being summarized was to “determine adherence to hospital policy and accuracy of growth documentation by obtaining data on the linear measuring practices to inform and improve nursing care” (Lipman, Euler, Markowitz, & Ratcliffe, 2009). The setting for the study was an urban children’s hospital in which the staff is exclusively registered nurses. “Registered nurses are significantly more likely to measure children accurately” (Hench, et al., 2005). Proper measurement and plotting of growth is invaluable information during a child’s development. Nurses in this urban hospital have more interactions with the patients and are responsible for measurements to be taken at admission. As nurses, we can gather pertinent data and relay any deviations from normal growth to the healthcare provider. The objective of this study was to evaluate if measurements were done in a timely manner, if they were done correctly, and if they were documented accurately in the inpatient setting.

Methods This study was a quantitative research study in which the study design was a retrospective random chart review. A random numbers table was used to obtain medical record numbers of 200 pediatric patient charts to be reviewed as samples. The charts reviewed were from all patient care units using a linear growth measurement collection tool. Two research assistants (RA) reviewed each chart and compared findings for data collection. The six locations in the chart in which measurements could be were reviewed. Additional dependent variables reviewed included whether the measurements were plotted, if they were plotted correctly and if appropriate referrals were made for noted deviations from normal growth. Independent variables reviewed included age, gender, admitting diagnosis and the patient unit of admission. All plotted measurements were replotted by the RA to measure accuracy. The plotted measurements had to be accurately placed for age and gender to be considered correct and adjusted as needed for prematurity. If discrepancies in measurement were noted, the differences were examined using chi-squared tests to determine variability in measurement practice. Any relationships between demographic and other independent variables were evaluated using chi-squared, Fisher’s exact, or Mann-Whitney U tests. The odds ratio was calculated by logistic regression using a confidence interval (CI) for variables of 95%. The SPSS 14.0 was used for statistical analysis.
Results
The researchers found that “of 200 admissions reviewed, 88% had documented weights and 57% had documented linear measurements” (Lipman, et al., 2009, p. 325). Other variables measured showed a mean patient age of 5.5 years, 52.2% female, 47.8% male, 0.9% Caucasian, 35.1% AA, and 14% other. There were 34 admitting diagnoses and patients were from a variety of patient units. Younger children and females were more likely to be measured. There were noted differences between the patient units. Race, diagnosis and admitting service had no associations with measurements. Only 73% of the 115 children measured were plotted and of those only 57% were plotted accurately. Females were plotted more accurately and some units were better at plotting. Younger children were more likely to be measured but are more difficult to measure. There was no reason found for the increase in female measurements. The researchers questioned if some of the RN’s in the hospital were unaware of the policy to obtain and plot linear growth measurements at least once during the hospital stay or if some nurses just thought it a low priority. They questioned if the variances in measuring between the units was because of differing goals of the unit manager. The accuracy of plotted measurements was found to be at only 24% of the total sample. The most common reason for this was found to be a miscalculation of age. Astonishingly, the researchers found that 16 of the 200 patient charts reviewed showed growth failure, yet only 9 were identified and only 7 of those referred for evaluation. Finally, the researchers determined that more education and supervision are needed to ensure timely and accurate measurements. The ethical considerations associated with this type of nursing research include the need to receive IRB approval for this retrospective chart review study. There was no direct patient involvement in the study and the RA’s were employees of the hospital.
Conclusion
The numbers of disorders in which growth discrepancies may be indicative of an issue make obtaining a proper height and weight increasingly important. These heights and weights can be taken in a variety of settings. School nurses are becoming actively involved. In Philadelphia, Pennsylvania, “many school districts now require school nurses to calculate BMI (body mass index) from height and weight measurements, and plot BMI using the revised “2000” CDC (Centers for Disease Control and Prevention) growth charts” (Flowers, Cooper & McKinney, 2006, para 1). This writer believes that school nurses and the health care providers who work in primary care settings should learn to routinely perform proper measurements children. This includes correct measuring techniques and correct plotting on the correct growth chart for age and gender. By measuring children routinely, we can be assured of a higher percentage of correct measurements leading to a higher number of identified health-related issues. Researchers must continue to evaluate all healthcare providers for accurate pediatric measurements and suggest changes to nursing practice that will benefit the patients’ care.

References
Flowers, P., Cooper, R.H., & McKinney, S. (2006, November). Knowledge and Practices of School Nurses Regarding Growth Measurements. Poster presentation at the meeting of the American Public Health Association (APHA) Annual Meeting and Exposition, Boston MA. Retrieved from http://web.me.com/pflowers/Home/Professional_Development_files/Knowledge%20and%20Practices%20of%20School%20Nurses%20Regarding%20Growth%20Measurements.pdf

Hench, K.D. Shults, J., Benyi, T., Chlow, C., Delaune, J., Gilluly, K., et al. (2005). Effect of educational preparation on the accuracy of linear growth measurement in primary care practices: Results of a multicenter nursing study. Journal of Pediatric Nursing, 20(2), 64-74. doi: [pic]10.1016/j.pedn.2005.02.006

Lipman, T.H., Euler, D., Markowitz, G.R., & Ratcliffe, S.J. (2009, August). Evaluation of Linear Measurement and Growth Plotting in an Inpatient Setting. Journal of Pediatric Nursing, 24,4, 323-329. doi: 10.1016/j.pedn.2008.09.001