How does this support the population of focus, your setting, and role?
NUR 590 Topic 1 Discussion Question One

Based on the PICOT you developed for NUR-550, summarize the intervention you are proposing. How does this support the population of focus, your setting, and role? Justify how the problem you selected to investigate is amenable to a research-based intervention using the PICOT format. Include your PICOT statement with your response.

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NUR 590 Topic 1 Discussion Question One

Will educating nurses to perform continuous compression during defibrillation with no shock pauses for patients in cardiac arrest compared to no education increase the probability of return of spontaneous. The latest guidelines emphasize that chest compressions should be performed with adequate rate and depth, complete recoils, and minimized pauses (Luo et al., 2021). Pauses during resuscitation have can extended pass the recommended guidelines of 5-10 seconds during defibrillation due to Charging defibrillators prior to analyzing heart rhythms may decrease the no-flow time during rhythm check pauses while resuscitating in cardiac arrest (Kemper et al., 2019). Administering high-quality chest compressions has been considered a key determinant for successful resuscitations (Luo et al., 2021). Devices such as the LUCUS device are capable of providing mechanical chest compressions allowing for continuous compressions to be in progress during shock administration. Educating nurses on the importance of continuous uninterrupted compressions may help eliminate or shorten prolonged pauses during resuscitation efforts. In addition, educating nurses about technologies available to help decrease pauses during resuscitation, ultimately improving patient outcomes by increasing perfusion.

This topic is important to continue research being that the American Heart Association has recently emphasized compressions as the first response action for patients in cardiac arrest. Compressions allow for perfusion, giving the patient the best chance for survival. As an Emergency Department nurse it is virtual, the pauses are kept to a minimum and human error is eliminated to the best of our ability. Human errors such as equipment malfunctions, equipment use, and overall knowledge that defibrillation can occur simultaneously during compressions are all factors that can affect a patient’s outcome.

References

Luo, L., Zhang, X. D., Xiang, T., Dai, H., Zhang, J. M., Zhuo, G. Y., Sun, Y. F., Deng, X. J., Zhang, W., & Du, M. (2021). Early mechanical cardiopulmonary resuscitation can improve outcomes in patients with non-traumatic cardiac arrest in the emergency department. Journal of International Medical Research, 49(6), 030006052110253. https://doi.org/10.1177/03000605211025368

Kemper M, Zech A, Lazarovici M, Zwissler B, Prückner S, Meyer O. Defibrillator charging before rhythm analysis causes peri-shock pauses exceeding guideline recommended maximum 5 s : A randomized simulation trial. Anesthetist. 2019 Aug;68(8):546-554. English. doi: 10.1007/s00101-019-0623-x. PMID: 31332449.

PICOT Statement:

Will implementation a mandatory patient to nurse ratio of 1:4 or 1:5 (I) Decrease Patient Mortality Rates (O) of patients medical and surgical wards (P) over a one-year period (T) in comparison not implementation of a patient to nurse ratio level.

One of the biggest risk to our nations health care system is the nursing shortage. The COVID-19 pandemic not only exposed the weaknesses and vulnerabilities within our healthcare system and public health policies but also the immense staffing shortages of nurses throughout the country. During the height of the pandemic, my hospital was already understaffed. When the pandemic hit, nurses were falling ill and had to quarantine. We lost a few our top nurses and nursing leaders in a matter of months. The situation became so dire that nurses had come in even if they tested positive for COVID, putting not only other nurses at risk but patients as well. The intervention that I proposed to would be to implement a mandatory nurse to patient ratio. Prior to the pandemic, the hospital privately did a research study that showed that high mortality rates, bedside falls, missed care opportunities increased when nurses began resigning from the hospital with not enough new hires replacing them. “Growing evidence indicates that improved nurse staffing in acute hospitals is associated with lower hospital mortality” (Haegdorens, Van Bogaert, De Meester & Monsieurs, p. 9). Now with the COVID delta variant spreading our hospital is no where near prepared to take on the influx of patients we have are hit the hard as we were when the pandemic began.

The population of focus are patients in medical and surgical wards. The intervention would support these patients in that nurses will have a more manageable patient workload that will allow them to meet the needs of the patients without having to rush care processes and create a more safe patient care environment and a more responsible and efficient nursing work environment as nurses will be a function more efficiently and provide appropriate care to patients without the burden of being overwhelmed, stressed and fatigue during their shift. The problem is amenable to the research based intervention in that the articles collected provide data analysis that show a direct correlation between inadequate staffing shortages to poor patient health outcomes. ““Some parts of the world such as California, USA, and Queensland, Australia has passed the law for the minimum nurse-to-patient ratio, which has scientifically found to be beneficial for the patients and healthcare system” (Sharma & Rani, 2020, para. 1).

References:

Haegdorens, F., Van Bogaert, P., De Meester, K. & Monsieurs, K. (2019). The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: An observational multicentre study. BMC Health Serv Res. (19) 864. https://doi.org/10.1186/s12913-019-4688-7.

Sharma, S. K., & Rani, R. (2020). Nurse-to-patient ratio and nurse staffing norms for hospitals in India: A critical analysis of national benchmarks. Journal of family medicine and primary care, 9(6), 2631–2637. https://doi.org/10.4103/jfmpc.jfmpc_248_20