Current Care Guidelines for Cardiopulmonary Resuscitation : Implementation, skills and attitudes

Background: The national resuscitation guidelines were published in Finland in 2002 and are based on international guidelines published in 2000. The main goal of the national guidelines, available on the Internet free of charge, is early defibrillation by nurses in an institutional setting. Aim: To study possible changes in cardiopulmonary resuscitation (CPR) practices, especially concerning early defibrillation, nurses and students attitudes of guideline implementation and nurses and students ability to implement the guideline recommendations in clinical practices after publication of the Current Care (CC) guidelines for CPR 2002. Material and methods: CPR practices in Finnish health centres; especially concerning rapid defibrillation programmes, as well as the implementation of CC guidelines for CPR was studied in a mail survey to chief physicians of every health centre in Finland (Study I). The CPR skills using an automated external defibrillator (AED) were compared in a study including Objective stuctured clinical examination (OSCE) of resuscitation skills of nurses and nursing students in Finnish and Swedish hospital and institution (Studies II, III). Attitudes towards CPR-D and CPR guidelines among medical and nursing students and secondary hospital nurses were studied in surveys (Studies IV, V). The nurses receiving different CPR training were compared in a randomized trial including OSCE of CPR skills of nurses in Finnish Hospital (Study VI). Results: Two years after the publication, 40.7% of Finnish health centres used national resuscitation guidelines. The proportion of health centres having at least one AED (66%) and principle of nurse-performed defibrillation without the presence of a physician (42%) had increased. The CPR-D training was estimated to be insufficient regarding basic life support and advanced life support in the majority of health centres (Study I). CPR-D skills of nurses and nursing students in two specific Swedish and Finnish hospitals and institutions (Study II and III) were generally inadequate. The nurses performed better than the students and the Swedish nurses surpassed the Finnish ones. Geriatric nurses receiving traditional CPR-D training performed better than those receiving an Internet-based course but both groups failed to defibrillate within 60 s. Thus, the performance was not satisfactory even two weeks after traditional training (Study VI). Unlike the medical students, the nursing students did not feel competent to perform procedures recommended in the cardiopulmonary resuscitation guidelines including the defibrillation. However, the majority of nursing students felt confident about their ability to perform basic life support. The perceived ability to defibrillate correlated significantly with a positive attitude towards nurse-performed defibrillation and negatively with fear of damaging the patient s heart by defibrillation (Study IV). After the educational intervention, the nurses found their level of CPR-D capability more sufficient than before and felt more confident about their ability to perform defibrillation themselves. A negative attitude toward defibrillation correlated with perceived negative organisational attitudes toward cardiopulmonary resuscitation guidelines. After CPR-D education in the hospital, the majority (64%) of nurses hesitated to perform defibrillation because of anxiety and 27 % hesitated because of fear of injuring the patient. Also a negative personal attitude towards guidelines increased markedly after education (Study V). Conclusions: Although a significant change had occurred in resuscitation practices in primary health care after publication of national cardiopulmonary resuscitation guidelines the participants CPR-D skills were not adequate according to the CPR guidelines. The current way of teaching is unlikely to result in participants being able to perform adequate and rapid CPR-D. More information and more frequent training are needed to diminish anxiety concerning defibrillation. Negative beliefs and attitudes toward defibrillation affect the nursing students and nurses attitudes toward cardiopulmonary resuscitation guidelines. CPR-D education increased the participants self-confidence concerning CPR-D skills but it did not reduce their anxiety. AEDs have replaced the manual defibrillators in most institutions, but in spite of the modern devices the anxiety still exists. Basic education does not provide nursing students with adequate CPR-D skills. Thus, frequent training in the workplace has vital importance. This multi-professional program supported by the administration might provide better CPR-D skills. Distance learning alone cannot substitute for traditional small-group learning, tutored hands-on training is needed to learn practical CPR-D skills. Standardized testing would probably help controlling the quality of learning. Training of group-working skills might improve CPR performance.Suomessa julkaistiin ensimmäinen kansallinen elvytyssuositus vuonna 2002 Lääkäriseura Duodecimin Käypä hoito suositus sarjassa. Suositus on näyttöön perustuva ja se pohjautuu pitkälti kansainväliseen elvytyssuositukseen. Varhainen defibrillaatio hoitolaitoksissa on osa suosituksen keskeistä sanomaa. Suositus on vapaasti luettavissa internetin www. sivuilla. Hoitosuositusten, kuten suomalaisten Käypä hoito suositusten, tarkoituksena on parantaa hoidon laatua ja vähentää tarpeetonta vaihtelua hoidossa hoidonantajien ja hoitopaikkojen välillä. Suosituksia on viime vuosikymmeninä lisääntyvästi laadittu kaikissa länsimaissa, mutta suositusten noudattamisessa on huomattavia osin tuntemattomista syistä johtuvia puutteita. Yksi syy suositusten vastaiseen toimintaan on epävarmuus suositusten noudattamisen vaikutuksista hoidon tulokseen. Tämän kuudesta jo julkaistusta osatutkimuksesta koostuvan väitöskirjatutkimuksen tarkoitus oli tuottaa tietoa kansallisen hoitosuosituksen implementoinnista ja selvittää sen vaikutuksia hoitokäytäntöihin. Osatutkimusten tavoitteena oli selvittää hoitosuosituksen käyttöönottoa, potilashoitoon osallistuvien terveydenhuollon ammattiryhmien peruselvytystaitoja sekä selvittää vaikutuksia elvytysvalmiuksiin ja asenteisiin perustuen edellä mainittuun elvytyksen Käypä hoito -suositukseen. Suosituksen mukaan kaikkien potilashoitoon osallistuvien tulisi pystyä peruselvytykseen mukaan lukien defibrillointi puoliautomaattisella defibrillaattorilla Suomalaisten terveyskeskusten elvytyskäytäntöjä selvitettiin 2004 terveyskeskusten johtaville lääkäreille osoitetulla kyselylomakkeella. Tutkimus osoitti, että 40.7 % terveyskeskuksista oli käytössä elvytyksen Käypä hoito suositus. Puoliautomaattisten defibrillaattorien määrä oli noussut ja noin 20.0 % terveyskeskuksista pyrittiin varhaiseen defibrillaatioon. Elvytyskoulutusta järjestettiin, mutta se oli harvoin säännöllistä tai riittävää. Hoitohenkilökunnan peruselvytystaitoja selvitettiin testaamalla elvytysvalmiuksia strukturoidulla OSCE testillä ja vertaamalla peruskoulutuksen sekä työelämän antamia valmiuksia hoitosuosituksen mukaiseen elvytykseen Ruotsissa ja Suomessa. Tutkimus osoitti, että elvytystaidot olivat yleisesti heikot. Työelämässä toimivilla hoitajilla oli paremmat elvytystaidot verrattuna vastavalmistuneisiin opiskelijoihin. Tutkimus osoitti myös, että ruotsalaisten hoitajien valmiudet suosituksen mukaiseen elvytykseen olivat suomalaisten hoitajien valmiuksia paremmat. Peruselvytystaitoja selvitettiin myös Käypä hoito suositukseen liittyvän kahden erilaisen koulutuksen jälkeen satunnaistetussa tutkimuksessa. Tutkimus osoitti, että internet kurssi ei yksinään voi korvata perinteistä pienryhmä opetusta, ohjattua harjoittelua tarvitaan elvytystaitojen oppimiseen. Asenteita hoitosuosituksia ja elvytystilanteita kohtaan selvitettiin lääketieteen ja sairaanhoidon opiskelijoille sekä hoitajille osoitetulla kyselylomakkeella. Tutkimus osoitti, että toisin kuin lääketieteen opiskelijat, sairaanhoidon opiskelijat eivät olleet saavuttaneet riittäviä valmiuksia elvytyssuosituksen mukaiseen elvytykseen defibrillointi mukaan lukien. Hoitajien asenteita ja kokemuksia selvitettiin ennen ja jälkeen Käypä hoito suositukseen liittyvää koulutusta. Tutkimus osoitti, että koulutus lisäsi hoitajien luottamusta omiin taitoihin mutta ei vähentänyt elvytystilanteeseen liittyvää ahdistuksesta tai potilaan vahingoittamisen pelosta aiheutuvaa epäröintiä. Elvytyksen Käypä hoito suosituksen julkaisemisen jälkeen elvytyskäytäntöihin on tehty huomattavia muutoksia. Elvytyskoulutuksen järjestäminen terveyskeskuksessa oli kuitenkin vielä riittämätöntä eivätkä elvytysvalmiudet olleet suosituksen vaatimalla tasolla. Nykyinen elvytysopetus ja harjoittelu eivät takaa varhaisen defibrillaation toteutumista

"Kuule vielä toiveeni" : Kuolevan potilaan toiveet

Kuolevan potilaan on tärkeä kokea, että hän on arvokas ihmisenä ja hänen loppuelämänsä on laadukas. Potilas tulee huomioida toiveineen kokonaisvaltaisesti. Potilaan toiveet sisältävät usein myös toivoa, mikä on keskeinen tekijä potilaan senhetkisessä elämässä. Opinnäytetyömme tarkoituksena oli kuvata, millaisia toiveita kuolevilla potilailla oli elämänsä loppuvaiheessa. Opinnäytetyön aineisto hankittiin elämänkertakirjallisuudesta. Opinnäytetyö tehtiin laadullisella menetelmällä ja analysoitiin sisällönanalyysi-menetelmällä. Opinnäytetyömme tuloksena kuolevat potilaat esittivät paljon toiveita läheisil-leen ja hoitohenkilökunnalle. Potilaiden toiveet liittyivät elämänarvoihin, ihmis-suhteisiin, hoitoon, aikaperspektiiviin ja eksistentiaaliseen ahdistukseen. Sairastumisen vastapainoksi potilaat toivoivat elämäänsä iloa ja elämyksiä. Opinnäytetyömme tulokset toivat esille tietoa kuolevien potilaiden toiveista, joi-den avulla potilaiden toiveiden kuulemista voidaan kehittää.It is important for dying patients to experience, that they are valued and the rest of their lives is of good quality. Every aspect of the patients and their wishes should be paid attention to. Most wishes include hope, which is an important factor in patiens’ lives. The aim of this study was to describe what kind of wish-es dying patients have. The Bachelor’s thesis was conducted using qualitative research method. The material was collected from biography literature. The collected material was analysed with the help of a content analysis. According to the results of the study, dying patients have wishes wich they tell to their nearest ones and nurses. The wishes were connected to life values, relations, care, time perspective and the existential anxiety. Dying patients wished for happiness and experiences in their end of lives. The results of this thesis revealed what kind of wishes dying patients have, and they can be utilized in developing the hearing of patients’ last wishes

The effects of interprofessional education - Self-reported professional competence among prehospital emergency care nursing students on the point of graduation - A cross-sectional study

The aim of the study was to investigate whether interprofessional education (IPE) and interprofessional collaboration (IPC) during the educational program had an impact on prehospital emergency care nurses' (PECN) self-reported competence towards the end of the study program. A cross-sectional study using the Nurse Professional Competence (NPC) Scale was conducted. A comparison was made between PECN students from Finland who experienced IPE and IPC in the clinical setting, and PECN students from Sweden with no IPE and a low level of IPC. Forty-one students participated (Finnish n = 19, Swedish n = 22). The self-reported competence was higher among the Swedish students. A statistically significant difference was found in one competence area; legislation in nursing and safety planning (p <0.01). The Finnish students scored significantly higher on items related to interprofessional teamwork. Both the Swedish and Finnish students' self-reported professional competence was relatively low according to the NPC Scale. Increasing IPC and IPE in combination with offering a higher academic degree may be an option when developing the ambulance service and the study program for PECNs. (C) 2017 Elsevier Ltd. All rights reserved.Peer reviewe

Pre-hospital suPAR, lactate and CRP measurements for decision-making : a prospective, observational study of patients presenting non-specific complaints

Publisher Copyright: © 2021, The Author(s).Background: In the pre-hospital setting, non-urgent patients with non-specific chief complaints pose assessment challenges for the emergency medical systems (EMS). Severely ill patients should be identified among these patients, and unnecessary transport to the emergency department (ED) should be avoided. Unnecessary admissions burden EDs, deplete EMS resources and can even be harmful to patients, especially elderly patients. Therefore, tools for facilitating pre-hospital decision-making are needed. They could be based on vital signs or point-of-care laboratory biomarkers. In this study, we examined whether the biomarker soluble urokinase plasminogen activator receptor (suPAR), either alone or combined with C-reactive protein (CRP) and/or lactate, could predict discharge from the ED and act as a pre-hospital support tool for non-conveyance decision-making. Methods: This was a prospective, observational study of adult patients with normal or near-normal vital signs transported by an EMS to an ED with a code referring to deteriorated general condition. The levels of suPAR, CRP and lactate in the patients’ pre-hospital blood samples were analysed. The values of hospitalized patients were compared to those of discharged patients to determine whether these biomarkers could predict direct discharge from the ED. Results: A total of 109 patients (median age: 81 years) were included in the study. Of those, 52% were hospitalized and 48% were discharged from the ED. No statistically significant association was found between suPAR and the ED discharge vs hospitalization outcome (OR: 1.04, 95% CI 0.97–1.13, AUROC: 0.58, 95% CI 0.47–0.69). Adding CRP (AUROC: 0.64, 95% CI 0.54–0.75) or lactate (AUROC: 0.60, 95% CI 0.49–0.71) to the regression models did not improve their diagnostic accuracy. None of the patients with a suPAR value of less than 2 ng/ml were admitted to hospital, while 64% of the patients with a suPAR value of more than 6 ng/ml were hospitalized. Conclusion: Pre-hospital suPAR measurements alone or combined with CRP and/or lactate measurements could not predict the ED discharge or hospital admission of 109 non-urgent EMS patients with non-specific chief complaints and normal or near-normal vital signs.Peer reviewe

Framing Smart Meter Feedback in Relation to Practice Theory

Smart metering is advancing rapidly and consumption feedback from smart meters is expected to help residents to reduce their energy and water consumption. In recent years, more critical views have been expressed based on theories of social practice, arguing that smart meter feedback ignores the role of various mundane practices where energy and water are consumed and instead targets individuals as active decision-makers. We present a review of qualitative studies on smart meter feedback and results of a survey to European smart metering projects. We argue that theories of social practice can be used to reframe the challenges and potentials of smart meter feedback that have been identified in the literature and our survey. This presents challenges of smart meter feedback as resulting from normalised resource intensive practices rather than from uninterested and comfort-loving individuals. Potentials of improving the effectiveness of smart meter feedback relate to supporting communities and peer-learning and combining smart meter feedback with micro-generation of renewable energy. This has implications for how domestic energy and water consumption is targeted by policy.Peer reviewe

Finnish and Swedish prehospital emergency care providers' knowledge and attitudes towards pressure ulcer prevention

Background: Despite the knowledge that transportation by emergency medical services may increase the risk of pressure ulcers (PU), there is still lack of knowledge about the possibility of prehospital emergency care providers to be a part of preventing and reducing the risk of PUs. Methods: A survey was carried out during 2017 in Finland and Sweden. Validated questionnaires were used. Results: A total of 179 (72.7%) Finnish and 188 (28.8%) Swedish prehospital emergency care providers participated in the study. The overall rate of correct answers and the mean total knowledge score was 58.8% (SD 21.8), 20/34, in the Finnish group and 70.5% (SD 15.7), 24/34, in the Swedish group (p < 0.000). The percent of the total and the mean attitude score was in the Finnish group 71.3% (SD 0.48), 37.1/52, and in the Swedish group 69.4% (SD 0.77), 36.1/52 (p < 0.813). Half of the Finnish and most of the Swedish participants felt they needed more education about PUs (Fin 50.2% & Swe: 76.0%). Conclusions: Prehospital emergency care providers don't see themselves as responsible for PU prevention. Therefore, there is a need for increasing the level of knowledge on PU prevention and classification among prehospital emergency care providers. They could play a key role in developing methods to improve PU prevention and identifying patients in risk of developing PUs.Peer reviewe