INTRODUCTION

To think too long about doing a thing often becomes its undoing.
(Eva Young)
Cardio Pulmonary Resuscitation (CPR) is a critical component of basic life
support and the established first line before advanced life support. Cardio
pulmonary resuscitation as a potential life saver is associated with survival and has
the potential to prevent sudden death. The American Heart Association (AHA)
resuscitation guidelines recommended that all hospital staff who are in contact with
the patients should have regular resuscitation training. Research shows that the
quality of cardio pulmonary resuscitation has a direct impact on victims chance of
survival. Cardio pulmonary resuscitation (CPR) is a procedure that should be used
for patients, for whom there is a reasonable chance of restoring and prolonging life.

When sudden death impends, cardio pulmonary resuscitation is the final

hope for survival, and involves external cardiac compression and mouth to mouth
resuscitation, which maintain circulation until normal circulation and ventilation
has been restored through definitive therapy. The necessary skills for conducting
cardio pulmonary resuscitation should be taught for all the health professionals. 2

According to the American Heart Association statistics EMS treats nearly

3,00,000 victims out of hospital cardiac arrests each year in US. Less than 8% of
people suffer cardiac arrest outside the hospital Scenario. Less than one third of out
of hospital sudden cardiac arrest victims receive bystanders CPR. The American
Heart Association trains more than 12 million people in CPR annually including
health care professionals and General public.

Heart disease is the worlds largest killer, claiming 17.5 million lives every
year. About every 29 seconds, an Indian dies of heart problem. As many as 20,000
new heart patients develop every day. In India 9 core Indian suffer from heart
disease and 30% more are at high risk 1. Sudden cardiac arrest is a major public
health problem. Basic Life Support (BLS) is the provision of treatment designed to
maintain adequate circulation and ventilation to the patient in cardiac arrest,
without the use of drugs or specialist equipment. Basic Life Support (BLS)
includes recognition of signs of sudden cardiac arrest (SCA), heart attack, stroke,
and foreign-body airway obstruction (FBAO); and cardiopulmonary resuscitation
(CPR) .
The most important aspects in Basic Life Support are ABC, is nothing but
the airway, breathing and circulation. Failure of the circulation for three to four

minutes will lead to irreversible cerebral damage3. For every minute that passes
after a patient goes into cardiac arrest their chance of survival decreases by seven
to 10 per cent until a defibrillator arrives (Metcalfe-Smith, 2003). A patient who
has suffered sudden cardiac arrest must receive effective treatment rapidly. When
delivered promptly, resuscitation can save the lives of many patients in cardiac
arrest4. Basic Life Support acts to slow down the deterioration of the brain and
heart until defibrillation and/or advance life support can be provided (Ruck and
Erc-2000). Prompt recognition of cardiopulmonary arrest and prompt instigation of
Basic Life Support can double the patients chance of survival (Bltf-2001).
Basic Life Support training is gaining more importance in nursing
education. Being trained to perform Basic Life Support can make the difference
between life and death for a victim. The Basic Life Support is an essential skill
taught to the nursing students. Nurses require skills of assessment for cardiac arrest
and need to initiate Basic Life Support, involving maintaining respiration and
circulation for the casualty until emergency services, or advanced life support
services, arrive. All nurses with a responsibility for patients must be offered regular
training and updates in resuscitation. As registered nurses, we all have a
responsibility to ensure we remain competent to perform resuscitation.

Educational change is necessary to meet the demands of the current

healthcare environment. Learning objectives should focus on the best practice
outcomes and should emphasize what the healthcare provider is expected to do
after the educational activity is over. Regulating agencies and consumers hold
healthcare personal accountable for providing high quality, safe patient care.
Educational activities should provide the skills and knowledge that enable nurses
to meet this goal. The new nursing generation need to grow in proper and timely
provision of essential care to their patients. For that, they need necessary
knowledge and skill by repeated training and practice.

Cardiopulmonary resuscitation is the first assistance given to the

collapsed person and is aimed at the prevention of further harm. The correct
CPR measures can reduce suffering, be instrumental in speeding up subsequent
recovery, prevent permanent disability and even save life. First few minutes
following injury is called the golden time. Many complications and events that
occur during this period, can convert a simple injury to death if unattended. It is
important to act and react during the golden time to reduce mortality and
morbidity.
The American heart association released its 2010 CPR guidelines
followed for lay persons. And the focus for CPR is on good quality chest

compressions. Now its C-A-B; the chest compression come first, only then do
focus on airway and breathing. No looking, listening, and feeling but is an
action, no assessment .push at least 2 inches deep on the chest. At the rate, 30
compressions should take 18 seconds.
A cross sectional study was conducted to awareness about BLS [CPR]
among medical students in Dow international medical college, Karachi. Using
questionnaire regarding BLS by 61 students. Out of 61 students 14.7% had
taken a BLS course, 85.3% students had not attended any course. The result
showed that significantly more number of students had the theoretical
knowledge about BLS 76.07% vs 49.18%, p<0.00. Of all the students, 57.3%
had no knowledge, among 34% had heard BLS somewhere, 22, 9% had some
knowledge, 50% heard about it. Significantly less number of students had
complete knowledge about BLS 4% P<0.05. Among the students who had taken
the course, 22% had complete knowledge p<0.05. Significantly less number of
students knew about the skills for BLS 21% p<0.05.
A nations hope rests on its youth. For their hopes to become reality, the
younger generation needs to grow into healthy behaviour and acquire health
related knowledge. According to WHO are the individuals in the age group of
16-24 years and there are 198 million young people in India [WHO, 2000].

World Health organization [WHO] Technical Report Series [1999] showed that
colleges have the potential to provide an excellent base for large scale
programming and there is need
to strengthen the college as a setting for health intervention. Colleges can
provide many services to young people in addition to formal education, such as
health education, skill development in the areas such as life saving skills. A
college is an appropriate setting for the introduction of teaching and training of
students on life saving CPR skill as it offers access to young adults on a large
scale. It is economically efficient and there are possibilities for short term and
long term evaluation.
Health Teaching is an integral part of nursing and it emphasis a scientific
attitude towards health which is very important to modern healthy living.
Planned health teaching of the masses is one of the most effective means of
health promotion. Patients suffering from cardiac diseases, shock, trauma and
other such critical conditions could collapse anywhere and effective life saving
measures commenced promptly by any lay person could help revive the patient.
College students better listen to the teachings and could follow demonstrations.
Hence the researcher felt that the need to conduct a planned teaching
programme and demonstration regarding CPR and to evaluate the effectiveness

of planned and skill training.

Pediatrics is the branch of medicine that deals with the medical care of
Infants, children and adolescents. The age limit of such patients ranges from birth
to 18 years. Pediatric Nursing is an area of nursing and medical practice with a
focus on providing holistic care to infants, children and adolescents. There are
different places Pediatric Nurses can work like pediatric ward, NICUs, PICUs etc
where the nurse support the patient and the family by providing comprehensive
care which the family cannot perform.

Basic life support in a level of medical care which is used for patients with
life threatening illness or injury until the patient can be given full medical care. In
pediatric setup there are many pediatric emergencies like accidents, injuries,
respiratory failure, sudden cardiac arrest and shock where the emergency
professional health care team members performs a number of life saving
techniques focused on the emergency care. Among which the Pediatric Cardio
Pulmonary Resuscitation stands first and foremost in ABCof hospital emergency
care.

Cardio Pulmonary Resuscitation in children has been used in hospitals for

approximately 40 years where the staff nurses are generally the first responders to

cardiac arrest and initiate basic life support while waiting for the advanced cardiac
life support team to arrive. Speed and competence of the first responder are factors
contributing to the initial survival of a person following a cardiac arrest. The
knowledge and attitude of the staff nurse may influence the speed and level of
involvement in the emergency situation. So this paper uses the theories of recent
action and planned behaviours and awareness of the members involved in pediatric
CPR .

Incidence rate of cardiac arrest in the world, In- hospital cardiac arrests of
children admitted to pediatric intensive care unit occur at a rate of 0.94 cardiac
arrests per 100 admissions. Pediatric patients suffering an in-hospital cardiac arrest
differ from the out-of-hospital cardiac arrest subpopulation due to a chronic preexisting condition being present twice as often and a cardiac etiology more likely
as the cause of the arrest. Extra Corporeal Membrane Oxygenation (ECMO)
initiated within 24 hrs after cardiac arrest is associated with a decrease in hospital
mortality. There is a lower incidence of mortality and greater likelihood of good
neurologic outcome with an in-hospital cardiac arrest than out-of-hospital cardiac
arrest. Survival also depends on other factors such as actual duration of CPR,
quality of CPR administered and the extent of necessary pharmacologic
intervention needed during CPR.

Incidence rate of cardiac arrest in India are due to various reasons. Main
causes like, 56% due to respiratory problem, 33% due to cardio vascular disorders.

In a population aged at least 12 years incidence of out of hospital cardiac

arrest is 36/1,00,000 81/1,00,000.

The average proportion of cases out of hospital cardiac arrest that receive
bystander CPR is 27.4%.

The rate of survival to discharge after in-hospital cardiac arrest 27% among
children. Incidence rate of cardiac arrest due to anaesthesia is 27 / 12,158.

A study conducted quality of cardio pulmonary Resuscitation training

programme in order to determine whether it was sufficiently addressed by the
trainee team leaders during training. CRP quality of 20 consecutive resuscitation
scenario training person was audited prospectively using pre-designed performa. A
consultant intensive and a senior nurse who were also Advanced Pediatric Life
Support (APLS) instructors assessed the CPR quality Which included Ventilation
frequency, chest compression, rate of depth and any unnecessary interruption in

chest compressions. The results showed that 50% of training session did not have
any change with the person in the team. So the quality of little awareness of this
inadequacy.

A retrospective study done at a childrens hospital following resuscitation

for out of hospital cardio pulmonary arrest to determine the outcome and cause for
children resuscitated following out of hospital cardio pulmonary arrest in an
organization pre hospital emergency medical system with in Birmingham, Ala,
with 150493 children under the age 15 years. Standard resuscitative techniques
were performed for all patients. Of 63 children with out of hospital cardio
pulmonary arrest 60 were pulseless and apneic on arrival 18 were successively
resuscitated and admitted to intensive care unit and 6 were discharged from the
hospital. 5 of the survivors had severe neurological deficits and 1 appeared normal.
On follow up 2 patient had died 3 were in vegetative state and 1 was normal.
Resuscitation efforts in the emergency department are commonly successful but
lead to death or severe neurological sequelae at discharge with extremely high cost
of care.

A study was conducted on epidemiologic review and assessment of current

knowledge in out of hospital pediatric cardiac arrest in outcome of children

younger than 18 years with an out of hospital cardiac arrest, with 5.363 patients
results showed that 12.1% survived to hospital discharge and 4% survived
neurologically intact. Trauma patients had greater survival submersion injury
associated arrest had greater survival (22.7%, 6% intact). Bystander cardio
pulmonary resuscitation showed increased survival (relative risks 1.99, 95%
confidence interval 1.54 to 2.57).

NEED FOR THE STUDY

Continuous effort, not strength or intelligence is the key to unlocking our
potential.
(Linaecardes)
Cardio pulmonary resuscitation is the method of providing oxygen and
blood circulation through the delivery of rescue breathing and chest compressions
to victim of sudden cardiac arrest, which occurs when the heart loses its ability to
pump blood and distribute oxygen through the blood. Cardiac arrest can occur due
to many accidents like road traffic, falls, sports accidents, drowning,
electrocutation etc. when the heart stops beating, the brain stop receiving fresh
oxygen rich blood. The brain can survive only about 4-6 minutes without oxygen.
This period of 4-6 minutes is therefore critical. To provide oxygen to the brain
circulation is very important. This can be done by external chest compression .
Everybody should learn cardio pulmonary resuscitation. Updating the
knowledge and skills about cardio pulmonary resuscitation is a necessary option in
the field of medicine. Emergencies can strike anyone anywhere. The only person
may be available at the time could be you. Therefore we should posses Cardio
pulmonary resuscitation skills no matter who you are. Fortunately a short period of
training is required to learn cardio pulmonary resuscitation.

There are no reliable national statistics on cardio pulmonary resuscitation

because no single agency collects information about how many people get cardio
pulmonary resuscitation? How many people dont get it? Who needs it? How many
people are trained etc. Many studies have examined cardio pulmonary resuscitation
in specific communities while they show varying rates of success. All are
consistent in showing benefits from early cardio pulmonary resuscitation5.

Heart diseases are the worlds largest killer. Claiming 7.5 million lives
every year about every 29 seconds an Indian dies of heart problem. As many as
200000 new heart patients develop every day in India. 6 crore India suffer from
heart disease and 30% more are at high risk. By 2020 India will have the largest
coronary heart disease (CAD) burden in the world and will account for one third of
all deaths. Many of them will be young. The risk of sudden cardiac death from
coronary heart disease in adult is estimated to be one per thousand adult 35 years
of age and older per year. About 75% to 80% of all out of hospital cardiac arrests
happen at home. Hence being trained to perform basic life support (BLS) can
make the difference between life and death of a victim.

Effective BLS provided immediately after Cardiac arrest can double a

victims chance of survival. If more people know BLS more lives can be saved.
Health behaviour is a major target of teaching and it is assumed that teaching helps
in changing behaviour through cognitive and psychomotor changes6.

As we mark the 50th anniversary of modern-era cardio pulmonary resuscitation, we

must acknowledge that, measurable progress aimed at its prevention. Cardiac arrest
both in and out of the hospital continues to be a nature public health challenge.
Over these 50 years scientific knowledge about arrest, pathophysiology and
resuscitation mechanism has increase substantially. In our on going commitment to
ensure optimal community based care for all victims of cardiac arrest, we must
continue effectively to translate the science of resuscitation into clinical care and
improved resuscitation outcomes. Each year cardio pulmonary resuscitation saves
thousands of lives in United States of America. More than 10 million Americans
are trained through American heart association and American Red Cross.

The cardiac arrest survival rate falls and estimated 7% to 10% for every minute
without effective cardio pulmonary resuscitation. Cardio pulmonary resuscitation if
not performed effectively within 4-6 minutes after cessation of breathing can lead

to failed cardio pulmonary resuscitation meaning the cardio pulmonary

resuscitation attempts were not successful in restoring life brain death. To prevent
such disastrous condition all health team professionals should be able to effectively
follow the chain of survival that is early recognition
Early basic life support
Early access to emergency services
Early defibrillation.

All the health team members should be expert in giving cardio pulmonary
resuscitation. If the nurses are educated and trained we can save many lives
because they are the people who are

the patients. Investigator believes that by broadening training and encouraging the
public and the health care professionals specially the nurses to perform cardio
pulmonary resuscitation will save thousands of life. Health team members should
be equipped with the skills of cardio pulmonary resuscitation not only to practice
in the hospital setting, but act as a good Samaritan where ever required7.
Cardiovascular disease is the worlds leading killer. According to world
Health Organization (WHO) estimates, 16.7 million people around the globe, die
of cardiovascular disease each year. This is over 29 percent of all deaths globally.
Cardiovascular diseases now more prevalent in India and China than all
economically developing countries in the world combined. Cardiovascular disease
in India quadrupled in the last 40 years. WHO estimates that by 2020 close to 60%
of cardiac patients worldwide will be Indian1.
Basic Life Support competency is considered a fundamental skill for
health care workers. In the wider community, it is an expectation that knowledge
and competence in Basic Life Support is at a high standard in nursing education 8.
Participation in both successful and unsuccessful cardiopulmonary resuscitation
and Basic Life Support is one of the most stressful situations that the nursing
students have to deal with after their registration. A thorough knowledge and

competency (skill) help them to perform Basic Life Support to the patients when
ever is needed9.
Basic Life Support is the fundamental technique for the emergency
treatment of cardiac arrest. The standardised training of cardio pulmonary
resuscitation has been emphasised more than ever. Common people in developed
countries have received popular education of cardiopulmonary resuscitation
programme of Basic Life Support training10. Cardio pulmonary resuscitation and
Basic Life Support training is mandatory for nurses and is important as nurses
often first discover the victims of cardiac arrest in-hospital. Available literature
suggests a need for both initial cardiopulmonary resuscitation training and refresher
courses. In this context, the training of nursing students to improve the knowledge
and competency in Basic Life Support is having atmost significance. It is because
in future they are the one who is assessing and providing the needed care for the
patient at the earlier stage11.
In a study conducted to assess the knowledge and skill regarding Basic
Life Support among nurses and nursing students in Finland, results showed that the
best predictors for good response assessment and resuscitation skills went to those
who were nursing students who had studied Basic Life Support sometime during
the previous 6 months6. In a survey conducted in Hainan Province, regarding the

knowledge of Basic Life Support and cardio pulmonary resuscitation was found
that the knowledge level was very low among nurses10.
Poor knowledge and skill retention following cardio pulmonary
resuscitation and Basic Life Support training has been documented over the past 20
years. In order to enhance the retention of knowledge and skill repeated training is
needed. However, some students have difficulties in developing competence in
cardiopulmonary resuscitation and evidence suggests that resuscitation skill may
only be retained for several months. So further training is necessary for developing
and retaining the skills11.
In a study conducted among nurses, regarding skill and knowledge of
Basic Life Support shows that retention of skill and knowledge quickly deteriorates
if not used or updated regularly12. In another study, the student performing Basic
Life Support for the second time achieved better results than those undertaking
practice and testing for the first time. These data and studies figure out the need of
repeated teaching and assessment to ensure adequate knowledge and skill gained
among the students6. The repeated training programme provides students with
sound basic knowledge and adequate practical skills in first aid and Basic Life
Support that adequacy of time and physical and human resources are important
prerequisites to facilitate practice and enhance confidence in skills11.

Hence, the investigator felt the need and desire to carry out a study on
assessing the effectiveness of structured teaching programme on progressive
improvement in knowledge and skill of administering Basic Life .

REVIEW OF LITERATURE
1.

Studies related to general information regarding CPR.

The study was conducted at Washington University School of Medicine in

St. Louis to rule out only giving Cardiac compression by the bystanders without
giving breath, there were improved survival rates. They combined the data from
the three studies in a meta analysis and were able to analyze survival rate in more
than 3.700 cardiac arrest patients who received either standard CPR or Chest
compression only. Those smaller studies had suggested chest compression only
CPR may improve survival. One noted a 14% increase in survival to hospital
discharge, while 2nd reported a 24% improvement in 30 days survival. But
analyzing all three studies the team determined that survival improved by 22%
when bystanders called 911 and were advised by the dispatches to do chest
compression-only CPR.

A study was conducted to evaluate the effect of compression-only CPR.

Data was collected from emergency medical services division of public health for
seattle and king country and colleagues. 1941 adults out of hospital cardiac arrest,
dispatches randomly provided CPR directions to bystanders for compressions

either alone or with rescue breathing. No significant differences were observed in

the proportion of patients who survived to hospital discharge or survive with the
favourable neurology outcome. Compression along was linked to a nonsignificant
trend towards a higher proportion of patients surviving to hospital discharge for
those with a cardiac cause of arrest or shockable rhythms.

The study was conducted to analyze survival rate using the two main
approaches. The daily telegraphs suggested we should Skip the Kiss. When
giving the kiss of life. While BBC News emphasized that the study backs chest
compression in resuscitation. The new study which does not constitute official
guidance examined a form of CPR that uses chest compression but not breathing
into the mouth. This is known as compression-only CPR.

The study was conducted to know the quality of CPR in an important

predictor of outcome from cardiac arrest. Mechanical chest compression devices
provide an alternative to manual CPR. Physiological and animal data suggest that
mechanical chest compression devices are more effective than manual CPR.
Consequently there has been much interest in the development of new technique
devices to improve the efficacy of CPR. The review will consider the evidence and

current indication for the use of some of the more common mechanical devices
developed to increase the safety and efficacy of CPR Administration.

The study was conducted with 7 emergency departments used AHA

recommended new CPR including increased compressions, full chest wall recoil
and use the impedance threshold device (ITD). When subjects were treated with
new CPR techniques including the use of an ITD, the hospital discharge rates went
from 7.9% to 15.7% or double the survival rate of the control group and more than
double the national survival rate of 5%. These results strongly support the wide
spread use of the AHAs new 2005 CPR guidelines.

2.

Studies related to knowledge of nurses regarding CPR.

A study was done to assess the knowledge in 35 cardio pulmonary

resuscitation staff of a hospital which was affiliated to the Golestan University of
Medical Sciences. Simple sampling with a before-after method was applied. Data
collection was done by a questionnaire of 43 questions about knowledge which
was completed by the participants before and after teaching and after two months
duration. Educational lectures were held by expert professions. The data were
analyzed by the wilcoxan test (P<0.01) were considered to be significant. The

mean age was 37.16+ 6.21 years. The result showed that the level of knowledge
had improved to 85% after training and to 87% after 2 months (P value <0.01). It is
suggested that a periodic training of practical skills should be scheduled for these
staff .

A study was conducted to investigate nurses knowledge regarding

cardiopulmonary

resuscitation

and

to

identify

barriers

to

appropriate

cardiopulmonary resuscitation evaluation, 100 questionnaires were distributed to

nurses working in a public government hospital in Bahrain. 82 of these were
returned. The result indicated that cognitive knowledge was not adequately
retained. 58% of respondents perceived recalling cardiopulmonary resuscitation
information as easy or extremely easy. Only 7% of respondents passed the
knowledge test. In general those who had less education and experience did not
recall essential cardiopulmonary resuscitation knowledge. This study identified a
significant

problem

with

the

knowledge

surrounding

cardiopulmonary

resuscitation. More concerning was the lack of professional responsibility in

dealing with this inadequacy.

A study was conducted to assess the cardiopulmonary resuscitation skills of

hospital medical and nursing staff. The cardio pulmonary resuscitation skills of 160

staff members at a large metropolitan teaching hospital were assessed by a multiple

choice questionnaire and a practical test of basic life support skills on a manikin.
Medical staff members performed significantly better than did nurses in the
multiple choice test, but significantly worse in the practical test; 48 (60%) of 80
nurses and only 26 (32.5%) of 80 doctors passed the practical test. Training
resuscitation by the St. John ambulance association as a medical student may have
improved the basic life support skills of doctors but there is clearly a need for
continued revision and assessment of resuscitation skills.
A survey was done on knowledge and attitude towards cardiopulmonary
resuscitation and provision of cardiopulmonary resuscitation education to nurses in
general wards. The survey was done on 280 nurses from the four university
hospital with 700beds. The mean score for knowledge of basic life support was
12.71 (mean converted to 100:63) about 76% of the nurses believed that they had a
responsibility to perform cardiopulmonary resuscitation, but 53.3% of the nurses
were not confident to perform cardiopulmonary resuscitation. About 94% of the
nurses had received education on cardiopulmonary resuscitation but 32.3% of
those took it 6-12 years ago. About 41% of the nurses spent 3-4 hours for the
education and 73.2% of those took simulation education. Most of the nurses had
received cardiopulmonary resuscitation education, who were not knowledgeable or
confident. Therefore better cardiopulmonary resuscitation education programme

including updated knowledge are needed. More reinforced education should be

offered every 6 months or on yearly basis in order to enhance lasting efficiency.

A study was conducted to assess the knowledge of cardiopulmonary

resuscitation among the nurses of (n=302) community based health services in
Hainan province of Chaina. A survey was made by randomized stratified cluster
sampling using self designed questionnaires. The passing rate for qualification of
knowledge of cardiopulmonary resuscitation was found to be very low in Hainan
province (23-18%). A significant difference of regions and different educational
level among the nurses were also noticed. It may be concluded from the study that
nurses of community based health services in Hainan province lack the basic
knowledge of cardiopulmonary resuscitation especially in rural region.

A study was conducted on effective resuscitation by nurses: perceived

barriers and needs: by states that when patients face a life-threatening event such as
cardiopulmonary arrest, they rely on the competence and skills of healthcare
professionals. Because nurses are often the healthcare providers closest to the
bedside and the first to respond to patients needs, their knowledge and skills need
to be optimal and their performance proficient.

The cross sectional survey was conducted in 2006 in the capital health
region of Kuwait including all registered nurses working in 21 primary health care
centers. A self administered questionnaire was distributed to all registered nurses. It
included personal characteristic training and practice of resuscitation, perceived
competence regarding practical skills. It also included multiple choice questions to
assess nurses knowledge about cardiopulmonary resuscitation. Nurses knowledge
was transformed into percentage score. Factors that could affect nurses knowledge
were studied out of 279 questionnaires 165 were returned back with 59.1%
response rate. The majority of them 86.1% had attended cardiopulmonary
resuscitation as a part of the nursing school curriculum and 65.5% of the nurses
had participated in a cardiopulmonary resuscitation learning session other than in
curriculum. It was found that 26.7% of the nurses had never participated in real
resuscitation attempt. Over all the median knowledge score of the registered nurses
were 42.9% for cardiopulmonary resuscitation and 52.0% for ECG. Factors that
affected nurses knowledge score were years of experience other than in curriculum
attempting real resuscitation and self confidence of the nurses.
A comparative survey was conducted in Asahikawa Medical college to compare
the knowledge regarding cardio pulmonary resuscitation among 66 nursing staff
and 53 student nurses. The average scores of the test among the nursing staff and
the student nurses were 61 points and 54 points, respectively. Although a

significant difference in the % of total correct answers was demonstrated between

the two groups, the rate of correct answers of the observation items was high,
whereas, that of skill items were comparatively low in each group. . Ability
defined as an indicator of capability of practicing CPR of the nursing staff was
17% and that of the student nurses was 0%. This shows that the CPR knowledge of
both the nursing staff and the student nurses was sufficient, indicating the necessity
of CPR education for both nursing staffs and student nurses.
3.

Studies related to the effectiveness of teaching programme among nurses.

A study was conducted on cardiopulmonary resuscitation skill among nurses

and nursing students in southern Finland and Hungary, and to assess the influence
of resuscitation teaching and other group characteristics on performance. The study
group consisted of 75 nurses 223 final term students of different nursing institutes.
(34 men and 264 women) participated in the study. Logistic regression showed that
the best predictors for good response assessment skills went to those who were
nursing students who had studied resuscitation skills sometime during the previous
6 months. The best predictor of the skill to open the airway was a positive attitude
towards personal cardiopulmonary resuscitation (CPR) skills, i.e. self-confidence.
The predictor for adequate skills in artificial ventilation was that they belonged in

the group of nursing students who had benefited from recent resuscitation training
(<6 months).
A prospective randomized interventional study was conducted that
hypothesized a multimodel training method comprising audiovisual feedback and
immediate debriefing would improve cardiopulmonary resuscitation performance
among care providers. A total of 80 nurses were randomized to 2 groups. Each
group underwent 3 trials of simulated cardiac arrest. The feedback group
received real time audiovisual feedback during the second and third trials. The
debriefing only group performed cardiopulmonary resuscitation without
feedback. Both groups received short individual debriefing after the second trial.
Cardiopulmonary resuscitation quality was recorded using a cardiopulmonary
resuscitation sensing defibrillator that measures chest compression rate/depth and
can deliver audiovisual feedback messages from both groups during the three
trials. In the debriefing only group, the percentage of participant providing
compressions of adequate depth increased after debriefing from 38% to 68%
(p=0.015). In the feedback group depth compliance improved from 19% to 58%
(p=0.002). Compression rate did not improve significantly with either intervention
alone. This study states that significant cardiopulmonary resuscitation quality
deficits exist among health care providers. Debriefing or feedback alone improved
cardiopulmonary resuscitation quality, but the combination led to marked

performance

improvements.

Cardiopulmonary

resuscitation

feedback

and

debriefing may serve as a powerful tool to improve rescuer training and care for
cardiac arrest patients.
A comparative study was conducted to know the confidence vs.
competence: basic life support skills of health professionals, to assess BLS
confidence as assessed against competence of doctors in-training, qualified nurses
and healthcare assistants (HCAs) following the development of structured
resuscitation training. This study has highlighted that the introduction of a
structured resuscitation training programme has resulted in a noticeable
improvement in BLS skills, particularly with regard to doctors. Registered nurses
have improved with regular training. There remains a mismatch between
confidence and competence, with only doctors demonstrating both confidence and
competency and therefore changes to training programmes may be required to
address this mismatch.
A study conducted among hospital nurses investigated the relation between
BLS quality and some of its potential determinants. During a BLS refresher course,
296 nurses from non-critical care wards completed a questionnaire including
demographic data and self confidence score. Subsequently, they performed a
BLS test on a manikin connected to a PC using skill reporting system software

(Laerdal, Norway). The study showed that male gender had greater self confidence,
recent BLS trainee and recent CPR were associated with better quality of BLS.
A study was conducted regarding the effectiveness of planned teaching
programme (PTP) on knowledge and practice of Basic Life Support among high
school students in Bangalore. The research design used for the study was quasiexperimental design. The sample consisted of 40 rural high school students. The
study was conducted in rural high school of Mangalore and the subjects were
selected through simple random sampling technique. The study showed that
majority (87.5%) of the students had inadequate knowledge and (100%) had poor
practice. The planned teaching programme facilitated them to update their
knowledge and practice related to Basic Life Support. Hence, the planned teaching
programme is an effective teaching strategy to improve knowledge and practice of
sample on BLS.
A study was conducted on assessment of cardiopulmonary resuscitation
and defibrillation (CPR-D) skills of nursing students in two institutions. The
purpose of this study was to use Objective Structured Clinical Examination
(OSCE) test in assessing guideline based CPR-D skills of newly qualified nurses.
The CPR-D skills of newly qualified registered nurses studying in Halmstad
University (n = 30) Sweden, and Helsinki Metropolia University of Applied

Sciences (n = 30) Finland, were assessed using an Objective Structured Clinical

Examination (OSCE) which was built up with a case of cardiac arrest with
ventricular fibrillation as the initial rhythm. Forty-seven percent of the students in
the Swedish group (mean score 32.47/49, range 26-39, SD 3.76) and 13% of the
students in the Finnish group (mean score 23.80/49, range 13-35, SD 4.32) passed
the OSCE (P<0.0001), the cut-off point being 32.47. Performance grade for the
Swedish group was 2.9/5.0 and for the Finnish group 2.1/5.0 (P<0.0001). Good
nontechnical skills correlated with high grading of the clinical skills. The results
shows, CPR-D skills of the newly qualified nurses in both the institutes were
clearly under par and were not adequate according to the resuscitation guidelines.
A study was conducted on Training nurses for cardiopulmonary
resuscitation (CPR) by using the problem-based approach, To assess whether
problem-based learning (PBL) is more effective over conventional teaching
methods by comparing final resuscitation exam results of nursing students who
received cardiopulmonary resuscitation (CPR) training either by traditional or by
problem-based learning (PBL) approach. A retrospective and comparative research
design was implemented. Data on final CPR exam grades, collected both from PBL
and traditionally trained students, were obtained for a total of 1775 students
between 2000 and 2007 in three major schools of health sciences in Hungary.
Comparison between PBL and traditional teaching methods as well as across

schools was made. t-tests on means yielded significant differences (t=3.569;

p<0.001) between PBL and conventional training favouring PBL instructed
students. Students who received PBL training had better final cardiopulmonary
resuscitation exam grades than traditionally trained peers. Students who attended
PBL classes achieved greater theoretical knowledge and demonstrated better
resuscitation skills when tested.
A study was conducted regarding exploration of student nurses thoughts
and experiences of using a video recording to assess their performance of basic
life-support (BLS) and cardiopulmonary resuscitation (CPR) during a mock
objective structured clinical examination. An action research project was
conducted with six students who were assessed by an examiner at a video-recorded
mock objective structured clinical examination. Students self-assessed their skills
using the video and a checklist. Semi-structured interviews were conducted to
compare checklist scores, and explore students' thoughts and experiences of the
objective structured clinical examination. The findings indicate that students may
need to repeat this exercise by comparing their previous and current performances
to develop both their self-assessment and CPR skills. All students reported the
benefits of participating in this project, by discussion and identification of
knowledge and skills deficits, thus emphasising the benefits of formative

assessments to prepare students for summative assessments and ultimately clinical

practice.
A study was conducted on Basic Life Support knowledge of
undergraduate nursing students and chiropractic students. The aim of this study
was to examine retention of cardiopulmonary resuscitation and basic life-support
(CPR/BLS) knowledge of third year nursing and fourth year chiropractic students
following instruction and assessment of CPR/BLS skills and knowledge as part of
their undergraduate degree program. Non-experimental exploratory survey to
determine perceived ability and knowledge of CPR/BLS following completion of
CPR/BLS instruction. The study was conducted in University Health Sciences
School. Eighty-seven third year undergraduate nursing and forty-three fourth year
undergraduate chiropractic students at Royal Melbourne Institute of Technology
(RMIT). The level of knowledge of CPR/BLS was assessed via the number of
correct responses to questions regarding CPR/BLS. A visual analogue scale was
used for the students to score their self-rated perceived knowledge and skill. The
majority of students (78%) felt they were well prepared to perform CPR/BLS,
however there were deficiencies in both groups about knowledge of current
guidelines. Chiropractic students were less likely to identify the correct
compression rate compared to the nursing group (Spearmans rho 0.669, p-.001)
with 95% of the chiropractic students not able to identify the correct rate. Thirty

four percent of the students were unable to identify the correct ventilation
compression ratio with nursing students again more likely to respond correctly
(Spearmans rho 0.508, p-.001). Nursing students scored themselves highly for self
rated knowledge and ability to perform CPR. Chiropractic students tended to score
themselves at a lower rating in these areas than the nursing students. Although
students from both disciplines had significant gaps in knowledge of CPR/BLS,
nursing students outperformed chiropractic students in all aspects of CPR/BLS
knowledge.
A study was conducted on Evaluation of the Basic Life Support CDROM, its effectiveness as learning tool and user experiences. This study presents
the evaluation of a Basic Life Support (BLS) CD-ROM, developed as part of the
Interactive Teaching and Learning (INTaL) staff development project. Student
nurses pre- and post-test percentage results were compared using the nonparametric Wilcoxon test. Competency in delivering BLS skills was measured at
one of the sites. A Pearsons co-efficient test was applied to measure any
correlation between knowledge attainment and skill performance. Focus groups
facilitated an exploration of the students experiences and feelings of using
interactive multi-media technology for learning. Lecturers views were sought
through individual interviews. Learning had occurred across all groups, though this
was not uniform. There was no correlation between knowledge of BLS and skill

attainment measured through expired air respiration and external chest

compression scores, though those students performing BLS for the second time
achieved better results than those undertaking practice and testing for the first time.

STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of planned video assisted teaching
programme on cardiopulmonary resuscitation among nurses working in the
selected hospital in Bareilly city.

OBJECTIVES
1. To assess the existing knowledge of the nurses on cardiopulmonary
resuscitation.
2. To administer planned video assisted teaching for nurses on cardio
pulmonary resuscitation.
3. To assess the post test knowledge of the nurses on cardiopulmonary
resuscitation.
4. To find out the effectiveness of planned video assisted teaching programme
on cardiopulmonary resuscitation by associating pre-test knowledge with
their post-test knowledge.
5. To associate pre-test knowledge with their selected demographic variables of
the nurses.

6.5 OPERATIONAL DEFINITIONS

Evaluation:
It refers to the assessment of pre-test and post test knowledge score of the
nurses.
Effectiveness:
It refers to the extent to which the planned video assisted teaching programme
enhances the knowledge of the Nurses in cardiopulmonary resuscitation.
Planned Video Assisted Teaching Programme :
It refers to planned and organized video assisted teaching programme which
provides information and knowledge regarding cardiopulmonary resuscitation.
Cardio Pulmonary Resuscitation:
Cardio pulmonary resuscitation is a technique of basic life support for the
purpose of oxygenating the brain and heart until appropriate definitive medical
treatment can restore the normal heart and ventilator action.
Nurses:
It refers to nurses who are having GNM & BSC (N) qualification and working
in the common wards, ICU, emergency medicine etc, and has below 5 years of
experience in the clinical area.
ASSUMPTIONS OF THE STUDY
Nurses may have basic knowledge regarding cardiopulmonary resuscitation.
Video assisted teaching programme may enhance the knowledge of the
nurses regarding cardiopulmonary resuscitation.

HYPOTHESIS:
H1: There will be significant co-relation in the level of knowledge of the
nurses on cardiopulmonary resuscitation before and after planned video
assisted teaching programme.
H2: There will be significant association between the pre test and post test
knowledge of the subjects on cardiopulmonary resuscitation with their
selected demographic variables.

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA

The nurses working in a selected hospital, Bangalore.
7.2 METHODS OF COLLECTING THE DATA
Research Design
Pre experimental one group pre test and post test.

Research variables
Dependent variables
Knowledge of the selected nurses regarding Cardiopulmonary
Resuscitation.

Independent Variables
Planned

video

assisted

resuscitation.

Demographic Variables

teaching

programme

on

cardio

pulmonary

The base line information such as age, gender, religion, education,

experience, area of work (ICU, CCU, Emergency and General ward Etc) and
previous knowledge about CPR, NCC / NSS members.

Setting :
The study will be conducted in the selected hospital, Bangalore.

Population :
Population for the present study consists of nurses working in the selected
hospital.

Sample :

Male and Female G.N.M. and B.Sc(N) qualification between the age group
of 22 to 28 years and has less than 5 years of clinical experience.

Criteria for selection of the samples

Inclusive Criteria
1.
2.
3.
4.
5.
6.

Nurses who are working in the selected hospital Bangalore.

Nurses who are between the age group of 22-28 years
Nurses who have G.N.M & B.Sc(N). qualification.
Nurses within the 5 years of experience in the clinical area.
Nurses who are available at the time of data collection.
Nurses who are willing to participate in the study.

Exclusive Criteria:
1. Nurses who are not willing to participate in the study.
2. Nurses with M.P.H.W (F).
3. Nurses who are having above 5 years of experience.
Sampling Technique
Non-probability convenience or purposive sampling technique is adopted for
selecting the samples.
Tool for data collection
Section A : Self administered questionnaire to assess the demographic data
of the nurses.
Section B : Self administer questionnaire to assess the knowledge of the
nurses regarding Cardio Pulmonary Resuscitation.
Methods of data collection:
Phase 1 : Permission from the significant authorities will be obtained. Self
administered questionnaire is given to collect demographic data for 15 minutes.
followed by, structured questionnaire will be administered for 30 minutes to assess
the knowledge of the nurses regarding Cardio Pulmonary Resuscitation..

Phase 2 : Video assisted planned teaching programme regarding CPR will

be conducted.
Phase 3 : Post test will be given to the nurses to assess the knowledge.
Duration of the study : 4 Weeks
Data analysis
Data collected will be analyzed by means of descriptive and inferential statistics.
Descriptive statistics
Mean, frequencies, percentage, and standard deviation to determine the
significance and to analyze the demographic data.
Inferential statistics
Paired ttest was used to determine effectiveness of planned teaching programme
of knowledge regarding cardio pulmonary resuscitation.
Chi-square was used to find out the association between the post test level
knowledge and selected demographic variables.

Projected outcome:

This study will be helpful to improve the knowledge of the nurses on cardio
pulmonary resuscitation, which will enable nurses to provide effective Cardio
Pulmonary Resuscitation.

7.3 Does the study require any investigation to be conducted on patients or

other human or animals?.

Yes the study will be conducted on staff nurses in selected hospital

Bangalore city.

7.4 Has ethical clearances has been obtained from your institution?

Yes informed consent will be obtained from the institution authorities and
subject privacy, confidentiality and anonymity will be guarded. Scientific
objectivity of the study will be maintained with honesty and impartiality.

DISCUSSION
Cardiopulmonary resuscitation (CPR) is an emergency procedure which is
attempted in an effort to return life to a person in cardiac arrest. It is indicated in
those who are unresponsive with no breathing or only gasps. It may be
attempted both in and outside of a hospital.CPR involves chest compressions at
a rate of at least 100 per minute in an effort to create artificial circulation by
manually pumping blood through the heart. In addition the rescuer may provide
breaths by either exhaling into their mouth or utilizing a device that pushes air
into the lungs. The process of externally providing ventilation is termed
artificial respiration.
An administering of an electric shock to the heart, termed
defibrillation, is usually needed to restore a viable or "perfusing" heart rhythm.
Defibrillation is only effective for certain heart rhythms, namely ventricular
fibrillation or pulse less ventricular tachycardia, rather than asystolic or pulse
less electrical activity. CPR may however induce a shockable rhythm. CPR is
generally continued until the person regains return of spontaneous circulation
(ROSC) or is declared dead CPR is indicated for any person who is
unresponsive with no breathing or only gasps as breathing as it is most likely
that they are in cardiac arrest. CPR training: CPR is being administrated while a
second rescuer prepares for defibrillation.2

A number of studies have confirmed that CPR can be life-saving when provided
either by laypersons or medical professionals. In several large investigations, the
prompt delivery of CPR served as a important predictor of survivalbystander
CPR may almost double the chance of survival.5-7 Other work has shown that the
probability of survival from cardiac arrest falls by 1015% per minute without
treatment, and well performed CPR likely shifts this curve towards higher
probability of survival. Furthermore, recent investigations have suggested that CPR
maintains the heart in a state favorable for defibrillation.8,9 That is, fatal cardiac
arrhythmias common in cardiac arrest have a greater chance of being successfully
terminated by electrical shock if CPR is performed first. A recent randomized trial
in Norway suggested that in cases of prolonged cardiac arrest, delaying
defibrillation in order to first provide several minutes of CPR significantly
improved patient survival.10 Not only can prompt CPR make an important impact
on outcomes, but the quality of CPR appears to matter greatly.5

Recent work has also shown that during actual human CPR, shallow
chest compressions have an adverse impact on outcomes.9 Therefore, it is crucial
that CPR be performed in accordance with published guidelines, which are
formulated based on the best available data and updated every five years.3 Given
the importance of CPR quality, it is perhaps surprising that the performance of

CPR has only recently been assessed during actual cases of cardiac arrest. In a
number of investigations over the past few years, CPR quality was found to be
lacking during both in-hospital and out-of-hospital cardiac arrest, both in Europe
and the US.11-15 In other words, poor CPR quality is endemic. In general, chest
compressions are delivered too slowly and in too shallow a fashion, and
ventilations are given too rapidly. There are several reasons why this might be the
case despite the best intentions of providers. 3

First, CPR is deceptively simple to describe and remarkably difficult to

perform, as humans generally do not have a good internal sense of timing to
recognize 100 compressions or 812 ventilations per minute, and fatigue often
prevents adequate depth efforts. Second, CPR is taught in the sterile conditions of a
classroom, but performed in the volatile environment of a dramatically ill person
surrounded by anxious onlookerstraining can be easily forgotten in the panic of
the moment, especially if that training has not taken place recently.

It is clear

from a variety of data that the majority of cardiac arrest patients do not receive
CPR at all until the arrival of medical personnel precious minutes after the onset of
arrest.

CPR training must be simplified and widely disseminated. Why, for

example, can we not require CPR competence as a prerequisite for a drivers
license, or provide CPR training to every parent during the hospital stay before the
birth of their child or before they leave the hospital with their newborn.3

Benjamin S Abella, MD, MPhil, is currently Assistant Professor of

Emergency Medicine at the University of Chicago, where he also serves as Chair
of the Hospital CPR Committee. Dr Abella maintains an active research program in
cardiac arrest and resuscitation care, including clinical projects evaluating
cardiopulmonary resuscitation (CPR) quality. Dr Abella is a recipient of research
funding from the National Institutes of Health (NIH), Laerdal Medical Corporation
and Philips Medical Systems, and has consulted on cardiac arrest topics for a
variety of academic and commercial organizations. He will soon take a position at
the University of Pennsylvania, where he will continue his clinical work and
research as a member of the new Center for Resuscitation Science.

CONCLUSION
Cardiopulmonary resuscitation is a procedure to support and maintain
breathing and circulation for a person who has stopped breathing [respiratory
arrest] and or whose heart has stopped. CPR is performed to restore and maintain
breathing and circulation and to provide oxygen and blood flow to the heart, brain,
and other vital organs. CPR can be performed by trained bystanders or healthcare
professionals on infants, children, and adults. It should always be performed by the
person on the scene who is most experienced in CPR.1
When a person develops cardiac arrest, the heart stops beating, and the
person becomes unresponsive and stops breathing normally. Sudden cardiac deaths
account for more than 40-45% of cardio vascular deaths in India, 75% of the
people who die of sudden cardiac arrest shows signs of a coronary artery disease.
In India the annual incidence of sudden cardiac death account for 0.55 per 1000
population. In India, in the year 2009 6,16,067 people died of heart disease. The
earlier you give CPR to person in cardio pulmonary arrest [no breathing, no heart
beat], the greater the chance of a successful resuscitation. Because up to 80% of all
cardiac arrests occur in the home.2
CPR may be necessary during many different emergences. Approximately 1,00,000
people die annually as a result of accidents such as drowning, suffocation,

electrocution, drug overdose, automobile accidents, fires, and poisoning. Medical

research and practical experience confirms that a significant number of these
fatalities estimated at approximately 20% could have been prevented if prompt and
proper cardiopulmonary resuscitation has been applied on the scene. India has the
highest number of road accidents in the world. According to National Crime
Records Bureau [NCRB, 2006figures] Tamil Nadu [14% of all accidents] and
Maharashtra [12.4%] have the maximum accidents in the country. Majority of the
deaths due to accidents occurs during the transportation of the victim to hospital.
Many deaths can be averted and disability can be limited by providing CPR
education services before taking the victim to hospital.3

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American

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