Trouble Performing Manual Blood Pressure. Advice?

[ModeratelyObscure]

When I was in nursing school, I could do manual BP no problem. Now that I’m out of school, I’m not sure if it’s my nerves while trying to do it or what? I feel more comfortable getting a manual since it tends to be more accurate than automatic, but I’m just not good at it. The first problem is that I feel like I can’t find a happy medium between deflating the cuff too slow and too fast. If I don’t do it extremely slow, and I mean SLOW, it goes so fast I can’t hear the beats. The second problem is I have a hard time hearing the beats in general. Third problem is that I work in intellectual disability plus psych, so more times than not they are moving around and it’s hard to do. 

Also, does anyone else hear the creaking in their fingers when holding the bell/diaphragm? 

Please no snarky comments about how I can’t perform a basic nursing skill. I’m extremely insecure about this. Advice please?

[RuralMOSchoolRN, ADN, RN]

1. I have a stethoscope where you can twist it for the small peds bell or the regular bell. Make sure you have it twisted correctly to the side you're using to listen.

2. I usually just use my thumb to hold it on the person's arm. If you need some stabilization if they are moving you can use your thumb above and wrap your fingers lightly around their elbow. If they have heavy clothes on I ether ask for them to take that arm out of put the bell up the sleeve onto their skin.  Thin long sleeve shirt, I'm good. Bulky sweater, not so much.

3. Distraction--with your population of patient find something that might distract them--while they are watching tv or talking to someone sitting next to them or whatever.

4. PRACTICE.  I practiced on my family, my kids, myself, etc.  

5.  Find a happy medium between too slow and too fast.  You can even practice blowing up the cuff and giving your fingers muscle memory of how to unscrew it at the right speed.

Good luck!  I think sometimes we just psych ourselves out a little!  I do a fair amount of blood draws, but my boss was talking with my patient the other day (not even really watching me but in the room) and I couldn't get a stick on a decent vein.  I just got into my head that she was watching me.