Perceived Need for ACLS Training among Nurses in a Selected Hospital - Research Paper Example

Perceived need for ACLS training among Nurses in a selected hospital Name Institution Introduction Nurses are critical for the provision of care to patients in hospitals. In fact nurses make up the majority of healthcare stuff in all healthcare institutions. In most cases, they attend to patients before the patients are checked by physicians. The receive patients and closely monitor the patients throughout their stay at the healthcare facilities. This means that it is necessary for nurses to be knowledgeable to deal with various complications and challenges that patient experience in the course of their treatment. Such knowledge would help the nurses save the many lives that are lost during. As trauma and medical emergencies increase, the need to improve the nurses’ skills and knowledge of cardiopulmonary resuscitation (CPR) continues to grow due to the need to improve their ability to save patients from cardiac arrest situations. In this regard, Advanced Life Support (ALS) skills-training is necessary for nurses. ALS is one of the most critical factors that influence the success rates of cardiopulmonary reanimation. There is a strong link between ACLS skills and the survival rate of patients who require in-hospital resuscitation. Such patients are able to make it to discharge after competing healing due to their nurses ACLS skills. However, in many hospitals have are not well equipped with ACLS skills as part of their cardiopulmonary resuscitations itinerary. Such little difference can be very influential on the number of patients that maker to discharge following in-hospital resuscitation. It is therefore, important to ensure that nurses are equipped with all the necessary skills to enable the help patients. When teaching the nurses new skills, the approach used is always important and therefore ACLS skills training could be important if taught as part of the main nurse teaching program Purpose Cardiopulmonary resuscitation (CPR) is an important element of component of basic life support (BLS) when responding to cardiac arrest. There various sets of skills and techniques that are used to resuscitate patients from cardiac arrests, as well as, prevent the patients from going to cardiac arrest again. One important skills that can nurses can employ is ACLS. ACLS skills may be the key to improving the nurses’ skills at in-hospital cardiopulmonary resuscitation. Based on this, the aim of this study is to establish the necessity to improve the nurses ACLS skills in order increase their ability to resuscitate and care for patient with heart challenges. This study will explore literature, through literature review, evidence that supports the need for ACLS skill training for nurses in hospitals. Already, there is an indication of the ability of the ACLS improving success of cardiopulmonary resuscitations in hospitals. Research study objectives This research will seek to meat several objectives which include the following Establishing the importance of training nurses to give them or improve these ACLS skills Establish the efficacy of the ACLS skills at improving the nurses’ skills at rescuing patients from cardiac arrest and preventing future cardiac arrests in hospital settings. Determining the best approaches for teaching nursing ACLS skills in hospital settings. Literature review There are numerous studies that have been conducted on the importance of ACLS skills to nurses in hospital settings. Most of the studies have pointed out to the importance of ACLS knowledge to improving nurseries skills and success rates at cardiopulmonary reanimation. Dane, Russell-Lingren, Paish, Durham & Brown (2000) explored the link between patient survival to discharge and ACLS training for nurses. The objective of their study was to determine whether nurses trained in ACLS had better chances of discovering cardiac arrest in patients. It also source to compare the survival rates between the patients whose arrest was discover by nurses with ACLS training and those whose arrest was discovered by nurses win not ACLS training. To the time of their study, no other study had ever explored the relationship between ACLS training of the healthcare workers who initiate the resuscitation initiates and the survival to discharge rates. The study design used a cohort case-comparison methodology. The study focuses on a tertiary healthcare center in Georgia with a 550 bed capacity. In the healthcare setting, the study focused on subjects that had had in-hospital resuscitation activated by the nurse that discovered their cardiopulmonary arrest. The patient survival discharge rates were the main outcome measure in their study. The finding of this study indicated a strong relation between the initial rhythm and the survival to discharge. The initials rhythm had 57% variability influence to the rates of survival among the patients. ACLS training in nurses had strong relation to survival of the patients with 29% variability. According to Dane, Russell-Lingren, Paish, Durham & Brown (2000) the combination of both variability’s influenced 62% variability in survival to discharge. Patients with cardiac arrest discovered by nurses who had training in ACLS had 38% chance of survival. On the other hand, patient discovered and first attended to by nurses without ACLS training had 10% rate of survival to discharge. This finding confirmed that cardiac arrest discovered by ACLS-trained nurses had increased probability to survive to discharge. Moretti, Cesar, Nusbacher, Kern, Timerman, & Tamires (2007) on the other hand sought to demonstrate the importance of ACLS training in improving survival rates in patients who experience cardiac arrest in hospitals. ACLS training emerged and got introduced to cardiac arrest care as a systematic way professional responder can adopt to help cardiac arrest patients. According to Moretti et al (2007) despite the dissemination of ACLS training, the effectiveness of such training has been adequately demonstrated. It was not clear whether the training improve outcomes for patients who experienced cardiopulmonary arrest. Moretti et al (2007) aimed to determine value of formal ACLS training in raising the chances of survival for patients with in-hospital cardiac arrest. To study captured data from various hospitals. It was a cohort study that examined patient outcomes after resuscitation efforts by rescue teams within these hospitals. The data capture efforts of resuscitation teams with and with no ACLS-trained nurses. Over the course of 38 months, the study used data from 156 patients who experienced a total of 172 in-hospital cardiac arrests. Moretti et al (2007) measures the return to spontaneous circulation (ROSC), the patient’s survival to discharge, survival for over the days and one year. The results showed 39% success of resuscitation attempts. ROSC rate was 43.4% where the personnel had ACLS training and 27.1% in cases where the personnel had no ACLS training. Patients handled by personnel by ACLS trained personnel had their survival to discharge rise from 20.6% to 31.7%. The patients also have a better chance for reaching 30 day survival rate from 5.9% to 26.8% while 1-year survival improved from 0% to 21.9%. In sum, Moretti et al (2007) found that the presence of at least one team member that had ACLS training in the rescue team improve resuscitation efforts success. It also improved short term and long term survival for cardiac arrest patients. Hagyard-Wiebe (2007) explored whether nurse needed ACLS training. According to Hagyard-Wiebe (2007) resuscitation serve to sustain life, to ensure that the neurological functioning and maintain the same quality of life a patient. ACLS is meant to achieve this purpose. Hagyard-Wiebe (2007) observed inconsistencies in ACLS training for nurses across Canada. His article explored the evidence on the need for ACLS training for nurses to improve critical care skills. Hagyard-Wiebe (2007) conducted research on MEDLINE and CINAHL databases for research on ACLS training, critical nursing care and resuscitation. The evidence collected supported the need for ACLS training for nurses. The evidence supported the need to provide nurses with continuous refresher training, practice using technological advance simulators, and video recorded reviews. Sodhi, Singla & Shrivastava (2011) explore the influence ACLS training on patient resuscitation in a tertiary healthcare facility. Sodhi, Singla & Shrivastava (2011) conducted their study on the background of limited evidence to support eh impact of CPR training on resuscitation of patients. Despite the availability of many guidelines for CPR published from time to time to inform CPR training programs, little data was available to support the incorporation to the guidelines into the training programs. Similarly, little data was available to support the training programs (Sodhi, Singla & Shrivastava, 2011). Thus on their study, Sodhi, Singla & Shrivastava (2011) aimed at assessing the outcomes of the American Heart Association (AHA) support training programs at improving CPR. The programs include advanced cardiac life support (ACLS) and basic life support (BLS) course in a tertiary hospital. Doctors and healthcare workers in critical and intensive care units were given training using these programs. The study was conducted over 18 months and the results of CPR prior to the training and after the training were compared. In total, 627 in-hospital cardiac arrests were captured. 284 of the arrest were recorded prior to the BLS/ACLS training while 342 were recorded after the training. Before the training 18.3% of the patients who suffered cardiac arrests were restored to spontaneous circulation, while after the training the number rose to 28.3%. Survival to discharge also increased from 23.1% from pre-training period to 69.1% in the post training period. These findings were a clear indication the training effective improves the healthcare workers ability to perform effective resuscitations. de Lima, de Macedo, Vidal & Sá (2009) also focused on BLS and ACLS training and the impact they had on the nursing professionals knowledge. The employed a cross-sectional study. The study subjects include nursing professional drawn from a tertiary level hospital. Their assessment also used data collected before and after the training programs. They further addressed the International Liaison Committee on Resuscitation (ILCOR) critical pints of analysis. A total of 213 professionals were captured by the study. The pre-training results indicated that the CPR knowledge among the healthcare workers was inversely proportional to the number of years following their completion of college degree or whatever technical training course they undertook. Main deficiencies in the knowledge included reduced knowledge on how to approach, appropriate post-resurrection care, and external cardiac massage approaches among others. The knowledge improved following BLS and ALS training, leading to conclude that permanent or continuous ALS and BLS training resulted in continued increment in the level of knowledge of the nursing professionals. Sanders, Berg, Burress, Genova, Kern & Ewy (1994) also confirmed the importance of training at improving CPR. They studied influence of ACLS training on resuscitation success at s rural hospital. Their research design was a retrospective case review of patients who had experienced cardiac arrest in the previous 13 months prior to ALCS training at the facility and after the training. There setting was a 24 bed rural hospital in a local community that had no prior ALS. The study captured 29 patients prior to the training and 35 after the training. The main intervention used during the study was training providers in ACLS. The outcomes of this study also supported ACLS training. Resuscitation success improved following ALCS training in the hospital. Out of hospital resuscitations also improved in the rate of success. Resuscitation levels rose from seven percent to 20 percent. Haukoos, Lewis, Stratton, & Niemann (2003) sought to externally validate the ACLS scores using patient population. ACLS scores were developed to estimate out-of-hospital cardiac arrest survival rates. Irrespective of who first witnessed the arrest or the whether a bystander performed the first CPR, the response of the paramedic unit was employed as the main predictive factor for survival. This study used and retrospective cohort study which was undertaken in an urban teaching hospital. The subjects comprised of adults who had experienced cardiac arrests and had been treated out of hospital. Mostly they had no traumatic incidents and had been transported to hospital after initial care out of hospital. The study entail and review of the patient record of all the patients during this period. The variable took into account initial arrest rhythm, witnessed arrest, bystander CPR, the response time of the paramedics and survival to discharge. The patients ACLS scores were used to establish the probability of the patient’s survival to discharge from hospital. The predicated rates were compared with flora’s Z score while Hosmer-Lemeshow test was adopted to evaluate the models appropriateness for good fit. 754 patients enrolled for the study but only 575 had proper documentation that would facilitate ACLS scoring. Only 4% of the patients survived to discharge from hospital. The results indicated that the ACLS score previously published was not valid when used alongside an external cohort of patients with out of hospital incidents. A different model was necessary to evaluate out of hospital cases. In another study, Gilligan et al (2004) explored the playing of leading role by ALS-trained in emergency care. In many critical care centers, ALS –trained nurse do not take the leading role in resuscitation of patients. Gilligan et al (2004) wanted to find out where the ALS trained nurse taking the team leadership role had different fortunes for the patients. The prospective study took place at five different emergency departments. The study also capture one nurses’ association meeting. The participants experience the same scenarios and recorded various variables from the patients. The participants who had ALS training scored highly than those who did not have training. The ALS trained nurses scored 72.3% whole the non trained one scored on average 69.5%. The nurses found the experience less stressful compare to doctors. The results supported the need to have ALS trained nurses lead the resuscitation efforts to improve the patients’ outcomes. All the evidence in literature point out to strong influence of ACLS training in influencing the nurses’ skills at resuscitation. According to the above literature, the training improves the nurses’ skills and their efficiency at resuscitating patients. It improves that that patients’ outcomes since many survive to get discharged from hospital. Also many survive for over a year. In addition ACLS has the ability to improve the nurses’ confidence. As a result, they are able to conduct resuscitation more effectively, which further improve the outcomes for the patients. By improve their confidence; it also improves their ability to lead the rescue teams. Finally, the evidence from these researches indicate the medical resuscitation team that had at least a member with ACLS training had improved chances of resuscitation patients that experiences cardiac arrest. All the evidence indicated that giving nurses ACLS training is important and should be encouraged. Theoretical framework The theoretical frame work for this study will be based upon the theory of andragogy by Malcom Knowles (Borst, 1998). This theory is based on how adults learn. The model is based on the fact that adults learn because they need to know, adults self concept of autonomy, role played by the learners experience, orientation to learning, readiness to learning, and the motivation to learning. The application of this model assumes that nurses are adults and will attend the classes because they feel the need to learn (Borst, 1998; Knowles Holton, & Swanson, 2004). Self concept will come into play to direct the nurses’ approaches to learning. Their experiences will influence will influence the way they learn. References Borst, LR 1998, Evaluation of Advanced Cardiac Life Support Written Examinations, Graduate Research and Creative Practice, Grand Valley State University Dane, FC Russell-Lindgren, KS Parish, DC Durham, MD Brown TD 2000, In-hospital resuscitation: association between ACLS training and survival to discharge, Resuscitation, 47(1), 83-7. de LimaI, SG de MacedoII, LA Vida, ML Sá, MPB 2009, Permanent education in BLS and ACLS: impact on the knowledge of nursing professionals, Arq. Bras. Cardiol, 93(6) http://dx.doi.org/10.1590/S0066-782X2009001200012 Gilligan, P Bhatarcharjee, C Knight, G Smith, M Hegarty, D Shenton, A Todd, F & Bradley, P 2004, To lead or not to lead? Prospective controlled study of emergency nurses’ provision of advanced life support team leadership, Emerg Med J, 22, 628-632. Hagyard-Wiebe, T 2007, Should critical care nurses be ACLS-trained? Dynamics, 18(4), 28-31. Haukoos, JS Lewis, RJ Stratton, SJ & Niemann, JT 2003, Is the ACLS score a valid prediction rule for survival after cardiac arrest? Acad Emerg Med, 10(6), 621-6. Knowles, MS Holton, EF & Swanson, RA 2004, The Adult Learner: The Definitive Classic in Adult Education and Human Resource Development, Routledge, London. Moretti, MA Cesar, LA Nusbacher, A Kern, KB Timerman, S & Ramires, JA 2007, Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest, Resuscitation, 72(3), 458-65. Sanders, AB Berg, RA Burress, M Genova, RT Kern, KB & Ewy GA 1994, The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community, Ann Emerg Med 23(1), 56-9. Sodhi, K Singla,MK & Shrivastava, A 2011, Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital, Indian J Crit Care Med, 15(4), 209–212. Read More