Nurses' behaviour regarding CPR and the theories of reasoned action and planned behaviour

Critical care nurses' experiences of caring challenges during post-resuscitation period: a qualitative content analysis

BACKGROUND

Patients in the post-resuscitation period experience critical conditions and require high-quality care. Identifying the challenges that critical care nurses encounter when caring for resuscitated patients is essential for improving the quality of their care.

AIM

This study aimed to identify the challenges encountered by critical care nurses in providing care during the post-resuscitation period.

METHODS

A qualitative study was conducted using semi-structured interviews. Sixteen nurses working in the intensive care units of three teaching hospitals were selected through purposive sampling. The Data collected were analyzed using qualitative content analysis.

RESULTS

Participants experienced individual, interpersonal, and organizational challenges when providing post-resuscitation care. The most significant challenges include inadequate clinical knowledge and experience, poor management and communication skills, lack of support from nurse managers, role ambiguity, risk of violence, and inappropriate attitudes of physicians towards nurses' roles. Additionally, nurses expressed a negative attitude towards resuscitated patients.

CONCLUSION

Critical care nurses face several challenges in providing care for resuscitated patients. To enhance the quality of post-resuscitation care, address the challenges effectively and improve long-time survival it is crucial to implement interventions such as In-service education, post-resuscitation briefing, promotion of interprofessional collaboration among healthcare teams, providing sufficient human resources, clarifying nurses' roles in the post-resuscitation period and increasing support from nursing managers.

Perception of Personal Participation of the Nurses in Resuscitation Procedures: A Qualitative Study

Background and Objectives: Resuscitation is one of the most stressful tasks in emergency medicine. The participation of nurses in this procedure can have specific effects on them. In this research, we wanted to find out what these effects are. Materials and Methods: A qualitative approach by conducting semi-structured interviews was used, and a thematic data analysis of the recorded interviews was carried out. The collected data were transcribed verbatim, with no corrections to the audio recordings. The computer program ATLAS.ti 22 was used for the qualitative data analysis. Results: Eleven male registered nurses were interviewed, with an average of 18.5 years of experience working in a prehospital environment (max. 32/min. 9). A total of 404 min of recordings were analyzed, and 789 codes were found, which were combined into 36 patterns and 11 themes. As the most stressful situations, the interviewees pointed out the resuscitation of a child, familiar persons, conflicts with the environment, conflicts within the resuscitation team, nonfunctioning or insufficient equipment, complications during resuscitation, and resuscitating a person only for training. As positive effects, the interviewees cited successful resuscitations or their awareness that, despite an unsuccessful resuscitation, they did everything they could. Conclusions: Participation in these interventions has a specific positive or negative impact on the performers. The interviewees shared the opinion that they can cope effectively with the adverse or stressful effects of resuscitation. Yet, despite everything, they allow the possibility of subconscious influences of this intervention on themselves.

Factors associated with willingness to perform basic life support in the community setting in Yogyakarta, Indonesia

BACKGROUND

Cardiac arrest is one of the fatal medical emergencies which need to be treated immediately. Poor survival rates in the community settings are common because of limited and ineffective bystander basic life support (BLS). This study aimed to identify factors that are associated with the willingness to perform BLS in communities in Yogyakarta, Indonesia METHODS: A descriptive study was conducted with a cross-sectional design. Participants (n = 251) were enrolled from the general population consisting of teachers, security personnel, and police officers recruited through cluster random sampling. Data were gathered using both digital or printed questionnaires. Ordinal logistic regression with adjusted odds ratio (AOR) was used to analyze the association between BLS predictors and willingness to perform BLS.

RESULTS

Most participants were willing to perform BLS for all genders (55.55%). The inability to perform BLS and fear of causing harm were the main barriers to performing BLS accounting for 61.35% and 43.82%, respectively. Compared to other independent predictors, ages 40-59 were found to be the highest predictors of willingness to perform BLS (AOR:1.44) followed by experience of seeing real or simulation of the emergency case (AOR:1.38) CONCLUSIONS: More than half of the respondents were eager to perform BLS although some barriers were also found. This study provides some understanding of the predictor factors associated with BLS performance and shows respondents with some training or experience were more likely to perform BLS. The results inform policymakers to develop a strategic plan for increasing willingness to apply BLS in the community. WC:250.

Factors affecting ward nurses' basic life support experiences: An integrative literature review

BACKGROUND

Performing cardiopulmonary resuscitation in non-critical care hospital wards is a stressful event for the registered nurse; stress may negatively affect performance. Delays in initiating basic life support and following current basic life support algorithms have been reported globally.

AIM

The aim of this review was to investigate factors that can affect registered nurses' experiences of performing basic life support.

METHODS

Using the five-step integrative literature review method from Whittemore and Knafl, this review searched articles published between January 2000 and June 2022 for qualitative and quantitative primary studies from the databases CINAHL Complete (EBSCO), Medline (Web of Science), Scopus and PubMed.

RESULTS

Nine studies from eight countries met the inclusion criteria and were appraised here. Five themes relating to factors affecting the performance of basic life support were found during this review: staff interaction issues, confidence concerns, fear of harm and potential litigation, defibrillation concerns and basic life support training issues.

CONCLUSIONS

This review revealed several concerns experienced by registered nurses in performing basic life support and highlights a lack of research. Factors affecting nurses' experiences need to be understood. This will allow education to focus on consideration of human factors, or non-technical skills during basic life support training, as well as technical skills, to improve outcomes for patients experiencing an in-hospital cardiopulmonary arrest.

Exploring factors influencing nurses' attitudes towards their role in dental care

BACKGROUND

The burden of oral disease requires collaboration between health care professionals. Nurses are frequently exposed to patients and can play a vital role in prevention of oral diseases. This study aimed to investigate nurses' attitudes towards their role in dental care and its associated factors.

METHODS

This cross-sectional, survey-based study recruited a total of 525 nurses in Eastern Saudi Arabia, using a snow-ball sampling technique. Data was collected using an online, pre-validated 40-item questionnaire with four domains (attitudes, knowledge, practices, and demographic data).

RESULTS

Nurses showed satisfactory attitudes (52.8 ± 8.2) and average knowledge (13.4 ±3.9). More than two thirds (70.3%) reported responding to patients' questions about oral health conditions, 47.1% and 19.7% conducted oral health screening and education respectively. Referral practices were reported by 266 (50.7%) of the participants with pain being the main reason for referrals. Attending lectures/ trainings on oral health and having a formal education about oral health were significantly associated with nurses' positive attitudes towards their role in dental care (P<0.001). Conducting oral health screening or education were also significantly associated with positive attitudes (P = 0.001).

CONCLUSION

Positive attitudes were observed among those with undergraduate oral health backgrounds, in continuous education, and those who were involved in oral health screenings. There is a need for under and postgraduate inclusion of oral health training in nurses' education.

The implementation of code blue by nurses as first responders in outpatient and inpatient rooms at Malang Indonesia Hospital

Introduction: In-Hospital Cardiac Arrest (IHCA) is a frequent occurrence that necessitates prompt and appropriate assistance to improve survival rates. Nurses in public care rooms and outpatients are expected to be first responders to IHCA until an activated hospital code blue team arrives. Therefore, this study aims to analyze the implementation of code blue response by nurses in outpatient and hospital inpatient rooms in Malang. Design and Methods: This is a quantitative study that uses observational methods with a cross-sectional approach comprising of 109 inpatient and outpatient care room nurses from 9 hospitals in Malang. The implementation of code blue was measured by a simulated case of adult cardiac arrest in a hospital inpatient room. Results: The nurses involved were 67.0% female, where the majority have a D3 education qualification (57.7%), with more than ten years working experience (45%). Furthermore, 83.5% of nurses work in regular care rooms and 16.5% come from outpatient rooms. The results showed that the implementation of code blue by nurses in regular care and inpatient rooms was 66.7% and 65.9%, respectively in the insufficient categories. In addition, the Mann-Whitney U test obtained a p-value of 0.929. Conclusions: In conclusion, there was no significant difference in the implementation of code blue that occurred in the inpatient and outpatient rooms. Further studies were recommended to observe code blue events directly and take samples with balanced proportions.  

Attitudes towards cardiopulmonary resuscitation situations and associations with potential influencing factors—A survey among in-hospital healthcare professionals

Introduction

Attitudes towards cardiopulmonary resuscitation (CPR) among in-hospital healthcare professionals (HCPs) are poorly understood. The aim of this study was to evaluate attitudes towards CPR situations among in-hospital HCPs and assess associations with potential influencing factors.

Materials and methods

A questionnaire was distributed to 3,085 HCPs in 2009 and 2,970 HCPs in 2015–2016. The associations of influencing factors were analyzed using binary logistic regression.

Results

In the event of a possible cardiac arrest situation, 61% of the HCPs would feel confident in their CPR knowledge, 86% would know what to do, and 60% would be able to take command if necessary. In the latest real-life CPR situation, 30% had been worried about making mistakes or causing complications, 57% had been stressed, and 27% had been anxious. A short time since the latest real-life CPR performance and a high number of previous real-life CPR performances were associated with lower odds of worrying about making mistakes/causing complications, lower odds of feeling stressed or anxious, and higher odds of feeling calm. Regardless of previous real-life CPR experience, there were differences in attitudes between groups of professions, where physicians showed increased odds of worrying about making mistakes/causing complications and nurses showed increased odds of stress. Working on a non-monitored ward meant increased odds of stress and worrying about making mistakes/causing complications. Twelve months or more having passed since the latest CPR training course was associated with increased odds of anxiety.

Conclusions

Despite HCPs’ generally positive attitudes towards performing CPR in the event of a possible cardiac arrest situation, feelings of stress and anxiety were common in real-life CPR situations. Regular CPR training among all HCPs is a key factor to maintain competence and reduce anxiety. The possible effects of attitudes on performing CPR need to be studied further.

Exploring the Feelings of Nurses during Resuscitation—A Cross-Sectional Study

Cardiopulmonary resuscitation (CPR) is one of the most stressful situations in emergency medicine. Nurses involved in performing basic and advanced resuscitation procedures are therefore exposed to a certain amount of stress. The purpose of this study was to determine the stressors and the level of stress experienced by nurses during resuscitation. A cross-sectional quantitative study was done. The sample consisted of 457 nurses who worked in emergency units. First demographic data were collected, followed by a questionnaire regarding the effect of different situations that occur during and after resuscitation on nurses including Post-Code Stress Scale questionnaire. The most disturbing situations for respondents were resuscitation of young person (MV = 3.7, SD = 1.4), when they fail to establish an intravenous pathway (MV = 3.5, SD = 1.4), chaotic situation during resuscitation (MV = 3.4, SD = 1.4) and making decision about termination of resuscitation (MV = 3.1, SD = 1.5). Research has shown that nurses are exposed to a certain amount of stress during resuscitation, but most of them manage to compensate for stress effectively.

Utility of Simulation as a Teaching Tool for Nursing Staff Involved in Code Blue Management

Background: The responsibility of nurses is early clinical deterioration and taking appropriate action. Knowledge and proficiency in Code Blue protocols come handy, which lacks in most nurses recognizing. Simulation-based learning plays a role in improving performance and confidence in handling such situations. This goal-based method of program evaluation aims to examine Code Blue training programs and compare them with current literature and established professional standards while assessing participants’ experience and change in knowledge to this educational method.

Materials and methods: Following ethical approval, a prospective interventional study was conducted in the simulation center of a private medical college in Mangalore on 65 nursing students.

A pretest was given to the participants on the day of the session to assess their baseline understanding followed by prebriefing, all previously having received didactic lectures on Code Blue protocol, crash cart, and cardiac arrest algorithms. They were divided into three batches and each batch performed on crash cart and cardiac arrest stations using an electrocardiogram simulator. A simulated drill was enacted by the faculty on managing a Code Blue event and a discussion was followed. Nurses underwent two simulated scenarios, shockable and nonshockable cardiac arrest algorithms, followed by debriefing. Posttest and feedback form was asked to be filled.

Results: A significant increase in mean% from pretest to posttest (55.69–77.33%) following simulated drills.

Conclusion: The use of simulation to train nurses in Code Blue scenarios records greater satisfaction and improvement in clinical reasoning, knowledge, and skills. Hence, the incorporation of simulation teaching in training of those involved in caring for high-risk patients is the need of the hour.

How to cite this article: D’Cunha RJ, Fernandes SF, Sherif L. Utility of Simulation as a Teaching Tool for Nursing Staff Involved in Code Blue Management. Indian J Crit Care Med 2021;25(8):878–880.

Follow the protocol and kickstart the heart-Intensive care nurses' reflections on being part of rescue situations in interdisciplinary teams

Aim

To describe intensive care nurses' reflections on being part of interdisciplinary emergency teams involved in in‐hospital cardiopulmonary resuscitation.

Design

A qualitative descriptive design. Methods: Eighteen intensive care nurses from two regions and three hospitals in Sweden were interviewed. The data were analysed with General Inductive Analysis.

Results

The work for intensive care nurses in the emergency team was reflected in three phases: prevention, intervention and mitigation—referred as before, during and after the CPR situation.

Conclusions

The findings describe the complexity of being an intensive care nurse in an interdisciplinary emergency team, which entails managing advanced care with limited and unknown resources in a non‐familiar environment. The present findings have important clinical implications concerning the value of having debriefing sessions to reflect on and to talk about obstacles to and prerequisites for performing successful resuscitation.

Factors influencing paramedics' and emergency medical technicians' level of knowledge about the 2015 basic life support guidelines

Background

This study aimed to determine the cardiopulmonary resuscitation (CPR) knowledge level and factors affecting the current CPR knowledge level among EMTs and paramedics working in the Kayseri 112 emergency health system.

Methods

This survey aimed to reach all paramedics and emergency medical technicians working in the 112 emergency health system in Kayseri province. The data collection consists of sociodemographic/occupational characteristics, CPR training and practice characteristics and 20 four-choice CPR knowledge questions. Multiple linear regression analysis was used to determine the independent variables that affect the number of correct answers given to the questionnaire.

Results

305 healthcare professionals were included in this study. 57.0% (n = 174) of the participants were female and 56.1% were under the age of 30. It was found that 65.6% (n = 200) of the healthcare professionals were EMTs, and 48.6% (n = 148) had been working for 6–10 years. The mean number of correct responses based on the 20 questions asked was 12.76 ± 3.11. In multivariable analysis, it was determined that having received training on CPR after 2015, having participated in a course or seminar on CPR in the last 3 months and having practiced defibrillation/cardioversion during CPR significantly increased the level of knowledge regarding CPR (respectively, p < 0.01, p = 0.025, p = 0.045).

Conclusion

CPR trainings, which have been received recently and based on the current guidelines, increase the level of CPR knowledge and the increasing knowledge level affects the use of defibrillation/cardioversion. Improving training increases knowledge and practice.

Caregiver Characteristics Associated With Quality of Cardiac Compressions on an Adult Mannequin With Real-Time Visual Feedback: A Simulation-Based Multicenter Study

INTRODUCTION

Chest compression (CC) quality directly impacts cardiac arrest outcomes. Provider body type can influence the quality of cardiopulmonary resuscitation (CPR); however, the magnitude of this impact while using visual feedback is not well described. The aim of the study was to determine the association between provider anthropometric variables on fatigue and CC adherence to 2015 American Heart Association CPR while receiving visual feedback.

METHODS

This was a planned secondary analysis of healthcare professionals from multiple hospitals performing continuous CC for 2 minutes on an adult CPR mannequin with dynamic visual feedback. Main outcome measures include compression data (depth, rate, and lean) evaluated in 30-second epochs to explore performance fatigue. Multivariable models examined the relationship of provider anthropometrics to CC quality. Binomial mixed effects models were used to characterize fatigue by examining performance for 4 epochs.

RESULTS

Three hundred seventy-seven 2-minute CC episodes were analyzed. Extreme (low and high) BMI and weight are associated with poorer CC. Larger size (height, weight, and BMI) is associated with better depth but worse lean compliance. Performance fatigued for all providers for 2 minutes, but shorter, lighter weight, female participants had the greatest decline. On multivariable analysis, rate compliance did not deteriorate regardless of provider anthropometrics.

CONCLUSIONS

Anthropometrics impact provider CC quality. Despite visual feedback, variable effects are seen on compression depth, rate, recoil, and fatigue depending on the provider sex, weight, and BMI. The 2-minute interval for changing chest compressors should be reconsidered based on individual provider characteristics and risk of fatigue's impact on high-quality CPR.

Effects of cardiopulmonary resuscitation training for Mozambican nursing students in a low-resource setting: An intervention study

BACKGROUND

There is an increasing incidence of cardiovascular diseases in Africa. Nurses' ability to undertake cardiopulmonary resuscitation (CPR) can significantly impact the survival of patients who experience cardiac arrest.

OBJECTIVES

We aimed to identify the effects of CPR training among Registered Nurse-Bachelor of Science in Nursing (RN-BSN) students in Mozambique.

DESIGN

A one-group pretest-posttest repeated-measures quasi-experimental design.

SETTING

Auditorium of a general hospital and 2 Anne manikins, but no automatic external defibrillator.

PARTICIPANTS

Thirty-two RN-BSN students.

METHODS

Students' attitudes and self-efficacy on CPR were measured by self-reported questionnaires three times (before, immediately after, and 20 weeks post intervention). Data were analyzed by the paired t-test and repeated-measures analysis of variance.

RESULTS

Attitude and self-efficacy scores of students on CPR significantly increased immediately after CPR training, but decreased 20 weeks after the intervention (p < .001). Sociodemographic characteristics did not significantly differ throughout the measurements of attitude or self-efficacy.

CONCLUSIONS

CPR manikin training positively affected attitude and self-efficacy in CPR among RN-BSN nursing students immediately, but not at 20 weeks, after the training. There is a need for research to repeatedly quantify parameters in a controlled study at different intervals and develop an instructor-training course customized to Mozambique.

Evaluation of self-reported confidence amongst radiology staff in initiating basic life support across hospitals in the Cape Town Metropole West region

Background

The immediate response to cardiac arrest is regarded as the most time-critical intervention. First responders for cardiac arrests in imaging departments are often radiology staff. The study aim was to determine radiology staff members' confidence in initiating basic life support.

Objectives

The objectives of this study included determining the general confidence levels regarding identifying cardiac arrest and initiation of basic life support (BLS) amongst Radiology staff within the studied sites, as well as to identify potential areas of uncertainty. Another objective included identifying what would contribute to increasing levels of confidence and competence in identifying cardiac arrest and initiating BLS.

Method

A multi-centre cross-sectional survey was conducted using peer-validated, anonymous questionnaires. Questionnaires were distributed to radiology staff working in public sector hospitals within the Cape Town Metropole West. Due to the limited subject pool, a convenience sample was collected. Data were therefore statistically analysed using only summary statistics (mean, standard deviation, proportions, and so on), and detailed comparisons were not made.

Results

We disseminated 200 questionnaires, and 74 were completed (37%). There were no incomplete questionnaires or exclusions from the final sample. Using a 10-point Likert scale, the mean ability to recognise cardiac arrest was 6.45 (SD ± 2.7), securing an airway 4.86 (SD ± 2.9), and providing rescue breaths and initiating cardiac compressions 6.14 (SD ± 2.9). Only two (2.7%) of the participants had completed a basic life support course in the past year; 11 (14.8%) had never completed any basic life support course and 28 (37.8%) had never completed any life support or critical care course. Radiologists, radiology trainees and nurses had the greatest confidence in providing rescue breaths and initiating cardiac compressions from all the groups.

Conclusion

The study demonstrated a substantial lack of confidence in providing basic life support in the participating hospital imaging departments' staff. The participants indicated that regular training and improved support systems would increase confidence levels and improve skills.

The effect of an International competitive leaderboard on self-motivated simulation-based CPR practice among healthcare professionals: A randomized control trial

BACKGROUND

Little is known about how best to motivate healthcare professionals to engage in frequent cardiopulmonary resuscitation (CPR) refresher skills practice. A competitive leaderboard for simulated CPR can encourage self-directed practice on a small scale. The study aimed to determine if a large-scale, multi-center leaderboard improved simulated CPR practice frequency and CPR performance among healthcare professionals.

METHODS

This was a multi-national, randomized cross-over study among 17 sites using a competitive online leaderboard to improve simulated practice frequency and CPR performance. All sites placed a Laerdal® ResusciAnne or ResusciBaby QCPR manikin in 1 or more clinical units - emergency department, ICU, etc. - in easy reach for 8 months. These simulators provide visual feedback during 2-minute compressions-only CPR and a performance score. Sites were randomly assigned to the intervention for the first 4-months or the second 4-months. Following any CPR practice by a healthcare professional, participants uploaded scores and an optional 'selfie' photo to the leaderboard. During the intervention phase, the leaderboard displayed ranked scores and high scores earned digital badges. The leaderboard did not display control phase participants. Outcomes included CPR practice frequency and mean compression score, using non-parametric statistics for analyses.

RESULTS

Nine-hundred nineteen participants completed 1850 simulated CPR episodes. Exposure to the leaderboard yielded 1.94 episodes per person compared to 2.14 during the control phase (p = 0.99). Mean CPR performance participants did not differ between phases: 90.7 vs. 89.3 (p = 0.19).

CONCLUSION

A competitive leaderboard was not associated with an increase in self-directed simulated CPR practice or improved performance.

Utility of Theory to Explain Village Doctors' Willingness to Treat People Living with HIV in Rural China

Stigma against people living with HIV in China is common, not only among the general public but also among Chinese health-care providers, impacting their ability to provide quality HIV treatment and care. HIV stigma may be particularly common in rural areas of China, where village doctors (i.e., "barefoot doctors") have limited medical training yet are charged with providing frontline care for much of China's rural population. Therefore, the present study aims to use communication and behavioral theory to better understand Chinese village doctors' beliefs about HIV, including their willingness to become involved in HIV treatment and care. In collaboration with the Behai Centers for Disease Control, we surveyed 228 village doctors in rural China to learn about their experiences in providing HIV treatment and care. We then applied a hybrid theoretical model, combining variables from the Situational Theory of Publics and the Theory of Reasoned Action, to explain providers' communication, attitudes, and behaviors. Findings suggest that enhanced information activity about HIV may increase providers' self-efficacy in caring for HIV patients and yield more positive attitudes towards caring for people living with HIV. Theoretical and practical implications are discussed.

Emergency department nurses' experience of performing CPR in South Korea

BACKGROUND

Emergency Department (ED) nurses often confront unexpected cardiopulmonary resuscitation (CPR) with little information about the patients.

METHODS

This qualitative study explored the experience of performing CPR among ED nurses. Data collection took place between May and June 2016 using an online advertisement to recruit 17 ED nurses. Each participant was interviewed for 40-90min. Interviews were recorded and transcribed verbatim. Data analysis was conducted using a conventional content-analysis method.

RESULTS

Four themes emerged: Pressure from the urgency of the CPR, becoming sharp tempered in addressing personnel during CPR, keeping psychological conflicts of CPR patient care to oneself, and growing as an ED nurse through CPR.

CONCLUSION

ED nurses had anxiety about CPR, regardless of their ability to perform CPR. They also suffered psychologically afterward. ED nurses could benefit from education that promotes their competencies for CPR and support systems to alleviate their psychological distress.

Nurses' Attitudes Regarding the Safe Handling of Patients Who Are Morbidly Obese: Instrument Development and Psychometric Analysis

BACKGROUND AND PURPOSE

Nurses' attitudes play an important role in the consistent practice of safe patient handling behaviors. The purposes of this study were to develop and assess the psychometric properties of a newly developed instrument measuring attitudes of nurses related to the care and safe handling of patients who are obese.

METHODS

Phases of instrument development included (a) item generation, (b) content validity assessment, (c) reliability assessment, (d) cognitive interviewing, and (e) construct validity assessment through factor analysis.

RESULTS

The final data from the exploratory factor analysis produced a 26-item multidimensional instrument that contains 9 subscales.

CONCLUSIONS

Based on the factor analysis, a 26-item instrument can be used to examine nurses' attitudes regarding patients who are morbidly obese and related safe handling practices.

Cardiac Arrest in Pregnancy

This is the first scientific statement from the American Heart Association on maternal resuscitation. This document will provide readers with up-to-date and comprehensive information, guidelines, and recommendations for all aspects of maternal resuscitation. Maternal resuscitation is an acute event that involves many subspecialties and allied health providers; this document will be relevant to all healthcare providers who are involved in resuscitation and specifically maternal resuscitation.

Self-motivated learning with gamification improves infant CPR performance, a randomised controlled trial

Background

Effective paediatric basic life support improves survival and outcomes. Current cardiopulmonary resuscitation (CPR) training involves 4-yearly courses plus annual updates. Skills degrade by 3–6 months. No method has been described to motivate frequent and persistent CPR practice. To achieve this, we explored the use of competition and a leaderboard, as a gamification technique, on a CPR training feedback device, to increase CPR usage and performance.

Objective

To assess whether self-motivated CPR training with integrated CPR feedback improves quality of infant CPR over time, in comparison to no refresher CPR training.

Design

Randomised controlled trial (RCT) to assess the effect of self-motivated manikin-based learning on infant CPR skills over time.

Setting

A UK tertiary children's hospital.

Participants

171 healthcare professionals randomly assigned to self-motivated CPR training (n=90) or no refresher CPR training (n=81) and followed for 26 weeks.

Intervention

The intervention comprised 24 h a day access to a CPR training feedback device and anonymous leaderboard. The CPR training feedback device calculated a compression score based on rate, depth, hand position and release and a ventilation score derived from rate and volume.

Main outcome measure

The outcome measure was Infant CPR technical skill performance score as defined by the mean of the cardiac compressions and ventilations scores, provided by the CPR training feedback device software. The primary analysis considered change in score from baseline to 6 months.

Results

Overall, the control group showed little change in their scores (median 0, IQR −7.00–5.00) from baseline to 6 months, while the intervention group had a slight median increase of 0.50, IQR 0.00–33.50. The two groups were highly significantly different in their changes (p<0.001).

Conclusions

A significant effect on CPR performance was demonstrated by access to self-motivated refresher CPR training, a competitive leaderboard and a CPR training feedback device.

Cardiopulmonary resuscitation knowledge and skills of registered nurses in Botswana

BACKGROUND

In Botswana nurses provide most health care in the primary, secondary and tertiary level clinics and hospitals. Trauma and medical emergencies are on the increase, and nurses should have cardiopulmonary resuscitation (CPR) knowledge and skills in order to be able to implement effective interventions in cardiac arrest situations.

OBJECTIVE

The objective of this descriptive study was to assess registered nurses’ CPR knowledge and skills.

METHOD

A pre-test, intervention and re-test time-series research design was adopted, and data were collected from 102 nurses from the 2 referral hospitals in Botswana. A multiple-choice questionnaire and checklist were used to collect data.

RESULTS

All nurses failed the pre-test. Their knowledge and skills improved after training, but deteriorated over the three months until the post-test was conducted.

CONCLUSION

The significantly low levels of registered nurses’ CPR skills in Botswana should be addressed by instituting country-wide CPR training and regular refresher courses

How do nursing students perceive substance abusing nurses?

Substance abuse among nurses was recognized by nurse leaders and professional nursing organizations as a growing threat to patient safety and to the health of the abusing nurse more than 30years ago. Although numerous studies on nurse impairment were published in the 1980s and 1990s, there was minimal focus on student nurses' perceptions about impaired nurses and less research has been published more recently, despite a growing rate of substance abuse. A quasi-experimental study to explore the perceptions of student nurses toward nurses who are chemically dependent was conducted using a two-group, pretest-posttest design. The Perception of Nurse Impairment Inventory (PNII) was completed by student nurses at the beginning of their junior course work, prior to formal education about substance abuse. The PNII was repeated after the students received substance abuse education. The PNII was also completed by a control group of sophomore student nurses who did not receive the formal substance abuse education. A repeated measures analysis of variance was used to measure the differences between the two groups of students. Students who received the education chose more compassionate responses on the PNII and were more likely to respond that an impaired nurse's supervisor is responsible for supporting and guiding the impaired nurse to access professional care. Discrepancies in study findings about the efficacy of education for effecting positive attitudes of student nurses toward impaired nurses may be related to the length and type of the education.

The Effect of Computer-Based Resuscitation Simulation on Nursing Students’ Performance, Self-Efficacy, Post-Code Stress, and Satisfaction

Computer-based simulation has intuitive appeal to both educators and learners with the flexibility of time, place, immediate feedback, and self-paced and consistent curriculum. The purpose of this study was to assess the effects of computer-based simulation on nursing students’ performance, self-efficacy, post-code stress, and satisfaction between computer-based simulation plus instructor-led cardiopulmonary resuscitation training group and instructor-led resuscitation training-only group. This study was a nonequivalent control group posttest-only design. There were 213 second year nursing students randomly assigned to one of two groups: 109 nursing students with computer-based simulation or 104 with control group. Overall nursing students’ performance score was higher in the computer-based simulation group than in the control group but reached no statistical significance (t = 1.086, p = .283). There were no significant differences in resuscitation-specific self-efficacy, post-code stress, and satisfaction between the two groups. Computer-based simulation combined with hands-on practice did not affect in nursing students’ performance, self-efficacy, post-code stress, and satisfaction in nursing students. Further study must be conducted to inform instructional design and help integrate computer-based simulation and rigorous scoring rubrics.

Effects of team coordination during cardiopulmonary resuscitation: a systematic review of the literature

PURPOSE

The purpose of this study is to identify and evaluate to what extent the literature on team coordination during cardiopulmonary resuscitation (CPR) empirically confirms its positive effect on clinically relevant medical outcome.

MATERIAL AND METHODS

A systematic literature search in PubMed, MEDLINE, PsycINFO and CENTRAL databases was performed for articles published in the last 30 years.

RESULTS

A total of 63 articles were included in the review. Planning, leadership, and communication as the three main interlinked coordination mechanisms were found to have effect on several CPR performance markers. A psychological theory-based integrative model was expanded upon to explain linkages between the three coordination mechanisms.

CONCLUSIONS

Planning is an essential element of leadership behavior and is primarily accomplished by a designated team leader. Communication affects medical performance, serving as the vehicle for the transmission of information and directions between team members. Our findings also suggest teams providing CPR must continuously verbalize their coordination plan in order to effectively structure allocation of subtasks and optimize success.

A survey of nurses' perceived competence and educational needs in performing resuscitation

BACKGROUND

Effective training is needed for high-quality performance of staff nurses, who are often the first responders in initiating resuscitation. There is insufficient evidence to identify specific educational strategies that improve outcomes, including early recognition and rescue of the critical patient. This study was conducted to identify perceived competence and educational needs as well as to examine factors influencing perceived competence in resuscitation among staff nurses to build a resuscitation training curriculum.

METHODS

A convenience sample of 502 staff nurses was recruited from 11 hospitals in a single city. Staff nurses were asked to complete a self-administered questionnaire.

RESULTS

On a five-point scale, chest compression was the lowest-rated technical skill (M = 3.33, SD = 0.80), whereas staying calm and focusing on required tasks was the lowest-rated non-technical skill (M = 3.30, SD = 0.80). Work duration, the usefulness of simulation, recent code experience, and recent simulation-based training were significant factors in perceived competence, F(4, 496) = 45.94, p < .001. Simulation-based resuscitation training was the most preferred training modality, and cardiac arrest was the most preferred training topic.

CONCLUSION

Based on this needs assessment, a simulation-based resuscitation training curriculum with cardiac arrest scenarios is suggested to improve the resuscitation skills of staff nurses.

The effects of simulation-based resuscitation training on nurses' self-efficacy and satisfaction

BACKGROUND

Nurses are often the first responders in clinical emergencies that require effective training to ensure high-quality resuscitation and patient safety. The aim of the study was to evaluate the efficacy of simulation-based resuscitation training by assessing two different training modalities (computer-based simulation versus mannequin-based simulation) with practicing nurses.

METHOD

The study used a comparative study design with random assignment to two simulation-based training modalities. A total of 38 nurses participated in the study: 18 nurses with computer-based simulation, and 20 nurses with mannequin-based simulation. Participants rated their self-efficacy and satisfaction after participating in a simulated scenario involving managing a cardiac arrest patient.

RESULTS

On a 10-point scale, the participants' overall self-efficacy rating was 6.50 (SD=1.66), and satisfaction rating was 7.53 (SD=1.20) for both groups. There were no significant differences between the groups. The computer-based simulation group had significant higher satisfaction ratings in 'Setting priorities for nursing intervention' and 'Implementing nursing skills as protocol' compared to the mannequin-based simulation group. Most nurses felt the simulation experience was useful for future performance in their workplace, but rated realism of simulation as unsatisfactory.

CONCLUSION

The introduction of simulation-based resuscitation training as an active-learning format was positively embraced by nurses. Computer-based simulation might be beneficial for acquiring nursing skills and decision making skills in resuscitation. Further study is needed to verify the effects of simulation-based resuscitation training with more rigorous outcomes.

[Nurses' cardiopulmonary resuscitation performance during the first 5 minutes in in-situ simulated cardiac arrest]

PURPOSE

The purpose of this study was to analyze the cardiopulmonary resuscitation skills and teamwork of nurses in simulated cardiac arrests in the hospital.

METHODS

A descriptive study was conducted with 35 teams of 3 to 4 registered nurses each in a university hospital located in Seoul. A mannequin simulator was used to enact simulated cardiac arrest. Assessment included critical actions, time elapsed to initiation of critical actions, quality of cardiac compression, and teamwork which comprised leadership behavior and communication among team members.

RESULTS

Among the 35 teams, 54% recognized apnea, 43% determined pulselessness. Eighty percent of the teams compressed at an average elapsed time of 108±75 seconds with 35%, 36%, and 67% mean rates of correct compression depth, rate, and placement, respectively. Thirty-seven percent of the teams defibrillated at 224±67 seconds. Leadership behavior and communication among team members were absent in 63% and 69% of the teams, respectively.

CONCLUSION

The skills of the nurses in this study cannot be considered adequate in terms of appropriate and timely actions required for resuscitation. Future resuscitation education should focus on improving the quality of cardiopulmonary resuscitation including team performance targeting the first responders of cardiac arrest.

Ward Nurses’ Resuscitation of Critical Patients

Little is known about the current training and barriers in resuscitation skills among practicing ward nurses. A convenience sample of 459 ward nurses, recruited from 11 academic teaching hospitals in Korea, were surveyed to assess current training and barriers to optimal resuscitation performance on the wards. The Perceived Barriers scale was developed, refined, and its psychometric properties were assessed. Approximately 36% of nurses had received simulation-based resuscitation skills training. Exploratory factor analysis identified four barriers accounting for 58.4% of the variance: insufficient training (37.7%), lack of competence (9.8%), lack of self-confidence (5.9%), and workload and tension (5.1%). Strategic planning and resuscitation skills training should be incorporated into staff development programs to reduce barriers to optimal resuscitation performance and cope with work demands for ward nurses.

Morphine administration by Paramedics: an application of the Theory of Planned Behaviour

Timely and appropriate pain management in the pre-hospital environment is paramount to effective patient care. Experts agree that there are many factors that hinder the delivery of adequate pain management to patients with pain. The purpose of this study was to use the Theory of Planned Behaviour (TPB) model to identify the factors influencing Ambulance Paramedics' intention to administer morphine to patients with pain. Participants of this study were Advanced Care and Intensive Care Paramedics who were deemed competent in morphine administration. Data were collected by means of a questionnaire that used the constructs of the TPB, including subjective norm, perceived behavioural control and attitude. Whilst participants reported strong intentions to administer morphine they also reported negative attitudes towards the behaviour. The constructs of the TPB explained 26% of the variance in intention to administer morphine with subjective norm being the strongest significant predictor. The findings related to specific attitudes and normative pressures provide an understanding into Paramedic's pain management behaviour.

Nurses' perceptions of simulation-based interprofessional training program for rapid response and code blue events

Following completion of an interprofessional simulation program for rapid response and code blue events, we explored hospital unit nurses' perspectives of the training, through a mixed-methods analysis. The results of this study advocate for the use of simulation training in preparing nurses and promoting communication among team members, effective teamwork, and early recognition of clinically deteriorating patients. This study provides support for the implementation and continued use of simulation interprofessional programs in hospital settings.

Nurses' attitudinal and normative beliefs concerning hemodynamic assessment by pulmonary artery catheterization

The objective of this study was to identify, by using the Theory of Reasoned Action/Theory of Planned Behavior, the attitude and normative beliefs that influence the behavioral intention of the nurse to perform a hemodynamic assessment using the pulmonary artery catheterization. Data were collected through semi-structured interviews involving 23 nurses from three hospitals in the city of Campinas, São Paulo. The data were analyzed according to a qualitative methodology. Among the Attitude Beliefs, affective beliefs and those related to the advantages and disadvantages of performing the behavior stand out. Among the Normative Beliefs social referents were identified for the behavior, as well as the behavior-stimulating factors and the factors that discourage the performance of the behavior.

Medical and nursing students’ attitudes toward cardiopulmonary resuscitation and current practice guidelines

PURPOSE OF THE STUDY

Every member of a healthcare organisation should be able to perform cardiopulmonary resuscitation and defibrillation (CPR-D). The purpose of this cohort study was to examine medical and nursing student's beliefs and attitudes toward CPR-D and current practice guidelines.

MATERIALS AND METHODS

A pilot questionnaire concerning beliefs and attitudes toward CPR-D was distributed to 120 fourth year medical students. After statistical analyses (Cronbach's alpha), the questionnaire was modified to increase its reliability. The second version was distributed via e-mail to 100 final sixth year medical students and to 120 final fourth year nursing students. The students had 2 weeks to answer the questionnaire. A reminder was sent via e-mail after 1 week.

RESULTS

The questionnaire was answered by 71 of 120 fourth year students (59.1%), 56 of 100 (56.0%) sixth year medical students and 76 of 120 (63.3%) nursing students. Seventy percent of the fourth year, 85.8% of the final (sixth) year medical students and 70.0% of the final (fourth) year nursing students felt confident about their ability to perform basic life support (p<0.01) and 24.0% of the fourth year, 84.0% of the final year medical students and 22.7% of the nursing students about defibrillation (p<0.001). The perceived ability to defibrillate correlated significantly with a positive attitude toward nurse-performed defibrillation (p<0.01) and negatively with fear of damaging the patient's heart by defibrillation (p<0.01). Negative attitude toward defibrillation correlated with perceived organisational attitudes toward practise guidelines (p<0.01).

CONCLUSIONS

Medical students' attitudes mature as hoped for, but the nursing students need encouragement. More information is needed to diminish anxiety concerning defibrillation. Negative beliefs and attitudes toward defibrillation affect the students' attitudes toward practice guidelines.

Évaluation de la mise en place d'une formation continue du personnel de l'hôpital Bichat à la prise en charge des arrêts cardiocirculatoires intrahospitaliers

Management of in-hospital cardiac arrest is now considered as a hospital quality indicator. Such management actually requires training health care workers (HCWs) for basic life support (BLS).

OBJECTIVE

To assess the usefulness and efficacy of a short mandatory BLS training course amongst general ward HCWs in a 1,200 bed teaching hospital.

STUDY DESIGN

The in-hospital medical emergency team (MET) established a 45-min BLS training course comprising 10 goals for basic CPR and preparing for the arrival of the MET. Assessment was based on satisfaction questionnaires, cross-sectional evaluation of knowledge and skills of HCWs before and 1 year after the start of the training course. Efficacy of BLS performed on ward was assessed by the MET on scene.

RESULTS

One year after, 68 training sessions had been fulfilled and 522 HCWs had been trained (46.27% of total HCWs). HCWs were satisfied with the teaching course. Instant retention of objectives was over 90%. Cross-sectional surveys showed an improvement of BLS knowledge and skills. The knowledge of initial clinical assessment remained low. Knowledge and skills were significantly higher amongst HCWs who had been trained than amongst those who had not. Unfortunately, general ward BLS performance showed no improvement.

CONCLUSION

Short mandatory training courses are stimulating and well appreciated amongst HCWs. Although basic knowledge and skills improve dramatically, no improvement of on-scene BLS performance occurs.

BCLS Certification of the Nursing Staff

This article describes the application of the Iowa Model of Evidence-Based Practice to Promote Quality Care to creating standards of practice for Basic Cardiac Life Support certification of the nursing staff at a merged health center in Montreal, Quebec, Canada. Selected outcomes and adopted practice guidelines are presented.

When minutes count--the fallacy of accurate time documentation during in-hospital resuscitation

The purpose of this study is to examine the commonly held assumption that time is measured and documented accurately during resuscitation from cardiac arrest in the hospital.

METHODS

A two-pronged approach was used to evaluate the accuracy of time documentation and measurement. First, two existing databases-the National Registry of Cardiopulmonary Resuscitation (NRCPR) and a 240-bed hospital's repository of cardiac arrest records-were evaluated for completeness and accuracy of documentation on resuscitation records of times required for calculating the Utstein gold-standard process intervals-recognition of pulselessness to starting cardiopulmonary resuscitation (CPR), delivery of first defibrillation shock, successful intubation, and epinephrine (adrenaline) administration. Second, nurses from a 900-bed hospital were interviewed to determine timepieces used during resuscitations, and timepieces were assessed for coherence and precision.

RESULTS

: From the NRCPR database that included 10,689 pulseless cardiac arrests submitted by 176 hospitals, time data for calculating the Utstein intervals were missing for 10.9% of the interventions; negative intervals were calculated for 4%. From 232 consecutive resuscitation records from the 240-bed hospital, 85 records were identified from non-monitored units with staff who provided only CPR. Defibrillation, intubation and epinephrine administration were delayed until after arrival of advanced life support (ALS) responders; unlikely intervals of 0 min from event recognition to these ALS interventions were calculated for 11.5%. Sixty-seven nurses from the 900-bed hospital were interviewed; when documenting information during resuscitations, 21 (31.3%) reported using only patient room clocks, 30 (44.8%) only their watches, and 16 (23.9%) several timepieces. In all in-patient units in the same hospital, 241 timepieces (nurses' and physicians' watches, clocks in patient rooms, defibrillator clocks, central station monitors, and nursing station clocks) were compared to atomic time. The mean absolute time difference from atomic clock was 2.83 min (S.D. +/-5.9 min), median 1.88 min, and range 52.1 min slow to 72.85 min fast. There was no difference among timepieces (P = 0.35).

CONCLUSIONS

Missing time data, negative calculated Utstein gold-standard process intervals, unlikely intervals of 0 min from arrest recognition to ALS interventions in units with CPR providers only, use of multiple timepieces for recording time data during the same event, and wide variation in coherence and precision of timepieces bring into question the ability to use time intervals to evaluate resuscitation practice in the hospital. Practitioners, researchers and manufacturers of resuscitation equipment must come together to create a method to collect and document accurately essential resuscitation time elements. Our ability to enhance the resuscitation process and improve patient outcomes requires that this be done.