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Research Proposal

The Importance of Accurate Manual


Blood Pressure Measurement
Among Registered Nurses in Private
Hospital
Chan Lang Sheon
Cohort 3B (Semester 4)
BSC(HONS) In Nursing (Post.Registration)
Lincoln University College, Malaysia
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Background of The Study (put some data or
references)

paramount importance skills for all


registered nurses in healthcare
the basic clinical procedure and the most
commonly performed medical test
its providing information that is used for
many purposes, including determining
whether a patient is at increased risk for
developing vascular disease because of
elevated blood pressure
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Aim of Study

to assess the knowledge and skills of


accurate measurement in manual blood
pressure among registered nurses in
healthcare setting.

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Problem Statement
Inaccuracy of blood pressure measurement could
lead to a patient being;

falsely classified as hypertensive


falsely classified as having high normal or
normal blood pressure as well as lead to faulty
clinical decisions regarding patient progression
Put references/data

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Problem Statement
Numerous factors can affect the accuracy of
measurement
inappropriately sized cuff,

failure to allow a rest period before measurement

deflating the cuff too fast

not measuring in both arms

failure to palpate maximal systolic pressure before


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auscultation.
General Objective of Study

To identifying the Importance of Accurate Manual


Blood Pressure Measurement Among Registered
Nurses in Private Hospital

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Specific Objectives

I. To identify the level of knowledge among nurses on the important


of accuracy in measuring blood pressure.

II. to identify the nurses technical skill in measuring blood pressure

using a sphygmomanometer and auscultation,

III. To identify the factors that causing inaccuracy measurement of

manual blood pressure.

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Research Questions
I. What are the nurses knowledge according to
guideline in manual measurement of blood pressure
technique?

II. What is the factor that causing inaccuracy of manual


blood pressure measurement?

III. What is the relationship between nurses knowledge


and their skill of blood pressure measurement
technique affect the accuracy in manual blood
8 pressure measurement?
Hypothesis
In order to answer the research questions,
the study set out to test the following
hypothesis:

H1: There is relationship between


knowledge and skill in measurement of
manual blood pressure.
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Any defect in independent variable (nurses knowledge,
skill and technique) will effect the (dependent variable)
result of the manual measurement of blood pressure.

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Research Conceptual Frame work

Knowledge, Accurate Blood


Skill and Pressure
Technique Measurement

-Age
-Gender
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Justification and Significance of
Study
Standardizing blood pressure measurement and
techniques is important for registered nurses to improve the
accuracy of blood pressure measurement.

To minimize measurement errors;

a. the knowledge of equipment

b. patient variability

c. operator variability on knowledge of manual

12 blood pressure measurement


Scope and Limitation

small scale study will only focus on registered


nurses in one of the 600s in private healthcare setting
who practicing manual blood pressure measurement
in each department
need for larger sample size over longer period of
time, need more accurate estimation of medical staffs
knowledge and proper techniques skills of manual
blood pressure
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Review of Literature

knowledge of blood pressure measurement is


still poorly understood in both the medical and
nursing professions (Torrance & Sergison, 1996;
Pickering et al., 2005).
Evidence has increasingly demonstrated that
inaccurate measurement techniques often lead
to the misclassification of large numbers of
individuals as hypertensive (Pickering et al.,
2005).
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Review of Literature

Rithalia.S., et al. (2000) stated that indirect


measurement is often called as non-invasive
blood pressure measurement.
Auscultatory method uses sphygmomanometer,
a cuff and a stethoscope.
Nurses are responsible for the monitoring and
assessment of blood pressure (BP) in the
clinical setting, and accurate measurement of
blood pressure is considered paramount in the
management of cardiovascular risks
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Review of Literature

to obtain a reliable and accuracy blood pressure


measurement value among registered nurses on
patients, there was several methodological
requirements have to satisfy;
(1) Device (sphygmomanometer) testing and
calibrated;
(2) Correct selection of cuff size;
(3) Correct positioning of the patients arm;

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Review of Literature

(4) Positioning of the patient;


(5) Rounding off to the nearest number;
(6) Proper seating of the patient;
(7) Avoiding the auscultatory gap;
(8) Utilization of the bell of the stethoscope;
(9) Korotkoff phase V sounds.

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Review of Literature
According to the British Hypertension Society (2006), the most
common causes for error in blood pressure measurement may
be attributed to:

Defective equipment such as leaking tubing or a damaged


valve

Failure to ensure the mercury column reads 0 mmHg at rest

Too speedy deflation of the cuff

Use of an incorrectly sized cuff: if the cuff is too small the BP


will be overestimated and if it is too large, the BP will be
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underestimated
If the cuff is not at the same level as the heart

Failure to observe the mercury level accurately the top


of the mercury column should be at eye level 19

Poor technique for example, failing to note when the


sound disappears

Digit preference, rounding the reading up to the nearest


5 or 10 mmHg

Observer bias for example, expecting a young patients


blood pressure to be between normal limits.
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Review of Literature
The ESH (2013) describes correct blood pressure
measurement as follows:

Let the patient sit for several minutes in a quiet room


before attempting the blood pressure measurements.

Take at least two measurements, spaced by 1-2 minutes,


and additional measurements if the two are noticeably
different. Use a standard bladder (12 13 cm long and 35
cm wide) but have a larger and a smaller bladder
available for obese and thin patients, respectively.
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The cuff should be at heart level, whatever the position
of the patient. Use phase I and V of the Korotkoff sounds
to identify systolic and diastolic blood pressures,
respectively.

Measure the heart rate by pulse palpation (at least 30


seconds) after the second measurement in the sitting
position

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Model on accuracy of manual measurement of
blood pressure

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Methodology
1. Study Type observational Study
2. Study design - a quantitative, descriptive design with an
observational checklist and survey method

2. Setting : ward?? Unit?? which Sunway Medical Center.

3. Target Population overall nurses in your study area??


approximately 80 registered nurses.

4. Study Population how to calculate sample size??


target sample size will be trained registered nurses from Nursing
Division and Allied Health Division

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Methodology

5. Sampling Method data will be gathered


through primary data

6. Inclusion Criteria will be registered nurses


from Nursing Division and Allied Health Division

7. Exclusion non-medical staffs which


categories as administration and support service.

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Methodology

8. Instruments
In first category - skills of blood pressure
measurement using a sphygmomanometer were
determine by means of an observation checklist
based on the guidelines from the European Society
of Hypertension
In second category - determined nurses knowledge
of blood pressure measurement technique by using
a standardized set of questions based on the
guidelines from the European Society of
Hypertension

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Methodology

9. Data collection process


Written permission from LUC, Institutional Review
Board.
The participants that randomly involve will be
screens by using self-report questionnaires before
taking manual blood pressure measurement
self-administration survey questionnaire will be
distributed by hand to registered nurses within the
inclusion criteria and will be giving a time frame of
26approximately 20 minutes to complete the survey
Methodology

Ethical Consideration
Provide a letter to each respondent to obtain informed
consent.
All information will be strictly confidential, no third parties
discloser.

Data analysis
Using SPSS software version 21
Frequency and percentage for demography data,
Knowledge and skill
Chi-Square Test for relationship between knowledge and
27 skill
Methodology

Estimated time for this study 2 months

Result is essential to classify individuals, to


ascertain blood pressure related risk and to guide
management decision as inaccuracy of measurement
may lead to over-or-under treatment of the patients
condition which resulting in adverse outcomes.
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Conclusion
the use of manual blood pressure measurement
using mercury sphygmomanometer is still pertinent
given its status as a gold standard of blood pressure
measurement

findings from the study by using descriptive study


design and data formulate using SPSS software
version 21 and will be able to give an evidence of
accurately measure manual blood pressure among
registered nurses in the healthcare setting when
assessing the blood pressure measurement and
accuracy skills
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Conclusion

clinical protocols and guidelines may require to


differentiate when manual recording of blood
pressures maybe more appropriate and more study
is needed to establish how frequently trained
registered nurses needs to record blood pressures
manually to avoid skill decay.

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Questionnaire??????

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Gantt Chart????

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References

Agarwal R, Andersen MJ. (2006).Prognostic importance of clinic and home


blood pressure recordings in patients with chronic kidney disease. Kidney Int;
69:406411.

Australian Heart Foundation Guide to Management of Hypertension 2008.


Retrieved from: http://www.heartfoundation.org.au/SiteCollectionDo
cuments/HypertensionGuidelines2008to2010Update.pdf

Bailey R.H., Bauer J.H. (1993).A review of common errors in the indirect
measurement of blood pressure (sphygmomanometry). Arch Intern Med.;
153: 2741-2748

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References
Christopher J., Astrid,.zf.,Jacqueline G.B. (2015). Nursing Students Blood
Pressure Measurement Accuracy During Clinical Practice. Journal of Nursing
Education and Practice. 5(5).46-54.

Dickson BK, Hajjar I. (2007).Blood pressure measurement education and


evaluation program improves measurement accuracy in communitybased
nurses: a pilot study. Journal of the American Academy of Nurse
Practitioners,;19:93-102.

Eser, I., Khorshid, L., Yapucu, G.U., & Demir, Y. (2007). The effect of
different body positions on blood pressure. Journal of Clinical Nursing, 16(1),
137-140.

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References
ESH (European Society of Hypertension). (2008).Guidelines for blood
pressure monitoring at home: a summary report of the Second International
Consensus Conference on Home Blood Pressure Monitoring. Journal of
Hypertension; 26:1505-1530. Lippincott Williams and Wilkens.

Gonzlez-Lpez JJ, Ramirez JG, Garcia RT, Esteban SA, Barrio JA,
Rodriguez-Artalefo F. (2008).Knowledge of Correct Blood Pressure
Measurement procedures among medical and nursing students. Revista
Espaola de Cardiologa.; 62(5):568-71.

Joel,H.,(2009). The Importance of Accurate Blood Pressure Measurement.


The Permanente Journal.13(3).51-54.

John J. Cienki, MD, Lawrence A. DeLuca, EdD, Natalie Daniel, BA.


(2003).The Validity of Emergency Department Triage Blood Pressure

35 Measurements. Retrieved from: http://dx.doi:10.1197/j.aem.2003.10.021


References

John.U., Guy.T., Yvonne.,H.,(2015). Man versus Machine: The Importance of Manual

Blood Pressure Measurement Skills Amongst Registered Nurses. Journal of Hospital


Administration. 4(6).61-67.

Jones DW, Appel LJ, Sheps SG, Roccella EJ, Lenfant C. (2003).Measuring blood
pressure accurately. JAMA: The Journal of the American Medical Association.
289(8):1027. Retrieved from: http://dx.doi.org/10.1001/jama.289.8.1027

Jones DW, Appel LJ, Sheps SG, Roccella EJ, Lenfant C. (2003).Measuring blood
pressure accurately: new and persistent challenges. JAMA.9(8):102730. [PubMed]

Little P, Barnett J, Barnsley L, Marjoram, J, Fitzgerald-Barron A, Mant, D.


(2002).Comparison of acceptability of and preferences for different methods of measuring
blood pressure in primary care. British Medical Journal.325: 258-259.

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References
Magdy A. D.,(2013). Human Phenomena: Blood Pressure and Hypertension, Clinical
Challenges and Dilemmas beyond Current Guidelines. Life Science Journal. 10(2):1072-
1082. Retrieved from: http://www.lifesciencesite.com

Mion D,.P. (1998).How accurate are sphygmomanometers? J Hum


Hypertens.12(4):245-8. PMID: 9607693.

Neufeld PD, Johnson DL. (1986).Observer error in blood pressure measurement.


CMAJ: Canadian Medical Association Journal..135(6):633.

Perloff D, Grim C, Flack J, et al. (1993).Human Blood Pressure Determination by


Sphygmomanometry. Dallas, Tex: American Heart Association.

Pickering TG, Hall JE, Appel LJ, et al. (2005).Recommendation for Blood Pressure
Measurement in Humans: An AHA Scientific Statement for the Council on High Blood
Pressure Research, Professional and Public Education Subcommittee. The Journal of
Clinical Hypertension. 7(2):102-109.
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References
Seventh report (2004) of the Joint National Committee on prevention, detection,
evaluation, and treatment of high blood pressure: U.S. Department of Health and Human
Services. Retrieved from: http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf.

Wallymahmed, M. (2008). Blood pressure measurement. Nurs Stand. 22: 45-48.


PMid:18274413 Retrieved from: http://dx.doi.org/10.7748/ns2008.01.22.19.45.c6314

Watson D.(2006). The impact of accurate patient assessment on quality ofcare.


Nursing Times.102(6): 32-37.

Williams B, Poulter N, Brown M, Davis M, McInnes G, Potter J, et al. (2004).Guidelines


for management of hypertension: report of the fourth working party of the British
Hypertension Society, 2004 - BHS IV. Journal of Human Hypertension..18(3):139-85.
Retrieved from: http://dx.doi.org/10.1038/sj.jhh.1001683

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