In this assignment I have chosen to discuss manual blood pressure a clinical skill, I performed whilst on placement as part of a community mental health team. I have chosen this skill as I was nervous about performing it in practice and could reflect on my experience. The aim of this essay is to reflect and discuss learning achieved and my application of the clinical skill in practice. The NMC require that as a nurse “you must have the knowledge and skills for safe and effective practice” (NMC 2008). A definition of the clinical skill is the pressure/exerted by the blood within the arteries, it can vary with the strength of the person’s heartbeat, and health conditions can effect a person’s blood pressure (Callaghan & Waldock 2006). Firstly in this essay I will describe my experience performing manual blood pressure, on a service user Jane (pseudonym). Next I will identify and reflect on two aspects of the skill experience in practice that requires further development. When reflecting on the skill used I have selected Gibbs model of reflection (1998) which consists of five parts description, feelings, evaluation, analysis conclusion and a action plan. Thirdly I will discuss and reflect on how the use of understanding and compassion of the skill experience will assist service user’s to meet their health care needs.Then a conclusion will summarise what has been learnt whilst undertaking the assignment. Confidentially and anonymity will be maintained throughout the essay to protect the identity of service users, health care settings and other professionals following the guidelines of the NMC code of conduct (NMC 2008).
During a practice visit with a community psychiatric nurse I was asked to perform the skill of manual blood pressure on Jane, after the CPN had carried out a electronic reading. Wrycraft, N (2009) suggests that when using a electronic sphygmomanometer that there can be errors in measurements. My mentor explained to me that a manual reading should be more accurate. When checking a blood pressure the most accurate method to use is a manual blood pressure (NICE 2010). I collected the equipment to check that it was in working order. I returned to Jane and asked her consent to carry out the procedure which I described to her, and she agreed for me to proceed. Following the NMC code of conduct (NMC 2008) gaining consent from a service user must be given before any procedure is commenced, and that they have the right to refuse treatment or care. I then washed my hands to prevent any contamination, research has found that infections have been reduced since the NHS campaign to wash your hands (DOH 2006). I would follow the framework practiced at university, and The Royal Marsden Hospital manual of Clinical Nursing Procedure of manual blood pressure to carry out the skill (Dougherty & Lister 2011). I then checked that Jane was not wearing any restrictive clothing and she was in a comfortable position sitting with her legs not crossed. I cleaned the sphygmomanometer with an alcohol based wipe to help prevent infection, and cleared the air remaining in the cuff. I placed a pillow under Jane’s elbow and located her brachial artery. I tried to put on a medium cuff using the arrow to try to position 2.5 cm above the brachial artery. I was having trouble fitting the cuff so I changed to the smaller size, and was able to correctly fit the cuff over her brachial artery. I palpated the radial pulse and checked that the valve of the bladder was closed. Then I inflated the cuff until the radial pulse disappeared and giving me the estimated systolic pressure, then I deflated the cuff and asked Jane if she would like a minute to rest. I placed the diaphragm of the stethoscope over the location of the brachial artery. Then proceeded to inflate the cuff to 30 mmHg above the estimated systolic pressure. I inflated the cuff again to the estimated systolic I had previously gained adding 30mmhg. I deflated the cuff at about 2mm per second and listened for the first of the korotoff sounds. I did not hear the last korotoff beat and so I asked Jane for permission if I could repeat that part of the procedure. The second time I was able to hear phase 5 and record the final reading of 140/80 mmHg. Now finished I informed Jane of her reading and that in comparison to her previous results her blood pressure which was stable.
Upon reflection and feedback from my mentor I have identified the two aspects I require to further develop my clinical skill. The first being selecting and using the correct cuff size for the service user. Using the correct size cuff is very important because using the incorrect cuff can give a false reading (Perry & Potter 2007). In my reflective diary from placement I was feeling very nervous and worried about taking a manual blood pressure. I had only practiced in the clinical skills lab and did not feel confident when performing the skill. On reflection I should have I should have practiced more to be comfortable when taking blood pressure. Also when I was with Jane I should taken more time so I wouldn’t have been so nervous. In future practice I will take the cuff size into consideration before I attempt to put it on a service user, and that the cuff should fit securely on the upper arm covering about 80% (BHS 2012). The second aspect is listening to the korotoff sounds accurately when deflating the cuff. On reflection I was anxious when trying to listen to the korotoff sounds, which played a part of me missing the sound on the first try. The second time I felt very self conscious and I tired to just focus on the korotoff phases. There are five phases, phase one a tapping sound , phase two a softening of the sound, phase three return of the sharper sound, phase four sudden muffling , phase five disappearance of the sound giving the diastolic pressure (Dougherty & Lister 2011). My mentor suggested that if the area was noisy or I couldn’t hear the sounds, that I could watch for a flicker on the needle of the sphygmomanometer to identify the first and last beat. For my future practice I intend to perform the skill regularly so that I can be confident in performing, and competent so that I meet the standards set by the NMC (2008).
One of the standards that is set by the NMC is communication and interpersonal skills are part of the essential skills cluster which include ‘skills for care, compassion and communication’(NMC 2010). On reflection I showed compassion to Jane making sure she was comfortable, and talking to her about why we took her blood pressure to monitor any possible health changes. I felt comfortable when having verbal communication with Jane. On reflection when I was feeling nervous I did well in explaining to Jane I didn’t get the reading and asked her consent to continue. Compassion is key in nursing, that helps you to try and understand the service users feelings ( Moss 2009 ). Mental health service users can become paranoid and distressed so it is about finding the right balance of contact, or the interaction and relationship might be affected (Greenberg 2007). In mental health nursing a showing compassion and understanding can help build a therapeutic relationship, which can aid in health promotion for the service user’s needs (Chambers & Ryder 2009). I felt that I needed to improve my knowledge further so that I could better understand about the health care needs of service users. As part of my role is to promote health well being I will have to able to explain in detail aspects that can effect blood pressure. For example Alcohol abuse is also linked to high blood pressure (Ross & Wilson 2010). High blood pressure is a very common condition in the United Kingdom if it is left undetected could lead to life threatening conditions (British Hypertension Society BHS 2009).
In conclusion in this assignment I have been discussing and reflecting about the use of the skill manual blood pressure, from my experience in practice. I have learnt that when checking a blood pressure the most accurate method to use is a manual blood pressure (NICE 2010). That there is many different factors that can effect blood pressure, from using the wrong cuff which would give a inaccurate reading and physical health conditions. I now feel more comfortable and confident to perform the skill in practice, and have a greater knowledge about manual blood pressure. I have identified my areas I need to improve for my future practice: I will practice the skill regularly to be competent, Continue to expand my knowledge to aid understanding and promotion of health needs, and select the correct cuff size before I attempt to put it on a service user.
British Hypertension Society(2009) Blood Pressure. Available at http://www.bhsoc.org/latest-guidelines/a/. Accessed 12 June 2013
Callaghan, P, Waldock, H (2006).Oxford Handbook of Mental Health nursing (1st edition) Oxford University Press, Oxford
Chambers, C. and Ryder, E. (2009) Compassion and Caring In nursing. 2nd edition. Oxford, New York: Radcliffe Publishing
Dougherty, L, Lister, S (2011) The Royal Marsden Hospital manual of Clinical Nursing Procedure of manual blood pressure to carry out the skill. Blackwell Publishing, Oxford
GIBBS, G. (1998) Learning by Doing: A Guide to Teaching and Learning. Further Educational Unit
GREAT BRITAIN. Department of Health (2006b) From Values to Action: The CNO’s Review of Mental Health Nursing. Department of Health :London www.dh.gov.uk (Accessed May 20 2012)
Greenberg, LS (2007) Emotion in the therapeutic relationship in emotion-focused therapy, in Gilbert, P and Leah, R(eds) The Therapeutic Relationship in the Cognitive Behaviour Psychotherapies. Hove: Routledge.
Moss, B (2009) Communication skills for health and social care. London. Sage National Institute for Health and Care Excellence (2010) Quality standard for hypertension S28. London: National Institute for Health and Care Excellence
Nursing and Midwifery Council (2008) The code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC.
Nursing and Midwifery Council (2010) Standards for Pre-registration Nursing. London: NMC.
Potter, P. & Perry, A. (2007). Basic Nursing Essentials for Practice (6th edition.).Mosby. St. Louis
(2010).Ross & Wilson Anatomy and physiology in health and illness. (11th edition). Oxford. Elsevier Limited
Wrycraft, N (2009) An introduction to mental health nursing. Berkshire. Open University Press