Parallel Practices: The First Day, October 3rd, 2016
Monday was my first day as maker in residence in the Florence Nightingale Faculty of Nursing and Midwifery at King’s College, London. For the time being I am in the Chantler SaIL (Simulated and Interactive Learning) Centre at the Guy’s site. This is where student nurses and midwives learn, practice and rehearse clinical skills that will take them into the community and onto the hospital wards. I am sitting in on a few sessions to get a ‘feel’ for how students are taught and learn before I move forward into ‘hands on’ work. Today’s session, which is led by Carol Fordham Clarke, is with first year students in their second week of training and they are going to learn how to take blood pressures. A few have done this before, some have worked as health care assistants, but most are complete beginners and a couple do seem to be ‘all fingers and thumbs’. Yet in just three hours Carol has taught sixty students an essential skill that will take them through the rest of their nursing careers.
Carol explains that it is usual for blood pressures to be taken electronically nowadays, particularly on hospital wards. She explains that students must learn the ‘hands on’ skill using a manual sphygmomanometer, this means they can take accurate readings without relying on electronic machines, which aren’t always available, and she tells us: “Don’t deskill yourselves before you even begin.”
Early on it becomes clear that this isn’t going to be easy and Carol reassures everyone that taking a blood pressure is one of the hardest skills to acquire. It is a skill with two elements; manipulation and hearing and both happen simultaneously. Students practice on each other, and occasionally me when we are an odd number. I’ve had my blood pressure taken many times, but I’ve never taken one and I am particularly satisfied when I finally manage to hear the two Korotkoff sounds we are told to listen for. These sounds correspond to the two readings associated with a blood pressure measurement, the systolic and diastolic pressures with which we are familiar. To measure these pressures blood flow to the artery is occluded, or cut off, by the expansion and tightening of a cuff wrapped around the upper arm. This cuff is inflated manually by squeezing a rubber bulb, which is held in the palm. When the cuff’s pressure is slowly released, blood begins to flow and this is where the listening comes in because as blood begins to move down into the artery it produces turbulence and becomes noisy. We are told to listen out for the first sound and the last sound. These correspond to the systolic and diastolic pressures – the pressure at which blood begins to flow and the pressure at which blood flows freely, after this there is no turbulence, so we are really trying to listen for the last sound before the absence of sound, this is the hardest bit – for me, at least. I look around the room to see how everyone is getting on, there are lots of concentrated faces; eyes are carefully pinned on the dials and ears tuned in. I notice a couple of students smile broadly when they ‘get it’ and one jumps back in her chair, it does feel a little bit like magic.
When we chat later, Carol explains that doing blood pressures the ‘old fashioned way’ enables the sort of skin-to-skin contact unavailable with digital testing. This means that students learn how a patient’s skin feels, perhaps clammy or cool, and this can give them other clues as to their patient’s well being. I think too that this contact might be reassuring for an anxious patient.
My work here requires me to find and explore parallels between nursing and my own field of practice, textiles. It doesn’t take long for me to realise the similarity between nursing fundamentals and textile ones. How both fields have foundations from which everything begins. I think of warping up, casting on, even threading a needle. All first steps that we can sometimes take for granted but out of which everything else comes into being. How in both fields we need a proper grasp of these things before we can become well practiced – I notice the link here between the hand and the grasp. Perhaps, in this respect, textile makers and nursing students both need to become properly ‘handy’.
There’s a long way to go and I must confess to being anxious about how this will all work out, I guess I am just like the new students in that sense and that we are all just starting out. Our next session together is all about elimination and skin assessment, now that will be interesting!
Listening in: Learning how to take a blood pressure manually