Exploring the Feelings of Nurses during Resuscitation—A Cross-Sectional Study

Exploring the effects of delivering CPR on nurses' mental health and well-being

Nurses are often first responders to patients in cardiac arrest and therefore have a critical role in delivering cardiopulmonary resuscitation (CPR), which can be physically, emotionally and ethically demanding and highly stressful. The stress of being involved in patient resuscitation is widely acknowledged, but there is limited research on how nurses cope during and after delivering CPR. This qualitative literature review aimed to develop an understanding of the effects of delivering CPR on nurses' mental health and well-being. The thematic synthesis of the 15 studies reviewed identified three main themes: work-related stress, burnout, and psychiatric morbidity. These all adversely affect nurses' mental health and well-being, and potentially the effectiveness of their delivery of CPR, and are implicated in nurse attrition. There is a need for stress-reduction programmes and strategies to enhance nurses' coping skills and for the provision of multidisciplinary training that supports effective teamwork and nurses' delivery of CPR.

Responding to In-hospital Cardiac Arrests During Times of System-wide Strain: A Code Refresher Training

BACKGROUND

Pandemic conditions of system-wide strain are associated with increased rates of in-hospital cardiac arrest (IHCA). During normal times, medical-surgical nurses may forget cardiopulmonary resuscitation (CPR) skills as soon as 3 months after training, leaving them unprepared and anxious about managing cardiac arrests. During pandemic surges, heightened anxiety can also impact concentration and confidence.

METHOD

Clinicians offered a 45-minute mock code training refresher for medical-surgical nurses to improve confidence performing CPR while adhering to pandemic-related safety procedures. In this pre-post clinical education project, nurses' confidence was measured with the Nursing Anxiety and Self-Confidence with Clinical Decision Making© Scale.

RESULTS

Although the results were not statistically significant, participants verbally reported increased confidence to initiate resuscitation, collaborate with team members, and use personal protective equipment during the posttraining debrief.

CONCLUSION

A high percentage of RNs do not have adequate confidence and/or competence in performing CPR, particularly during times of system-wide strain, and this brief, inexpensive refresher training warrants further study. [J Contin Educ Nurs. 2024;55(9):442-448.].

Implementing debriefing after cardiac arrest: benefits and challenges

Healthcare professionals, including nurses, will be involved in the care and management of patients in cardiac arrest. This highly stressful and demanding situation can lead to breakdowns in communication, difficulty in decision-making and emotional distress for members of the healthcare team. Debriefing is a recommended tool that team members can use to acknowledge what went well, what could be improved and areas for learning or development. However, debriefing is often not prioritised due to pressures in clinical practice. This article discusses the benefits of debriefing and outlines some of the approaches and tools that may be used. The author argues that by recognising the importance of debriefing after cardiac arrests in the hospital setting and committing to best practices, nurses can be better prepared for the challenges of resuscitation and improve patient outcomes.

Integrative virtual nursing simulation in teaching cardiopulmonary resuscitation: A blended learning approach

BACKGROUND

Online learning resources facilitated educational development during the COVID-19 pandemic. This study focuses on the integration of online virtual simulation with interactive exercises and offline low-fidelity simulation for the first time to explore the impact on CPR skills.

METHODS

First year nursing students from a medical college participated as volunteers in this study. They were divided randomly into two groups with both having a cardiopulmonary resuscitation (CPR) lesson with the same timings and objectives. The experimental group (n = 36) adopted a blended learning method, with virtual simulation and low-fidelity simulation as resources; the control group (n = 36) used the same method without virtual simulation. The same lecturers taught both classes. Students' self-directed learning (SDL) and critical thinking skills were assessed before and after the intervention and their CPR skills were examined afterward.

RESULTS

The experimental group exhibited significantly greater improvement in their SDL abilities and CPR skills. By contrast, we found no statistical differences in their critical thinking abilities.

CONCLUSIONS

During CPR training, blended learning method was used to integrate virtual nursing simulation in teaching, which effectively improved students' SDL and CPR skills.

Compassion fatigue and stress related to cardiopulmonary resuscitation: a study of critical care nurses' experiences

BACKGROUND

Cardiopulmonary resuscitation (CPR) is considered one of the most stressful experiences in critical care nursing; it directly and indirectly leads to compassion fatigue and burnout.

AIM

Determine the levels of and relationship between postcode stress and compassion fatigue.

DESIGN AND METHODS

A descriptive-correlational study using 300 critical care nurses from five intensive care units in two hospitals was conducted.

TOOLS

Demographic and work-related data, the Postcode Stress Scale, and the Professional Quality of Life Scale: Compassion Fatigue subscale.

RESULTS

Nurses had moderate to high postcode stress and compassion fatigue (67.98 ± 16.39 and 65.40±14.34, respectively). Moreover, there was a significant positive correlation between postcode stress, burnout (r=0.350, p=<0.001), secondary traumatic stress (r=0.518, p=<0.001), and subsequently, compassion fatigue (r=0.449, p=<0.001). In addition, higher levels of postcode stress were associated with higher levels of compassion fatigue with its subscales: burnout and secondary traumatic stress, with a coefficient of determination for compassion fatigue (0.199), burnout subscale (0.121), and secondary traumatic stress (0.266).

CONCLUSION

Critical care nurses involved in resuscitation experiences are susceptible to postcode stress, burnout, secondary traumatic stress, and compassion fatigue. There is a significant relationship between these factors, with higher levels of postcode stress contributing to higher levels of compassion fatigue and its subscales: burnout and secondary traumatic stress. These results highlight the importance of addressing and managing the psychological well-being of nurses in resuscitation settings to mitigate the adverse effects of stress and promote their overall resilience and well-being.

Treatment patterns and clinician stress related to care of out-of-hospital cardiac arrest patients with a do not attempt resuscitation order

OBJECTIVE

This research investigated treatment patterns for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders in Japanese emergency departments and the associated clinician stress.

METHODS

A cross-sectional survey was conducted at 9 hospitals in Okayama, Japan, targeting emergency department nurses and physicians. The questionnaire inquired about the last treated out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation. We assessed emotional stress on a 0-10 scale and moral distress on a 1-5 scale among clinicians.

RESULTS

Of 208 participants, 107 (51%) had treated an out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation order in the past 6 months. Of these, 65 (61%) clinicians used a "slow code" due to perceived futility in resuscitation (42/65 [65%]), unwillingness to terminate resuscitation upon arrival (38/65 [59%]), and absence of family at the time of patient's arrival (35/65 [54%]). Female clinicians had higher emotional stress (5 vs. 3; P = 0.007) and moral distress (3 vs. 2; P = 0.002) than males. Nurses faced more moral distress than physicians (3 vs. 2; P < 0.001). Adjusted logistic regression revealed that having performed a "slow code" (adjusted odds ratio, 5.09 [95% CI, 1.68-17.87]) and having greater ethical concerns about "slow code" (adjusted odds ratio, 0.35 [95% CI, 0.19-0.58]) were associated with high stress levels.

CONCLUSIONS

The prevalent use of "slow code" for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders underscores the challenges in managing these patients in clinical practice.