Nurses’ knowledge and skills concerning cardiopulmonary resuscitation: a descriptive study

Ahmed Lateef Alkhaqani

1Ministry of Health,Al-Najaf Direction,Al-Sadder Medical Hospital,Al-Najaf 00964,Iraq.

Abstract Background: Nurses are usually the first to identify and initiate cardiopulmonary resuscitation (CPR) for cardiac arrest in hospitalized patients. Consequently, the assessment of nurses’ knowledge of CPR is very important for improving training programs. Basic life support will be designed to achieve this goal. However, when received by adequately trained healthcare professionals, basic life support has been shown to reduce in‐hospital deaths. Aims: The study aims to assess the knowledge and attitude of nurses when facing cardiac arrest regarding basic life support/cardiopulmonary resuscitation among nursing professionals and to design a proposed training program for nurses working in Al‐Najaf Teaching Hospital in their training needs. Methodology: This descriptive and exploratory cross‐sectional study will be conducted at Al‐Najaf city in the southern region of Iraq in Al‐Najaf teaching hospital to assess the nurses’ knowledge concerning cardiopulmonary resuscitation. The methodological strategies for data collection will be using assessment questionnaire survey, participative observation, and questionnaires to evaluate the need to learn,the educational practices,and their methodology, allowing for grouping the results in nurses’ expectations. Data collection will be from July to August of 2022 by the application of a semi‐structured questionnaire developed by the authors, to be used toward 250 nurses who work at a hospital in Al Najaf city; those on sick leave or vacations will be excluded.The project was approved by the Committee of Ethics in Research from Al‐Najaf health direction. Expected results: To know how CPR is performed and to check whether the actions taken differ from the knowledge and practice approved by nurses in their professional activities. Subsequently, to plan educational interventions associated with the practice if necessary.

Keywords: cardiac arrest; cardiopulmonary resuscitation; critical care nursing; basic life support

Introduction

A sudden cardiac arrest is a dramatic event responsible for elevated morbidity and mortality, even in situations with ideal assistance; it is an often‐unexpected intercurrence that constitutes a grave threat to the patient’s life.Thus,medical teams need speed,efficiency,scientific knowledge, and technical skills to carry out the necessary processes[1]. In addition, it requires adequate infrastructure and harmonic and synchronized teamwork among professionals; performance is necessary to achieve the patient's recovery. It is more common among individuals with pre‐existing cardiovascular morbidity. The global incidence of sudden cardiac arrest outside the hospital ranges between 20 and 140 for every 100,000 people,with an alarmingly low survival rate ranging between 2 and 11% [2].

So basic life support(BLS)is considered that all health professionals must have basic emergency skills. Early initiation of cardiopulmonary resuscitation (CPR) and activation of the chain of survival are key factors in saving the life of patients with cardiac arrest. Basic life support is an emergency procedure that consists of maneuvers that include recognizing sudden cardiac arrest signs, stroke, heart attack,foreign‐body airway obstruction, CPR, and defibrillation using an automated external defibrillator [3]. In order to improve this situation, it is necessary to ensure that CPR is effective and timely,based on sufficient knowledge and practical skills, since the quality of intervention affects the survival of the patient. CPR is a life‐saving action that improves the likelihood of survival after cardiac arrest.Training medical staff, including emergency medical technicians and volunteers who have received BLS training,can provide these services[4].

As the nurses remain with patients round the clock and spend significant time alongside patients, they are usually the first witnesses of sudden cardiac arrest in the hospital setting.Also,they are often the first health care professionals to a patient with cardiopulmonary arrest, therefore, should possess adequate competency to provide effective resuscitation [5]. Cardiopulmonary resuscitation training was meant only for healthcare professionals in the early days.CPR has been shown to reduce in‐hospital deaths when received from adequately trained healthcare professionals. Quality of life is also found to be better for victims who immediately receive bystander CPR, even in the absence of healthcare workers. Literature indicates differences in nurses’ CPR knowledge and skills from their areas of work and experience [6]. CPR knowledge and skills differ among healthcare workers in western countries and other developing countries. Cardiopulmonary resuscitation has been practiced for over 50 years. Many studies have shown that knowledge and skills decline within six months after initial training in CPR. All nurses’qualifications and practical life support training courses improve their performance when certified [7].

The last 20 years have recorded a decline in the knowledge and skills of nurses and medical staff following cardiac resuscitation training. Cardiopulmonary resuscitation training is important for nursing staff. Several different methods have been developed and evaluated to improve this conservation[8]. The American Association of Critical‐Care Nurses includes those working in“intensive care units,pediatric ICUs, neonatal ICUs, cardiac care units, cardiac catheter labs, progressive care units, emergency departments, and recovery rooms”. Critical care nurses are also known as ICU nurses. They treat acutely ill and unstable patients requiring more frequent nursing assessments and using life‐sustaining technology and drugs. Although their contribution to effective CPR is critical, both individually and as a member of the rapid response team, studies have often found that they have mediocre knowledge and poor skills in light of international guidelines and recommendations [9]. The training program in CPR will significantly reduce nurses’ fear and self‐confidence. As a result,individually or as team members,effectiveness in dealing with cardiac arrest and CPR could also be improved [10].

Study significance

Cardiac arrests are more frequent than we think and can happen anytime to anyone. Approximately 400,000 people in hospitals are seriously sudden cardiac arrests yearly, and 88 percent of patients are outside the hospital. Four of the five heart attacks occurred at home.The American Heart Association trains more than 12 million CPR members every year, empowering people with the necessary skills to perform CPR in the presence of observers. Even in developed countries, the knowledge and skills of health professionals in CPR vary. In developed countries such as the United States, the United Kingdom, Finland, and Ireland, several studies on CPR found that the level of knowledge and skills of registered nurses in CPR was revealed to be inadequate [11].

Effective chest compressions re‐establish the blood flow during the CPR, and the guidelines emphasize the following aspects: for the purposes of effective chest compressions, all workers must perform“strong, fast, and non‐stopping compressions”; compress the chest in frequencies of at least 100 compressions per minute for all victims(except newborns); allow the chest to fully refill (return to normal position) after each compression, and use about the same time for compression and relaxation [12]. The guidelines also minimize the importance of checking the pulse by the trained healthcare professional because the detection can be difficult, especially if the blood pressure is too low, and it should not take more than ten seconds to be checked.The changes aim to simplify and emphasize the maneuvers for basic life support as key strategies to improve survival after a cardiac arrest [13]. All first responders should perform high‐quality CPR: these responders must apply chest compressions reaching the appropriate depth and number, allow the chest to fill after each compression, and minimize interruptions between compressions. The nursing staff is necessary to understand that by being the ones that generally stay next to the patient,most of the time,they are the professionals responsible for identifying a cardiac arrest and initiating resuscitation maneuvers [14].

In Iraq, there are no mandatory CPR training schedules and a strict need for license/certification renewal for basic life support for healthcare providers in hospitals, which has resulted in a wide gap in CPR knowledge and practice. Hence, in light of international guidelines and recommendations, the researcher has felt the need to assess the knowledge and practice of CPR among nurses working in Al‐Najaf Hospital teaching. The objective of this study is to describe and explore nurses professionals’ levels of knowledge and practice as regards CPR, whether they are appropriately up to date, and to confirm whether the training courses for critical care nurses on CPR performed to improve health personnel’s knowledge levels to support code blue team efficiency for effective resuscitation. Considering this topic, it is relevant to answer the following research question: what is the importance of knowledge and attitude of nurses who work in directassistancetoadultmedical‐surgicalpatientson cardiopulmonary arrest and resuscitation? The study will answer the question: is it mandatory for all critical care nurses to be trained in basic life support? It is necessary that the nurse hold control and technical‐scientific skills to get a satisfactory result from the assistance. Therefore, this research will investigate how CPR is conducted through a questionnaire since this method seeks to emphasize the routinely correct decision and ideal practice in addition to knowledge. This study will propose systematic interventions upon the results.The study will be done as it is not yet.

Methodology

Study design

This will be a descriptive cross‐sectional study with a quantitative approach using the semi‐structured questionnaire prepared by the researcher will be conducted at Al‐Najaf city in the southern region of Iraq in Al‐Najaf teaching hospital from July 24th, 2022 to August 20th, 2022, in order to assess the nurses’ knowledge concerning cardiopulmonary resuscitation and basic life support. The study will be used the problem‐based learning methodology, which focuses on problem situations of sudden cardiac arrest. The surveys on knowledge and attitudes will be justified by the fact that individuals(nurses)differ in their knowledge about health,non‐uniform attitudes,and the practice of their profession. The resulting information will be useful for planning and conducting programs and activities.

Population and study sample

The study participants will include approximately two hundred nurses who graduated from the clinical area setting.Nurses can describe their experience very well, as they are still transitioning from school education to their jobs.In addition, participants must work for at least six months.This will be implemented to collect data from persons who have had some experience as nurses. Participants can describe their experiences and challenges in the clinical field before the survey begins. Nurses who have not worked in a critical care unit for more than a year will be excluded.

A Non‐probability, convenience sampling technique will be used to select 200 nurses working in male and female medical wards;coronary care unit, an intensive care unit, respiratory care unit, an emergency department, an operation room, and surgical wards in Al‐Najaf teaching hospital. The study population all nurses who work at Al‐Najaf teaching hospital. During the study period, the total number of nurses eligible for the study period was 200, all of which are targeted.

Procedure and data collection tool

The researcher designed a semi‐structured survey questionnaire for the purpose of the present study.It contained two parts.The first part focuses on demographic and academic data, such as age and level of education. The second part assessed participants’ attitudes regarding BLS,including opinions about the necessity of BLS,attitudes regarding performing CPR, and opinions about including BLS in the curriculum also assessed the awareness and knowledge about BLS. The questionnaire was subjected to contents and face validity checks to evaluate the relevance and clarity of all components and the content.Further, internal consistency will be analyzed by calculation of Cronbach’s alpha.The data will collect for 30 days so that participants can respond as they wish. Researchers will be used the Google survey form to create surveys. Only subjects who have agreed to participate in the survey will be allowed access to the survey in the form of Google.

A pilot test for the evaluation of the instrument will be executed,and changes might be applied to the questionnaire after the evaluation.The researcher will collect the data in the workplace at the most convenient time and date for the participants. The professionals will be informed about the aims of the research. Those who agree to participate will be asked to sign the Term of Informed Consent. The questionnaire can be answered at the time when information is being provided or at a later scheduled time if more convenient to the professional. The CPR questionnaire should only be answered after a brief explanation by the researcher about the instrument.

Analysis of the data and statistical methods

The data analysis process will be evaluated and depicted entailed using Statistical Package for Social Sciences computer software to categorize information in graphs and charts that SPSS created and subsequently discussed. Statistical analysis will be performed using Statistical Package for Social Sciences version 24.0 for Windows(SPSS Inc., Chicago,IL, USA).Discourse questions are individually analyzed,characterized accordingly, and collected and documented in the scientific documents on the subject. Statistical analysis will include descriptive statistics to present demographic data and response patterns to various survey items; categorical variables will be presented as frequency and percentage, while numerical variables will be presented as mean ± standard deviation. The use of frequency distributions for the variables, the Chi‐square Pearson’s test. A 95%confidence interval andP＜ 0.05 statistical significance will be considered.

The validity questions are whether evidence supports the assertion,which is answered by a trained nurse survey. Although the results were consistent, the study was reliable but lacked a method for measuring the variables. The researchers determined that pilot studies are needed in future studies to determine the factors that may affect the capabilities of individuals and organizations of new graduates.Said pilot study will provide a list to include individual and organizational factors but provide subjects with “other” categories to allow them to indicate any other potential factors that could influence the study. A future survey will determine the level of knowledge and practice of nurses in basic life support after reviewing the validity and reliability of the data. Recommendations for the population survey will be drawn up between the types of nursing education programs associated with nursing education. Furthermore, the researcher constructed questionable questions to include explanations in responses. The researcher asked less “yes/no” answers and more discussion.