The research article chosen to critique is, “Using Mock Code Simulation to Improve Responder Performance During the First 5 Minutes of a Code” by Delac, K., Blazier, D., Daniel, L., & N-Wilfong, D. (2013).
Introduction: Cardiopulmonary resuscitation is a lifesaving technique, and is very useful in emergencies like drowning or accidents, where the patient is likely to have a heart arrest. Nurse educators are responsible for training nurses and students on this important technique. Training program differs from real life scenario. In real life scenario, nurses go through a range of emotions like fear, confusion, anxiety, etc., that immobilizes them, and prevents them from providing immediate resuscitation to the patients. Delay in resuscitation is an important cause of failure of this technique. The first 5 minutes following a cardiac arrest is crucial, and decides the success and failure of the resuscitation. There was a need for a realistic educational experience and training that focuses on the initial stages of resuscitation. The Five Alive program was planned to improve nurse’s performance during patient crisis.
Identify the phenomenon: The study tries to identify nurse’s response in the natural setting. The analysis is done from prerecorded data. The study is subjective and thus prone to bias. The phenomenon of interest in this study is the assessment of the Five Alive program in nurses.
Review of literature: There was no extensive review of literature in this study, as the proposed research was exploratory in nature. Nevertheless, the work is supported rationally. The facts presented in the introduction and discussion are supported by literature evidence. Though, previous literature that examines ways of determining the retention of knowledge transferred during resuscitation are available, there has been no research to understand the causes of failure in cardiopulmonary resuscitation applied in patients.
Theoretical framework: There is no nursing theory discussed in this paper. The nursing theory that would best suit the model in this paper would be, Hildegard Palau’s Interpersonal Relations theory. According to this theory, nursing is an interpersonal relationship between a patient who is in need of help and the nurse who is educated/trained to respond to the patient’s needs.
The purpose of this study: This program will train nurses on five important steps in the resuscitation program: 1. Identify the patient status that requires urgent intervention and to notify the emergency response team 2. Execute the procedure of the first responder 3. Patient assessment and appropriate intervention 4. Demonstrate the ability to provide basic cardiac life support 5. Demonstrate the ability to effectively communicate to the arriving health team members. The aim of this study was to help nurses overcome the initial barriers to effective resuscitation. The population being studied are the nurses in the telemetry and medical surgery unit of the trauma 1 teaching hospital. Two hundred and fifty nurses, were sampled in this study.
The purpose of the study is to assess the nurses in the Five Alive Program. The purpose is not clearly defined. It is an exploratory research and there is no clear research question. Most of the data are descriptive and may be useful for further in-depth study. The present study does not have a clear research question.
Methodology Congruence: A hospital resuscitation committee was consulted to develop the Five Alive Program. The hospital team reported high rates of rapid response call. The records were collected and the data was drawn from the information in a retrospective way. The Five Alive program started in 2011 and the data was analyzed later in 2013. All the nurses irrespective of their seniority and experience, participated in this study. Close to 250 nurses were sampled and there is no mention about the inclusion criteria. The sample size is fair enough to draw logical conclusion.
The contexts and details of the location are described. The Five Alive program was developed in consultation with the hospital resuscitation committee. The American Heart Association standard for early intervention: 1 minute to CPR and 3 minutes to defibrillation was adopted in this study. The new Five Alive Program of educating nurses, is expected to increase patient safety and quality of resuscitation. The in-situ-mock code design is explained in detail. There is an initial video briefing about the technique, to the nurses, followed by choosing the in-situ-model in a standard simulation laboratory environment. The aim of each component of the model is well explained. The video briefing at the beginning of the study is thought provoking and helps identify faults in one’s skills and to correct it. There is no clear briefing on how the confidence level in the nurses was measured. Similarly, there is also no clear description of the assessment protocol for other descriptive data as well.
The in-situ mock code simulation, was held for 1 hour, every month, on a randomly selected telemetry/medical -surgical unit of the hospital. All the telemetry and medical surgery nurses are open to practice. The participants can choose to respond to any one of the two emergency scenarios using a 3G-Sim Man, oxygen suction and hospital arrest cart. The time taken to do start CPR and defibrillation was recorded and evaluated. The telemetry/surgical or medical unit, participating in the study was alerted, well ahead of the in-situ mock code simulation. The mock code was repeated every month. Only one staff from each unit participated each day, and the program lasted for 60 minutes. The nurses were motivated to participate, by providing them with an education credit for each participation.
Legal and ethical issues: Cardiopulmonary resuscitation is a mandatory training that all nurses have to undertake. The nurses were informed about the study. However, no information on obtaining an informed consent is mentioned in the article. There is no evidence for violation of participant’s right. The participation in the test was voluntary.
Procedural approach and data collection: The method used to measure confidence level, before and after the test, is not explained in the article. Hence, its validity is not known. There is no mentioning about the questionnaire nor interview in the article. Information on data collector is also not provided. There is no description about saturation of data as well. The article mentions about 2 scenarios. But, there is no clear description of these scenarios, throughout the paper.
Data analysis: The article does not mention the methods used for data analysis. The data were classified as first and second scenario. The time for CPR and the time for defibrillation, under each scenario was estimated. The nurses were also categorized into 5 groups, based on their confidence level: “strongly disagree”, “disagree”, “neutral”, “agree” and “strongly agree”. It is not known, why these categories are chosen and no justification is provided for the same. There is no information on strategies used to control bias.
Findings: The video debriefing that was provided prior to the simulation mode code, help reduce reaction time to CPR and defibrillation, in both the scenario. There was improvement in response time to CPR and defibrillation. Sixty-five percent of the people responded within 1 minute of CPR and within 3 minutes to defibrillation. An improvement in the nurse’s confidence level, was noticed. There was a quicker initiation of response and better confidence in handling and operating the needed equipment, before the arrival of the rapid response team. The nurse’s confidence, increased from 60% to 80%, after the training.
The findings are presented in the context of the time taken to initiate response. Nevertheless, there is no mention on the criteria used for grading confidence level in the nurses. There is also no indication as to what it means by the terms: “strongly agree”, “agree”, “neutral”, “disagree” and “strongly disagree”. The study was conducted to improve nurse’s performance and increase patient outcome. The effect of this simulation on patient outcome was not tested in this study.
Discussion and Researchers Interpretation of the Finding: There is no discussion section in this paper. The discussion was not provided with the results as well. Thus, it is difficult to appreciate the author’s interpretation. There were no clear objectives at the beginning of the study. The lack of a discussion, makes it difficult to draw interpretations. The researchers explain the results, but, not in the context of the research objectives. There is no mention of the limitations of the study, throughout the paper. However, the authors have drawn, far reaching conclusions from limited information. The Five Alive in-situ mock code simulation, improve the performance of the responder towards the simulation model and not on real patients. The future plan of the study is to extend the program to other community and teaching hospitals.
Implication and Recommendation: The implications of the study are discussed. The Five Alive Program can be an effective teaching tool and has developed into a mandatory training that all the nurses have to attend. The authors also talk about the shortage of time and staff, required to conduct the training in many hospitals. The training will be especially useful for the first responder nurses of cardiac arrest. Generalization is made to other hospitals and nurses as well.
Applicability to practice, research and education: The research findings, do have practical applications in nursing practice. It helps to increase confidence. A more in-depth and systematic study will be required to understand its contribution to healthcare knowledge. There is no comparison with other resuscitation programs. Thus the benefits highlighted in this study are questionable.
References:
Delac, K., Blazier, D., Daniel, L., & N-Wilfong, D. (2013). Five Alive. Critical Care Nursing Quarterly, 36(2), 244-250. http://dx.doi.org/10.1097/cnq.0b013e3182846f1a
