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Education: Part 2
BP measurement: practice without evidence. Are we teaching it wrong? By Sara Geale and Elisabeth Jacob
References Alexis O. (2009). Providing best practice in manual blood pressure measurement. BJN. 18(7), 410-415.
We would like to throw down the gauntlet or in this case the blood pressure cuff. Blood pressure (BP) assessment is reportedly the most frequently done of the vital sign measurements in healthcare. The importance of accuracy in BP measurements is well recognised (Rabbia et al. 2013).
Measuring BP is usually taught to student nurses early in their education program. Mastering the skills required to measure BP with accuracy is demanding for nursing students. Taking a BP requires the development of new psychomotor skills, an understanding of what they are measuring and an ability to achieve a level of accuracy (Alexis, 2009).
Historically in Australian schools of nursing, students are taught to do a preliminary palpatory systolic determination (PPSD) prior to a complete BP reading (Tollefson, 2010). Students are directed to palpate a brachial pulse with the BP cuff insitu. They then pump up the cuff until they cannot longer feel a brachial pulse. The student is advised that they have now palpated the systolic BP. They lower the cuff, wait two to three minutes and reinflate the cuff to 30 to 40mmHg above the systolic BP that they had initially palpated. The 34 August 2015 Volume 23, No. 2
AS SUPPORTERS OF EVIDENCE BASED PRACTICE WE, THE ACADEMICS TEACHING THIS PROCESS, NEED TO QUESTION WHY WE ARE TEACHING A PRACTICE THAT SEEMS TO BE BASED ON ‘DOING WHAT WE HAVE ALWAYS DONE’ student then takes and documents the systolic and diastolic BP. They have now pumped the cuff up occluding blood flow to the periphery, lowered it slowly to produce the turbulent flow required to hear Korotkoff sounds and they have done this twice within a short period of time. While there may be an argument for the PPSD helping to increase reading accuracy by enabling identification of an auscultatory gap (Blank et al. 1991) to date there is no research to show that the gap is being recognised or documented
by nurses or that it makes any difference to patient outcomes. Current recommendations from The Joanna Briggs Institute, (2014) exclude the use of PPSD or use it in conjunction with the first BP reading. It is questionable that this practice is carried into the clinical area especially given nursing time management issues associated with large patient loads in most healthcare areas and the need to wait for one to two minutes between cuff inflation for traditional PPSD (Tollefson, 2010). It is also questionable if this procedure leads to improved patient outcomes and satisfaction. As supporters of evidence based practice we, the academics teaching this process, need to question why we are teaching a practice that seems to be based on ‘doing what we have always done’. We need to ask if by doing what we have always done we are actually improving the student experience and improving patient care. We should be asking if there is a better way to teach BP measurement that would encourage accuracy and reduce risk. Dr Sara Geale is a Lecturer and Dr Elisabeth Jacob is a Senior Lecturer in the School of Nursing and Midwifery at Edith Cowan University in WA
Blank, S. G., West, J. E., Muller, F. B., Pecker, M. S., Laragh, J. H., & Pickering, T. G. (1991), Characterization of auscultatory Gaps with Wideband External Pulse Recording, Hypertension, 17(2), 225-233. doi: 10.1161/01. HYP.17.2.225 Gordon, C.J. Frotjold, A., Fethney, J., Green, J.; Hardy, J., Maw, M., Buckley, T. (2013, October). The Effectiveness of Simulation-Based Blood Pressure Training in Preregistration Nursing Students. Journal of Simulation in Healthcare. 8(5), 335-340. doi: 10.1097/ SIH.0b013e3182a15fa7 Rabbia, F., Testa, E., Rabbia, S., Praticò, S., Colasanto, C., Montersino, F., Veglio, F. (2013). Effectiveness of blood pressure educational and evaluation program for the improvement of measurement accuracy among nurses. High Blood Pressure & Cardiovascular Prevention, 20(2), 77-80. Retrieved from http:// ezproxy.ecu.edu.au/ login?url=http://search. proquest.com/ docview/1462385739? accountid=10675 The Joanna Briggs Institute. (2014). Vital signs. Retrieved 29 April 2015 from http:// ovidsp.tx.ovid.com. ezproxy.ecu.edu.au/ sp-3.15.1b/ovidweb. cgi?&S=LDEFFPOP HBDDAMCANCKK AHIBKEDMAA00& Link+Set=S. sh.21|12|sl_190 Tollefson, J. (2010). Clinical Psychomotor Skills: Assessment tools for nursing students (4th Ed.). South Melbourne, Vic: CENGAGE Learning
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