Self-teaching to improve patient confidence in resuscitation skills

David E. Winchester, MD & Irene Kittles, ARNP

Journal of the American Association of Nurse Practitioners


Abstract

Background and purpose: Sudden cardiac death occurs predominantly at home where cardiopulmonary resuscitation (CPR) is often not provided. We tested the hypothesis that a self-teaching kit distributed to patients would effectively increase self-confidence in CPR.

Methods: Patients seen by an advanced registered nurse practitioner in a general cardiology clinic were offered a self-teaching kit to learn CPR. Four-point scale survey questions were assessed at distribution and via phone call at 30 days.

Conclusions: Kits were distributed to 21 patients; of whom, 17 (81%) patients used the kit. Patients reported greater self-confidence of performing CPR (2.6 before versus 3.2 after, p < .05) and greater comfort if someone needed CPR (2.4 before versus 3.1 after, p < .05).

Implications for practice: Self-teaching CPR kits were used by the substantial majority of patients and were effective at increasing both self-confidence and willingness to perform CPR. Similar nurse-run programs could increase awareness and impact of CPR in communities.


Introduction

Sudden cardiac death is common among people with cardiovascular disease and cardiovascular disease risk factors, with 347,000 events occurring in the United States annually (Benjamin et al., 2017). Most (80.2%) of sudden cardiac deaths occur in the home; while cardiopulmonary resuscitation (CPR) rates are increasing, the minority of sudden death victims receive bystander CPR (Benjamin et al., 2017). We conducted a quality improvement project at our facility with the goal of educating cardiac patients on CPR. We hypothesized that patients would be able to increase their self-confidence in performing CPR by using a kit for self-teaching of CPR skills.

Methods

Between January 20, 2017, and June 27, 2017, we distributed a self-teaching CPR kit (CPR Anytime, American Heart Association, Dallas, TX) to patients in our outpatient cardiology clinic. All patients in our clinic were considered eligible for participation. We did not track the number of patients who declined to receive a CPR kit. The kit consists of an instructional video, a printed manual, and an inflatable manikin for practicing CPR skills. The kit's current retail price is $38.50 USD and was purchased with an institutional innovation grant. At the time of receiving the kit, patients completed a short survey about previous training in CPR and their self-confidence to perform CPR on a 4-point scale. Patients were asked to use the kit together with a friend or family member and share it with others. The questions from the short survey were repeated during a follow-up phone call performed at 30 days. In accordance with Veterans Affairs Handbook 1058.05, this quality improvement project was determined to not qualify as human subject research. Data were analyzed by the Wilcoxon signed-rank test because of the paired, nonparametric nature of the data using SPSS version 25 (IBM, Armonk, NY).

Results

Kits were distributed to 21 patients: 17 (81.0%) had coronary artery disease, 3 (14.3%) had congestive heart failure, 4 (19.0%) had diabetes mellitus, and 14 (66.7%) reported previous training in CPR. After using the kit, patients reported increased confidence in performing CPR and willingness to aid others having an emergency (Table 1). Reported improvement in CPR self-confidence was not associated with any baseline characteristics. Most patients reported using the kit (n = 17, 81%) and using it with a family member (n = 14, 66.7%). A substantial proportion shared the kit with someone else after they used it (n = 8, 47.1%).

Discussion

Between 2006 and 2015, the absolute rate of bystander CPR has increased 7.1% but is still performed in the minority of sudden death events 43.6% (Benjamin et al., 2017). The primary clinical implication of our findings is that self-teaching CPR may be an alternative to class-based teaching for getting more members of the public to perform CPR. The importance of bystander CPR for improving survival after out of hospital sudden cardiac death cannot be understated. In the United States, half of the variability sudden cardiac death survival is attributable to the performance of bystander CPR (Girotra et al., 2016).

Our findings add to a growing body of literature suggesting that abbreviated training and self-teaching of CPR are effective (Godfred, Huszti, Fly, & Nichol, 2013 Lynch et al., 2005 Wanner, Osborne, & Greene, 2016). From a practical perspective, self-teaching of CPR offers advantages over class-based teaching including picking one's own pace and time for learning, lower cost, and lower potential for social anxiety about performance. The primary disadvantage to self-teaching is the lack of an expert trainer who can provide meaningful feedback about the quality of simulated CPR being provided. With self-teaching, the quality of the manikin is inferior to the more sturdy and realistic class-based manikins. Other recently tested strategies include education directed toward high-risk patients before hospital discharge (Blewer et al., 2011 2016). Although self-confidence in CPR skills is an important step to improving survival after cardiac arrest, a recent qualitative study revealed that bystanders often experience a multitude of barriers to performing CPR beyond skills and confidence (Malta Hansen et al., 2017).

Our investigation is limited by the small sample size; however, we would expect the results to be readily reproducible at other centers. The statistical difference in self-confidence scores may not reflect an actual change in practice should the patients encounter someone suffering sudden death. A larger scale investigation with more robust clinical outcomes would be warranted before widespread adoption.

Conclusion

Cardiopulmonary resuscitation self-teaching kits effectively increase confidence and comfort with performing CPR among engaged cardiovascular disease patients. Such a program can be effectively implemented in a nurse practitioner–led clinic environment.

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