RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION.
1. / NAME OF THE CANDIDATEAND ADDRESS / MR.SACHIN KONKANI
AT-POST; SHINDIKURBET
TALUK-GOKAK,
DIST-BELGAUM.
KARNATAKA-591306
2. / NAME OF THE INSTITUITION / M.S.RAMAIAH INSTITUTE OF NURSING EDUCATION AND RESEARCH.
3. / COURSE OF STUDY AND SUBJECT / M.Sc. NURSING
MEDICAL SURGICAL NURSING
DISSERTATION PROTOCOL
4. / DATE OF ADMISSION: / 25-07-2011
5. / TITLE OF THE STUDY:
KNOWLEDGE OF HEALTH PROFESSIONALS REGARDING REVISED GUIDELINES OF CARDIOPULMONARY RESUSCITATION
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION:
Cardiopulmonary system consists of Heart and Lungs which are located in the thoracic cavity of the body. The most important function of the cardiopulmonary system is regulation of the blood flow between the heart and the lungs.1
The last decade has seen significant change in mortality trends with chronic disease replacing infectious disease as the leading cause of death and the World Health Organization has declared India the coronary artery disease (CAD) capital of the world.2
In any health setting there is a chance of the patient’s condition to deteriorate. The cessation of breathing and circulation will result in cardiopulmonary arrest. When a patient is determined to be in cardiopulmonary arrest, seconds matter. Effective Cardiopulmonary Resuscitation immediately after sudden cardiac arrest, can delimit the further brain damage.3
‘‘Cardiopulmonary resuscitation (CPR) is a series of lifesaving actions that improve the chance of survival following cardiac arrest.’’(According to American Heart Association 2010)4.
During the past 50 years the fundamentals of early recognition and activation, early Cardiopulmonary Resuscitation, early defibrillation, and early access to emergency medical care have saved hundreds of thousands of lives around the world, these lives demonstrate the importance of resuscitation research and clinical translation. 5
The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care are based on the most current and comprehensive review of resuscitation literature ever published, the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency cardiovascular care Science with Treatment Recommendations. The 2010 evidence evaluation process included 356 resuscitation experts from 29 countries who reviewed analyzed, evaluated, debated, and discussed research and hypotheses through in-person meetings, teleconferences, and online sessions (“webinars”) during the 36-month period before the 2010 Consensus Conference. The experts produced 411 scientific evidence reviews on 277 topics in resuscitation and emergency cardiovascular care.5
The recommendations in the 2010 Guidelines confirm the safety and effectiveness of many approaches, acknowledge ineffectiveness of others, and introduce new treatments based on intensive evidence evaluation and consensus of experts. 5
New guidelines of Cardiopulmonary resuscitation were provided by American Heart Association (October 2010) which has the following changes made in the events of cardiopulmonary Resuscitation-
· A change in the basic life support (BLS) sequence of steps for trained rescuers from “A-B-C”(Airway, Breathing, Chest compressions) to “C-A-B” (Chest compressions, Airway, breathing) for adults and paediatric patients (children and infants, excluding newborns). 5
· “Look, listen and Feel” has been removed from the Basic Life Support algorithm.
· A compression rate of at least 100/min. The new recommendation for chest compression depth push down on the adult breastbone at least 2 inches (5 cm).5
· If a bystander is not trained in Cardiopulmonary resuscitation, the bystander should provide Hands-Only (compression-only) Cardiopulmonary resuscitation for the adult victim who suddenly collapses, with an emphasis to “push hard and fast” on the centre of the chest.5
· The new guidelines do not recommend routine use of cricoid pressure in cardiac arrest. 5
The guidelines were changed with the following evidences
· In the C-A-B sequence, chest compressions will be initiated sooner and ventilation only minimally delayed until completion of the first cycle of chest compressions.5
· The A-B-C sequence could be a reason why less than a third of people in cardiac arrest receive bystander Cardiopulmonary resuscitation. ABC starts with the most difficult procedures: opening the airway and delivering rescue breaths. Effective bystander Cardiopulmonary resuscitation, provided immediately after sudden cardiac arrest, can double or triple a victim’s chance of survival. 5
· Performance of “Look, Listen and Feel,” is inconsistent and time consuming.5
· The number of chest compressions delivered per minute during Cardiopulmonary resuscitation is an important determinant of return of spontaneous circulation (ROSC) and survival with good neurologic function. In most studies, delivery of more compressions during resuscitation is associated with better survival, and delivery of fewer compressions is associated with lower survival. 5
· Compressions generate critical blood flow and oxygen and energy delivery to the heart and brain. Rescuers often do not push the chest hard enough. 5
· Cricoid pressure can prevent gastric inflation and reduce the risk of regurgitation and aspiration during bag-mask ventilation, but it may also impede ventilation. Seven randomized studies showed that cricoid pressure can delay or prevent the placement of an advanced airway and some time aspiration can still occur despite application of cricoid pressure. In addition, it is difficult to appropriately train rescuers in use of the maneuver.5
A study to find the efficacy of compression only Cardiopulmonary Resuscitation reported that the provision of chest compressions alone did not have a negative influence on survival to hospital discharge, compared with conventional Cardio Pulmonary Resuscitation.6
Three nonrandomized observational studies on human bystander Cardiopulmonary Resuscitation published in 2007, the results of the study shows none of these 3 studies demonstrated any negative impact on survival when ventilations were omitted from the sequence of bystander cardiopulmonary resuscitation. Using the important end point of 30-day survival with favourable neurological outcome, the studies shown that survival after chest compressions only cardiopulmonary resuscitation did not differ from survival after conventional Cardiopulmonary Resuscitation for adult patients with witnessed out-of-hospital cardiac arrests from both cardiac” and “non cardiac” causes.6
A study conducted by using registry of one month survival of all adult victims of cardiac arrest who received bystander cardiopulmonary resuscitation found to have no statistically significant difference between victims that received chest compressions alone and those that received conventional cardiopulmonary resuscitation.6
NEED FOR THE STUDY
Saving life demands only two hands and some basic knowledge. A qualified person can massage a heart, open airways, resuscitate and call for help. A person with cardio-pulmonary resuscitation (CPR) training can sustain an ailing person's heart and brain for a short time.7
The trend towards increasing sudden cardiac death events in developing nations of the world is taught to reflect the change in dietary and lifestyle habits. It has been estimated that Sudden Cardiac Death claims more than 7,000,000 lives per year worldwide.8
An article on ‘‘Global public health problem of sudden cardiac death’s reports that cardiovascular disease is a leading cause of global mortality, accounting for almost 17 million deaths annually (30% of all global mortality). The survival rate from sudden cardiac arrest is less than 1% worldwide.9
It is estimated that about 95 percent of sudden cardiac arrest victims die before reaching the Hospital. Survival is directly linked to the amount of time between the onset of sudden cardiac arrest and the provision of cardiopulmonary resuscitation.10
Karnataka, ranks number 1 for the Ischemic heart disease (IHD)deaths accounting for every 12th death in the state. 43.12% of deaths are caused due to IHD. Bangalore tops the list with nearly 30% of over 1.15 lakh registered deaths in the state. 11
Cardiopulmonary resuscitation (CPR) training and knowledge among health professionals is a topic of vital importance as the doctors and the nurses often are the first person to attend to patients in emergency situations Unfortunately, knowledge about the cardiopulmonary resuscitation is not enough, as healthcare professionals need to have hands-on practice regularly in order to retain the skills. Furthermore, it has been found that skill retention deteriorates as early as five months after Cardiopulmonary resuscitation training.12
An article published in the Journal of American Medical Association says that, physicians, paramedics and other health professionals do not perform Cardiopulmonary resuscitation as per the American Heart Association Guidelines.13
A cross-sectional study on the Awareness of basic life support among medical, dental, nursing students and doctors showed that a majority of them (84.82%) had secured less than 50% marks showing that the Awareness of Basic Life Support among doctors, medical, dental and nursing students is very poor.14
Most of the deaths from cardio-pulmonary arrest can be prevented and the disabilities due to cardiac arrest can be limited if a timely Cardiopulmonary resuscitation is provided at the time of cardiac arrest. So it’s of prime importance for all health professionals to have knowledge of the revised guidelines of cardiopulmonary in order to perform a proper cardiopulmonary resuscitation. Hence the student researcher felt the need to assess the knowledge of the health professionals regarding revised guidelines of cardiopulmonary resuscitation.
6.2. REVIEW OF LITERATURE:
A study conducted on 2005 American Heart Association resuscitation guidelines among 112 cardiologists shows that for theoretic knowledge questions, overall mean score was 9.9 + 4.6 (range 3-20). Furthermore, no correlation was observed between the theoretic knowledge scores and self appraisal of resuscitation knowledge. The study concluded that Cardiologists have knowledge gaps in the 2005 AHA resuscitation guidelines and resuscitation knowledge decay is evident one year after the course.15
A study to assess knowledge of Cardiopulmonary Resuscitation among 87 Undergraduate nursing & 43 Chiropractic students after completion of cardiopulmonary resuscitation instruction by using a non-experimental exploratory survey design. The results showed that 78% students felt that they were well prepared to perform cardiopulmonary resuscitation, however there were deficiencies in both groups with regards to knowledge of current guidelines of cardiopulmonary resuscitation. 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, while in the nursing group 25% of them were unable to identify the correct rate. 69% percent of the chiropractic students were unable to identify the correct ventilation compression ratio, while 17% nursing students failed to respond correctly to the ventilation compression ratio. (Spearman’s rho 0.508, p.001). 16
A survey to assess the knowledge on cardiopulmonary resuscitation among the 302 nurses of community-based health services by randomized stratified cluster sampling, the data was collected using a self-designed questionnaire. The study results showed that the passing rate regarding knowledge of Cardiopulmonary resuscitation was found to be very low (23.18%). The study concluded that nurses of community-based health services lack the basic knowledge of cardiopulmonary resuscitation, especially in rural region.17
A cohort study conducted to assess the attitude towards the cardiopulmonary resuscitation and correct practice guidelines among 71 fourth year medical, 56 final year medical and 76 final year nursing student by using a pilot questionnaire. The result shows that 70 % of fourth year, 85.8% final year medical and 70 % of the final nursing students felt confident to perform basic life support and 24% of the fourth year, 84 % of the final year medical students and 22.7% of nursing students about defibrillation(p<0.001). The perceived ability to defibrillate correlated significantly with a positive attitude toward nurse performed defibrillation (p<0.001) and negatively with fear of damaging the patient’s heart by defibrillation (p<0.001), negative attitude toward defibrillation correlated with perceived organisational attitudes toward practice guidelines. The study concluded that negative attitude and beliefs toward defibrillation affect the students’ attitude towards practice guidelines.18
A cross sectional survey to assess the Knowledge and Personal experience of cardiopulmonary resuscitation among, 241 dentists by using a self administered structured questionnaire. It revealed that 75.9 % of dentist had received basic knowledge about Cardiopulmonary resuscitation but only 56% of them had a concept of performing it, & only 12% had received practical training in Cardiopulmonary resuscitation. The level Of knowledge was significantly higher among dental faculty (126.61) compared with dental practitioners (100.10).The study also revealed that a few dentists (12%) had undergone training in Cardiopulmonary resuscitation and there is a perceived need for training on cardiopulmonary resuscitation among dentists. 19
STATEMENT OF THE PROBLEM
‘‘A descriptive study to assess the knowledge on revised guidelines of cardiopulmonary resuscitation among health professionals in selected hospitals, at Bangalore.’’
6.3. OBJECTIVES
1. To assess the knowledge level of health professionals regarding revised guidelines of Cardiopulmonary resuscitation.
2. To find the association between level of knowledge and selected socio-demographic variables.
6.4. HYPOTHESIS
H01- There is no significant association between the level of knowledge and selected socio-demographic variables.
6.5. OPERATIONAL DEFINITIONS
Knowledge –Knowledge refers to the ability of the subjects in giving correct response to the questions regarding revised guidelines of Cardiopulmonary resuscitation as assessed by structured knowledge questionnaire.
Revised guidelines of Cardiopulmonary resuscitation - It refers to the changes made in the sequence of cardiopulmonary Resuscitation from “A-B-C” (Airway, Breathing, Chest compressions) to “C-A-B” (Chest compressions, Airway, breathing) for adults and paediatric patients (children and infants, excluding newborns).
Health professionals- It refers to the Doctors, Nurses and physiotherapists who have accredited by a professional body upon completing a course of their study, & licensed to practice.
6.6. ASSUMPTIONS
· Health professionals may have varying levels of knowledge regarding revised guidelines of Cardiopulmonary resuscitation.
· Assessing the knowledge of the health professionals regarding revised guidelines of Cardiopulmonary resuscitation may help to give recommendations for further intervention.
· Evaluation of the knowledge of health professionals may create awareness of revised guidelines of cardiopulmonary resuscitation among health professionals.
6.7. DELIMITATIONS
Study is delimited to:
· Health professionals working in selected hospitals at, Bangalore.
· Four weeks of data collection
7. MATERIALS AND METHODS:
7.1. SOURCE OF DATA:
Health professionals working in selected hospitals, at Bangalore.