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Woolfe Loftus N, Smith D, Aitken LM. The Scope of Nurses' Assessment of Deteriorating Patients in Coronary Care Units: A Mixed Methods Study. J Clin Nurs 2025; 34:1250-1263. [PMID: 39861931 PMCID: PMC11933513 DOI: 10.1111/jocn.17500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 07/26/2024] [Accepted: 10/07/2024] [Indexed: 01/27/2025]
Abstract
BACKGROUND Despite the high acuity of coronary care unit (CCU) patients and their risk of deterioration, little is known about how nurses assess them. AIM Increase understanding of the scope of nurses' assessments of deteriorating CCU patients. DESIGN Online mixed methods survey. METHODS The mRAPIDS (modified Rescuing a Patient in Deteriorating Situations) tool was used to measure assessment scope in responses to a patient vignette with a higher mRAPID score signalling broader scope (maximum score 24). Reflections on day-to-day practice were collected concurrently and thematically analysed. Themes were integrated with scores using a joint display table and organised into domains. Comparing 'fit' between data showed expansion (overlap with broader nonoverlapping findings) and disconcordance (contradictory findings). RESULTS Thirty-four nurses responded, and scope of assessment was found to be narrow (median mRAPIDS 5). Two domains were identified that helped explain this finding 'the act of assessment' and 'education and experience'. Participants emphasised the importance of education and experience, neither increased assessment scope. CONCLUSION This study showed that participant assessments were generally narrower than widely accepted best practice (ABCDE assessment). IMPLICATIONS Participant assessments did not reflect gold standard A-E assessment, which may partly reflect a need for assessment frameworks that are more compatible with real-world practice. Further research is required to understand the role of healthcare assistants in the care of deteriorating CCU patients. Clinical judgement is important, but not yet well understood in rapid response systems. IMPACT This study offers preliminary understanding of nurses' assessments of deteriorating patients in CCUs. REPORTING METHOD American Psychological Association, Mixed Methods Standards. PATIENT OR PUBLIC CONTRIBUTION Reviewed protocol, aided result interpretation and shared ideas for future research.
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Affiliation(s)
| | - Duncan Smith
- City St George's, University of LondonLondonUK
- University College London HospitalsLondonUK
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Alcázar Artero PM, Pardo Rios M, Greif R, Ocampo Cervantes AB, Gijón-Nogueron G, Barcala-Furelos R, Aranda-García S, Ramos Petersen L. Efficiency of virtual reality for cardiopulmonary resuscitation training of adult laypersons: A systematic review. Medicine (Baltimore) 2023; 102:e32736. [PMID: 36705392 PMCID: PMC9875948 DOI: 10.1097/md.0000000000032736] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Virtual reality (VR) is an interesting and promising way to teach cardiopulmonary resuscitation (CPR) to adult laypersons as its high immersive characteristics could improve the level of skills and acquired knowledge in learning basic life support (BLS). METHODS This systematic review assesses current literature about BLS training with VR and its possible effect on CPR-quality parameters, self-efficacy, perceived learning, and learners' satisfaction and short and long-term patients' outcome. We screened the Cochrane Library, PubMed, CINAHL, MEDLINE Ovid, Web of Science, and Scopus databases and included only clinical trials and quasi-experimental studies published from inception to October 1, 2021, which analyzed adult laypersons' BLS training with the use of VR. Primary outcomes were CPR parameters (chest compression rate and depth, Automated External Defibrillator use). Secondary outcomes were self-efficacy, perceived learning and learners satisfaction, and patients' outcomes (survival and good neurologic status). The risk of bias of included study was assessed using the Cochrane Handbook for Systematic Reviews of Interventions tool to evaluate randomized control trials and the transparent reporting of evaluations with nonrandomized designs checklist for nonrandomized studies. RESULTS After full article screening, 6 studies were included in the systematic review (731 participants) published between 2017 and 2021. Because of the heterogeneity of the studies, we focused on describing the studies rather than meta-analysis. The assessment of the quality of evidence revealed overall a very low quality. Training with VR significantly improved the rate and depth of chest compressions in 4 out of 6 articles. VR was described as an efficient teaching method, exerting a positive effect on self-efficacy, perception of confidence, and competence in 2 articles. CONCLUSION VR in BLS training improves manual skills and self-efficacy of adult laypersons and may be a good teaching method in a blended learning CPR training strategy. VR may add another way to divide complex parts of resuscitation training into easier individual skills. However, the conclusion of this review suggests that VR may improve the quality of the chest compressions as compared to instructor-led face-to-face BLS training.
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Affiliation(s)
- Petronila Mireia Alcázar Artero
- UCAM Universidad Católica de Murcia, Murcia, España
- Gerencia de Urgencias y Emergencias 061 de la Región de Murcia, Murcia, España
| | - Manuel Pardo Rios
- UCAM Universidad Católica de Murcia, Murcia, España
- Gerencia de Urgencias y Emergencias 061 de la Región de Murcia, Murcia, España
- * Correspondence: Manuel Pardo Rios, UCAM Universidad Católica de Murcia, Campus de los Jerónimos, No 135 Guadalupe 30107, Murcia, España (e-mail: )
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, Bern, Switzerland
- School of Medicine, Sigmund Freud Private University Vienna, Vienna, Austria
| | | | - Gabriel Gijón-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Spain
| | | | - Silvia Aranda-García
- GRAFAIS Research Group, Institut Nacional d’Educació Física de Catalunya (INEFC), Universitat de Barcelona, Barcelona, Spain
| | - Laura Ramos Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Spain
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Pan DF, Li ZJ, Ji XZ, Yang LT, Liang PF. Video-assisted bystander cardiopulmonary resuscitation improves the quality of chest compressions during simulated cardiac arrests: A systemic review and meta-analysis. World J Clin Cases 2022; 10:11442-11453. [PMID: 36387811 PMCID: PMC9649565 DOI: 10.12998/wjcc.v10.i31.11442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/10/2022] [Accepted: 09/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It remains unclear whether video aids can improve the quality of bystander cardiopulmonary resuscitation (CPR).
AIM To summarize simulation-based studies aiming at improving bystander CPR associated with the quality of chest compression and time-related quality parameters.
METHODS The systematic review was conducted according to the PRISMA guidelines. All relevant studies were searched through PubMed, EMBASE, Medline and Cochrane Library databases. The risk of bias was evaluated using the Cochrane collaboration tool.
RESULTS A total of 259 studies were eligible for inclusion, and 6 randomised controlled trial studies were ultimately included. The results of meta-analysis indicated that video-assisted CPR (V-CPR) was significantly associated with the improved mean chest compression rate [OR = 0.66 (0.49-0.82), P < 0.001], and the proportion of chest compression with correct hand positioning [OR = 1.63 (0.71-2.55), P < 0.001]. However, the difference in mean chest compression depth was not statistically significant [OR = 0.18 (-0.07-0.42), P = 0.15], and V-CPR was not associated with the time to first chest compression compared to telecommunicator CPR [OR = -0.12 (-0.88-0.63), P = 0.75].
CONCLUSION Video real-time guidance by the dispatcher can improve the quality of bystander CPR to a certain extent. However, the quality is still not ideal, and there is a lack of guidance caused by poor video signal or inadequate interaction.
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Affiliation(s)
- Dong-Feng Pan
- Department of Emergency Medicine, The First Affiliated Hospital of Northwest Minzu University, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
- Department of Emergency Medicine, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Zheng-Jun Li
- Department of Emergency Medicine, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Xin-Zhong Ji
- Department of Emergency Medicine, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Li-Ting Yang
- Department of Emergency Medicine, The Third Clinical Medical College of Ningxia Medical University, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Pei-Feng Liang
- Department of Medicine Statistics, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
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Hassan EA, Elsaman SEA. The effect of simulation-based flipped classroom on acquisition of cardiopulmonary resuscitation skills: A simulation-based randomized trial. Nurs Crit Care 2022; 28:344-352. [PMID: 35801367 DOI: 10.1111/nicc.12816] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) is an essential skill required by critical care nurses. Evidence has shown that the use of a novel method called simulation-based flipped classroom (SBFC) can save training time in nursing laboratories and, to some extent, enhance social distancing during the current COVID-19 pandemic. AIM To evaluate the effects of SBFC on nursing students' acquisition of CPR skills. STUDY DESIGN A two-parallel prospective, single-centre, simulation-based, randomized, controlled trial. METHODS The total sample size was 326 students. A CPR video was recorded and uploaded on Microsoft Teams channel for the SBFC group only. Thereafter, both groups demonstrated and redemonstrated the CPR procedure. Both groups were then compared according to the simulation experience satisfaction scale and CPR skills acquisition checklist. RESULTS Two equally randomly selected groups of 163 undergraduate nursing students completed the study. The SBFC group had a significantly better satisfaction with the simulation experience than the traditional simulation (TS) group (p = 0.03). As regards the mean score of the CPR checklist after simulation, the SBFC group had a significantly higher score than TS group (p = 0.01). CONCLUSIONS SBFC using a pre-recorded video can be an effective method that can reduce the time needed for CPR clinical simulation and can be used for the CPR simulation among critical care nurses. RELEVANCE TO CLINICAL PRACTICE This study provides critical care nursing educators with a deep understanding regarding the benefits and value of utilizing the SBFC method in the clinical training of CPR skills. SBFC can be used to increase critical care nurses' satisfaction and skill acquisition during CPR training.
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Affiliation(s)
- Eman Arafa Hassan
- Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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Al-Kalaldeh M, Al-Olime S. Promoting Nurses' Self-Efficacy in Advanced Cardiac Life Support Through High-Fidelity Simulation. J Contin Educ Nurs 2022; 53:185-192. [PMID: 35357994 DOI: 10.3928/00220124-20220311-09] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Self-efficacy in resuscitation is influenced by various educational models, including high-fidelity simulation (HFS). Method Sixty-two nurses who were enrolled in an Advanced Cardiac Life Support (ACLS) course using HFS were recruited for this pretest-posttest, quasi-experimental study. Self-efficacy was assessed three times-twice via the participants' self-report and once via the instructor's assessment-using the Resuscitation Self-Efficacy Scale (RSES). Results The four dimensions of self-efficacy-recognition, debriefing and recording, responding and rescuing, and reporting-improved after the HFS education (t = 4.89, SE = 1.84, p < .001, confidence interval [-12.7, -5.33]). The instructor's scoring was higher than the participants' scoring in two of the four dimensions. The score on the ACLS written examination was positively correlated with the posttest RSES score (r = 0.303, p = .017). Despite minimal variations between demographic subgroups, nurses who had never been involved in resuscitation exhibited a significant improvement in self-efficacy after the HFS ACLS education (t = 4.72, SE = 2.54, p < .001, confidence interval [-17.3, -6.7]). Conclusion Self-efficacy can be a core measurable outcome that gauges nurses' clinical competency concerning HFS education for ACLS. [J Contin Educ Nurs. 2022;53(4):185-192.].
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Lee DK, Im CW, Jo YH, Chang T, Song JL, Luu C, Mackinnon R, Pillai S, Lee CN, Jheon S, Ahn S, Won SH. Comparison of extended reality and conventional methods of basic life support training: protocol for a multinational, pragmatic, noninferiority, randomised clinical trial (XR BLS trial). Trials 2021; 22:946. [PMID: 34930418 PMCID: PMC8687636 DOI: 10.1186/s13063-021-05908-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/03/2021] [Indexed: 11/11/2022] Open
Abstract
Background Conventional cardiopulmonary resuscitation (CPR) training for the general public involves the use of a manikin and a training video, which has limitations related to a lack of realism and immersion. To overcome these limitations, virtual reality and extended reality technologies are being used in the field of medical education. The aim of this study is to explore the efficacy and safety of extended reality (XR)-based basic life support (BLS) training. Methods This study is a prospective, multinational, multicentre, randomised controlled study. Four institutions in 4 countries will participate in the study. A total of 154 participants will be randomly assigned to either the XR group or the conventional group stratified by institution and sex (1:1 ratio). Each participant who is allocated to either group will be sent to a separate room to receive training with an XR BLS module or conventional CPR training video. All participants will perform a test on a CPR manikin after the training. The primary outcome will be mean compression depth. The secondary outcome will be overall BLS performance, including compression rate, correct hand position, compression, and full release and hands-off time. Discussion Using virtual reality (VR) to establish a virtual educational environment can give trainees a sense of realism. In the XR environment, which combines the virtual world with the real world, trainees can more effectively learn various skills. This trial will provide evidence of the usefulness of XR in CPR education. Trial registration ClinicalTrials.gov NCT04736888. Registered on 29 January 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05908-z.
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Affiliation(s)
- Dong Keon Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 13620, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Republic of Korea.,Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Woo Im
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 13620, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 13620, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Republic of Korea. .,Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Todd Chang
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Joo Lee Song
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Cindy Luu
- Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Ralph Mackinnon
- Department of Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK
| | - Suresh Pillai
- Centre for Healthcare Simulation, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chuen Neng Lee
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Centre, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Hyun Won
- Division of Statistics, Medical Research Collaborating Centre, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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