| Course | NUR 553 Dynamics of Professional Nursing II |
|---|---|
| Module | Module 5 |
| Paper type | PICO(T) and evidence appraisal worksheet |
| Length | About 651 words, 5 pages |
| Format | APA 7 student paper |
| School | Arizona State University |
| Program | MS in Nursing |
| Updated | October 2026 |
Free sample paper for NUR 553 Module 5
The Right Cuff for the Arm: A PICO(T) Question, Search and Appraisal on Blood Pressure Cuff Size and Accuracy
Student Name
Edson College of Nursing and Health Innovation, Arizona State University
NUR 553: Dynamics of Professional Nursing II
Instructor Name
Month Day, Year
The Right Cuff for the Arm: A PICO(T) Question, Search and Appraisal on Blood Pressure Cuff Size and Accuracy
Clinical Problem
On my telemetry unit, nurses and technicians usually take blood pressure with the regular adult cuff kept on each wall unit, regardless of arm size. Larger cuffs are stored at the nurses' station. After writing about weight bias in my previous course, I began to wonder how often patients with larger arms receive treatment decisions based on inaccurate readings.
Step 1: The PICO(T) Question
Question: In adults whose arms call for a large or extra-large cuff (P), does measuring blood pressure with a cuff sized to the arm (I), compared with a regular adult cuff (C), produce more accurate systolic readings (O) during a single measurement session (T)?
Question type: This is a foreground question about diagnosis and measurement, comparing two ways of obtaining a clinical value.
| Element | Content |
|---|---|
| P (population) | Adults with a mid-arm circumference that calls for a large or extra-large cuff |
| I (intervention) | Blood pressure measured with a cuff sized to the patient's arm |
| C (comparison) | Blood pressure measured with a regular adult cuff |
| O (outcome) | Accuracy of systolic blood pressure readings |
| T (time) | During a single measurement session |
Step 2: The Search
Database: ASU Library One Search, then PubMed to confirm.
Search terms: ("blood pressure cuff" OR "cuff size" OR miscuffing) AND (accuracy OR "measurement error") AND (adult*).
Limits: English, 2018 to 2025, peer-reviewed, human studies.
Results: One Search returned 146 records; after screening titles and abstracts for quantitative studies in adults comparing cuff sizes directly, I selected one randomized trial. PubMed returned the same trial near the top of a similar search.
Article selected: Ishigami et al. (2023), a randomized crossover trial in JAMA Internal Medicine.
Step 3: Appraisal of the Study
Purpose: To measure how much blood pressure readings change when a regular cuff, rather than an appropriately sized cuff, is used, across a range of arm sizes.
Design: Randomized crossover trial. Each participant had blood pressure measured with an appropriate, a too-small and a too-large cuff in random order, followed by a final set with the appropriate cuff. Because each person served as their own control, differences between people did not confound the comparison.
Sample: 195 community-dwelling adults in Baltimore with a wide range of mid-arm circumferences; mean age 54, 68% Black and 51% with hypertension.
Findings: Among participants needing a large cuff, using a regular cuff produced systolic readings 4.8 mm Hg higher on average (95% CI, 3.0 to 6.6). Among those needing an extra-large cuff, the regular cuff read 19.5 mm Hg higher (95% CI, 16.1 to 22.9). For people needing a small cuff, the regular cuff read 3.6 mm Hg lower. The authors concluded that miscuffing produces strikingly inaccurate readings, especially where one regular cuff is used for everyone (Ishigami et al., 2023).
Strengths: Randomized order of cuff sizes, standardized triplicate measurements, a diverse sample and precise confidence intervals.
Limitations: Participants were healthy community-dwelling adults measured under research conditions, not hospitalized patients measured during busy shifts. The study used automated devices in a controlled setting, so the size of error in practice may differ.
Level of evidence: Level II, a single randomized controlled trial, using the hierarchy in our course resources (Melnyk & Fineout-Overholt, 2023).
Quality: High for the question asked, with the main limitation being generalizability to inpatient settings.
Application to Practice
The evidence supports measuring arm circumference at admission and using a correctly sized cuff, in line with national guidance on measuring blood pressure accurately, which calls for selecting cuff size based on arm circumference (Muntner et al., 2019). A 19.5 mm Hg error in a patient needing an extra-large cuff could lead to an unnecessary dose of an antihypertensive medication. A practical first step on my unit would be to hang the larger cuffs beside the regular one in every room and record arm circumference at admission.
References
Ishigami, J., Charleston, J., Miller, E. R., III, Matsushita, K., Appel, L. J., & Brady, T. M. (2023). Effects of cuff size on the accuracy of blood pressure readings: The Cuff(SZ) randomized crossover trial. JAMA Internal Medicine, 183(10), 1061-1068. https://doi.org/10.1001/jamainternmed.2023.3264
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Muntner, P., Shimbo, D., Carey, R. M., Charleston, J. B., Gaillard, T., Misra, S., Myers, M. G., Ogedegbe, G., Schwartz, J. E., Townsend, R. R., Urbina, E. M., Viera, A. J., White, W. B., & Wright, J. T., Jr. (2019). Measurement of blood pressure in humans: A scientific statement from the American Heart Association. Hypertension, 73(5), e35-e66. https://doi.org/10.1161/HYP.0000000000000087
NUR 553 Module 5 instructions, in plain terms
Week 5, Approaches to Systematic Inquiry: EBP and Quality Improvement, opens with a lesson on clinical questions and PICO(T). Students learn to write a PICOT question with resources from the ASU Library, then write a clinical foreground question on a worksheet. They must search for one quantitative study that supports the question, record the search strategy on the worksheet and answer prompts that appraise the study's quality and level of evidence. One Search is allowed, and the selected article is attached to the submission. The assignment is worth 15 points. Choose a question from your own practice, narrow enough that one quantitative study can address it directly.
How this NUR 553 Module 5 example is built
A short clinical problem explains where the question came from on the writer's unit. Step 1 presents the PICO(T) elements in a table and then as a single question, identifying its type. Step 2 records databases, search terms with Boolean operators, limits, the number of results and the screening that led to one trial. Step 3 appraises the study under purpose, design, sample, findings with actual numbers and confidence intervals, strengths, limitations, level of evidence and quality. A closing section applies the findings to practice with a national measurement statement. Three sources support the worksheet, and the trial itself would be attached in Canvas.
NUR 553 Module 5 rubric: what earns full marks
Fifteen points rest on a correctly structured PICO(T) question, a reproducible search strategy, the choice of an appropriate quantitative study and a sound appraisal of its quality and level of evidence. Questions earn most when each element is specific and measurable. Search strategies should be detailed enough that someone else could repeat them, including terms, operators, limits and numbers. The appraisal is stronger when it reports actual results and judges both strengths and limitations. Matching the level of evidence to the course's hierarchy shows correct use of the framework. Linking findings back to practice completes the evidence-based practice steps the worksheet covers, and a concrete next step on the writer's unit shows the evidence will be used.
NUR 553 Module 5 help: mistakes that cost marks
The most common error is a PICO(T) with a vague outcome, such as "better care." Name something measurable. Another is selecting a qualitative or review article when the worksheet asks for one quantitative study. Search sections are often too thin to repeat; record every term and limit. Report the study's results with numbers rather than "it worked." If you send the desk your clinical question, the PICO(T), search and appraisal can be built around it. Attach the article, as the syllabus requires, and check that it is peer reviewed. Keep the time element realistic for the outcome you chose, and leave it out if your question, like a measurement question, has no meaningful time frame. Name the database each search ran in, so a reader could repeat it.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More NUR 553 and MS in Nursing sample papers
- NUR 553 Module 1: Critical Analysis Essay: A Fifth Element for the Nursing Metaparadigm
- NUR 553 Module 2: Paper: Clinical Judgment Scenario Using Tanner's Model
- NUR 553 Module 3: EBP Assignment: Appraising a Quantitative Nursing Research Study
- NUR 553 Module 4: Planning a Quantitative Research Study: Mini Research Proposal
- NUR 553 Module 6: Discussion Board: Health Policy Platform and Peer Response
- NUR 553 Module 7: Integration and Application of Concepts Worksheet
- NUR 501 Module 7: Innovation in Practice Paper
- NUR 673 Module 2: Assessment Portfolio, Part 1: Test Blueprint
- NUR 552 Module 4: Triple Aim to Quintuple Aim Essay
- NUR 670 Module 6: Checkpoint: How Do Educators Know When Curriculum Connections Are Working?
NUR 553 Module 5 questions, answered
Where can I find a free NUR 553 Module 5 sample paper?
A complete NUR 553 PICO(T) worksheet sample on cuff size and blood pressure accuracy, with a search and appraisal of a 2023 trial, is on this page.
What does the NUR 553 PICOT assignment require?
A clinical foreground question in PICO(T) form, a recorded search for one quantitative study and an appraisal of its quality and level of evidence.
What does PICO(T) stand for?
P is the patient group, I the intervention, C the comparison, O the outcome and T the time frame.
Does cuff size affect blood pressure readings?
Yes. In a 2023 randomized crossover trial, a regular cuff read about 4.8 mm Hg high for large arms and 19.5 mm Hg high for extra-large arms.
Can I use One Search for the NUR 553 search?
Yes. The syllabus allows ASU Library One Search for finding the quantitative study.