Construção e validação de vídeo educativo para estudantes de enfermagem sobre a parada cardiorrespiratória obstétrica / Construcción y validación de un video educativo para estudiantes de enfermería sobre parada cardiorrespiratoria obstétrica / Construction and validation of an educational video for nursing students about obstetric cardiopulmonary arrest

RESUMO Objetivo construir, validar e avaliar vídeo educativo para estudantes de enfermagem sobre a parada cardiorrespiratória obstétrica. Método estudo metodológico, composto pela construção do vídeo, validação de conteúdo por 22 especialistas em parada cardiorrespiratória obstétrica e avaliação por 21 estudantes de graduação em enfermagem. Utilizou-se o Instrumento de Validação de Conteúdo Educacional em Saúde, para validação com os especialistas, e o questionário adaptado do Suitability Assessment of Materials, para avaliação dos estudantes. Na validação com juízes e com o público-alvo, foi considerado válido o item com concordância mínima de 80%, obtida a partir do Índice de Validação de Conteúdo e do Teste Binomial. Resultados o vídeo, com duração de 8 minutos e 53 segundos, contemplou as etapas da assistência de enfermagem na realização do suporte básico de vida à gestante acometida por parada cardiorrespiratória. Na validação de conteúdo, dos 18 itens avaliados, 16 tiveram concordância de 100%, um obteve 95% e o item restante obteve 81%. Na avaliação dos estudantes, dos 13 itens avaliados, 12 possuíram concordância de 100% e o item restante possuiu 95%. Conclusão e implicações para a prática o vídeo foi considerado válido pelos especialistas em parada cardiorrespiratória obstétrica e compreensível pelos estudantes de enfermagem, assim, trata-se de recurso educativo viável para contribuir com a formação da enfermagem.

RESUMEN Objetivo construir, validar y evaluar videos educativos para estudiantes de enfermería sobre parada cardiopulmonar obstétrica. Método estudio metodológico, consistente en la construcción del video, validación de contenido por 22 expertos en parada cardiorrespiratoria obstétrica y evaluación por 21 estudiantes de enfermería. Se utilizó el Instrumento de Validación de Contenidos Educativos en Salud, para la validación con los expertos, y el cuestionario adaptado del Suitability Assessment of Materials, para la evaluación de los estudiantes. En la validación con jueces y público objetivo, se consideró válido el ítem con una concordancia mínima del 80%, obtenido del Índice de Validación de Contenido y la Prueba Binomial. Resultados el video, de 8 minutos y 53 segundos, contempló los pasos del cuidado de enfermería en la realización de soporte vital básico a gestantes afectadas por paro cardíaco. En la validación de contenido, de los 18 ítems evaluados, 16 tuvieron un 100% de concordancia, uno tuvo un 95% y el restante un 81%. En la evaluación de los estudiantes, de los 13 ítems evaluados, 12 tuvieron un 100% de concordancia, y el ítem restante tuvo un 95%. Conclusión e implicaciones para la práctica el video fue considerado válido por especialistas en parada cardiopulmonar obstétrica y comprensible por estudiantes de enfermería, por lo que es un recurso educativo viable para contribuir a la formación en enfermería.

ABSTRACT Objective to construct, validate and assess educational video for nursing students about obstetric cardiopulmonary arrest. Method this is a methodological study consisting of video construction, content validation by 22 experts in obstetric cardiopulmonary arrest and assessment by 21 undergraduate nursing students. The Health Educational Content Validation Instrument was used for validation with experts, and a questionnaire adapted from the Suitability Assessment of Materials, for student assessment. In the validation with judges and the target audience, the item with a minimum agreement of 80% was considered valid, obtained from the Content Validation Index and the binomial test, was considered valid. Results video, lasting 8 minutes and 53 seconds, contemplated nursing care stages in carrying out basic life support to pregnant women affected by cardiac arrest. In content validation, of the 18 items assessed, 16 had 100% agreement, one had 95% and the remaining item had 81%. In students' assessment, of the 13 items assessed, 12 had 100% agreement, and the remaining item had 95%. Conclusion and implications for practice the video was considered valid by experts in obstetric cardiopulmonary arrest and understandable by nursing students, thus it is a viable educational resource to contribute to nursing education.

The impact of a nurse-led elective direct current cardioversion in atrial fibrillation on patient outcomes: A systematic review.

AIMS AND OBJECTIVES: To examine and present the success rate in relation to nurse-led elective DCCV service in AF patients. BACKGROUND: As the incidence of AF increases healthcare settings will continue to face challenges in providing appropriate timely intervention. The provision of DCCV has primarily been medical-led. Due to the increasing requirement of hospital beds, cost restriction and medical team stress the roles of nurse specialists have been driven to include elective DCCV. DESIGN: A systematic review with a narrative synthesis was undertaken. METHODS: The databases searched include the following: The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Clinical Key, Web of Science, Cochrane Library and HSE library website. A total of 187 articles were identified, and seven studies were included for synthesis. The EBL checklist was used to assess validity. The PRISMA checklist was used for transparency. RESULTS: The results of this review show an acceptable complication rate, no negative patient outcomes and a high rhythm conversion success rate. A disparity was identified due to the lack of distinction between registered nurse (RGN), advanced nurse practitioner (ANP), advanced practice provider (APP) and nurse practitioner (NP) roles. These results support the belief that a highly skilled nurse in this specific background working in a supportive organisational framework can make a valuable contribution to such practices. CONCLUSION: A structured nurse-led elective DCCV service appears safe, effective and has a high success rate in restoration to sinus rhythm in AF. However, the need for further research in order to advance knowledge and support changes in nurse-led DCCV practice is evident. RELEVANCE TO CLINICAL PRACTICE: This review demonstrates that a nurse-led elective DCCV service appears safe and successful in restoring sinus rhythm. It has promising potential effects in terms of waiting time, cost saving and achieving patient satisfaction.

Intermediate life support for the adult.

Stuart Barker, Graduate Tutor in Adult Nursing, Northumbria University (stuart.j.barker@northumbria.ac.uk), discusses more advanced skills to complement basic life support, including early recognition of deterioration, different types of airway support for an unconscious patient and automated defibrillation.

Effectiveness of remote monitoring of CIEDs in detection and treatment of clinical and device-related cardiovascular events in daily practice: the HomeGuide Registry.

AIMS: The HomeGuide Registry was a prospective study (NCT01459874), implementing a model for remote monitoring of cardiac implantable electronic devices (CIEDs) in daily clinical practice, to estimate effectiveness in major cardiovascular event detection and management. METHODS AND RESULTS: The workflow for remote monitoring [Biotronik Home Monitoring (HM)] was based on primary nursing: each patient was assigned to an expert nurse for management and to a responsible physician for medical decisions. In-person visits were scheduled once a year. Seventy-five Italian sites enrolled 1650 patients [27% pacemakers, 27% single-chamber implantable cardioverter defibrillators (ICDs), 22% dual-chamber ICDs, 24% ICDs with cardiac resynchronization therapy]. Population resembled the expected characteristics of CIED patients. During a 20 ± 13 month follow-up, 2471 independently adjudicated events were collected in 838 patients (51%): 2033 (82%) were detected during HM sessions; 438 (18%) during in-person visits. Sixty were classified as false-positive, with generalized estimating equation-adjusted sensitivity and positive predictive value of 84.3% [confidence interval (CI), 82.5-86.0%] and 97.4% (CI, 96.5-98.2%), respectively. Overall, 95% of asymptomatic and 73% of actionable events were detected during HM sessions. Median reaction time was 3 days [interquartile range (IQR), 1-14 days]. Generalized estimating equation-adjusted incremental utility, calculated according to four properties of major clinical interest, was in favour of the HM sessions: +0.56 (CI, 0.53-0.58%), P < 0.0001. Resource consumption: 3364 HM sessions performed (76% by nurses), median committed monthly manpower of 55.5 (IQR, 22.0-107.0) min × health personnel/100 patients. CONCLUSION: Home Monitoring was highly effective in detecting and managing clinical events in CIED patients in daily practice with remarkably low manpower and resource consumption.

Terapias elétricas em crianças e neonatos: novidades nas Diretrizes da American Heart Association 2010 / Electrical therapies in children and infants: news in the American Heart Association 2010 Guidelines / Terapias eléctricas en niños y neonatos: novedades en las Directrices de la American Heart Association 2010

Artigo de atualização cujo objetivo é apresentar as principais modificações sobre o uso da desfibrilação em pediatria apontadas pelas Diretrizes da American Heart Association 2010 para reanimação cardiorrespiratória e discutir a importância do treinamento e aperfeiçoamento da equipe de enfermagem frente a essas mudanças.

Update article aiming at presenting the main changes in the use of defibrillation in children for cardiopulmonary resuscitation, cited in the American Heart Association 2010 Guidelines; and discussing the relevance of training and improvement of  nursing staff  in the face of  those changes.

Artículo de actualización cuyo propósito es presentar los principales cambios en el uso de la desfibrilación en pediatría citados por las Directrices de la American Heart Association 2010 para la reanimación cardiopulmonar y discutir la importancia de la formación y desarrollo del equipo de enfermería frente a esos cambios.

Nurse-initiated defibrillation: are nurses confident enough?

OBJECTIVES: To determine the capability of nurses to identify ventricular fibrillation (VF) and ventricular tachycardia (VT) rhythms on an ECG and carry out subsequent defibrillation on their own as soon as they identify and confirm cardiac arrest. METHODS: This was a prospective cohort study to determine the capability of emergency department (ED) nurses to recognise VF or pulseless VT correctly and their willingness to perform defibrillation immediately in an ED of a teaching hospital in Hong Kong. A questionnaire was completed before and after a teaching session focusing on the identification of rhythms in cardiac arrest and defibrillation skills. Correct answers for both ECG interpretation and defibrillation decisions scored one point for each question. The differences in mean scores between the pre-teaching and post-teaching questionnaires of all nurses were calculated. RESULTS: 51 pre-teaching and 43 post-teaching questionnaires were collected. There were no statistically significant changes in ECG scores after teaching. For defibrillation scores, there was an overall improvement in the defibrillation decision (absolute mean difference 0.42, p=0.014). Performance was also improved by the teaching (absolute mean difference 0.465, p=0.046), reflected by the combination of both scores. Two-thirds (67%) of nurses became more confident in managing patients with shockable rhythms. CONCLUSION: Nurses improve in defibrillation decision-making skills and confidence after appropriate brief, focused in-house training.

ICU nurses' perceptions of potential constraints and anticipated support to practice defibrillation: a qualitative study.

AIM: The study examines the experience of intensive care nurses in caring for patients in cardiac arrest, and their perceptions of introducing nurse-led defibrillation. METHOD: This was a descriptive, exploratory and qualitative study at an intensive care unit (ICU) of an acute regional hospital in Hong Kong. Twelve registered nurses were purposefully selected for interview. RESULTS: Although all the participants were trained in basic life support, only 50% were trained in advanced cardiac life support (ACLS), and those trained in ACLS described having limited opportunities to apply their defibrillation knowledge. Whilst participants believed that they were theoretically prepared to influence the patient's resuscitation outcomes, newly qualified nurses were reluctant to be accountable for defibrillation. In contrast, experienced nurses were more willing to perform nurse-led defibrillation. Support from management, cooperation between nurses and doctors, regular in-hospital 'real-drill' programmes, sponsorship for training, and the use of alternative defibrillation equipment should be considered to encourage nurse-led defibrillation in ICU settings. CONCLUSION: Nurse-led defibrillation is an approach of delivering prompt care to critically ill patients, and a way ahead for intensive care nursing in Hong Kong. Emphasis on a consistent policy to promote nurse-led defibrillation practice is needed.

Nurses' role in the early defibrillation of cardiac patients: implications for nursing in Hong Kong.

The time taken to initiate early defibrillation is crucial to improve survival, prevent neurological deficit and improve the quality of life of patients suffering from sudden cardiac arrest. Despite the extension of training and the authorization of nurses to perform early defibrillation (advocated by the American Heart Association), such practice has not been widely adopted in hospitals. Inadequate knowledge, lack of skill retention, insufficient organizational support and the passive culture of nurses are barriers preventing the move towards nurse-led defibrillation. This paper discusses the need to extend the registered nurses' role in the early defibrillation of cardiac patients in Hong Kong. Current nursing practice in emergency resuscitation care and the hurdles constraining early defibrillation will be discussed. Recommendations to facilitate the future development of nurse-led defibrillation will also be provided. The successful extension of the registered nurses' role in early defibrillation will enable them to possess broader knowledge to be clinically competent in providing efficient patient care.

Assessment of CPR-D skills of nursing students in two institutions: reality versus recommendations in the guidelines.

Significant differences in basic life support skills including cardiopulmonary resuscitation and defibrillation (CPR-D) were detected when nurses working in one Finnish and one Swedish hospital were tested using an Objective Structured Clinical Examination (OSCE). The purpose of this study was to use OSCE test in assessing guideline based CPR-D skills of newly qualified nurses. The CPR-D skills of newly qualified registered nurses studying in Halmstad University (n = 30), Sweden, Helsinki Metropolia University of Applied Sciences (n = 30), and Finland were assessed using an OSCE which was built up with a case of cardiac arrest with ventricular fibrillation as the initial rhythm. The Angoff average, 32.47, was calculated as cutoff point to pass the test. Forty-seven percent of the students in the Swedish group (mean score 32.47/49, range 26-39, SD 3.76) and 13% of the students in the Finnish group (mean score 23.80/49, range 13-35, SD 4.32) passed the OSCE (P<0.0001), the cutoff point being 32.47. Performance grade for the Swedish group was 2.9/5.0 and for the Finnish group 2.1/5.0 (P<0.0001). Good nontechnical skills correlated with high grading of the clinical skills. In conclusion, CPR-D skills of the newly qualified nurses in both the institutes were clearly under par and were not adequate according to the resuscitation guidelines. Current style of teaching is unlikely to result in students being able to perform adequate CPR-D. Standardized testing would help in controlling the quality of learning.

Terapéutica en Atención Primaria: Opciones terapéuticas en el tratamiento de la fibrilación auricular / Therapeutics in Primary Care: Therapeutics options in the treatment of atrial fibrillation

La fibrilación auricular es una alteración del ritmo muy frecuente. El riesgo de tromboembolismo en pacientes con fibrilación auricular es elevado, constituyendo un factor de riesgo independiente para el desarrollo de accidentes cerebrovasculares. La cardioversión eléctrica o farmacológica es muy importante. Actualmente, la cirugía de la fibrilación auricular mediante radiofrecuencia es una nueva medida terapéutica a considerar (AU)

Atrial fibrillation is a very frequent rhythm disorder. The risk of thromboembolism in patients with atrial fibrillation is high, constituting an independent risk factor for the development of stroke. Electrical or drugs cardioversion for atrial fibrillation is a very important treatment. Surgery for atrial fibrillation using radiofrequency catheter ablation is currently a new treatment measure of the atrial fibrillation (AU)

A practical guide to external direct current cardioversion.

Cardioversion is a procedure used to convert a tachyarrhythmia to normal sinus rhythm by applying a synchronised electric shock. This can be carried out on an elective or urgent basis. The purpose of this article is to provide the reader with a greater understanding of external direct current (DC) cardioversion by exploring some of the theoretical and practical issues associated with the procedure.

Biphasic external defibrillation for adults in ventricular fibrillation or pulseless ventricular tachycardia.

Cardiac arrest, as a result of ventricular fibrillation or pulseless ventricular tachycardia, is a common phenomenon, and the only treatment available is defibrillation. Currently, defibrillators deliver either a monophasic or biphasic shock, depending on the device used. In 2005, the American Heart Association published new cardiac arrest management guidelines, which included directions about energy selection for both types of defibrillators. These guidelines created a platform to address misconceptions that exist in the practice setting with regard to the use of biphasic defibrillators. The purpose of this literature review was to highlight the issues related to the practical use of biphasic energy, including optimal energy selection and safety.

Desfibrilador externo semiautomático (DESA). Actualización en su manejo / Update in the use of a semiautomatic external defibrillator

La supervivencia depende de la rapidez con que se aplique al paciente el primer choque eléctrico desde el inicio de la arritmia mortal, por ello se debe recomendar y divulgar el desfibrilador externo semiautomático (DESA)(AU)

Survival depends on the speed by which one applies the first electric shock to a patient after the onset of a deadly arrhythmia; therefore, the authors recommend and publicize the use of a Semiautomatic External Defibrillator(AU)

Nurse-initiated defibrillation? Reality or rhetoric.

Evidence indicates that hospital nurse-initiated defibrillation improves survival following cardiac arrest. Accordingly, hospitals are changing their policies to permit nurses to initiate defibrillation. However, if nurse-initiated defibrillation is to be successful implemented, nurses' beliefs about this practice need to be understood. Therefore, the aim of this study was to explore the attitudes of rural nurses towards defibrillation to assist in the development of nurse-initiated defibrillation programmes. This cross-sectional study examined the defibrillation beliefs of registered nurses in rural areas. A proportionally stratified sample of registered nurses (n = 436) were drawn from 51 rural acute care hospitals in Australia. Most (n = 224; 52%) of the participants were not permitted to initiate defibrillation. A one-way between-groups multivariate analysis of variance showed that nurses who were permitted to initiate defibrillation held stronger positive beliefs towards defibrillation than nurses not permitted (10,410) = 13.88, p < 0.001. Nurses not permitted were more concerned about the challenge of learning rhythms, incurring litigation and harming the patient or themselves. If it is accepted that defibrillation will become an essential part of all nurses' roles, these beliefs should be explored and integrated into educational programmes as inappropriate beliefs about defibrillation may impede implementation and skills development.

Supraventricular dysrhythmias: nursing research to improve health outcomes.

Cardiovascular nursing practice includes accountability for the clinical and organizational processes to ensure positive outcomes for patients having cardiac dysrhythmias. For patients with supraventricular dysrhythmias, nurses have studied patient outcomes related to mortality, morbidity, quality of life, psychological and physical functioning, and symptoms. Nurses have also explored these same outcomes associated with the management of supraventricular dysrhythmias. In addition, nurses have contributed to understanding organizational outcomes such as healthcare utilization and costs associated with these patients. For patients with atrial fibrillation after cardiac surgery, nurses have studied patient and organizational outcomes related to mortality, morbidity, symptoms, psychological and physical functioning, and economic outcomes. This research has included numerous interdisciplinary studies, and most of it has been descriptive or observational in design. Areas for future nursing outcomes research, including more interventional studies, are discussed.

A change of heart. Interview by Carol Davis.

One Cambridge nurse has transformed the service for people needing elective cardioversion. Instead of complaints, the hospital now receives plaudits and its success has garnered an award.