NURSING STUDENT STORY - MANUAL BP'S

Many healthcare professionals take for granted the basic skills they had to learn when they were beginning their careers. One of those skills is taking manual blood pressures (BP's). Although this becomes easy and comfortable after working in the medical field for a while, for those just learning and just beginning their careers it can be a very stressful and frustrating skill to master.

I remember learning how to take a manual BP early in my EMS days over twenty years ago. I had no medical experience or knowledge and fumbled with every skill I needed to learn. Anybody who walked into the ambulance building had to get their blood pressure checked to make sure I was getting it right. I remember fumbling with the stethoscope trying to make sure it was over the brachial artery while pumping up the cuff and watching the reading. I felt like I needed four hands and an assistant to get the difficult task done correctly. I remembered this the other day because I teach nursing assistant (NA) students. They go through the exact same feelings and frustrations I once did when I was first learning basic skills. When I watched them fumble with the BP cuffs, stethoscopes, and finding the brachial artery I remembered how I learned way back in my early years of medicine.  

Nursing assistant students are “usually” not currently working in the medical field but have the goal of one day becoming registered nurses (RN’s). They are anxious to learn new skills and be exposed to numerous types of patients and their needs. Even “code browns” were a different experience they were willing to undertake just to say they did it without throwing up or passing out. Last week I had a group of NA students who needed to be checked off on manual BP’s. Even though they had done them before it still was a difficult and awkward skill they had to master to pass the course. This was one of the check-offs from the State Board of Nursing to get certified as a CNA.

The NA students were almost done with their course. They needed to be checked-off on several skills which included manual BP’s. Five of them brought their own cuffs they purchased to practice on their family members, neighbors, or anybody else they could grab to master the skill and pass the course. There were ten students and were paired up in twos to get checked off on manual BP’s. All of the students had a concerned look on their face because I (the instructor) was watching them. This always made them nervous. I told them to write down their BP’s without telling their classmates to determine if they were close. I watched them as they tried to put on the cuff with the arrows over the brachial artery.

“That’s not right. It goes this way,” said Stacey. Amber ripped off the Velcro and repositioned the cuff on Stacey’s left arm.

“Not that way. Look at the arrows. It goes this way,” said Stacey in a frustrated voice. Amber looked at the cuff and Stacey’s arm.

“What!?!” said Amber.

“It needs to be tighter,” said Stacey. I walked up behind them.

“You need to get it a little tighter to get an accurate BP,” I told Amber. It was loose enough to almost put all of my fingers up behind it. I took the cuff off of Stacey’s arm and replaced it slightly tighter than what Amber had it showing the two of them the correct way of putting on a BP cuff. Although Stacey was acting like she knew what she was doing she also struggled with BP’s.

“You need to make sure you don’t grab any skin. Especially on the elderly. That can cause pain while you are trying to take the BP,” I told the both of them. Amber watched intently.

“Okay,” said Amber. She then proceeded to put her finger over where she thought the brachial pulse was located. After about thirty seconds and feeling over most of Stacey’s forearm she took the ear pieces out of her ears and looked at me with a frustrated expression.

“I can’t feel it!” said Amber.

I proceeded to show her where the brachial artery was located. She took her fingers and felt where I showed her. She looked at me.

“I can’t feel it!” said Amber.

“Push a little harder. You are not pushing down hard enough,” I told her. She pushed a little harder.

“Ohhhh. There it is,” said Amber as she got a smile on her face. Eagerly she put the ear pieces back into her ears. She pumped up the cuff with the diaphragm of the stethoscope over where she felt the pulse. She pumped the cuff up the 160. Stacey watched her as Amber tried to take her BP. Very slowly Amber started to release the pressure. It was going slow enough to where I knew Stacey’s arm was going numb and tingly. Finally she got to 40 and stopped. Stacey looked at her.

“Let the air out! My arm is numb!” said Stacey.

“Oh. Sorry,” said Amber. She wrote down her reading. Now it was time for Stacey to get Amber’s BP. I hoped she wouldn’t take revenge on the numb arm.

After 45 minutes the students were becoming more comfortable. Several had their ear pieces in awkward and they were shown the correct way of placing them in their ears. There were a few who had the bell turned on and were listening on the diaphragm side. Needless to say they didn’t hear anything and thought their classmate didn’t have a BP. When they realized what they did they felt embarrassed and continued taking their classmate’s BP’s.

By the end of the clinical day most of the ten student’s readings were close to each other. I verified several and the students were within a few numbers from what I had gotten. There were a couple of students who were still struggling and knew they needed to practice more. I told them their healthy classmates had very strong BP’s and pulses while their patients may have difficult BP’s because of their disease processes and health status. They agreed they needed to practice more because their practicum was in two weeks.

I knew the students will do well with the skills they have learned while in the NA course. Taking manual BP’s unfortunately is a skill that needs time to master. There would be many relatives and friends of these students who will be subject to getting their BP checked over and over again. Afterall, they needed to get it right to pass the course.