Learning Objectives
By the end of this section, you will be able to:
- Explain why patients would need to self-monitor vital signs
- Describe the process of educating a patient about self-monitoring vital signs
- Recognize how a patient should validate the obtained vital sign data
An important responsibility of healthcare providers is not only to provide care but also to educate patients and their families on how to better care for themselves. Patient education is a major part of the duties of a nurse, and this sometimes includes teaching patients how to monitor their own vital signs. By teaching patients how to do this without the assistance of a licensed healthcare provider, nurses help patients understand their own bodies and physiological processes and empower them to live healthier lives.
Educating a Patient to Self-Monitor
There are many situations that require patients to self-monitor their vital signs. Consider this situation: a patient has been going in to see the doctor, and their blood pressure readings are always abnormally high (150s/90s). The patient exercises regularly, maintains a healthy weight, and eats a reasonably healthy diet. The patient also has no symptoms of ongoing high blood pressure like vision problems or headaches. However, hypertension often has no symptoms, and people with healthy lifestyle habits can be diagnosed with hypertension, so the doctor and the healthcare team must take it seriously. It could be possible that the patient is unconsciously nervous when they go into the doctor’s office, thus elevating their blood pressure higher than usual, a condition known as white coat hypertension or white coat syndrome. To figure out whether the patient genuinely has hypertension, the doctor needs the patient to monitor their blood pressure at home in a comfortable environment.
There are many scenarios in which a patient may need to monitor their own vital signs, for instance, a patient is on a new heart medication, and the doctor needs to monitor the patient’s pulse and blood pressure to ensure no harmful side effects. Or perhaps a patient has low white blood cells related to chemotherapy and needs to monitor their temperature for signs of fever. Or maybe a patient has cystic fibrosis or symptoms of long COVID and needs to monitor their oxygen saturation in case they have trouble breathing and need to go to the emergency room. In any case, it is important for healthcare providers to understand how to teach patients how to self-monitor. To self-monitor their vital signs, patients need to obtain the proper equipment, learn how to use it, learn how to validate their own results, and report their results accurately to their healthcare provider.
To teach self-monitoring, nurses first need to know how the patient best likes to learn; some people prefer to read brochures and articles, while others may prefer diagrams and pictures. Others may learn best with videos or with in-person demonstrations. Once the nurse has established how the patient best learns new information, they can begin teaching the patient how to obtain their own vital signs.
Educating a Patient to Obtain Vital Signs
The following equipment is needed to obtain vital signs at home:
- properly sized electronic blood pressure cuff and blood pressure machine
- In situations where patients take manual blood pressures, they will need a properly sized cuff, a stethoscope, and a sphygmomanometer.
- pulse oximetry machine to measure heart rate and/or oxygen saturation
- digital thermometer to measure temperature
- Mercury thermometers are no longer recommended for home use due to the dangers of breaking glass and mercury poisoning.
Consistency is important for all vital signs measurements; thus, patients should be taught to take their vital signs at the same time of day every day. Because blood pressure is lowest in the morning before eating anything, teaching patients to take their vital signs when they first get up is most ideal. Patients will also need a method of recording their vital signs. Possibilities include writing them down in a notebook or keeping track on their cellphone in a memo app. There are also specialized health apps to help keep track of vital signs.
Patient Conversations
You Can Always Learn Something New
Scenario: Mr. Atambe has been directed by his doctor to monitor his blood pressure at home. This is the first time he has had to do this, and he’s not happy about it. Mr. Atambe’s nurse, Wendy, realizes his reluctance and considers what would be the best way to help him.
Nurse [entering the room]: Hi, Mr. Atambe, how was your talk with the doctor?
Patient: Stupid. The man wants me to check my blood pressure at home. He says I might have high blood pressure. But that’s what I come to the doctor’s office for! Doing this at home myself is stupid. If I wanted to do something like this, I would have gone to medical school.
Nurse: I understand your frustration, but this is important information that will keep you healthy and away from the doctor’s office in the long run! What can I do to help you and make this easier?
Patient: Ugh. Well, if I have to, I guess. But I’m probably going to get it wrong anyway, and I’ll still have to come back all the time.
Nurse: Why do you think you’re going to get it wrong?
Patient: Well, I never told anyone, but I can’t read so well. Pictures and diagrams really confuse me too. I was such a bad student in school. And now my health depends on me learning something they teach doctors and nurses! This is horrible!
Nurse: I understand your concerns, and I want to reassure you that there are machines that can make taking your blood pressure very easy! People learn how to do it every day. Here, let me get a few things, and I will show you. Is that okay?
Patient: I guess so.
[Wendy leaves the room briefly and returns with an automatic blood pressure machine, several sizes of blood pressure cuffs, and a laptop.]
Nurse: Okay! Here is a blood pressure machine and some cuffs. Getting the right-sized cuff is an important part of taking your pressure with a machine. I brought some cuffs to try on and see which one fits best. Then we can try using the blood pressure machine together—I will show you how to sit and position yourself for the best reading possible.
Patient: This is great, I really appreciate your help! But what if I forget the steps to do this? And how do I know when the numbers are good or not?
Nurse: I have some videos that explain everything. I’ll add the number to the office, too, if you have any questions once you get started.
Patient: Thank you so much!
Nurse: Of course! Let’s take a look at them now, and then let’s try that blood pressure.
To obtain an oral temperature, a digital thermometer should be obtained. Patients should be instructed on proper placement of the thermometer in the mouth, under the tongue and back toward the sides of the mouth but not touching the gums. Patients should be instructed to refrain from eating or drinking anything thirty minutes prior to measuring their temperature so they do not artificially alter the reading.
To obtain heart rate and/or oxygen saturation, an oximetry probe and monitor must be obtained. Hands should be clean and dry before placing the probe on a finger without nail polish or fake nails. The patient should be seated upright and comfortably; to obtain the best reading possible, it may be helpful to instruct the patient to take a few deep, calming breaths before recording the results. Although patients can monitor their own respiratory rate at home, it may not be as accurate as when someone else does it when the patient is not aware. Patients tend to not breathe as they naturally do if they know they have to count respiratory cycles. If the patient has family or a caregiver who can monitor the respiratory rate while the patient is relaxing, that would be a better option.
To obtain blood pressure at home, patients must be taught proper body placement to ensure accuracy. They must sit upright with their back supported. The arm they will take their pressure in must be supported at heart level and bared to the upper arm. Legs must be uncrossed and feet flat on the ground. The cuff must be the correct size and wrapped snugly around the upper arm. It may be helpful to demonstrate proper cuff placement over the brachial artery for patients. A machine that is validated for home use and for the use of the particular patient should be selected. Each time the patient measures their blood pressure, they should do two readings, one minute apart (American Heart Association, 2023). This is recommended in the home setting because research has shown that monitoring the average of a series of readings gives the provider more accurate information about blood pressure fluctuations and can better manage hypertension (Kumar, 2021).
Link to Learning
The American Heart Association has helpful tips for patients on taking their blood pressure at home. Viewing this can give you ideas on how to educate your own patients.
Validating Vital Sign Data
Similar to how nurses and other healthcare providers must analyze and validate (prove the accuracy of) the vital signs data they obtain, it is important to educate patients who are taking their own vital signs at home how to analyze and validate their own numbers. Is there an unusually high or low reading? Was there anything different about when the patient took that pressure? Were any new medications introduced? This information will provide much needed context to the readings and allow the physician to make a well-informed decision about care decisions and medications prescribed going forward.
Rechecking Abnormal Readings
When monitoring vital signs at home, patients should be given information regarding the normal ranges of vital signs to look for so that they can then identify results that fall out of these normal ranges (abnormal) (Table 7.6).
The nurse must also educate the patient on signs and symptoms to help validate their readings. If the patient takes their blood pressure at home and receives a reading of 190/110, the patient should ask themselves if they have any symptoms or are feeling differently. Do they have a headache or blurred vision? How does their heart feel? Do they have pain anywhere? Similarly, if they get a heart rate or oxygen saturation that is not within normal limits, the patient must be able to ask themselves if anything is different for them. It may be beneficial for patients to keep a journal or log with their vital sign readings as well as any corresponding symptoms. This will help keep a record of each event and will alleviate the burden of remembering the details that can then be discussed with the healthcare team.
Notifying Provider of Abnormal Readings
Sometimes vital signs truly are abnormal, and if the patient has taken their vital signs and validated the data, they must inform their healthcare provider immediately. Some healthcare offices have urgent care lines where patients can call to report abnormal vital signs; others have mobile applications that the patient can use to directly contact a doctor, nurse, or healthcare provider at the practice. Check what the protocol is on reporting this information, and be sure the patient understands the process. Some facilities may prefer nurses to call the doctor via a hospital work phone, others may allow nurses to page the doctor through the computer system or through the charting record. Either way, if a nurse has determined the recorded vital signs are indeed valid, it is the nurse’s duty to inform the doctor in a timely manner.