The use of Non-Invasive Blood Pressure measurement devices to accurately measure irregular heart rhythms - Essay Example

Evidence Based Research: The use of Non-Invasive Blood Pressure measurement devices to accurately measure irregular heart rhythms. University Date Evidence-Based Evidence: The use of Non-Invasive Blood Pressure measurement devices to accurately measure irregular heart rhythms. Evidence based practice (EBP) has gained popularity in nursing since it provides valuable information that helps emphasize on the need for provision of health care that is efficient, safe and effective. Practices based on findings of a research are more likely to overshadow evidence from basic science, clinical knowledge and opinions from experts in producing the desired patient outcomes in different locations and settings. The impulse for evidence-based practice is fuelled by pressures from the tax payer and the healthcare facilities who strive for lesser costs, improved access to information and better understanding of treatment and care options among the clients. Rycroft-Malone et al. (2004) defined evidence-based practice as the provision of clinical practice with the aid of the best possible evidence available. Evidence-based practice promotes change in the education/learning of nursing students that encourages them to indulge more on research that is relevant to the practice and encourages a collaborative partnership with clinicians. According to Dougherty and Lister (2011), it is vital to have a wide knowledge about the different forms of evidence that relate to the daily encounters of nurses in clinical practice. The aim of the study is to investigate evidence of the difference in the accuracy of using automated and manual blood pressure measurement device on patients with irregular heartbeats in a bid to determine the better method of obtaining the readings. Methods: PICO was used as follows to establish a question deriving from this issue (Aveyard & Sharp 2011): Population Patients with Atrial Fibrillation Intervention Manual Blood Pressure measurements Comparison Automated Blood Pressure Measurements Outcome Accurate Blood Pressure readings A literature search was accomplished using electronic databases such as Science Direct and by hand searching. Key words included in the search included: Blood Pressure, measurements, accuracy and BP measurement devices. Undesired articles were filtered by limiting the search to articles published after the year 2000 to date to ensure that they were recent. The search was further limited to adult patients since the study involved only the adult patients. The search included both male and female patients since the study was not influenced by the sex of the patient as key terms. After a systematic research, a number of relevant literatures was obtained. 6 articles from the search were found to be relevant. Results: Out of the 6 articles, one article was chosen to provide an answer for the formulated question. The study is entitled, ‘Comparison of Non-invasive Blood Pressure Measurements in Patients with Atrial Fibrillation’ Vol. 23, No. 6, pp. 519Y524 published in the Journal of Cardiovascular Nursing. The study was aimed at determining the difference between the blood pressure measurements taken with an automated Dinamap 8100 machine and those taken using a manual mercury sphygmomanometer. The sampling of the nurses and adult patients in hospitals involved in the study was heterogeneous with the blood pressure measurements being obtained from patients of various ages, gender and with different ailments. AAMI criteria, BHS grades and Bland-Altman plots were used to test the hypothesis that there was no difference between the automatic and manual blood pressure measurements. With the Bland-Altman method, both measurement devices had similar readings for both diastolic and systolic blood pressures while with the AAMI criteria the readings were only similar for systolic readings. With the BHS method, there was no similarity in the results for both systolic and diastolic blood pressure readings. Thus the conclusion from the study is that the automatic blood pressure machine is preferable when assessing the systolic blood pressures of hospitalised patients with various medical and surgical conditions but in the case of diastolic blood pressure readings, more caution should be taken to avoid errors. The research focuses on the impact of using the different blood pressure measuring devices in patients with disorders of the heart rhythm. The automated non-invasive technique is generally used on hospitalised patients hence other measurement techniques were not common for hospitalised patients. According to the study, the manual non-invasive devices were utilised mainly in the outpatient departments as well as in hospitalised patients but at a lower frequency. The Critical Appraisal Process (CAP) is an approach in evidence based research that is defined as the process of carefully and systematically identifying methodological flaws in the literature and provide the researchers with an opportunity to make informed decisions about the quality of the research evidence. Useful CAP together with SWOT (strengths, weaknesses, outcomes and threats) analysis has been used to analyse this study and the chosen research article respectively. The authors of the article were Anastas, Jimerson, Garolis who are all reliable professionals from the Providence Portland Medical Centre from Portland in USA. A convenient sample of hospitalised patients with atrial fibrillation was used to conduct the study. A method-comparison design study design was used to examine the agreement between the manual and automatic BP measuring instruments. The results obtained were calculated and graphed according to the Bland-Altman method using student t tests. The level of significance of the study was set at 0.05 (Anastas et.al 2008). Strengths The research was carried out in a mixed setting in different health care institutions whereby both methods of blood pressure measurement were used on patients. This ensured the study was variable enough to promote the conformity of the results since the patients under study were randomly placed into both control and experimental groups. This reduced the possible errors since the study involved two different variables to act as guidelines. The study was void of administration technique errors since both the manual and automated BP measurement devices were operated by experienced nurses who had quality training prior to the research. Further the study involved real patients hence the results obtained were authentic and practical. Both measurement techniques were non-invasive which meant that there were no ethical issues involved in the study that would limit the reliability of the research results. The sampling methods used incorporated a number of viable results hence it avoided selection bias. The healthcare workers and nurses who participated in the study worked in both inpatient and outpatient setting as well as in acute and mild hospital settings. This further reduced the selection bias of the study. The research sites were also diversified to include healthcare institutions that had both private wards and public wards that were quiet and those that were busy and noisy. This enabled the researchers to compare results based on the patient condition, their level of stress and the stimulants around the patient. Irregular heart rhythms are associated with a combination of factors and hence cannot be determined solely by researching on a single case. A pilot study was also conducted to test the procedures for measuring blood pressure and to ensure the research design was random and to achieve a blind methodology. Both male and female adult patients of various age groups were placed randomly in each group in the study. Selecting the patients randomly without regarding their sex is preferred since it reduces bias performance and produces a more legitimate result. This ensured that the results of the study were not based on predisposed preference of care practitioners regarding gender inequalities when doing the practice. The content of the research has several strengths that helped corroborate its results. The research is an important and valuable tool for assessing and guiding health care providers to determine the most preferable BP measurement instrument to use in different clinical cases. The research uses a novel approach to assess the causes and sources of surgical site infections in the hospital environment. The research study is of immense value due to its capacity to put into consideration both all the individual sources of risk of infection as well as unique combination of risk factors that cause these infections and result in adverse conditions. The study includes both quantitative and qualitative data into the models which enables the creation of real-world experiences that can be tested using sensitivity analysis methodology. This allows the health provider using this study to maintain the scientific integrity of the tool. The authors also reviewed existing literature by other professionals to accommodate for non-conforming results that would have resorted from varying sampling methods and the frequency of the study on the patients. They used written articles that discussed the use of both automated and manual blood pressure measurement. The research was published in the Journal of Cardiovascular Nursing which is peer-reviewed by the international scientific community. The journal is dedicated to advancement of cardiovascular nursing research around the world as well as education and clinical practice fields. It is a renowned journal that offers quality research studies on a monthly basis that provide valuable information to surgeons and nursing staff in addressing work related events. Thus this allows for the easy availability of the research for both education and for other clinical researcher to perform further investigations to improve it as new information is acquired either through direct observation or by using improved study methods. Limitations The study was localized which reduced the universality of the data collected. The technique instructions were provided by the measuring instrument manufacturer which generated a bias among the nursing participants. Many nurses including those involved in the study were of the opinion that automated blood pressure devices are unreliable and this might have influenced the results of the study. The results for the automatic BP machine were considerably lower for both systolic and diastolic blood pressures especially in pre-eclamptic women, which were caused by haemodynamic changes such as intravascular volume and arterial compliance. These factors could have contributed to incorrect blood pressure readings. The Dinamap measurement device was also observed to over-read the systolic blood pressure readings and under-read the diastolic blood pressure which was observed in several other studies it was used in (Jin et.al 2001, 545-549) (Coe & Houghton, 2002, 10:9-15). Outcomes and Threats Over the years, the use of automated blood pressure measurement devices has gained popularity in hospitals and other healthcare institutions. This can be related to the fact that the method is easy to use, it allows sporadic monitoring of blood pressure, and it provides readings as printouts and is less time consuming. In some machines it can even be used to measure pulse rate and oxygen saturation levels simultaneously. However, there is a high likelihood of false readings from the automated BP measurement tools due to various factors such as patient discomfort, the need to regularly adjust the machine and also the first inflation. A research study by the A Emergency Nursing Resources Development Committee (ENA) utilised several oscillometric BP devices on different patients and found that these devices could both overestimate and underestimate the BP measurements. However, BPs were statistically different and the reported differences were not considered clinically significant since they did not exceed 10% of baseline BP (Amadasun & Isa, 2005). From the research it is evident that the manual sphygmomanometer thermometer is a better instrument than the automatic Dinamap instrument. The manual readings were more reliable and it would be important for a nurse to understand this when making a decision about which type of instrument to use when taking blood pressure measurements. For a long time nurses have had doubts about the accuracy and reliability of automated blood pressure readings and this lack of confidence in the instruments was consistent with the findings of the research study. It would be recommended to continue using the manual BP devices which are the widely used in clinical practice. From the study, the use of manual BP device is more accurate and this is important in ensuring the collection of accurate patient data. Summary and Conclusions From the study, it is evident that the importance of automated blood pressure measurement devices cannot be overlooked. However, due to its noticeable shortcomings, the use of these automatic machines can be safely limited to normotensive patients and the manual machines should be preferred when the patient has hypertension. Further, when used on female patients with pre-eclampsia the readings should be interpreted with caution. From the study, it was found that in the presence of irregular cardiac rhythms, diastolic blood pressure and heart rate the automated BP device could not be reliably used to measure the blood pressure. The conclusion of the study is that automatic blood pressure measurement instruments are not the most reliable for measurement of blood pressure and that if a nurse is unsure about the accuracy of the automated readings, the blood pressure of the patient should not be taken using the automated blood pressure instrument. Instead, the measurement should be taken manually by an experienced colleague. There is need for more research on the use of automatic blood pressure measurement to establish its accuracy for use on adult patients with various clinical conditions within the clinical setting. Further research would require thorough designs to control the many factors that would cause varying blood pressure readings as well as using a well-established criteria to determine the difference between the automatic and manual blood pressure measurement devices. References Amadasun, F. E., & Isa, J. I. (2005). A comparison of sphygmomanometric and oscillometric methods of blood pressure measurements in adult in-patients. Nigerian Journal of Clinical Practice, 8(2), 86-89. Anastas, Z. M., Jimerson, E., & Garolis, S. (2008). Comparison of Non-invasive Blood Pressure Measurements in Patients with Atrial Fibrillation. The Journal of cardiovascular nursing, 23(6), 519-524. Armstrong, J.S., 2012. Illusions in Regression Analysis. International Journal of Forecasting, 28(3), p.689. Aveyard, H. & Sharp, P. 2013. A Beginner’s Guide to Evidence-Based Practice in Health and Social Care. 2nd ed. Open University Press, Berkshire. Burrows, E.A., 2004. Critiquing Nursing Research. Journal of Advanced Nursing, 46(4), p.460. Cutcliffe, J.R. & Ward, M.F., 2007. Critiquing Nursing Research, 2nd ed., London: Quay Books Ltd. Good, P.I. & Hardin, J.W., 2012. Common Errors in Statistics, 4th ed., New Jersey: Willey. Hanneman, S.K., 2008. Design, analysis, and interpretation of method-comparison studies. AACN Advanced Critical Care, 19(2), pp.223–234. Read More