Comparison of real-time feedback and debriefing by video recording on basic life support skill in nursing students.

BACKGROUND: Cardiopulmonary resuscitation skill have a direct impact on its success rate. Choosing the right method to acquire this skill can lead to effective performance. This investigation was conducted to compare the effect of Real-time feedback and debriefing by video recording on basic life support skill in nursing students. METHODS: This quasi-experimental study was performed on 67 first year nursing students. First, a theoretical basic life support (BLS) training session was held for the all participants, at the end of session the pre-test was taken. Students were randomly assigned to two groups. A 4-hour practical BLS training session was conducted in the real - time feedback group as well as the debriefing by video recording group, and at the end of the training, a post-test was taken from each group. Each group received a post-test. Data were analyzed using SPSS 25 software. RESULTS: Results showed a significant difference between mean (SD) of debriefing by video recording group in pre-test and post-test (p < 0.001) and in the real-time feedback group there was a significant difference between mean (SD) in pre-test and post-test (p < 0.001), respectively. In addition, there was no significant difference between the mean score of basic life support skill in real-time feedback and debriefing by video recording. CONCLUSIONS: Both real-time feedback and debriefing by video recording were effective on basic life support skill.

The Diagnostic Evaluation of the SINEH Cardiopulmonary Triage Scale and the Emergency Severity Index in the Emergency Department: A Comparative Study.

Introduction: The diagnostic evaluation of the emergency severity index (ESI) in the triage of patients with cardiopulmonary complaints has a high sensitivity but a low specificity in the emergency department (ED). Therefore, triage scales with more accurate diagnostic evaluation are required. As a result, accuracy of the SINEH triage scale (SinTS) and the ESI was compared to compare mistriage of critically ill patients with cardiopulmonary complaints. Methods: This descriptive, analytical and cross-sectional study was conducted between December 2022 and April 2023. In this study, two nurses independently examined each patient using two triage scales. The admission unit and length of hospital stay were also recorded. The outcome was classified as high-risk admission (cardiac care unit and intensive care unit) and low-risk admission (internal unit or discharge from the ED). Undertriage and overtiage were defined as high-risk admission with triage level 3 and 4 and low-risk admission with triage level 1 or 2, respectively. A panel of experts evaluated content validity of SinTS and kappa designating agreement on relevance reported. The inter-rater reliability of two scales was also reported. Results: Finally, the study included 145 patients. The average age of the patients studied was 61.35 years. SinTS has a total mistriage of 29.63%, with 4.13% being undertriage and 25.5% being overtriage. In ESI, the total mistriage is 66.8%, with 1.3% being undertriage and 65.5% being overtriage. The undertriage of the two scales did not differ significantly by admission unit (p=0.26), but the overtriage of the two methods did (p=0.001). The sensitivity, specificity, and accuracy of SinTS were 86.3%, 63.37%, and 72.27%, respectively, while those of ESI were 95.4%, 5.94%, and 32.79%, respectively. Conclusion: SINEH triage scale has achieved the optimal accuracy in recognizing the acuity of the patients with chest pain and dyspnea by using SpO2, pressure of end-tidal carbon dioxide, troponin I, and peak expiratory flow. When triaging patients with chest pain and dyspnea, SinTS may exhibit a higher level of accuracy compared to ESI. More research is needed to improve accuracy of triage scales in patient with cardiopulmonary complaints.

The Effects of Manual Lung Hyperinflation on Pulmonary Function after Weaning from Mechanical Ventilation among Patients with Abdominal Surgeries: Randomized Clinical Trial.

Introduction: After abdominal surgery, the patients who are separated from mechanical ventilation and provided with oxygen therapy via a T-piece are at risk for respiratory complications. Therefore, they need additional respiratory support. This study aimed to evaluate the effects of manual hyperinflation (MHI) on pulmonary function after weaning. Methods: This randomized clinical trial included 40 patients who had undergone abdominal surgery and were receiving oxygen via a T-piece. Patients were selected from the intensive care units (ICU) of two hospitals in Mashhad, Iran. The subjects were randomly allocated to intervention (MHI) and control groups. Patients in the MHI group were provided with three 20-minute MHI rounds using the Mapleson C, while the control group received routine cares. Tidal volume (Vt), Rapid Shallow Breathing Index (RSBI), and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) were measured before the intervention, as well as 5 and 20 minutes after the intervention. Atelectasis prevalence was assessed before and 24 hours after the intervention. Data were analysed by SPSS software version 13. Results: At baseline, there were no significant differences between the groups regarding Vt, RSBI, P/F ratio, and atelectasis rate. No significant difference was also found between the groups regarding atelectasis rate 24 hours after the intervention. However, at both posttests, Vt, RSBI, and P/F ratio in the MHI group were significantly better than the control group. Conclusion: In patients with artificial airway and spontaneous breathing, MHI improves pulmonary function.

The design and psychometric evaluation of the emergency medical services resilience scale (EMSRS).

INTRODUCTION: The nature of pre-hospital emergency medical care can expose healthcare workers to significant stresses that might lead to psychological problems such as job burnout and impaired resilience. A valid and reliable tool is, therefore, needed to investigate resilience in emergency medical services (EMS) personnel. This study was conducted to design a tool for assessing the resilience of emergency medical personnel in Iran and to examine the psychometric properties of the designed tool. METHODS: This methodological study was conducted in two phases: A qualitative stage with individual interviews and a review of literature to generate items, and a quantitative stage of psychometric evaluations that assessed the face, content, and construct validity of the tool. The reliability of the tool was also assessed using the internal consistency and test-retest methods. RESULTS: Exploratory factor analysis was used to design a 31-item scale with a six-factor structure. These six factors, i.e. job motivation, communication challenges, social support, remaining calm, self-management, and consequences of stress, explained 51.8% of the variance. The scale's Cronbach's alpha coefficient and intraclass correlation coefficient were calculated as 0.91 and 0.85, respectively. CONCLUSION: The scale developed on the resilience of EMS personnel can be used as a valid and reliable tool for assessing resilience in EMS personnel. It can also assist emergency service managers to plan courses to improve their staff's resilience.

Comparison between Emergency Severity Index plus peak flow meter and Emergency Severity Index in the dyspneic patients with chronic obstructive pulmonary disease: A randomized clinical trial.

INTRODUCTION: It is unclear whether the Emergency Severity Index (ESI) can identify high-risk patients with Chronic Obstructive Pulmonary Disease (COPD). This study aims to compare the mistriage rates of the ESI plus the Peak Expiratory Flowmeter (PEF) approach and ESI approach among dyspneic patients with COPD. METHODS: This study was a randomized clinical trial conducted between July and October 2018. We randomly assigned COPD patients with dyspnea to the ESI + PEF or ESI groups. Triage levels, disposition rates, number of resources used, and time to first physician contact were compared in patients admitted to the Intensive Care Unit (ICU), the Pulmonary Care Unit (PU), or discharged from the ED. Reliability of the ESI was evaluated by using the interobserver agreement (Kappa). RESULTS: Seventy COPD patients were equally assigned to the ESI + PEF and ESI groups. The under-triage rates were 11.42% and 0%, the over-triage rates were 31.42% and 2.85% in the ESI and ESI + PEF groups, respectively. The triage levels of the patients admitted to the ICU (2 vs. 3), the PU (2 vs. 4), or discharged from the ED (3 vs. 2) were significantly different between the ESI + PEF and ESI groups. CONCLUSIONS: Addition of PEF to the ESI provides a more accurate method for triaging COPD patients compared to ESI alone. We recommend using PEF for the triage of COPD patients in the ED.

A quasi-experimental study of the effect of teaching Orem's self-care model on nursing students' clinical performance and patient satisfaction.

AIMS: This study aims to determine the effect of teaching Orem's self-care model on nursing students' clinical performance and patient satisfaction. DESIGN: The study was a quasi-experimental, non-randomized, two-group design with posttest. METHODS: In this quasi-experimental study, 66 nursing students were selected via convenience sampling method. The intervention group was trained based on Orem's self-care model and the control group based on the routine nursing process method. Both groups cared patients for a week. Students' performance was evaluated during the clinical course by performance observation checklist and patient satisfaction was assessed at the end of clinical course using patient satisfaction form. Data were analysed in SPSS software using chi-squared, Fisher Exact test, Mann-Whitney, t test and two-way ANOVA. RESULTS: Clinical performance evaluation mean score in the intervention group was significantly higher than that of the control group. However, patient satisfaction scores in both the control group and intervention group did not show statistically significant differences. Orem's self-care model showed a 23% improvement in students' performance. It is recommended to use Orem's self-care model for undergraduate courses, especially in clinical training.

Recognizing Sudden Cardiac Arrest May Require More Than Two Questions during Telephone Triage: Developing a Complementary Checklist.

OBJECTIVE: To develop decision-support tools to identify patients experiencing sudden cardiac arrest (SCA). METHODS: Eighty calls related to SCA were content analyzed, and the contextual patterns that emerged were organized into a checklist. Two researchers independently analyzed the recorded calls and compared their findings. Eighteen dispatchers scored 20 cases (which included SCA and non-SCA cases) both with and without the checklist. Correct responses for each case and agreement among dispatchers have been reported. RESULTS: Eighty audio files (total time, 96 min) were analyzed, and a total of 602 codes were extracted from the text and recordings. The caller's tone of voice and presence or absence of background voices, calling for an ambulance and giving the dispatcher the address promptly, and description of the primary complaint and respirations accounted for 38%, 39%, and 23% of all codes, respectively. A 15-item complementary checklist has been developed. The mean percentages of correct responses were 66.9%+27.96% prior to the use of checklist and 80.05%+10.84% afterwards. Results of the independent t test for checklist scores showed that statistically significant differences were present between the SCA and non-SCA cases (t=5.88, df=18, p=0.000). CONCLUSION: Decision support tools can potentially increase the recognition rate of SCA cases, and therefore produce a higher rate of dispatcher-directed CPR.

24-Hour survival after cardiopulmonary resuscitation is reduced in patients with diabetes mellitus.

Introduction: Diabetes mellitus is a risk factor for cardiovascular disease. Some recent studies have shown an association between diabetes and out-of-hospital cardiac arrest incidence and survival. We aimed to investigate whether there is an association between the presence of diabetes mellitus and survival after cardiopulmonary resuscitation (CPR) in patients with an in-hospital cardiac arrest. Methods: A cross-sectional study was conducted during the period of January to February 2014, among 80 cases of cardiopulmonary arrest in patients at Qaem hospital of Mashhad, Iran. A code 99 was announced after a cardiac arrest was identified, and CPR was performed by the cardiac arrest team. Twenty four hour survival was compared in diabetic and non-diabetic patients who had a return to spontaneous circulation after CPR. We used SPSS statistics for Windows version 16 for data analysis. Results: The return to spontaneous circulation in the diabetic group was not significantly lower than for the non-diabetic group (42.9% versus 61.0% [P = 0.15]). However, the 24-hour survival in the diabetic group was significantly lower than for the non-diabetic group (19.0% versus 44.1% [P = 0.04]). Conclusion: The presence of diabetes mellitus is associated with a significantly lower rate of survival after CPR.

A Comparison of the Effect of Interposed Abdominal Compression Cardiopulmonary Resuscitation and Standard Cardiopulmonary Resuscitation Methods on End-tidal CO2 and the Return of Spontaneous Circulation Following Cardiac Arrest: A Clinical Trial.

OBJECTIVES: Sudden cardiac arrest is a major cause of death in the adult population of developed countries, with only 10%-15% of cardiopulmonary resuscitations (CPRs) being successful. We aimed to compare the effects of interposed abdominal compression CPR (IAC-CPR) with standard CPR (STD-CPR) methods on end-tidal CO2 (ETCO2 ) and the return of spontaneous circulation (ROSC) following cardiac arrest in a hospital setting. METHODS: After cardiac arrest was confirmed in a patient at Mashhad Ghaem Hospital, 80 cases were randomly assigned to one of the two methods of resuscitation, either IAC-CPR or STD-CPR, respectively. The inclusion criteria for the study were nontraumatic cardiac arrest, in patients between the age of 18 and 85 years, and the presence of endotracheal tube. Exclusion criteria were abdominal surgery in the past 2 weeks, active gastrointestinal bleeding, pulmonary embolism, and suspected pregnancy. RESULTS: There was a significant difference between the two groups in ETCO2 (p < 0.003), but there was no significant difference as far as the ROSC (p > 0.50). CONCLUSION: The increase in the ETCO2 during IAC-CPR is an indicator of the increase in cardiac output following the use of this method of CPR.

The effect of Cincinnati Prehospital Stroke Scale on telephone triage of stroke patients: evidence-based practice in emergency medical services.

BACKGROUND: The emergency medical service is designed to recognize and transfer critically ill patients. Evidence-based practice has rarely been emphasized in the emergency medical service field, especially in the dispatch center. AIMS: To identify the effect of the Cincinnati Prehospital Stroke Scale (CPSS) on telephone triage of stroke patients by telephone triage nurses at the emergency medical dispatch center and to compare CPSS with the National Guidelines for Telephone Triage Tool (NGTT). METHODS: A quasi-empirical study was conducted from June 2013 to June 2014. The setting of the study was the Mashhad dispatch center of the EMS. Two hundred and forty-six patients were randomly allocated to the CPSS intervention group (n = 121) and the NGTT control group (n = 125). True triage, triage error and odds ratio were statistically reported. RESULTS: The mean age of the patients was 70.9 ±â€Š12.7 years. Of all the cases, 77.7 and 65.6% of patients in the intervention and the control groups, respectively, were accurately triaged. Under-triage cases were 10.7 and 13.6% of the patients in the intervention and the control groups. Odds ratio was 1.14 (95% confidence interval 0.62-2.07) for the CPSS compared with the NGTT. CONCLUSION: CPSS is more efficient for use by telephone triage nurses in identifying stroke. The use of CPSS assists nurses by reducing the triage error and supports the evidence-based care. It needs to be developed to cover signs and symptoms of posterior-circulation stroke patients.

A standardized shift handover protocol: improving nurses' safe practice in intensive care units.

INTRODUCTION: For maintaining the continuity of care and improving the quality of care, effective inter-shift information communication is necessary. Any handover error can endanger patient safety. Despite the importance of shift handover, there is no standard handover protocol in our healthcare settings. METHODS: In this one-group pretest-posttest quasi-experimental study conducted in spring and summer of 2011, we recruited a convenience sample of 56 ICU nurses. The Nurses' Safe Practice Evaluation Checklist was used for data collection. The Content Validity Index and the inter-rater correlation coefficient of the checklist was 0.92 and 89, respectively. We employed the SPSS 11.5 software and the Mc Nemar and paired-samples t test for data analysis. RESULTS: Study findings revealed that nurses' mean score on the Safe Practice Evaluation Checklist increased significantly from 11.6 (2.7) to 17.0 (1.8) (P < 0.001). CONCLUSION: using a standard handover protocol for communicating patient's needs and information improves nurses' safe practice in the area of basic nursing care.