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Research Methodology

Robie -Ann Shippey 620040392 Nekiesha Thompson 620031859 Andrea Watson 620011659 Sade` Weir 620046946 Hadia Williams 620037376. Research Methodology . PICO. Population- Adult hospitalized patients with hypertension Intervention- manual sphygmomanometer

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Research Methodology

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  1. Robie-Ann Shippey 620040392 Nekiesha Thompson 620031859 Andrea Watson 620011659 Sade` Weir 620046946 Hadia Williams 620037376 Research Methodology

  2. PICO • Population- Adult hospitalized patients with hypertension • Intervention- manual sphygmomanometer • Comparison- automated device • Outcome- accuracy of reading.

  3. PICO Question In adult hospitalized patients with hypertension, does the use of manual sphygmomanometer compared to automated blood pressure machines gives a more accurate reading to evaluate the patients’ condition?

  4. Introduction A wide variety of devices can be used to measure blood pressure in the clinical setting. These include automated blood pressure devices and manual sphygmomanometer but the question still remains, which gives a more accurate reading?

  5. Procedure Preparation: • Obtain informed consent from patient • Position machines on the appropriate side of the beds • Place patient in a supine position with arms straight and legs uncrossed • Ensure cuff size is appropriate

  6. Procedure cont’d • Fit cuff to patient’s arm • Face dial away from the other nurse

  7. Procedure cont’d Standardized procedures used for each device includes the following: Mercury sphygmomanometer • Determine an estimate of the systolic pressure by inflating the cuff until the radial pulse can no longer be palpated. Inflate cuff to an additional 30mmHg and release valve at 2mmHg per second until the radial pulse reappears. This recording would be the systolic blood pressure. • Wait 3 minutes to allow circulation to return

  8. Procedure cont’d • Inflate the cuff 30mmHg higher than the systolic estimate. Deflate cuff 2mmHg per second. Using a stethoscope, record results heard on the 1st and 5th Korotkoff sounds (diastolic reading) • Record both systolic and diastolic readings

  9. Procedure cont’d Automated Blood Pressure Machine: • Plug machine into power socket • Turn on machine • Press start button to begin blood pressure measurement • Record displayed readings for the diastolic and systolic pressure

  10. Summary of Evidence According to Myers (2010), measurement of a patients blood pressure using a manual sphygmomanometer is affected by several factors. These flaws could possibly lead to misdiagnosis or even inappropriate drug therapy.

  11. Summary cont’d In a survey carried out by Ostchega et al (2012), it was observed that the systolic blood pressure reading was higher using a manual sphygmomanometer as opposed to using a automated blood pressure machine. On the other hand, the diastolic blood pressure reading was higher using the automated blood pressure machine as opposed to using the manual sphygmomanometer.

  12. Summary Cont’d “Blood pressure measurement with the auscultatory technique by a trained observer, using the mercury sphygmomanometer remains the most accurate and reliable form of indirect blood pressure measurement and is currently regarded as the ‘gold standard’. All alternative blood pressure measurement devices need to be clinically validated in clinical protocols against the current ‘gold standard’ of the mercury sphygmomanometer”. (SCENIHR, 2009)

  13. Summary Cont’d According to Heinemann et al (2008) automated machines are easier to use as it allows continuous or intermittent blood pressure monitoring, provide printouts of readings, allow pulse rate and oxygen saturation levels to be taken concurrently. On the other hand, automated machines are potential to provide false readings especially on the first reading. It is therefore important that nurses are aware that automated blood pressure machines can provide less reliable readings than those taken with a manual sphygmomanometer.

  14. Appraisal of Evidence The articles that were used to complete this research can be said to be of good quality. This is so because: • Contents of the articles are current and valid • Citations are accurately done • The articles compose of all the elements of a thorough research

  15. Appraisal of Evidence • Actual studies were carried out to support the evidence being presented

  16. Limitations Although the articles are said to be of good quality, some flaws were still noticed: • One study was too generalized and so the authors were not able to formulate a proper conclusion. • One author failed to cite some of his references accurately. • Another author presented biased literature.

  17. Conclusion After completing this PICO research, it can be seen that more evidence supports the traditional way of monitoring blood pressure. Based on the four (4) articles that were used, it is seen where three (3) articles supported the manual sphygmomanometer comparing to one (1) which supports the automated blood pressure machine.

  18. Conclusion Cont’d It can be concluded that the mercury sphygmomanometer also referred to as the goal standard remains the most accurate and reliable form of blood pressure measurement so as to better evaluate and properly monitor the condition of hypertensive patients.

  19. References • Heinemann, M., Sellick, K., Rickard, C., Reynolds, P., & Mcgrail, M. (2008). Automated versus manual blood pressure measurement: A randomized crossover trial, 296-302. Retrieved from http://web.ebscohost.com.rproxy.uwimona.edu.jm/ehost/ pdfviewer/pdfviewer?sid=6c3a98b8-56b5-418a-9e95- cba8267af4f0%40sessionmgr12&vid=4&hid=1 • Myers, M., (2010). Why automated office blood pressure devices should replace the mercury sphygmomanometer: The Journal of Clinical Hypertension, 12, 478-480. DOI: 10:1111/j.1751-7176.2010.00301.x Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1751- 7176.2010.00301.x/full

  20. References Cont’d • Ostchega, Y., Zhang, G., Sorlie, P., Hughes, P.J., Reid- Gillette, S.D., Nwankwo, T., Yoon, S. (2012). Blood pressure randomised methodology study comparing automatic oscillometric and mercury sphygmomanometer devices: National health and nutrition examination survey, 2009-2010. National health statistics reports. Retrieved from http://www.cdc.gov/nchs/data/nhsr/nhsr059.pdf • Scientific Committee on Emerging and Newly Identified Risks. (2009). Sphygmomanometers. Retrieved from http://ec.europa.eu/health/scientific_committees/opi nions_layman/sphygmomanometers/en/l-3/5.htm#0

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