ARTICLE INFO

Article Type

Original Research

Authors

Chamanzari   H. (1)
Ahmadi Maymodi   S.K (*)
Behnam   H. (2)
Malekzadeh   J. (2)
Abdollahi   H. (3)
Robati   P. (4)
Eftekhar   S. (5)






(*) CPR Unit , Quem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
(1) School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
(2) School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
(3) School of Nursing and Midwifery, Azad University, Mashhad, Iran
(4) Quality Improvement Office, Quem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
(5) Quem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

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Article History

Received:  December  31, 2017
Accepted:  October 27, 2018
ePublished:  January 27, 2019

BRIEF TEXT


Cardiac arrest is the leading cause of death for adults over 40 years of age [1], leading to significant mortality and a very poor prognosis, and about 300,000 people die of heart disease every year in the United States [2].

... [3-6].The results of various studies have shown that human factors are the main reasons for the poor quality of cardiac recovery. It is expected that in dealing with such an acute problem, the principles of scientific standardization and high level of human resources can be applied [7]. ... [8, 9]. Recent studies have shown that although resuscitators are familiar with the new knowledge of cardiopulmonary resuscitation, the quality of performing these skills is very weak, and the defect in the quality of performing these vital skills reduces the survival rate of the patients [7,10, 11]. ... [12].Various studies have shown nurses' weakness in cardiac rehabilitation [13]. As a result, there is concern that these patients will be at risk of further loss of life. Therefore, promotion of psychomotor skills in cardiopulmonary resuscitation is essential [12].

The purpose of this study was to determine the effect of capnographic feedback on improving the psychomotor skills of the resuscitators.

This research is a semi-experimental study.

The population of this research included personnel working in the cardiopulmonary resuscitation team, pulmonary department of Ghaem Hospital, Research and Therapy Center in Mashhad in 2014-15.

The sample size was 35. In order to estimate the sample size, the formula of “mean and standard deviation of a society” was used. Then, these means and standard deviations were placed in three formulas and according to the sample size of 35, the error rate was estimated in three turns and for each of the three dependent variables, which was 0.015 for the number of massage, 0.04 for the number of ventilation and 0.02 for the duration of the interruption. Criteria for entering the study included the willingness to participate in the study, having a bachelor's degree (nursing or anesthesia) or above, having at least 6 months of resuscitation experience, participating in the first day training program, patient with advanced air track (tracheal tube and laryngeal mask). Exit criteria were the reluctance to continue to participate in the study, the failure to perform at least 3 cases of resuscitation, and the failure to record the data related to the recovery of the patient due to inadequate equipment or inappropriate space. This article is the result of a research project of a student dissertation approved by Mashhad University of Medical Sciences with the code 930938 dated 14.03.2019 and the clinical trial code IRCT2015061422730N

The tools used in this study were a checklist for assessing psychomotor skills and a demographic record form. The validity of the tools was evaluated by content validity index. This was reviewed and approved by using the latest books and articles of authorship including supervisor professor and clinical specialist consultants as well as 10 faculty members of the Faculty of Nursing and Midwifery of Mashhad. After obtaining a reference from the Faculty of Nursing and Midwifery of Mashhad and presenting it to the Nursing Director of Ghaem Hospital, the researcher coordinated with the hospital authorities in order to carry out the sampling process and, by introducing the units of research and explaining the goals and benefits of the study (to the extent necessary) for their collaboration. Those who were willing to participate in the research were requested to complete and sign the consent form. Satisfaction was obtained in writing and knowingly from the research units. At the beginning of the intervention stage, a separate code was assigned to each of the research units. Then, the questionnaire of individual characteristics as well as the form of entry criteria were separately provided to the research units to complete it. In the pre-intervention phase, the researcher, first, specified a separate code for each of research unit. Then, the questionnaire of demographic characteristics and the form of entry criteria were given to research samples to be completed. In the pre-intervention stage, the researcher, evaluated the skills of research samples including the number of cardiac massage, the number of resuscitation done by resuscitators using the evaluation checklist. In the next step, resuscitators used a capnographic device for 1 month in all cases of cardiac rehabilitation. The use of capnography in the recovery process was initiated by the presence of the CPR team and the restoration efforts were initiated and followed by the patient's intubation, the capnographic sensor was connected to the tracheal tube (using side stream) and the exhaled end capsule dioxide quantitatively (numerically) and the waveform (graphical) appeared on the monitor of the capnographic machine, which was visible to all the people in the group. At the end of each CPR cycle, after two minutes of recovery efforts, the cardiac massage stopped and the blood flow to the patient returned, which is to evaluate the heart rhythm on the monitor and touch the carotid pulse. At this stage, each resuscitator should use a pulmonary device for resuscitation at least in 3 cases of cardiac rehabilitation. After this period (one month), the researcher participated in the CPR before and with the purpose of registering the resuscitation, and in a subtle manner (attendance at the time of resuscitation to record the cases of resuscitation), the research units' skills included the number of cardiac massage, the number of resuscitation carried out by resuscitators were re-evaluated using a checklist for evaluating psychomotor skills. Data were analyzed by SPSS 11.5 software. In order to study the quantitative variability of this part, the normal distribution was evaluated by Kolmogorov-Smirnov test. Paired t-test was used to analyze the data of the research.

The participants included 35 nurses, 18 of whom were women and 17 were men (Table 1). There was a statistically significant difference between the mean number of heart resuscitation done by resuscitators before and during intervention (P <0.001) (Table 2). There was a statistically significant difference between the mean number of resuscitation carried out by resuscitators before and at the end of intervention (P <0.001) (Table 3). The mean interval between insertion of the endotracheal tube and confirmation of its correct location in the pre-intervention and post-intervention stage, at the post-intervention stage, decreased by 35% in comparison with before the intervention, and there was a statistically significant difference (P <0.001).

.. [14-24]. Pazner et al. found that the number of cardiac massage in the group receiving voice feedback (101 ± 9) was less than the mean number of group massage that did not receive feedback (127 ± 13) [25]. This study, which evaluated the effect of feedback on cardiac massage skills, was similar with the present study and its results were consistent with the decrease in the number of massage and approaching the standard level with the present study. Purdy et al. have concluded that feedback from the feedback mannequin improves the depth and number of massages. [26] The method of this study was similar to the present study in considering the feedback during resuscitation and its results regarding the effect of feedback on quality improvement of the performance of resuscitators was consistent with the present study. ... [27]. O'Neill et al. found that the resuscitation rate of resuscitators was higher than the level of international recommendations (26 times per minute) and when the feedback on the number of resuscitation was given by monitoring, the number of resuscitation was reduced [28], the results of which was in line with the present study concerning the improvement of resuscitation following feedbacks. ... [29]. Miller et al. also found that the duration of intubation was about 40 seconds, but of 41 resuscitators, only one person made interruption for intubation for 2-3 seconds in cardiac massage. However, other resuscitators did not make any interruption during the cardiac massage [30] the results of which was not similar to the current study Wang et al. concluded that the interruption time for cardiac resuscitation by intubation was about 45.6 seconds (23.5-73.5), of which more than one third of them lasted up to a minute. The study was similar to the current study regarding investigating the rate of interruption. However, its results was not similar to the results of this study [31].

The use of capnography during resuscitation will improve the performance of the resuscitators. However, further and deeper studies are needed in this area.

From the research limitations, not having similar experience among the resuscitators due to the different work experience of individuals, may result in different skills in the field of cardiac resuscitation.

Capnography feedback during resuscitation improves resuscitators` skills. Therefore, it is recommended in case of resuscitation.

The research group expresses its gratitude and honor to the respectful officials of the Faculty of Nursing and Midwifery of Mashhad University of Medical Sciences and the CPR unit of Ghaem Hospital because of providing the conditions for conducting research and their relentless support.

None declared.

The code has IR.MUMS.REC.1393.962.

Sponsored by the Research Deputy of Mashhad University of Medical Sciences.

TABLES and CHARTS

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