Core Skill: Blood Pressure

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“Select one clinical skill in which you are developing competence in and reflect upon how you have achieved the necessary level of competence for this stage of the programme”

For the purpose of this essay the author has chosen to discuss blood pressure. The author has selected non-invasive blood pressure monitoring. An explanation will be provided to identify the rationale for selecting this technical skill and how the author has demonstrated knowledge base in relation to developing competence in this chosen skill. The author will also use Gibbs reflective model (1988) to facilitate critical thought and relating theory to practice where the model allows. Using the Dreyfus (1980) model of skill acquisition before commencing placement the author was classed as level one, novice, having only performed this skill once. Non-invasive blood pressure is measured externally, causes less pain, requires less expertise and is not as effective as invasive blood pressure monitoring (Wicker & O’Neill 2010, Kingsnorth & Bowley 2011) The author’s clinical placement was based in an anaesthetic room where non-invasive blood pressure was monitored frequently on a day to day basis. The author has chosen this skill as it is a fundamental skill and extensively used during practice as a baseline to monitor fluctuations in a patients’ blood pressure. The author has the ability apply both underpinning knowledge gained at university and practical experience to reflect on this clinical skill. Blood pressure is the pressure exerted against arterial walls during a cardiac cycle (Foxall 2009) The contraction of ventricles is the systolic phase, and the interval in between contractions where the ventricles refill with blood is known as the diastolic phase. During the systolic phase the aorta and large arteries stretch to a certain extent due to a large amount of energy in the vessel whereas in the diastolic phase this energy is then released in a form of elastic recoil. This effect of squeezing is how blood pressure and the blood flow through the capillaries is maintained (Coni&Coni 2003) A pressure gradient, the difference between diastolic and systolic pressure, is required to determine a normal blood pressure (Wicker & O’Neill 2010) Blood pressure is monitored in millimetres of mercury (mm Hg) written as the systolic over the diastolic. A normal blood pressure is classed as 120mmHg systolic over 80mmHg diastolic (Bishop 2009) However in a population with increasing co-morbidities it is argued that there is no normal blood pressure. An individual may constantly have a blood pressure reading lower or higher than the normal value and suffer no ill adverse effects. Therefore the reading would become normal for this individual (Clancy &McVicar 2009) At university the author attended both practical and theoretical sessions in which a comprehensive propositional knowledge was gained. The theoretical sessions taught the author about the different techniques used to measure blood pressure, the rationale of why blood pressure is taken, how it is maintained, what effects blood pressure and how it is recorded. Theoretical sessions further informed the author that blood pressure is a fundamental skill required of all qualified practitioners. Hilton (2004) reinforces this by stating that healthcare professionals must continuously monitor and accurately record patients’ blood pressure in order to determine their well-being.

Timby (2008) states that numerous factors must be taken into account when determining a patients’ blood pressure such as age, weight, circulating volume and pre-existing heart conditions. Anaesthesia and surgery also have a major effect on a patients’ blood pressure. During practice the author witnessed most patients being anaesthetised using intravenous access, with Propofol being the most preferred induction agent. Propofol is a soybean and egg phosphatide based induction agent that can cause vasodilation in which...
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