CPR Training for Nurses: How often Is It Necessary?

BACKGROUND: The ability to respond quickly and effectively to a cardiac arrest situation rests on nurses being competent, prepared and up-to-date in the emergency life-saving procedure of cardiopulmonary resuscitation (CPR). This study aimed to determine the extent to which nurses acquire and retain CPR cognitive knowledge and psychomotor skills following CPR training courses. METHODS: A quasi-experiment was used. CPR knowledge of 112 nurses was assessed via a questionnaire using valid multiple-choice questions. An observatory standard checklist was used and CPR performance on manikins was evaluated to assess psychomotor skills (before the course baseline, after the course, after 10 weeks and then 2 years after the 4 hours CPR training course). Scores were based on a scale of 1 to 20. RESULTS: A mean baseline score of 10.67 (SD=3.06), a mean score of 17.81 (SD=1.41) after the course, 15.26 (SD=3.17) 10 weeks after and 12.86 (SD=2.25), 2 years after the 4 hours CPR training course was noticed. Acquisition of knowledge and psychomotor skills of the nurses following a four-hour training program was significant. However, significant deterioration in both CPR knowledge and psychomotor skills was observed 2 years after the training program among 42 nurses. CONCLUSION: The study findings present strong evidence to support the critical role of repetitive periodic CPR training courses to ensure that nurses were competent, up to date and confident responders in the event of a cardiac arrest.

Assessment and outcome of 496 penetrating gastrointestinal warfare injuries.

AIM: The abdominal viscera are among the most vulnerable organs of the body to penetrating trauma. Proper management of such trauma in war victims at the first-line hospital where these victims are first seen is of paramount importance. We reviewed medical records of war victims suffering small bowel and colorectal injuries treated at first, second and third-line hospitals during the Iraq-Iran War (1980-88) to assess surgical outcomes. METHODS: The medical records of 496 Iranian war victims suffering penetrating gastrointestinal (GI) injuries treated at first, second and third-line (tertiary) hospitals, a total of 19 centres, were reviewed. Laparotomy had been performed at the 1st line hospitals for all patients who had an acute abdomen, whose wounds violated the peritoneum or whose abdominal radiographs showed air or shrapnel in the abdominal cavity. Stable patients were transferred from first-line to second-line or from second line to tertiary hospitals postoperatively. The treatments, complications and patient outcomes were documented and analyzed. RESULTS: There were 496 patients; 145, 220 and 131 victims underwent laparotomy for GI injuries at first, second and third-line hospitals respectively. The small intestine and colon respectively were the most prevalent abdominal organs damaged. Those first treated for GI injuries at front-line hospitals (145 victims) had more serious conditions and could not be transferred prior to surgery and presented a higher prevalence of complications and mortality. Overall mortality from GI surgery was 3.6% (18 patients). Eleven patients (7.5%) whose first GI operation was performed at frontline hospitals and 7 patients (3.2%) who underwent their first surgical operation at second-line hospitals died. The most common reason for these deaths was complications relating to the gastrointestinal operation such as anastomotic leak. Six missed injuries were seen at the frontline and one at second line hospitals. There were no deaths at the 3rd line hospitals. CONCLUSION: Penetrating abdominal injuries were common in Iranian victims of war often causing multiple organ injuries. The colon and small intestine were the more commonly injured organs and carried the most postoperative complications. Mortality at 1st line hospitals was more than double that of 2nd line hospitals; the complication rate was also greater as was the number of missed injuries. Adherence to the standard surgical protocols, prompt evaluation, proper triage and management are factors which may lower patient morbidity and complications.

Anxiety, depression and health-related quality of life in those injured by landmines, Ilam, Islamic Republic of Iran.

We assessed depression, anxiety and health-related quality of life (HRQOL) in 137 cases of landmine injury in Ilam province, using the Hospital Anxiety & Depression Scale (HADS) and the Short Form Health Survey (SF36) questionnaires. We also compared their scores with an uninjured control group (n = 360). Most of the injured were male (93.4%) and illiterate (54.7%) with some irreversible sequelae (86.9%). Overall, 69.3% of the injured participants scored high for both anxiety and depression. The level of anxiety and depression was significantly higher in older cases, those not completely recovered compared with recovered cases and those with amputation compared with those without amputation. The injured also had significantly lower mean scores in all HRQOL components than the control group. Landmine injured should be monitored for early identification and treatment of depression and anxiety.

Improving trauma care in rural Iran by training existing treatment chains.

INTRODUCTION: Iran has a major land mine injury problem in its border areas. Mine injuries have a high mortality and morbidity, and the injuries generally occur in remote areas. Iran has a well developed system of rural health workers and clinics, covering most border areas. These have mainly had prevention, immunization and curative treatment for medical conditions as their focus. We hypothesized that adding a short training in trauma care to the already existing system of rural health workers would improve the care for trauma victims. The objective of the present study was to describe the training and evaluate its effect using mortality and change in physiological function of victims after prehospital treatment as outcome measures. METHODS: The training was arranged in villages and clinics in the border area. Physicians, nurses and emergency technicians from a local emergency clinic, the Mehran Clinic, were given a two-day course with monthly refreshers; while rural healthcare workers and lay people were given shorter training courses in their villages. All patients treated were registered and patients were followed up. Physiological changes after treatment was assessed with a modified three-component 'revised trauma score'. Patients entered the system directly through the local emergency clinic (some with prehospital treatment before arriving at the local emergency clinic). Some were transferred to the referral university hospital, and there they could be compared with a convenience comparison group of patients transported directly to the referral university hospital without treatment during transportation. RESULTS: During the three-year study period 109 physicians, nurses and 76 emergency technicians (behwarses) were trained, while 4649 lay persons had first-responder training. A total of 366 patients were treated by the system. Prehospital support was given to 238 victims before admission to the primary clinic. We found no difference in mortality between patients with and without first-responder treatment. In all, 226 of these patients were transferred to the university hospital. During the period a group of 245 other victims of injury was admitted directly to the university hospital. The physiological status of the transferred victims improved significantly by treatment from the emergency clinic to the university hospital with a mean improvement in the Physiological Severity Score (PSS) of 1.11 (95% CI 0.98-1.24). The PSS of the intervention group was significantly higher than the status of the group brought directly to the university hospital without treatment during transportation (difference 0.73, 95% CI difference 0.55-.91, p < 0.0005). CONCLUSIONS: We found that the existing rural healthcare system in Iran's western border area could be upgraded to care for mine victims and victims of other injuries by using available resources. This system improved the physiological status of the victims during transportation, and was able to handle penetrating as well as blunt injury. The use of existing health structures should be considered when planning improvements.