• First clinical competencies nurses acquire
• Important to understand the differences and benefits every BP taking
• To know the right way of putting the cuff
• To find out whether if it will affect the accuracy of the reading
  

During the planning, we came with out questions to make us understand more about our Topic. Slowly we answer our questions, and understand the Topic deeper.

Here are the questions and answers…

Why we choose manual BP set?

• Because we are student Nurses! We must use the manual way!

Why we need to check for accuracy?

• For non hypertensive: To detect any abnormalities
• For hypertensive: To prescribe medication precisely

Why we need the manual of the BP set?

• Because different brands have the different manual.

What influence our outcome?

• The extraneous variable.

Why we need to check the BP set?

• To check for any faulty.

Why we should use different types of cuff?

• To select the appropriate cuff width.

After hours of sourcing for journals, articles and other literatures, finally we found one in the internet.

Here is the summary of the literature…
“Sphygmomanometers have been the most popular devices for measuring blood pressures and are dependent on one common feature – occluding the artery of an extremity (arm, wrist, finger, or leg) with an inflatable cuff. Blood pressure measuring depends on cuff occlusion of the arm (as are the majority of devices), it will then be prone to the inaccuracy induced by miscuffing, whereby a cuff containing a bladder that is either too long or too short relative to arm circumference is used.”

Here's the start of our journey!

Phase 1: PlanningObjective of the project

Purpose of study

• Apply what we have learnt in statistics
• To find out whether different placement of the cuff will affect the BP reading.

Null hypothesis

• There is no relationship between the BP reading and the different placement of the cuff

Research Hypothesis

• There is a relationship between BP reading and the different placement of the cuff.

Independent variables

• The different placement of the cuff

Dependent variables

• BP readings

Extraneous variables

• Emotion
• Age
• Gender
• Overweight/obese
• Activity before BP taking
• Intake before BP taking
• Medical history
• Equipment
• Environment
• Position of the hand
• Time interval for 1st and 2nd BP reading
• Using of right or left hand
• Position of the cuff
• Position of the BP set
• Social lifestyle
• Full bladder

Operationalization

• Independent:Placement of the cuff
• Dependent: - Blood pressure: mmHg

- Mercurial Sphygmomanometer Stethoscope

Phase 2: PlanningObjective of the project

• Population: NYP SHS Nursing Student Year 2
• Age : 17-25
• Gender: Male & Female
• No. of population: 30
• In NYP library

And this is how our sampling goes and also why we choose this way…

• Probability
  - Simple random Sampling
  - Why??
  - Not bias
  - Calculable
  - Non-zero probability
  - It offers representativeness with sufficient sample size
  - We pick certain numbers from sample frame (age group)

To have a standard measurement, we decide on having a standard procedure…

Measuring Instrument

• BP measurement
• Stethoscope
• Size of the cuff
• Non-elastic measuring tape
• Simple mercury sphygmomanometer

• Abstain from eating or drinking, smoking and taking drugs that can affect BP 1 hour before measurement.
• Bladder should be emptied.
• Subject should be sitting at a comfortable position.
• Subject should be sitting quietly for about 2 minutes

Position of subject

• Sitting position
• Sitting upright
• Feet should be touching the floor flat, not dangling
• Legs apart parallel to shoulders
• Hand should be resting on the desk, is at the level of the heart and palm is facing up
• Should be always feel comfortable

Number of measurements

• Two measurements should be taken one minute apart

1. Place manometer at eye level, subject should not be able to see the column of the manometer
2. Obtain estimated systolic pressure
   - Palpate the radial artery pulse.
   - Inflate the cuff to the point where the pulse can no longer be felt.
   - Slowly deflate the cuff, noting on the gauge the point where the pulse reappears/can again be felt. This is the estimated systolic pressure.
3. Rapidly deflate the cuff
4. Wait at least 15-30 seconds before re-inflating the cuff to begin the first auscultator measurement.
5. Calculate the maximum inflation level by adding 30 mm Hg to the estimated systolic pressure
6. Located the diaphragm of the stethoscope at the brachial pulse below the cuff
7. Inflate the cuff as rapidly as possible to maximum inflation level
8. Deflate the cuff slowly and consistently at the rate of 2 mm per pulse beat
9. Note where the first sharp rhythmic sound appears in relation to the number or markings on the gauge, this is the systolic pressure
10. Continue to deflate, note on the gauge where the last sound is heard, this is the diastolic pressure
11. Record measurements to the nearest 2mmHg
12. After one minute of wait to allow redistribution of blood in the forearm a second
    measurement is made by repeating steps 2 to 11.

Feasibility and Ethics

• Confidentiality - No disclosure of patient's information
• Informed Consent - They are mature to make the decision and we have explain what we are doing on.
  

Phase 3: Data Collection

Roles: Each person do to on 6 subject = 30 subject