<MASTER IN EDUCATION>

<SEPTEMBER/2022>

<HMEE5043>

< SEMINAR PAPER IN EDUCATIONAL MANAGEMENT >

MATRICULATION NO : <CGS02267006>
IDENTITY CARD NO. : <820212085442>
TELEPHONE NO. : <0125808872>
E-MAIL : <chongmeiteen@oum.edu.my >
LEARNING CENTRE : <JOHOR BAHRU LEARNING>
Factors Affecting Nurses to Perform High Quality Chest Compression during
CardioPulmonary Resuscitation cluster KPJ’s ICU

TABLE OF CONTENTS PAGE

ABSTRACT 1
INTRODUCTION 2
PROBLEM STATEMENT 2
RESEARCH OBJECTIVE 3
RESEARCH QUESTIONS 3
LITERATURE REVIEW 3-7
THEORETICAL / CONCEPTUAL FRAMEWORK 8
RESEARCH METHODOLOGY 9
CONCLUSION 10

Abstract
Background: High Quality Chest Compression have been established since year 2010 to
2015 under announcement of American Heart Association (AHA). Depth of compression
for adult victim is at least 5cm but not more than 6cm. Objective: To identified the
factors affecting nurse’s performance for high quality Chest Compression during the
event of Cardiopulmonary Resuscitation (CPR). Research Question: What are the
factors affecting nurses to perform high quality of chest compression during
Cardiopulmonary Resuscitation (CPR) in the event of patient’s cardiopulmonary arrest?
Method: 6 to 10 State Registered Nurse was enrolled to this study from Intensive Care
Unit which have valid Basic Life Support certificate using Qualitative research
methodology. Conclusion: Nurses, mostly will be the first responder during an event of
cardiac arrest. It is important to clear their doubt and increase their competent level by
practical and also gain their basic knowledge towards what is high quality of chest
compression and what should they apply to.

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Introduction
In cases of cardiac arrest, suffocation, near drowning, electrical injuries or any situation
when a victim's respiration or circulation completely stopped, cardiopulmonary
resuscitation (CPR) may be required to save the victim's life. Cardiopulmonary
Resuscitation is the must know technique for all qualified State Registered Nurse no
matter in Malaysia or over sea. Under American Heart Association year 2020 guideline,
High quality CPR include of the depth of chest compression at least 5cm but not more
than 6cm in adult, Compression’s rate between 100 to 120 compression per minutes,
allow complete chest recoil after each chest compression, Minimal interruption during
chest compression and avoid excessive ventilation. (AHA,2020).
Cardiopulmonary arrest patients must receive effective CPR in order to survive. Each
minute that CPR is delayed decreases the likelihood of survival in cardiac arrest by 7–
10%. One of the signs of cardiac arrest that calls for CPR is blood circulation failure
brought on by a cardiac issue. Failed to perform CPR in case of emergency may lead to
irreversible brain death.

Problem statement
Majority of State registered Nurse has the mindset of body weight as a rescuer play an
importance role during Cardiac arrest event or during cardiopulmonary resuscitation. But
the fact which they should remember is that the correct technique in performing high
quality of chest compression was crucial during any event of chest compression. Practice
make perfect are always the slogan to be used for most of the practical or hands on
session. the present study was to explore the factors affecting nurses to perform high
quality of chest compression during Cardiopulmonary Resuscitation (CPR) in the event
of patient’s cardiopulmonary arrest. Cluster ICU in KPJ’s Healthcare represent the
study's domain. Six to Ten Qualified State Registered Nurse was enrolled to this study
from Intensive Care Unit who have valid Basic Life Support certificate by using
Qualitative research methodology.
This study is based on primary data, which has collected with open ended questionnaire
through personal interview session with the responder and the responder identity will be
confidential.

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Research Question
This study focuses on the investigation of the main question:
What are the factors affecting nurses to perform high quality of chest compression during
Cardiopulmonary Resuscitation (CPR) in the event of patient’s cardiopulmonary arrest?

Using the following sub-questions, this question has been addressed:

1. What have come across in your mind, when we take about CPR?
2. What do you understand about high quality of chest compression during CPR?
3. Are there any challenges in performing high quality of chest compression?
4. How to overcome all this challenges?

The objective of this study is to find out the factors affecting nurses in performing high
quality of chest compression during CPR in the event of cardiopulmonary arrest?

Literature Review
In the first article published by Guetta M (2022), is to identified the Factors Affecting
Cardiopulmonary Resuscitation Practice Among Nurses in Mizan Tepi University
Teaching Hospital, Tepi General Hospital, and Gebretsadik Shawo Hospital, Southwest
Ethiopiahe. The researcher using both quantitative and qualitative research methodology
for data collection. For quantitative research methodology, the researcher used
institution-based cross-sectional study and was supported by qualitative data which
conducted from March 20 to April 20, 2021 in the three hospitals which provide surgical,
gynecological and obstetric, general medical, pediatrics, minor and major operations,
ophthalmologic and diagnostic services. A total of 100% of the 422 nurses who worked
in the three hospitals that were chosen responded. 250 of them (or 59.2%) were women,
and 172 (or 40.8%) were men.
In the chosen hospitals, the proportion of nurses who practiced good CPR was 31.8%
(95% CI: 27.5-36.3). The results were less than those of a study conducted in Nigeria,
which indicated that 65.2% of study participants had practiced CPR while 34.80% had
not. Due to their inability to recall facts crucial to performing CPR, the majority of study
participants in this study did not receive adequate instruction. Cardiopulmonary

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resuscitation-related knowledge was determined to be at a good level in 70.2% of people.
The outcome was consistent with research conducted at Wolaita Sodo Teaching Hospital.
The similarities in the settings and participant profiles of the two studies could be the
cause, according to one theory. Additionally, both investigations made use of the same
tool. This study demonstrates a relationship between experience and good CPR
technique. In comparison to nurses with 1 to 5 years of experience, nurses with work
experience of 6 to 10 years and >10 years were twice as likely to have strong CPR
practice, respectively. As a conclusion, in terms of cardiopulmonary resuscitation, good
practice was prevalent in 31.8% of cases. Being assigned to the emergency department,
having a nursing degree, having experience between 6 and 10 years and more than 10
years, being actively or frequently involved in cardiopulmonary resuscitation, having
good CPR knowledge, and maintaining these characteristics were all indicators of good
CPR practice. Cardiopulmonary resuscitation was not routinely practiced by nurses.
Nurses should improve knowledge and skills of cardiopulmonary resuscitation.

The second research paper was published by Filho et al in year 2015, the objective of the
study was to identified the perceptions of nurses for the factors affecting quality
cardiopulmonary resuscitation in in-patient units and investigate the influence of both
work shifts and professional experience length of time in perception of these factors. The
nurses' sociodemographic and professional profiles, as well as their perceptions of caring
for patients that arrive at the hospital, were covered in a questionnaire with closed-ended
questions that was used to gather the data. Experienced nurses working in adult medical
and surgical wards who had helped at least one arrested patient there and who signed an
informed consent form indicating their willingness to participate in the study were chosen
as participants. Total of 49 responder who were invited to participate in the study. As a
result, the majority of nurses who the presence of family members at the start of cardiac
arrest support (57.1%) and the high number of professionals in the scenario (75.5%), as
well as staff unhappiness (77.6%) and stress (67.3%), a lack of materials and/or
equipment failure (57.1%), a lack of knowledge with the emergency trolleys (98.0%), are
all variables that have a negative impact on the standard of care given during CPR.
Longevity of professional experience and nurses' shifts had no effect on how these factors

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were perceived. It been concluded in this study has discovered that, in the opinion of the
nurses, the primary characteristics that adversely affect the quality of CPR in adult
inpatient units are: a high number of professionals on the scenario, disagreement or stress
of any staff member, a lack of materials and/or equipment failure, a lack of familiarity
with the emergency trolley, and the presence of a family member at the beginning of
attendance. The presence of a leader enhances the quality of CPR, according to experts,
and personal conflict does not interfere with one's effectiveness when providing care. The
nurses' work shift and the length of their professional experience had no bearing on how
these elements were perceived.

In the third research paper done by Rahman N et al which published in year 2013, id
regarding multicenter controlled trial on knowledge and attitude about cardiopulmonary
resuscitation among secondary school children in Malaysia. The objective is to determine
the effectiveness of CPR training on knowledge and attitude about Basic Life Support
(BLS) among secondary school children in the district of Kota Bharu, Malaysia. Six
schools were chosen to take part in the study, which was carried out over a six-month
period. A control group of three schools and an intervention group of three other schools
were chosen. Through a process of randomization amongst form three and four classes,
the schools and classes from the designated schools were picked. The following were the
inclusion and exclusion standards:
inclusion criteria: Written parental or guardian consent; all participants were chosen at
random from forms two, three, and four of secondary schools; Students who missed class
on the day of the selection are excluded. who refused to give their permission for their
children to participate in this study as parents or guardians. pupils at boarding schools.
colleges for the disabled. The selected secondary school students from six different
schools in the Kota Bharu district received a total of 477 questionnaires. During the pre-
intervention study, there were 256 respondents in the intervention group and 226
respondents in the control group. The response rate for the intervention group was 96%,
compared to 98% for the control group. For the intervention and control groups, the mean
(SD) total knowledge scores were 62.43 and 62.29, respectively (maximum score 72) (p
> 0.05). On the other hand, the intervention and control groups' respective mean (SD)

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total attitude scores were 19.33 and 17.85, with the maximum score 28 (p 0.001). The
intervention and control groups' mean knowledge and attitude ratings were significantly
different with regard to time (pre- and post-intervention). Between the two study groups,
there were 8.31 (p 0.001) and 2.39 (p 0.001) median differences in knowledge and
attitude scores, respectively. As a conclusion, it has been demonstrated that secondary
school students had adequate levels of CPR knowledge and attitudes prior to the
intervention. Additionally, compared to individuals who had never received instruction,
their attitudes and level of knowledge had dramatically improved after the CPR training
session. Finally, we have persuaded higher authorities that CPR instruction for
schoolchildren should begin right away for a brighter future.

In the fourth paper done by Chelladurai G et al which published in year 2022, was study
on Improving cardiopulmonary resuscitation (CPR) performance using an audio-visual
feedback device for healthcare providers in an emergency department setting in Malaysia.
The objective of this study was to determine the efficacy of an AV CPR feedback device
in improving the quality of CPR delivered by healthcare providers working in an ED in
Malaysia. 140 healthcare professionals working in the emergency department of Hospital
Ampang in Malaysia were randomly selected for a pre-post, single-arm, quasi-
experimental study. The hospital's medical personnel were used to choose for study
participants. Both having a current CPR certification and being an ED staff member who
is classified as a healthcare practitioner were requirements for inclusion. Employees who
had been away from their jobs for longer than six months and those with physical
limitations or illnesses that limited their physical activity were excluded from the study.
The main tool for measuring the results was an AV CPR feedback device with real-time
audio-visual feedback prompt (ZOLL R series Serial No: AF15H048510; ZOLL Medical,
Chelmsford, MA), which monitored the compression rate (chest compression/min) and
compression depth (cm). On a training manikin (AmbuMan mannikin, Ambu;
Copenhagen, Denmark) that was set up on a flat, hard surface without any feedback cues,
participants first did five cycles of 30 chest compressions. Following a 10-minute break,
participants were instructed and given an orientation on how to use the AV CPR feedback
device before conducting five additional cycles of 30 chest compressions on the same

6
manikin while using the device. The device served as the intervention component of the
study during this part of the implementation process by giving the healthcare provider
administering CPR real-time audiovisual feedback instructions. As a result, only 38.6%
of research participants met the chest compression depth criterion when AV input was
not given to them. Additionally, only 39.3% of them reached the 100–120 compressions
per minute chest compression rate advised by the AHA guidelines. However, statistically
significant gains were seen when the AV feedback device was used; chest compression
improved by 46.4% to 85.0% and chest compression rate by 47.1% to 86.4%,
respectively. Numerous initiatives have been developed to close the gap in the delivery of
health services caused by the low retention of CPR skills despite having training in basic
life support. This study's findings suggest that using an AV feedback device during
mannikins-based CPR training can considerably increase the depth and rate of chest
compressions given by healthcare professionals, putting them closer to AHA-
recommended criteria. The use of these tools in actual CPR delivery environments could
enhance the care that patients receive.

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Theoretical/ Conceptual framework

fig 1: The American Heart Association 2020 Chains of Survival. A, Pediatric In-Hospital
Chain of Survival. B, Pediatric Out-Hospital Chain of Survival

Fig 2:C, Adult In-Hospital Chain of Survival. D, Adult Out-Hospital Chain of Survival.

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According to American Heart Associations guideline year 2020, which have actually
stated in the Chain of survival. The two interventions most closely linked to successful
resuscitation outcomes are high-quality CPR with minimal interruptions and early
defibrillation. The likelihood of survival can be increased by two or three times with
high-quality CPR administered as soon as possible after cardiac arrest and early
defibrillation.
The main factor that affects survival after cardiac arrest is high-quality CPR. Healthcare
professionals must be skilled at performing high-quality CPR, and patient care teams
must be organized and skilled at working together efficiently if more lives are to be
saved.
High-quality CPR performance metrics include: more than 80% in the chest compression
fraction; 100–120 compression per minute; For adults must have a compression depth of
at least 5cm (2 inches), whereas infants and children must have a compression depth that
is at least 1/3 the chest's AP dimension. And last avoid excessive ventilation.
Majority of state registered nurses have the concept if wish to perform good and perfect
technique of chest compression need to have bigger body size compare to those small
body size nurses. CPR proficiency is no different from other skills in that it needs to be
utilized or exercised to stay current. Nevertheless, for those nurses who rarely perform
CPR in clinical settings and may only occasionally every one to two years, when the
course is finished put them into practice. To remain competent, this doesn't happen
frequently enough. Numerous studies have shown that CPR abilities significantly decline
as soon as two months after training. Especially in the context of compression depth,
learning how to compress correctly is an essential skill for all healthcare professionals to
understand. They require a specific input to help them choose how far they should push.
It's possible that the way we're training now. Don't explain to learners how deep to
compress, that they need more experience with constructive criticism during training, or
that they require purposeful practice after training to master this ability. (Oermann M et
al, 2012)

Research Methodology

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Factors affecting nurses to perform high quality of chest compression during an event of
cardiopulmonary resuscitations was always the key words to search for better solution to
improve chest compression during cardiac arrest. To have better understanding of the
issue related to impair in chest compression, qualitative research methodology was
introduced to this study. A purposive sampling population was selected and one-to-one
depth interview session need to be arranged with all the consented responder. Sampling is
between six to ten responder who currently working in Intensive Care unit with valid
Basic Life Support Certificate.
For data analysis process, firstly need to gathered all data through interview session, then
need to organize and connecting it into subthemes to analyze the data. Lastly report the
insights from the analysis into themes.
CODING, SUBTHEMES AND THEMES
(INTERVIEWTRANSCRIPT)
LINES CODES SUB THEMES THEMES
Fig 3: the sample to put interview transcript into the coding.

Conclusion
The factor affecting nurses to perform high quality chest compression are the main issue
to be discuss in this research paper. To identified and overcome the problem may
increase the survival rate for patient during cardiopulmonary resuscitation compare to
only blaming the situation. Nurses, mostly will be the first responder during an event of
cardiac arrest. It is important to clear their doubt and increase their competent level by
practical and also gain their basic knowledge towards what is high quality of chest
compression and what should they apply to.

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Part 2

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PART 3

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 ATTACHMENT

REFERENCES
Author’s name (year). Book, Title, Publication
 Guteta M. (2022). Factors Affecting Cardiopulmonary Resuscitation Practice
Among Nurses in Mizan Tepi University Teaching Hospital, Tepi General
Hospital, and Gebretsadik Shawo Hospital, Southwest Ethiopia
https://www.dovepress.com/factors-affecting-cardiopulmonary-resuscitation-
practice-among-nurses--peer-reviewed-fulltext-article-OAEM

 Improving cardiopulmonary resuscitation (CPR) performance using an audio-

visual feedback device for healthcare providers in an emergency department
setting in Malaysia: a quasi-experimental study
http://www.e-mjm.org/2020/v75n5/cardiopulmonary-resuscitation.pdf
 Factors Influencing Performance of Cardiopulmonary Resuscitation (CPR) by
Foundation Year 1 Hospital Doctors
https://www.researchgate.net/publication/236088196_Factors_Influencing_Perfor
mance_of_Cardiopulmonary_Resuscitation_CPR_by_Foundation_Year_1_Hospit
al_Doctors
 American Heart Association. (2020). The American Heart Association guidelines
for cardiopulmonary resuscitation. Emerg Cardiovasc Care Elvister.
 Filho C et al. (2015). Factors affecting the quality of cardiopulmonary
resuscitation in inpatient units: perception of nurses. journal of the school of
nursing. https://www.scielo.br/j/reeusp/a/N3vpsRKDKQMv88Ym6VhbWVJ/?
format=pdf&lang=en
 Rahman N et al. (2013). A multicenter controlled trial on knowledge and attitude
about cardiopulmonary resuscitation among secondary school children in
Malaysia. https://link.springer.com/content/pdf/10.1186/1865-1380-6-37.pdf
 Chelladurai G et al. (2020). Improving cardiopulmonary resuscitation (CPR)
performance using an audio-visual feedback device for healthcare providers in an
emergency department setting in Malaysia: a quasi-experimental study. Med J

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 Malaysia Vol 75. http://www.e-mjm.org/2020/v75n5/cardiopulmonary-
resuscitation.pdf
 Oermann M et al. (2012). Competence in CPR, Nurses need more frequent
training to meet new guidelines that emphasize the rate and depth of chest
compressions. The American Journal of Nursing.
https://www.researchgate.net/publication/224867428_Competence_in_CPR

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