- Email: [email protected]
Cardiopulmonary resuscitation — a teaching guide
02606917/90/0010-0050/$10.00
NunrEducatronTodq(1990) 10,50-53 @ Longman GroupUK Ltd 1990
ne#t
WORK Cardiopulmonary guide
resuscitation - a teaching
Anne Ferguson
As a teacher working in an acute area - Accident and Emergency, I have been concerned for some time about the teaching input on the curriculum for cardiopulmonary resuscitation. In my experience, the students are given a short lecture on the procedure for calling an arrest team in the introductory unit and this is followed by a more in-depth lecture in their final year prior to commencing their clinical allocation on an acute unit such as accident and emergency or intensive care. I have found this to be inadequate as students are, in their own opinion, highly stressed by the thought of dealing with an arrest situation and the skills they demonstrate in their third year are, in my opinion, also inadequate. In my own hospital, we are fortunate to be one of the few centres which train the general public in how to deal with arrest situations in the home or work environment. I, am a trainer on this programme and have successfully argued for a similar programme to be incorporated into the introductory unit of the students’ course. What has become clear is that other teachers are equally unnerved by the thought of a cardiac arrest and willingly admit to being inefficient at the actual resuscitation procedure. As a result, I have written teaching guidelines which should help those less experienced at cardiopulmonary resuscitation and will provide them with the necessary information which can be passed on to students.
There they
are times in every nurses’ career have to assist in the reshscitation
collapsed
individual.
when of a
The whole event is a har-
rowing, chaotic experience
in which they have to
recall rarely practised skills while trying to remain calm. The scene at most cardiac arrests runs high with emotions, adrenaline surges through
the
veins,
leaving
every
person
involved,
50
both
physically
and
relatively routine,
but for those on the general
wards, it is a frightening infrequent event. It is also one of the few situations for which the nurse cannot
practise
on a ‘real’ patient
but which
requires near perfection of the skills. There has been limited research country,
Anne Ferguson RNCT RNT School of Nursing, St. Bartholomew’s Hospital, West Smithfield, London EC1 (Requests for offprints to AF) Manuscript accepted 30 May 1989
drained
emotionally. For some nurses, such as those in specialised units, cardiac arrests may become
but the
indications
are
that
in
this
health
workers are inefficient at the cardiac arrest procedure. Most of the groups studied have been doctors and medical students, but as their preparation for cardiopulmonary resuscitation is not dissimilar to that of the nurse, one can
NURSE EDUCATION
assume that if nurses were similarly tested the results could be the same, Skinner (1986). Wynn’s recent study at a London teaching hospital seems to bear out this theory, as of the 53 nurses tested, not one performed Basic Life Support effectively. In another unpublished large scale training programme at another London teaching hospital, of the 130 qualified nurses tested, not one was found to be effective at Adult Basic Life Support (Mackereth 1988). Unless more hospitals carry out the necessary research into health worker skills in cardiac arrest situations, further information will remain scarce. The plans for the future of nursing recommends that, The practitioner of the future should be both a ‘doer’ and a ‘knowledgeable doer’. S/he should be able to marshal1 the relevant information to make an assessment of need, to devise a plan of care consequent upon that assessment, to implement, monitor and evaluate it. (Project 2000 1986 P40) Emergency situations demand the same ability to demonstrate those management skills as required by other more routine nursing procedures. The only difference is that they must be implemented at speed. The present research finding would seem to indicate that education has a responsibility to improve cardiopulmonary resuscitation training if Project 2000’s proposals are to become fact. Project 2000 has also made specific recommendations that there should be specialist practitioners, able to undertake a specified teaching role within their speciality (Project 2000 1986 P44). Resuscitation officer posts are a relatively new innovation, and most of those appointed are nurses. Their role does appear to follow the recommendations of Project 2000 with regard to a specialist nurse:
1) They have specialist knowledge
of resuscitation. 2) They are expected to undertake a specified teaching role. working in the practical 3) They continue setting by attending and, if necessary, participating at cardiac arrests.
TODAY
51
4) By coordinating the resuscitation teaching programme throughout the district they are engaging in managerial functions. 5) Most resuscitation officers are also expected to have up to date knowledge of relevant research findings and to carry out research into various aspects of resuscitation within their district. Within nurse education it would be expected that the nurse teachers would assist the Resuscitation Officer as one person alone would not be able to manage all the teaching sessions. As it is, the majority of Health Authorities are without an officer in post and provision must be made by Schools of Nursing to educate nurses, qualified and unqualifed in the skills of resuscitation. Within schools, individuals working in acute areas with specific knowledge about resuscitation, should advise their colleagues. As a teacher in an acute area, with a keen interest in resuscitation, the author has written what she considers to be an appropriate teaching guide/information source for registered general nurse courses. It is designed for use by those teachers less experienced at cardiopulmonary resuscitation skills. The teaching guide is divided into: Part 1 The introduction which explains why cardiopulmonary resuscitation needs to be taught and briefly, the level of achievement required. It also describes how the guide is divided into skills, knowledge and attitudes. Part 2 A brief outline of the contents, divided into adult and paediatric life support, both basic and advanced. Part 3 The phases during the Registered General Nurse programme when cardiopulmonary resuscitation should be taught or reviewed. Part 4 The broad objectives for the skills, knowledge and attitude components for the Registered General Nurse programme. Part 5 The aims and objectives for the introductory phase and recommended learning methods for each of the three components.
52
NURSE EDUCATION
It is envisaged
TODAY
that the complete
package
would
contain detailed objectives and learning methods for each of the phases identified in Part 3. This
guide has been written
own
school’s
curriculum
with the author’s
in mind,
but
schools would have units of learning
other
probably
at
similar phases and should have no difficulty in adjusting the guide to suit their own particular curriculum. The three components of the guide, knowledge, skills and attitudes relate to the three domains devised by the American Psychological Society, the cognitive,
Bloom (1956),
the psycho-
motor, Dave (1967) and the affective domain, Krathwohl (1956). It is recognised that some skills span both the psychomotor,
cognitive
and
affective domains but for ease of understanding, the skills component skills
of
refers
cardiopulmonary
knowledge
component
only to the motor resuscitation.
covers
not
only
The the
anatomy and physiology specific to resuscitations but also related subjects such as health education, nursing practice and statistical information. This component is inextricably linked to the attitude component as by having the relevant information, the student can develop an informed viewpoint. The objectives for the attitude
component
are very broad and
the emphasis is placed more on preparing the student for the emotive experience of resuscitation.
Later
in the student’s
two components
will enable
career, them
these last not only to
come to terms with their own feelings regarding this subject but also to speak as an equal partner in the multidisciplinary
decision making process.
tions in the student’s
course,
is more in keeping
with the American Heart Association’s and guidelines UAMA 1986 P2911). Basic Life Support at least
effectively
6 sessions,
require
but
standards To teach
will probably
reviews
one full session covering
take
should
only
all components
of the session.
The knowledge component This is designed
to give a theoretical
to the other components.
framework
By developing
a know-
ledge base, the student will have a sound, rational understanding of the skills involved in resuscitation,
beginning
progressing Resuscitation
on to Advanced Life Support. requires clear decision making
skills in an intensely learning enhance abilities.
with Basic Life Support
stressful
situation.
Active
methods have been suggested which the development of critical thinking
The attitude component In a hypothetical dilemma presented to nurses during a workshop on the ethics of critical care nursing,
the
confusion pants whether
responses
clearly
and divided
opinions
(Lawrence
1982).
The
illustrated
the
of the particiquestion
or not to act in accordance
of
with the
patient’s wishes presents a problem as legal judgement of the case may go against the nurse.
These three components are seen as essential in order to develop the ‘knowledgable doer’, able to
The author feels it is imperative that the questions surrounding the nurse’s role as an
cope with the cardiac arrest event, be it success-
independent
ful or not.
The teaching package is designed to explore issues relating to resuscitation and while not providing the answers will give the student or
The skills component The Royal College
of Physicians
qualified guidelines
quite specific as to the actual psychomotor
are skills
that should be taught, as recommended by the Resuscitation Council (United Kingdom). However the recommended 2 hour teaching session is, in the author’s opinion, inadequate. The package, while appreciating the time limita-
decision
nurse
maker be addressed.
the opportunity
to reflect
on
their viewpoints, and develop the skills necessary to make their feelings known. It is recognised that didactic teaching methods have limitations in developing the affecting domain (Macleod Clark, Tomlinson, Faulkner 1984), and subsequently, experiential learning been chosen for this package.
methods
have
NURSE EDUCATION
CONCLUSION It is recognised
that a guide
such as that written
by the author may well reflect an individual opinion, and should preferably be designed 1
collectively by all those involved in teaching However, cardiopulmonary resuscitation. bearing all this in mind, no guidelines have so far been wfitten on the subjeccwhich
take in all the
aspects of what cardiopulmonary
resuscitation
means to the individual
nurse. The author
sees
this as a ‘pilot’ package for discussion and possible modification which reflects individual schools’ philosophies. Resuscitation taught correctly
is a vital skill which should be and reviewed
regularly.
While
the nurse has a duty to the patient to provide that skill, surely the school has a duty to teach that skill? [Note:
The
complete
package
is open
to dis-
cussion with the author.]
References American Heart Association 1986 Standards and guidelines for cardiopulmonary resuscitation and
TODAY
53
emergency care. journal of the American Association 255: 284 l-3044 Bloom B S 1956 Taxonomv of education ohiectives: The classification of ed&ational goals: Handbook 1 Cognitive Domain. David McKay Co, New York Dave R H 1967 Taxonomy of educational objectives and achievement testing: DeveioDments in educational L
testing proceedings of the International Conference
of Educational Measurement. University of London
Press, London Krathwohl D R 1956 Taxonomy of educational objectives: The classification of educational goals Handbook: Affective Domain David. McKay Co. New York Mackereth P 1988 Results of in-hospital teaching programme. Unpublished Macleod Clark J 1984 Learning to relate. Nursing Times Sept 19th: 48-5 1 Lawrence J A 1982 The nurse should consider: Critical Care Ethical Issues. Journal of Advanced Nursing 7, 3: 223-229 Resuscitation Advisory Council 1988 Resuscitation Guide. Dept of Anaesthetics Hammersmith Hospital, London Royal College of Physicians 1987 Resuscitation from cardiopulmonary arrest-training and oreanisation. Repor; of the RAyal College of Fhysicia&, London Skinner D V 1985 Cardiopulmonary resuscitation skills of pre-retistration house officers. British Medical JoGma 2%0,6481: 1549-1550 UKCC 1986 Project 2000 - A new preparation for practice. UKCC, London Wynn G 1987 Inability of trained nurses to perform basic life support. British Medical Journal 294. 6581: 1198.
NunrEducatronTodq(1990) 10,50-53 @ Longman GroupUK Ltd 1990
ne#t
WORK Cardiopulmonary guide
resuscitation - a teaching
Anne Ferguson
As a teacher working in an acute area - Accident and Emergency, I have been concerned for some time about the teaching input on the curriculum for cardiopulmonary resuscitation. In my experience, the students are given a short lecture on the procedure for calling an arrest team in the introductory unit and this is followed by a more in-depth lecture in their final year prior to commencing their clinical allocation on an acute unit such as accident and emergency or intensive care. I have found this to be inadequate as students are, in their own opinion, highly stressed by the thought of dealing with an arrest situation and the skills they demonstrate in their third year are, in my opinion, also inadequate. In my own hospital, we are fortunate to be one of the few centres which train the general public in how to deal with arrest situations in the home or work environment. I, am a trainer on this programme and have successfully argued for a similar programme to be incorporated into the introductory unit of the students’ course. What has become clear is that other teachers are equally unnerved by the thought of a cardiac arrest and willingly admit to being inefficient at the actual resuscitation procedure. As a result, I have written teaching guidelines which should help those less experienced at cardiopulmonary resuscitation and will provide them with the necessary information which can be passed on to students.
There they
are times in every nurses’ career have to assist in the reshscitation
collapsed
individual.
when of a
The whole event is a har-
rowing, chaotic experience
in which they have to
recall rarely practised skills while trying to remain calm. The scene at most cardiac arrests runs high with emotions, adrenaline surges through
the
veins,
leaving
every
person
involved,
50
both
physically
and
relatively routine,
but for those on the general
wards, it is a frightening infrequent event. It is also one of the few situations for which the nurse cannot
practise
on a ‘real’ patient
but which
requires near perfection of the skills. There has been limited research country,
Anne Ferguson RNCT RNT School of Nursing, St. Bartholomew’s Hospital, West Smithfield, London EC1 (Requests for offprints to AF) Manuscript accepted 30 May 1989
drained
emotionally. For some nurses, such as those in specialised units, cardiac arrests may become
but the
indications
are
that
in
this
health
workers are inefficient at the cardiac arrest procedure. Most of the groups studied have been doctors and medical students, but as their preparation for cardiopulmonary resuscitation is not dissimilar to that of the nurse, one can
NURSE EDUCATION
assume that if nurses were similarly tested the results could be the same, Skinner (1986). Wynn’s recent study at a London teaching hospital seems to bear out this theory, as of the 53 nurses tested, not one performed Basic Life Support effectively. In another unpublished large scale training programme at another London teaching hospital, of the 130 qualified nurses tested, not one was found to be effective at Adult Basic Life Support (Mackereth 1988). Unless more hospitals carry out the necessary research into health worker skills in cardiac arrest situations, further information will remain scarce. The plans for the future of nursing recommends that, The practitioner of the future should be both a ‘doer’ and a ‘knowledgeable doer’. S/he should be able to marshal1 the relevant information to make an assessment of need, to devise a plan of care consequent upon that assessment, to implement, monitor and evaluate it. (Project 2000 1986 P40) Emergency situations demand the same ability to demonstrate those management skills as required by other more routine nursing procedures. The only difference is that they must be implemented at speed. The present research finding would seem to indicate that education has a responsibility to improve cardiopulmonary resuscitation training if Project 2000’s proposals are to become fact. Project 2000 has also made specific recommendations that there should be specialist practitioners, able to undertake a specified teaching role within their speciality (Project 2000 1986 P44). Resuscitation officer posts are a relatively new innovation, and most of those appointed are nurses. Their role does appear to follow the recommendations of Project 2000 with regard to a specialist nurse:
1) They have specialist knowledge
of resuscitation. 2) They are expected to undertake a specified teaching role. working in the practical 3) They continue setting by attending and, if necessary, participating at cardiac arrests.
TODAY
51
4) By coordinating the resuscitation teaching programme throughout the district they are engaging in managerial functions. 5) Most resuscitation officers are also expected to have up to date knowledge of relevant research findings and to carry out research into various aspects of resuscitation within their district. Within nurse education it would be expected that the nurse teachers would assist the Resuscitation Officer as one person alone would not be able to manage all the teaching sessions. As it is, the majority of Health Authorities are without an officer in post and provision must be made by Schools of Nursing to educate nurses, qualified and unqualifed in the skills of resuscitation. Within schools, individuals working in acute areas with specific knowledge about resuscitation, should advise their colleagues. As a teacher in an acute area, with a keen interest in resuscitation, the author has written what she considers to be an appropriate teaching guide/information source for registered general nurse courses. It is designed for use by those teachers less experienced at cardiopulmonary resuscitation skills. The teaching guide is divided into: Part 1 The introduction which explains why cardiopulmonary resuscitation needs to be taught and briefly, the level of achievement required. It also describes how the guide is divided into skills, knowledge and attitudes. Part 2 A brief outline of the contents, divided into adult and paediatric life support, both basic and advanced. Part 3 The phases during the Registered General Nurse programme when cardiopulmonary resuscitation should be taught or reviewed. Part 4 The broad objectives for the skills, knowledge and attitude components for the Registered General Nurse programme. Part 5 The aims and objectives for the introductory phase and recommended learning methods for each of the three components.
52
NURSE EDUCATION
It is envisaged
TODAY
that the complete
package
would
contain detailed objectives and learning methods for each of the phases identified in Part 3. This
guide has been written
own
school’s
curriculum
with the author’s
in mind,
but
schools would have units of learning
other
probably
at
similar phases and should have no difficulty in adjusting the guide to suit their own particular curriculum. The three components of the guide, knowledge, skills and attitudes relate to the three domains devised by the American Psychological Society, the cognitive,
Bloom (1956),
the psycho-
motor, Dave (1967) and the affective domain, Krathwohl (1956). It is recognised that some skills span both the psychomotor,
cognitive
and
affective domains but for ease of understanding, the skills component skills
of
refers
cardiopulmonary
knowledge
component
only to the motor resuscitation.
covers
not
only
The the
anatomy and physiology specific to resuscitations but also related subjects such as health education, nursing practice and statistical information. This component is inextricably linked to the attitude component as by having the relevant information, the student can develop an informed viewpoint. The objectives for the attitude
component
are very broad and
the emphasis is placed more on preparing the student for the emotive experience of resuscitation.
Later
in the student’s
two components
will enable
career, them
these last not only to
come to terms with their own feelings regarding this subject but also to speak as an equal partner in the multidisciplinary
decision making process.
tions in the student’s
course,
is more in keeping
with the American Heart Association’s and guidelines UAMA 1986 P2911). Basic Life Support at least
effectively
6 sessions,
require
but
standards To teach
will probably
reviews
one full session covering
take
should
only
all components
of the session.
The knowledge component This is designed
to give a theoretical
to the other components.
framework
By developing
a know-
ledge base, the student will have a sound, rational understanding of the skills involved in resuscitation,
beginning
progressing Resuscitation
on to Advanced Life Support. requires clear decision making
skills in an intensely learning enhance abilities.
with Basic Life Support
stressful
situation.
Active
methods have been suggested which the development of critical thinking
The attitude component In a hypothetical dilemma presented to nurses during a workshop on the ethics of critical care nursing,
the
confusion pants whether
responses
clearly
and divided
opinions
(Lawrence
1982).
The
illustrated
the
of the particiquestion
or not to act in accordance
of
with the
patient’s wishes presents a problem as legal judgement of the case may go against the nurse.
These three components are seen as essential in order to develop the ‘knowledgable doer’, able to
The author feels it is imperative that the questions surrounding the nurse’s role as an
cope with the cardiac arrest event, be it success-
independent
ful or not.
The teaching package is designed to explore issues relating to resuscitation and while not providing the answers will give the student or
The skills component The Royal College
of Physicians
qualified guidelines
quite specific as to the actual psychomotor
are skills
that should be taught, as recommended by the Resuscitation Council (United Kingdom). However the recommended 2 hour teaching session is, in the author’s opinion, inadequate. The package, while appreciating the time limita-
decision
nurse
maker be addressed.
the opportunity
to reflect
on
their viewpoints, and develop the skills necessary to make their feelings known. It is recognised that didactic teaching methods have limitations in developing the affecting domain (Macleod Clark, Tomlinson, Faulkner 1984), and subsequently, experiential learning been chosen for this package.
methods
have
NURSE EDUCATION
CONCLUSION It is recognised
that a guide
such as that written
by the author may well reflect an individual opinion, and should preferably be designed 1
collectively by all those involved in teaching However, cardiopulmonary resuscitation. bearing all this in mind, no guidelines have so far been wfitten on the subjeccwhich
take in all the
aspects of what cardiopulmonary
resuscitation
means to the individual
nurse. The author
sees
this as a ‘pilot’ package for discussion and possible modification which reflects individual schools’ philosophies. Resuscitation taught correctly
is a vital skill which should be and reviewed
regularly.
While
the nurse has a duty to the patient to provide that skill, surely the school has a duty to teach that skill? [Note:
The
complete
package
is open
to dis-
cussion with the author.]
References American Heart Association 1986 Standards and guidelines for cardiopulmonary resuscitation and
TODAY
53
emergency care. journal of the American Association 255: 284 l-3044 Bloom B S 1956 Taxonomv of education ohiectives: The classification of ed&ational goals: Handbook 1 Cognitive Domain. David McKay Co, New York Dave R H 1967 Taxonomy of educational objectives and achievement testing: DeveioDments in educational L
testing proceedings of the International Conference
of Educational Measurement. University of London
Press, London Krathwohl D R 1956 Taxonomy of educational objectives: The classification of educational goals Handbook: Affective Domain David. McKay Co. New York Mackereth P 1988 Results of in-hospital teaching programme. Unpublished Macleod Clark J 1984 Learning to relate. Nursing Times Sept 19th: 48-5 1 Lawrence J A 1982 The nurse should consider: Critical Care Ethical Issues. Journal of Advanced Nursing 7, 3: 223-229 Resuscitation Advisory Council 1988 Resuscitation Guide. Dept of Anaesthetics Hammersmith Hospital, London Royal College of Physicians 1987 Resuscitation from cardiopulmonary arrest-training and oreanisation. Repor; of the RAyal College of Fhysicia&, London Skinner D V 1985 Cardiopulmonary resuscitation skills of pre-retistration house officers. British Medical JoGma 2%0,6481: 1549-1550 UKCC 1986 Project 2000 - A new preparation for practice. UKCC, London Wynn G 1987 Inability of trained nurses to perform basic life support. British Medical Journal 294. 6581: 1198.