Research Methods for Nursing

Research Methods for Nursing
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Part 1
The best practice for measuring a patient’s BP is as follows: (i) Hand Hygiene: this should be consistent with the guidelines of the hospital. (ii) Positioning: seat the patient for five minutes before measuring his/her blood pressure. The patient’s legs should be uncrossed and arm needs to be supported at heart level (Heinemann et al., 2011). (iii) Blood pressure measurement machine: calibrate the BP measurement machines as recommended by the manufacturer. Measurement using an automated machine is advised if the patient has a white coat effect resulting in an increase in recordings whenever his/her blood pressure is taken. (iv) Cuff size: the available sizes include large, extra long cuff of 35cm x 46cm; large, long cuff size 27.5cm x 36.5cm; and standard cuff 12cm x 26cm which should be utilized for arms of less than 33 cm in circumference. (v) Cuff placement: cuff should be applied directly to the bare arm on the patient’s upper arm 2-3cm above the brachial artery. (vi) Stethoscope placement: stethoscope should be placed over the brachial artery – medially over the antecubital space – at the point of maximum pulsation (Nelson et al., 2008).
Part 2
PICO Question
In adult hospitalized patients with hypertension (P), does the use of manual blood pressure measurement (I) compared to automated blood pressure measurement (C) provide more accurate readings? (O)
Retrieving the evidence
A total of 15 peer-reviewed journal articles were retrieved and analyzed to help answer the PICO. These journals were obtained from scholarly online databases since these databases have high credibility in an academic context (Young, 2009). These online databases include CINHAL, MEDLINE, EBSCOHOST and PROQUEST. Regarding their recency, the journal articles obtained are all published within the last 7 years, hence they are all to a certain extent recent. The hierarchy of evidence that would be used will be dependent on the recency of the source, the type of study and the relevance of the article in helping to answer the PICO question.
The peer-reviewed journal articles are based on several types of studies including Randomized Controlled Trials, Grounded Theory, Cohort study, Correlational and well-designed control trials without randomization. The main search terms that would be used in finding information include the following: blood pressure best practice, evidence-based BP measurement, automated measurement of BP, and manual BP measurement. The key search strategies include the use of Boolean operators. The inclusion criteria – the article should peer-reviewed and from a scholarly database, not more than 7 years old, should explore manual and automated methods of BP measurement. Exclusion criteria – older than 7 years, not from a scholarly database, does not describe evidence-based BP measurement.
Examining the literature
Examining the evidence entails asking the following questions: Is the research question actually significant, and is the work important and original? Does the design of the research completely test the hypothesis? Have the instruments utilized been shown as valid and reliable? Do the outcome measures used relate unmistakably to the variables with which the research is concerned? Did the investigator adhere to ethical rules? Do the subjects represent the population to which generalizations are made? Has the investigation got to such a phase that its publication is justified and the outcomes are significant? (Young, 2009). It is important to examine evidence-based information to support clinical decision-making in order to obtain evidence that clearly refutes or supports a clinical fact (Young, 2009).
Summarizing evidence
AuthorsHierarchy of evidence ranking – type of evidence and ranking
(4-point scale)Focus of the studyKey variables studied (quantitative)Phenomena of interest (qualitative)Type of research method1Ostchega, Y., Zhang, G., Sorlie, P., Hughes J. P, Reed-Gillette, D.S., Nwankwo, T., & Yoon. S. (2012).ITo explore an alternative to mercury sphygmomanometer which has been the gold standard used for obtaining BP The accuracy of Omron BP readings with that of mercury BP device readings for BMI, ethnicity and race, -Randomized Controlled Study. 2Heinemann, M., Sellick, K., Rickard, C., Reynolds, P,. & McGrail, M (2011).ITo evaluate the reliability and accuracy of the Dinamap 8100 automated blood pressure machine against manual techniques of BP measurementSystolic and diastolic blood pressures, automated and manual measures-A randomized crossover clinical trial design was used. 3Watson, S., Wenzel, R. R., di Matteo, C., Meier, B., & Luscher, T. F. (2006).ITo compare the accuracy of a new wrist cuff oscillometric BP device with intra-arterial and mercury manometer measurements -Diastolic and systolic BP measurementsControlled Randomized study
4Myers, M. G., Godwin, M., Dawes, M et al. (2011).ITo compare the accuracy and quality of automated office BP and manual office BP using the awake ambulatory BP as gold standardWhite coat response, manual office BP, systolic BP and diastolic BP-Multi-site cluster randomized controlled trial5Nelson, M. R., Quinn, S., Bowers-Ingram, L.., Nelson, J. M., & Winzenberg, T. M. (2009).ITo evaluate oscillometric device with manual sphygmomameter for the management of BP in primary care. Blood Pressure Management, mercury sphygmomanometers-Cluster-randomized controlled trial in 24 family practices in Tasmania, Australia6Myers, M.G. (2014).IITo determine how manual sphygmomanometers can be replaced with automated BP measurement in routine clinical practice-BP readings, home BP, awake ambulatory BP, automated office blood pressureArticle review7Cedric, E., Swapnil, H., Ankur, G., Brendan, M., & Marcel, R. (2013). IITo find out whether or not automated blood pressure monitors outperform mercury? Systolic AOBP and ambulatory blood pressure measurement, MOBP, white coat effect-Retrospective review 8Skirton, H., Chamberlain, W., Lawson, C., Ryan, H., & Young, E. (2012).IITo compare the appropriateness and accuracy of oscillometric (automated) and auscultatory (manual) devices for measuring blood pressure in clinical settings.-BP readingsSystematic review. Studies were searched in CINAHL, MEDLINE and The Cochrane Library9Rogers, P., Burke, V., Stroud, P., & Puddey, I. B. (2007).ITo compare oscillometric BP measurements at the wrist with an upper-arm auscultatory mercury sphygmomanoter.-Comparisons of
oscillometric wrist
measurements (using
Boso
-mediwatch®
OR
Omron R3®) to
auscultatory
BPs. Prospective,
comparative cohort
study. 10Pavlik, V. N., Hyman, D. J., & Toronjo, C. (2006).ITo assess whether using automated oscillometric devices resulted in differences in classification of BP levels at the 140mm HG systolic and 90mm diastolic thresholds compared to readings obtained with a standard mercury sphygmomanometer-BP readings from Dinamap Plus automated device and readings from a manual column deviceCorrelational study.
The study was conducted in a clinical setting.11Ni, H., Wu, C., Prineas, R., Shea, S., Liu, K., Kronmal, R., & Bild, D. (2006). ITo compare Dinamap PRO-100 and Mercury Sphygmomanometer BP measurements in a population-based studyDinamap PRO-100 BP readings and mercury sphygmomanometer BP readingsDescriptive Randomized Controlled Trial. 12Elliot, W. J., Young, P. E., DeVivo, L., Feldstein, J., & Black, H. R. (2007).ITo compare two sphygmomanometers which may replace the traditional mercury column in the healthcare workplace. Two independent observers, SBP and DBP readings-Randomized controlled trial. 13Myers, M. G., McInnis, N. H., Fodor, G. J., & Leenen, F. H. (2007).ITo compare an automated and a manual sphygmomanometer in a Population Survey. Standard mercury device, automated BP recorder
-Randomized controlled trial14Gupta, P., Mittal L.,
Rizzo, R.A., Bikkina,
M., Debari, V.A.,
(2009).
ITo compare
oscillometric and
auscultatory
BP
measurement.
Oscillometric and
auscultatory
BP readings
-Descriptive,
comparative cohort
study.
15Nelson, D., Kennedy, B., Regnerus, C., & Schweinle, A. (2008).ITo compare automated
oscillometric BP
measurements of both
wrist and arm to
auscultatory
BP
measurements.
Comparison of BPs with
cuff pla
cement at wrist
and upper arm using
oscillometric devices
to
auscultatory
BP measurements. Same
arm was used; 5 minutes
between measurements. -Descriptive,
comparative study.

Synthesizing evidence
The majority of the sources obtained support the use of manual blood pressure measurement with the use of auscultatory devices such as manual mercury sphygmomanometer compared to the use of automated device such as oscillometric device. In essence, automated devices yield systematically biased blood pressure readings (Myers et al., 2007; Nelson et al., 2008). This may change the evaluation of the prevalence of hypertension as well as control within clinical populations. In the study by Heinemann et al. (2011), the key findings and conclusions were that the automated BP measurement device Dinamap gives readings that are considerably lower for DBP and SBP than those taken manually. The manual method gives more accurate BP readings. The strength of the findings is that they are relevant to answering the PICO question and, and provide a better understanding of both automated and manual methods of BP measurement, including their accuracy and quality in obtaining BP measurements. The other strengths of the study is that it was carried out in a primary care setting, the methodology used is generally good, the intervention could be feasibly utilized within the primary care setting, and there was no bias or conflict of interest. The best practice recommendations is that nurses should use manual blood pressure measurement as the gold standard because of its proven quality and accuracy in BP measurement (Heinemann et al., 2011; Rogers et al., 2007; Ostchega et al., 2012). However, there is gap in knowledge on how the gold standard manual method of measuring BP could be improved to reduce the chances of getting false readings.
Nelson et al., (2009) in their study concluded that manual mercury sphygmomameter machine provides consistently more accurate BP readings relative to oscillometric device in the management of BP in primary care. The best practice recommendations from their study is that manual devices, particularly the mercury sphygmomanometer should be utilized in clinical care settings since they are more accurate than automated devices such as dinamap (Nelson et al., 2009). There is gap in literature regarding how the increase in BP associated with the traditional manual office measurement can be eradicated. The strengths of the findings from this study is that it has demonstrated how the mercury sphygmomanometer manual method can be used effectively in to manage blood pressure in clinical care settings.
Part 3
The qualitative study
Rogers, P., Burke, V., Stroud, P., & Puddey, I. B. (2007). Comparison of Oscillometric Blood Pressure Measurements at the Wrist with an Upper-arm Auscultatory Mercury Sphygmomanometer. Journal of Clinical Exp Pharmacol Physiol; 26(5-6):477-81
The aim of the research was to compare oscillometric BP measurements at the wrist with an upper-arm auscultatory mercury sphygmomanoter. A total of 80 participants took part. The Boso-Mediwatch was applied to the left wrist by an observer in 40 subjects who were normotensive and another 40 treated hypertensive subjects. Another observer then compared it with mercury sphygmomaometry of the right upper arm. BP r...