The effects of awareness and count duration on adult respiratory rate measurements: An experimental study

Aims and objectives To investigate whether awareness of manual respiratory rate monitoring affects respiratory rate in adults, and whether count duration influences respiratory rate estimates. Background Nursing textbooks typically suggest that the patient should ideally be unaware of respiratory rate observations; however, there is little published evidence of the effect of awareness on respiratory rate, and none specific to manual measurement. In addition, recommendations about the length of the respiratory rate count vary from text to text, and the relevant empirical evidence is scant, inconsistent and subject to substantial methodological limitations. Design Experimental study with awareness of respiration monitoring (aware, unaware; randomised between‐subjects) and count duration (60 s, 30 s, 15 s; within‐subjects) as the independent variables. Respiratory rate (breaths/minute) was the dependent variable. Methods Eighty‐two adult volunteers were randomly assigned to aware and unaware conditions. In the baseline block, no live monitoring occurred. In the subsequent experimental block, the researcher informed aware participants that their respiratory rate would be counted, and did so. Respirations were captured throughout via video recording, and counted by blind raters viewing 60‐, 30‐ and 15‐s extracts. The data were collected in 2015. Results There was no baseline difference between the groups. During the experimental block, the respiratory rates of participants in the aware condition were an average of 2.13 breaths/minute lower compared to unaware participants. Reducing the count duration from 1 min to 15 s caused respiratory rate to be underestimated by an average of 2.19 breaths/minute (and 0.95 breaths/minute for 30‐s counts). The awareness effect did not depend on count duration. Conclusions Awareness of monitoring appears to reduce respiratory rate, and shorter monitoring durations yield systematically lower respiratory rate estimates. Relevance to clinical practice When interpreting and acting upon respiratory rate data, clinicians should consider the potential influence of these factors, including cumulative effects.