My Skill In Manual Blood Pressure Taking: A Self-Reflection Based On My Studies And Practice In My Clinical Area

Introduction

The purpose of this essay is to present a self-reflection based on my personal experience, knowledge, and skills gained from both my studies and practice in my clinical area. The clinical skill I would like to focus on is manual blood pressure taking in which I developed to become competent. All the nursing associate learners must demonstrate the ability, skill, and knowledge to manage devices and perform a nursing procedure by practicing effectively and safely to meet the patient’s needs (NMC, 2018). I would like to use Gibbs (1998) reflective cycle as it gives you the capability to evaluate things and can influence your learning positively and constructively while carrying out nursing care. The placement setting, hospital, and patient’s details have been kept confidential and should not be revealed to adhere to the Nursing and Midwifery Council Code of Conduct (NMC, 2018).

I chose this nursing skill because it plays a big part in the decision making before and after the patient’s treatment in the renal dialysis unit where I spend most of my time completing my professional practice placement. An electronic blood pressure taking method has always been preferred to use not only in the unit where I work but also in almost all the clinical areas I have been. However, any electronic medical device will then encounter some unavoidable problems like a power failure, technical issues and not being properly charged. Therefore, having the knowledge, skill, and competence to perform a manual blood pressure is necessary for therapeutic and diagnostic decisions for the patients (Kaczorowski, Dawes and Gelfer 2012) and to avoid delaying their treatment.

The patient will be named Mrs. M, a 65 years old lady who has chronic renal disease and is known to have hypertension or high blood pressure. Hypertension is a very common condition in people with renal disease and it accounts for about 28% of the cases. It affects the kidney to function by damaging and impairing the blood vessels and reducing the circulation to vital organs (Marieb, 2015).

Description

While I am working in my home placement, I was asked to perform the manual blood pressure by my mentor. The automated device that we usually use in gauging patient’s blood pressure was faulty and unable to obtain an accurate reading. As an Apprentice Nursing Associate learner, I was taught and practiced the skill in the university with the other learners but did not have enough opportunity to demonstrate it on placement. I went back and asked for the patient’s consent if she would let me carry out this procedure. After gaining valid verbal consent, I started washing my hands to comply with the trust policy and guideline to perform this before getting in contact with or touching the patient (Bartshealth, 2019).

I begin to assess the patient’s position to make sure that she was comfortable and her clothing is not restricting access to her arm. While Mrs. M is lying on the bed, I approached her on the left side because her arteriovascular fistula (AFV) is located on her right arm and it is not allowed to perform a blood pressure on it as it will cause an obstruction to the blood flow (NKF, 2020). Using a pillow under her left elbow, I put on a size medium blood pressure cuff around the patient’s upper arm. Using the arrow on the blood pressure cuff, it was centered over the brachial artery and I then placed my two fingers to locate the brachial pulse. Making sure that the valve of the bladder remains closed, I started inflating the blood pressure cuff until the pulse could no longer be felt, which gives me an indication of the estimated systolic pressure and then I deflated the cuff.

After waiting a few seconds before I continue, I located again the brachial pulse and placed the stethoscope’s diaphragm over this point. I started inflating the cuff again up to the estimated systolic I have previously measured and adding 30mmHg.

When I get through at this point I began deflating it slowly while listening to the first beat or the korotkoff sounds. With this, the systolic pressure will be determined and I continued listening until the last beat is heard which would tell me that is the diastolic pressure. The patient started to cough and it makes it very hard to listen to the last beat so I inflated the cuff once more until I get an accurate reading. After successfully doing the procedure, I informed the patient about her blood pressure measurements and left her comfortable. I went to disinfect the equipment, document the result, and reported it to my mentor.

My mentor asked me right after I finished performing the skill to perform the same skill on her so that I can practice more. During the procedure, she gave me advice and tips that can improve and help my practice. She gave me a suggestion that If I was in a noisy area, I could stare and observe for a mild flicker on the sphygmomanometer’s needle to identify it’s first and the last beat. Another tip that she mentioned is aside from brachial artery, I could use the radial artery to measure the blood pressure. She also suggested making sure that the patient’s legs are not crossed.

Feelings

After doing this procedure, I felt that I did well performing it even though I did not have enough opportunity to practice it. When I was being asked by my mentor to do the manual blood pressure, I had reservations and doubt whether I am competent doing the procedure or I was just not confident. As my reflection, I should have had more confidence to myself given a chance and the opportunity to practice it in the clinical area.

Evaluation

As a result, a positive outcome has been achieved because I feel more confident now to perform a manual blood pressure taking skill accurately. To perform this skill on my mentor right after doing it to the patient and been given several tips that can help improve my practice has given me the right confidence in performing the skill. Also, I now have a good understanding and knowledge about the evidence-based practice of performing a manual blood pressure after learning the subject and the significance of measuring the blood pressure accurately. It includes factors that affect blood pressure and different factors that prevent obtaining quality and accurate reading. However, the negative side of the situation is that manual blood pressure monitoring has not been widely used and the other clinical areas are heavily dependent and reliant on the electronic method.

Analysis

I have been asked to perform a manual blood pressure by my mentor because the electronic blood pressure machine is faulty and not obtaining an accurate reading. Discussing to her before about the significance of being able to accurately perform the skill and the procedure has given me the confidence to do it. Having able to apply a holistic approach made me aware to look at the patient as a whole and not only look to certain aspects. Being an effective holistic nurse is to have the theories and proper knowledge behind a specific skill. To have the evidence-based practice is knowing what factors can affect the blood pressure and taking these reasons into consideration.

By collecting the necessary equipment before doing the procedure and by making sure that it is all functioning properly and in order will help in obtaining a correct and accurate reading. It is also important to assess the environment to be quiet, normal room temperature and a comfortable location is optimal in reducing variation and can enhance the reading interpretation (NICE, 2011).

The NMC (2018) states that you should secure proper consent before carrying out such action to the patient. Gaining valid consent from the patient must be secured and obtain before carrying out any type of clinical procedure and they also have the right to understand, to choose, and refuse treatment or care and as a nurse, we have to respect the patient’s wishes.

Performing effective hand washing is the cornerstone of the infection and control practice (Chadwick, 2019). It is very important for any healthcare-care worker who will provide direct or indirect care to the patient to observe good hand hygiene to avoid any cross infections or transmission of harmful germs and viruses and prevent hospital-associated infections (WHO, 2009).

Selecting the correct cuff size is very important as yielding to a too small will give you a falsely high and a too-large cuff gives a falsely low measurement reading (Williams et al. 2004). Making sure that the sphygmomanometer cuff is wrapped around the patient’s bare arm and the bladder is properly centered over the brachial artery (Marieb and Hoehn, 2010).

Utilizing the tips and suggestions given by mentor, I am more equipped with the knowledge to perform an accurate manual blood pressure. By doing self-directed learning through gathering supporting evidence from sources like journals, books, and nursing websites has helped my learning to improve the way I practice and has made me more competent and confident to do this skill accurately.

Conclusion

I am more than pleased that my mentor has given me the chance and opportunity to enhance my practice in performing and improving my skill in manual blood pressure taking. It gave me so much confidence to perform this skill again and to understand it better concerning the importance of delivering an accurate reading. Manual blood pressure taking is a very important skill to learn and to associate it through an evidence-based practice is a vital part of this procedure. I learned that it can give you a more accurate and reliable reading compare to an electronic blood pressure device.

Action Plan

When it is possible, I am always going to take the chance and opportunity to perform a manual blood pressure taking because I am more than competent and confident to do so. Learning to effectively do this skill means that I am capable to carry on my responsibility and duties to provide patient care even if an electronic or automated device fails to function. The tips, knowledge, and suggestions that my mentor has provided me about manual blood pressure taking have also given me the task to pass it on and share with my fellow nursing associate learners and to health care professionals where they can improve their performance, knowledge, and confidence when doing a manual blood pressure. Through this, I am very hopeful and positive that I can provide quality care and make it more individualised patient care.