ESCALA NURSES STRESS

Choice of tape

Tapes are available in fibreglass (e.g. CMS Equipment), steel (e.g. S. Hegner & Co), special non stretch, non-tear, paper-like plastic (e.g. TALC), and made from old X-ray film (e.g. Shakir and Morley, 1974). The tape measure used was usually the high quality Eslon 150 cm x 1 mm. It is made o f non-stretchable polyvinyl chloride (PVC) coated fibreglass. (For a few of the children the TALC plastic "insertion type” tape was used measuring 20 cm x 0.5 cm).

Tapes have been designed either for continuous measurement and/or with cut-off points (for screening), (e.g. Lech tig, 1988). Bangles used for children in India serve the same purpose. Some tapes can be used as an individual record (e.g. WHO birthweight tape, 1987) and a prototype exists for longitudinal use through pregnancy and lactation, with or without measurement graduations (see Zerfas, 1991).

Recent tapes tend to be of the insertion type often with a window (e.g. TALC 1985; WHO, 1987).

Ratio tapes are also available (arm to head circumference; height to arm circumference (QUAC stick, Anidekar et al, 1972; Shakir, 1973); and for muscle evaluation (arm circumference minus biceps skinfold thickness).

Mid upper arm circumference was measured (as in other studies, e.g. Stephenson et al, 1983) to the nearest 0.1 cm on the left arm, half way between the tip o f the acromion

Box 2.7.5 Summary of circumference procedures before all sessions

Before all the circumference sessions

• The tape was checked to ensure it was straight and not stretched, the numbers and lines were clear and not scratched, and there were no wrinkles.

• About every month the tape was checked. This was done by measuring two solid objects three times each. The objects used were a solid cardboard tube, and a broom handle. A piece o f metal tubing could have been better but might have been more susceptible to expansion in the heat than the wood chosen.

• The procedures were explained to the mother and to the children, when they were able to understand.

1 .1,3.2 Procedures during the mid upper arm circumference sessions for adults

Box 2.7.6 Procedures during the mid upper arm circumference sessions for

adults

• All work was kept at eye level. When mothers were measured while standing on the beam balance scale, this brought their arms up almost to observer height without undue bending down.

• By convention (since 1912 in Belgium) the left arm is measured.

• The mother was asked to move her sari blouse sleeve out of the way (if loose fitting).

• The mid point of the adult’s left upper arm was calculated by first locating with finger tips the tip of the shoulder (the acromion process of the scapula). By bending the arm at the elbow and feeling for the olecranon process of the ulna the lower point was found. A measurement was then made between these joints, the halfway point calculated and then marked on the arm with a "biro" although use of a water soluble pen has been suggested (Cox, personal communications). However, no one seemed to mind having a biro mark! For quite a number of ladies a tailor had already made this measurement and it coincided exactly with the lower end of the short sleeve of the sari blouse.

For a few the sari blouse was tight fitting and longer than the midpoint. Where (as in most cases this occurred) the material was very thin and the hem came below the midpoint plus the width of the tape, i.e. the tape was not measuring a double thickness of material there was obviously little difference in measurement between bone, skin and the thin blouse. However, where there was a hem this was recorded and some time was spent then recalculating these arm measurements to correct for sari error. After extensive measurements of cloth and the research assistant’s arm in various saris, also the cook’s, even witli a hem just on the measurement point the difference in arm circumference was only 0.1 to 0.15 millimetres which was the same or

less than the expected likelihood of error, so in the end die measurements were not adjusted.

• The arm was then straightened and the tape wrapped round the arm at the marked midpoint. The tape was positioned at right angles to the longitudinal axis of the arm. The tape was flat on the skin and positioned so that the numbers could be read. There was no problem (as experienced in some studies. United Nations, 1986) with sweaty or wet arms as readings were taken in the shade or indoors and it was not excessively hot.

• The tape was pulled to get "the feel o f the arm"

• The tension of the tape was inspected to make sure it was correct. It should not be loose, the back of the tape was felt with the finger to make sure it was lying flat on that side too. It should not be too tight, there should be no "bite" (no dent) on the arm (Cox, personal communication). Steps were repeated if necessary.

Figure 2.7.5 Determining the mid-arm point

Determination o f the midpoint of the arm (half-way between the acromial process and the olecranon process). (Jelliffe 1966).