In the previous evidence based case study, I presented the major problem and the question which I identified to have required attention within the EBP practice. In the case study in Titler (2010), Emily( a nurse) wanted to use the oscillometric approach to obtain a child’s calf blood pressure, instead of using the more safe and accurate method (auscultation) as advised by the doctor in the case. Briefly, oscillometric method and auscultation are both professional means of obtaining a patient’s blood pressure. However, auscultation is favored by the latest evidence based health care practitioners, especially when applied to the children and people of ages above 65 years (Long et al, 2010). Among some of the reasons that make oscillometric method unpopular among the medical practitioners in obtaining BP measurements include the fact that sometimes the oscillometric curves become difficult for one to accurately read them (Crabtree et al, 2016). Secondly, oscillometry is usually too sensitive to any movements as a result of signal bandwidth and therefore a patient’s arm must be remain immobile, a requirement that may not always be practical especially when dealing with children, like in the case above. Further in oscillometry systolic and diastolic Blood Pressure accuracy in patients relies on the algorithm that a nurse might have chosen to use.
On the other hand, the doctor advised for auscultation, which has its own major advantages over oscillometry. Among the advantages of auscultation approach is that the blood pressure measures it gives is similar with the patient’s actual clinical blood pressure. In this case, if Emily could use auscultation to take the child’s calf blood pressure, the reading could be similar to the actual clinical body blood pressure (Titler, 2014). Further, because auscultation is based Korotkoff sound detections, it helps in accurate detection of both systolic and diastolic patient’s pressure as the sounds appear and disappear. In this presentation therefore, I will indicate how I located the evidence and appraised it, including the recommendations for handling the case, described here in.
The first way through which I obtained the evidence that auscultation is more appropriate than oscillometry in taking children’s blood pressure, including the procedures involved, was the mass media and the internet. The main websites dedicated to medical practice that have similar information include MEDLINE, CINAHL and PubMed among others (McCabe, 2006). These websites have been instrumental not only to online health care seekers but also to health practitioners in the field. I also obtained the evidence through mass media messages through special articles in newspapers, medical magazines and journals, and television channels dedicated to pediatric health. These mass media approaches according to DePalma (2010), have always targeted health care consumer groups and thus effective on influencing decision making in health care choices for targeted group and/or individual behavior.
Secondly, I obtained this evidence on the need to choose auscultation over oscillometry in taking a child’s calf BP through interaction with nurses among other medical practitioners. Just like Emily in the case provided in the previous study, I obtained this opinion from a medical doctor. This means that interactive inter-professional education and expert opinion from opinion leaders are crucial tools in obtaining evidence in evidence-based health care practice (Hamaideh, 2016). It is renowned that opinion leaders including senior medical officers play a big role in boosting evidence based health care approaches. They are much respected and yet influential due their competence, experience in the service and the fact that they are trusted in assessing new information, to give a better direction.
Further, I obtained the evidence of auscultation for BP measurement in children from my peers and professional social interaction forums among nursing students and registered nurses while on internship. It is clear that most nurses prefer obtaining information from peers (Fedorova et al, 2016). Core group conjunctions among nursing students and the use of change champions are among the procedures through which I have been able to obtain such evidence for EBP. Core groups include health care practitioners that focus on the dissemination of such information and ensuring adequate facilitation of the necessary changes by staff members in a given health microsystem. As a nursing intern, I learnt this procedure from core group members who represented various duty shifts and week days with an intention to always impart evidence-based health care information and influencing a change in practice among peers.
I saw the need to choose auscultation over oscillometry in obtaining a child’s calf blood pressure because of different reasons. The first reason as to why I appraised this approach is that auscultation is more effective in obtaining a child’s calf blood pressure (Sanders et al, 2010). This is because it provides accurate measures that are similar to one’s clinical BP measure. In this regard, the child could not be given wrong medication when the right blood pressure could be obtained. Secondly, the evidence is compatible with the values and societal norms, which include the need for ethical practice among health professionals (Cullen, & Titler, 2004). While the child has a right to quality health care, there was need to provide the same. Quality health care involves accuracy and the use of the most effective ways to treat conditions. Auscultation according (Pfeiffer et al, 2011) will help the child be treated appropriately and given the right amounts of dosages including necessary referrals, as it will give accurate BP, to influence right decisions.
Another reason to appraise and choose on Auscultation as the best EBP procedure in taking a child’s calf BP is that it makes work easier for health practitioner like Emily, in the case study. For most nurses according to research oscillometric curves become difficult for one to accurately read them. Oscillometry is also too sensitive to any movements as a result of signal bandwidth and therefore a patient’s arm must be remain immobile, a requirement that may not always be practical especially when dealing with children, like in the case above(Titler et al 2016). Further in oscillometry systolic and diastolic Blood Pressure accuracy in patients relies on the, that a nurse might have chosen to use. Therefore, I chose on auscultation it helps make the work easier for nurses while ensuring that accuracy is maintained throughout the provision of health care.
In summary, auscultation is the most preferred method in obtaining blood pressure not only among children but among adults like those beyond 65 years of age. Apparently the procedure features in every evidence based practice platform in regard to obtaining blood pressure, as it is not only effective, accurate and suitable for both the health practitioners and patient needs (Titler and Moore, 2010). One recommendation is that EBP should adopt auscultation as it gives BP measures that are similar with the patient’s actual clinical blood pressure. Accuracy is paramount in health care and blood pressure determines the classification of individuals as to whether they might be hypertensive or not. Blood pressure may also determine the type of medicine to give to a child, and the procedures to follow (Archer-Kuhn, Bouchard & Greco, 2014). In case wrong BP measures are provided for children especially by use of oscillometric methods, then it is likely that in accurate medication may be offered. Therefore, there is need for auscultation as an effective and safe evidence-based approach.
Further as a recommendation, auscultation is the best approach in obtaining a child’s calf blood pressure as it addresses the needs of both the health practitioner and those of the patient. Children’s universal rights include the right to proper and quality medication. Similarly, medical practitioners are bound to their ethical values that call for quality service to their patients and the communities they serve (DeMont, 2015). Therefore, evidence based practice provides an opportunity for the patients to receive quality care and the same time, efficiency and effectiveness in the delivery of health services by medical practitioners (Zeleníková et al 2014). There is thus a need for health care institutions in conjunction with governments, to encourage the development of EBP. This can be through financial support to institutions according to Wilson et al (2015), to fund health information systems, train experts to take up the roles of opinion leaders, core group directors and peer influencers in promoting evidence based approaches.
This report includes a review of the problem and question in the case study in Titler (2010) where Emily (nurse) was advised by the doctor to use auscultation rather than oscillometry in taking a child’s calf BP. The report shows how I obtained the evidence on the need for auscultation and how I appraised this practice so that I choose it over the oscillometry. Among the reasons include the fact that it is accurate, effective and convenient for both the health practitioners and the patients, especially children. The report also includes the recommendations as to why there is need to adopt this evidence, including a summary of the details here in. It is evident that evidence based practice in healthcare is an emerging component in health care and thus requires special structures to thrive and boost healthcare delivery world over.
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