Skills and self-assessment in cardio-pulmonary resuscitation of the hospital nursing staff.

UNLABELLED: Differences in the success rates of the pre-hospital or in-hospital resuscitation attempts seem to be attributable to the skill of the various rescuers. Whereas the definite success rate for pre-hospital resuscitation is 7%, the corresponding rate for in-hospital settings is 15%. In this context, the resuscitation skills and the self-assessment of CPR methods of hospital staff were investigated.

METHODS: during 53 CPR refresher courses offered to nursing staff members, the individual skills and competence in CPR procedures of 425 nurses were examined according to the standards and guidelines of the German Medical Association. During the first part of the study the participants were asked to subjectively rate their proficiencies in CPR followed by a practical assessment of their manual CPR skills by an independent observer. Scores were calculated for artificial ventilation and chest compression. Quality criteria were defined, grouped and analysed statistically by the chi-squared test.

RESULTS: 16.2% of the participants felt sufficiently trained to perform CPR independently and 77.2% did not. Thirty-six percent estimated their CPR skills to be sufficient or good. Only four participants (0.9%) were able to perform all standard CPR procedures as recommended by the guidelines and 71.8% failed to perform effective CPR manoeuvres. The CPR skills did not differ with regard to the nurses' educational degree, professional experience, previous CPRs performed or work area within the hospital. Of the nursing staff, 6.6% were found to have good skills in artificial ventilation. The attempts at artificial ventilation made by 58.6% were completely inadequate. Correct chest compression was performed by 14.1%. The majority of the test group (44.7%) failed to carry out effective cardiac message.

CONCLUSIONS: CPR skills of hospital staff are inadequate, mainly because of lack of manual dexterity. Obviously the special skills learned in CPR courses are lost in spite of a positive self-assessment after a relatively short time. The results, however, do not suggest completely inadequate handling of CPR procedures in a hospital setting. Indeed, an increasing rate of successful resuscitations inside the hospital (up to 27%) has been reported in the literature. As a consequence of our findings, refresher courses in specific CPR techniques must be demanded, which should be made compulsory for nursing staff every 2 years.