Essay on Reflection on Clinical Skills
Number of words: 1921
As a nurse professional I must be full equipped with appropriate skills to offer the right services to my clients. As such, in my clinical practice I applied the blood pressure diagnosis skill. In the exercise I carried out a systematic process involving, wrapping a cuff, pressing the stethoscope, inflating the cuff, listening to the stethoscope and taking measurements. My approach is affirmed by the existing literature, which offers key insights about the process. Consequently, my practice was highly influenced by professional values outlined in local policies and the NMC.In this regard, the report is a reflection of how I applied the blood pressure diagnosis skill in my clinical practice and how the experience impacted my nursing practice.
To measure the manual blood pressure, I used the sphygmomanometer and the stethoscope. First, I welcomed the patient, informed her about my intentions. I also informed the consent and asked her if she had any concern or preferences. I confirmed that the cuff was of the right size for the patient arms circumference. Since the patient was in a seated position, I ensured that her arm was flexed and her elbow was at the same level as the heart.I waited for four minutes for the patient to rest before initiating the measurement process. I then wrapped the patient’s upper arm, one inch above the antecubital fossa, with the cuff and located the brachial artery. Then using one hand, I positioned the stethoscope so that it was over the brachial artery. I then rapidly inflated the cuff of size 16 by 36 cm to 180mmHg, which is within the range of a normal person’s systolic pressure and released air at a moderate rate of 3mm/sec. I recorded the reading on the sphygmomanometer as the systolic pressure when I heard the first knocking sound with the stethoscope. On further deflation, I listened to the heartbeat stop at some point and recorded the reading as diastolic pressure180/120. After waiting for a few minutes, I took the second measurement using an automatic sphygmomanometer. I wrapped the cuff around the patients left arm, turned on the power and recorded the reading as180/114 to affirm my earlier readings. I then pressed the exhaust button to release the air from the cuff and repeated the measurement after 2 minutes using a sphygmomanometer to improve my accuracy. Since the blood pressure was high, I referred the patient for further analysis and management.
Before taking blood pressure measurements, The British and Irish Hypertension Society recommends that a patient should be allowed to rest quietly and comfortably for a period of between 3-5 minutes (Williams et al., 2018). Typically, the rest period reduces anxiety and allows significant drop in blood pressure of up to 75% within the first 10 minutes (Levy et al., 2016). However, some studies suggest that five minutes resting time is not enough and recommend periods of up to 25 minutes (Mahe et al., 2017). Such findings question whether the examination of blood pressure can be effectively made during routine outpatient visits. Waiting for 25 minutes may not be feasible especially in situations where there are limited resources and a high number of patients hence explaining why I allowed a rest of between 3-5 minutes.
According to NMC guidelines, a carer is required to select a diagnosis tool that accurately detects what is being diagnosed (NMC, 2018). My tool of choice for measurement of blood pressure was the sphygmomanometer. Based on robust evidence, a sphygmomanometer is regarded as a standard device for measuring blood pressure (Seongll et al., 2018). I performed the second measurementusing electronic digital sphygmomanometer. Studies show that electronic digital sphygmomanometer significantly increases precision by reducing statistical errors (Padwal & Ringrose, 2018).The British and Irish Hypertension Society recommends a bladder length and cuff width of approximately 80% and 46% respectively of the patient’s arm circumference to reduce errors (Muntner et al., 2019). Since my patient had an arm circumference of between 35 and 44 cm, I used an appropriate cuff size of 16 by 36 cm.
Hypertension is a modifiable cardiovascular risk factor hence correct diagnosis and management depend on accurate measurements (Stergiou et al., 2018). Taking measurements both arms was important in improving the accuracy of the diagnosis(Keisuke et al., 2018).Also, I placed the patient’s elbow at the same level as the heart. According to Medicines and Healthcare Product Regulatory Agency, putting the arm below or above the heart level can lead to underestimation or overestimation of blood pressure (Medicines and Healthcare products Regulatory Agency, n.d.).According to a study conducted by Levy et al. (2016), body posture is also important when determining a persons blood pressure. If I had left the arm unsupported, the muscles might have contracted to increase diastolic blood pressure (Lai et al., 2018).
A healthcare professional should act professionally and in the best interest of the patient (NMC, 2018).When using the sphygmomanometer, I ensured that I wrapped the patient’s upper arm, one inch above the antecubital fossa, with the cuff and then using one hand, I positioned the stethoscope so that it is over the brachial artery. Studies show that placing the stethoscope over the brachial artery is the surest way to measure blood pressure (Smith, 2015).
Moreover, several studies have recommended taking more than one blood pressure reading at intervals especially when high blood pressure or low blood pressure is detected during the first reading(Shahbabu et al., 2016; Kario et al., 2018). However, for effectiveness, the successive readings should be in intervals of between 1-3 minutes and the average of the intervals used to represent the patients’ blood pressure, thus informing my approach (Levy et al., 2016). Equally, I had to use the automated sphygmomanometer to improve the accuracy of the diagnostic process by calculating weighted averages (Seongll et al., 2018). Notably, hypertension and hypotension, which refers to high and low blood pressure can lead to severe complications in patients such as stroke and dizziness. Therefore, hypertension quality metrics that rely on single clinic measurements have a high potential of misclassifying a large proportion of patients (Padwal & Ringrose, 2018). Using a different measurement method is also vital in determining the validity and reliability of measurement instruments (Muntner et al., 2019). The main aim of using the automatic aneroid device was to provide a confirmatory test.
According to NMC standards, healthcare professionals should promote not only non-judgemental care but also be sensitive to patient needs to avoid assumptions, disrespect and poor diagnosis (NMC, 2018).Indulging and conversing with the patient ensured that I support compassionate care. Since the patients’ blood pressure was high, I flagged her case as of top priority. To ensure that I act in the best interest of the patient, I showed her consent while at the same time valuing her right to confidentiality and privacy.
On reflection, I realised that my capability to set a conducive environment for communication with the patient highlighted my ability to deal more efficiently with the situation. I could have faced challenges if I had lacked empathy and compassion (RCN, 2018). My feeling is that by promoting effective communication and being able to relate well to the patient, I significantly improved the accuracy of the diagnosis by proper preparation of the patient for the procedure. Studies show that the ability to connect with patients is essential which explains why the patient felt comfortable under my care (Delaney, 2017). I also discovered that there is a difference in accuracy between manual and automatic blood pressure measurement tools with the automatic one being superior in reliability and validity. Hence in the future, I will use the automatic sphygmomanometer in specific occasions where need arises to improve patient care outcomes.
Nevertheless, carrying out several confirmatory tests is also essential in enhancing the overall effectiveness of the diagnosis process (Delaney, 2017). I felt a range of both negative and positive emotions during the consultation, the patients’ blood pressure was very high,and that disturbed me. In similar situations, I will continue to provide quick referrals and lifestyle education whenever necessary. Generally, the experience helped me understand that I need to research and attend more training opportunities regarding management advocacy on high blood pressure. Also, with more experience and training, I will gain more skills in managing various emotional issues that come with providing care.
Overall, the report offers a reflection on blood pressure by examiningthe process involved in creating a conductive environment for the patient and then taking a measurement using both manual and automatic sphygmomanometer.Taking measures on both arms using multiple diagnoses was important in improving the accuracy of the outcome, considering the fact that patient care is paramount. Other considerations included the positioning of the patient, professionalism and following NMC standards. On reflection, I understood that my positive relationship with the patient, empathy, and compassion contributed significantly to an accurate diagnosis. The experience helped me understand that I am competent, but I also need to attend more training opportunities regarding management of high blood pressure.
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