INTRODUCTION

“To think too long about doing a thing often becomes its undoing.”

(Eva Young)

Cardio Pulmonary Resuscitation (CPR) is a critical component of basic life

support and the established first line before advanced life support. Cardio

pulmonary resuscitation as a potential life saver is associated with survival and has

the potential to prevent sudden death. The American Heart Association (AHA)

resuscitation guidelines recommended that all hospital staff who are in contact with

the patients should have regular resuscitation training. Research shows that the

quality of cardio pulmonary resuscitation has a direct impact on victims chance of

survival. Cardio pulmonary resuscitation (CPR) is a procedure that should be used

for patients, for whom there is a reasonable chance of restoring and prolonging life.

When sudden death impends, cardio pulmonary resuscitation is the final

hope for survival, and involves external cardiac compression and mouth to mouth

resuscitation, which maintain circulation until normal circulation and ventilation

has been restored through definitive therapy. The necessary skills for conducting

cardio pulmonary resuscitation should be taught for all the health professionals. 2

According to the American Heart Association statistics EMS treats nearly

3,00,000 victims out of hospital cardiac arrests each year in US. Less than 8% of

people suffer cardiac arrest outside the hospital Scenario. Less than one third of out

of hospital sudden cardiac arrest victims receive bystanders CPR. The American

Heart Association trains more than 12 million people in CPR annually including

health care professionals and General public.

Heart disease is the world’s largest killer, claiming 17.5 million lives every

year. About every 29 seconds, an Indian dies of heart problem. As many as 20,000

new heart patients develop every day. In India 9 core Indian suffer from heart

disease and 30% more are at high risk1. Sudden cardiac arrest is a major public

health problem. Basic Life Support (BLS) is the provision of treatment designed to

maintain adequate circulation and ventilation to the patient in cardiac arrest,

without the use of drugs or specialist equipment. Basic Life Support (BLS)

includes recognition of signs of sudden cardiac arrest (SCA), heart attack, stroke,

and foreign-body airway obstruction (FBAO); and cardiopulmonary resuscitation

(CPR) .

The most important aspects in Basic Life Support are ABC, is nothing

but the airway, breathing and circulation. Failure of the circulation for three to four

minutes will lead to irreversible cerebral damage3. For every minute that passes

after a patient goes into cardiac arrest their chance of survival decreases by seven

to 10 per cent until a defibrillator arrives (Metcalfe-Smith, 2003). A patient who

has suffered sudden cardiac arrest must receive effective treatment rapidly. When

delivered promptly, resuscitation can save the lives of many patients in cardiac

arrest4. Basic Life Support acts to slow down the deterioration of the brain and

heart until defibrillation and/or advance life support can be provided (Ruck and

Erc-2000). Prompt recognition of cardiopulmonary arrest and prompt instigation of

Basic Life Support can double the patient’s chance of survival (Bltf-2001).

Basic Life Support training is gaining more importance in nursing

education. Being trained to perform Basic Life Support can make the difference

between life and death for a victim. The Basic Life Support is an essential skill

taught to the nursing students. Nurses require skills of assessment for cardiac arrest

and need to initiate Basic Life Support, involving maintaining respiration and

circulation for the casualty until emergency services, or advanced life support

services, arrive. All nurses with a responsibility for patients must be offered

regular training and updates in resuscitation. As registered nurses, we all have a

responsibility to ensure we remain competent to perform resuscitation.

Educational change is necessary to meet the demands of the current

healthcare environment. Learning objectives should focus on the best practice

outcomes and should emphasize what the healthcare provider is expected to do

after the educational activity is over. Regulating agencies and consumers hold

healthcare personal accountable for providing high quality, safe patient care.

Educational activities should provide the skills and knowledge that enable nurses

to meet this goal. The new nursing generation need to grow in proper and timely

provision of essential care to their patients. For that, they need necessary

knowledge and skill by repeated training and practice.

Cardiopulmonary resuscitation is the first assistance given to the

collapsed person and is aimed at the prevention of further harm. The correct

CPR measures can reduce suffering, be instrumental in speeding up subsequent

recovery, prevent permanent disability and even save life. First few minutes

following injury is called the golden time. Many complications and events that

occur during this period, can convert a simple injury to death if unattended. It is

important to act and react during the golden time to reduce mortality and

morbidity.

The American heart association released its 2010 CPR guidelines

followed for lay persons. And the focus for CPR is on good quality chest

compressions. Now it’s C-A-B; the chest compression come first, only then do

focus on airway and breathing. No looking, listening, and feeling but is an

action, no assessment .push at least 2 inches deep on the chest. At the rate, 30

compressions should take 18 seconds.

A cross sectional study was conducted to awareness about BLS [CPR]

among medical students in Dow international medical college, Karachi. Using

questionnaire regarding BLS by 61 students. Out of 61 students 14.7% had

taken a BLS course, 85.3% students had not attended any course. The result

showed that significantly more number of students had the theoretical

knowledge about BLS 76.07% vs 49.18%, p<0.00. Of all the students, 57.3%

had no knowledge, among 34% had heard BLS somewhere, 22, 9% had some

knowledge, 50% heard about it. Significantly less number of students had

complete knowledge about BLS 4% P<0.05. Among the students who had

taken the course, 22% had complete knowledge p<0.05. Significantly less

number of students knew about the skills for BLS 21% p<0.05.

A nation’s hope rests on its youth. For their hopes to become reality, the

younger generation needs to grow into healthy behaviour and acquire health

related knowledge. According to WHO are the individuals in the age group of

16-24 years and there are 198 million young people in India [WHO, 2000].

World Health organization [WHO] Technical Report Series [1999] showed that

colleges have the potential to provide an excellent base for large scale

programming and there is need

to strengthen the college as a setting for health intervention. Colleges can

provide many services to young people in addition to formal education, such as

health education, skill development in the areas such as life saving skills. A

college is an appropriate setting for the introduction of teaching and training of

students on life saving CPR skill as it offers access to young adults on a large

scale. It is economically efficient and there are possibilities for short term and

long term evaluation.

Health Teaching is an integral part of nursing and it emphasis a scientific

attitude towards health which is very important to modern healthy living.

Planned health teaching of the masses is one of the most effective means of

health promotion. Patients suffering from cardiac diseases, shock, trauma and

other such critical conditions could collapse anywhere and effective life saving

measures commenced promptly by any lay person could help revive the patient.

College students better listen to the teachings and could follow demonstrations.

Hence the researcher felt that the need to conduct a planned teaching

programme and demonstration regarding CPR and to evaluate the effectiveness

of planned and skill training.

Pediatrics is the branch of medicine that deals with the medical care of

Infants, children and adolescents. The age limit of such patients ranges from birth

to 18 years. Pediatric Nursing is an area of nursing and medical practice with a

focus on providing holistic care to infants, children and adolescents. There are

different places Pediatric Nurses can work like pediatric ward, NICU’s, PICU’s etc

where the nurse support the patient and the family by providing comprehensive

care which the family cannot perform.

Basic life support in a level of medical care which is used for patients with

life threatening illness or injury until the patient can be given full medical care. In

pediatric setup there are many pediatric emergencies like accidents, injuries,

respiratory failure, sudden cardiac arrest and shock where the emergency

professional health care team members performs a number of life saving

techniques focused on the emergency care. Among which the Pediatric Cardio

Pulmonary Resuscitation stands first and foremost in ‘ABC’of hospital emergency

care.

Cardio Pulmonary Resuscitation in children has been used in hospitals for

approximately 40 years where the staff nurses are generally the first responders to

cardiac arrest and initiate basic life support while waiting for the advanced cardiac

life support team to arrive. Speed and competence of the first responder are factors

contributing to the initial survival of a person following a cardiac arrest. The

knowledge and attitude of the staff nurse may influence the speed and level of

involvement in the emergency situation. So this paper uses the theories of recent

action and planned behaviours and awareness of the members involved in pediatric

CPR .

Incidence rate of cardiac arrest in the world, In- hospital cardiac arrests of

children admitted to pediatric intensive care unit occur at a rate of 0.94 cardiac

arrests per 100 admissions. Pediatric patients suffering an in-hospital cardiac arrest

differ from the out-of-hospital cardiac arrest subpopulation due to a chronic pre-

existing condition being present twice as often and a cardiac etiology more likely

as the cause of the arrest. Extra Corporeal Membrane Oxygenation (ECMO)

initiated within 24 hrs after cardiac arrest is associated with a decrease in hospital

mortality. There is a lower incidence of mortality and greater likelihood of good

neurologic outcome with an in-hospital cardiac arrest than out-of-hospital cardiac

arrest. Survival also depends on other factors such as actual duration of CPR,

quality of CPR administered and the extent of necessary pharmacologic

intervention needed during CPR.

Incidence rate of cardiac arrest in India are due to various reasons. Main

causes like, 56% due to respiratory problem, 33% due to cardio vascular disorders.

In a population aged at least 12 years incidence of out of hospital cardiac

arrest is 36/1,00,000 – 81/1,00,000.

The average proportion of cases out of hospital cardiac arrest that receive

bystander CPR is 27.4%.

The rate of survival to discharge after in-hospital cardiac arrest 27% among

children. Incidence rate of cardiac arrest due to anaesthesia is 27 / 12,158.

A study conducted quality of cardio pulmonary Resuscitation training

programme in order to determine whether it was sufficiently addressed by the

trainee team leaders during training. CRP quality of 20 consecutive resuscitation

scenario training person was audited prospectively using pre-designed performa. A

consultant intensive and a senior nurse who were also Advanced Pediatric Life

Support (APLS) instructors assessed the CPR quality Which included Ventilation

frequency, chest compression, rate of depth and any unnecessary interruption in

chest compressions. The results showed that 50% of training session did not have

any change with the person in the team. So the quality of little awareness of this

inadequacy.

A retrospective study done at a children’s hospital following resuscitation

for out of hospital cardio pulmonary arrest to determine the outcome and cause for

children resuscitated following out of hospital cardio pulmonary arrest in an

organization pre hospital emergency medical system with in Birmingham, Ala,

with 150493 children under the age 15 years. Standard resuscitative techniques

were performed for all patients. Of 63 children with out of hospital cardio

pulmonary arrest 60 were pulseless and apneic on arrival 18 were successively

resuscitated and admitted to intensive care unit and 6 were discharged from the

hospital. 5 of the survivors had severe neurological deficits and 1 appeared normal.

On follow up 2 patient had died 3 were in vegetative state and 1 was normal.

Resuscitation efforts in the emergency department are commonly successful but

lead to death or severe neurological sequelae at discharge with extremely high cost

of care.

A study was conducted on epidemiologic review and assessment of current

knowledge in out of hospital pediatric cardiac arrest in outcome of children

younger than 18 years with an out of hospital cardiac arrest, with 5.363 patients

results showed that 12.1% survived to hospital discharge and 4% survived

neurologically intact. Trauma patients had greater survival submersion injury

associated arrest had greater survival (22.7%, 6% intact). Bystander cardio

pulmonary resuscitation showed increased survival (relative risks 1.99, 95%

confidence interval 1.54 to 2.57).

NEED FOR THE STUDY

“Continuous effort, not strength or intelligence is the key to unlocking our

potential.”

(Linaecardes)

Cardio pulmonary resuscitation is the method of providing oxygen and

blood circulation through the delivery of rescue breathing and chest compressions

to victim of sudden cardiac arrest, which occurs when the heart loses its ability to

pump blood and distribute oxygen through the blood. Cardiac arrest can occur due

to many accidents like road traffic, falls, sports accidents, drowning,

electrocutation etc. when the heart stops beating, the brain stop receiving fresh

oxygen rich blood. The brain can survive only about 4-6 minutes without oxygen.

This period of 4-6 minutes is therefore critical. To provide oxygen to the brain

circulation is very important. This can be done by external chest compression .

Everybody should learn cardio pulmonary resuscitation. Updating the

knowledge and skills about cardio pulmonary resuscitation is a necessary option in

the field of medicine. Emergencies can strike anyone anywhere. The only person

may be available at the time could be you. Therefore we should posses Cardio

pulmonary resuscitation skills no matter who you are. Fortunately a short period of

training is required to learn cardio pulmonary resuscitation.

There are no reliable national statistics on cardio pulmonary resuscitation

because no single agency collects information about how many people get cardio

pulmonary resuscitation? How many people don’t get it? Who needs it? How many

people are trained etc. Many studies have examined cardio pulmonary resuscitation

in specific communities while they show varying rates of success. All are

consistent in showing benefits from early cardio pulmonary resuscitation5.

Heart diseases are the world’s largest killer. Claiming 7.5 million lives

every year about every 29 seconds an Indian dies of heart problem. As many as

200000 new heart patients develop every day in India. 6 crore India suffer from

heart disease and 30% more are at high risk. By 2020 India will have the largest

coronary heart disease (CAD) burden in the world and will account for one third of

all deaths. Many of them will be young. The risk of sudden cardiac death from

coronary heart disease in adult is estimated to be one per thousand adult 35 years

of age and older per year. About 75% to 80% of all out of hospital cardiac arrests

happen at home. Hence being trained to perform basic life support (BLS) can

make the difference between life and death of a victim.

Effective BLS provided immediately after Cardiac arrest can double a

victims chance of survival. If more people know BLS more lives can be saved.

Health behaviour is a major target of teaching and it is assumed that teaching helps

in changing behaviour through cognitive and psychomotor changes6.

As we mark the 50th anniversary of modern-era cardio pulmonary resuscitation, we

must acknowledge that, measurable progress aimed at its prevention. Cardiac arrest

both in and out of the hospital continues to be a nature public health challenge.

Over these 50 years scientific knowledge about arrest, pathophysiology and

resuscitation mechanism has increase substantially. In our on going commitment to

ensure optimal community based care for all victims of cardiac arrest, we must

continue effectively to translate the science of resuscitation into clinical care and

improved resuscitation outcomes. Each year cardio pulmonary resuscitation saves

thousands of lives in United States of America. More than 10 million Americans

are trained through American heart association and American Red Cross.

The cardiac arrest survival rate falls and estimated 7% to 10% for every minute

without effective cardio pulmonary resuscitation. Cardio pulmonary resuscitation if

not performed effectively within 4-6 minutes after cessation of breathing can lead

to failed cardio pulmonary resuscitation meaning the cardio pulmonary

resuscitation attempts were not successful in restoring life brain death. To prevent

such disastrous condition all health team professionals should be able to effectively

follow the chain of survival that is early recognition

Early basic life support

Early access to emergency services

Early defibrillation.

All the health team members should be expert in giving cardio pulmonary

resuscitation. If the nurses are educated and trained we can save many lives

because they are the people who are

the patients. Investigator believes that by broadening training and encouraging the

public and the health care professionals specially the nurses to perform cardio

pulmonary resuscitation will save thousands of life. Health team members should

be equipped with the skills of cardio pulmonary resuscitation not only to practice

in the hospital setting, but act as a good Samaritan where ever required7.

Cardiovascular disease is the world’s leading killer. According to world

Health Organization (WHO) estimates, 16.7 million people around the globe, die

of cardiovascular disease each year. This is over 29 percent of all deaths globally.

Cardiovascular diseases now more prevalent in India and China than all

economically developing countries in the world combined. Cardiovascular disease

in India quadrupled in the last 40 years. WHO estimates that by 2020 close to 60%

of cardiac patients worldwide will be Indian1.

Basic Life Support competency is considered a fundamental skill for

health care workers. In the wider community, it is an expectation that knowledge

and competence in Basic Life Support is at a high standard in nursing education 8.

Participation in both successful and unsuccessful cardiopulmonary resuscitation

and Basic Life Support is one of the most stressful situations that the nursing

students have to deal with after their registration. A thorough knowledge and

competency (skill) help them to perform Basic Life Support to the patient’s when

ever is needed9.

Basic Life Support is the fundamental technique for the emergency

treatment of cardiac arrest. The standardised training of cardio pulmonary

resuscitation has been emphasised more than ever. Common people in developed

countries have received popular education of cardiopulmonary resuscitation

programme of Basic Life Support training10. Cardio pulmonary resuscitation and

Basic Life Support training is mandatory for nurses and is important as nurses

often first discover the victims of cardiac arrest in-hospital. Available literature

suggests a need for both initial cardiopulmonary resuscitation training and refresher

courses. In this context, the training of nursing students to improve the knowledge

and competency in Basic Life Support is having atmost significance. It is because

in future they are the one who is assessing and providing the needed care for the

patient at the earlier stage11.

In a study conducted to assess the knowledge and skill regarding Basic

Life Support among nurses and nursing students in Finland, results showed that the

best predictors for good response assessment and resuscitation skills went to those

who were nursing students who had studied Basic Life Support sometime during

the previous 6 months6. In a survey conducted in Hainan Province, regarding the

knowledge of Basic Life Support and cardio pulmonary resuscitation was found

that the knowledge level was very low among nurses10.

Poor knowledge and skill retention following cardio pulmonary

resuscitation and Basic Life Support training has been documented over the past 20

years. In order to enhance the retention of knowledge and skill repeated training is

needed. However, some students have difficulties in developing competence in

cardiopulmonary resuscitation and evidence suggests that resuscitation skill may

only be retained for several months. So further training is necessary for developing

and retaining the skills11.

In a study conducted among nurses, regarding skill and knowledge of

Basic Life Support shows that retention of skill and knowledge quickly deteriorates

if not used or updated regularly12. In another study, the student performing Basic

Life Support for the second time achieved better results than those undertaking

practice and testing for the first time. These data and studies figure out the need of

repeated teaching and assessment to ensure adequate knowledge and skill gained

among the students6. The repeated training programme provides students with

sound basic knowledge and adequate practical skills in first aid and Basic Life

Support that adequacy of time and physical and human resources are important

prerequisites to facilitate practice and enhance confidence in skills11.

Hence, the investigator felt the need and desire to carry out a study on

assessing the effectiveness of structured teaching programme on progressive

improvement in knowledge and skill of administering Basic Life .

REVIEW OF LITERATURE

1. Studies related to general information regarding CPR.

The study was conducted at Washington University School of Medicine in

St. Louis to rule out only giving Cardiac compression by the bystanders without

giving breath, there were improved survival rates. They combined the data from

the three studies in a meta analysis and were able to analyze survival rate in more

than 3.700 cardiac arrest patients who received either standard CPR or Chest

compression only. Those smaller studies had suggested chest compression –only

CPR may improve survival. One noted a 14% increase in survival to hospital

discharge, while 2nd reported a 24% improvement in 30 days survival. But

analyzing all three studies the team determined that survival improved by 22%

when bystanders called 911 and were advised by the dispatches to do chest

compression-only CPR.

A study was conducted to evaluate the effect of compression-only CPR.

Data was collected from emergency medical services division of public health for

seattle and king country and colleagues. 1941 adults out of hospital cardiac arrest,

dispatches randomly provided CPR directions to bystanders for compressions

either alone or with rescue breathing. No significant differences were observed in

the proportion of patients who survived to hospital discharge or survive with the

favourable neurology outcome. Compression along was linked to a nonsignificant

trend towards a higher proportion of patients surviving to hospital discharge for

those with a cardiac cause of arrest or shockable rhythms.

The study was conducted to analyze survival rate using the two main

approaches. The daily telegraphs suggested we should “Skip the Kiss”. When

giving the kiss of life. While BBC News emphasized that the study “backs chest

compression in resuscitation”. The new study which does not constitute official

guidance examined a form of CPR that uses chest compression but not breathing

into the mouth. This is known as compression-only CPR.

The study was conducted to know the quality of CPR in an important

predictor of outcome from cardiac arrest. Mechanical chest compression devices

provide an alternative to manual CPR. Physiological and animal data suggest that

mechanical chest compression devices are more effective than manual CPR.

Consequently there has been much interest in the development of new technique

devices to improve the efficacy of CPR. The review will consider the evidence and

current indication for the use of some of the more common mechanical devices

developed to increase the safety and efficacy of CPR Administration.

The study was conducted with 7 emergency departments used AHA

recommended new CPR including increased compressions, full chest wall recoil

and use the impedance threshold device (ITD). When subjects were treated with

new CPR techniques including the use of an ITD, the hospital discharge rates went

from 7.9% to 15.7% or double the survival rate of the control group and more than

double the national survival rate of 5%. These results strongly support the wide

spread use of the AHA’s new 2005 CPR guidelines.

2. Studies related to knowledge of nurses regarding CPR.

A study was done to assess the knowledge in 35 cardio pulmonary

resuscitation staff of a hospital which was affiliated to the Golestan University of

Medical Sciences. Simple sampling with a before-after method was applied. Data

collection was done by a questionnaire of 43 questions about knowledge which

was completed by the participants before and after teaching and after two months

duration. Educational lectures were held by expert professions. The data were

analyzed by the wilcoxan test (P<0.01) were considered to be significant. The

mean age was 37.16+ 6.21 years. The result showed that the level of knowledge

had improved to 85% after training and to 87% after 2 months (P value <0.01). It is

suggested that a periodic training of practical skills should be scheduled for these

staff .

A study was conducted to investigate nurses knowledge regarding

cardiopulmonary resuscitation and to identify barriers to appropriate

cardiopulmonary resuscitation evaluation, 100 questionnaires were distributed to

nurses working in a public government hospital in Bahrain. 82 of these were

returned. The result indicated that cognitive knowledge was not adequately

retained. 58% of respondents perceived recalling cardiopulmonary resuscitation

information as easy or extremely easy. Only 7% of respondents passed the

knowledge test. In general those who had less education and experience did not

recall essential cardiopulmonary resuscitation knowledge. This study identified a

significant problem with the knowledge surrounding cardiopulmonary

resuscitation. More concerning was the lack of professional responsibility in

dealing with this inadequacy.

A study was conducted to assess the cardiopulmonary resuscitation skills of

hospital medical and nursing staff. The cardio pulmonary resuscitation skills of

160 staff members at a large metropolitan teaching hospital were assessed by a

multiple choice questionnaire and a practical test of basic life support skills on a

manikin. Medical staff members performed significantly better than did nurses in

the multiple choice test, but significantly worse in the practical test; 48 (60%) of 80

nurses and only 26 (32.5%) of 80 doctors passed the practical test. Training

resuscitation by the St. John ambulance association as a medical student may have

improved the basic life support skills of doctors but there is clearly a need for

continued revision and assessment of resuscitation skills.

A survey was done on knowledge and attitude towards cardiopulmonary

resuscitation and provision of cardiopulmonary resuscitation education to nurses in

general wards. The survey was done on 280 nurses from the four university

hospital with 700beds. The mean score for knowledge of basic life support was

12.71 (mean converted to 100:63) about 76% of the nurses believed that they had a

responsibility to perform cardiopulmonary resuscitation, but 53.3% of the nurses

were not confident to perform cardiopulmonary resuscitation. About 94% of the

nurses had received education on cardiopulmonary resuscitation but 32.3% of

those took it 6-12 years ago. About 41% of the nurses spent 3-4 hours for the

education and 73.2% of those took simulation education. Most of the nurses had

received cardiopulmonary resuscitation education, who were not knowledgeable or

confident. Therefore better cardiopulmonary resuscitation education programme

including updated knowledge are needed. More reinforced education should be

offered every 6 months or on yearly basis in order to enhance lasting efficiency.

A study was conducted to assess the knowledge of cardiopulmonary

resuscitation among the nurses of (n=302) community based health services in

Hainan province of Chaina. A survey was made by randomized stratified cluster

sampling using self designed questionnaires. The passing rate for qualification of

knowledge of cardiopulmonary resuscitation was found to be very low in Hainan

province (23-18%). A significant difference of regions and different educational

level among the nurses were also noticed. It may be concluded from the study that

nurses of community based health services in Hainan province lack the basic

knowledge of cardiopulmonary resuscitation especially in rural region.

A study was conducted on “effective resuscitation by nurses: perceived

barriers and needs: by states that when patients face a life-threatening event such as

cardiopulmonary arrest, they rely on the competence and skills of healthcare

professionals. Because nurses are often the healthcare providers closest to the

bedside and the first to respond to patients needs, their knowledge and skills need

to be optimal and their performance proficient.

The cross sectional survey was conducted in 2006 in the capital health

region of Kuwait including all registered nurses working in 21 primary health care

centers. A self administered questionnaire was distributed to all registered nurses.

It included personal characteristic training and practice of resuscitation, perceived

competence regarding practical skills. It also included multiple choice questions to

assess nurses knowledge about cardiopulmonary resuscitation. Nurses knowledge

was transformed into percentage score. Factors that could affect nurses knowledge

were studied out of 279 questionnaires 165 were returned back with 59.1%

response rate. The majority of them 86.1% had attended cardiopulmonary

resuscitation as a part of the nursing school curriculum and 65.5% of the nurses

had participated in a cardiopulmonary resuscitation learning session other than in

curriculum. It was found that 26.7% of the nurses had never participated in real

resuscitation attempt. Over all the median knowledge score of the registered nurses

were 42.9% for cardiopulmonary resuscitation and 52.0% for ECG. Factors that

affected nurses knowledge score were years of experience other than in curriculum

attempting real resuscitation and self confidence of the nurses.

A comparative survey was conducted in Asahikawa Medical college to compare

the knowledge regarding cardio pulmonary resuscitation among 66 nursing staff

and 53 student nurses. The average scores of the test among the nursing staff and

the student nurses were 61 points and 54 points, respectively. Although a

significant difference in the % of total correct answers was demonstrated between

the two groups, the rate of correct answers of the observation items was high,

whereas, that of skill items were comparatively low in each group. . “Ability”

defined as an indicator of capability of practicing CPR of the nursing staff was

17% and that of the student nurses was 0%. This shows that the CPR knowledge of

both the nursing staff and the student nurses was sufficient, indicating the necessity

of CPR education for both nursing staffs and student nurses.

3. Studies related to the effectiveness of teaching programme among nurses.

A study was conducted on cardiopulmonary resuscitation skill among nurses

and nursing students in southern Finland and Hungary, and to assess the influence

of resuscitation teaching and other group characteristics on performance. The study

group consisted of 75 nurses 223 final term students of different nursing institutes.

(34 men and 264 women) participated in the study. Logistic regression showed that

the best predictors for good response assessment skills went to those who were

nursing students who had studied resuscitation skills sometime during the previous

6 months. The best predictor of the skill to open the airway was a positive attitude

towards personal cardiopulmonary resuscitation (CPR) skills, i.e. self-confidence.

The predictor for adequate skills in artificial ventilation was that they belonged in

the group of nursing students who had benefited from recent resuscitation training

(<6 months).

A prospective randomized interventional study was conducted that

hypothesized a multimodel training method comprising audiovisual feedback and

immediate debriefing would improve cardiopulmonary resuscitation performance

among care providers. A total of 80 nurses were randomized to 2 groups. Each

group underwent 3 trials of simulated cardiac arrest. The “feedback” group

received real time audiovisual feedback during the second and third trials. The

“debriefing only” group performed cardiopulmonary resuscitation without

feedback. Both groups received short individual debriefing after the second trial.

Cardiopulmonary resuscitation quality was recorded using a cardiopulmonary

resuscitation sensing defibrillator that measures chest compression rate/depth and

can deliver audiovisual feedback messages from both groups during the three

trials. In the debriefing only group, the percentage of participant providing

compressions of adequate depth increased after debriefing from 38% to 68%

(p=0.015). In the feedback group depth compliance improved from 19% to 58%

(p=0.002). Compression rate did not improve significantly with either intervention

alone. This study states that significant cardiopulmonary resuscitation quality

deficits exist among health care providers. Debriefing or feedback alone improved

cardiopulmonary resuscitation quality, but the combination led to marked

performance improvements. Cardiopulmonary resuscitation feedback and

debriefing may serve as a powerful tool to improve rescuer training and care for

cardiac arrest patients.

A comparative study was conducted to know the “confidence vs.

competence: basic life support skills of health professionals, to assess BLS

confidence as assessed against competence of doctors in-training, qualified nurses

and healthcare assistants (HCAs) following the development of structured

resuscitation training. This study has highlighted that the introduction of a

structured resuscitation training programme has resulted in a noticeable

improvement in BLS skills, particularly with regard to doctors. Registered nurses

have improved with regular training. There remains a mismatch between

confidence and competence, with only doctors demonstrating both confidence and

competency and therefore changes to training programmes may be required to

address this mismatch.

A study conducted among hospital nurses investigated the relation between

BLS quality and some of its potential determinants. During a BLS refresher course,

296 nurses from non-critical care wards completed a questionnaire including

demographic data and “self confidence” score. Subsequently, they performed a

BLS test on a manikin connected to a PC using skill reporting system software

(Laerdal, Norway). The study showed that male gender had greater self

confidence, recent BLS trainee and recent CPR were associated with better quality

of BLS.

A study was conducted regarding the effectiveness of planned teaching

programme (PTP) on knowledge and practice of Basic Life Support among high

school students in Bangalore. The research design used for the study was quasi-

experimental design. The sample consisted of 40 rural high school students. The

study was conducted in rural high school of Mangalore and the subjects were

selected through simple random sampling technique. The study showed that

majority (87.5%) of the students had inadequate knowledge and (100%) had poor

practice. The planned teaching programme facilitated them to update their

knowledge and practice related to Basic Life Support. Hence, the planned teaching

programme is an effective teaching strategy to improve knowledge and practice of

sample on BLS.

A study was conducted on assessment of cardiopulmonary resuscitation

and defibrillation (CPR-D) skills of nursing students in two institutions. The

purpose of this study was to use Objective Structured Clinical Examination

(OSCE) test in assessing guideline based CPR-D skills of newly qualified nurses.

The CPR-D skills of newly qualified registered nurses studying in Halmstad

University (n = 30) Sweden, and Helsinki Metropolia University of Applied

Sciences (n = 30) Finland, were assessed using an Objective Structured Clinical

Examination (OSCE) which was built up with a case of cardiac arrest with

ventricular fibrillation as the initial rhythm. Forty-seven percent of the students in

the Swedish group (mean score 32.47/49, range 26-39, SD 3.76) and 13% of the

students in the Finnish group (mean score 23.80/49, range 13-35, SD 4.32) passed

the OSCE (P<0.0001), the cut-off point being 32.47. Performance grade for the

Swedish group was 2.9/5.0 and for the Finnish group 2.1/5.0 (P<0.0001). Good

nontechnical skills correlated with high grading of the clinical skills. The results

shows, CPR-D skills of the newly qualified nurses in both the institutes were

clearly under par and were not adequate according to the resuscitation guidelines.

A study was conducted on Training nurses for cardiopulmonary

resuscitation (CPR) by using the problem-based approach, To assess whether

problem-based learning (PBL) is more effective over conventional teaching

methods by comparing final resuscitation exam results of nursing students who

received cardiopulmonary resuscitation (CPR) training either by traditional or by

problem-based learning (PBL) approach. A retrospective and comparative research

design was implemented. Data on final CPR exam grades, collected both from

PBL and traditionally trained students, were obtained for a total of 1775 students

between 2000 and 2007 in three major schools of health sciences in Hungary.

Comparison between PBL and traditional teaching methods as well as across

schools was made. t-tests on means yielded significant differences (t=3.569;

p<0.001) between PBL and conventional training favouring PBL instructed

students. Students who received PBL training had better final cardiopulmonary

resuscitation exam grades than traditionally trained peers. Students who attended

PBL classes achieved greater theoretical knowledge and demonstrated better

resuscitation skills when tested.

A study was conducted regarding exploration of student nurse’s thoughts

and experiences of using a video recording to assess their performance of basic

life-support (BLS) and cardiopulmonary resuscitation (CPR) during a mock

objective structured clinical examination. An action research project was

conducted with six students who were assessed by an examiner at a video-recorded

mock objective structured clinical examination. Students self-assessed their skills

using the video and a checklist. Semi-structured interviews were conducted to

compare checklist scores, and explore students' thoughts and experiences of the

objective structured clinical examination. The findings indicate that students may

need to repeat this exercise by comparing their previous and current performances

to develop both their self-assessment and CPR skills. All students reported the

benefits of participating in this project, by discussion and identification of

knowledge and skills deficits, thus emphasising the benefits of formative

assessments to prepare students for summative assessments and ultimately clinical

practice.

A study was conducted on Basic Life Support knowledge of

undergraduate nursing students and chiropractic students. The aim of this study

was to examine retention of cardiopulmonary resuscitation and basic life-support

(CPR/BLS) knowledge of third year nursing and fourth year chiropractic students

following instruction and assessment of CPR/BLS skills and knowledge as part of

their undergraduate degree program. Non-experimental exploratory survey to

determine perceived ability and knowledge of CPR/BLS following completion of

CPR/BLS instruction. The study was conducted in University Health Sciences

School. Eighty-seven third year undergraduate nursing and forty-three fourth year

undergraduate chiropractic students at Royal Melbourne Institute of Technology

(RMIT). The level of knowledge of CPR/BLS was assessed via the number of

correct responses to questions regarding CPR/BLS. A visual analogue scale was

used for the students to score their self-rated perceived knowledge and skill. The

majority of students (78%) felt they were well prepared to perform CPR/BLS,

however there were deficiencies in both groups about knowledge of current

guidelines. Chiropractic students were less likely to identify the correct

compression rate compared to the nursing group (Spearman’s rho 0.669, p-.001)

with 95% of the chiropractic students not able to identify the correct rate. Thirty

four percent of the students were unable to identify the correct ventilation

compression ratio with nursing students again more likely to respond correctly

(Spearman’s rho 0.508, p-.001). Nursing students scored themselves highly for self

rated knowledge and ability to perform CPR. Chiropractic students tended to score

themselves at a lower rating in these areas than the nursing students. Although

students from both disciplines had significant gaps in knowledge of CPR/BLS,

nursing students outperformed chiropractic students in all aspects of CPR/BLS

knowledge.

A study was conducted on Evaluation of the Basic Life Support CD-

ROM, its effectiveness as learning tool and user experiences. This study presents

the evaluation of a Basic Life Support (BLS) CD-ROM, developed as part of the

Interactive Teaching and Learning (INTaL) staff development project. Student

nurses’ pre- and post-test percentage results were compared using the non-

parametric Wilcoxon test. Competency in delivering BLS skills was measured at

one of the sites. A Pearson’s co-efficient test was applied to measure any

correlation between knowledge attainment and skill performance.  Focus groups

facilitated an exploration of the students’ experiences and feelings of using

interactive multi-media technology for learning.  Lecturers’ views were sought

through individual interviews. Learning had occurred across all groups, though this

was not uniform. There was no correlation between knowledge of BLS and skill

attainment measured through expired air respiration and external chest

compression scores, though those students performing BLS for the second time

achieved better results than those undertaking practice and testing for the first time.

STATEMENT OF THE PROBLEM

“A study to evaluate the effectiveness of planned video assisted teaching

programme on cardiopulmonary resuscitation among nurses working in the

selected hospital in Bareilly city.

OBJECTIVES

1. To assess the existing knowledge of the nurses on cardiopulmonary

resuscitation.

2. To administer planned video assisted teaching for nurses on cardio

pulmonary resuscitation.

3. To assess the post test knowledge of the nurses on cardiopulmonary

resuscitation.

4. To find out the effectiveness of planned video assisted teaching programme

on cardiopulmonary resuscitation by associating pre-test knowledge with

their post-test knowledge.

5. To associate pre-test knowledge with their selected demographic variables of

the nurses.

6.5 OPERATIONAL DEFINITIONS

Evaluation:

It refers to the assessment of pre-test and post test knowledge score of the

nurses.

Effectiveness:

It refers to the extent to which the planned video assisted teaching programme

enhances the knowledge of the Nurses in cardiopulmonary resuscitation.

Planned Video Assisted Teaching Programme :

It refers to planned and organized video assisted teaching programme which

provides information and knowledge regarding cardiopulmonary resuscitation.

Cardio Pulmonary Resuscitation:

Cardio pulmonary resuscitation is a technique of basic life support for the

purpose of oxygenating the brain and heart until appropriate definitive medical

treatment can restore the normal heart and ventilator action.

Nurses:

It refers to nurses who are having GNM & BSC (N) qualification and working

in the common wards, ICU, emergency medicine etc, and has below 5 years of

experience in the clinical area.

ASSUMPTIONS OF THE STUDY

Nurses may have basic knowledge regarding cardiopulmonary resuscitation.

Video assisted teaching programme may enhance the knowledge of the

nurses regarding cardiopulmonary resuscitation.

HYPOTHESIS:

H1: There will be significant co-relation in the level of knowledge of the

nurses on cardiopulmonary resuscitation before and after planned video

assisted teaching programme.

H2: There will be significant association between the pre test and post test

knowledge of the subjects on cardiopulmonary resuscitation with their

selected demographic variables.

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA

The nurses working in a selected hospital, Bangalore.

7.2 METHODS OF COLLECTING THE DATA

Research Design

Pre experimental one group pre test and post test.

Research variables

Dependent variables

Knowledge of the selected nurses regarding Cardiopulmonary

Resuscitation.

Independent Variables

Planned video assisted teaching programme on cardio pulmonary

resuscitation.

Demographic Variables

The base line information such as age, gender, religion, education,

experience, area of work (ICU, CCU, Emergency and General ward Etc) and

previous knowledge about CPR, NCC / NSS members.

Setting :

The study will be conducted in the selected hospital, Bangalore.

Population :

Population for the present study consists of nurses working in the selected

hospital.

Sample :

Male and Female G.N.M. and B.Sc(N) qualification between the age group

of 22 to 28 years and has less than 5 years of clinical experience.

Criteria for selection of the samples

Inclusive Criteria

1. Nurses who are working in the selected hospital Bangalore.

2. Nurses who are between the age group of 22-28 years

3. Nurses who have G.N.M & B.Sc(N). qualification.

4. Nurses within the 5 years of experience in the clinical area.

5. Nurses who are available at the time of data collection.

6. Nurses who are willing to participate in the study.

Exclusive Criteria:

1. Nurses who are not willing to participate in the study.

2. Nurses with M.P.H.W (F).

3. Nurses who are having above 5 years of experience.

Sampling Technique

Non-probability convenience or purposive sampling technique is adopted for

selecting the samples.

Tool for data collection

Section A : Self administered questionnaire to assess the demographic data

of the nurses.

Section B : Self administer questionnaire to assess the knowledge of the

nurses regarding Cardio Pulmonary Resuscitation.

Methods of data collection:

Phase 1 : Permission from the significant authorities will be obtained. Self

administered questionnaire is given to collect demographic data for 15 minutes.

followed by, structured questionnaire will be administered for 30 minutes to assess

the knowledge of the nurses regarding Cardio Pulmonary Resuscitation..

Phase 2 : Video assisted planned teaching programme regarding CPR will

be conducted.

Phase 3 : Post test will be given to the nurses to assess the knowledge.

Duration of the study : 4 Weeks

Data analysis

Data collected will be analyzed by means of descriptive and inferential statistics.

Descriptive statistics

Mean, frequencies, percentage, and standard deviation to determine the

significance and to analyze the demographic data.

Inferential statistics

Paired ‘t’test was used to determine effectiveness of planned teaching programme

of knowledge regarding cardio pulmonary resuscitation.

Chi-square was used to find out the association between the post test level

knowledge and selected demographic variables.

Projected outcome:

This study will be helpful to improve the knowledge of the nurses on cardio

pulmonary resuscitation, which will enable nurses to provide effective Cardio

Pulmonary Resuscitation.

7.3 Does the study require any investigation to be conducted on patients or

other human or animals?.

Yes the study will be conducted on staff nurses in selected hospital

Bangalore city.

7.4 Has ethical clearances has been obtained from your institution?

Yes informed consent will be obtained from the institution authorities and

subject privacy, confidentiality and anonymity will be guarded. Scientific

objectivity of the study will be maintained with honesty and impartiality.

DISCUSSION

Cardiopulmonary resuscitation (CPR) is an emergency procedure which is

attempted in an effort to return life to a person in cardiac arrest. It is indicated in

those who are unresponsive with no breathing or only gasps. It may be

attempted both in and outside of a hospital.CPR involves chest compressions at

a rate of at least 100 per minute in an effort to create artificial circulation by

manually pumping blood through the heart. In addition the rescuer may provide

breaths by either exhaling into their mouth or utilizing a device that pushes air

into the lungs. The process of externally providing ventilation is termed

artificial respiration.

An administering of an electric shock to the heart, termed

defibrillation, is usually needed to restore a viable or "perfusing" heart rhythm.

Defibrillation is only effective for certain heart rhythms, namely ventricular

fibrillation or pulse less ventricular tachycardia, rather than asystolic or pulse

less electrical activity. CPR may however induce a shockable rhythm. CPR is

generally continued until the person regains return of spontaneous circulation

(ROSC) or is declared dead CPR is indicated for any person who is

unresponsive with no breathing or only gasps as breathing as it is most likely

that they are in cardiac arrest. CPR training: CPR is being administrated while a

second rescuer prepares for defibrillation.2

A number of studies have confirmed that CPR can be life-saving when provided

either by laypersons or medical professionals. In several large investigations, the

prompt delivery of CPR served as a important predictor of survival—bystander

CPR may almost double the chance of survival.5-7 Other work has shown that the

probability of survival from cardiac arrest falls by 10–15% per minute without

treatment, and well performed CPR likely shifts this curve towards higher

probability of survival. Furthermore, recent investigations have suggested that CPR

maintains the heart in a state favorable for defibrillation.8,9 That is, fatal cardiac

arrhythmias common in cardiac arrest have a greater chance of being successfully

terminated by electrical shock if CPR is performed first. A recent randomized trial

in Norway suggested that in cases of prolonged cardiac arrest, delaying

defibrillation in order to first provide several minutes of CPR significantly

improved patient survival.10 Not only can prompt CPR make an important impact

on outcomes, but the quality of CPR appears to matter greatly.5

Recent work has also shown that during actual human CPR, shallow

chest compressions have an adverse impact on outcomes.9 Therefore, it is crucial

that CPR be performed in accordance with published guidelines, which are

formulated based on the best available data and updated every five years.3 Given

the importance of CPR quality, it is perhaps surprising that the performance of

CPR has only recently been assessed during actual cases of cardiac arrest. In a

number of investigations over the past few years, CPR quality was found to be

lacking during both in-hospital and out-of-hospital cardiac arrest, both in Europe

and the US.11-15 In other words, poor CPR quality is endemic. In general, chest

compressions are delivered too slowly and in too shallow a fashion, and

ventilations are given too rapidly. There are several reasons why this might be the

case despite the best intentions of providers. 3

First, CPR is deceptively simple to describe and remarkably difficult to

perform, as humans generally do not have a good internal sense of timing to

recognize 100 compressions or 8–12 ventilations per minute, and fatigue often

prevents adequate depth efforts. Second, CPR is taught in the sterile conditions of a

classroom, but performed in the volatile environment of a dramatically ill person

surrounded by anxious onlookers—training can be easily forgotten in the panic of

the moment, especially if that training has not taken place recently. It is clear

from a variety of data that the majority of cardiac arrest patients do not receive

CPR at all until the arrival of medical personnel precious minutes after the onset of

arrest.

CPR training must be simplified and widely disseminated. Why, for

example, can we not require CPR competence as a prerequisite for a driver’s

license, or provide CPR training to every parent during the hospital stay before the

birth of their child or before they leave the hospital with their newborn.3

Benjamin S Abella, MD, MPhil, is currently Assistant Professor of

Emergency Medicine at the University of Chicago, where he also serves as Chair

of the Hospital CPR Committee. Dr Abella maintains an active research program

in cardiac arrest and resuscitation care, including clinical projects evaluating

cardiopulmonary resuscitation (CPR) quality. Dr Abella is a recipient of research

funding from the National Institutes of Health (NIH), Laerdal Medical Corporation

and Philips Medical Systems, and has consulted on cardiac arrest topics for a

variety of academic and commercial organizations. He will soon take a position at

the University of Pennsylvania, where he will continue his clinical work and

research as a member of the new Center for Resuscitation Science.

CONCLUSION

Cardiopulmonary resuscitation is a procedure to support and maintain

breathing and circulation for a person who has stopped breathing [respiratory

arrest] and or whose heart has stopped. CPR is performed to restore and maintain

breathing and circulation and to provide oxygen and blood flow to the heart, brain,

and other vital organs. CPR can be performed by trained bystanders or healthcare

professionals on infants, children, and adults. It should always be performed by the

person on the scene who is most experienced in CPR.1

When a person develops cardiac arrest, the heart stops beating, and the

person becomes unresponsive and stops breathing normally. Sudden cardiac deaths

account for more than 40-45% of cardio vascular deaths in India, 75% of the

people who die of sudden cardiac arrest shows signs of a coronary artery disease.

In India the annual incidence of sudden cardiac death account for 0.55 per 1000

population. In India, in the year 2009 6,16,067 people died of heart disease. The

earlier you give CPR to person in cardio pulmonary arrest [no breathing, no heart

beat], the greater the chance of a successful resuscitation. Because up to 80% of all

cardiac arrests occur in the home.2

CPR may be necessary during many different emergences. Approximately

1,00,000 people die annually as a result of accidents such as drowning, suffocation,

electrocution, drug overdose, automobile accidents, fires, and poisoning. Medical

research and practical experience confirms that a significant number of these

fatalities estimated at approximately 20% could have been prevented if prompt and

proper cardiopulmonary resuscitation has been applied on the scene. India has the

highest number of road accidents in the world. According to National Crime

Records Bureau [NCRB, 2006figures] Tamil Nadu [14% of all accidents] and

Maharashtra [12.4%] have the maximum accidents in the country. Majority of the

deaths due to accidents occurs during the transportation of the victim to hospital.

Many deaths can be averted and disability can be limited by providing CPR

education services before taking the victim to hospital.3

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