Assessment and evaluation of body temperature is one of the oldest known diagnostic methods and still has a huge impact on decisions about medical diagnosis, nursing care, treatment and ordering of laboratory test (Sund-Lavender & Grodzinsky, 2010).
Body temperature is of two types, shell temperature and core temperature. Temperature of the skin surface of the body is called shell temperature, is measured in groin, axilla and oral cavity. Temperature of the deep tissues represents the core temperature; i.e. the temperature of blood surrounding the hypothalamus (Falzon, Grech, Caruana, Margo & Attard-Montalto, 2003).
Ideally, recorded temperature should represent body core temperature (Falzon, Grech, Caruana, Margo & Attard-Montalto, 2003). Oral temperature is said to be related closely to the core body temperature by the determination of keeping the thermometer in the sublingual cavity with mouth covered closely during measurement of temperature.
Besides that, there is evidence in the middle of the 19th century when thermometer was introduced into medical practice; the measurements of temperature were performed using the axillary site in a non-standardised way on patients which it gives a poor estimation of the core body temperature (Sund-Lavender & Grodzinsky, 2010).
If both oral and axilla temperature are taken from an adult at the same time, can the axilla temperature reflect the oral temperature which clinically oral temperature is commonly used to measure temperatures among the adults (Potter & Perry, 2006)? We would also like to find out the relationship of oral and axilla temperature between males and females.
Therefore, this study has been designed to study the correlation of oral temperature and axilla temperature in 30 young adults 15 males and 15 females aged 18-27, from Nanyang Polytechnic.
Labels: INTRODUCTION
For our research hypothesis, we claim that there is a positive relationship between oral and axilla temperatures in a person. The results will still be the same in different genders, which also reflects positive relationship between oral and axilla temperatures for males and females.
Besides, null hypothesis, (H₀), is also being made where it claims that there is no significant relationship between oral and axilla temperatures in a person. Similarly, there is also no relationship between oral and axilla temperatures for males and females.
Labels: HYPOTHESIS
Temperature taking is the integral part of patient care as it influences diagnosis and subsequent patient management. The aim of measurement of body temperature is to obtain a representative average temperature and measurement sites are important factors to be taken into consideration while doing so.
Literature reviews based on literature research (different sites of temperature measurements) in MEDLINE and CIHNAHL, namely the oral and axilla site, was done to evaluate our research question: is a person oral temperature related to the axilla temperature?
Oral Temperature
The axilla and oral cavity have been the classical locations for measuring body temperature. Temperature taken in the oral site with proper technique will provide accurate surface temperature reading. This is because its proximity to the external carotid artery which allows oral temperature to reflect changes in core temperature (Blatties, 1998), but the sublingual temperature will differ between the right and left posterior pockets and front area in the oral cavity (Modell et al, 1998). Salivation, previous intake of hot or cold food and fluids, gum chewing, smoking and rapid breathing would be the other possible influencing factors (Blatties, 1998: Rabinowitz et al, 1996).
Axilla Temperature
Ambient temperature, local blood flow, underarm sweat, inappropriate placement of the probe or poor closure of the axillary cavity, and the time it takes to record a reading will strongly affect the accuracy of the axilla site (Blatties, 1998). Moreover, a temperature difference of 1.4ºC between the right and left axilla has been found in a study (Howell, 1972). Axilla measurements, even with careful positioning, it slowly detects changes in core temperature and the readings are widely deviate from the other measurements sites (Robinson et al, 1998), especially during fever. These factors make the axilla site inappropriate for approximating core body temperature. It does not reliably reflect oral temperature and therefore axilla temperature should be interpreted carefully (Falzon, Grech, Caruana, Margo & Attard-Montalto, 2003).
Normal Body Temperature
Today, World Health Organisation define normal core temperature was taken to be 36.5°C to 37.5°C. Besides, research findings are contradictory among the different sites of temperature taken; however it is generally accepted that the axilla temperature is 0.5ºC lower than oral temperatures (Potter & Perry, 2006).
The results may also be influenced by several confounding factors: e.g. age differences, the influence of thermoregulation, ageing factor and ovulation, which can affect female body temperature (Sund-Lavender, Forsberg & Wahren, 2002).
However, this study was carried out to ascertain the relationship of whether oral temperature related to axilla temperature in 30 young adult students, aged of 18 to 27 from Nanyang Polytechnic without taking the consideration of most of the factors.
Yet, we would like to find out whether the relationship of oral and axilla temperature for males and females is still the same when gender factor is taken for consideration.
Labels: LITERATURE REVIEW
The data collection of this present study was carried out in the centralised air-conditioned library of Nanyang Polytechnic of Singapore. The oral and axilla temperature were measured between 1600 hours to 1900 hours on 28 January, 2010.
The relationship between oral and axilla temperature was studied in a quota sample of a total of 30 young adults, whereby we had chosen 15 males and 15 females from NYP library. The 30 young adults that were involved in this research were Nanyang Polytechnic students. They were between the ages of 18 years and 27 years.
The inclusion of criteria comprised the following before their temperature are taken:
- · Healthy individuals without ongoing febrile illness, systemic, oral disease and skin disease over the axilla site.
- · Non-smokers.
- · The absence of medication in the form of anti-inflammatory, antihypertensive, or corticoid drugs during the week prior to the study.
- · No food or drink consumption, or oral washing, in the 30 minutes before the exploration.
- · Did not perform vigorous activity, e.g. jogging or exercise prior to temperature taking.
- · No application of deodorant or of anything else to the axilla measurement surface.
Temperature was recorded by digital clinical thermometer. There were 4 thermometers altogether, 2 were used for oral temperature taking and the other 2 were used for axilla temperature taking. Digital clinical thermometers (microlife®) were used. Proper functioning of the thermometer was tested automatically each time it was turned on, if a malfunction was detected, this was indicated “ERR” on the display and a measurement becomes impossible. No malfunction of the thermometers was detected. All the digital thermometers were in good condition. During a measurement, the current temperature was displayed continuously. The “ºC” symbol flashes during this period of time. If the signaling tone sounds (beep- beep-beep- beep-) for 10 times and the “ºC” was no longer flashing, this meant that the measurement of increase in temperature was now less than 0.1ºC in 16 seconds and that the thermometer was ready for reading.
All the measurements in each individual were carried out within 15 minutes. The temperatures were taken 3 consecutive times at the same sites and recorded to get the mean of the readings. Oral readings were taken before axilla readings.
All thermometers with a disposable shield were changed and swiped with 70% alcohol spirit® for each repeated measurements in each intraoral and axilla fold anatomic regions. The same site was used for repeated measurements; sublingually left posterior pocket in the oral cavity for oral temperature and right axilla fold to measure axilla temperature.
The purpose of the research was explained to the subjects and the methods of obtaining the oral and axilla temperatures had been given in verbal and practical instructions to the subjects.
The thermometer was kept underneath the subject’s tongue, sublingually, left posterior pocket in the oral cavity with mouth covered closely. Subjects were instructed not to talk and not to bite on the thermometer during oral temperature taking. The thermometer was kept until the temperature reading was finalised on the thermometer.
For axilla temperature taking, the thermometer was placed deep in the right axillary fold and the arm was firmly held down. The arm was held close to the subject and subjects were instructed not to move until the temperature taking was completed. Finalised reading of the thermometer for both oral and axilla readings was taken when the signaling tone sounds (beep- beep-beep- beep-) for 10 times and the “ºC” was no longer flashing.
No rejections were encountered from the subjects.
Labels: methodology
MALE'S ORAL & AXILLA TEMPERATURES TAKING
FEMALE'S ORAL & AXILLA TEMPERATURES TAKING
Labels: EVIDENCE OF TEMPERATURE TAKING
Statistical analysis
The 3 readings for each individual’s oral and axilla temperatures were registered into Microsoft Excel® to evaluate the mean numbers.
Mean from the 3 consecutive readings of each Oral and Axilla Temperatures for Males and Females
Data was processed using the SPSS 14.0 for Windows Integrated Student Version.
Under Variable view
Under data view
We have delegated our research question into two parts; Part 1: Is a person’s oral temperature related to axilla temperature and Part 2: Is this relationship the same for males and females?
Labels: ANALYSIS OF DATA
To analyse Part 1: Is a person’s oral temperature related to axilla temperature
Scatter plot was produced to check for the linearity and homogenous variance whereby the assumption of the relationship between the dependent (axilla temperature) and independent (oral temperature) variables of the 30 individual subjects should be linear.
Further that, Pearson’s R was computed. When oral and axilla variables for those 30 individual subjects were measured on a scale, Pearson’s R was used to ascertain the correlation coefficients which measure the strength of the linear association between these two variables.
Is a person’s oral temperature related to axilla temperature?
Results:
Scatter Plot
The scatter plot appears to follow a general positive linear trend. There is no violation of the linearity assumption.
Part 1: Final Statement
There is a positive, moderate and significant association between oral and axilla temperatures in a person. (r=0.418, p=0.022, N=30)
We choose 0.10 as the significance level. Reject Ho since p<0,10, whereby there is a relationship between oral and axilla temperatures in a person.
Labels: ANALYSIS OF DATA
To analyse Part 2: Is this relationship the same for males and females?
Scatter plot was also generated to verify the linearity of dependent (axilla temperature) and independent (oral temperature) variables of the two different genders (male and female) from those 30 subjects.
Moreover, Pearson’s R was computed. It was used to determine correlation coefficients between the two different genders’ from the 30 subjects’ oral and axilla temperatures.
Is this relationship the same for males and females?
Results:
Scatter Plot
The scatter plot appears to follow a general positive linear trend. There is no violation of the linearity assumption.
Part 2: Final Statement
There are positive, moderate and significant associations between a person’s oral and axilla temperatures for different gender with the association for male and female. The association for male is r=0.466, p=0.080, N=15 and female association is r=0.560, p=0.030 and N=15.
We choose 0.10 as the significance level. Reject Ho since both p<0.10, whereby there are relationship between oral and axilla temperatures in a person with the association for male and female.
Labels: ANALYSIS OF DATA
Predicting a person’s oral and axilla temperatures
From the generated results, we decided whether to accept or reject Ho. Subsequently, both Part 1 and Part 2 Ho were rejected, regression equation was computed to quantify the relationship by having equation predicting a person’s oral and axilla temperatures.
Linear Regression
Knowing that a relationship between a person’s oral and axilla temperatures exists, linear regression quantifies the relationship by having an equation predicting a person’s oral and axilla temperatures.
Labels: ANALYSIS OF DATA
The results reject the null hypothesis, Ho, which was being made earlier where it claims that there is no significant relationship between oral and axilla temperature in a person and even in two different genders.
Research hypothesis are accepted whereby we claim that there is a positive relationship between oral and axilla temperatures in a person. The results will still be the same in different genders, which it also reflects positive relationship between oral and axilla temperatures for males and females.
Putting all into a nutshell,
In PART 1: There is a positive, moderate and significant association between oral and axilla temperatures in a person.
In PART 2: There are positive, moderate and significant associations between a person’s oral and axilla temperatures for different gender with the association for male and female.
Labels: CONCLUSION
Our group was preparing with our piling up group projects :)
Here we are, project and blog finally done!
Labels: group photos
Kang Hwee Nee Winnie
Typing, collecting and collating all the data from scratch is not an easy task even though we had previous research journals as reference. Asking strangers to allow us to take temperatures from them was an awkward and uneasy thing but we had to, for the sake of collecting data. We had to do data collection twice as the results were incorrect the first time. This made me more careful when obtaining data and to ensure accuracy always. It made me understand the various difficulties and challenges that occur in the process of doing a research.
Liu Lei
In our research method project, we are doing the relationship between oral and axilla temperature. As for me, the most important thing I had learnt was I must be careful no matter what I am doing. The reason why I felt that is we did wrongly when we first collect our data without consistency. Therefore, at last, we have to redo the data collection to. Anyway, the wrong data alerted us to take our project seriously. Although, was a mistake that we made, it also gives us a very important lesson.
Ng Zhe Theng
To me, I have learnt a lot from the beginning which was the process of data collection, data analysis till the last when I finalized the statistical conclusion for our research question: “Is a person’s oral temperature related to axilla temperature?” On top of that, we are given opportunity to play the role of researchers for this particular research question. It was very fun to go around the library to take the temperatures from the students. I find that Statistics Module is very beneficial to nursing students where nowadays nursing practice is very evidence-based, a lot of research should be done to match up with the trend of this practice and one way to be effectively interpret the results get from the data collected is to be familiar with the elements of Statistics.
Ong li Lin Cheryl
I found the project interesting as I was able to experience or have a glimpse into the life of a researcher. Temperature taking was a breeze as my subjects were cooperative and did not hesitate to help. When my subjects were asked to insert the thermometer under their arms, they were more than willing to do so though I was quite sure that they found having a thermometer directly under the arm uncomfortable. From this project, I’ve also learnt how to collate, calculate and examine data. I’ve also managed to improve my blogging skills from this project.
Tan Suan Geok (aka. Jasmine-Group leader)
This study exposed us to experience a real life data collection activity. From my point of view, conducting these activities is not only based on the procedure but also upon our professional responsibilities to carry it out correctly without doctoring the data. The activities of data collection and its application are based on our understanding of statistical literacy that had been taught to us. It allows us to look at the actual data and compare our predictions. It has facilitated our learning process.
Tan Yan Kang Garyson
After doing the statistics of taking data of oral and axilla temperature, I find that most of the people were willing to help us take the test. It’s quite tired because we have to take the temperature from the same person 3 times from each oral site and axilla site to have a clearer data. It consumes some time and money because we have to buy the protective shield and spend a day taking temperature from 30 people. Someway along the temperature taking, we found it very dull. Therefore, we encouraged each of our group members to carry on and don’t give up.
Vanitha D/O Madasamy
In our research method project, we were given to compare the relationship between the samples of oral temperature and axilla temperature. At first I was nervous to approach strangers in the public to take their samples so my group mates and I started off with some of our own classmates. Gradually, we gain the confidence and courage to approach public. I would say the participants were cooperative and sporting in helping us with our samples. I felt fortunate to get such wonderful participants.
Labels: reflection
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Perry, A. G., & Potter, P. A. (2006). Clinical nursing skills and techniques (6th ed.). St. Louis: Elseveir Mosby.
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Sund-Levander, M., Forsberg, C., & Wahren, L.K. (2002). Normal oral, rectal, tympanic and axillary body temperature in adult men and women: A systematic literature review. Scandinavian Journal of Caring Sciences, 16 (2), 122 – 128.
Sund-Levander, M., Grodzinsky, E., Loyd, D., & Wahren, L. K. (2004). Errors in body temperature assessment related to individual variation, measuring technique and equipment. International Journal of Nursing Practice, 10, 216 – 233.
Sund-Levander, M., & Grodzinsky, E. (2010). What is the evidence base for the assesment and evaluation of body temperature? Nursing times [On-line serial] 106, 1, Available: http://www.nursingtimes.net/nursing-practice-clinical-research/acute-care/what-is-the-evidence-base-for-the-assessment-and-evaluation-of-body-temperature/5010223.article (18 January, 2010).
Sund-Lavender, M., Wahren, L. K. (2002). The impact of ADL-status, dementia and body massindex on normal body temperature in elderly nursing home residents. Archives of Gerontology and Geriatics, 35, 161-169.
Labels: REFRENCES
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