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KNOWLEDGE, PRACTICE AND BARRIERS TO FOLLOW RECOMMENDED GUIDELINES FOR MEASURING BLOOD PRESSURE AMONG PRIMARY HEALTH CARE NURSES IN JEDDAH 2018/2019.

Dr. Amna Osama Jamjoom, Dr. Khadija Hassan Eid, Dr Abdulhameed M. Hassan

Background: Hypertension is among the most common conditions examined in PHC. Moreover, hypertension leads to many comorbidities such as renal failure, myocardial infarction, strokes, and if not appropriately treated leads to early death. Approximately 20% of world’s population is hypertensive it is also called “silent killer” because it often has no symptoms, that’s precisely why it is essential for people to check their blood pressure regularly. Accurately measuring blood pressure, is a critical skill that must be performed with practice and proper training by the person obtaining the reading because many factors will affect the accuracy of the reading.Patients’ Blood pressure is sually obtained by nurses; it is clinically important for the blood pressure reading to be accurate for the physician to manage the patient correctly and avoid over diagnosing or over the treatment of hypertension. This issue is of high importance to the individuals and community since it’s one of the top common diseases. Hypertension is a preventable disease if managed well. There are no studies carried out locally, and only a few similar studies performed internationally; being said, this makes this topic of high importance. Subject and Methods: A cross-sectional study was conducted in 25 primary health care centers in Jeddah, Saudi Arabia, which were selected using a multi-stage stratified sampling technique. Main Results: Reliability analysis showed good internal consistency with Cronbach’s alpha for full observer-assessed questionnaire (0.915), Patient-Related Standards (0.881), Equipment-Related Standards (0.741), and Examiner-Related Standards (0.804) subscales. Regarding Patient-Related Standards, compliance rates varied depending on the standard and ranged from 9.0% for measuring blood pressure in standing position if postural hypotension is suspected to 98.1% for measuring blood pressure in sitting position with back supported, where applicable. Regarding Equipment-Related Standards, compliance rates ranged between 50.0% for correct stethoscope position maintained to 98.8% for adequate cuff wrapping around the upper arm. Regarding Examiner-Related Standards, given the use of automated instruments, 6 out of the 10 standards were not applicable for majority of the participants; however, compliance rate was relatively high. No statistically significant association of practice was found with nurse’s gender, nationality, years of experience and degree. Among the investigated barriers, only lack of proper training was associated with low practice levels in Patient-Related Standards (mean [SD] PRSS=0.49 [0.10] versus 0.59 [0.17], p=0.029) and ERS (mean [SD] ERSS=0.65 [0.13] versus 0.75 [0.16], p=0.031) compared to absence of this barrier, respectively. As to self-assessed practice, analysis showed relatively high compliance rates with majority of the standards. Conclusion and recommendation: Our study showed high knowledge and practice levels for BP measurement among a sample of nurses regarding providing a pre-measurement rest to the patient, back and elbow support, cuff position, and rounding the values to 2 mmHg as well as moderate practice levels about measuring BP in both arms, undressing patients’ arms and following the specific guidelines. Nonetheless, the participants exhibited inadequate practice levels regarding several parameters, including the assurance of bladder distension, measuring BP twice at each visit, and measuring BP in a standing position if postural hypotension is suspected. Findings from this study corroborate the importance of addressing blood pressure measurement errors by raising awareness about the implied guidelines and providing regular and frequent training to nurses, including students and more experienced ones. Key Words: Knowledge, Practice, Barriers, Blood Pressure, Primary Health Care, Nurses.

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