Have you ever been required to administer CPR to one of your patients?
Perhaps you are a senior nurse working in a critical care area and have done this many, many times.
Perhaps you have not been nursing long and have only ever done it once.
Perhaps you are a wardsperson (orderly) or other healthcare worker.
How did you feel about giving CPR?
Did you feel your were prepared?
Did it go as you imagined?
Was there any opportunity for you to express your feelings or discuss the event afterwards.
A small study by Fredric Sjoberg and colleagues used qualitative, semi-structured interviews to examine nurses experiences during and after a critical incident requiring them to perform CPR.
This study had a relatively small sample size of eight ICU nurses in Sweden.
Interestingly, the authors attempted to enrol ICU nurses from three different public hospitals but only one unit responded.
Many nurses find their first experience of CPR stressful.
This stress can be minimised by prior simulation training.
Teamwork is critical with too many responders negatively effecting performance.
Opportunity to debrief afterwards important.
It was felt that even though training in CPR tended to be a bit repetitive, it was an essential and positive activity.
The use of varying simulation scenarios enabled staff to develop mastery of the CPR process as well as enabling communication skills, teamwork and providing an environment where mistakes could be made and learnt from.
The prior scenario training was found to provide a structured foundation for bringing order to actual situations requiring CPR.
It was felt that the involvement of too many people resulted in a chaotic situation and made it more difficult to operate from a place of order.
Five experienced staff was identified as the ideal number of team members and the team leader may need to remove excess staff from the area to achieve this optimum group size.
Some staff identified feelings of panic and being completely unprepared. This response was enhanced during the night shift when there may be some delay before a doctor was in attendance.
Cardiac arrest was seen as significant when they realised that they had to save the patient’s life and needed to act energetically and instinctively. In such situations, they experienced both physical and mental reactions to difficulties in estimating time, distancing themselves from emotions, and tunnel-vision. In addition to following the procedures in the chaotic situation, managing the administration of medication was also perceived as stressful and unpleasant:
Respondents identified the importance of having the opportunity to ‘debrief’ or “talk about difficult events” before the end of the shift.
This was felt to both provide an important opportunity to grow personally and as a group, and to give a space for giving feedback and praise.
It seems unit involved did not provide structured debriefing sessions but instead this occurred as ad-hoc conversations during breaks etc.
The participants felt that this opportunity to debrief shortly after the event was critical in enabling them to process their feelings around the incident.
Even when debriefing sessions were not organised, staff members frequently initiated informal sessions by talking with each other and found this experience to be invaluable. It was also noted in the findings that it was considered important that no one should leave work with unprocessed feelings after acute events. We believe that a lack of debriefing post-CPR can evoke negative feelings that can adversely affect the staff’s professional roles and personal lives. However, additional research is needed to elucidate precisely how unprocessed feelings correlate with the quality of life of the staff.
[…]We strongly emphasise the importance of establishing debriefing sessions as a habit within the culture of professionals rather than something regarded as an extraordinary event. Finally, we call for a cultural shift from the original perceptions of debriefing to highlight its intrinsic value that extends beyond ‘scapegoat thinking’.
Reference: Sjöberg, F., Schönning, E., & Salzmann-Erikson, M. (2015). Nurses’ experiences of performing cardiopulmonary resuscitation in intensive care units: a qualitative study. Journal of Clinical Nursing, 24(17–18), 2522–2528. http://doi.org/10.1111/jocn.12844