Ways of Measuring Blood Pressure Accurately

Introduction

Accurate measurement of blood pressure is critical for making appropriate clinical decisions in the management of high blood pressure in order to reduce cardiovascular risk and prevent organ damage. This is important because an inaccurate measurement of blood pressure could lead to a patient being falsely classified as hypertensive or falsely classified as having high normal or normal blood pressure. It could also lead to faulty clinical decisions regarding patient progression in an exercise program (White et al., 2013). This topic is one that is worth examining because blood pressure reading is one of the most inaccurately performed measurements in clinical medicine (White et al., 2013). Efforts are ongoing to increase hypertension awareness, treatment, and control among adults, but the high prevalence of undiagnosed (22%) and uncontrolled (36%) hypertension remains a challenge (White et al, 2013). For that reason, this DNP aims to address that issue.

An assessment of literature regarding education of nurses on how to properly measure blood pressure serves as the focus of this DNP: the review will impact social change because it aims at enhancing nurses’ knowledge and awareness concerning blood pressure among a specific population that exists exclusively of veterans—the target demographic of this DNP. This project supports the mission of Walden University to promote positive social change because teaching nurses to accurately measure blood pressure can help to improve the health outcomes of veterans by enhancing hypertension management. By improving nurse’ knowledge and skills regarding how to measure blood pressure, nurses can perform more accurate diagnoses and make appropriate treatment decisions more enhanced (Badeli & Assadi, 2014; Fallon, 2015). If the project proves to be effective, recommendations can be made for other veterans’ centers to include the education program as part of a quality improvement strategy. Therefore, this project is consistent with Walden University mission of promoting positive social change in practice.

Problem Statement

Local Nursing Practice Problem

Reading blood pressure accurately is one of the most fundamental types of care that a nurse can provide (Myers, 2014). Blood pressure tells so much about the patient’s condition; and so many approaches to care, intervention and treatment are based on the initial blood pressure reading. In other words, inaccurate readings can impact how a patient is perceived, diagnosed and treated. It is essential that nurses be able to provide blood pressure readings accurately, especially for veterans who are a vulnerable population and need quality care from nurses. The problem is, however, that a significant number of nurses are failing to read blood pressure accurately (White et al., 2013).

I currently work as a Patient Aligned Care Team Coordinator (PACT) at a veteran administration primary care clinic in the Northeastern United States. The primary care clinic provides patients with services, including regular annual checkups, blood work, and blood pressure checks/monitoring. As the wars in Iraq and Afghanistan come to end, and the large U.S. army is dissembled, more veterans will need high-quality care as they seek to transition to civilian life (Copper et al., 2016). However, healthcare providers serving the population have less knowledge on the health needs of the population in addition to inadequate knowledge on how to measure blood pressure accurately (Creswell, 2014). Copper et al. (2016) explained that the inadequacy of knowledge about the health needs of veterans prompted the American Academy of Nursing (AAM) to initiate the Have you ever served in the military initiative. The program deals with raising awareness to reinforce the dire need of educating nurses delivering healthcare services to the patients about the unique and specific health conditions of the patient so that appropriate care can be provided.

Relevance

Hypertension is the most common primary diagnosis in the United States. It is a major risk factor for coronary heart disease, stroke, and renal failure, and affects 29% of the adult US population (Ukpabi & Ewelike, 2017). 22% of persons who have hypertension are unaware that they have it (Ukpabi & Ewelike, 2017). Data on hypertension among veterans indicate that 30% of the population has high blood pressure with 17% of the soldiers developing hypertension while in service (Gillespie, Hurvitz, & Centers for Disease Control & Prevention [CDC], 2013). Hypertension is associated with conditions such as cardiovascular diseases, stroke, and ischemic heart disease which reduce the quality of life of the individuals. The Center for Disease Control and Prevention Center (CDC) indicates that 30% of hypertensive patients develop stroke and other cardiovascular complications, indicating the need for effective screening and management strategies (Gillespie et al., 2013).

Incorrect readings can result in misdiagnosis and inappropriate treatment decisions which may have adverse effects on the health and well-being of patients, including veterans (Badeli & Assadi, 2014; Fallon, 2015; Schonberger et al., 2015). Cooper et al. (2016) noted that nurses providing healthcare services, such as measuring blood pressure, lack comprehensive education programs to support their knowledge and enhance their skills. Considering that approximately 44% of the veteran population seeks medical attention at the Veterans Affairs centers in the US, these nurses need to possess the knowledge and skills required for assessing veterans for high blood pressure so that correct screening can be conducted and appropriate treatment recommended (Nathaniel & Hardman, 2017).

Significance to Nursing

Copper et al. (2016) showed that an educational program specifically for patient care in primary care settings and other civilian hospitals could increase nurses’ knowledge on what constitutes appropriate blood pressure measurements, control, and hypertension self-management practices. With nurses being knowledgeable on the needs of their patients, and the circumstances under which hypertension developed, they can design appropriate hypertension control and management strategies, thereby reducing the high risk of mortality and morbidity associated with hypertension (Badeli & Assadi, 2014; Fallon, 2015; Kertai& Gan, 2015; Schonberger et al., 2015). Additionally, because nurses participate in patient education, improved knowledge, skills, and attitudes on consistent blood pressure monitoring can enhance communication and promote patient engagement.

Purpose Statement

Gap

The performance gap related to hypertension measurement is mainly associated with the lack of staff, equipment, and nurse educational resources as evidenced by the increase in misdiagnoses (Fallon, 2015). Nurses have the responsibility to assess and monitor blood pressure in the clinical setting. However, according to Machado et al. (2017), because of the lack of adequate knowledge about accurate blood pressure (BP) measurement processes, nurses make numerous errors when taking blood pressure readings. Underestimating true blood pressure by 5 mm Hg would mislabel more than 20 million Americans with prehypertension when true hypertension is present; also, it has been predicted that the consequences of an untreated 5 mm Hg of excessive systolic blood pressure would be a 25% increase over current levels of fatal strokes and fatal myocardial infarctions for these individuals (Fallon, 2015). Conversely, overestimating true blood pressure by 5 mm Hg would lead to inappropriate treatment with antihypertension medications in almost 30 million. Misclassification of patients leads to an increased number of untreated individuals with hypertension, which in turn contributes to the overall burden of diseases among the population, to include veterans (Himmelfarb, Commodore-Mensah, & Hill, 2016). Correct measurement of blood pressure is influenced by knowledge and skill of nurses. The knowledge and skills relating to the measurement of blood pressure are important in the management of hypertension among veterans.

This DNP has the potential to address the gap-in-practice by providing information on how education can help nurses obtain correct measurement of blood pressure. If the project shows that such education is effective in producing the desired outcome among the target population, continuing education could be promoted among nurses working with a variety of patients.

Guiding Practice-Focused Question

The practice-focused question to be used in the study is: Does literature support the use of a continuing education program in blood pressure checks to improve the nurses’ knowledge, skills, and attitudes necessary to promote patients’ quality of life?

Nature of the Doctoral Project

Sources of Evidence

The project will apply evidence-based literature derived from peer reviewed, scholarly articles using CINAHL, Medline Plus, Pub Med, and Walden University databases. The review was limited to English language literature published between 2013 and 2018. Key words used during the literature search included “primary care,” “hypertension,” “accurate measuring of blood pressure,” “barriers to correct blood pressure readings,” and “blood pressure teaching methods.”

Analysis

These sources of evidence indicate that inaccurate measurement of blood pressure among veterans can cause cardiovascular disease (CVD) risk factors and related complications (Leblanc, Cloutier, & Poirier, 2015; Lee & Rhee, 2016; McGlynn & Kerr, 2016). According to Nitzan, Slotki, and Shavit (2017), inaccurate measurement of blood pressure could also lead to misdiagnosis of patients in need of diagnosis and treatment. The evidence justifies that this problem is important to the nursing profession because the findings can be used to reduce the inappropriate measurement and prevent possible death (Sepucha & Scholl, 2014).

Organization

The evidence will be organized thematically, with categories for blood pressure accuracy methods, blood pressure accuracy barriers, continuing education for blood pressure reading, and so on. It is anticipated that the literature will help to show that continuing education for nurses regarding proper blood pressure measurement utilized will help to close the gap-in-practice by providing nurses with the justification to continue their education on how to conduct an accurate blood pressure reading.

Significance

Stakeholders

My primary care clinic provides patients with services, including regular annual checkups, blood work, and blood pressure checks/monitoring. The clinic comprises the microsystem of interest which includes eight primary care physicians, eight RN care managers, six LPNs, two health techs, and six clerks. The participants will be the eight registered nurses and the six license practical nurses working in the clinic as they are the ones who measure blood pressure. The selected setting agreement process has begun for the project and the project is receiving the full support from the stakeholders, educator Diane Owens DNP, and administrators.

Potential Contributions to Nursing Practice

The facility at which I work provides primary care services to approximately 5,830 veteran patients, and 3,400 of these patients have a hypertension diagnosis (Department of Veteran Affairs, 2015), and each one of them potentially stands to benefit from this project. The project aims to show that an educational program specifically for patient care in primary care settings and other civilian hospitals could increase nurses’ knowledge of what constitutes appropriate blood pressure measurements, control, and hypertension self-management practices. This project could substantially benefit the nursing practice by helping nurses to provide greater quality care for patients when reading their blood pressure.

Transferability

The project could be transferable to similar areas wherever continuing education might be of use to nurses who require extra training in conducting a routine procedure that has a high risk of leading to problems for the patient. One particular issue currently impacting nursing is the issue of catheter-related infections, which are still quite high in many clinics because nurses lack a standardized guideline for inserting, maintaining and removing catheter lines (Zingg et al., 2014; Yazici & Bulut, 2018). In any area where it can be shown that nurses benefit from more training, this project would have transferability because at root it would show that training and continuing education are beneficial for nurses as they help ensure that optimal quality care is being provided to patients.

Potential Implications for Social Change

This blood pressure education project could have implications for social change as its focus is on enhancing nurses’ knowledge and awareness of how to accurately read blood pressure for patients in a population that is currently recognized as not receiving the level of care that it requires (Kehle-Forbes, Harwood, Spoont, Sayer, Gerould &

Murdoch, 2017). In other words, today’s veterans are a vulnerable population (Dichter, Haywood, Butler, Bellamy & Iverson, 2017), so any effort made to help them by helping the nurses who provide care for them would be a step towards positive social change.

Summary

A lack of precise and accurate blood pressure readings can result in misdiagnoses of hypertension for patients. One particularly vulnerable population for this problem is the veteran population. I currently work at a clinic that provides care for veterans. This DNP asks the question of whether literature supports the use of a continuing education program in blood pressure checks to improve nurses’ knowledge, skills, and attitudes necessary to promote patients’ quality of life. The implications for this project for nursing practice are that it could improve the ability of nurses to provide quality care for patients, no matter the population.

In Section 2, the theory that best relates to this DNP will be discussed along with a discussion of the broader manner in which this problem relates to nursing. Local background and context will also be provided as well as an examination of the role of the DNP student and the role of the project team in this DNP.

Section 2

Introduction

The practice problem for this DNP is that a significant number of nurses are failing to read blood pressure accurately (White et al., 2013). This is a problem because reading blood pressure accurately is one of the most fundamental types of care that a nurse can provide (Myers, 2014): blood pressure tells so much about the patient’s condition, and so many approaches to care, interventions and treatment are based on blood pressure readings. Inaccurate readings can impact how a patient is perceived, diagnosed and treated. It is essential that nurses be able to provide blood pressure readings accurately, especially for veterans who are a vulnerable population and in need of greater quality care from nurses.

The practice-focused question is: Does literature support the use of a continuing education program in blood pressure checks to improve the nurses’ knowledge, skills, and attitudes necessary to promote patients’ quality of life?

This chapter will examine the most relevant theory to this DNP and discus the broader manner in which this problem relates to nursing. Local background and context are also examined, as are the role of the DNP student and the role of the project team in this DNP.

Theory of Lifelong Learning

In its report, The Institute of Medicine (2010) recommends that 80% of RNs possess at the very least a baccalaureate degree by 2020. The reason for this is that continuing education (CE) is a vital way to maintain high standards and quality of service within the nursing field. As new research, new methodologies, new strategies, and new interventions are constantly being discovered, tried, and validated it pays for nurses to stay abreast of this research through CE: it provides them with the knowledge they need to help patients in the best manner possible, and it gives them confidence in themselves in that they recognize the fact that they themselves are at the forefront of their industry in terms of treatments and theoretical approaches to nursing. RNs who do not continue their education run the risk of forgetting important principles that apply to their discipline, missing out on innovative and new ideas on nursing practices, and being a weak link in the chain of quality care service. Indeed, lifelong learning is recommended by researchers for nurses who want to excel in their industry and be able to offer services and talents that will be useful to both colleagues and those in need (Davis, Taylor & Reyes, 2014).

The problem facing nurses today is that more than half of them do not go on to continue their education or obtain the kind of degree recommended by the Institute of Medicine. They take just enough classes to get their license or certificate and then they never look back, as though education were merely a means to an immediate end. Education is more than just a gateway to one’s career—especially if that career is in nursing. Education is to nursing as oxygen is to life: without it, the body and the mind die.

Thus, nurses should be mindful of the fact that education is extremely vital to their success. This is especially true in the 21st century wherein the manner of nursing and nursing approaches is changing rapidly thanks to advancements in technology. If nurses do not stay abreast of these changes, they are likely to be unable to utilize the advancements that technological innovation offers.

Kirschling (2017) notes that educated RNs are critical to a country’s survival. They provide medical, social, and psychosocial care for many types of individuals in a variety of contexts. Nurses are a valuable asset in health care—but they can also become a liability if they are not trained to be the kind of experts that patients and other health providers expect them to be. Kirschling (2017) states that “RNs make up the single largest segment of the health care workforce” and that “the demand for nurses will continue to increase along with demands on the nation’s health care system.”

The theory of lifelong learning applies to this particular DNP because it shows that in order for nurses to conduct an accurate measure of blood pressure, they ultimately need to be open to the idea that continuing education is a positive factor. Thus, it should be kept in mind that, throughout this DNP, the goal is not only to educate the nurse on the proper method but also to help inspire or motivate the nurse to want to be self-actualized in both this and other areas of nursing so that quality care is the most important objective. For that reason, education information on blood pressure accuracy will always aim to achieve a positive and supportive tone so that nurses feel encourage, supported and empowered to continue to pursue lifelong learning.

Relevance to Nursing Practice

As White et al. (2013) show there is a strong need for the problem of misdiagnoses from misread blood pressure to be addressed in nursing practice. The longer this problem goes unaddressed, the longer patients will be subjected to treatments that they are not really in need of and that actually do more harm than good. For nurses, such a situation should be intolerable and a desire to remedy the situation should be felt by one and all. Awareness of the option of continuing education could be raised through this DNP. Lifelong learning and continuing education (CE) have been promoted by the Institute of Medicine, which means nurses should take note. CE could help to boost their confidence—and confidence levels are important when nurses set about implementing evidence-based practices (Wilson Banner, Austria & Wilson, 2017). Also important is the need for nurses to have proper guidance and training (Humphrey, 2015). Lifelong learning theory posits that education increases nurses’ confidence, which can in turn help to build self-efficacy levels in nurses and propel them to the top of the motivation pyramid, whereupon they can acquire more and more nursing knowledge and increase their ability to provide quality care.

Local Background and Context

Justification for this Practice-Focused Question

Inaccurate readings have often led to misdiagnoses and unnecessary treatments which have had negative effects on the health and well-being of patients, including this DNP’s target population—veterans (Badeli & Assadi, 2014; Fallon, 2015; Schonberger et al., 2015). It is extremely important that nurses be able to read blood pressure accurately (Myers, 2014) as this type of fundamental care is a building block for so many other decisions that will be made. If the patient is wrongly perceived as having high or low blood pressure, it can impact the type of drugs he is prescribed, the type of pre-conceived ailments that care providers might unwittingly associate with this type of reading, and the way in which the patient receives care. Reading blood pressure accurately is very important to providing quality care in nursing.

Brief History

In the past, various approaches, techniques and tools have been proposed to help solve the problem of inaccurate readings of blood pressure (Deepak, 1992; Hendrickson, 1999). However, there are numerous factors and variables that can impact an outcome at any level of nursing—and the reality of the situation is that nurses can be rushed, overworked, overburdened, burned out, and fatigued at any point while on the job. These variables can impact their ability to provide quality care, even at the most basic level of reading blood pressure accurately (Cañadas-De la Fuente, Vargas, San Luis, García, Cañadas & Emilia, 2015; Wang, Liu & Wang, 2015). In spite of the attention given to improving the accuracy of blood pressure readings over the years, the problem has persisted, as noted by White et al. (2013). From the theoretical position of lifelong learning, it could be implied that the problem is rather one of multiple variables impacting the nurse’s ability to deliver quality care. Stress, pressure, overwork and other external factors could weigh on a nurse, and unless continuing education is there to provide a support, problems may persist in nursing quality.

Current State

The current state of nursing practice with respect to reading blood pressure accurately has been shown to be poor, as indicated by the literature and the many studies calling for an improved approach to the practice (Zheng, Yan, Zhang & Poon, 2014; Siu, 2015; Mukkamala, Hahn, Inan, Mestha, Kim, Toreyin & Kyal, 2015). For veterans in particular there is a need for greater service in terms of providing quality care starting with the most basic of functions performed by nurses—taking blood pressure (Roy, Foraker, Girton & Mansfield, 2015; Porr, 2017).

Strategies and Standards Used Previously to Address the Gap-in-Practice

Various technological strategies have been employed to attempt to address the gap-in-practice: arm bands that monitor blood pressure, automatic sensors that remove the human factor from the process and thus reduce the risk of error occurring and many others (Mukkamala et al., 2015)—and yet the problem persists, especially among the vulnerable population of veterans.

Demographics and Measurements

It is unknown how many veterans are impacted by misdiagnosis of blood pressure annually, though it is known that approximately 44% of the veteran population seeks medical attention at the Veterans Affairs centers in the US. It is also unknown as to how many patients are misdiagnosed who are not veterans—but as Fallon (2015) points out, underestimating true blood pressure by 5 mm Hg would mislabel more than 20 million Americans with prehypertension when true hypertension is actually present; likewise, it has been predicted that the consequences of an untreated 5 mm Hg of excessive systolic blood pressure would be a 25% increase over current levels of fatal strokes and fatal myocardial infarctions for these individuals. At the same time, overestimating true blood pressure by 5 mm Hg would lead to inappropriate treatment with antihypertension medications in almost 30 million.

Data on hypertension among veterans indicate that 30% of the veteran population has high blood pressure with 17% of soldiers developing hypertension while in service (Gillespie et al., 2013). The CDC indicates that 30% of hypertensive patients develop stroke and other cardiovascular complications (Gillespie et al., 2013). If improper management of these issues comes about as the result of misdiagnosis stemming from inaccurate readings of blood pressure, many lives could be at risk.

State and Federal Contexts

Currently there are not state or federal stipulations or regulations with regard to blood pressure reading that would have any impact on this DNP.

Role of the DNP Student

My Professional Context

My professional background with regard to this topic is that I currently work as a PACT at a veteran administration primary care clinic in the Northeastern United States. The primary care clinic provides patients with services, including regular annual checkups, blood work, and blood pressure checks/monitoring. The facility at which I work provides primary care services to approximately 5,830 veteran patients, and 3,400 of these patients have a hypertension diagnosis (Department of Veteran Affairs, 2015).

My Role in the DNP

My role in the DNP will be to lead the project under the guidance of my DNP educator and the administrators where I work as a PACT.

My Motivations

My motivations for this project are rooted in my own experience and my awareness of how important is for patients to receive quality care, beginning with having their blood pressure read accurately. This reading is so fundamental that if it is not done well, one must wonder what other lapses are occurring. The hope of this project is that if nurses can be motivated and guided to take better care to perform blood pressure readings accurately, they will go on to perform the other functions of their nursing practice with care and skill, motivated by the confidence they possess knowing they are performing their job correctly and obtaining accurate measurements. Through education to empowerment is the idea that best expresses this DNP.

Potential Bias

My potential bias is rooted in my belief that education is the way to help people overcome whatever defects in practice they currently reflect. If a person is shown how to do something correctly, I believe that the person will respond by changing his or her ways to better reflect the right way. However, as always, there are other factors that can impact a person’s behavior, so it is important for me to remember that just because the informatoin is provided does not mean it will be utilized. That is why I want to incorporate the aspect of lifelong learning theory to ensure that the nurses are motivated to want to practice the right way.

Role of the Project Team

The primary care clinic staff consists of eight primary care physicians, eight RN care managers, six LPNs, two health techs, and six clerks. The sample for the blood pressure education project will be the eight registered nurses and the six licensed practical nurses working in the clinic as they are the ones who measure blood pressure. In this sense, they will serve as the project team, since I am acquainted with all of them. The selected setting agreement process has begun for the project and the project is receiving the full support from the stakeholders, educator Diane Owens DNP, and administrators.

Summary

The theory of lifelong learning is important to this project because it serves as an indication of why it is important that nurses continue their education. That is why this project aims to highlight the beneficial aspects of continuing education with regard to accurate blood pressure reading. The theory of lifelong learning posits that information is constantly being updated in nursing, so it is crucial that nurses stay abreast of these changes by continuing their education.

In the next section, the sources of evidence that support this project will be analyzed and discussed.

Section 3

Introduction

The practice problem for this DNP is that a significant number of nurses are failing to read blood pressure accurately (White et al., 2013). This is a problem as reading blood pressure is one of the most fundamental types of care that a nurse can provide (Myers, 2014). Blood pressure reading is the first step in understanding the patient’s condition, and so many approaches to care, interventions and treatment can be based on blood pressure. Inaccurate readings will impact how a patient is perceived, diagnosed and treated. It is essential that nurses be able to provide blood pressure readings accurately, especially for veterans who are a vulnerable population and need quality care from nurses.

The theory of lifelong learning is utilized to guide this project, as continuing education is promoted by the Institute of Medicine (2010) to help nurses obtain the knowledge they need to remain abreast of updates in practice. As there is a need for nurses to conduct better readings of blood pressure, this project aims to assess whether the literature supports the idea of continuing education with regard to this topic.

The practice-focused question is: Does literature support the use of a continuing education program in blood pressure checks to improve the nurses’ knowledge, skills, and attitudes necessary to promote patients’ quality of life?

This chapter will look at the sources of evidence and discuss how they were obtained and how they relate to the DNP.

Practice-focused Question

Veterans require quality care just like any other population, yet they are a vulnerable population in the U.S. (Dichter et al., 2017). Currently there is a gap-in-practice with respect to this population and the accuracy of readings of blood pressure (White et al., 2013). The practice-focused question for this DNP is: Does literature support the use of a continuing education program in blood pressure checks to improve the nurses’ knowledge, skills, and attitudes necessary to promote patients’ quality of life?

The approach of this project is to assess whether the literature supports the use of continuing education on blood pressure checks by using the nurses in my work place as participants who will receive a training guide supplied by this DNP that will show them how to precisely and accurately measure blood pressure of patients in the veterans’ clinic.

Sources of Evidence

The sources of evidence that will be used for the DNP are scholarly articles obtained from online databases—CINAHL, Medline Plus, Pub Med, and Walden University databases. The review is limited to English language literature published between 2013 and 2018. Searching for literature within the last five years will ensure that data is up to date and relevant to today’s standards.

Key word searches used during the literature search include “primary care,” “hypertension,” “accurate measuring of blood pressure,” “barriers to correct blood pressure readings,” and “blood pressure teaching methods.” These keywords can be entered into search engines on the very databases of the online platforms where articles are stored.

This search will be exhaustive and comprehensive in so far as I am able to dedicate time to reading the articles that match the relevance factor, determined by perusal of the Abstract. The relevance factor will be determined by whether the Abstract indicates that the study bears relation to the topic of blood pressure readings. This will be determined by whether the Abstract mentions a term related to the idea of misreading or inaccurate readings or some concept geared towards improving readings or the problem of blood pressure readings.

These sources of evidence indicate that inaccurate measurement of blood pressure among veterans can cause cardiovascular disease (CVD) risk factors and related complications (Leblanc, Cloutier, & Poirier, 2015; Lee & Rhee, 2016; McGlynn & Kerr, 2016). According to Nitzan, Slotki, and Shavit (2017), inaccurate measurement of blood pressure could also lead to misdiagnosis of patients in need of diagnosis and treatment. The evidence justifies that this problem is important to the nursing profession because the findings can be used to reduce the inappropriate measurement and prevent possible death (Sepucha & Scholl, 2014).

Analysis and Synthesis

Content analysis will be conducted in order to thematically organize the data obtained from the collection of articles. The kind of data that is collected in a qualitative research study about blood pressure can be thematically organized. Thematic analysis focuses on common themes being identified, as van Dipten et al. (2018) showed in their qualitative study of practitioners’ perspectives on managing patients. Data can also focus on what steps researchers recommended in terms of improving blood pressure readings. Open coding can be conducted in order to organize themes and eidetic reduction may also be used to filter out the noise that sometimes seeps into remarks or discussions provided by researchers.

Summary

The sources of information that will be used for this DNP are online databases that can be accessed using the Internet. Keyword searches will be conducted for literature published within the last five years, between the years 2013 and 2018. This will help to ensure that information is relevant and up to date. Data will be organized thematically and open coding will be conducted in order to categorize themes. The next chapter will discuss the next steps of this DNP.

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