The Exploration of CPR Performance in ED Nursing Staff Using the Digital-simulated Manikin System and Video Film Teaching

• Main Authors: Wen-Hua Lu, 盧文華
• Other Authors: Shiow-Ching Shun
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/82025500500079366642

碩士 === 國立臺灣大學 === 護理學研究所 === 103 === The American Heart Association (AHA) published the 2010 AHA Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) based on evidence-based medical research findings in recent years, as well as changed its emergency rescue procedure for the first time. The Guidelines repeated emphasized the importance of high quality of CPR (high frequency and deep compression, 1:1 compression-release ratio and to continue uninterrupted). Although this is an essential technique of the emergency nursing staff and is almost practiced every day, currently in Taiwan, there are no rules for evaluation and review of CPR techniques, and the quality of CPR was not evaluated objectively as well. The purposes of this study were to (1) investigate the demographic characteristics and working experiences ( i.e., of the emergency nursing staff, including gender, age, nursing skill level, work experiences and emergency experiences) and CPR related knowledge influenced the quality CPR techniques implemented (including depth, frequency, 1:1 compression-release ratio and frequency of un-interruption); (2) to explore whether the retention of high quality CPR skill diminishes with time, and (3) to investigate the effectiveness of instructional video on the retention of high quality CPR skill. This longitudinal, correlation with pre- and post-test in one group study investigated the current status of CPR skills in emergency nursing staff, and further explore whether CPR skills change with time, and examine the effect of instructional video on the retention of high quality CPR skill. The eligible participants were clinical nursing staff members from an emergency ward at a teaching hospital in northern Taiwan. The purpose sampling was used to recruite the nurses and collected data every 3 months for four times. The data for the first time was used to explore the baseline status analysis; Before the day for collecting the fourth data, instructional video were applied and the fourth recruitment in order to examine the immediate effect of the video. Measurement for collecting outcomes included digital CPR simulator, the demographic and work experience survey, a 20-item CPR knowledge test and CPR instructional video. After the data was collected, descriptive statistics were used to analyze the baseline information. The evaluation of nursing staff performing high quality CPR techniques and factors affecting CPR skills were analyzed with inferential statistics such as chi-square analysis and logistic regression analysis. The retention of CPR skills with time and effectiveness of CPR instruction video were evaluated by generalized estimating equation. Totally, 77 nurses were completed the first survey, and 33 nurses were completed the four times of data collection. The results has shown that generally the high quality CPR implementation by the ursing staff was poor and only one nurse reached the high quality CPR. The factors associated with high quality CPR included gender, emergency work experiences, total nursing work experiences and frequency of CPR training. In addition, we found that the CPR skills were diminishing by time after 6 months, especially on compression-release ratio, which was decreased from 0.896 to 0.808(p < 0.05). For depth of chest compression, we found that it decreased from 55.363 mm to 54.211 mm (p = 0.209). Although it was statistically non-significant, we nevertheless noted a decreasing trend. After intervention with instructional video, we found that the compression-release ratio has increased by 0.618(p<0.05) after intervention, indicating good results from instructional video. The factors associated with high quality CPR were age, gender, N level, total nursing work experiences, emergency work experiences, and frequency of CPR training. Study limitations were with small sample size due to longer recruitment preiod for one year, physical strength involved and low willingness to participate. Moreover, since participants were recruited from only one hospital in northern Taiwan, the results could not be generalized to other institutions. It is recommended to have regular clinical training and evaluation of CPR skills in clinical settings and the re-evaluation period is recommended at very 6 months after CPR training in order to maintain high quality CPR.