Assessment task 3:Evaluation of practice Essay Example

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Assessment Task Three, Evaluation of Practice: Manual Blood Pressure versus Automated Blood Pressure


Assessment Task Three, Evaluation of Practice: Manual Blood Pressure versus Automated Blood Pressure

The area of practice where I have a particular interest is the measurement of blood pressure using the manual and automated methods. It is important to know the method of blood pressure measurement that suits a particular state of the patient. In other words, my main interest is to know the circumstances under which manual blood pressure should be used, and the circumstances under which automated blood pressure measurement should be used. In addition, it is important to know which method should receive greater preferences and the reasons for its preference.

There are differing opinions among nurses, concerning the use of manual and automated methods of blood pressure measurement. Many nurses tend to believe that the automated method is unreliable, and they, therefore, prefer to use the manual method. The Dinamap 8100 machine measures blood pressure in the automated method. Studies reveal that nurses have observed that the machine tends to over-read the systolic blood pressure and it under-reads the diastolic blood pressure. The Welch Allyn “Vital signs monitor” is another machine that measures blood pressure automatically. Nurses have observed that the machine under-reads both the diastolic and systolic blood pressures (Heinemann, Sellick, and Rickard, et al. n.d: 4).

The differences that the machines use in automated blood pressure measurement yield are of clinical significance. Comparing the automated method to the manual method, nurses observe that the latter gives accurate readings, and is therefore better than the automated method (Heinemann, Sellick, and Rickard, et al. n.d: 4).

The Liverpool hospital is a health organization that has a clear policy that guides how the nurses should measure blood pressure using the two methods. The title of the policy document for the hospital is “Observations of Adult patients”, and the policy document has the approval of the general manager and the director of nursing and midwifery services at the hospital. The approval shows that the policy is effective in the hospital, and it guides all the practices, including the methods that the nurses apply in the measurement of blood pressure. Another organization that has a policy that guides the measurement of blood pressure is the Bankstown-Lidcombe Hospital in Southwest Sidney. The policy directive has the title “Blood pressure measurement and recording”, and it has the approval of the nursing practice committee and the OH&S committee.

The policy at Liverpool hospital recommends that the manual method should be used when the patient’s blood pressure is out of the normal range, and during CSR/MET. The policy outlines the requirements that the nurses should observe when measuring BP manually. It requires the patient to be at rest, without engaging in any physical activity for 20 minutes. The patient’s arm should not have any restrictive clothing, and the nurse should check the patient’s health records for any contraindications. The nurse should also select the right cuff for the patient. The guideline for the right cuff in the policy states that it should be 40% of the circumference of the patient’s limb at the midpoint. The nurse should also support the arm at the level of the heart. The policy also guides the nurse on how to handle the cuff. It states, for example, that the nurse should remove the cuff when the patient is at a stationary position (Liverpool, 2014: 5-6).

The Bankstown-Lidcombe Hospital (2009) policy document gives similar guidelines on the procedures that nurses should follow when measuring the blood pressure of their patients. It also gives the guidelines for taking postural BP, stating that under the measurement, the BP of the patient is measured when he is lying and when he is standing. When taking the patient’s BP while he is lying, the nurse should keep the patient’s posture at 450. The nurse should also check the patient for dizziness when taking the postural BP at the standing position. When measuring the BP, the two policy documents state that the nurse should take the diastolic and systolic pressures.

The following is the research question for my paper. I have developed the question using the PICO format. What are the patient problems, interventions, comparison, and outcomes in the use of manual and automated methods of blood pressure measurement? The question shall help me to collect data that shall show the patient problems that are suitable for manual and automated methods of BP measurement; it will enable me to compare the two methods of measuring blood pressure; the interventions that the nurse should use when measuring BP using the two methods, and the outcomes that the nurse has to expect after using the methods. My policy covers the research question, as it addresses the area of interest of measuring a patient’s blood pressure using manual and automated methods.

I conducted my search for the highest level of evidence by visiting different professional websites that publish journal articles in the field of nursing. I selected the peer reviewed journal articles that address the issue of measurement of blood pressure using either manual or automated method. I ensured that each of the article tackled the issues in my research question, which are patient problems, interventions, comparison (of the two methods), and the outcomes of the methods of BP measurement. I selected three research articles, which I considered to possess the highest evidence on the measurement of blood pressure using the two methods.

Fostner, Tholl and Anlauf (2014) study looks at the pitfalls of blood pressure measurement using manual and automated methods, and it gives the recommendations on how nurses should overcome such problems. In their abstract, Fostner, Tholl and Anlauf (2014:1) state that the use of a hand cuff with a mercury manometer for measuring blood pressure has existed for a long time (100 years), and it has gained a world-wide application in clinical and hospital settings. New technical developments have occurred in the area of blood pressure measurement, and they have affected the accuracy of the measurement of blood pressure. The automated methods, according to Fostner, Tholl, and Anlauf (2014:1) have a lower accuracy of measuring BP, and nurses should be aware of the inaccuracies. They should preferably use the manual method, which has registered long time trusted accuracy in the area of BP measurement.

The Myers, Godwin, and Dawes et al. (2011) research is a randomized designed control study that measures the accuracy of conventional (manual) and automated methods of BP measurement. In their abstract, the researchers state that their objective is to measure the blood pressure of patients using the two methods, and compare their accuracies. The gold standard that they use is the “awake ambulatory blood pressure”. They conduct their study within the setting where there are primary care practices in Canada. They use 555 patients who have systolic hypertension. The patients do not have serious comorbidities. They are under the care of eighty-eight primary care physicians in the hospital setting (Myers, Godwin, and Dawes, et al. 2011:1).

Kaczorowsky, Dawes, and Gelfer (2012) is a research study that focuses on the new development in the area of measurement of blood pressure, and the challenges that have emerged from the new methods. I selected this study because it looks at the area of my interest. Unlike the previous two studies, which largely focus on comparing manual/conventional and automated methods, the study looks at the newly emerging methods, especially the automated methods, and the challenges that they present to the nurses, which may affect the accuracy of the readings. The problem that the study focuses on is the High Blood Pressure (HBP) disease, which is a different patient problem from other two researches. The evidence that the research gives, therefore, applies to patients with HBP, creating a beneficial variation in the evidence that I present. The abstract of the study emphasizes on the need for accurate BP readings, and that nurses must appreciate the modalities of the new methods of BP measurement (Kaczorowsky, Dawes, and Gelfer, 2012:1).

Foster, Tholl, and Anlauf present evidence that shows that the automated method, which uses the mercury sphygmomanometer is not a reliable method of measuring blood pressure (2014:1). Although the method may have high degree of accuracy, several research studies have revealed the practices that contribute the reduction of the accuracy of the automated method, which give it inaccurate readings of the diastolic and systolic blood pressure measurement. Liverpool Hospital (2014:5) policy document states that the automated method gives the wrong readings for both diastolic and systolic BP measurements. Foster, Tholl, and Anlauf (2014:1) give the reasons that can lead to the inaccuracies of the BP measurements using the method. The researchers state that in one study that surveyed the maintenance of the mercury sphygmomanometer in a nurse teaching facility, only 5% of the equipment underwent maintenance. In the general practice environment, only 30% of the devices received maintenance. 50% of the manometers also had defects, issues which contributed to their inaccurate readings. On the basis of comparing the outcomes of the two methods of measuring BP, Foster, Tholl, and Anlauf established that the manual method is more accurate that the automated method, a finding that the two policy documents support.

Myers, Godwin, and Dawes et al. (2011); and Kaczorowsky, Dawes, and Gelfer (2012) show the patient problems during the measurement of blood pressure. Kaczorowsky, Dawes, and Gelfer (2012:1) state that Hypertension or high blood pressure is a problem that increases with the patient’s age. The problem is, therefore, common in the aging patient population. The use of postural blood pressure measurement should be done carefully, with a lot of patient support. The patients with hypertension are commonly old people. In addition, depending on the duration of the patient’s stay in the hospital, the patient may be too tired, and the postural method of BP measurement may be unsuitable. Bankstown-Lidcombe (2009:3) and Liverpool Hospital (2014:6) policies warn that nurses should not use postural method if the patient is too tired, or they should offer the patient with the necessary support.

In the Myers, Godwin, and Dawes et al. (2011) study, the problem of the patients is systolic hypertension. The patients do not have serious comorbidities. Unlike in the other study, the patients in this study are strong enough and the use of postural blood pressure measurement is suitable. Myers, Godwin, and Dawes (2011:1) also show the interventions that the nurses undertook during the measurement of the BP, and he outcomes of the measurement. Checking the patient’s enrolment record, an issue which the Liverpool Hospital policy emphasizes, is one of the interventions during BP measurement. The nurse knows the history of the patient’s BP measurement. Also, the nurse must compare the blood pressure readings before the enrolment of patient, and after their enrolment. The nurse must also compare all the readings to the “awake ambulatory blood pressure” of the patient. The outcome of research established that the introduction of the automated method greatly reduced the accuracy of the readings, when its results were compared with the “awake ambulatory blood pressure” and the readings from the manual method.

Several barriers exist in the use of automated method compared to the manual method. The manual method is technologically simple, as it only involves the use of an air-filled hand cuff, which has mercury, and a stethoscope. The nurse uses the stethoscope to monitor the blood pressure, and observes the mercury readings on the handcuff. The clinician places the stethoscope of brachial artery, from which he listens to the pulses. However, the barrier of the manual method is that it depends on the accuracy of the clinician to read the indications of the blood pressure. The method, like any other procedure for measuring blood pressure, is not suitable when the patient is under unrest. The presence of the clinician (physically) can cause panic in the patient, a factor which reduces the accuracy of the readings under the manual method. The method, therefore, requires a high degree of accuracy of the clinician who takes the readings, and the nurse/clinician must use approaches that make the patient to relax for the best results.

Low maintenance of the machines and devices, which the nurses use in the automated method of blood pressure measurement, can be a crucial barrier to the accuracy of the readings. However, the automated method beats the challenge of the physical presence of the clinician in the room, which can create discomfort in the patient, and interfere with the accuracy of the readings. The Foster, Tholl, and Anlauf research evidence shows only 5% of the devices in nurse training institutions, and 30% in patient treatment centers, undergo maintenance. The remaining 95% of the devices in the nurse training institutions, and 70% in the treatment centers, have high chances of giving inaccurate readings because of the problem of low maintenance. The high level of lack of maintenance in learning facilities reduces the competence of the nurse trainees in making accurate readings; while the low levels of maintenance in hospitals and clinics lead to wrong readings of blood pressure. Maintenance is, therefore, a barrier that the hospitals and nurse training institutions must consider keenly, to increase the accuracy of readings using the automated method. Their competence in making accurate readings is crucial in the manual method.

The use of mercury sphygmomanometer, which the manual method highly relies on, has the barrier of the disappearance of mercury from the workplace. The method has been in application for a very long time (100 years) according to Mayers, Godwin, and Dawes et al. (2011:1). However, the environmental changes are reducing the availability of mercury in the hospital setting at a considerably first rate, which means that the manual method will become less popular with time. Mayers, Godwin, and Dawes (2011:1) recommend that hospitals and home caregivers should quickly solve the barriers of the automated method of blood pressure measurement, as it may become the most reliable method in the near future. Lack of mercury, means that the handcuff manual method will become inapplicable in the future. Challenges/barriers such as low maintenance of the devices and machines for the automated method, high accuracy of the clinicians, and proper training on the use of the automated method, are necessary recommendations that the healthcare institutions/hospitals and the nurse training institutions must implement.


Bankstown-Lidcombe Hospital. 2009. Blood Pressure Measurement and Recording. Sydney

Southwest Area Health Service: NSW Health (pdf).

Fostner, K., Tholl, U., & Anlauf, M. 2014. Measuring Blood Pressure: Pitfalls and

Recommendations. Oxford Journals: Nephrology Dialysis Transplantation. Retrieved on May 5, 2014 from

Heinemann, M., Sellick, K., Rickard, C., Reynolds, P., & McGrail, M. n.d. Automated versus

Manual Blood Pressure Measurement: A Randomized Crossover Trial. Retrieved on May 5, 2014 from,d.ZGU

Kaczorowsky, J., Dawes, M., & Gelfer, M. October, 2012. Measurement of Blood Pressure: New

Developments and Challenges. In BCMJ, Vol. 54 (8). Retrieved on May 5, 2014 from

Liverpool Hospital Policy Guideline Manual. 2014. Observations of Adult patients: Blood

Pressure (BP) Measurement. South Western Sydney Health District: NSW Government (pdf).

Myers, M.G., Godwin, M., Dawes, M., Kiss, A., & Tobe, S.W. February 7, 2011. Conventional

versus Automated Measurement of Blood Pressure in Primary Care Patients with Systolic Hypertension: Randomized Parallel Design Control Trial. In BMJ. Retrieved on May 5, 2014 from