• Jayne Flood

Introduction

This report aims to discuss the best practice on the measurement of a lying and standing blood pressure. In addition to this; formulate a search strategy to provide the best evidence based practice. Doctor David Sackett defines evidence based practice as; “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett et al. 2000). This in Laymen’s terms means; to use all available resources of information to form an opinion or judgement on how to provide the best possible care to the patient. Some people suffer from a condition called Presyncope, this can cause them to feel lightheaded or unsteady on their feet when rising from a lying or sitting position; this condition is often associated with the older generation and can cause them to fall. They feel this way because the brain or cerebral cortex does not receive enough oxygen, due to a lack of circulation when they stand up. This can then cause them to fall over or pass out. This condition is also known as Hypotension or Orthostatic Blood Pressure. The best way to diagnose or determine if the patient is suffering from this condition, is too perform a procedure called a lying and standing blood pressure. This usually requires the Health Care Professional to take the patient’s blood pressure while they are lying down, then to record the blood pressure immediately on standing and then again when they have been standing for two minutes; to determine if the patient has a significant drop in their blood pressure in a standing position.

Formulating a search strategy for the three resources

The three resources for this report that will be searched and discussed are books, journals and the internet. The key words used in this report will be; Lying and Standing Blood Pressure, Orthostatic Blood Pressure, Hypotension and measurement. The main sentence used will be measurement of orthostatic blood pressure. Before beginning the search it can be helpful to design a mind map, spider graph or brainstorm, to help generate any new key words that can be used in the search. (Cottrell, 2003). The main focus for this report will be on Measurement of Orthostatic blood pressure.

Internet

A good search resource is the internet because it is fast and instant. Turn on the computer and connect to www.google.com; then in the search bar, type in the words lying and standing blood pressure. This yielded nine hundred and forty two thousand search results in fifty four seconds. The word measurement was used to try and narrow the search results down. Type in the words measurement of orthostatic blood pressure, this narrowed the search results down to two hundred and twenty four thousand. Applying Boolean logic to the search bar, can help to narrow the results further; simply add the words “AND” or “OR”. George Boole was a mathematician who came up with the idea to add either of these words to the keywords to narrow down a search, (Freeman and Thompson, 2009). The word AND added to the keywords lying and standing blood pressure, will produce results that include both the keywords lying and standing. Adding the word OR will also produce results that include the keywords lying and standing, this severely increase the search results. The word NOT can also be added to the key words, which will narrow the results considerably as this searches for only one of the key words and rules out the other. (Freeman and Thompson, 2009). Using Boolean logic did not help in this particular search. Scrolling through the Google search results, revealed that a lot of the websites were generated abroad. This can be reduced down by clicking on the search tool button, then clicking on country United Kingdom only, this reduced the results down by half. To try and reduce the results further, type google scholar in the Google search bar, this will access google scholar (www.scholar.google.co.uk.) Type in measurement of orthostatic blood pressure in the search bar, this produced a search result of forty five thousand meaning it was considerably less. By clicking on advanced search and inputting the dates to no more than five years, reduces the results down to twenty in seven seconds. The downside to advance search on google scholar, is that there is no discrimination against foreign websites.

When searching the internet, it is important to remember the three ‘W’s.’ Who; What and When. Who produced the website and can they be trusted; for instance; is it written by a drug company who are trying to sell their products. Where the website is from; is it British or from abroad? Ideally healthcare professionals should be using information from their own country in their assignments. And finally, when was the website last updated? A lot of websites are rarely updated, so it is important to look at when the website was created and updated. (Freeman and Thompson, 2009).

Journals

Another great resource that healthcare professionals can research are journals or e-journals. Journals are current and up to date. Written by qualified professionals and peer reviewed, they also contain many volumes. The downside to using journals is that they can be very costly, difficult to store and hard to search (O’Dochartaigh, 2002). The university has a library that can be accessed day or night, or you can use their library website or the university website. Sign in to the library account and type in measurement of orthostatic blood pressure. This produced a hundred and seventy six results, this includes journals and books. You can refine the search results further by going to the advanced search section, and clicking on the relevant boxes that may be needed to do this, for example, in this case all that was needed was to refine the search was the date which yielded only fifty two results. Also underneath the refine results section is a list of the authors, the name of the journals and the databases they were found in. This information is helpful if the name of certain journals is not known; the same with databases. By clicking on the more options part of these lists, you can eliminate or include whichever journals or databases required; for example, in this case all articles from abroad were eliminated, reducing the search results down to forty nine. If the name of the journal is known, then the library website has an e-journals section; click on the box that says “find e journals.” This will bring up a separate box with the alphabet, click on the relevant letter or type in the name of the journal in the search bar. For example the nursing times was searched. This then opens up a new link box, click on the nursing times title; this will open up a separate box where the year, volume, issue and page numbers can be inserted to access the particular e-journal required. For the purpose of this report, it is known that the particular nursing times journal was printed in the year two thousand and seven (2007), the volume number is one hundred and three (103), the issue number is twenty (20), and the page starts on number twenty four (24). These numbers when inputted into the boxes, will take you directly to the e-journal required. The hospital library also has its own journal and e-journals databases. A lot of the e-journals are accessed via an Athens database account, this is an Access Management System developed by Eduserv; a safe service provider that allows access to all electronic resources the hospital or university are subscribed to. Access to Athens can be done through the university or the hospital, you can register an account with them at no cost to the user, as long as you are a healthcare professional or student. Databases are a systematic collection of data that can be accessed for information, either through the World Wide Web, work or university library. Once again, it does help if you know the name of any databases. On the university webpage there is a box that says “databases”. Clicking on this link will open up a separate box to which you can type in the name of the database required. For the purpose of this report; Cumulative Index to Nursing and Allied Health Literature (Cinahl) will be used. Type Cinahl into the search bar, this generates one search result; double click on the title and this will take you directly to the database. In the search bar type in measurement of orthostatic blood pressure, this will then open up a separate link with new keywords; tick the boxes of the keywords to be used. For example, in this case the keywords are measurement of orthostatic blood pressure. Click the search database button and this yielded ten results. To try and find other articles, type in lying and standing blood pressure in the top search bar; in the search bar underneath, type the word “AND” next to it and type in the word measurement this yielded no results. When searching journals, it is vital to ensure the writers are British; what their qualifications are; and are they qualified healthcare professionals. Checking the date of the journal may be vital, as anything older than five years can be considered out of date. The same should be taken under consideration when searching databases.

Books

Books are another great search tool for healthcare professionals; they can be easier than journals and the internet to search for, and more reliable than the internet. Books give the reader a summary of what is written in the book, by reading the blurb on the back. Books also contain a contents and index page; this allows the reader to go to a specific page or chapter instead of having to read the whole book; unlike journals. Unfortunately books are expensive and take up a lot of storage space. There are four options available when searching for books: The public library, the hospital library, the university library and google books (www.books.google.co.uk). For the purpose of this report the university library will be used. The university provide tuition on how to search and use the library website within a month of starting the course. The university library informs the researcher what books are available, how many books there are, where they can be located in the library and on which campus, how long the book can be borrowed for and whether the book is available online as an e-book. Searching for measurement of orthostatic blood pressure; or lying and standing blood pressure yielded no results for books; the search was then changed to hypotension which yielded one result. To try and yield a few more results, the title was changed to orthostatic blood pressure, this only yielded journals. Blood pressure was then typed into the search bar, this produced over three hundred and nineteen thousand results; they included journals, books and full text online. To reduce this down; there is the option to advance the search; by clicking on the “available in the library” option reduced the results down to fifteen books, ruling out all the journals etc. Choose an appropriate book and look at the options available underneath the title and description of the book. The location option tells you which campus the book is located on and therefore where it can be located in the library. This can also inform the researcher if the book is available to borrow on the day, or when it becomes available to borrow; it can also allow the user to hold the book; meaning the previous borrower cannot renew the book. Clicking on the details option gives the user the author(s), the subject, identifier and a brief description of the book; this can allow the user to choose or eliminate the book quickly and easily. Clicking on the virtual browse button, allows the user to view other books that are along the same shelves as the book the user is looking at. To the left of the library webpage as mentioned earlier; is the option to advance search. Above the words available in the library is “full text online”; clicking on this option gives the user access to the e-books online, allowing them to download the book for a maximum period of two days or to read the book online. Once the user has chosen the books they require, it is just a simple matter of going to the library and borrowing the books. It is important when looking at books for the user to take into account the date, who wrote the book and whether it contains the relevant information required.

Discussion

Formulating a search strategy requires planning, organisation, time and practice. Journals, internet and books are essential tools needed to improve the quality of information assembled from the research. Therefore it is essential to check the credentials of the person writing the information, where the information is from and when it was written or compiled. When searching the internet it became apparent that the websites accessed only spoke about the signs and symptoms of orthostatic blood pressure and not about how to measure the blood pressure only three websites produced the results required, one produced a useable tool, the other gave a step by step explanation on how to do a lying a standing blood pressure, but no other information. The last website explained the correct procedure, explained the signs and symptoms of orthostatic blood pressure, was written by a qualified healthcare personnel, however the webpage did not give a date for when it was updated or due to be reviewed only that it was produced in nineteen ninety six. Searching the hospital and university libraries produced one journal which gave the correct procedure on how to measure a lying and standing blood pressure, this was found in the Nursing times but was out of date by eighteen years. Searching through the university library yielded several books on blood pressure, all with a section on the cause of orthostatic blood pressure, but nothing on the correct measurement of lying and standing blood pressure. The hospital library produced one book with the correct procedure for measuring orthostatic blood pressure. Formulating the search took up an amazing amount of time and resources and has proved to be illusive and inconclusive. In order to find the correct procedure for measuring orthostatic blood pressure further research will be required. With more practice on the use of keywords will hopefully produce the required results. Formulating this search strategy and report has proven how easy it is to get bogged down with information. Using Boolean logic is extremely useful in most search criteria’s but did not work for this particular search. Adding speech marks to measurement of orthostatic blood pressure also did not help, the search tended to focus on the words blood pressure, how to measure blood pressure or just orthostatic blood pressure. This has proven that the keywords should also include words such as “how to” or “correct”.

Conclusion

This report has shown how the use of a spider graph or mind map, is an extremely useful way of beginning the formulation of a search strategy (Cottrell, 2003). It has also demonstrated that using Boolean logic can be an effective tool when searching for information (Freeman and Thompson, 2009). The use of evidence based practice or medicine has also been discussed by discussing what was good and bad about the information and the indicators used to determine this, such as the three W’s, who, when and where to whittle the information down. The internet has proven to be the most interesting and time consuming because anything can be typed in the search bar and it will come up with a vast amount of results. Using different techniques to try and reduce the information down was time consuming. Using the hospital and university was more reliable to find books and journals was less time consuming. They also have librarians that are helpful in times of crisis. Books and journals were the most reliable sources of information because they are generally written by experts in the field being researched. Completing this report has proven to be a useful way of improving knowledge, skills and an effective learning curve. Learning that evidence based practice is based on the best available evidence. Ensuring any advice given is evidence based especially if recommending healthcare products or services and ensuring that any complementary or alternative therapies are in the best interests of the person in the healthcare professionals care (NMC, 2008). Completing this report has acknowledge that less time is required on the structure of the report and more time must be spent on the research.

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