Personal Protection of Nurses During Resuscitation: A Study in a Major Emergency

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Table of Contents

Background
Critical Literature Review
Research Aim
References

Background

Resuscitation is relatively new “to the world of evidence-based practice” (Moule & Albarran, 2009, p. 2). Unfortunately, it is founded on a limited body of scientific evidence. The existing evidence presents the basis for current best practice. Modern cardiopulmonary resuscitation has remained mainly the same since its introduction. In fact, the resuscitation techniques, CPR in particular, attract much less additional research than other areas of medical services. This tendency results in the lack of actions aimed at modernizing and improving current emergency medical practice. The enhancement of resuscitation procedure has a huge potential for preventing an extensive amount of deaths. Therefore, further research should be encouraged, as considering resuscitation activities those that suggest no improvements or alternatives is the wrong belief that costs millions of lives. Studying the existing evidence of the best resuscitation practices is of vital importance for any healthcare giver eager to provide the best treatment of his/her patients in emergency situations. International collaboration is also of paramount importance for creating the guidelines that can standardize the management approach to cardiac arrests and other life-threatening conditions based on the exchange of experience in saving adults and children (Moule & Albarran, 2009).

The responsibilities of nurses are directly related to eliminating the conditions putting the life and well-being of the patient at risk. Therefore, nurses should know how to deliver appropriate treatment and perform resuscitation procedures. The responsibilities of nurses include performing basic cardiac life support measures and maintaining the appropriate certification. Nurses should have the knowledge of CPR and use it effectively. The continuous refreshing of skills is of vital importance, as the abilities to perform appropriate procedures can become lower to critical levels if not used often. Many researchers suggest the methods of enhancing the appropriate attitudes of nurses to personal protection during resuscitation. Dwyer and Williams (2002) emphasize the essential role of educating nurses about the significance of providing appropriate resuscitation procedures. Makinen, Niemi-Murola, Kaila, and Castren (2009) support this view and consider intensive education able to reduce anxiety among the nurses.

Besides the knowledge about the resuscitation procedures, nurses need to be aware of precautions necessary for protecting them from possible transmission of diseases. Unprotected resuscitation is dangerous, as infections are one of the most important causes of morbidity and mortality related to clinical procedures (Vaz et al., 2010). Therefore, knowledge about appropriate personal protection is required. Pieces of protection equipment include mouthpieces, pocket resuscitation masks with one-way valves and other ventilation devices (Pankhurst & Coulter, 2009). Delivering resuscitation with the help of such equipment presents “a safe alternative” to mouth-to-mouth resuscitation (Pankhurst & Coulter, 2009, p. 85). By using such equipment, the caregiver prevents exposing his/her mouth and nose to the patient’s oral and respiratory fluids. It helps to prevent potential harm caused by the procedure to the caregiver, including being infected.

Certain factors affect the nurses’ compliance with the standards of using personal protection equipment during resuscitation. Nichol et al. (2013) studied such factors and identified availability of appropriate equipment, regular training and fit testing, and “organizational support for worker health and safety” as the main contributors to ensuring personal protection of nurses (p. 8). Ganczak and Szych (2007) also emphasize the importance of providing the availability of appropriate equipment for eliminating the risks of noncompliance with personal protection standards during resuscitation among nurses.

Arab countries are currently investing much money and efforts in improving their health care systems and ensuring the effectiveness of medical services. Personal protection of nurses is one of the issues that are of vital importance for providing the safety and efficacy of medical interventions. Sreedharan, Muttappillymyalil, and Venkatramana (2011) conducted a study aimed at revealing the level of knowledge about standard precautions among nurses in one of the Arab countries. The researchers gained the results that demonstrate that most nurses in the hospital in Ajman, the United Arab Emirates, are aware of standard precautions. However, the level of knowledge about the guidelines and implementations related to these precautions appeared to be lower than the appropriate (Sreedharan, Muttappillymyalil, & Venkatramana, 2011). The findings of this study help to understand the necessity of conducting further research on knowledge about personal protection during resuscitation and launch appropriate training programs.

Medical services in Saudi Arabia are largely funded by the government. The quality of health care in the country has been improved greatly during the last several decades (Almalki, Fitzgerald, & Clark, 2011). Though Saudi Arabia has achieved significant results in modernizing the health care system in a short period, the medical services in the country still need to overcome many challenges, which require the enactment of appropriate laws and policies (Almalki, Fitzgerald, & Clark, 2011). As in any country, nurses comprise a huge sector of the health care system in Saudi Arabia, and, therefore, the use of the protection equipment during resuscitation by nurses belongs to the vital issues that need to be properly assessed and improved if needed.

Critical Literature Review

Search Strategies

A literature search was conducted to explore peer-reviewed publications that provide information about personal protection equipment of nurses in Saudi Arabia. Three major databases were used for literature search, including Google Scholar, CINAHL, and Medline. Such search terms as “personal protection”, “protection equipment”, “resuscitation”, “nurses”, “Saudi Arabia”, and “emergency department” were used. As there is a very limited amount of literature about the research topic, the term “Saudi Arabia” was further substituted with the terms “Middle East” and “worldwide”. The search was limited from the period of 2005 to 2015. Only articles published in the English language were included.

By using the initial criteria, 30 articles providing information related to the research topic were found. The search was condensed, and ten articles were included while twenty articles were not included because they were not relevant to the research aim. The reference lists of the selected articles were hand searched to extend the search. It resulted in 5 more articles to be included in the review process. Overall, 15 articles were selected to be reviewed.

Summary of Reviewed Literature

The literature search has revealed that there is a very limited number of studies investigating the research topic. It is rather difficult to find a study investigating the personal protection of nurses during resuscitation in a major emergency department in Saudi Arabia. However, there are many studies related to the topic. Various studies investigate the specifics of the resuscitation procedures, the risks related to the procedure, and the importance of the usage of personal protection equipment in emergency departments in Saudi Arabia and worldwide.

Al-Turki et al. (2008) investigated knowledge and attitudes towards cardiopulmonary resuscitation among students in one of the universities in Saudi Arabia. This study sheds some light on the specifics of resuscitation in the country, as it shows how well the future specialists are prepared for such type of activities. The researchers conducted a cross-sectional survey among King Saud University Students in Riyadh, Kingdom of Saudi Arabia. The results showed that though attitudes to cardiopulmonary resuscitation (CPR) were positive, the knowledge about the topic was insufficient. The findings of the study demonstrate that more effort should put in the improvement of CPR skills among the potential healthcare givers in Saudi Arabia.

Alanazi (2012) conducted a study aimed at revealing the common problems faced by the members of emergency departments in Saudi Arabia. The investigation was based on the usage of the questionnaire that included eight different commonly experienced barriers. 140 paramedics from three different regions (Jeddah, Riyadh, and Dammam) of Saudi Arabia participated in the research. The results revealed that certain barriers put a threat on the efficiency of emergency interventions. Therefore, the authorities and administration should put more effort in eliminating the defined barriers. Training and education were also suggested as the essential part of the activities aimed at providing positive changes.

Gouda, Al-Jabbary, and Fong (2010) investigated the specifics of delivering resuscitation in Saudi Arabia in cases when the policy addressing patient care at the end of life should be addressed. The researchers emphasized that there is a lack of studies investigating the compliance of physicians in Saudi Arabia with Do Not Resuscitate (DNR) policy. A cohort study of data was conducted at King Abdulaziz Medical City. The results demonstrate that the compliance with the policy is relatively poor and proves the fact that the advance directive is not a common practice in Middle Eastern countries.

Chiang et al. (2008) attempted to evaluate the compliance of the performance of healthcare workers in emergency departments with standard precautions aimed at reducing the risks of being exposed to communicable diseases. The researchers conducted a prospective observational study to check if the workers of emergency departments use personal protection equipment and other methods to protect themselves from contamination. The results of the study demonstrate the suboptimal compliance with basic infection control methods. The findings of the study reflect the positive tendencies in providing the safe environment for primary caregivers worldwide.

Another study aimed at evaluating the effectiveness of strict infection control measures (ICMs) on emergency resuscitation was conducted by Chuang, Leung, Chung, Chang, and Cheng (2007). The researchers provided this retrospective observational study by collecting the appropriate data and analyzing the variables, including demographic data of patients, response time and duration of resuscitation, and results of resuscitation. The results of the study revealed that strict infection control measures implementation plays a role in the increased failure rate in emergency resuscitation. The findings of the study show that delivering an adequate care to patients and providing appropriate protection of healthcare workers while performing emergency resuscitation is very important during the outbreaks of contagious diseases.

Liang, Theodoro, Schuur, and Marschall (2014) managed to study the specifics of preventing infections in emergency departments while delivering care to the patients who have experienced life-threatening conditions. The researchers studied the current methods of preventing transmission of infectious organisms in emergency settings, including, hand hygiene, standard precautions, airborne precautions (usage of personal protection equipment in particular), droplet and contact precautions, and environmental control. The results of the study show that future research is needed to optimize and improve infection prevention in emergency departments. The findings of the study also demonstrate the significance of comprehensive approach to providing the efficient protection from contagious diseases.

Talikowska, Tohira, and Finn (2015) attempted to evaluate the relation between the quality of cardiopulmonary resuscitation and patient survival outcome. The researchers conducted a systematic review and meta-analysis to investigate the topic issue and revealed that the survival after cardiac arrest directly depends on the quality of delivered resuscitation. The findings of the study demonstrate the importance of ensuring the best training and education of all primary caregivers involved in the activities that include the performance of resuscitation.

Clements and Curtis (2012) managed to investigate the state of knowledge about the impact of nursing roles on hospital patient resuscitation. The systematic search and review of the literature helped to find out that nurses contribute significantly to providing positive outcomes of the resuscitation. The conducted analysis of the literature also revealed the lack of appropriate research and the need for further investigation.

Pothitakis, Ekmektzoglou, Piagkou, Karatzas, and Xanthos (2011) conducted a study aimed at investigating the nursing role in monitoring during cardiopulmonary resuscitation. A comprehensive literature review was provided and helped the researchers to reveal the significance of the role of nurses in providing appropriate resuscitation procedure.

Schumacher et al. (2008) investigated the methods of personal respiratory protection while conducting resuscitation of patients contaminated with chemical warfare agents. The researchers conducted a study aimed at testing the efficacy of state-of-the-art respirators during delivering resuscitation. The evaluation of the effectiveness of existing personal protection equipment is of vital importance as medical personnel can become exposed to chemical warfare agents during delivering resuscitation to patients with chemical contamination.

Greenland, Tsui, Goodyear, and Irwin (2007) investigated the possibility of use of personal protection equipment used during resuscitation procedures for tracheal intubation. The researchers found out that the use of appropriate personal protection equipment during tracheal intubation contributes to the safety of healthcare givers. The findings of the research help to understand the possible variations of the usage of the equipment used while conducting resuscitation and its effectiveness for providing the necessary protection of medical specialists during different procedures.

Coia et al. (2013) provided the guidance on the use of respiratory and facial equipment by healthcare workers. The guidance is based on the review of literature and expert consensus. The guidance includes the information about types of respiratory and facial protection equipment, the process of selecting and wearing the equipment, advice on respiratory and facial protection, future research, and evidence gaps. As the experience with outbreaks of respiratory contagious diseases has shown the possible difficulties faced by healthcare workers while using protection equipment, the researchers contribute to improving the situation by providing the extensive amount of efficient and relevant information.

Ehlenbach et al. (2009) investigated the specifics of delivering cardiopulmonary resuscitation to elderly people. The results of the study reveal that survival after in-hospital CPR does not appear to improve during the period from 1992 to 2005. Such findings show that the lack of research on possible improvements of resuscitations techniques leads to the lack of innovations able to save more lives.

Cowan and Haslam (2006) conducted a study aimed at assessing the guidelines on resuscitation. The researchers provided an analysis of recent claims and complaints handled by the Medical Protection Society. They also analyzed the problems reported to the National Patient Safety Agency. Many critical questions were defined during the study, including issues related to the competence of healthcare professionals and the effective usage of appropriate equipment. The study helps to understand the role of health caregivers in providing appropriate resuscitation able to save the life of the patient.

Lippert, Raffay, Georgiou, Steen, and Bossaert (2010) provided an investigation on the ethical issues related to resuscitation decisions reflected in the European resuscitation council guidelines. The researchers analyze the principles that should be considered by every healthcare provider while dealing with the situations suggesting end-of-life decisions.

Research Aim

Research Question

The research aim is to investigate the research problem that can be defined as the specifics of personal protection of nurses during resuscitation in the major emergency department in Saudi Arabia. The research question is whether the level of personal protection of the nurses in Saudi Arabia corresponds to the world standards and whether particular challenges related to the issue can be identified in this region.

Significance

Nurses often face emergency situations that require appropriate knowledge about all specifics of resuscitation procedure. Unfortunately, no studies investigate the specifics of personal protection of nurses during resuscitation in the major emergency department in Saudi Arabia. Many studies focus on the questions related to the topic issue. This research can help to identify the gaps in the literature presenting information about the topic issue and suggest further investigations necessary for determining the potential improvements.

References

Alanazi, A. F. (2012). Emergency medical services in Saudi Arabia: A study on the significance of paramedics and their experiences on barriers as inhibitors of their efficiency.International Journal of Applied and Basic Medical Research, 2(1), 34-37. Web.

Almalki, M., Fitzgerald, G., & Clark, M. (2011). Health care system in Saudi Arabia: An overview. Eastern Mediterranean Health Journal, 17(10), 784-793. Web.

Al-Turki, Y. A., Al-Fraih, Y. S., Jalaly, J. B., Al-Maghlouth, I. A., Al-Rashoudi, F. H., Al-Otaibi, A. F.,…Al-Shaykh, A. S. (2008). Knowledge and attitudes towards cardiopulmonary resuscitation among university students in Riyadh, Saudi Arabia. Saudi Medical Journal, 29(9), 1306-1309. Web.

Chiang, W. -C., Wang, H. -C., Chen, S. -Y., Chen, L. -M., Yao, Y. -C., Wu, G. -H.,…Ma, M. (2008). Lack of compliance with basic infection control measures during cardiopulmonary resuscitation – Are we ready for another epidemic?Resuscitation, 77(3), 356-362. Web.

Chuang, H. –L., Leung, W. –S., Chung, Y. –T., Chang, Y. –T., & Cheng, W. –K. (2007). Impact of enhanced infection control procedures on clinical outcome following resuscitation attempts.Journal of Hospital Infection, 67(3), 258-263. Web.

Clements, A., & Curtis, K. (2012). What is the impact of nursing roles in hospital patient resuscitation? Australasian Emergency Nursing Journal, 15(2), 108-115. Web.

Coia, J. E., Ritchie, L., Adidesh, A., Makinson Booth, C., Bradley, C., Bunyan, D.,…Zuckerman, M. (2013). Guidance on the use of respiratory and facial protection equipment.Journal of Hospital Infection, 85(3), 170-182. Web.

Dwyer, Trudy, and Williams, L. M. (2002). Nurses’ behaviour regarding CPR and the theories of reasoned action and planned behaviour. Resuscitation, 52(1), 85-90.

Ehlenbach, W., Barnato, A., Curtis, J. R., Kreuter, W., Koepsell, T. D., Deyo, R. A., & Stapleton, R. D. (2009). Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. The New England Journal of Medicine, 361(1), 22-31. Web.

Ganczak, M., & Szych, Z. (2007). Surgical nurses and compliance with personal protective equipment. Journal of Hospital Infection, 66(4), 346-351. Web.

Gouda, A., Al-Jabbary, A., Fong, L. (2010). Compliance with DNR policy in a tertiary care center in Saudi Arabia. Intensive Care Medicine, 36(12), 2149-2153. Web.

Greenland, K., Tsui, D., Goodyear, P., & Irwin, M. (2007). Personal protection equipment for biological hazards: Does it affect tracheal intubation performance?Resuscitation, 74(1), 119-126. Web.

Haslam, J. C. J. (2006). Resuscitation: turning guidelines into practice. Clinical Governance: An International Journal, 11(2), 160-165. Web.

Liang, S. Y., Theodoro, D. L., Schuur, J. D., & Marschall, J. (2014). Infection prevention in the emergency department. Annals of Emergency Medicine, 64(3), 299-313. Web.

Lippert, F. K., Raffay, V., Georgiou, M., Steen, P. A., & Bossaert, L. (2010). European Resuscitation Council guidelines for resuscitation 2010 Section 10. The ethics of resuscitation and end-of-life decisions. Resuscitation, 81(10), 1445-1451. Web.

Makinen, M., Niemi-Murola, L., Kaila, M., & Castren, M. (2009). Nurses’ attitudes towards resuscitation and national resuscitation guidelines – Nurses hesitate to start CPR-D. Resuscitation, 80(12), 1399-1404. Web.

Moule, P., & Albarran, J. W. (2009). Practical resuscitation for healthcare professionals. Oxford, United Kingdom: John Wiley & Sons, Ltd.

Nichol, K., McGeer, A., Bigelow, P., O’Brien-Pallas, L., Scott, J., Holness, D. L. (2013). Behind the mask: Determinants of nurse’s adherence to facial protective equipment. American Journal of Infection Control, 41(1), 8-13. Web.

Pankhurst, C., & Coulter, W. (2009). Basic guide to infection prevention and control in dentistry. Oxford, United Kingdom: John Wiley & Sons, Ltd.

Pothitakis, C., Ekmektzoglou, K. A., Piagkou, M., Karatzas, T., & Xanthos, T. (2011). Nursing role in monitoring during cardiopulmonary resuscitation and in the peri-arrest period: A review. Heart & Lung: The Journal of Acute and Critical Care, 40(6), 530-544. Web.

Schumacher, J., Runte, J., Brinker, A., Prior, K., Heringlake, M., & Eichler, W. (2008). Respiratory protection during high-fidelity simulated resuscitation of casualties contaminated with chemical warfare agents. Journal of the Association of Anaesthetists of Great Britain and Ireland, 63, 593-598. Web.

Sreedharan, J., Muttappillymyalil, J., & Venkatramana, M. (2011). Knowledge about standard precautions among university hospital nurses in the United Arab Emirates. Eastern Mediterranean Health Journal, 17(4), 331-334. Web.

Talikowska, M., Tohira, H., & Finn, J. (2015). Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: A systematic review and meta-analysis. Resuscitation, 96, 66-77. Web.

Vaz, K., McGrowder, D., Alexander-Lindo, R., Gordon, L., Brown, P., & Irving, R. (2010). Knowledge, awareness and compliance with universal precautions among health care workers at the University Hospital of the West Indies, Jamaica. The International Journal of Occupational and Environmental Medicine, 1(4), 171-181. Web.

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