Incidence and case ascertainment of treated in-hospital cardiac arrest events in a national quality registry - A comparison of reported and non-reported events.

BACKGROUND: Approximately 2500 in-hospital cardiac arrest (IHCA) events are reported annually to the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) with an estimated incidence of 1.7/1000 hospital admissions. The aim of this study was to evaluate the compliance in reporting IHCA events to the SRCR and to compare reported IHCA events with possible non-reported events, and to estimate IHCA incidence. METHODS: Fifteen diagnose codes, eight Classification of Care Measure codes, and two perioperative complication codes were used to find all treated IHCAs in 2018-2019 at six hospitals of varying sizes and resources. All identified IHCA events were cross-checked against the SRCR using personal identity numbers. All non-reported IHCA events were retrospectively reported and compared with the prospectively reported events. RESULTS: A total of 3638 hospital medical records were reviewed and 1109 IHCA events in 999 patients were identified, with 254 of the events not found in the SRCR. The case completeness was 77% (range 55-94%). IHCA incidence was 2.9/1000 hospital admissions and 12.4/1000 admissions to intensive care units. The retrospectively reported events were more often found on monitored wards, involved patients who were younger, had less comorbidity, were often found in shockable rhythm and more often achieved sustained spontaneous circulation, compared with in prospectively reported events. CONCLUSION: IHCA case completeness in the SRCR was 77% and IHCA incidence was 2.9/1000 hospital admissions. The retrospectively reported IHCA events were found in monitored areas where the rapid response team was not alerted, which might have affected regular reporting procedures.

When caring becomes an art - how clinical gaze are perceived to be developed.

PURPOSE: This qualitative study describes nurses' experiences and perceptions of how they develop the clinical gaze. METHODS: This qualitative study used an inductive approach and content analysis to assess the experiences of newly graduated nurses, nurse managers, and nursing teachers. Nineteen interviews were conducted. To achieve credibility, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative research (COREQ). RESULTS: Two themes emerged: nurses' personal abilities and the learning culture. Learning culture was considered the foundation of the development of the clinical gaze. The clinical gaze was found to be developed in relationships with patients and when learning together with colleagues, in which the opportunities for reflection are central. To develop the clinical gaze, structures for learning activities, such as reflection, communication exercises, and simulation, are needed so that they become a natural part of daily work. This can also be achieved through supervision and skills training both at university and in a care context. CONCLUSIONS: Prerequisites for the development of the clinical gaze include physical presence with the patient combined with learning activities such as conscious reflection with others in a safe learning culture.

Smartphone activated community first responders' experiences of out-of-hospital cardiac arrests alerts, a qualitative study.

Aim: The aim was to illustrate how community first responders perceive out-of-hospital cardiac arrest alerts delivered via smartphone, what support they have and how they cope with potentially distressing experiences. Method: A qualitative interview study was conducted with a volunteer sample of 14 community first responders in two regions of Sweden. The interviews were transcribed and analysed using thematic analysis with a data-driven inductive approach supported by NVivo 1.3. Results: The responders' experiences were illustrated in three main themes, each including several subthemes: 1) Profound wish to help, including the sense of importance and sense of emergency; 2) Facing the situation, including essential actions performed in collaboration, confidence from training and experience, challenges posed by unforeseen situations and ethical dilemmas, and coping with emotional reactions; and 3) Potential for improvements, including technical and communication development, feedback and debriefing, training and social marketing. Conclusion: The community first responders were motivated and eager to help but simultaneously feared the mission and were not always prepared for their own reactions in the emergency when dispatched. Although cardiopulmonary resuscitation training and experience gave them skills that enabled them to act constructively, they faced situations that might be facilitated by improvements in the community first responder system and further training. The responders were proud of their efforts and were good ambassadors for the system. Appreciation of their commitment, better preparation and providing support in the aftermath of an emergency appears to be a good investment in societies' efforts to bring quick help to distressed persons.

Nursing Faculties' Perceptions of Integrating Theory and Practice to Develop Professional Competence.

BACKGROUND: Nursing faculties' perceptions influence nursing education. This article describes how nursing faculty perceive nursing students' development of professional competence by integrating theory and practice, and by examining how this context influences this integration. METHOD: With a phenomenographic approach, interviews were conducted with nine participants and analyzed into qualitatively different categories of description. RESULTS: The integration of theoretical and practical knowledge is perceived as a challenge or as naturally intertwined in the entire education, focusing mainly on individual prerequisites for learning. Perceptions of a common mission create coherence for students. Evident learning structures are needed, and there is a perceived discrepancy between nurses' competence and expectations in health care. CONCLUSION: If the theory and practice gap could be perceived as a driving force for continuous learning, it could become an incentive for closer collaboration by creating structures for competence development that include individuals, teams, and organizations. [J Nurs Educ. 2022;61(5):236-241.].

The impact of CPR and AED training on healthcare professionals' self-perceived attitudes to performing resuscitation.

BACKGROUND: Healthcare professionals have shown concern about performing mouth-to-mouth ventilation due to the risks to themselves with the procedure. However, little is known about healthcare professionals' fears and attitudes to start CPR and the impact of training. OBJECTIVE: To examine whether there were any changes in the attitudes among healthcare professionals to performing CPR from before to after training. METHODS: Healthcare professionals from two Swedish hospitals were asked to answer a questionnaire before and after training. The questions were relating to physical and mental discomfort and attitudes to CPR. Statistical analysis used was generalized McNemar's test. RESULTS: Overall, there was significant improvement in 10 of 11 items, reflecting various aspects of attitudes to CPR. All groups of health care professionals (physicians, nurses, assistant nurses, and "others" = physiotherapists, occupational therapists, social welfare officers, psychologists, biomedical analysts) felt more secure in CPR knowledge after education. In other aspects, such as anxiety prior to a possible cardiac arrest, only nurses and assistant nurses improved.The concern about being infected, when performing mouth to mouth ventilation, was reduced with the most marked reduction in physicians (75%; P < 0.001). CONCLUSION: In this hospital-based setting, we found a positive outcome of education and training in CPR concerning healthcare professionals' attitudes to perform CPR. They felt more secure in their knowledge of cardiopulmonary resuscitation. In some aspects of attitudes to resuscitation nurses and assistant nurses appeared to be the groups that were most markedly influenced. The concern of being infected by a disease was low.

In-hospital cardiac arrest characteristics and outcome after defibrillator implementation and education: from 1 single hospital in Sweden.

BACKGROUND: Survival after in-hospital cardiac arrest (CA) has been reported to be surprisingly low without any major improvement during the last decade. AIMS: The aim of this study is to evaluate the clinical impact (delay to defibrillation and survival after CA) of an intervention within 1 single hospital (Västerås, Sweden), including (1) a systematic education of all health care professionals in cardiopulmonary resuscitation and (2) the implementation of 18 automated external defibrillators. METHODS: Information was retrieved from the Swedish National Register of Cardiopulmonary Resuscitation. The differences between the 2 calendar periods were evaluated by χ(2) and Fisher exact tests. Logistic regression was used to control for potential confounders. RESULTS: In total, there were 73 in-hospital CAs before (12 months) and 133 after (18 months) the intervention. The overall delay to defibrillation was not reduced after the intervention, and the proportion of survivors to hospital discharge was 26% before and 32% after the intervention (P =.51). Cerebral function, however, was improved after the intervention (as judged by the cerebral performance categories score; P < .001). Thus, the proportion of survivors among all CA patients discharged with a cerebral performance scale score of 1 or 2 (good or acceptable cerebral function) increased from 20% to 32%. CONCLUSION: An intervention within 1 single hospital (systematic training of all health care professionals in cardiopulmonary resuscitation and implementation of automated external defibrillators) did not reduce treatment delay or increase overall survival. Our results, however, suggest indirect signs of an improved cerebral function among survivors.

Occupational affiliation does not influence practical skills in cardiopulmonary resuscitation for in-hospital healthcare professionals.

BACKGROUND: D-CPR (Defibrillator Cardiopulmonary Resuscitation) is a technique for optimal basic life support during cardiopulmonary resuscitation (CPR). Guidelines recommend that healthcare professionals can perform CPR with competence. How CPR training and provision is organized varies between hospitals, and it is our impression that in Sweden this has generally improved during the last 15-20 years. However, some hospitals still do not have any AED (Automated External Defibrillators). The aim was to investigate potential differences in practical skills between different healthcare professions before and after training in D-CPR. METHODS: Seventy-four healthcare professionals were video recorded and evaluated for adherence to a modified Cardiff Score. A Laerdal Resusci Anne manikin in connection to PC Skill reporting System was used to evaluate CPR quality. A simulated CPR situation was accomplished during a 5-10 min scenario of ventricular fibrillation. Paired and unpaired statistical methods were used to examine differences within and between occupations with respect to the intervention. RESULTS: There were no differences in skills among the different healthcare professions, except for compressions per minute. In total, the number of compression per minute and depth improved for all groups (P < 0.001). In total, 41% of the participants used AED before and 96% of the participants used AED after the intervention (P < 0.001). Before intervention, it took a median time of 120 seconds until the AED was used; after the intervention, it took 82 seconds. CONCLUSION: Nearly all healthcare professionals learned to use the AED. There were no differences in CPR skill performances among the different healthcare professionals.

Hospital employees' theoretical knowledge on what to do in an in-hospital cardiac arrest.

BACKGROUND: Guidelines recommend that all health care professionals should be able to perform cardiopulmonary resuscitation (CPR), including the use of an automated external defibrillator. Theoretical knowledge of CPR is then necessary.The aim of this study was to investigate how much theoretical knowledge in CPR would increase among all categories of health care professionals lacking training in CPR, in an intervention hospital, after a systematic standardised training. Their results were compared with the staff at a control hospital with an ongoing annual CPR training programme. METHODS: Health care professionals at two hospitals, with a total of 3144 employees, answered a multiple-choice questionnaire before and after training in CPR. Bootstrapped chi-square tests and Fisher's exact test were used for the statistical analyses. RESULTS: In the intervention hospital, physicians had the highest knowledge pre-test, but other health care professionals including nurses and assistant nurses reached a relatively high level post-test. Improvement was inversely related to the level of previous knowledge and was thus most marked among other health care professionals and least marked among physicians.The staff at the control hospital had a significantly higher level of knowledge pre-test than the intervention hospital, whereas the opposite was found post-test. CONCLUSIONS: Overall theoretical knowledge increased after systematic standardised training in CPR. The increase was more pronounced for those without previous training and for those staff categories with the least medical education.