Hamilton Rosemary
Newham University Hospital NHS Trust, Newham University Hospital, London, UK.
J Adv Nurs. 2005 Aug;51(3):288-97. doi: 10.1111/j.1365-2648.2005.03491.x.
This paper reports a literature review examining factors that enhance retention of knowledge and skills during and after resuscitation training, in order to identify educational strategies that will optimize survival for victims of cardiopulmonary arrest.
Poor knowledge and skill retention following cardiopulmonary resuscitation training for nursing and medical staff has been documented over the past 20 years. Cardiopulmonary resuscitation training is mandatory for nursing staff and is important as nurses often discover the victims of in-hospital cardiac arrest. Many different methods of improving this retention have been devised and evaluated. However, the content and style of this training lack standardization.
A literature review was undertaken using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and British Nursing Index databases and the keywords 'cardiopulmonary resuscitation', 'basic life support', 'advanced life support' and 'training'. Papers published between 1992 and 2002 were obtained and their reference lists scrutinized to identify secondary references, of these the ones published within the same 10-year period were also included. Those published in the English language that identified strategies to enhance the acquisition or retention of Cardiopulmonary resuscitation skills and knowledge were included in the review.
One hundred and five primary and 157 secondary references were identified. Of these, 24 met the criteria and were included in the final literature sample. Four studies were found pertaining to cardiac arrest simulation, three to peer tuition, four to video self-instruction, three to the use of different resuscitation guidelines, three to computer-based learning programmes, two to voice-activated manikins, two to automated external defibrillators, one to self-instruction, one to gaming and the one to the use of action cards.
Resuscitation training should be based on in-hospital scenarios and current evidence-based guidelines, including recognition of sick patients, and should be taught using simulations of a variety of cardiac arrest scenarios. This will ensure that the training reflects the potential situations that nurses may face in practice. Nurses in clinical areas, who rarely see cardiac arrests, should receive automated external defibrillation training and have access to defibrillators to prevent delays in resuscitation. Staff should be formally assessed using a manikin with a feedback mechanism or an expert instructor to ensure that chest compressions and ventilations are adequate at the time of training. Remedial training must be provided as often as required. Resuscitation training equipment should be made available at ward/unit level to allow self-study and practice to prevent deterioration between updates. Video self-instruction has been shown to improve competence in resuscitation. An in-hospital scenario-based video should be devised and tested to assess the efficacy of this medium in resuscitation training for nurses.
本文报告一项文献综述，探讨在复苏培训期间及之后增强知识和技能保留的因素，以确定能优化心肺骤停受害者生存率的教育策略。
在过去20年中，已有文献记载医护人员进行心肺复苏培训后知识和技能保留情况不佳。心肺复苏培训对护理人员来说是强制性的，且很重要，因为护士常常是院内心脏骤停患者的发现者。人们已经设计并评估了许多不同的方法来改善这种知识和技能的保留情况。然而，这种培训的内容和方式缺乏标准化。
使用护理学与健康相关学科累积索引数据库、医学文献数据库及英国护理索引数据库进行文献综述，关键词为“心肺复苏”“基础生命支持”“高级生命支持”和“培训”。获取了1992年至2002年发表的论文，并仔细查阅其参考文献列表以识别二次参考文献，其中在同一10年期间发表的也被纳入。纳入综述的文献需为英文撰写且确定了增强心肺复苏技能和知识获取或保留的策略。
共识别出105篇一次参考文献和157篇二次参考文献。其中，24篇符合标准并被纳入最终文献样本。发现4项研究涉及心脏骤停模拟，3项涉及同伴辅导，4项涉及视频自学，3项涉及使用不同的复苏指南，3项涉及基于计算机的学习程序，2项涉及语音激活人体模型，2项涉及自动体外除颤器，1项涉及自学，1项涉及游戏，1项涉及使用行动卡片。
复苏培训应基于院内场景和当前基于证据的指南，包括识别患病患者，并且应使用各种心脏骤停场景的模拟进行教学。这将确保培训反映护士在实际工作中可能面临的潜在情况。临床科室中很少见到心脏骤停情况的护士应接受自动体外除颤培训并能使用除颤器，以防止复苏延误。应使用带有反馈机制的人体模型或专家教员对工作人员进行正式评估，以确保培训时胸外按压和通气充分。必须根据需要随时提供补救培训。应在病房/科室层面提供复苏培训设备，以便进行自学和练习，防止技能在更新之间退化。视频自学已被证明可提高复苏能力。应设计并测试基于院内场景的视频，以评估这种媒介在护士复苏培训中的效果。
