Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses

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.

Experience of cardiopulmonary resuscitation by healthcare professionals in emergency departments: A descriptive phenomenological study

BACKGROUND

Emergency department healthcare professionals have the most contact with patients in cardiac arrest, and their physical and mental state has a significant impact on the quality of cardiopulmonary resuscitation and patient outcomes. However, there is limited research discussing the experience of resuscitation by emergency department healthcare professionals.

AIM

To explore the experiences of emergency department healthcare professionals in performing cardiopulmonary resuscitation.

METHODS

A descriptive phenomenological study. The study used purposive sampling and selected 9 nurses and 6 physicians from the emergency departments of four general hospitals of different levels in western China between May 2022 and October 2022. Semi-structured interview guides and face-to-face interviews were used to collect information. Colaizzi analysis was used to analyze the data.

RESULTS

The study identified 3 themes and 11 sub-themes. These themes and sub-themes include 1) emotional experience (A sense of achievement, A sense of powerlessness and trauma, Stress, Empathy, Psychological resilience strengthens), 2) cognitive growth (Understanding CPR rationally, Increasing concern for personal and family health, Mastering self-relaxation methods), and 3) the desire for continued development (Seeking professional development, Hoping for professional psychological assistance, Strengthening team support).

CONCLUSIONS

The experience of performing cardiopulmonary resuscitation by healthcare professionals in emergency departments is dynamic, with changes in mood and cognitive growth. Managers in hospitals should pay attention to their experiences and need at different stages of career development and actively carry out targeted cognitive guidance, skills training, and psychological support to help them achieve professional development and physical and mental health. At the same time, to promote the development of CPR for all, it is recommended that the authorities actively improve the public infrastructure for first aid and related policy protection.

Perceptions of nurses regarding quality of adult cardiopulmonary resuscitation in Ghana: a qualitative study

OBJECTIVES

Cardiopulmonary resuscitation (CPR) is a necessary life-saving emergency intervention for patients with cardiac arrest and other medical conditions. The study's primary objective was to qualitatively explore nurses' perceptions of the quality of adult cardiopulmonary resuscitation in Ghana.

METHODS

An exploratory descriptive qualitative study was conducted among 13 purposively sampled nurses in Ghana. We collected thirteen face-to-face and telephone interviews using a semi-structured interview guide. Data were transcribed verbatim and analysed using the thematic analysis approach recommended by Braun and Clarke.

RESULTS

Data analysis revealed that nurses were filled with positive emotions when patients regained consciousness following resuscitation. When the otherwise happens, they tend to become tortured psychologically and filled with negative emotions. Besides, environmental factors such as the time of initiating CPR following a cardiac arrest, the availability and appropriateness of equipment and medications, workplace ergonomics, and institutional regulations affected the quality of resuscitation practices of nurses. Participants perceived that attitudes of condemnation, prejudice, apathy and skills deficiency also impacted the quality of resuscitation practices. Significant aspects of self-reported behavioural competence that affected resuscitation were knowledge and skills of CPR, confidence in initiating CPR, and the need for effort maximisation.

CONCLUSION

This study revealed several non-medical factors that influenced the resuscitation practices of nurses from their perspective. Nurses need to maximise their effort toward seeking further education in speciality areas such as emergency nursing and critical care nursing to guide their CPR practices and other newly emerging evidence-based protocols.

Self-confidence and knowledge in leadership in critical care: simulation with the "blindfolded" technique

OBJECTIVE

To verify the contributions of using the "blindfolded" technique on nursing students' self-confidence and knowledge in critical patient care in simulated clinical scenarios.

METHOD

A quasi-experimental study conducted with 25 nursing students from a Federal University in the inland of São Paulo between November and December 2021. The participants answered the "Self-confidence Scale" and the Checklist of CPR Knowledge, Skills and Attitudes, before and after the intervention. A descriptive analysis of the checklist was performed and the Wilcoxon test was used to evaluate the checklist and the "Self-confidence Scale".

RESULTS

There was a mean of 4.04 additional correct answers in the sample analyzed, based on the difference in the number of correct answers between both moments. A total of 80% of the sample showed an increase in knowledge.

CONCLUSION

After the clinical simulation with the "blindfolded" technique, the students in leadership roles presented an increase in knowledge and self-confidence during the assistance provided in critical scenarios.

Self-Assessed Capabilities, Attitudes, and Stress among Pediatric Nurses in Relation to Cardiopulmonary Resuscitation

Background

In emergency medicine, cardiopulmonary resuscitation (CPR) is one of the most stressful scenarios for nurses who conduct both basic and advanced resuscitation methods.

Aim

This study aimed to assess nurses' self-assessed capabilities, attitudes, and stress related to CPR.

Methods

This cross-sectional, observational study was carried out on 748 pediatric nurses at six governmental hospitals. A self-assessed ability questionnaire and a structured stress and attitude questionnaire was used for data collection.

Results

For self-assessed abilities, 45.5% of the nurses had moderate scores. Concerning stress, 48.3% had moderate scores and 63.1% negative attitudes. Also, attitude and self-assessed abilities had a high-frequency negative effect on stress scores (P<0.05).

Conclusion

Attitude scores increased and stress scores decreased significantly with postgraduate educational level, attendance at training courses on pediatric basic life support and automated external defibrillator use, being exposed to >10 cardiac arrest cases in the previous year, and having an advanced life-support license (P<0.05). Positive attitudes and improving self-assessed abilities decreased the nurses' stress levels related to CPR.

Autoconfiança e conhecimento na liderança em atendimento crítico: simulação com a técnica “olhos vendados”

RESUMO Objetivo: Verificar as contribuições do uso da técnica de “olhos vendados” na autoconfiança e conhecimento de estudantes de enfermagem no atendimento ao paciente crítico em cenários clínicos simulados. Método: Estudo quase-experimental com 25 estudantes do curso de enfermagem de uma Universidade Federal do interior de São Paulo entre novembro e dezembro de 2021. Os participantes responderam à Escala Self-confidence Scale e ao Checklist de Conhecimento, Habilidades e Atitudes em Reanimação Cardiorrespiratória, pré e pós-intervenção. Realizou-se a análise descritiva do checklist e o teste de Wilcoxon para avaliar o checklist e Self-confidence Scale. Resultados: Média de 4,04 acertos adicionais na amostra analisada, através da diferença de acertos entre os dois momentos. Um total de 80% da amostra demonstrou um aumento no conhecimento. Conclusão: Os estudantes em papéis de liderança após a simulação clínica com a técnica “olhos vendados”, apresentaram um aumento de conhecimento e autoconfiança durante a assistência nos cenários críticos.

Analyzing the operational conditions of crash carts in clinical and surgical hospitalization units

OBJECTIVE

To evaluate the operational conditions of crash carts in all clinical and surgical hospitalization units of public hospitals in a region in Southern Brazil.

METHOD

Quantitative, cross-sectional study to evaluate crash carts in adult clinical and surgical hospitalization units. The data were collected through a checklist containing 16 continuous variables.

RESULTS

Nineteen crash carts in nineteen units were evaluated. Analysis shows that the most frequent problems were excess of equipment and its lack of organization, medication in incorrect compartments and/or with no identification, and inappropriate environment for transportation.

CONCLUSION

The most relevant factors that possibly interfere with the operational conditions of crash carts are directly related to the organization and management of material resources, which may lead to the reduction of its functionality during patient care. Such problem may be solved by readjusting items and performing frequent verification.

Ferramentas da qualidade aplicadas à conferência do carro de emergência: pesquisa de métodos mistos

RESUMO Objetivo verificar as causas da não conferência do carro de emergência e o efeito sobre a taxa de adesão, por meio do emprego de ferramentas da qualidade em uma Unidade de Terapia Intensiva Neonatal. Método pesquisa mista do desenho exploratório sequencial, desenvolvida com enfermeiros e fonte documental na Unidade de Terapia Intensiva Neonatal de hospital universitário, em três etapas: 1) Brainstorming para levantamento das causas de não conferência/construção de Lista de Verificação; 2) Coleta/análise de dados pela aplicação da Lista de Verificação e Diagrama de Pareto; 3) Análise documental. Utilizou-se o teste qui-quadrado para verificar o efeito do emprego das ferramentas de qualidade na adesão à conferência. Resultados 13 causas de não conferência do carro de emergência foram identificadas, sendo oito evitáveis e cinco não evitáveis. As causas evitáveis (n=63) representaram 87,5%, sendo as principais: falta de hábito (n=17; 27%), priorizar atividades assistenciais (n=17; 27%) e realizar divisão do cuidado dos pacientes/priorizar atividades administrativas (n=9; 14,3%). A aplicação das ferramentas da qualidade teve efeito significativo (p-valor<0,001) na adesão à conferência. Conclusão e implicações para a prática o emprego das ferramentas da qualidade foi factível para a identificação causal da não conferência do carro de emergência e melhoria na sua adesão.

Barriers to the success of cardiopulmonary resuscitation from the perspective of Iranian nurses: A qualitative content analysis

BACKGROUND

The survival rate following Cardiopulmonary Resuscitation (CPR) has been reported to be 7-26.7%. Various studies have shown that CPR failure is high in many countries. This study was aimed to explore the barriers to the success of CPR from the perspective of Iranian nurses.

METHODS

Participants were 14 Iranian nurses recruited through purposive sampling. In-depth semi-structured interviews were used to collect data. Data were analyzed using qualitative content analysis.

RESULTS

The barriers to successful CPR were developed in three main categories and nine subcategories. Some of the barriers to CPR success were: "delayed attendance of the CPR team and start of CPR", "inadequate experience and skill of the CPR team", "poor access to special units", "insufficient and deficient CPR equipment", "poor CPR location", "critical clinical conditions of the patient", and "interference of the patient's family members.

CONCLUSION

The results showed that human and environmental factors can result in CPR failure. These barriers can be minimized by measures such as empowerment of the CPR team, and providing the necessary facilities and equipment.

A Grounded Theoretical Analysis of Room Elements Desired by Family Members and Visitors of Hospitalized Patients: Implications for Medical/Surgical Hospital Patient Room Design

Objective:

To identify family members’ and visitors’ needs with relation to the design of a hospital room.

Background:

There is a trend toward incorporating family zones in hospital patient rooms in order to improve patient satisfaction and encourage family caregivers to stay longer and overnight.

Method:

A mixed-method study was employed. Interviews of patients and family caregivers were conducted to understand opportunities to improve hospital room designs based on recent experiences. Features intended to support short-term and overnight visitors were embedded in five full-scale simulated room design concepts. Small groups of family caregivers and patients toured two room design concepts and reacted real time to room features. A grounded theory approach was employed to identify emerging themes.

Results:

A theoretical design framework is developed for the needs of family members and visitors for a range of time periods. This framework is founded upon desires to help make the patient feel more comfortable. There are various levels of helping the patient feel more comfortable, including visiting, keeping company, providing support, providing assistance, and being a caregiver. Beyond this core need, family members and visitors must take care of their own needs in order to feel comfortable in the hospital room. Activities associated with these needs include sitting, relaxing, eating, working, tending to daily needs, and resting overnight.

Conclusions:

Potential implications for architects, healthcare planners, and interior space designers are described. Design and renovation guidance for the hospital room environment in order to support the needs and expectations of families and visitors is provided.