1.

ABSTRACT

Cardiovascular diseases are the leading cause of death in both men and women throughout the
world. According to the Centers for Disease Control and Prevention (CDC), approximately 61
million people in the United States have heart disease. Cardiopulmonary resuscitation is a
technique of oxygenating the brain and heart until appropriate and definitive medical treatment
can restore normal heart and ventilatory action. So in such scenario the knowledge about this
technique can be helpful in saving the patients' life. The working staff especially nurses should
be completely aware about this technique because they are the responsible wing working for the
care and safety of patient. So this study was an effort to evaluate the knowledge of the nursing
staff regarding this technique. The objectives of study were: (1) to assess the knowledge of staff
nurses regarding Cardio Pulmonary Resuscitation (2) to determine the association between
knowledge of staff nurses with their selected demographic variables. A quantitative research
approach was used to assess the knowledge regarding cardio pulmonary resuscitation among
staff nurses of Fortis Escort Hospital, Amritsar. Sample size of the present study was 100 staff
nurses working in Fortis Escort Hospital, Amritsar. The research tool was a Self-structured
questionnaire which was used to assess the knowledge regarding CPR. The results revealed that
the knowledge of staff nurses was Average. Only 8% of the Staff nurses' knowledge score was
excellent, whereas 81% had average knowledge. There was significant association found
between the knowledge of staff nurses regarding cardiopulmonary resuscitation with their
selected demographic variables except gender. If similar studies are conducted across many other
hospitals we can get greater idea about the knowledge levels of the nursing staff of the respective
hospitals. So in this study it is found out that the knowledge levels regarding cardiopulmonary
resuscitation are dipping in general and awareness campaigns can be run in order to educate the
nursing staff about this technique.

2. INTRODUCTION

Cardiac arrest is one of the leading causes today for most of the deaths occurring around the
world. Due to the stressful lifestyle and wrong eating habits the people are falling prey to this
fatal disease. We have evolved in terms of technology and healthcare but still there are few
techniques which would be ever useful no matter how advanced and upgraded we become
technology wise. Cardiopulmonary resuscitation is one those techniques which are not only
effective but essential in case of handling an emergency cardiac arrest patient. Cardiopulmonary
resuscitation (CPR) is an emergency procedure for manually preserving brain function until
further measures to restore spontaneous blood circulation and breathing in a person who is
in cardiac arrest. It is indicated in those who are unresponsive with no breathing. CPR alone is
unlikely to restart the heart. Its main purpose is to restore partial flow of oxygenated blood to
the brain and heart. The aim here is to delay tissue disintegration and to prolong the small
window of chance for a successful resuscitation without permanent brain. Administration of an
electric shock to the subject's heart, called defibrillation, is usually needed in order to restore a
viable or "perfusing" heart rhythm. Earlier such studies have also been conducted in many parts
of the world. A similar study was conducted to assess the knowledge of nurses regarding
cardiopulmonary resuscitation in a Tertiary Care Teaching Hospital in Nepal. The self-developed
questionnaires containing 21 questions were distributed to the nurses and the filled
questionnaires were analyzed as per the study objectives. Among the total 175 nurses, 70 of them
responded with a response rate of 40%. So it can be concluded that the knowledge of the nurses
found to be low. So keeping in mind the importance of this technique this study was conducted
in order to check if one of the most reputed hospitals in the city had staff having the knowledge
of this technique. Also the fact that most of the developing countries lack the knowhow of this
technique of cardiopulmonary resuscitation prompted the researcher to carry out this study. Also
a guideline was prepared regarding this technique to enhance the knowledge of the nursing staff
regarding the technique of CPR. The quantitative approach was adopted in this study in order to
assess the knowledge of the nursing staff in the hospital. Sample size of the present study was
100 staff nurses working in Fortis Escort Hospital, Amritsar. A Self-structured questionnaire was
used to assess the knowledge regarding CPR. Various demographic variables like age,
occupation, location etc were used in order to establish a correlation with all these variables and
see if the knowledge levels vary according to these variables. This study is not important for just
knowing whether there is awareness about the CPR among the nursing staff of the hospitals but
may well also help in creating awareness about this life-saving technique.
3. MATERIALS AND METHODS
A quantitative research approach was used to assess the knowledge regarding cardio
pulmonary resuscitation among staff nurses of Fortis Escort Hospital, Amritsar. Keeping
in view the objectives of this study, descriptive research design was used and study was
conducted. The socio–demographic variables that were used were: Age, Gender, Marital
status, Professional qualification, Professional experience, Area of work, attended in-
services education. Staff nurses involved in this study were working in different wards of
Fortis Escort Hospital, Amritsar. Convenience sampling technique was adopted to draw
the sample from target population. Sample size of present study was 100 staff nurses. The
research tool was a Self-structured questionnaire used to assess the knowledge regarding
CPR. Content validity of tool had been ascertained with the help of guide and experts in
the field. It had 30 items to assess the knowledge of the staff nurses regarding CPR. The
Criterion measure was under three levels of knowledge which were as following:
Excellent (21–30), Average (11–20), and below average (1–10). The design of the entire
study though looked very simple but was very effective when it came to the actual
execution. The consent of the staff nurses was taken in written before the entire study and
only those members of the staff were involved in the study who were willing to
participate. The confidentiality of the names was also assured to each participating
member. There was also designed a set of guidelines to enhance the knowledge of the
nursing staff regarding the cardiopulmonary resuscitation.

4. RESULTS
The results showed that there exists a significant relationship between knowledge score
and all the variables except the gender. The relationship between the knowledge score
and the variables like education, experience, and area of work showed that there is direct
link between the knowledge of this technique and the backgrounds that a nursing
personal belongs to. The better education and work experience helped the nursing staff in
getting better knowhow of CPR. There are various outcomes that were found in this study
which are summed up in the preceding sections.
 TABLE 1: FREQUENCY AND PERCENTAGE DISTRIBUTION OF STUDY
SAMPLE BY THEIR SOCIO-DEMOGRAPHIC VARIABLES

S.NO SAMPLE CHARATERISTICS FREQUENCY PERCENTAGE

DISTRIBUTION
1. AGE
20–24 63 63%
25–29 23 23%
30–35 10 10%
35 and above 4 4%
2. GENDER
Male 8 8%
Female 92 92%
3. MARITAL STATUS
Unmarried 66 66%
Married 34 34%
4. PROFESSIONAL QUALIFICATION
GNM 68 68%
B.Sc.( N) 26 26%
Post-basic B.Sc. (N) 6 6%
M.Sc. (N) 0 0%
5. PROFESSIONAL EXPERIENCE
1–5 years 82 82%
6–10 years 10 10%
11–15 years 5 5%
16–20 years 3 3%
6. AREA OF WORK
ICU 28 28%
 Emergency 10 10%
O.T 8 8%
Wards 54 54%
7. ATTENDED IN-SERVICE
EDUCATION
Yes 78 78%
No 22 22%
Percentage distribution of staff nurses by their age showed that 63% belonged to 20–24 age
group followed by 23% in the age group 25–29, 10% in the age group 30–35 and 4% belonged to
35 or above age group. Maximum population belonged to the age group between 20 and24 years.

Percentage distribution of staff nurses by their gender depicted that majority of them i.e. 92% of
them were females and only 8% were male.

Percentage distribution of staff nurses by their marital status showed 66% were unmarried, 34%
were married and none was divorcee/separated.

Percentage distribution of staff nurses by their professional qualification revealed that majority
(68%) of them were GNMs, 26% B.Sc. Nursing whereas only 6% were Post-Basic B.Sc.
Nursing.

Percentage distribution of staff nurses by their Professional experience revealed that 82% staff
nurses were having 1–5 years of experience followed by 10% staff nurses with 6–10 years of
experience. Staff nurses who had 11–15 years and 16–20 years professional experience were 5%
and 3% respectively.

Percentage distribution of staff nurses by their Area of work indicated that the maximum study
subjects (54%) were working in the wards and the minimum study subjects (8%) were in OT
whereas 28% were in ICU and 10% in emergency.

Percentage distribution of staff nurses by their Attended in-service education showed that 78% had
attended in-service education related to CPR and 22 % had never attended in-service education.

TABLE 2. Mean and standard deviation of knowledge score of subjects.

 Level of knowledge Mean S.D

Below average 9 1.18

Average 14.86 3.10

Excellent 21.75 0.70

Table 2 reveals that mean value of staff nurses having below-average knowledge is 9 and SD is
1.18, mean value and SD values of staff nurses having average knowledge are 14.86 and 3.10
respectively whereas mean and SD values of staff nurses having excellent knowledge are 21.75
and 0.70 respectively.

Table 3:- Frequency and Percentage distribution of staff nurses based on the
level of knowledge regarding cardiopulmonary resuscitation.

n=100

Level of Score N Percentage

knowledge

Below average 0–10 11 11%

Average 11–20 81 81%
Excellent 21–30 8 8%
 % excellent average below average

11% 8%

81%

Figure 1: Pie chart showing frequency and percentage distribution of staff nurses according to
level of knowledge regarding cardiopulmonary resuscitation.

Table 3 and figure 1 reveal that out of 100 staff nurses, 81 % have average knowledge, 11%
below average and 8% have excellent knowledge.

Table 4:- Frequency and percentage distribution of knowledge score in

association with selected demographic variables.

Variables Knowledge of nurses Chi P value

square
value
Excellent Average Below-average
Age

8.213 0.222*
20–24 years 7 (7%) 49 (49%) 7 (7%)
25–29 years 0 (0%) 21 (21%) 2 (2%) df = 6

30–35 years 0 (0%) 8 (8%) 0 (0%)

35 and above 0 (0%) 4 (4%) 0 (0%)

Gender

0.29 0.865NS
Male 1 (1%) 6 (6%) 1 (1%)
Female 8 (8%) 76 (76%) 8 (8%) df = 2

Marital status

7.22 0.124*
Unmarried 5 (5%) 56 (56%) 5 (5%)
Married 2 (2%) 26 (26%) 6 (6%) df = 4

Divorcee/separated 0 (0%) 0 (0%) 0 (0%)

Professional
qualification 4.405 0.354*

6 (6%) 53 (53%) 9 (9%) df = 4

GNM
B.Sc.(N) 2 (2%) 22 (22%) 2 (2%)

Post Basic B.Sc.(N) 0 (0%) 6 (6%) 0(0%)

M.Sc.(N) 0 (0%) 0 (0%) 0 (0%)

Professional
experience 22.36 0.001*

8 (8%) 65 (65%) 9 (9%) df = 6

1–5 years
5–10 years 0 (0%) 9 (9%) 1 (1%)

11–15 years 0 (0%) 2 (2%) 3 (3%)

16–20 years 0 (0%) 3 (3%) 0 (0%)

Area of work

6.12 0.409*
I.C.U 3 (3%) 23 (23%) 2 (2%)
Emergency df = 6
1 (1%) 9 (9%) 0 (0%)
OT 1 (1%) 6(6%) 1 (1%)
Wards 3 (3%) 43 (43%) 8 (8%)

In-service education

5.4030 0.05*
Yes 8 (8%) 63 (63%) 7 (7%)
df = 2
No 0 (0%) 18 (18%) 4 (4%)

P*< 0.05 = Significant. NS=Non-significant

Table 4 denotes the association of knowledge regarding CPR with selected demographic
variables. The result reveals that there is significant association between demographic variables
and knowledge except the gender. The significance values for various variables are as following:

With their age=0.222

With their marital status=0.124
With their area of work=0.409
With their qualification=0.354
With their professional experience=0.001

5. DISCUSSION
The knowledge score shows that 11% of study population had excellent knowledge, 81% of
study population had average knowledge and 8% of study population had below-average
knowledge. It is supported by a cross-sectional study conducted to assess the knowledge of
nurses regarding cardiopulmonary resuscitation in a Tertiary Care Teaching Hospital in Nepal. A
self-developed questionnaire containing 21 questions was distributed to the nurses and the filled
questionnaires were analyzed as per the study objectives. Among the total 175 nurses, 70 of them
responded with a response rate of 40%. So it can be concluded that the knowledge of the nurses
was found to be low. And if we look around the studies that have been conducted around the
world they show the similar trends in under-developed and developing countries. So this clearly
suggests that there is a great vacuum for teaching and creating awareness about this technique.
The significance of this study also increases when we look at the previous studies which
involved delivering the guidelines regarding CPR to the nursing staff. It was found that the
awareness about this technique increased once the guidelines were delivered to the staff. So this
study lay the foundation for future work in which we can incorporate the delivery of guidance, in
the various regions, to the nursing staff of various hospitals and then can check for the
improvement in the knowledge. The knowledge about this technique will not only save many
lives but also assure us the better complete medical treatment for the cardiac patients.

6. CONCLUSION

The major goal of the study was to assess the knowledge of the nursing staff of the Fortis, escorts
hospital, Amritsar. Earlier studies on the same topic had covered many different regions of the
world and especially the developing countries in which it was found that most of these countries
lacked knowledge regarding CPR among the hospital staff of nurses. Our study came to a
conclusion that only 15% of the nurses had excellent knowledge regarding the procedure
whereas 70% had average knowledge and the rest of them were below-average. So this study
was almost in a correlation with the previous studies. Like in a similar study in Nepal, a self-
developed questionnaire containing 21 questions was distributed to the nurses and the filled
questionnaires were analyzed as per the study objectives. Among the total 175 nurses, 70 of them
responded with a response rate of 40%. So it can be concluded that the knowledge of the nurses
was low in that case also. This study points to some implications that may have a great role to
play if implemented and followed consistently which are summed up as follow:
  Continue education programme should be conducted for nurses in hospitals with an aim of
updating their knowledge regarding CPR so that they can secure the life of needy people in
emergency.
 The CPR procedure must be added in the curriculum of final year of their nursing
diploma/degree so as to make the nursing students aware of this vital procedure.
 Workshops and Conferences regarding the effective techniques of CPR can be conducted
 Nursing Administrator should provide necessary facilities and opportunities to nursing staff
to equip them to deal with the clients who require CPR.
 Nursing Administrator should help the families and communities to understand the need of
CPR

The present study provides an opportunity to expand the scope of the awareness regarding CPR
to the higher level. Different communities and societies can be involved. To begin with the
Amritsar district can be covered first and later moving to the different parts of the state of
Punjab.

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