Obtaining an accurate maternal blood pressure: A quality improvement initiative to improve nursing knowledge and confidence

Background: Inaccurate assessment of maternal blood pressure (BP) contributes to misdiagnosis of hypertension, unnecessary or missed interventions, and maternal morbidity. This study examines obstetric nursing knowledge and confidence in proper assessment of maternal BP before and after an institutional quality improvement project.Methods: We implemented an online educational initiative in our women’s health unit based on the American Heart Association’s Blood Pressure Improvement Program. Simultaneously, a standard assessment of BP cuff sizing by arm measurement was implemented. We conducted a pre- and post-intervention assessment of nursing knowledge and confidence of BP measurement. Responses were analyzed using the χ2 test, two-sample t test, ordinary least squares and logistic regression.Results: A total of 145 nurses completed the pre- and 68 completed the post-intervention assessments. Participants answered 62% of pre- and 73% of post-intervention questions correctly (p < .001). Before implementation, 86.9% of participants reported feeling very or extremely confident in obtaining an accurate BP measurement, increasing to 98.5% following (p = .007). 73.8% of pre-intervention respondents reported feeling very or extremely confident in choosing an appropriate BP cuff compared to 96.3% post (p < .001). Following implementation, confidence levels were similar irrespective of years in practice, years of experience at our hospital, and primary nursing unit.Conclusions: A BP educational initiative and standardized BP cuff assessment increased nurses’ knowledge and confidence in selecting the correct cuff size and obtaining accurate readings. Increased knowledge and confidence may lead to greater adherence to standardized BP assessment during peripartum admission, more accurate BP measurements, and improved management of hypertensive disorders in pregnancy.

The flash of a van: A cartography of a mobile educational initiative in the Claymore district of Sydney

Modern cities produce areas of poverty, despite their overall wealth. These pockets of living can exacerbate societal problems, especially because the opposite end of the societal spectrum is often close by. This paper examines an educational initiative in one such district, called Claymore, in the suburbs of outer Sydney. The project deployed a mobile youth van equipped with high-tech educational hardware and software, and encouraged local youth to take advantage of the van, to further high-tech skills acquisition. This paper offers a Deleuze/Guattari (1988) cartographic approach to mapping the effects of the van extracted from their opus maxima, 1000 Plateaus. This approach is a mode of social topology that deepens the type of discourse analysis that one may take from Foucault and its uses in educational research (e.g., Ball, 2012). The social cartography that one might derive from Deleuze/Guattari involves producing a ‘plane of immanence’ and assemblages about the phenomena under scrutiny, in the case of this article, the mobile van initiative in Claymore. This does not mean that hierarchies are diminished, but that they are reset for the purposes of analysis, so that their complex relationships are realized and understood. This paper looks to describe and analyse what is immanent to the situation in Claymore, and what effects the mobile van might have given this state of affairs.