Measuring And Reporting Vital Signs Of Blood Pressure

Measuring And Reporting Vital Signs Of Blood Pressure

1.0 Manual Blood Pressure Measurement

Nurses have a specific responsibility to accurately assess, screen, and monitor individuals, which includes measuring blood pressure (BP). Blood pressure measurement is the primary tool used to confirm the diagnosis of hypertension and classify individuals based on their blood pressure levels (Dai et al., 2021). It also helps identify the risks associated with high blood pressure and guides interventions for controlling it (Waguespack & Dwyer, 2019)Measuring And Reporting Vital Signs Of Blood Pressure. Additionally, blood pressure measurement is crucial in evaluating the effectiveness of interventions and assessing the outcomes of these interventions.

Numerous studies conducted over several decades have shown variations in the practice of blood pressure measurement among healthcare professionals. These studies have also highlighted the lack of adherence to blood pressure measurement guidelines (Rana et al., 2022). These variations and lack of adherence compromise the accuracy of blood pressure readings, leading to reduced effectiveness in preventing, diagnosing, and controlling hypertension. Furthermore, this can result in poor disease outcomes, increased healthcare costs, and premature mortality. Nurses need to follow standardized guidelines for blood pressure measurement to ensure accurate readings and improve patient outcomes (John et al., 2021)Measuring And Reporting Vital Signs Of Blood Pressure. By doing so, they can contribute to the effective prevention, diagnosis, and control of hypertension, leading to better overall public health.

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1.1 Course Objectives

By the end of this assessment training, the student will be able to:

1. Understand the cardiovascular system and its components and how they maintain overall health.
2. Explain the role of blood vessels, heart, and blood in regulating and sustaining blood pressure.
3. Understand important blood pressure terminology and how to interpret and assess cardiovascular health.
4. Understand the importance of precise blood pressure measurement in evaluating and monitoring cardiovascular health.
5. Master the technique of placing the blood pressure cuff and interpreting blood pressure sounds.
6. Interpret blood pressure readings accurately and document them in patient records.
7. Understand factors that can affect blood pressure readings and how to account for them during manual measurement

1.3 Defining Blood Pressure

Blood pressure is the force exerted by the blood against the walls of blood vessels. It can be categorized into arterial, capillary, venous, and heart pressure. Systole refers to the contraction of the heart muscle, while diastole refers to its relaxation. Both systolic and diastolic pressures are measured. Systolic Blood Pressure (SBP) is the force required to pump blood from the lungs into the arteries. It is determined by the first tapping sound heard during measurement (Korotkoff Phase 1). Diastolic Blood Pressure (DBP) is the pressure in the arteries when the heart is at rest. It is determined by the last tapping sound heard when the pressure cuff is deflated (Korotkoff Phase IV)Measuring And Reporting Vital Signs Of Blood Pressure. SBP represents the higher pressure, while DBP represents the lower pressure. Monitoring blood pressure is essential for assessing cardiovascular health.

In this course, the focus will be on arterial blood pressure. This pertains to the force per unit area applied on an artery by the blood flowing through its lumen. The regulation of arterial blood pressure is influenced by several factors, including the volume of blood present in the artery, the intensity of the heart muscle’s contraction, the tension of the arterial wall, and the viscosity of the blood.

1.4 Sites for Blood Pressure Measurements

Measurement sites include the upper arm, thigh, forearm/leg, and intra-arterial. The upper arm is one of the commonest sites where measurements can be taken. Another site for measurement is the thigh. The forearm or leg can also be used as a site for measurement. Intra-arterial measurement is an invasive method of measuring certain parameters (van Helmond et al., 2020).

1.5 Requirements for Taking Manual BP Measurement

Manual BP measurement using the sphygmomanometer has been considered the gold standard for measuring accurate blood pressure despite being phased out in the US practice due to the use of mercury in the scales. To measure arterial blood pressure in the brachial artery, it is essential to have a functioning manual BP machine that is well-serviced. The machine should also have an appropriate cuff size, which is approximately 40% of the arm circumference, measured midway between the acromion and olecranon or 2/3 of the arm length Measuring And Reporting Vital Signs Of Blood Pressure.

• A stethoscope is another crucial tool required for this procedure. The stethoscope allows the healthcare professional to listen to the sounds of blood flow in the brachial artery, which helps determine blood pressure accurately.
• An appropriate observation chart is necessary to record the measured blood pressure readings. This chart helps in documenting the patient’s blood pressure over time, allowing for better monitoring and analysis of any changes or trends.
• It is also important to have paper or a recording device to document the findings for reporting purposes. This ensures that the measured blood pressure readings are accurately recorded and can be easily shared with other healthcare professionals or included in the patient’s medical records.

1.6 Steps in Manual BP Measurement

1. Step 1: Consent and Positioning: Begin by explaining the procedure to the patient, seeking their consent, and ensuring they are in a comfortable position with their forearm supported at heart level and their arm supinated. Ensure that the upper arm is completely exposed by removing any tight clothing. This step ensures cooperation. The influence of cooperation can be effectively appreciated by considering the impact of arm positioning on blood pressure. It has been observed that blood pressure tends to rise when the arm is positioned below the level of the heart, while it decreases when the arm is positioned above the heart level. By understanding and utilizing this knowledge, you can promote cooperation to reduce the impact of confounding positional factors.
2. Step 2: Positioning of the Sphygmomanometer: Place the sphygmomanometer on top of the patient’s bed or locker and ensure it is at the same level as the patient’s heart. This allows for correct reading by minimizing the impact of atmospheric and postural factors on blood pressure.
3. Step 3: Zeroing the cuff and measurement: Completely deflate the bladder cuff and check the zero point. Test the pump to ensure it is moving freely. This step affirms the equipment’s fitness for use and effectiveness in minimizing the risk of BP measurement errors.
4. Step 4: Palpation of the brachial artery and placement of the cuff: To take a blood pressure reading, first locate the brachial artery in the inner elbow area. Then, position the cuff so that the center of the inflatable part covers the pulsation of the artery. Wrap the cuff firmly and evenly around the upper arm, ensuring that the bottom edge is 2 cm above the medial elbow crease where the stethoscope will be placed. This step enables accurate identification of the artery. Positioning the bladder directly over the brachial artery guarantees efficient compression of the artery while inflating the cuff. This also ensures an even distribution of pressure, resulting in precise readings.
5. Step 5: Inflation of the cuff: Using your non-dominant hand, gently feel the brachial artery using your fingertips. Employ your dominant hand to close the valve on the pressure bulb and gradually inflate the cuff until the pulse is no longer detectable. Observe the level of mercury at which the brachial pulse disappears and proceed to inflate the cuff an additional 30mmHg beyond that point. The valve’s closure effectively stops any air leakage, allowing for an accurate estimation of the systolic blood pressure reading by observing the point at which the brachial pulse disappears. By inflating the blood pressure cuff with 30mmHg above the systolic blood pressure, one can identify an approximate baseline systolic blood pressure reading without the risk of underestimating it. Measuring And Reporting Vital Signs Of Blood Pressure
6. Step 6: Auscultation: Place the earpieces of the stethoscope on your ears and position the diaphragm over the brachial artery site.
7. Step 7: Deflation: Gradually release the pressure on the cuff by 2-3 mmHg by opening the valve while carefully monitoring the Korotkoff sounds. Take note of the pressure level at which the initial Korotkoff sound is detected. This pressure indicates the onset of phase V. As the cuff deflates, the artery gradually opens up, allowing blood to flow through. The first Korotkoff sound signifies systolic blood pressure, while the last sound indicates diastolic blood pressure. The artery permits an increased blood flow when the cuff is fully deflated, resulting in a reduction of pressure. As the flow becomes more laminar, the sounds become less distinct. The initiation of laminar flow is indicated by the final Korotkoff sound, which aligns with the diastolic pressure.
8. Step 8: Retake the blood pressure. After waiting at least 60 seconds, repeat steps 3 to 7. This particular action facilitates the restoration of the mechanisms responsible for regulating blood pressure to their usual state following the occlusion of the brachial artery.
9. Step 9: Conclusion of the process: Conclude the procedure by fully deflating the cuff and carefully removing it from the client’s arm while assisting the patient in assuming a comfortable position. This demonstrates the completion of the process and allows the patient to engage in other activities as desired. Ensure infection prevention and control measures by removing the stethoscope from the ears and thoroughly cleaning the earpiece with an antiseptic solution. This step helps to maintain a hygienic environment and minimize the risk of potential infections.
10. Step 10: Proper Equipment Storage and Documentation: Properly store equipment to ensure safety and preparedness for future use. By storing equipment appropriately, we can minimize the risk of accidents or damage and ensure that it is readily available when needed again. Document the patient’s blood pressure at first and second measurements, then the average of the two, and any abnormal findings to ensure continuity of care. By recording and noting any abnormalities, healthcare professionals can maintain a comprehensive and accurate record of a patient’s condition and ensure that the process is patient-focused and also aimed at acting on any abnormalities. This information is crucial for providing consistent and effective care, as it allows for proper monitoring and follow-up actions to be taken. Measuring And Reporting Vital Signs Of Blood Pressure

Part Two: Assessment of the Learner’s Skills and Application: Scoring guide

Skill: Manual Blood Pressure Measurement	Satisfactory (Yes/No)	Unsatisfactory (Yes/No)	Assessor’s comments on what the learner missed or performed excellently, also areas for future learning
The learner explains the procedure to the patient and seeks their consent.
Positions the patient’s arm and sphygmomanometer correctly
Deflates the  cuff and ensures the reading at baseline is zero
Locates the brachial artery correctly
Places the cuff correctly
Inflates the cuff to a reading that exceeds the point of loss of brachial pulse
Auscultates over the brachial artery and notes Korotkoff sounds
Appreciates the patient and assists the patient in becoming comfortable
Removes the cuff and records the reading
Repeats the process or demonstrates the intention to retake the BP

 

Part Three Explanation of the Assessment

The learners demonstrated a satisfactory performance, achieving key objectives in different areas of the procedure. Notably, they effectively conveyed the procedure to the patient, obtained consent, and displayed empathy in ensuring the patient’s comfort. The learners exhibited proficiency in crucial skills such as correctly positioning the patient’s arm and the sphygmomanometer, accurately placing the cuff, and inflating it precisely beyond the point of pulse loss. However, after competently performing auscultation over the brachial artery, two learners used the bell instead of the diaphragm to auscultate the Korotkoff. The majority identifying Korotkoff sounds reflected a strong understanding of the fundamental concepts. Generally, the learners showcased their competence by successfully meeting the goals and requirements of the procedure.

I identified gaps and areas for future learning. The learners achieved a baseline reading of zero after cuff deflation, but there is room for improvement in obtaining consistent and precise readings. Techniques for cuff placement and locating the brachial artery could be refined to enhance the accuracy of blood pressure measurements. One learner forgot and tied the cuff too tight, while one made it too loose. These skills are important in ensuring BP accuracy. Some learners should continuously improve pressure control during cuff inflation for optimal results. I also identified the difference in the speed and precision in locating the brachial artery. Some took longer, but I finally achieved this step independently. Enhancing the speed and precision in locating the brachial artery could further enhance the overall accuracy of the blood pressure measurement process.

When it comes to engaging with patients, learners showcased empathy; however, there is room for improvement in their ability to build rapport and create a more comfortable environment for the patient. To achieve this, learners should focus on enhancing their techniques for establishing a strong connection with patients. Although learners generally maintained accuracy in their documentation practices, there is an opportunity to adopt a more comprehensive approach. This would ensure that blood pressure readings are recorded with utmost clarity and completeness. By implementing such an approach, learners can enhance the overall quality of their documentation. The manual only provided a rationale for documenting but did not reinforce the need for completeness, especially in including time and biodata in the documentation.

All learners demonstrated satisfactory commitment to quality assurance by expressing their intention to repeat the process when necessary. However, it would be beneficial for them to review the protocols that defend why the repeat measurement is warranted further. Filling this gap would provide learners with a more nuanced understanding of when and why repeat measurements are necessary, ultimately improving their ability to ensure accurate results. Measuring And Reporting Vital Signs Of Blood Pressure

Room for Improvement

The assessment conducted demonstrated the achievement of critical objectives on effective communication, technical proficiency, patient-centered care, and acute observational skills. Recognizing these accomplishments while addressing areas for improvement will contribute to the continuous growth of these nursing students as competent and compassionate healthcare practitioners. The evaluation of manual blood pressure measurement indicated that the learners effectively met several crucial objectives essential to mastering this critical nursing skill. One of the significant accomplishments was the successful communication of the procedure to the patient and obtaining their consent, showcasing the learners’ dedication to ethical and patient-centered care. This aligns to ensure that healthcare practitioners possess not only technical proficiency but also the ability to communicate and engage effectively with patients.

This demonstrates a strong comprehension of the anatomical and physiological aspects of blood pressure measurement, fulfilling the objective of mastering the fundamental principles of the procedure. The learners competently performed auscultation over the brachial artery and accurately identified Korotkoff sounds, highlighting their achievement in developing acute listening skills necessary for precise blood pressure assessment. The successful execution of these tasks underscores the goal of cultivating acute observational skills, which are vital for accurate blood pressure assessment. The learners’ proficiency in these areas reflects their commitment to continuous improvement and their dedication to providing high-quality healthcare. By acknowledging their achievements and addressing areas for improvement, these nursing students will continue to develop into skilled and compassionate healthcare practitioners.

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References

Dai, H., Bragazzi, N. L., Younis, A., Zhong, W., Liu, X., Wu, J., & Grossman, E. (2021). Worldwide trends in prevalence, mortality, and disability-adjusted life years for hypertensive heart disease from 1990 to 2017. Hypertension, 77(4), 1223–1233. https://doi.org/10.1161/hypertensionaha.120.16483

John, O., Campbell, N. R. C., Brady, T. M., Farrell, M., Varghese, C., Velazquez Berumen, A., Velez Ruiz Gaitan, L. A., Toffelmire, N., Ameel, M., Mideksa, M., Jaffe, M. G., Schutte, A. E., Khan, T., & Lopez Meneses, L. P. (2021). The 2020 “WHO technical specifications for automated non-invasive blood pressure measuring devices with cuff.” Hypertension, 77(3), 806–812. https://doi.org/10.1161/HYPERTENSIONAHA.120.16625

Rana, S. R. L., Thapa, B., Budhathoki, L., Rajaure, Y. S., Shrestha, B. K., Mahat, B., Dhungel, S., & Amatya, T. M. (2022). Knowledge regarding blood pressure measurement among first and second-year undergraduate medical students: A descriptive cross-sectional study. JNMA; Journal of the Nepal Medical Association, 60(247), 299–302. https://doi.org/10.31729/jnma.7413

van Helmond, N., Day, W., Martin, S. S., & Plante, T. B. (2020). Cuff-less, personal, ambulatory blood pressure devices and disruption of existing blood pressure measurement paradigms. American Journal of Hypertension, 33(9), 813–815. https://doi.org/10.1093/ajh/hpaa090

Waguespack, D. R., & Dwyer, J. P. (2019). Assessment of blood pressure: Techniques and implications from clinical trials. Advances in Chronic Kidney Disease, 26(2), 87–91. https://doi.org/10.1053/j.ackd.2019.02.002 Measuring And Reporting Vital Signs Of Blood Pressure

Assessment & Explanation: Assessment of ability to initiate Peripheral Intravenous (IV) Access

 

Many students in the nursing program plan to pursue a career in acute care nursing – which is essentially hospital-based nursing. One of the most vital skills to have in this setting is the ability to initiate a peripheral IV access, as patients receive a good number of medications through the intravenous route. As such, I decided to issue a formative assessment to evaluate the students’ ability to initiate a peripheral IV access in the laboratory portion of my Introductory to Medical Surgery class during their midterm week.

 

Prior to coming to lab, students must complete assigned modules which includes videos demonstrating the assigned skills for the week on our nursing skills platform (ATI learning). They must complete a pre-test (no minimum score required) that assesses their knowledge of the topic prior to completing the module and a posttest (after completion of the module scoring at least 80%) to demonstrate assimilation of the knowledge learned.

 

Given the aforementioned, I enter into the lab environment expecting my students to have gained an understanding of the knowledge behind the skill and have familiarized themselves with the steps involved to demonstrate this skill in the lab environment.  During week 2, I review this skill and demonstrate it to the students. After ensuring that they have a good understanding on the demonstration of the skill, and they have asked questions as needed, I then ask them to practice on their own to ensure proficiency. I observe each of them as they re-demonstrate the skill to me, correcting any wrong techniques.

 

I inform them during week 2, that on their 8^th lab week, an assessment wherein they would demonstrate their competency in initiating a peripheral IV access, would occur. My hope was that the combination of learning about the skills through completion of the module (with a posttest score of 80%), watching my demonstration of the skill in lab during week 2, and re-demonstrating the skill to me during week 2, they would obtain competency in the skill (demonstrated by the formative assessment during week 8).

 

Overall, the goals of the assessments are:

 

1. To ensure that my students can insert a peripheral IV in a competent and safe manner. Thus, any changes in techniques, or unsafe practices can be noted and corrected to achieve competency of the skill.
2. To increase the comfortability of the student and to reduce the anxiety that the student may feel when their competency of a skill is being assessed in future lab or clinical settings. Throughout their student nursing clinicals and future skills labs, they will be incessantly observed; hence, this would serve as additional preparation for the future.
3. To ascertain competency of this skill for future clinical practice.

 

 

Scoring guide for the above assessments follow:

 

 

 

Student’s Name ____________________________________________________

Date: _____________________________________________________________

Faculty’s Name: _____________________________________________________

Pass/Fail/Remediate: ________________________________________________

 

 

 

Skill: Peripheral Intravenous (IV) insertion	Satisfactory	Unsatisfactory	Evaluator’s comments
*Verify prescription for peripheral vascular access, including the purpose of access
Gather necessary supplies
*Verify client identification
Introduce yourself to the client, provide privacy as needed
Determine whether the client has allergies
Provide client education
*Perform hand hygiene
Adjust the client’s bed to a comfortable working level
Assess the client for an appropriate site for peripheral access based on client condition and reason for access
Select the appropriate catheter size for location and purpose of IV
Position the client in low-Fowler’s and place a towel or protective pad under the client’s arm
*Apply clean gloves
Prepare supplies, including IV catheter, extension tubing, and dressing
*Select and palpate the appropriate vein
*Cleanse the area with 0.5% chlorhexidine or per facility policy, using a gentle, but from back and forth motion. Allow to dry completely
Apply tourniquet
*Do not touch insertion site after cleaning the skin
Using nondominant hand, hold the skin taut about 1 to 2 inches below the venipuncture site and anchor the vein
*Align the IV catheter with the vein, with bevel side up. At a 10- to 30-degree angle, puncture the skin. Advance the needle into the vein.
Once blood is visible in the flashback chamber, continue to advance the catheter about 0.25 inches into the vein
*Advance the catheter off of the needle and into the vein, When needle is completely out, activate safety device.
*Release the tourniquet
Apply pressure to vein above insertion site to prevent bleeding
Quickly attach extension tubing to IV catheter hub
Stabilizing the catheter, pull back on the syringe to assess for blood return. Then flush the IV site with the saline, observing for signs of infiltration or leaking. Remove syringe and close the tubing clamp
If necessary, apply skin protectant prior to stabilization device
*Place a transparent  dressing over the IV insertion site and stabilization device (if used)

 

*If starred item is missed student requires automatic remediation.

 

Assessment Explanation

 

Starred items were pre-selected by myself by considering the actions that if missed would impose a patient safety risk, or pose an infection risk to the patient.

 

The following learning objectives were addressed by this assessment:

 

• Select the appropriate equipment for initiating intravenous therapy.
• Describe the steps for initiating intravenous therapy.
• Use the correct techniques for inserting and securing an intravenous line.

 

The following student learning outcomes were addressed by this assessment:

 

• Describe a management plan for various physiological alterations
• Evaluate the use of evidence-based practice in the delivery of client care.

 

Reasoning: IV insertion is a necessary component in the acute care setting to managing certain physiological alterations. An Intravenous line is utilized to administer intravenous medications that can correct many of the physiological alterations discussed throughout the course. In addition, the theoretical and practical portion of this skill is evidence-based practice.

 

Initially, the students get a brief overview of IV insertion and get to watch a video demonstration of the skill during the lecture portion of this course (which I also teach). During Week 2 in lab, I review the theoretical aspects of the skill in discussion format during which I ask my students to regurgitate the knowledge they have learned on most aspects of the skill while highlighting vital aspects of the skill (see the starred items). The reasoning behind highlighting the starred items during discussion is that these items ensure patient safety. After the discussion, I then demonstrate the skill as I reiterate those items that ensure patient safety. After my demonstration, I then encourage students to practice as I observe each student re-demonstrate the skill. Some of the students emphasized that the skill was more difficult to execute than it looked during my demonstration.

 

Of note, I have two lab sections with 7 students in one section and 8 students in the other section.

During the practice time, the students worked in pairs, and I would observe students completing the skills. I would also correct their techniques during the session. I found that most students struggled with applying the tourniquet. This part of the skill is not a starred item (see scoring guide) but in clinical environment, learning how to tie a tourniquet is a critical action needed to find a viable vein for peripheral IV insertion. Given this, I spent some extra time re-demonstrating the skill to the students. In general, most students were proficient in redemonstrating the skill to me during practice time although there were some noted struggles and they were as follows:

 

1. About 3/4^th of all the students could not tie the tourniquet correctly (not a starred item). Though this action is not a starred item, this action is paramount critically to locating a viable vein. I corrected their error by redemonstrating to them how to appropriately tie the tourniquet.
2. About half of the students advanced the entire needle into the vein, whereas they were supposed to advance the catheter into the vein (this action is a starred item). I corrected their error by letting them know that the reason for this was to prevent puncturing of the vessel wall leading to infiltration of the vein which leads to inability to use the vein to administer medications intravenously. I then redemonstrated the skill showing them that the catheter not the needle needed to be advanced.
3. Over half of the students struggled with inserting the needle at the correct angle (10-30 degrees) (this action is a starred item). This was corrected by re-demonstrating the correct angle for insertion. The reasoning behind the necessity of IV insertion at the correct angle is that if the angle is not low enough, this could also lead to infiltration of the vein.

 

On the day I officially assessed their competency on the skill of inserting an Intravenous line only 2 students required remediation of the skill due to missing a starred item. The first student missed only one starred item – “do not touch insertion site after cleaning the skin”. The second student missed – “verify client identification” and “perform hand hygiene”.

I reemphasized the need to not miss the aforementioned critical item and set a remediation date with both of those students for 2 weeks after the official assessment date.

 

Of the students who performed the procedure correctly, the most missed items (non-starred items) were as follows:

 

1. Tied the tourniquet too loose.
2. Assess for blood return

 

As this is my first time administering an official lab assessment at Malcolm X College, I have no established trends in this assessment for which I can make historical comparisons. Therefore, I will highlight trends in my previous experience administering assessments in the lab setting. In my previous experience in administration of assessments in the lab, students typically do make some minor mistakes on their initial practice sessions after they have witnessed a demonstration of the skill. They usually do not typically miss actions which pose a safety risk or infection control risk (during official assessment after they have had practice sessions) – especially if it is highlighted by their instructor and they have previously completed assigned modules and watched assigned demos prior to attending class.

Students who typically miss critical actions (starred items) during official assessments tend to miss those actions due to unpreparedness, inadequate use of practice opportunities, or nervousness and overthinking during their assessment. Students who miss critical actions due to

 

nervousness are usually able to identify exactly what they did wrong even before instructors tell them. Students who are unprepared usually cannot identify what they did wrong. Even when the skill steps are reviewed with them and context clues are given, they are still not able to identify what they did wrong.

With the two students who missed starred items, I could see that one of the students was very nervous, thus missing those critical actions, but the other one was unprepared. These conclusions were made due to my previous experience and trends I have noted in administration of assessments in the lab setting.

After reviewing the skill verbally with both students and reassessing their understanding by asking for teach back in verbal form, they were required to repeat this assessment 2 weeks later so that I could assess their competency.

Both students successfully completed the assessment without missing any starred items.

 

Improvement of Assessment

 

Please note my recommendations for improvement of this assessment for the future below:

 

1. To ensure that the students’ have a more robust learning experience and have more practice time to master the skill, I would allow for review of this skill again during a review week prior to an official assessment.
2. I would also highlight the trends from this assessment (as a new baseline) specifically pitfalls and commonly missed actions by previous students.

 

Summary

 

This assessment gave me the following invaluable feedback regarding my students:

 

1. Their level of preparedness prior to seeing a live demonstration of the skill based on the modules they completed and pre-watched demos of the skill
2. Their learning styles – a large majority of my students are visual learners. Therefore, demonstration of a skill for their learning was more valuable to them than hearing or reading about the skill. This feedback enables me to tailor my lessons to
3. Their ability to insert a peripheral intravenous line correctly and safely.

 

Though this assessment was designed to evaluate my students, I also had some learning points I gleaned through this process and they are as follows:

 

1. I assumed that most of my students would not miss this (non-starred) action – “Cleanse the area with 0.5% chlorhexidine or per facility policy, using a gentle, but back and forth motion. Allow to dry completely”. I made this assumption because this action was emphasized on numerous occasions – specifically in the modules they cover, the demo videos, and my demonstrations. In addition, no one missed this action during their practice sessions. Thus, I did not make this a starred item. Forgetting to perform the aforementioned item poses a huge infection risk to the patient – therefore, this should have been a starred item. I realized this during the official assessment when vone student (one of the ones who required remediation) missed this action.  Moving forward, I will make this a starred item and ensure that in future assessments, this action is mentioned as a potential pitfall.

 

2. Having an extra practice session (two total) at the midterm point could reduce the anxiety surrounding being observed by the instructor, instead of only having the one at the beginning of the semester.

 

3. Demonstration of a skill further solidifies the theoretical knowledge regarding the skill – I found that students in this lab section readily and eagerly answered questions posed in the lecture portion of this class regarding the skill especially surrounding maintaining patient safety and infection prevention.

 

To conclude, assessments not only give information on students’ theoretical and practical knowledge, it also delineates their learning styles and creates an opportunity to establish baseline metrics for refining the assessment in the future.

I was also able to realize assumptions that I make that could potentially not accommodate comprehensive learning. All in all, assessment and learning are a two-way street; it can foster learning that targets students’ learning styles and it can refine delivery of course content.