NRSG139 Reflection: Health Assessment (Measurement of Blood Pressure)

This assignment is a reflective journal entry by a nursing student detailing their experience in a clinical setting, specifically focusing on the measurement of a patient's blood pressure. The student recounts the scenario of assessing a 42-year-old male patient in the emergency room who presented with giddiness and a history of hypertension. The reflection utilizes Gibbs' Cycle of Reflection to explore the student's feelings, evaluation of the experience, analysis of the situation, and the development of an action plan for future practice. The student initially experienced nervousness, which affected their ability to accurately measure blood pressure. However, with reassurance from a registered nurse, they were able to successfully complete the assessment. The reflection highlights the importance of clinical knowledge, confidence, and the ability to remain calm under pressure in nursing practice, emphasizing the impact of efficient nursing care on patient outcomes and adherence to NMBA standards. The student outlines a plan to gain further experience and confidence in patient assessment and monitoring.

Reflection: Health assessment (measurement of blood pressure)
1. Description:
I was posted in emergency room. At around 11 am, a 42 year old male, presented with
severe giddiness since morning. Along with me there was a casualty medical officer and a
registered nurse present in the emergency room. I was the nursing student and was
responsible for collaborative nursing care.
The registered nurse had to assess the vitals of the patient.
The doctor was examining the patient’s cardiovascular and respiratory systems.
I was asked by the casualty doctor to measure the patient’s blood pressure.
I politely asked the patient to be comfortable. I encouraged the patient to calm down and
provide me with complete information about his medical condition. I also assured him that
he should not hesitate or be embarrassed to provide accurate information. I then,
proceeded to enquire details about his current problem and also about any past history. I
asked questions relevant to his present condition. In the course of this assessment, I
obtained relevant information that he also had severe headache. He was a known
hypertensive and but was not taking the medication regularly.
I proceeded to assess the patient’s blood pressure. I couldn’t record the blood pressure
accurately the first time. After reassurance from the registered nurse, I tried again and could
accurately measure the blood pressure. I completed the assessment in acceptable time
period. I adopted the appropriate techniques for the assessment.
I compared the results of his blood pressure with normal values. I diagnosed that the patient
had hypertension. I asked for supplementary information such as previous medical records
which he had. I analysed the medical records and noted that he was a known hypertensive
and was prescribed medications. However, in the course of assessment I noted that he was
not taking the prescribed dose regularly. I promptly informed the doctor about his high
blood pressure findings.
The casualty medical doctor prescribed anti-hypertensives to the patient. After 30 minutes, I
recorded his blood pressure again and found that it had returned to normal levels.
I provided the patient education regarding importance of adhering to the medication
dosage. I also counselled him regarding diet modifications and regular exercise. I asked him
to visit for a follow-up after 15 days.
The result of the medical care was that the patient’s blood pressure was restored to normal
and his symptoms of giddiness and headache were relieved.
2. Feelings:
Initially I was a little apprehensive about assessing the patient independently.
I was recollecting all the details about blood pressure measurement which I had learnt
during the course of my practical classes.
At the beginning of the examination of the patient, I was nervous. However, the registered
nurse reassured me about my capability which made me confident. I spoke politely and
confidently to the patient and recorded his blood pressure accurately in acceptable time.
This helped to boost up my confidence. During the event my feelings changed from being
nervous to being confident and able to independently assess an important parameter of the
patient.

Now, I know that I can assist a doctor to provide collaborative nursing intervention and
evaluate and monitor a patient’s parameters especially the blood pressure.
3. Evaluation:
 The bad experience was that due to my nervousness, I could not record the blood
pressure accurately the first time.
 However, the good part was that when I tried again, I could independently evaluate
the patient’s blood pressure which raised my confidence level.
 I was very anxious and therefore could not perform the required examination the
first time.
 However, the registered nurse contributed positively and reassured me. This helped
me to boost my confidence and try again.
 I could successfully measure the blood pressure not once but twice, one
immediately and again 30 minutes after medication.
Nurses play a very important role in patient care and efficient nursing care has a positive
impact on patient outcome (Kieft, Brouwer, Francke & Delnoij, 2014). Appropriate nursing
diagnosis is required based on which interventions can be planned and executed effectively
(Muller-Stuab, Lavin, Needham & Achterberg, 2006). Nursing interventions can be provided
effectively by well trained nurses (Conn, Rantz, Tevis & Maas, 2001; Fernández, Luciano &
Valdivia-Salas, 2012).
4. Analysis:
The event can be broken down into two components.
 One was the initial blood pressure measurement
 The other was the same examination but with reassurance from the registered
nurse.
 The reassurance by the registered nurse had a positive impact on me.
 The first time that I recorded the blood pressure it went wrong and I didn’t get an
accurate reading. Therefore, it didn’t turn out the way it was supposed to, because
the treating doctor relied on me to give the accurate results.
 However, the registered nurse contributed positively and encouraged me to try
again without any anxiety. I could then accurately perform the blood pressure
recording due to less anxiousness.
5. Conclusion:
I have understood the importance of efficient clinical knowledge and judgement in nursing
practice. It is very important for a nurse to be confident and remain calm and composed
during patient evaluation and management. Nervousness and anxiety can result in
unnecessary errors and duplication of work resulting in a loss of critical time. In certain
situations performing evaluation is critical and inability to do so can even prove to be fatal.
I need to develop skills such as gaining self confidence. I need to practice recording blood
pressure of more number of individuals so that I gain the skill to independently and
accurately perform the examination without any hesitation or nervousness. (Ratanasiripong,
Ratanasiripong & Kathalae, 2012). Nursing interventions involve providing treatment by

nurses on the basis of their medical knowledge and clinical judgement with an aim to
improve patient outcome (Meijel, Gamel, Swieten-Duijfjes & Grypdonck, 2004; Bronken et
al., 2012).The nurse providing the intervention is accountable for the outcome (Muller-Stuab
et al., 2006). Efficient nursing care has a positive impact on patient experience (Kieft et al.,
2014; Coburn, Marcantonio, Lazansky, Keller & Davis, 2012).
6. Action plan:
 The action plan is that I need to practice patient evaluation and monitoring on more
number of patients to be able to gain the kind of confidence which a nurse should
possess.
 As per the NMBA Standard 4 on clinical practice, a nurse should be able to be
confident and gain accurate information from the patient.
 The nurse is expected to be polite and should demonstrate good communication
skills to encourage the patient to provide complete information without hesitation.
 The assessment should be completed in acceptable time and should prioritise the
findings.
 As a part of collaborative medical care the nurse should also participate in patient
education and follow-up strategies to provide comprehensive medical care.
References:
Bronken, B.A., Kirkevold, M., Martinsen, R., Wyller, T.B., Kvigne, K. (2012). Psychosocial Well-Being in
Persons with Aphasia Participating in a Nursing Intervention after Stroke. Nursing Research
and Practice, doi:10.1155/2012/568242.
Coburn, K.D., Marcantonio, S., Lazansky, R., Keller, M., Davis, N. (2102). Effect of a Community-Based
Nursing Intervention on Mortality in Chronically Ill Older Adults: A Randomized Controlled
Trial. PLoS Med, 9(7), pp.e1001265.
Conn, V.S., Rantz, M.J., Wipke-Tevis, D.D., Maas, M.L. (2001). Focus on Research Methods Designing
Effective Nursing Interventions. Research in Nursing & Health, 24, pp.433-442.
Fernández, M.D., Luciano, C., Valdivia-Salas, S. (2012). Impact of Acceptance-Based Nursing
Intervention on Postsurgical Recovery: Preliminary Findings. The Spanish Journal of
Psychology, 15(3), pp.1361-1370.

Kieft, R. A., de Brouwer, B. B., Francke, A. L., & Delnoij, D. M. (2014). How nurses and their
work environment affect patient experiences of the quality of care: a qualitative
study. BMC Health Services Research, 14(1).
Meijel. B., Gamel, C., Swieten-Duijfjes, B., Grypdonck, M.H.F. (2004). Nursing Theory And Concept
Development or Analysis. The development of evidence-based nursing interventions:
methodological considerations. Journal of Advanced Nursing, 48(1), pp.84–92.
Müller-Staub, M., Lavin, M. A., Needham, I., & van Achterberg, T. (2006). Nursing diagnoses,
interventions and outcomes ? application and impact on nursing practice: systematic review.
Journal of Advanced Nursing, 56(5), pp.514–531.
Ratanasiripong, P., Ratanasiripong, N., Kathalae, D. (2012). Biofeedback Intervention for Stress and
Anxiety among Nursing Students: A Randomized Controlled Trial. ISRN Nursing,
doi:10.5402/2012/827972.