How much and where: assessment of knowledge level of the application of cricoid pressure.

INTRODUCTION: Application of cricoid pressure is a frequently used technique in both rapid sequence intubation in multiple settings and in a more controlled setting in the operating room. In a survey of emergency department personnel performed at the University of Michigan, it was found that there is a knowledge deficit in the recommended force and the anatomic localization of cricoid pressure. Participants in the original study, which included emergency nurses, medical residents, and attending physicians, rated their training in cricoid pressure as poor or nonexistent. A review of the literature shows that, although cricoid pressure is used during endotracheal intubation to protect against regurgitation of gastric contents, many people applying cricoid pressure do not have a good knowledge of where to apply the pressure or how much pressure to apply to be effective. Because cricoid pressure is applicable in areas other than the emergency department, our study surveys personnel in emergency medical services/flight crew; emergency, intensive care unit, and operating room nurses; and respiratory therapists. Even though the use of cricoid pressure is no longer recommended, it is still routinely used. Although applying cricoid pressure is a simple procedure, persons using it must be thoroughly trained and retrained to prevent complications. METHODS: When we replicated the University of Michigan study at a 254-bed tertiary care facility, a potential of 325 staff members were given access to an online survey using the questions in the original survey. Staff were assigned to a HealthStream module and sent an invitation through their employee e-mail account. The module included a link to the questionnaire, and demographic data were gathered. The module was optional and results confidential. RESULTS: Operating room nurses were most likely to receive supervised instruction on anesthetized patients. These operating room nurses also showed the highest overall knowledge level about the application technique of cricoid pressure. DISCUSSION: There continues to be a lack of knowledge about the application of cricoid pressure during intubation. There is an opportunity for collaboration between staff and academic educators to allow for additional theoretical as well as hands-on practice.

Do performance appraisals of registered nurses reflect a relationship between hospital size and caring?

PROBLEM: Patients and family members expect nurses to demonstrate caring during their contact with patients. If caring is so important, it should be measured on the performance appraisals of registered nurses. METHODS: Watson's carative factors. A review of performance appraisals, for evidence of Watson's carative factors, for medical-surgical nurse positions from 87 hospitals in one Midwestern state. FINDINGS: Facility size did not seem to be associated with the appearance of Watson's carative factors. Size of facility was only significant between small hospitals and Watson's carative factor two, sustaining faith and hope. CONCLUSIONS: Although caring is important to the profession of nursing, it is not measured as a part of nursing performance appraisals.