Journal List > Korean J Adult Nurs > v.27(2) > 1076312

Kim and Lee: Relationship between Non-technical Skills and Resuscitation Performance of Nurses’ Team in in-situ Simulated Cardiac Arrest

Abstract

Purpose

The aim of this descriptive study was to explore the relationship between non-technical skills (NTSs) andcardiopulmonaryresuscitation(CPR)performanceof nurses' teams insimulatedcardiacarrest inthehospital.

Methods

Thesample was 28teams of nurses inoneuniversity hospital located in Seoul. A high fidelity simulator was used toenact simulated cardiacarrest. The nurse teams were scored by raters using both the CPR performance checklist and the NTSs checklist. Specifically the CPR performance checklist included critical actions; time elapsed to initiation of critical actions, and quality of cardiac compression. The NTSs checklist was comprised of leadership, communication, mutual performance monitoring, maintenance of guideline, and task management. Data were collected directly from manikin and video recordings.

Results

There was a significant difference between the medians of the NTSs and CPR performance (Mann WhitneyU=43.5, p=.014). In five subcategories, communication (p=.026), mutual performance monitoring (p=.005), and maintenance of guideline (p=.003) dif-feredsignificantlywithCPR performance inmedians. Leadership(p=.053) andtaskmanagement (p=.080) were not significantlydifferent withCPR performance.

Conclusion

Thefindings indicate that NTSsof teams inaddition to technical skills of individual rescuers affect the outcome of CPR. NTSs development andassessment should be considered an integral part of resuscitation training.

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Table 1.
Nurses' CPR Performance Scales
Items Critical action Range of scores Scale
0 1 2 3
Assessment Check unresponsiveness 0~1 no yes        
Call for help 0~1 no yes  
Check pulse 0~1 no yes  
Start CPR Time to initiate chest compression 0~2 60 sec > 30~60 sec 30 sec <
Apply back board 0~2 no incorrect correct
Initiate BVM ventilation 0~2 no incorrect correct
Connect to oxygen 0~2 no incorrect correct
Quality of CPR Mean rate of correct compression rate (%) 0~3 NC 50% < 50~80% 80% >
Mean rate of correct placement of hands (%) 0~3 NC 50% < 50~80% 80% >
Mean rate of correct compression depth (%) 0~3 NC 50% < 50~80% 80% >
Mean rate of full chest recoil (%) 0~3 NC 50% < 50~80% 80% >
30 compression and 2 ventilation 0~2 NC or BVM incorrect correct
Hands off time 0~2 2 min > 1~2 min 1 min <
Defibrillation Check ECG rhythm 0~2 no incorrect correct
Give a shock (defibrillation) 0, 2 no   yes
Select a shock energy and charge 0~1 no or incorrect correct  
Place the defibrillator paddle in AP 0~1 no yes  
Clear the victim before delivering a shock 0~1 no yes  
Time to deliver first shock 0~2 no shock 2min > 2 min <
Drug Administer epinephrine 0~1 no yes  

CPR=cardiopulmonary resuscitation; BVM=bag valve mask; ECG=electrocardiography; NC=no compression; AP=appropriate position;

Total compression interruption time during 5 minutes.

Table 2.
Non-technical Skills Rating during 5 minutes Simulated Cardiac Arrest (N=28)
Variables Behavior marker None Incomplete or untimely Complete & timely
n (%) n (%) n (%)
Leadership Clearly identified in team   2 (7.1) 12 (42.9) 14 (50.0)
Communicate efficiently  6 (21.4) 15 (53.6)  7 (25.0)
Delegate (distribute) tasks  6 (21.4) 12 (42.9)  10 (35.7)
Manage workload and resource 11 (39.3) 4 (14.3)  13 (46.4)
Communication Use closed loop communication (check-back)  9 (32.1) 5 (17.9)  13 (46.4) 
Call for help appropriate/think out loudly 8 (28.6) 7 (25.0)  13 (46.4) 
Mutual performance monitoring Unnecessary hand-off time corrected 19 (67.9) 4 (14.3)  5 (17.9) 
Hyper- or hypoventilation corrected  23 (82.1) 3 (10.7)  2 (7.1) 
Check & speak out the rhythm   8 (28.6) 5 (17.9)  15 (53.6) 
Knowledge sharing, situation monitoring 12 (42.9) 5 (17.9)  11 (39.3) 
Maintaining of standards and guideline Defibrillation is performed safely  10 (35.7) 5 (17.9)  13 (46.4) 
Change person performing chest compression 7 (25.0) 4 (14.3)  17 (60.7) 
every 2 min.       
Ensuring cardiac rhythm after 5 cycles 9 (32.1) 7 (25.0)  12 (42.9) 
Task management Back-up behavior provided as needed
(support other team members)
2 (7.1) 7 (25.0)  19 (67.9) 
All team members contribute with behavior 2 (7.1) 3 (10.7)  23 (82.1) 
Table 3.
Nurses' CPR Performance Scores during 5 minutes Simulated Cardiac Arrest (N=28)
Variables Critical action Scale M±SD (possible range)
0 1 2 3
n (%) n (%) n (%) n (%)
Assessment Check unresponsiveness 0 (0.0) 28 (100.0)   2.50±0.58
Call for help 1 (3.6) 27 (96.4) (0~3)
Check pulse 13 (46.4) 15 (53.6)
Start CPR Time to initiate chest compression 3 (10.7) 5 (17.9) 20 (71.4)   5.57±1.83
Apply back board 6 (21.4) 7 (25.0) 15 (53.6) (0~8)
Initiate BVM ventilation 1 (3.6) 16 (57.2) 11 (39.3)
Connect to oxygen 9 (32.1) 1 (3.6) 18 (64.3)
Quality of CPR Mean rate of correct compression rate (%) 5 (17.9) 21 (75.0) 3 (10.7) 4 (14.3) 11.28±1.36
Mean rate of correct placement of hands (%)   4 (14.3) 7 (25.0) 17 (60.7) (0~16)
Mean rate of correct compression depth (%)   13 (46.4) 9 (32.1) 6 (21.4)
Mean rate of full chest recoil (%)   6 (21.4) 22 (78.6) 28 (100.0)
30 compression and 2 ventilation   21 (75.0) 2 (7.1)  
Hands off time        
Defibrillation Check ECG rhythm 7 (25.0) 6 (21.4) 15 (53.6)   6.07±3.05
Give a shock (defibrillation) 5 (17.9) 21 (75.0) 23 (82.1) (0~9)
Select a shock energy and charge 7 (25.0) 20 (71.4)  
Place the defibrillator paddle in AP 8 (28.6) 20 (71.4)
Clear the victim before delivering a shock 8 (28.6) 23 (82.1)
Time to deliver first shock 5 (17.9)  
Drug Administer epinephrine 15 (53.6) 13 (46.4)   NA
Total scores 27.32±4.59

CPR=cardiopulmonary resuscitation; BVM=bag valve mask; ECG=electrocardiography; AP=appropriate position; NA=not applicable;

Total compression interruption time during 5 minutes.

Table 4.
Association NTSs and CPR Performance during 5 minutes Simulated Cardiac Arrest (N=28)
Variables Groups CPR performance
Median (IQR)
Mann-
Whitney U
Z p
Total NTSs Better (n=16) 29.5 (27.0~31.8) 43.5 -2.447 .014
Worse (n=12) 25.0 (23.0~28.8)
Leadership Better (n=14) 29.5 (26.8~31.3) 56.0 -1.938 .053
Worse (n=14) 25.5 (22.8~29.3)
Communication Better (n=15) 30.0 (27.0~32.0) 49.5 -2.220 .026
Worse (n=13) 26.0 (24.0~28.5)
Mutual performance monitoring Better (n=18) 30.0 (26.75~32.0) 31.5 -2.816 .005
Worse (n=10) 25.0 (21.5~28.3)
Maintaining of standards and guideline Better (n=17) 30.0 (27.0~32.0) 30.5 -2.975 .003
Worse (n=11) 25.0 (23.0~28.0)
Task management Better (n=19) 29.0 (25.0~32.0) 50.0 -1.753 .080
Worse (n=9) 26.0 (21.0~29.0)

NTSs=non-technical skills; CPR=cardiopulmonary resuscitation; IQR=interquartile range.

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