Training and Experience Against the Implementation of BLS on Patients with Cardiac Arrest by Nurses in ER and ICU of General Hospital

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Published on International Journal of Health, Nursing, & Medicine
Publication Date: May 3, 2019

Maulidah, Titin Andri Wihastuti & Dhelya Widiasmara
Postgraduate Program of Nursing, Brawijaya University
Department of Nursing, Brawijaya University
Department of Dermatology and Venerology, Brawijaya University
Pontianak, Indonesia

Journal Full Text PDF: Training and Experience Against the Implementation of BLS on Patients with Cardiac Arrest by Nurses in ER and ICU of General Hospital (Study at Dr. Soedarso Hospital, Pontianak).

Abstract
BLS is a series of initial effort in protecting patient’s life, where patient is in a life-threatening situation. BLS is very important foundation that should be conducted to save lives. Cardiac arrest would be overcome if it handled by conducting Cardiac Pulmonary Resuscitation (CPR) and defibrillation, thus the heart can return into normal condition. The reduced chance of patient’s life occurred about 7 to 10% per minute if you do not carry out CPR and defibrillation. The implementation of BLS can be affected by several factors, such as training and experience of a nurse. The purpose of this study was to analyze the correlation between training and experience against the implementation of BLS in patients with cardiac arrest patients by nurses in ER and ICU of General Hospital of dr Soedarso Pontianak. This study used cross sectional method. The population in this study were 56 nurses. Sampling technique used in this study was total sampling. The results of this study shown that training variable had p value of p=0.000 or α <0.05 it meant that there was a correlation between training against the implementation of BLS in patients with cardiac arrest, while variable of experience had p value of p=0,270, it meant that there was no correlation between experience against the implementation of BLS in patients with cardiac arrest in General Hospital of dr. Soedarso Pontianak.

Keywords: Basic Living Assistance, Training and Experience.

1. INTRODUCTION
BLS is Basic Life Support which is a series of initial efforts in protecting patient’s life, where the patient is in a life-threatening situation (Guyton Arthur and Hall 2007). According to (Berg, Hemphill et al. 2010) stated that BLS is very important foundation that should be conducted to save lives. In the process of BLS implementation includes the identification of cardiac arrest and activation system Emergency Medical Services (EMS), early CPR, defibrillator using an automatic defibrillator paddles that called Automated External Defibrillator (AED). BLS is an action process that should be carried out immediately by ones if found the victims who needs it. Therefore, it is a mandatory for every nurse or the other medical personnel to be able to master it (Keenan, Lamacraft et al. 2009).
Cardiac Arrest is an accident where the heart is experiencing failure in contracting process effectively, its occurrence is not predictable (Travers, Perkins et al. 2015). Cardiac arrest would be overcome if it handled by conducting Cardiac Pulmonary Resuscitation (CPR) and defibrillation, thus the heart can return into normal condition. The reduced chance of patient’s life occurred about 7 to 10% per minute if you do not carried out CPR and defibrillation. Resuscitation with high quality and good self confidence is one of the most important things for nurses who are usually being the first responder in the emergency room of hospital. It requires coordinated action component in the Chain of Survival, and include initial recognition and immediate activation, early CPR, defibrillation, advanced life support treatment that is effective, and after heart attack they should got integrated intervention (Travers, Rea et al. 2010).
The level of successful in implementing CPR when overcoming patient with the problem of cardiac arrest is influenced by several factors, such as training, and experience. Training is an effort in educational process, that held by organization in both by the government or private organizations, for the fulfillment and achievement of organizational goals (Widodo 2015). The training has the goal to improve the skills and psychomotor of someone and this is the goal of a comprehensive education program. Additionally, the training also has a goal to be able to improve a person’s performance, thus, there is a process of renewal of expertise in accordance with the advance of technology that already exists today (Ambar 2009). The improvement of someone’s performance is not enough just with the holding of training process, but it is also required motivation to change from someone who already attend the training. According (El-Sharkasy, Shenouda et al. 2015), training in first aid may include cardiopulmonary resuscitation training, injuries and bleeding, shock management and management in fractures. In a study based on AHA in 25 years ago obtained result that 21% of participants who attend CPR training got the better implementation as soon as they carry out training, and only about 9%, which can perform well after 3 months (Jäntti 2010).
Experience is something that has been run even felt (Notoatmodjo 2010). The experience can be a good teacher in acquiring the truth, Benner’s Theory states to become expert nurses should be able to multiply skills and proficient in treating patients. Benner divide the expertise in 5 levels novice, advanced beginner, competent, proficient and expert. Nurses are expected in the level of competent where in this stage, nurses have been able to consider and make the necessary planning for an upcoming latest situation (Alligood 2014).
Based on the result of observation and preliminary study that had been conducted on 10 nurses, there were about 60% of nurses who conducted BLS were not in accordance with standard operating procedures that already exist, especially located on the High Quality CPR, and only 48% of nurses who had competency in BLS in the ER and ICU. This study purposed to understand the correlation of training and experience against implementation of BLS in patient with cardiac arrest by nurses.

2. METHODOLOGY
This study used cross sectional method with research type of descriptive corelational. The population in this study were 56 nurses. Sampling technique used in this study by using total sampling, because the number of population in this study was less than 100 samples. Research conducted at General Hospital of dr Soedarso Pontianak on 21 December 2018-1 January 2019. The analysis used in this study was bivariate analysis using Spearman test and multivariate analysis using multiple linear regression.

3. RESULTS
The following was the study result that conducted on 21 December 2018-1 January 2019:

According to table 1, respondents consisted by male and female with the same total number, 28 respondents were male and 28 respondents were female. While in the terms of respondents’ age found that the respondents who were less than <40 years were 38 people (67.8%) and respondents who were more than > 40 years were 18 people (32.1%).

According to Table 2, obtained total respondents who had attended training data obtained for training BLS were 31 respondents (55.4%), BTCLS/PPGD-were 13 respondents (23.2%), ACLS were 3 respondents (5.3%), ATLS was 1 respondent (1.8) and the remaining 8 respondents had never participated in training (14.3%). For data experience of respondents was according to the length work of patient, obtained data respondents who were experienced less than <2 years were 7 respondents (12.5%) and respondents who were experienced more than >2 years were 49 respondents (87.5%).

According to Table 3. statistical test results obtained p value was p=0.000 (α <0.05) that could be interpreted there was significant correlation between training against implementation of BLS by nurse in general hospital of dr Soedarso Pontianak. The correlation between training against implementation of BLS shown a strong correlation, where (r=0.680) and a positive pattern which meant that the higher training, the better implementation of BLS by nurse in general hospital of dr Soedarso Pontianak. Table 4, shown the statistical test results that obtained p value of p=0.270 (α> 0.05), it meant there was no correlation between the experience against the implementation of BLS by nurses in the ER and ICU of general hospital of dr. Soedarso Pontianak.

4. DISCUSSION
1. Correlation The Training Against The Implementation of Basic Life Support (BLS) in Patients with Cardiac Arrest by Nurses in the ER and ICU of General Hospital of dr Soedarso Pontianak
In this study could be understand that there were several respondents who had participated in training including training of BLS, BTCLS/PPGD, ATLS and ACLS. The results obtained by researcher after analysis shown a significant correlation between training and implementation of BLS in patient with cardiac arrest by nurses in general hospital of dr Soedarso Pontianak with p value of p=0.000. In this study, respondents who had participated in training of BLS were more than respondents who participated in advanced training such as BTCLS, ATLS and ACLS.
Training was one of the factors that could affect the implementation of BLS, because training was application of action in the field. However, data obtained from the respondents and based on data according to certificate of training, most of respondents who had participated training only when they were in college and it’s been a few years before they started work in general hospital of Dr Soedarso, it was because they had not been able to attend training again and update their knowledge constrained due to high cost and work schedule, even though they knew a lot of the latest emergency training and preferably as nurses working who in the ER and ICU installations, it was better to be exposed to the training and continue to update existing knowledge, especially the knowledge of handling emergencies according to the place or part they were assigned.
Based on the data, the researcher argued that a nurse should require more frequent training to be more mature and ready to handle patients. This statement was in line with a study conducted by (Keenan, Lamacraft et al. 2009) stated that the training should be carried out every 6-12 months in order to get a refresher and could also maintain the ability of BLS.
Regular training method that conveyed during training with simulation methods, the training process with simulation methods would further contribute much in terms of increasing knowledge of the trainees. In the study conducted by (suhu and Lata 2010) described the benefits of simulation method that could more enhance the knowledge of students in the training because with this method the participants would go through a process of critical thinking through problems or cases that had been provided, except that participants could trying to direct what was simulated and viewed directly by an instructor or coach there. According to (Bala and Rakhmat 2014) stated that a respondent could carry out Basic Life Support because the most important in the implementation of the BLS could be either because the respondents had attended training of BLS. The way in order to increase knowledge, skills of a nurse, especially in patients who required BLS was a nurse should never follow or exposed to training in order to carry BLS in fast, responsive, skilful and meticulous (Cristian 2009).
The results of this research was in line with the research conducted by (Ivancevich and john 2008) that the correlation between the training by nurses with the readiness of nurses in facing patient’s cardiac arrest, where Ivancevich said that a training would be oriented to the present and could assist a nurse in mastering skills and its ability to succeed in their job. (Marquis and Huston 2010) also revealed that people could learn quickly if it gets something about the developments that happened (Yulia 2010).
Training could be used as an information to know something of progress. Information was a factor that could increase knowledge. The results also strengthened by research (Adryan 2012), (Roshana 2012) which stated that a person who attended the emergency training had a deeper level of knowledge of the implementation of the BLS. This result was also strengthened by the results of research conducted (Chaundhary, Parikh et al. 2011) suggested that improvement of knowledge and skill in CPR could be obtained by training of BLS.
2. Correlation The Experience Against The Implementation of Basic Life Support (BLS) in Patients with Cardiac Arrest by Nurses in the ER and ICU of General Hospital of dr Soedarso Pontianak
In this study, the respondents’ experience was assessed based on length of service of the respondent. Working period was a period of time that had passed by someone and could described their experience in mastering the tasks and areas practiced. Research results obtained that there was no correlation between experience and implementation of BLS by nurses in cardiac arrest patients in the ER and ICU of General Hospital of dr. Soedarso Pontianak with p value of p=0.270 (α> 0.05). This situation was usually due to the more frequent the nurses involved in rescuing patient with cardiac arrest, thus the nurse enriched their experience and knowledge about cardiac arrest and its handling. This was according to research from (Arthur, Guyton et al. 1998) which explained that something memorized would be easier to lose than with something that was obtained by the process or experience during practice or work.
This study was not in line with the study results of (Lestari 2015) explained that the experience could be a factor that could affect the knowledge, because in this study could be interpreted that someone working life did not guarantee that they had more experience than the new one. Researchers statement was supported by data obtained from the respondents and observations by the researcher to the respondents during the implementation of the research shown that their experience obtained because the respondents more often exposed and treat patients with cardiac arrest cases that required the implementation of BLS. In general, each person with the longer experience, they were no longer needed guidance as compared to someone who had little experience.