Undertaking Blood Pressure

Assignment Brief

1. A critical understanding of professional issues that underpins the care provided in relation to your chosen clinical skill. 
2. A critical discussion and debate of the evidence that relates to how the essential skill you have chosen should be undertaken
3. A critical evaluation of evaluation of the potential influence of psychological, social and cultural factors that impacted, or may impact, the nursing care provided when undertaking your chosen essential skill  

Sample Answer

Undertaking Blood Pressure: A Critical Review

Introduction

Measuring blood pressure (BP) is a key clinical skill in nursing practice. It helps in detecting and monitoring conditions such as hypertension and cardiovascular diseases. This essay critically explores the professional issues involved in taking blood pressure, debates the evidence supporting best practice, and evaluates how psychological, social, and cultural factors may affect the process and care given.

Professional Issues in Blood Pressure Measurement

Nurses are expected to demonstrate competence, accuracy, and person-centred care when performing blood pressure checks. This involves following the Nursing and Midwifery Council (NMC, 2018) Code, which sets out professional standards of practice and behaviour. Key issues include:

• Accountability: Nurses must ensure accurate readings and act appropriately on the results.

• Consent and communication: Patients should be informed and asked for verbal consent before the procedure.

• Confidentiality: BP readings and associated health information must be kept private.

• Clinical accuracy: Following guidelines such as those from NICE (2019) and using calibrated equipment is essential to reduce errors.

• Training and competence: Nurses should be regularly trained and assessed in vital sign measurement to maintain professional standards.

Failure to meet these responsibilities can lead to misdiagnosis, patient anxiety, and compromised care.

Evidence-Based Practice in Measuring Blood Pressure

The correct technique for taking blood pressure is well supported by clinical guidelines and studies. Best practice involves:

• Patient Preparation: The patient should be seated comfortably, with legs uncrossed and arm supported at heart level, resting for at least 5 minutes before measurement (NICE, 2019).

• Cuff size: Using the correct cuff size is crucial. A cuff that is too small or too large can give inaccurate readings (Pickering et al., 2005).

• Positioning and technique: The arm should be bare, and the cuff placed 2-3 cm above the elbow crease. Using either a manual sphygmomanometer with stethoscope or an automated device is acceptable, provided they are validated and maintained.

Evidence also shows the value of ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) for more accurate results over time, especially to avoid "white coat hypertension" (O`Brien et al., 2013).

Digital devices are becoming more common in practice due to ease of use, but manual readings are still valuable in certain clinical situations, such as detecting irregular heartbeats or confirming high BP readings.

Psychological, Social and Cultural Influences

When measuring blood pressure, several non-medical factors can influence both the reading and the patient`s experience:

Psychological Factors

• Anxiety and stress: A patient who is nervous may show artificially high readings, known as white coat syndrome.

• Fear of diagnosis: Some individuals worry that a high BP reading means something is seriously wrong, which increases their stress.

• Nurses must remain calm and supportive, explaining the process clearly and answering any questions to reduce anxiety.

Social Factors

• Socioeconomic status: Patients from lower-income backgrounds may have limited understanding of blood pressure and its implications. They may also have reduced access to follow-up care or healthy lifestyle options.

• Literacy: Health literacy plays a role in how patients interpret BP readings and advice. It’s important for nurses to use simple language and visual aids when needed.

Cultural Factors

• Beliefs about health: Some patients may view BP checks as unnecessary or believe in alternative medicine approaches.

• Language barriers: A lack of shared language can lead to misunderstandings or poor compliance.

• Gender roles or religious customs: These may affect whether a patient is comfortable being examined by a nurse of the opposite gender.

To provide person-centred care, nurses must be culturally sensitive, ask about preferences, and respect the patient`s background while still educating them on the importance of BP monitoring.

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