Effect of Educational Protocol about Resuscitation Process on Nurses' Performance

Introduction

Cardiopulmonary resuscitation (CPR) procedure as a basic skill is one of the most important inventions of the history in medicine with a rapid and urgent intervention to prevent or postpone death in a patient with cardiac arrest (Hasselqvist et al., 2015).  CPR consists of an initial assessment of the patient and a subsequent number of steps that includes chest compressions, airway maintenance and rescue breathing (Yang, et al., (2012).   CPR is one of the procedures that can be administered without an explicit order from a doctor which most incidences of cardiac arrest are both sudden and unexpected so, immediate actions are necessary (Waldron et al, 2016).CPR has been shown to reduce cardiac death in-hospital and related facilities when patients are managed by adequately trained health care professionals (Simmes et al., 2012).‏ CPR is a medical practice for all cardiac arrests except where a “Do not resuscitate” (DNR) or “No CPR” order has been given for a particular patient ( Burkle et al., 2013). Nurse is a key role in respond to a cardiac arrest and initiate basic life support while waiting for the advanced cardiac life support team to arrive (Terzi, 2012). Throughout the years, as CPR guidelines are altered and the roles of the multidisciplinary team members are also subjective to change. So, Some of these new roles include: the rapid response nurse, the initiation of external defibrillation, the involvement in CPR decision making, chest compression , ventilation role,  the understanding of the use of resuscitation drugs and the family support in the cases of witnessed resuscitation (Monsieurs et al., 2015). Nurses are the central part of the health care system and they are believed to be knowledgeable and competent in caring for patients. )Ray, 2016).

Significance of the study

Cardiac arrest is a major public health problem affecting thousands of individuals each year in both out-of-hospital and in-hospital settings (Hasegawa et al. (2013). In 2012 nearly 383,000 out-of-hospital sudden cardiac arrests occurred and approximately 209,000 cardiac arrests occurred within a hospital. Survival rates from cardiac arrest are improving, however overall rates of survival are still low (American Heart Association, 2012).

Through my experience as a clinical instructor over a period of 2 years working in intensive care units I observed lack in nurses’ knowledge and practice during resuscitation process that affect on patient’s condition and delayed patient out. Therefore, this study designed in an attempt to improve nurses’ performance during resuscitation process.

Aim of the Study

Evaluate effect of educational protocol about resuscitation process on nurses' performance.

Research Hypothesis:

The nurses’ knowledge and practice about resuscitation process will be better than pre educational protocol.

Study Design:

Quasi - experimental research design was utilized to fulfill the purpose of this study

Subjects:

A purposive sample of about 60 critical care nurses who were working in a five Critical Care Units at Minia University Hospital at the time of conducting the study and willing to participate in the study was included.

Inclusion Criteria:-

• All nurses were in duties.
• Nurses who attended or not attended previous training courses about resuscitation process.

Exclusion Criteria: 

• Nurses refuse participation in the study.  

Setting: 

All Critical Care units affiliated to Minia University Hospital including (Intensive Care Unit, Emergency unit, Cardiothoracic Care Unit, Cardiac Care Unit, Stroke).

Study Duration:

The total data collection was collected for five months from February to July 2019.

Tools for data collection

Two tools were designed and used for collecting data for this study, these tools were formulated and tested by the researcher, and the content of the tools was established after extensive literature review.

First Tool: “Structured Questionnaire Sheet” it consists of (two parts):

1st Part: - Nurses’ personal data to collect nurses' data related to the following (age, gender, years of experience, level of education …etc.

2nd Part: - Knowledge assessment questionnaire sheet about resuscitation process and nurses' role in resuscitation team.it was multiple choice questions sheet translated into Arabic language.

Scoring System:

Each right answer takes one grade and the wrong answer take zero grade with a total scores 38, so (< 60%) was considered unsatisfactory; (≥60%) was considered satisfactory.

Second Tool:"Observational checklist for assessment nurses' practice in resuscitation Process"

This tool consists of (23) items for evaluating nurses′ performance regarding their roles during resuscitation for critically ill patients in different critical care units.

Scoring System:

Each right answer (Done) take one grade and the wrong answer (Not done) take zero grade with a total scores 23, so (≤ 70%) was considered poor, (<70-85%) was considered fair and more than (85%) was considered good practice scores.

Educational Brochure about CPR Process. It was formulated by the researcher after extensive literature review and revised by experts in the field of critical care nursing. It was translated into the Arabic language with figures for more clarification.

Tools validity:

The study tools were developed after reviewing the related literature. To determine content and face validity, these tools were tested by a Jury committee that consists of five medical surgical-nursing experts. Recommendations were followed; the questions that were not appropriate were taken out and some questions needed clarification and modifications were done.

Tools reliability:

Tools were tested for content reliability using Alpha Cronbach’s test. It was (0.81) for the first tool, (0.79) for the second tool.

Pilot study: A pilot study was carried out on 6 nurses working in the Critical Care units who fulfilled the inclusion criteria to test the feasibility, objectivity, applicability of the study tools, and to estimate the needed time to fill the data collection. Based on the results of the pilot study, no refinement/ modifications were done for data collection instruments; nurses who shared in the pilot study were included in the actual study sample.

Ethical consideration: Official permission to conduct the study was obtained from faculty ethical committee of research, dean of the faculty of nursing at Minia University, Research center afflicted to Egypt Ministry of Health, agreement from Egypt academic for the research center and technology and from directors of Critical Care Units at Minia 43 University Hospital. Oral consents were obtained from each nurse after explanation of the nature and purpose of the study. Each head nurses who were on duty during study implementation and nurses were free to either participate or not in this study and had the right to withdraw from the study at any time without any rational; also, nurses were informed that data will not be included in any further researches without another new consent. Confidentiality and anonymity of each subject were assured through coding of all data. (60%) was considered poor, (≥ 60-85%) was considered fair and more than (85%) was considered good practice scores.

Study Procedure: Once official permissions were granted, the pre-educational data (pre-test) collected through (four weeks) to test studied sample for actual level of knowledge and practices regarding resuscitation process. The researcher distributed the Knowledge assessment questionnaire sheet to assess study sample′ s actual level of knowledge after clearly explaining the way to fill it, then Observational checklist for assessment nurses' practice in resuscitation Process"

The total number (60) of the study participants was divided into twenty classes each class consists of three participants. The appointment for starting educational sessions was scheduled with the study sample according to their circumstances. The educational protocol was conducted as one session for knowledge teaching, two sessions for practice teaching for every class; each session took about 30- 45 minutes. At the end of teaching sessions (knowledge & practice), the researcher gave the study participants  brochure as an educational protocol about resuscitation process: It was formulated by the researcher after extensive literature review by experts in the field of critical care nursing , and translated into the Arabic language with figures for more clarification.

The researcher collects post educational evaluation (post-test) for knowledge through giving the sample the Knowledge assessment questionnaire sheet and Observational checklist.

as an immediate posttest assessment, then follow up was done by the researcher after three months by using 2 nd Part (Knowledge assessment questionnaire) & Observational checklist .

To evaluate the effectiveness of the educational protocol regarding study sample′ performance. Statistical analysis of data: Data obtained from the study tools were categorized, tabulated, analyzed and data entry was performed using the SPSS software (statistical package for social sciences version 22.0). Descriptive statistics were applied (e.g. mean, standard 45 deviations, frequency, and percentage). Pearson's correlation coefficient was applied between quantitative variables. A significant level value was considered when p<0.05. The smaller the P-value obtained, the more significant is the result (*), less than 0.001 was considered highly significant (**). The P- value is the probability of error of the conclusion.

Results

Table (1):  Percentage distribution of the studied groups  as regards personal data (n= 60).

Table (1) revealed that more than half of the study group′s age was between 20-24 years and their Mean average age ± SD was (27.88 ± 7.709) years and the highest  percentage from them constituted (68.3%) were females, also as regards their educational level results  found that above the half among them  had graduated from technical institute degree in nursing. On  the other hand, the highest percentage of participants constituted (60%) had less than five  years of experience in working at critical units ,but lowest percentage of them were more than five  years of experience and their Mean average ± SD was (5.2667 ± 2.655   years). Finally, as regards, previous  workshop attendance regarding cardiopulmonary resuscitation process results revealed that the  majority of the study group constituted (76.7%) hadn't attended any previous  workshop .

Figure (1):  Overall total studied samples' knowledge  levels about CPR process in the pre-post education

Figure (1) revealed that 78.3% of studied sample had unsatisfactory knowledge during pre education; while100% of them had hundred percent knowledge levels immediately post education, while post education after three months 93.3 % of them had satisfactory knowledge level.

Figure (2):  Overall total practice levels of the Studied groups in about CPR process through pre-post educational protocol

l(three months)

Figure (2) displayed that 83% of study sample had poor practice level during pre test, while 45 % of them had good practice level post three months test.

Table (2) Correlations between total knowledge score and total practice score among studied sample pre& post educational protocol

Table (2) showed that there was highly statistical significance between total knowledge and practice score at pre & post – educational protocol (three months).

Table (3) Correlations between personal data and total practice score at pre& post educational protocol

Table (3) reveled that there was no statistically significant correlation between all personal characteristics for studied groups and their total practice score pre and post-educational protocol except in a studied sample's age categories it had a significant correlation with mean practice score after three months post education with p-value (052*).