literature review on blood pressure measurement

This literature reviews located six well-designed studies that used established criteria to determine the common errors occur during blood pressure (BP) measurement with sphygmomanometer. Measuring blood pressure is core procedure taught to nursing students during first semester in nursing school. However, studies have indicated generally poor level of training of BP measurement for nurses and doctors deficit in both performance and knowledge (Cienki et.al 2004, Ahmed (1997). Poor level of BP training will cause error in blood pressure result and will effect diagnosis of patient and treatment.

Findings from these studies tend to confirms that common errors during BP measurement were choosing the right BP cuff. It proved by Drevenhorn.et.al (2001) which concluded , only 9 out 21 public health nurses chose the right cuff. This error occurred because they did not measure the upper arm circumference. The guideline from National Swedish was use as reference. Torrence & Serginson (1996) conducted two studies on student’s knowledge of BP measurement and student’s skill technique during measuring BP. On the first study he concluded that when skill was observed, he identifies that their skill were contrast with their knowledge. Student knows they should choose the right cuff but they don’t know how to choose and measure it. Second study found that 45% of them recognized that a narrow cuff would cause a greater error than wide cuff , 22% thought a wide cuff would cause more error and others doesn’t know about it. It showed major deficit in their knowledge in choosing the right cuff. Both studies were using American Heart Association, the Heart Society guidelines.

Study by Ahmed (1997) determined that majority of participants had a poor knowledge of the correct length cuff and nurses score better (25.5%) than junior hospital staff (7.5%) and consultants (10.7%). When the width of the cuff was asking, nurses score is the highest (52.8) among others.It is because nurses always performed the procedure in the ward but not for others. Armstrong (2002) study is on knowledge of error on BP measurement among nurses.From the study,57% nurses give the correct answer on how to assess for the correct cuff but it still show the deficit in their knowledge.Bland and Ousey (2011) research doesn’t state on errors during blood pressure measurement but he identified reason of student cannot perform blood pressure measurement. The result showed that students are lack of confident if not supervised by mentor , if the mentor did not use double headed sthetescope and lack of supervision. The usage of automatic blood pressure also cause the students  unable to perform well.

Most studies suggest ways to prevent this error. Torrence & Serginson (1996) suggest that teaching and practice need to be asses and review within nursing curriculum, Ahmed (1997) suggest that nurses and all practitioners should improve their technique and educational programme should be develop and implement as part of continuing medical education. In Armstrong (2002) study , many participants suggest that they need to update their knowledge and skills.

The main different between the studies were the participants involved. Two studies were using staff nurses, three studies used nursing students and one study is mixed participants as a sample. Studies varied in sample size, different guideline and study design. Three studies used questionnaire to identify their knowledge and three used demonstration method. The similarities in these study are the participants is among hospital staffs that have been taught on BP measurement during their study period.

From all the research paper that I search, there is no recent study done which I mean from 2009 and above. Many studies are around 1990’s . Latest research should be done with latest guidelines to identify latest error done by student and practitioner since many private college produced nurses which people identified them as “producing quantity nurse not a quality nurse”. This trend should be observed more deeply. It is clear from the review that further study are need to identify both skills and knowledge of participants in one study because most of the study do separate study either observations on the skills or questionnaire on the knowledge. It is because skill and knowledge need to be together to produce practitioner with the analytical skills to become ‘knowledgeable doer’ (Serginson and Torrance 1996). These study need to use the standard guidelines, choosing the sample among all level include students, nurses, houseman and consultant and use both questionnaire with Likert scale and observation method.

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