Impact Of Cardiopulmonary Resuscitation Education Use Of Difibrillator Nursing Essay

Impact Of Cardiopulmonary Resuscitation Education Use Of Difibrillator Nursing goatvasPoor knowledge and accomplishment retention pastime AED and mouth-to-mouth resuscitation training for breast feeding and former(a) aesculapian exam supply has been observed. Resulting of the increasing of the mortality rate mouth-to-mouth resuscitation and AED training argon master(prenominal) for nursing staff and is important as the halts a great deal ar the first witness for the victim with cardiac bring forth in hospital set. The outcome of t case-by-caselying approach is necessary to improve the knowledge and skill of the nurses and new(prenominal) medical team that increase the survival rate.AimThe aim of this literary employments survey was to nominate belief approaches for cardiorespiratory resuscitation commandment in relation to acquired skills and knowledge in the design of an automatise impertinent defibrillation in a cardiac take into custody stain in a cl inical setting.MethodThe authors hand selected a literary productions freshen up for this demand and key word that determination be Cardiopulmonary resuscitation and statement, nursing, continuing, cardiopulmonary resuscitation, nursing skill and schooling and cardiopulmonary resuscitation. Papers published two month ago since 04-2011 from m any(prenominal) sources, such as books and Pubmed database including 10 age period. Those published paper in English language which covers strategies to improve the knowledge and skills of the nurses and other medical staff in cardiopulmonary resuscitation and automated immaterial defibrillation utilize. In addition manual enquiry has been used to get more breeding.ResultThere are more diametrical teaching approaches sens be used in cardiopulmonary resuscitation and automated impertinent defibrillation training such as digital Video Disc without manikin, DVD with manikin with scenario, peer tuition and instructor facilitate d regularitys which the best method. The quality of facts of life in cardiopulmonary resuscitation and automated external defibrillation training fire be inciteed by the typesetters case of teaching approach which has been used. The education and refreshment of cardiopulmonary resuscitation and automated external defibrillation training buttocks set up skill and knowledge of nursing staff and give ego confidence during resuscitation sequence and in development automated external defibrillation, which can necessitate to increase the survival rate and improve the quality of perseverings life. final stageNurses in hospital setting who seldom encounter cardiac arrest, should received automated external defibrillation and cardiopulmonary resuscitation training to rid of time delays in resuscitation. Staff should be evaluated by using manikin with feedback brass and expert instructors to ensure the quality f chest compression are satisfied at the time of training. The avail might of resuscitation training equipment in unit and ward can enhance the nursing staff for self education and refresh their skill and knowledge.INTRODUCTIONEach year in United States of America on that depict are 325,000 victims of sharp cardiac arrest. The mortality rates due to cardiac arrest are frequently observed in or so of emergency stain, which is most often the result of ventricular tachycardia (VT) according to Mosesso, Shapiro, Stein, Burkett, Wang (2009). Moreover, cardiovascular attacks cause one third of all deaths in the world today (Lindstrand, Bergstrm, Rosling, Rubenson, Stenson Tylleskr, 2010).The nursing staffs are often the first witness for cardiac arrest in a hospital setting (Dwyer, Mosel, 2002 Gombotz, Weh, Mitterndorfer Rehak, 2006). Moreover, the nurses are more efficient in training of automated external defibrillation (AED) as say by Xanthos et al.2009. Bardy et al (2008) point out that due to the effectiveness of automated external defibrill ation, it becomes recommended in macrocosm places such as public places are airports, schools, restaurants, planes, and crowded places. Furthermore they recommend that the AED machine is red in color with tuitions for use. In evoke of the effectiveness of AED in cardiac patient ofs, a better beneathstanding and knowledge about the use of AEDs is required (Hancock, Roebuck, Farrer Campbell, 2006 Martinez-Rubio, et al.2003).Therefore, the authors see a need to explore how Cardio-Pulmonary Resuscitation (CPR) education can enhance and improve nursing skills and knowledge in the use of AED in order to reduce mortality rate in cardiac patients.BACKGROUNDAutomated external defibrillationwww.priceit.inAED is an electronic devise which has two diggingsdles sternum and apex which can booster to deliver the profane to the heart of the patient. This machine has been created and upgraded to convert the VT and ventricular fibrillation (VF) to sinus normal heart rounds, which are the mo st emergency situation that needs immediate medical intervention (Anas, Lee, Hasan, 2010). Moreover AED may be used in hospital setting or out of the hospital setting (Nettina, 2001). Winkle (2010) stated that around 250 000 victims are dying in United States of America every year caused by cardiac arrest 40% are resulting of VF.Therefore medical staff mustiness(prenominal) be aware , develop in using AED to enhance the quality of life of cardiac arrest patient. However, using this machine needs medical education and knowledge as stated by (Ammirati et al.2011).As mentioned above Brown, Rittenberger, Ammon, Harrington Guyette (2010) stated AED can retain affect scarce in shockable rhythms like VF.Types of automated external defibrillationThere are two types of AED Monophesic which gives (360 joules) and the secound type is Biphasic which gives 150-200 joules (Sraj, 2005).The different between the two types according to (Sraj, 2005)FeatureMonophesicBiphasicDirection of the curr entMoves in one direction just now from paddleMoves in both direction (first positive direction then in milliseconds in a negative directionJoulesForm 360150 (Some machines can go up 200)Potential myocardial ill-useMore damagingless damagingEfficacy93% in laboratory trails99% in laboratory trailsVentricular tachycardia (VT)Ventricular tachycardia is a heart rhythm described as a cast of three or more premature ventricular contractions (PVCs) (Lewis, Heitkemper, Dirksen, OBrien Bucher, 2007, p. 854).VT clinical associationVT legislates with Coronary arteria unhealthiness (CAD), cardiomyopathy, significant electrolyte imbalance, mitral valve prolapse, long QT syndrome, some(a) medicine toxicity like digitalis and central spooky establishment disease. Furthermore, this type of dysrhythmia can be notice in non cardiac patients (Lewis et al, 2007).VT clinical significance tolerant with VT may be found with impulse or pulseless and VT if persistent can lead to change magnitude in Carbon monoxide (CO) due to decreasing of ventricular filling times and loss of atrial contraction. all told this finding can lead to several complications which include hypotension, pulmonary edema, cerebral blood flow go out decrease and cardiopulmonary arrest (Lewis et al, 2007).VT treatmentThis type of dysrhythmia can be treated simply if the causes set like electrolyte imbalance and ischemia. If the VT is monomorphic (patient has appearance of all the beats match each other in each lead of a surface electrocardiogram) and patient with pulse, Procaimade, Sotalol, Amiodarone or Lidocaine Intravenous injection (IV) can be used. If the patient in polymorphic (has beat-to-beat variations in morphology) VT with prolonged baseline QT interval Magnesium, Isoprterenol, Lidocaine Intravenous injection can be administer. If the patient has no pulse it must be taken in high precedency level emergency case, in this condition CPR and defibrillation are the first line if treatment (Lew is et al, 2007).Ventricular fibrillation (VF)Ventricular fibrillation is described as a heart rhythm witha severe derangement of the rhythm characterized on electrocardiogram (ECG) by irregular undulation of varying shapes and amplitude (Lewis et al., 2007, p. 855).VF clinical associationVF can occur in acute myocardial infarction (MI), myocardial ischemic disease like Coronary Artery Disease and cardiomyopathy. Furthermore this type of abnormal heart rhythm can be associated with coronary reperfusion afterward fibrinolytic therapy. Other VF clinical associations are like electric shock, hypekalemia, drug toxicity and acidosis (Lewis et al, 2007).VF clinical significance enduring with VF can be found unconscious, pulseless and apneic condition and if this type of dysrhythmia not treated straight off and rapidly patient will die (Lewis et al, 2007).VF treatmentVF is life-threatening condition and the best treatment for this dysrhythmia is the CPR and Advance Cardiovascular Life Sup port (ACLS) with using defibrillation immediately if available (Lewis et al, 2007).Cardiac arrestIt is the sudden loss heart function either the victim is diagnosed as a heart disease or not, which occur within minutes after symptoms appear. (American heart.org.2011).Cardiopulmonary resuscitation (CPR)Cardiopulmonary resuscitation is a combination of oral resuscitation (mouth-to-mouth breathing), which supplies atomic number 8 to the lungs, and external cardiac massage (chest compression), which is intended to normalize cardiac function and blood circulation(Kozier, Erb, Snyder Berman, 2008, P.1419). American Heart Association (2011) has emphasized the updated CPR guidelines for the chest compression rate is rate is 100 compressions per-minute.DefibrillationIt is a thrash out of administering the electrical shock to an individual heart for stop any abnormality heart impulse such For VT and restore the normal heart rhythm (Kozier, Erb, Snyder Berman, 2008).Public Access Defibri llation (PAD)It is a program that improves the automated external defibrillator in public facilities (Federal occupational health,2010).Cardiopulmonary resuscitation / automated external defibrillation providerAn employee, who has finished or stainless training in CPR, in addition has knowledge and understands an AED operation (Sraj, 2005).Chain of survivalIt is that overture which concentrates on the increasing of the survival chance .according to these components archaean bother to care (local emergency medical schema number)Early CPR.Early defibrillation.Early advance of care.www.circ.ahajournals.orgSequence of actions when nursehealth provider is using an automated external defibrillatorThese procedures should be following when the patientvictim is unconscious or not breathing Start with calling for help then start with CPR if the AED not available immediately.1-When the AED arrivesContinue CPR until the AED is switched on in case of more than one rescuer. If you are alone s top CPR and switch on the AED.Follow the voice guidance.Pads attaching to the patientvictim chest (the positive pad is placed on the patientsvictims left chest below the nipple, whereas the negative pads is placed on the victimspatients right speed chest above the nipple to the right from patient s perspective of the sternum).Be sure that no body touches the patientvictim during the AEDis analyzing the rhythm.2-When the shock is needed.Be sure that nobody is touching the patientvictim.Push the shock outlet as instructionFollow the voice instruction.3-When no shock is neededContinue CPR using a ratio of 30 compression to 2 rescue breathesFollow the voice instruction.Doing these procedures till the patient starts to regaining consciousness signs such as coughing, movement and breathing or you become tired (Nettina, 2001 Sraj, 2005).Precautions in the use of automated external defibrillationSraj (2005) has emphasized several precautions which must be taken into devotion by the AEDs operator before using it. Furthermore, these precautions are very important in keeping the operator and the patient in a safe and secure surround.These precautions areUnresponsivenessThe rescuer should check the patients level of consciousness, pulse and any signs of life like moving or coughing. This step is very important step to avoid any problems or misusing of AED.Wet chestDue to water and sweat AED might not be very effective. So In order to get defibrillations effectiveness use the piece of cloth which is unbroken in the AED kit to dry the chestMoving vehicleUsing AED devise needs finical care especially during the transportation of the patient. In case of using moving vehicle it may affect AEDs analyzing the heart rhythm which can lead to wrong analysis.Flammable materialsTry to avoid using any flammable materials like alcohol and stop any flammable gases like oxygen .using these flammable materials can make fire due to the expected spark from the shock.Chest patchesBe cl ose to the patient and survey for any nitroglycerine patches and remove it right away before attaching the AEDs paddles. These patches can make burn to the patients chest. coat surfaceAvoid using the metal or any electric conductive surface because the ability of transmitting the shock to the rescuers or any persons nearby.PacemakerThe rescuer should look to the patients chest closely and grade if this patient using pacemaker especially if its implanted one. Try to attach the paddles one to one and have inches distance from the pacemaker to avoid destroying the pacemakers batteries.Age considerationAED is not recommended to be used in children under age of 8 especially in unadjusted energy AEDs.Hands offThe users during analyzing the heart rhythm must be hands off to avoid analyzing disturbance. Furthermore the users and any person nearby must be clear before delivering the shock avoiding the transmission of the shock to them.Wireless devicesThe nearby people they must not use the ir wireless devices like cell phone and especially during the analyzing heart rhythm and delivering shock process. These devices can cause trouble made by waves interference which may influence the analysis.Education in a clinical settingEducation can be defined as a teaching opportunity which is planned by an individual or a committee to reach a relate objective (Rogers, 2002). One of the main differences between nurse education and education of children in school is, that nurse education is based upon the theory and practice of adult education. Furthermore, there are different teaching strategies, some of these teaching strategies like lectures method, (lecturers) are the main instrument in this method. Experiential learning depends on learning result from experience. Last method is pairs exercise in this method the group members are asked to from pairs then work together (Quinn Hughes, 2007).The coordinators and teachers must chose the best teaching strategy accordingly and p rovide good learning environment to achieve teaching program goals (Quinn Hughes, 2007).McEwen Willss, (2007) have referred to one of the grand theory which is Henderson theory.The Henderson theory is centering on the important of education for medical team, patient and families that translate to practice and experience to improve the quality of care. If this re attempt has been done in a clinical setting it can enhance the education.Categorization of learning theoriesMcEwen Willss, (2007) have mentioned, that sometime it will come to the nurses mind a question why is it very important to be aware of about the process of learning and to understand learning theories. The importance of understanding learning theories is to describe the process used to get about changes in the way individuals understand information and skills or tasks. Moreover, Bigge Shermis (1999) reason the learning theories to two categories which areBehavioral learning theoriesBehavioral learning theories w hich depend on demeanour response and ignore the feeling, thoughts and cognitive processes of the student. In addition, behavioral learning theories were the first widely used in education and these types of learning theories includes the work of Pavlov, Skinner and others. Furthermore, these types of learning theories persistent in the American educational system in 1959s and 1960s, as well(p) as behavioral learning theories enhance the American educational system in 20th century (McEwen Willss, 2007).Cognitive learning theoriesCognitive learning theories which based on the mental processes and activities which go within the student. These type of theories start to get wide thrust in 1960s. Moreover, Jean Piaget is the most important theorists in cognitive science which developed main components of his theory in 1920s (McEwen Willss, 2007). education approachTeaching can be defined most of the time as the facilitation of learning and is base on balls on to intentional act of communicating information (Bas dishearten, 2003). To achieve this, the teachers must know the learning methods and the individual needs and connect them to instruction (Forrest, 2004).Skill and knowledgeSkill is defined as a goal-directed, well organized behavior that is acquired with practice and performed with economy of effort (Proctor Dutta, 1995, p.18). Knowledge can be defined, as set of organized statements of facts or ideas, presenting a reasoned judgment or an experimental result, which is transmitted to others through some communication medium in some systematic form (Bell, 1976, p.175).Up to date, there are a lot of re look to articles regarding cardiopulmonary resuscitation education and use of an automated external defibrillation. Therefore it is important to identify teaching approaches and critically evaluate the effect of the education on skills and knowledge.The effect of Cardiopulmonary resuscitation education on nurses skill and knowledgeKardong ,Oermann,Odom,Ha (2010) conclude in their article if the nurses used manikin with voice informative they will be more competent than the nurses how used normal manikin without voice advisory. Furthermore the median value number of chest compression before Basic Life Support course was three and so fast, but after BLS training increased to 13 as stated by (Mellor Woollard, 2010). In addition, craze (2010) found in his involve that, the nurses are more confidant and competent in case of cardiac emergency situation after CPR training.AIMThe aim of this literature review was to describe teaching approaches for cardiopulmonary resuscitation education in relation to acquired skills and knowledge in the use of an automated external defibrillation in a cardiac arrest situation in a clinical setting.Research questionsWhich teaching approaches are used for cardiopulmonary resuscitation education when nurses use an automated external defibrillation in a cardiac arrest situation in a clinical setting?What effect has the cardiopulmonary resuscitation education on nurses skills in their use of an automated external defibrillation in a cardiac arrest situation in a clinical setting?What effect has the cardiopulmonary resuscitation education on nurses knowledge when an automated external defibrillation is used in a cardiac arrest situation in a clinical setting? ruleThe method chosen for this study is a literature review with a systematic approach. A literature review is a critical summary of research on a topic of interest, often brisk to put a research problem in context (Polit Beck, 2008, p.757).Literature searchThe literature search was carried out in PubMed which is a data base that anyone, anywhere in the world with internet access can search for journal articles and permanent resource regardless of your institutional affiliation (Polit Beck, 2008, p.757). MeSH hurt are created by the National Center for Biotechnology Information (NCBI). PubMed, works through searching in Nati onal Library of Medicine (NLMs) Web site, it helps the researchers to get full text of the articles from biomedical literature and helps to access further links to selected life sciences journals not in MEDLINE (National Center for Biotechnology Information, 2010). The search strategies were made by combining MeSH bournes in PubMed and the result of this database search are shown in delay 1.In order to get relevant original articles to this literature review the authors have used Mesh term and limited the research which published in the last 10 years between 2001-2011, English military man and any age.Table 1. Database search in Pubmed.DatabaseKey word determine articles (hits)Abstracts reviewedArticles examinedArticlesIncludedDate for searchPubmed22032011(Cardiopulmonary ResuscitationMesh) AND Education, Nursing, ContinuingMesh4141234Pubmed22032011Cardiopulmonary ResuscitationMesh nursing skill2221214Pubmed22032011(education Subheading) AND Cardiopulmonary ResuscitationMesh72550 03011Key wordsIn this literature review the authors completed this research with the following key words(Cardiopulmonary Resuscitation AND Education, Nursing, ContinuingMesh,Cardiopulmonary ResuscitationMesh nursing skill and (Education Subheading) AND Cardiopulmonary ResuscitationMesh.Identified original articles had to be published in peer-reviewed journals with an available abstract and had to focus on cardiopulmonary resuscitation education in relation to the use of an automated external defibrillation in a cardiac arrest situation in a clinical setting. Furthermore studies on adult, children eight years and older, SVT-VT patients and nurses were included. Non medical people and young children (less than eight years), patients with pacemaker and refusal of informed consent were excluded, as were studies that did not involve health-care professionals in clinical settings.The firsthand search yielded 19 original articles of interest. In addition bibliographic searches revealed X articles. The articles are presented in the hyaloplasm (Appendix 1). The selected articles were assessed independently by the authors usingAppendix 1Sophiahemmet University College classification guide of academic articles and studies regarding quality in both quantitative and qualitative research (Appendix 2). The studies were classified as Randomised controlled trial (RCT), Clinical controlled trial (CCT), Non- controlled study (P), Retrospective study (R) or Qualitative study (Q). Scientific quality of the studies was assessed on a three-grade dental platehigh- (I), moderate- (II) or low- (III) quality. The authors intended to work systematically by highlighting the similar words in the articles e.g., AED, clinical setting, skills and knowledge and discuss on regular basis to compare and discuss responses to the research questions.This literature review content the cardiopulmonary resuscitation education in relation to acquired skills and knowledge in the use of an automated e xternal defibrillation in resuscitation situation in hospitals for most of the medical professionals like doctors, technicians and nursing staff, but the authors will focus on nursing staff avoiding the vagueness of this literature review.Manual search can be defined as finding an original article which has been used in literature review (Polit Beck, 2008).ETHICAL CONSIDERATIONSThe ethical consideration which are so important in this literature review, include the authors must check who is the sponsor of the study because it includes the use of technology Furthermore the authors must assess if the participants in the reviewed studies were informed and consented before they participated, especially in case of patients are involved. Finally, the authors must clarify if these studies have got approval from the ethical committees (Spouse, 2003).RESULTS19 primary published articles have been reviewed by the authors in this study which have focused on Teaching approaches used for cardiop ulmonary resuscitation education when nurses use an automated external defibrillation in a cardiac arrest situation in a clinical setting and the Effect of cardiopulmonary resuscitation education on nurses skills knowledge in their use of an automated external defibrillation in a cardiac arrest situation in a clinical setting. Results from the studies are chosen which are relevant to this studys aim and research questions The selected results from the primary published articles have been categorized under the following headingsTeaching approaches used for cardiopulmonary resuscitation education when nurses use an automated external defibrillation in a cardiac arrest situation in a clinical settingPerkins, Hulme, Bion, (2002) stated in their article that , peer tuition is the one type of teaching approach which depends on peer of tutors with exceptional teaching background and experience by lecture-led CPR training. However, it pointed out that, in spite of cardiopulmonary resuscita tion and AED skills performance enhance with peer tuition, knowledge remained the same over the participants.The quality of performance can be improved with audible feedback system (Noordergraaf, et al.2006). Furthermore, if audible feedback system has been used there is significant procession in skill acquisition and skill retention has been reported that is available in automated external defibrillation (Handley Handley, 2003)Szgedi , Zrnyi , Betlehem, Ujvrin Tth(2010) defined problem-based learning as one of learning methods which organize the knowledge in clinical setting ,strengthens to motivate the students to learn, enhances clinical reasoning skills, and improve self-directed and continues education. Furthermore they concluded this method is better and more efficient method form the traditional method which is class room during cardiopulmonary education. Moreover this method can enhance and improve the outcome of cardiopulmonary education which can lead to better understa nding and skill demonstrating during resuscitation in clinical setting.The other teaching approach which has been emphasized by Bjrshol, Lindner, Sreide , Moen Sunde(2009) is manikin and 24-min video instruction during cardiopulmonary resuscitation training. They made a study on hospital employees by distributing 5118 personal manikins.3466 responded to the first questionnaire the result can be seen in table 2Table 2. Questionnaire administered to all hospital employees before receiving their personal resuscitation manikin.QuestionAnswer issue forth of repliesWhat is your age?43 (11) years3445What is your gender?Female 87%3298Male 13%How long ago did you have training in canonic life support (BLS)?15 (8-60) months3295Never 296How well do you feel that you are trained in BLS (1-5, 1=very bad and 5=very good)?3.1 (1.0)3412Have you been in a situation where you needed skills in BLS, whether at work or not?Yes, at work 1121 (33%)3425Yes, outside work 363 (11%)No 2071 (60%)Altogether 9 08 replied to second questionnaire which they attended the classroom training the result can seen in table 2Table 2. Questionnaire to all hospital employees nine months after receiving their personal resuscitation manikin.QuestionAnswerNumber of repliesWhere did you perform the BLS training with your MiniAnne manikin?Hospital meeting room 908 (65%)1397Own dept. 366 (26%)At home 73 (5%)Did not participate 120 (9%)How long ago did you train with your MiniAnne manikin?39 (26-48) weeks1184How well do you feel that you are trained in BLS (1-5, 1=very bad and 5=very good)?3.8 (0.8)1333How many persons, in addition to yourself, have trained on BLS with your MiniAnne manikin/self-instruction movie?1 (0-3)1165Have you go through any discomfort using the manikin?Yes 49 (4%)1272No 1223 (96%)After receiving the participants their personal manikin by six month the result is displayed in table 3Table 3. Number of study subjects playacting different BLS tasks before and six months after BLS trai ning with a personal resuscitation manikin and video instruction (percentages in brackets). The number of correct chest compressions and mouth-to-mouth breathings are measured for 2min after insertion of BLS (interquartile range in brackets).Before BLS training, n=59Six months after BLS training, n=39P valueAssessed responsiveness42 (71)34 (87)0.02Opened airways before assessing internal respiration10 (17)17 (44)0.01Assessed respiration42 (71)28 (72)0.73Pulse check34 (58)13 (33)0.02Called for help before starting BLS45 (76)32 (82)0.61Correct telephone number for EMS activation56 (98)39 (100)NsCorrect compression ventilation (CV) ratio32 (54)36 (98)Number of correct chest compressions60 (5-102)119 (75-150)Number of correct mouth-to-mouth ventilations3 (0-8)4 (0-7)0.23After finalizing the result by Bjrshol , Lindner , Sreide , Moen Sunde(2009) they came to that cardiopulmonary resuscitation training with manikin and video instruction benefit and improve the staff self-confidence a nd clinical basic life support skill. In other hands using assessment of cardiopulmonary resuscitation defibrillation (CPR-D) nursing skills and informing the leaders is necessary to give information for kind of education they need seems to improve resuscitation performance (Mkinen, et al.2007).Spearpoint, Gruber Brett (2009) mentioned in their article that permanent cardiopulmonary education as one of the teaching approaches. Moreover they stated that , The simplicity, continuous and quality of the education on basic life support program are affected on CPR performance and hospitals cardiac arrest through increasing patient discharge and decrease the cardiac arrest. There was study done by Moule , Albarran , Bessant , Brownfield Pollock (2008) in united kingdom comparing two teaching met