[Resuscitation skills of hospital nursing staff]

P Sefrin, T Paulus
Der Anaesthesist 1994, 43 (2): 107-14
The hospital nursing staff represents a distinct group of cardiopulmonary resuscitation (CPR) providers. Differences in the success rates of resuscitation attempts inside or outside the hospital seem to be attributable to the skill of the various rescuers. Whereas the definite success rate for prehospital resuscitation is 7%, the corresponding rate for in-hospital settings is 15%. METHODS. During 53 CPR refresher courses offered to nursing staff members, their individual skills and competence in CPR procedures were examined according to the standards and guidelines of the German Medical Association (Bundesärztekammer). The efficacy of cardiac massage and artificial ventilation performed by each nurse was recorded. Quality criteria were defined, grouped and analysed statistically by the Chi-square test. RESULTS. Only 6.6% of the nursing staff were found to have good skills in artificial ventilation. The main faults observed were insufficient tilting of the head (24%) and failure to prevent leakage from the insufflation airway (35%). For 42.8% it proved impossible to insufflate a minimum ventilatory tidal volume of 400 ml. The attempts at resuscitation made by 58.6% were completely inadequate. Although 14.1% of the nurses carried out effective cardiac massage, the majority of the test group (44.7%) failed to do so. For 29.4% the appropriate position of their own upper body to allow adequate chest compression remained elusive. In 41.4% of the compression cycles, the rescuer's hands lost contact with the sternum. The compression period proved too long in relation to the decompression period in 21.4%. Only 4 individuals (0.9%) were able to perform all standard CPR procedures as recommended by the guidelines and 71.8% failed to perform effective CPR manoeuvers. The test results did not differ with respect to the nurses' educational or professional status, clinical CPR experience or work area within the hospital. CONCLUSION. Cardiopulmonary resuscitation skills of hospital nurses are inadequate, mainly because of lack of manual dexterity. Obviously the special skills learned in CPR courses are lost after a relatively short time. These results, however, do not suggest completely inadequate handling of CPR procedures in the hospital setting. Indeed an increasing rate of successful resuscitations inside the hospital (up to 27%) has been reported in the literature. In consequence of our findings, refresher courses in specific CPR techniques must be demanded, which should be made obligatory for nursing staff every 2 years. Qualified nursing personnel routinely trained in CPR and supported by effective hospital logistics is essential if the life-saving benefits of modern CPR are to be provided to our patients.

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