Roslinda Isa*, Nuramalina Rahmad, Sharifah Nabilah Syed Mohd, Rosuzeita Fauzi, Siti Nor Ismalina Isa
Centre for Nursing Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Puncak Alam Campus, Selangor, Malaysia
Department of Basic Sciences, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Puncak Alam Campus, Selangor, Malaysia
*Corresponding Author’s Email: roslindaisa@uitm.edu.my
ABSTRACT
Introduction: Basic Life Support (BLS) is a mechanism that maintains or restores life by creating and sustaining airway, ventilation and circulation without the need for adjunctive equipment and successful cardiopulmonary resuscitation, increasing the chances of survival. Objective: to determine the registered nurse knowledge and practice of BLS in one of private hospital in Seremban. Methods: A quantitative cross sectional study regarding knowledge and practice of BLS among staff nurses was done. Questionnaires were distributed to 170 respondents in one of the private hospitals in Seremban. Questionnaire were divided in four part; Part A demographic data, Part B regarding knowledge on BLS, Part C practice on BLS. Results: Data analysis showed that respondents have good knowledge with 143(84.1%); respondent show an average level of practices with 92(54.1%). There was an association between level knowledge and practice with p = 0.0319. Conclusion: There was a good knowledge and an average practice towards BLS among nurses in one of private Hospital in Seremban. This show that the educational programs can be enhanced to sustain the theoretical and practical aspect of BLS while performing in nursing expertise. Therefore future research is suggested to further investigate BLS issue as this skill is important for the nurses in order to provide better prognosis during emergency in patient care.
Cardiac disorder was known as the most common cause of death. According to the Department of Statistic Malaysia (2018), the leading cause of world biggest killer is ischemic heart disease. Sudden cardiac arrest involves medical procedures that are rapidly occurring in all age groups. To avoid sudden cardiac arrest-related deaths, lifesaving interventions are important (Chandrasekaran et al., 2010). Basic Life Support (BLS) is a mechanism that maintains or restores life by creating and sustaining airway, ventilation and circulation without the need for adjunctive equipment. Cardiopulmonary resuscitation is the first important step in managing patient with cardiac arrest. Efficient cardiopulmonary resuscitation by healtcare members was important to reduce death due to cardiac arrest (Vanden Hoek et al., 2010).
Effective emergency aid services are expected to be provided by nurses either in their working area or outside of hospital. Nurses can experience numerous emergency cases such as sudden cardiac arrest and respiratory failure. Nurses have to be the first to practice BLS in these emergency scenarios. The American National Red Cross (2015) reported that the BLS applies to patients suffering from respiratory failure, cardiac arrest and respiratory obstruction from healthcare practitioners and public safety professionals. Cardiac arrest-related morbidity and mortality rates can be significantly impacted by nurses first action (Greif et al., 2020). Training on BLS will also improve nurses' self-esteem connected to BLS activities and lead to the management of anxiety. To improve knowledge and skills in this field, training on BLS with periodic replication is important. It is expected that nurses who are one of the healthcare providers will know about BLS since they often face life-threatening circumstances in the workplace, and BLS expertise, experience and practice will certainly help them in an emergency (Raguindin, 2010). Bhanji et al., (2015) reported that a strong grasp of basic knowledge and procedures in cardiac life support was important to minimize the mortality rate and improve the victim's outcome.
Kose et al., (2019) found that knowledge of healthcare professionals in Pakistan is feeble, and it needs to do a structured training of BLS for a healthcare provider. While Alanazi, Nicholson & Thomas (2017) reported that the nurses' knowledge toward BLS might be on the poor site. During the 10 Golden minutes after cardiac arrest, cardiac arrest victims' fate is considered crucial (Salameh et al., 2018). A poor resuscitation may cause devastating results due to the nurses' lack of practice and experience. Many nurses are not competent to provide what they have practiced during BLS training and code blue drill, thus giving a poor impact on patient life (Salameh et al., 2018).
Sufficient knowledge and understanding of BLS are important to ensure that rescuers are capable of providing the requisite lifesaving steps at the time of emergencies. According to Piryani et al., (2019), the nurse's knowledge contributed a lot during an emergency and cardiac manoeuvre. Updating clinical knowledge and practical skill will improve cardiac manoeuvre efficiency and save the life of a patient. Nurses with excellent knowledge and skill have the highest outcome to save patient life (Kose et al., 2019). Training nurses in cardiopulmonary resuscitation contributed to a major increase in hospital discharge survival after cardiac arrest in the hospital (Novaes Neto & Freitas, 2020). Thus, this research was done to determine the registered nurse knowledge and practice of BLS in one of private hospital in Seremban.
The study designs use quantitative cross-sectional to determine knowledge and practice of BLS among staff nurses at a private hospital in Seremban
.
The study was conducted at KPJ Seremban Specialist Hospital. The staff nurses who attended BLS training in more than one year became the target population.
Selected respondent was choose by using purposive samopling tehnique. The inclusion criteria for the respondents in this study were, all staff nurse who has attended BLS training in more than one year and staff nurse who can read and converse in English. While the exclusion criteria were staff nurses who had just attended BLS course in less than one year, staff nurses who never attend BLS course, other health care providers such as doctors, allied health, non-clinical staff and nursing care aid, and a student nurse.
The sample size has been calculated based on Krejcie & Morgan (1970) with the population number was 300 staff nurses. Confidence Level (α): 95%, Margin of Error (e): 5%, Population Proportion (p): 50, Population Size (N) 302. The sample size required was 170 staff nurses.
A set of questionnaire was used which consist of 4 main parts adapted from Yunus et al., (2015). Part A consist of demographics data; part B consist of Knowledge on BLS. Part C consist of Practice on BLS questionnaires. In Part A, the questionnaires covered socio-demographics, which covers information about the respondent's detail including age, gender, race, educational level, years of services and previous BLS training. Part B was questionnaire on Knowledge of BLS adapted from Yunus et al., (2015). The questionnaire consist of 10 multiple choice questions and each correct answer will be given '1' mark while '0' mark will be given for the wrong answer. A score of 30% to 45% was considered as poor, “45% - 55%; average”, “55% - 65%; good”, “65% - 75%; very good” and “excellent: >75. Part C was questionnaire on practice towards BLS adapted from Yunus et al., (2015). The questionnaires consist of 8 multiple choice questions, and each correct answer will be given '1' mark while '0' mark will be given for the wrong answer. A score of 30% to 45% was considered as poor, “45% - 55%; average”, “55% - 65%; good, “65% - 75%; very good” and excellent: >75%. A pilot study was done among 20 respondents. The Cronbach's Alpha obtained was 0.75, which was acceptable.
Permission from Universiti Teknologi Mara (UiTM) and KPJ Seremban Specialist Hospital Research & Quality Innovation Committee were obtain prior data collection. After identifying respondents who meet the inclusive criteria, the respondents were approached and explanation was given. Then, informed consent was given. Next, the researcher personally distributed the questionnaires and respondents need to answer immediately. The respondents were given questionnaires after they finished their working hours. The questionnaire was collected immediately after respondent’s finish answering. The questionnaire was distributed and collected between June to August 2020.
Data was analyse based on each specific objective.
Research Objectives | Data Analysis |
1. To identify knowledge among staff nurses on Basic Life Support in one of private hospital in Seremban. | Descriptive Statistic |
2. To determine the Practice among staff nurses towards Basic Life Support in one of private hospital inSeremban | Descriptive Statistic |
3. To identify the relationship between knowledge and practice among staff nurses on Basic Life Support in one of private hospital in Seremban. | Chi- Square |
Approval from the UiTM Ethic Committee was obtained on 2 June 2020 and KPJ Seremban Specialist Hospital Research & Quality Innovation Committee on 9 June 2020, before the study started. Respondents were given written consent prior to the commencement of the study.
RESULTS
Table 2 showed the respondent's demographic data where most of the respondent were female with 158 (92.9%) while male were12 respondents (7.1%). Age of 21 – 30 years old were the highest respondent with numbers of 86 respondents (50.6%).
Most of the respondents were Malay with 150 (88.2%) respondents. Most staff nurses had a diploma with 151 (88.8%) respondents, while another 19 (11.2%) respondents had a Bachelor background. 68 (40%) of respondent work more than 10 years. Lastly, the result found that all the respondents attended BLS courses with 170 (100%) respondents.
Demographic Characteristic | Frequency (n) | Percentage (%) |
Age | ||
21 to 30 | 86 | 50.6 |
31 to 40 | 64 | 37.6 |
41 to 50 | 16 | 9.4 |
51 to 60 | 4 | 2.4 |
Gender | ||
Male | 12 | 7.1 |
Female | 158 | 92.9 |
Race | ||
Malay | 150 | 88.2 |
Indian | 18 | 10.6 |
Chinese | 2 | 1.2 |
Education Level | ||
Diploma | 151 | 88.8 |
Degree | 19 | 11.2 |
Year of Services | ||
< 5 years | 46 | 27.1 |
6 to 9 years | 56 | 32.9 |
More than 10 years | 68 | 40 |
Attended Basic Life Support Courses | ||
Yes | 170 | 100 |
No | 0 | 0 |
Table 3 showed the distribution of the knowledge question among respondent regarding BLS. The frequency and percentages represented the correct answer from the respondents. For question "What is the abbreviation of BLS?"most respondents know the abbreviation with 164 (96.5%) respondents. Most of the respondents 156 (91.8%) gave a correct response on first question “When they found someone who are unresponsive in middle of the road”. Besides that, half of the respondents 96 (56.5%) answered correctly for the question their immediate action “when respondents is not responding after shaking or shout”. Most of the respondents know the compression location with 164 (96.5%), and 117 (68.8%) knew the technique of rescue breathing in infants. Meanwhile, 151 (88.8%) and 132 (77.6%) respondents knew the depth of compression for adult and neonate, respectively. Moreover, most of the respondents 151(88.8%) and 158 (92.9%) know the abbreviation for Automated External Defibrillator (AED) and Emergency medical services (EMS). Lastly, 76 (44.7%) answered correctly for the question “respondents first response for a friends experiencing choking while eating”.
Question | Frequency (n) | Percentages (%) |
What is the abbreviation of “BLS” | 164 | 96.5 |
“Your first response when found someone unresponsive?” | 156 | 91.8 |
“First response when somebody not responding after shaking and shouting at him?” | 96 | 56.5 |
“Location for chest compression?” | 164 | 96.5 |
“In infants how do you give rescue breathing?” | 117 | 68.8 |
“Depth of compression for adults?” | 151 | 88.8 |
“Depth of compression for neonates?” | 132 | 77.6 |
“AED stand for?” | 151 | 88.8 |
“EMS stand for?” | 158 | 92.9 |
“Your first response when someone choking but responsive?” | 76 | 44.7 |
Table 4 shows that most of the respondent had a good knowledge with 143 (84.1%) respondent, 26 (15.3%) had average knowledge, and only 1 (0.6%) have poor knowledge.
Level of Knowledge | Frequency (n) | Percentages (%) |
Good | 143 | 84.1 |
Average | 26 | 15.3 |
Poor | 1 | 0.6 |
Total | 170 | 100.0 |
Table 5 showed that most of the respondent had an average level of practices with 92 (54.1%), and 78 respondents (45.9%) have a good practice. No respondent shows poor practices in this study.
Question | Frequency (n) | Percentages (%) |
“All of the following was adult Chain of Survival EXCEPT?” | 97 | 57.1 |
“Time to switch roles in 2-rescuer CPR” | 149 | 87.6 |
“First step in BLS for adults?” | 118 | 69.4 |
“In adults the location for a pulse check checked?” | 168 | 98.8 |
“What is the ratio for compression to ventilation?” | 157 | 92.4 |
“AED proper steps are?” | 163 | 95.9 |
“Signs of severe airway obstruction?” | 72 | 42.4 |
“Characteristics of high-quality CPR?” | 147 | 86.5 |
Table 6 shows only 78 (45.9%) had a good level of practices toward BLS, while half of the respondent had a average level of practice with 92 (84.1%).
Level of Practice | Frequency (n) | Percentages (%) |
Poor | 0 | 0 |
Average | 92 | 54.1 |
Good | 78 | 45.9 |
Total | 170 | 100.0 |
Table 7 showed that data analysed on association between level of knowledge and practices towards BLS among staff nurses. The result showed that most of the respondent had a good knowledge with 143 (84.1%) respondent, 26 (15.3%) had average knowledge, and only 1 (0.6%) have poor knowledge. In addition, result found that there was an association between level knowledge and practice with p-value = 0.0319 (p<0.05).
Variables | Level of Knowledge (n) (%) | x² (df) | P – value | ||
Level of practices | Poor | Average | Good | ||
Poor | 1 (6%) | 26(15.3%) | 143(84%) | 3.816(6) | 0.0319 |
Average | 0 (0%) | 92 (54.1%) | 0(0%) | ||
Good | 0 (0%) | 0 (0%) | 78(45.9%) | ||
* Chi-Square
DISCUSSION
BLS was integrated while managing patients in the health setting. Knowledge played an important element in ensuring the input's content to deliver while managing the patients holistically. As mentioned by Salameh et al., (2018) during cardiac arrest the first 10 minutes was very crucial in order to provide a good prognosis to the patient. The nurse who always remain with the patients, knowledge on BLS was very important to give the immediate action in every emergency situation. This study reported that majority of the respondent had a good level of knowledge towards BLS with 143 (84.1%). The result was good because the continuous nursing education (CNE) learning program and training were frequently conducted by the Nurse Educator and BLS team to the staff nurses in the hospital as they need to renew BLS certificate every two years. CNE program on BLS provide an update which play a vital role for brushing up the knowledge. The hospital management also keeps on teching the latest version of BLS to ensure the knowledge of the nurses remain updated. This result is parallel with the study from Ralapanawa et al., (2016) that showed almost 90% of the respondent had good knowledge in BLS. Other studies from Moon et al., (2019) also found that 80% of the respondents had good knowledge. In contrast with Kose et al., (2019) who found that the knowledge of healthcare professional was still low and the main cause was due to inadequate slot of the BLS training. Kose et al., (2019) also suggested the needs to do a structured training of BLS to healthcare providers.
This study also shows that most of the respondent 156 (91.8%) answer correctly on question “the first action when someone was unresponsive in the middle of the road”. This showed that respondents were confident in performing BLS with knowledge acuired. Moon et al., (2019) highlights the importance of knowledge: BLS's success rate can be improved with good knowledge. Even though different studies have been conducted worldwide to analyze BLS's general knowledge, the most important was the education process to impart the nurses' knowledge. Irfan et al., (2016) also reported that healthcare providers' knowledge was higher, especially medical officer in comparison to the nurses in the medical and nurses from dental departments. Good knowledge can be acquired by the nurses possiblely derived from the good support from the educational program and course attended by the respondents. The study by Abolfotouh et al., (2017) found that education programmed on BLS improved significantly the level of knowledge among healthcare providers.
This study showed that most of the respondent have average practices with 54.1% toward BLS. The practice might be at average level due to the staff nurses having low exposure to real situations as most of the staff nurses' years of service were less than 10 years. This finding agree with Sheeraz et al., (2020) who found that most of the nurses have average practice towards BLS. This finding shows despite having a good level of knowledge, still respondents lack in practices.
According to Moon et al., (2019) the educational programmes will improve the knowledge and attitudes towards performing a good practice. Another study from Yunus et al., (2015) also found moderate practice among healthcare workers toward BLS. This study highlighted the importance of continuous assessment and practical course to enhance knowledge and practices. According to Abolfotouh et al., (2017), despite respondent having good knowledge, the practical does not determine the good reflection from the knowledge. In addition, behaviour towards practice was still the main component to sustain the good practices toward BLS. Conducting BLS using mannequin was simpler than conducting BLS on a real human. One of the main issues was when the nurses were nervous, they forgot to perform and to deliver well.
Component knowledge and practice were important to derive BLS's good performances while managing patients in emergencies. This component was important among nurses to represent a good outcome while managing the patients. This study analyzed the relationship between two variables between knowledge and practice and found that knowledge and practices have a significant relationship towards BLS among nurses in the hospital with X²(df) = 3.816 (6) and p-value 0.0319 (p-value <0.05). This study was similar to Yunus et al., (2015), where they found a strong association between knowledge and practice among nurses towards resuscitation with- p<0.0001. Papi et al., (2020) found that good knowledge reflects in the outcome of the good of practices. A good knowledge and practice in resuscitation skills can give a better prognosis to the patient during emergency situation. The skill while performing CPR was important to increase survival chances in a potentially life threatening situation (Avabratha, 2012). This study finding shows that both variables which were knowledge and practices have a strong association towards BLS .This show that every nurse need to have a good knowledge and practice in BLS to save patients lives and improves the nursing management and practices among organization (Aaberg et al., 2014).
CONCLUSION
This study found that a good knowledge and an average practice towards BLS among nurses in one of private Hospital in Seremban. This shows that educational program can be enhanced to sustain the theoretical and practical aspects while performing BLS by nursing expertise. In additions, this study also indicates the importance of BLS course among nurses to gain knowledge and improve attitudes for delivering a good practice towards BLS. Lastly, this study indicates the importance of basic resuscitation among nurses and should be mandatory for everyone. Therefore, more attention must be considered in maintaining and improving BLS in personnel emergency. Intensive training and safe practices towards BLS can be done among nurses in Malaysia.
Conflict of Interests
The authors declare that they have no conflict of interests.
The authors are thankful to all the staff nurses and also to KPJ Seremban administrators.
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