Blood pressure measurement is a basic but very significant skill for nurses and other healthcare professionals in gaining vital information about a patient’s health which is fundamental for the purposes of diagnosis, monitoring and treatment. Blood pressure is essentially the force exerted by the blood on the internal wall of the blood vessels.
This is the force that keeps blood circulating in the body and moving from high to low pressure areas (Marieb, 2015). The heart, blood vessels and kidneys are required to work collectively with the brain to regulate normal blood pressure (Marieb, 2015). Blood pressure is therefore one of the vital signs just as important as respiratory rate, oxygen saturation, heart rate and temperature. Blood pressure is universally measured in mmHg (millimetres of mercury) with two different readings, namely the systolic and diastolic figures. The systolic figure articulates the pressure in the blood vessels in synchronicity of when the heart beats and the diastolic figure articulates the pressure in the blood vessels while the heart rests between the heartbeats. The average resting blood pressure in a healthy adult is considered to be in the range of between 110-149 mmHg systolic and 70/80 mmHg diastolic (Marieb and Hoehn, 2010).
High blood pressure (Hypertension) is when the systolic figure is higher than the average range, which is usually the warning indicator for cardiovascular disease, or the side-effects of some medications and also caused by trauma. On the other hand, low blood pressure (Hypotension) is when the systolic figure is lower than the average range, thus indicative of hypovolaemia, cardiogenic trauma or septic shock. Blood pressure can be measured manually using Sphygmomanometers either electrically with an automated device or via auscultation with a stethoscope. The known manual blood pressure measuring devices are mercury Sphygmomanometers and aneroid Sphygmomanometers. In recent years clinical staff have been dependent on automated blood pressure measuring devices. The accuracy and reliability of these devices however have been debated, particularly in patients with arrhythmias (Cork, 2007). This is supported by NICE guidelines who suggest that blood pressure should be measured manually using direct auscultation over the brachial artery if automated devices cannot gauge patient blood pressure accurately due to pulse irregularity (arrhythmia) (NCGC, 2011). The Medicine and Healthcare Products Regulatory Agency (MHRA, 2013), still consider the manual BP measurement as the ‘gold standard’ in measurement accuracy.
The argument now arises regarding fully depending on automatic devices and thus the loss of manual BP measurement skills amongst healthcare professionals. However, an alternate viewpoint exists which suggests that in order to gain an accurate BP reading, it is less of an importance whether manual or automatic measurements are taken and more important to use an appropriate cuff size (British Hypertension Society (BHS), 2009). This article will demonstrate the nurse’s skilled role in measuring blood pressure manually and the challenges faced while performing the measurement.