An innovative resuscitation training strategy for primary care nurses: feasibility study for a randomised controlled trial

Chalk, A

Abstract

Unexpected cardiac arrest remains a significant cause of out-of-hospital death world-wide, and prompt recognition of cardiac arrest and initiation of resuscitation is the predominating factor in quadrupling survival from out-of-hospital cardiac arrest. Patients with more complex needs are being cared for in primary care, yet primary care nurses lack access to a dedicated cardiac arrest team. An annual resuscitation training interval is frequently recommended, but the optimum resuscitation training interval is not known. Globally, resuscitation knowledge and skill retention is notoriously poor, and skills decay takes place well before the commonly adopted 12 month re-training interval.

The primary aims were to develop and refine a new intervention with involvement of relevant stakeholders, determining the feasibility and acceptability of proposed study procedures and outcome measures. The secondary aim was to determine whether useful data were likely to result from the main study. The intended outcome was that the following post-doctoral, statistically-powered, full-scale randomised controlled trial to assess the effect of the new resuscitation training intervention will deliver maximum benefit. The development of a cost-effective, optimal model of resuscitation training should provide the best care for patients, resulting in more lives being saved.

A stakeholder meeting gained consensus on the design of the strategy, content, delivery method and frequency of training, consistent with current Resuscitation Council UK guidelines. Consensus from the stakeholder meeting was the addition of the Lifesaver app as the intervention. A mixed methods design was adopted. Participants engaged in a scenario using a manikin and a scenario from the Lifesaver app to demonstrate resuscitation including defibrillation skills. Quantitative data were collected using the Lifesaver app, scenario observations sheets, QCPR app and questionnaires. Narrative data were elicited at each visit from a short, in-person focused interview. The study was conducted at a variety of NHS sites.

Sampling worked well. Additional primary care roles were included during recruitment due to demand and feedback from participants. All data collection modes were effective and resulted in robust data. Minor changes were highlighted for the main study: removing ambiguity from the true/false questionnaire and improving the layout of the this and the observation sheet for easier completion. Participants were positive about the interactive app as the intervention. Debriefing was essential, and participants valued repeated practice as unconscious competence was revealed. Resuscitation knowledge and skills were maintained over time. Modifications to the study necessitated by the COVID-19 pandemic allowed the study to continue. This will inform essential training during future pandemics.

The procedures used in this study were deemed to be feasible and acceptable, such that the main study can proceed. Application of the intervention at three-monthly intervals promoted maintenance of resuscitation knowledge and skills over time. This suggests sufficient justification to proceed to the main intervention study.

Citation

Chalk, A. An innovative resuscitation training strategy for primary care nurses: feasibility study for a randomised controlled trial. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Feb 2, 2023
• Publicly Available Date: Mar 2, 2023
• Award Date: Jun 28, 2022