Searching for the “sacred cow”: a conceptual analysis of the term in nursing literature

Purpose

The idiom “sacred cow” is problematic due to its inaccuracy and cultural insensitivity. The purpose of this paper is to examine the term’s meaning within the nursing literature, describe connotations in religious contexts, explore subject headings applied to research using the phrase, and discuss alternative terminology.

Design/methodology/approach

This paper employs Rodgers’ evolutionary concept analysis methodology to identify the concept “sacred cow” and surrogate terms, collect and analyze sample articles and headings, explore an exemplary case, and look for concept implications.

Findings

The term “sacred cow” appears frequently in the healthcare literature, particularly within the nursing literature. Its meaning within this literature pertains primarily to practices not supported by empirical evidence and performed to maintain a status quo. Headings applied to the relevant literature do not describe this concept, and more accurate headings could not be found within widely used controlled vocabularies.

Research limitations/implications

“Sacred cow” is an inaccurate descriptor for practices not supported by evidence as these practices do not usually apply to holiness or cattle. The term’s implied meaning comes only when viewed within a context satirizing beliefs considered as “other.”

Originality/value

This paper appears to be the first to methodically explore the concept of “sacred cow” within the nursing literature. The paper breaks ground in proposing solutions for the lack of applicable controlled vocabulary. By exploring these topics, it is hoped future authors use more accurate, culturally neutral terminology when discussing non-evidence-based practices and indexers increase discoverability by using more descriptive headings.

Preferential effects of low volume versus high volume replacement with crystalloid fluid in a hemorrhagic shock model in pigs

Background

Fluid resuscitation is a core stone of hemorrhagic shock therapy, and crystalloid fluids seem to be associated with lower mortality compared to colloids. However, as redistribution starts within minutes, it has been suggested to replace blood loss with a minimum of a three-fold amount of crystalloids. The hypothesis was that in comparison to high volume (HV), a lower crystalloid volume (LV) achieves a favorable coagulation profile and exerts sufficient haemodynamics in the acute phase of resuscitation.

Methods

In 24 anaesthetized pigs, controlled arterial blood loss of 50 % of the estimated blood volume was either (n = 12) replaced with a LV (one-fold) or a HV (three-fold) volume of a balanced, acetated crystalloid solution at room temperature. Hemodynamic parameters, dilution effects and coagulation profile by standard coagulation tests and thromboelastometry at baseline and after resuscitation were determined in both groups.

Results

LV resuscitation increased MAP significantly less compared to the HV, 61 ± 7 vs. 82 ± 14 mmHg (p < 0.001) respectively, with no difference between lactate and base excess between groups. Haematocrit after fluid replacement was 0.20 vs. 0.16 (LV vs. HV, p < 0.001), suggesting a grade of blood dilution of 32 vs. 42 % (p < 0.001) compared to baseline values. Compared to LV, HV resulted in decreased core temperature (37.5 ± 0.2 vs. 36.0 ± 0.6 °C, p < 0.001), lower platelet count (318 ± 77 vs. 231 ± 53 K/μL, p < 0.01) and lower plasma fibrinogen levels (205 ± 19 vs. 168 ± 24 mg/dL, p < 0.001). Thromboelastometric measurements showed a significant impairment on viscoelastic clot properties following HV group. While prothrombin time index decreased significantly more in the HV group, activated partial thromboplastin time did not differ between both groups. HV did not result in hyperchloraemic acidosis.

Discussion

Coagulation parameters represented by plasma fibrinogen and ROTEM parameters were also less impaired with LV. With regrad to hematocrit, 60 % of LV remained intracascular , while in HV only 30 % remained in circulation within the first hour of administration. In the acute setting of 50 % controlled blood loss, a one fold LV crystalloid replacement strategy is sufficient to adequately raise blood pressure up to a mean arterial pressure >50 mm Hg. The concept of damage control resuscitation (DCR) with permissive hypotension may be better met by using LV as compared to a three fold HV resuscitation strategy.

Conclusion

High volume administration of an acetated balanced crystalloid does not lead to hyperchloraemic acidosis, but may negatively influence clinical parameters, such as higher blood pressure, lower body temperature and impaired coagulation parameters, which could potentially increase bleeding after trauma. Replacement of acute blood loss with just an equal amount of an acetated balanced crystalloid appears to be the preferential treatment strategy in the acute phase after controlled bleeding.