From left: Abdul Halim, Eddie Lim, Neelavathi SK, Hannah Ler, Liew Shiau Wen
We are students from the accelerated diploma course in nursing. We began our course in April 2009 and are currently in our third semester. Our group (sub-group 3 of ND0902) is now doing a research on the relationship between oral and axilla temperature. After two semesters of clinical attachments, we discovered that temperature measurement is not standard after all - every hospital has its own protocol in measuring temperature.
Therefore, we are conducting a research to determine if there is any significant relationship between different routes of temperature taking.
As a start, it is good to know that there is no single number that represents a normal or healthy temperature for all people under all circumstances using any route of measurement. Temperature readings should be read in relation to interdependent variables.
RELATIONSHIP BETWEEN ORAL & AXILLARY
Rationale in choosing the variables
We have chosen the Oral and Axillary Temperature routes as our independent variables as they are the most common sites for temperature taking.
Variables are important as results from each site are affected by factors, such as:
- Environment
- Activity
- Smoking
- Food or drink taken
- Placement of the thermometer
- Mood
- Material of clothes
- Exercise
- Age
Also, to begin with, normal human body temperature varies slightly from person to person.
Oral temperature route
Oral temperatures are influenced by factors such as drinking, eating and breathing. To get an accurate temperature, the person must be able to breathe through the nose.
Axilla temperature route
Skin temperatures, measured under the arm or at the forehead, are not always reliable indicators of core body temperature, especially during those critical times when core body temperature is increasing or decreasing. This is because the skin is a tool the body uses to control core body temperature. For example, when fever is increasing people are likely to react by shivering and drawing in heat from the increased core body temperature. Skin temperatures are further influenced by factors such as fever-lowering medication, clothing and external temperature.
IMPORTANCE OF THE STUDY
This study is important because -
a. Taking a patient's temperature is an integral part of a full clinical examination.
b. It sets to determine if these common sites are reliable in terms of producing accurate readings (of core temperature) concomitant with varying variables all of the time.
c. It sets to determine if changes in core body temperature are reflected more accurately and rapidly (depending on the location).
d. It sets to determine, through comparison, if one site can act as a surrogate for the other.
e. In certain situations, accuracy in temperature taking is important. For example, elderly patients may have a decreased ability to generate body heat during a fever, so even a low-grade fever can have serious underlying causes in geriatrics.
HYPOTHESIS
Null hypothesis:
There is no relationship between oral temperature and axillary temperature.
Alternative hypothesis:
There is a significant relationship between oral temperature and axillary temperature.
REFERENCE LITERATURE
Please click4Oral Versus Axilla Temperature Measurement: A Review of the Evidence
METHODOLOGY
INSTRUMENTATION AND CALIBRATION
We use four digital thermometers for the study. Thermometer sheaths and alcohol swabs were made available for hygiene purposes.
Thermometers were calibrated to ensure the validity of the thermometer readings. Calibration was done by immersing the thermometers in warm water and observing the readings.
CHOOSING THE SAMPLE
Sampling methods – non-probability (Quota)
Participants were chosen from HSNF01 Group. Out of 46 students from the accelerated batch, 30 volunteers were chosen to participate in the trial to test our hypotheses. Participants were between 22-51 years old and comprised of both females and males.
We ensured that they met the minimum criteria before they could participate. Participants were excluded if they have dry lesions in their axillary area, have lower or upper respiratory infections.
INFORMED CONSENT
The study protocol requires that each student is well-informed about the study and what is required of them before a consent form is signed. This is also to highlight that the data collected will be published without breach of confidentiality. Participants were required to complete certain personal data such as gender, age and general health conditions. 
CONDUCTING THE STUDY
All participants were directed to a chosen venue and have their temperature taken by the oral & axilla route. Participants were briefed that they should be feeling well and not be on any medication for the last 3 days. Also, participants should not be perspiring as this would interfere with the readings especially for the axilla temperature. Each participant was given a thermometer. They took their temperature using the oral and axilla route. A time interval of 2 minutes was observed before the thermometers were used for the next participant. Each participant was asked to take their oral and axilla temperatures 3 times with an interval of 2 minutes.
Participants were given chocolates as a token of appreciation.
Rejections
Some results from the study were rejected as the thermometer used was not put to "reset" when placed at the axilla route after measuring the oral temperature. As a result, subsequent readings were artificially higher.
RESEARCH DATA
CORRELATION COEFFICIENT (linear association)
From our scatter plot:
The scatter plot illustrates a positive slope. The scatter plot appears to follow a general positive linear trend. There is no violation of the linear assumption. The points cluster around a straight line. The oral and axillary routes are linearly related.
Positive correlation:
As the temperature of the oral route increase, the corresponding temperature on the axillary route increases also, and vice versa.
With R sq linear = 0.637, there is a strong relationship between the oral and axillary route measurements.
As it is an interval measurement that we are measuring, we use the pearson's correlation coefficient.
Assumption for Pearson's R:
From the scatter plot, the axillary route have the same variability at each value of the oral route.
The relationship between the oral and axillary route is linear.
Pearson's correlation coefficient of 0.798 indicates a strong relationship between oral and axillary route.
There is a positive strong and significant association between the oral and axillary route [r = 0.798, 'p' is less than 0.05 (assuming alpha is 0.05), 'n' equals to 30]
In our case, the pearson's correlation coefficient shows that the p value is less than 0.05. Therefore, we reject the null hypothesis and accept the alternative hypothesis.
A relationship between the oral and axillary route exists. Linear regression quantifies the relationship. An equation can be used to predict oral and axillary route temperature.
The linear equation is: Y = BX + A
Therefore, oral = 0.815 x (axillary) + 7.106
CONCLUSION
There is a significant positive relationship between oral and axillary temperature measurements. Therefore, in temperature taking, the axillary route can be used to complement the oral route for clinical judgments.
For neonates and patients with facial and/or head injury, the axilla route will serve as a reliable method for temperature taking.
REFLECTION
Our body temperature is critical in achieving homeostasis. At the beginning of our research journey we know that the “appropriate” body temperature is achieved when the body is homeostatistically balanced. Its numerical value, however, varies from one body to another.
Reading through various articles we find that different locations can give a difference in temperature results. Research done for each temperature locations is indicative; individually falling in a narrow range but somewhat higher or lower than the other locations.
We set off our research with an open mind (and try not to be influenced by our prior knowledge). Our methodology is to ensure that the final results were taken using procedures that inhibit the activation of variable factors. Besides proper calibration of our thermometers, we have to work the ground by explaining to our fellow classmates on how we are conducting the research and what is required of them.
There were a few discrepancies along the way. For example, we found out that some participants were perspiring, indicating some prior physical activities (possibly climbing the staircases as the test was conducted at the 5th level and some prefer to avoid the lifts). This condition affected results for the axilla, since this region is also used to regulate body temperature. Therefore, we have to do away with these results.
After collating the results, it could only confirm the relational attributes of temperature taken from different locations. We were “comforted” by the end results.
