Date of Award


Degree Name

Master of Nursing (Research)

First Supervisor

Professor Leanne Monterosso

Second Supervisor

Professor Max Bulsara


Background: Endotracheal tube (ETT) suction is a common nursing procedure performed in paediatric intensive care settings. Significant side effects of this procedure can dramatically affect the stability of the critically ill ventilated paediatric patient. The lack of clear standards for determining when the procedure is warranted, especially in paediatrics, can present challenges for the inexperienced paediatric intensive care nurse when assessing a patient’s need for ETT suction. Previous research underpinned the development of an Endotracheal Suction Assessment Tool© (ESAT©) to guide inexperienced nurses through the decision making process to determine suction requirements. The aim of the ESAT© is to improve patient health outcomes through improved nursing practice for patients with an artificial airway (endotracheal tube) in situ.

Aim: To evaluate the psychometric properties of the ESAT© for the clinical setting, namely content validity and the scale level content validity index, criterion-related (construct) validity and test-retest (stability) reliability.

Design: A five-phase sequential mixed method study using standard psychometric testing principles was performed. Phase one comprised an integrative literature review to determine the clinical indicators used to establish the original format of the ESAT©. In phase two, a clinical audit was performed to establish the link between current clinical practice and the clinical indicators within the ESAT©. Phase three established scale level content validity index of the ESAT© using “expert” paediatric intensive care nurses’ opinion (n=9) and developed clinical scenarios (n=10) with predetermined outcomes. In phase four, criterion-related (construct) validity testing of the ESAT© was undertaken by comparing clinical scenario outcomes between expert, “inexperienced” and “experienced” paediatric intensive care nurses. In phase five, test-retest (stability) reliability of the ESAT© was performed where the previously developed scenarios were presented at two time points to the same groups of inexperienced and experienced paediatric intensive care nurses.

Results: All items met the a-priori criteria for content validity. Content validity index (0.8-1.0) and scale content validity index (0.9-1.0) scores were high for all items. Construct validity was established as no differences were observed between endotracheal tube suction decisions made by expert (n=9), inexperienced (n=14) and experienced (n=12) nurses using clinical scenarios. There were no differences observed between groups for endotracheal tube suction decisions at T1 and T2 confirming test-retest reliability.

Conclusion and significance: To the best of our knowledge this study is the first to provide an assessment tool to guide decisions about endotracheal tube suction. Originally designed for nurses, the ESAT© could potentially be used by other healthcare professionals. Using clinical scenarios, the tool proved to be valid, user-friendly and useful for inexperienced nurses. Further testing is required in the clinical setting.

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