運用即時回饋裝置提升護理人員心肺復甦品質成效

The Effect of Using a Real-Time Feedback Device on the Quality of Cardio Pulmonary Resuscitation (CPR) Performed by Nursing Staff

10.6224/JN.202208_69(4).06

李柏勳(Po-Hsun LEE)；蕭詠勳(Yung-Hsun HSIAO)；翁想容(Shiang-Rung WENG)；林佩欣(Pei-Hsin LIN)；林思親(Sih-Cin LIN)

護理人員 ； 即時回饋 ； 心肺復甦術 ； 自我效能 ； nursing staff ； real-time feedback ； cardiopulmonary resuscitation ； self-efficac

護理雜誌

69卷4期（2022 / 08 / 01）

33 - 42

繁體中文

背景：病人發生心跳停止時，立即進行心肺復甦術（cardiopulmonary resuscitation, CPR）已是標準急救措施，因此，CPR執行品質攸關心臟停止病人的存活率。目的：探討運用即時回饋裝置提升護理人員CPR執行品質及CPR自我效能之成效。方法：本研究採隨機對照研究設計，共納入72位護理人員（實驗組38位，對照組34位），使用即時回饋裝置記錄及提供CPR品質回饋，所有研究對象都執行五次CPR循環（約2分鐘），執行期間僅有實驗組使用即時回饋裝置，對照組則未使用，並使用問卷收集研究對象基本屬性及CPR自我效能分數。結果：本研究結果顯示：即時回饋裝置能顯著提升胸部按壓速率正確比率（76.3 vs. 52.3, p ＜ .001）、平均深度（52.8 mm vs. 50.6 mm, p = .003）、深度正確比率（65.6 vs. 55.1, p = .014）、CPR執行品質分數（44.1 vs. 26.1, p ＜ .001）、達高品質CPR標準比率（60.5 vs. 26.5, p ＜ .001）及CPR自我效能分數（40.22 vs. 36.71, p ＜ .001）。按壓後完全回彈比率及胸部按壓佔總急救時間（chest compression fracture）比率則未達到顯著差異（p ＞ .05）。結論：使用即時回饋裝置可以使護理人員在急救安妮上有更良好的CPR執行品質，並提升對於能正確執行CPR的自信心。

Background: Cardiopulmonary resuscitation (CPR) is a standard procedure delivered to patients experiencing cardiac arrest. CPR quality is associated with the rate of survival of patients with cardiac arrest. Purpose: To determine the efficacy of a real-time feedback device in terms of improving CPR performance quality and CPR self-efficacy in nursing staffs. Methods: A total of 72 nursing staffs were enrolled in this randomized trial (intervention n = 38, control n = 34). A real-time feedback device was used to monitor CPR quality and provide real-time feedback. The participants performed CPR on a manikin with (intervention) or without (control) feedback for 5 cycles (about 2 minutes). Data on participant demographic characteristics and CPR self-efficacy scores were also collected. Results: The intervention group performed better in terms of the compression adequate rate ratio (76.3 vs. 52.3, p ＜ .001), mean depth (52.8 mm vs. 50.6 mm, p = .003), adequate depth ratio (65.6 vs. 55.1, p = .014), quality of CPR performance score (44.1 vs. 26.1, p ＜ .001), proportion of excellent CPR (60.5 vs. 26.5, p ＜ .001), and CPR self-efficacy score (40.22 vs. 36.71, p ＜ .001). However, no significant differences between the two groups were found in terms of proportion of complete chest decompression and chest compression fracture (p ＞ .05). Conclusions: Using a real-time feedback device may not only significantly improve the quality of CPR performed on a manikin but also improve self-confidence to implement CPR correctly in practice.

1. 鄧秋蓮、張筱玉（2018）．提升護理師立即救命術能力之改善專案．台大護理雜誌，14（1），129–143。[Teng, C.-L., & Chang, H.-Y. (2018). The project of increasing nurses’ competency in immediate life support. National Taiwan University Hospital Journal of Nursing, 14(1), 129–143.] https://doi.org/10.6740/NTUHJN.201801_14(1).0013
   連結：
2. 盧文華、曾倩倩、侯重光、高芷華、孫秀卿（2020）．急診護理人員執行心肺復甦術品質及其相關因素．台灣醫學，24（2），150–159。[Lu, W.-H., Tseng, C.-C., How, C.-K., Kao, T.-W., & Shun, S.-C. (2020). Cardiopulmonary resuscitation performance quality and its related factors in nursing staff at emergency department. Formosan Journal of Medicine, 24(2), 150–159.] https://doi.org/10.6320/FJM.202003_24(2).0003
   連結：
3. 謝明芫、謝素英、許麗齡（2014）．某醫學中心護理人員接受高級心臟救命術課程自評執行急救能力之研究．新臺北護理期刊，16（1），17–28。[Hsieh, M.-Y., Hsieh, S.-I., & Hsu, L.-L. (2014). A study of medical center nurse’s self-assessment in performance of advanced cardiac life support skills. New Taipei Journal of Nursing, 16(1), 17–28.] https://doi.org/10.6540/NTJN.2014.1.003
   連結：
4. 羅雨凡、謝素英、楊久滕、許麗齡（2019）．緊急救護技術員自評急救處置能力之研究．護理雜誌，66(2)，48–56。[Lo, Y.-F., Hsieh, S.-I., Yiang, G.-T., & Hsu, L.-L. (2019). A study of the self-assessed emergency management competencies of emergency medical technicians. The Journal of Nursing, 66(2), 48–56.] https://doi.org/10.6224/JN.201904_66(2).07
   連結：
5. Adams, J. A. (1971). A closed-loop theory of motor learning. Journal of Motor Behavior, 3(2), 111–150. https://doi.org/10.1080/00222895.1971.10734898
   連結：
6. Aguilar, S. A., Asakawa, N., Saffer, C., Williams, C., Chuh, S., & Duan, L. (2018). Addition of audiovisual feedback during standard compressions is associated with improved ability. Western Journal of Emergency Medicine, 19(2), 437–444. https://doi.org/10.5811/westjem.2017.11.34327
   連結：
7. Ali, D. M., Hisam, B., Shaukat, N., Baig, N., Ong, M. E. H., Epstein, J. L., Goralnick, E., Kivela, P. D., McNally, B., & Razzak, J. (2021). Cardiopulmonary resuscitation (CPR) training strategies in the times of COVID-19: A systematic literature review comparing different training methodologies. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1), Article 53. https://doi.org/10.1186/s13049-021-00869-3
   連結：
8. Augusto, J., Santos, M., Faria, D., Alves, P., Roque, D., Morais, J., Gil, V., & Morais, C. (2020). Real-time visual feedback device improves quality of chest compressions: A manikin study. Bulletin of Emergency and Trauma, 8(3), 135–141. https://doi.org/10.30476/BEAT.2020.83080
   連結：
9. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295x.84.2.191
   連結：
10. Cheng, A., Nadkarni, V. M., Mancini, M. B., Hunt, E. A., Sinz, E. H., Merchant, R. M., Donoghue, A., Duff, J. P., Eppich, W., Auerbach, M., Bigham, B. L., Blewer, A. L., Chan, P. S., & Bhanji, F. (2018). Resuscitation education science: Educational strategies to improve outcomes from cardiac arrest: A scientific statement from the American Heart Association. Circulation, 138(6), e82–e122. https://doi.org/10.1161/CIR.0000000000000583
    連結：
11. Gugelmin-Almeida, D., Tobase, L., Polastri, T. F., Peres, H. H. C., & Timerman, S. (2021). Do automated real-time feedback devices improve CPR quality? A systematic review of literature. Resuscitation Plus, 6, Article 100108. https://doi.org/10.1016/j.resplu.2021.100108
    連結：
12. Hernández-Padilla, J., Suthers, F., Fernández-Sola, C., & Granero-Molina, J. (2016). Development and psychometric assessment of the basic resuscitation skills self-efficacy scale. European Journal of Cardiovascular Nursing, 15(3), e10–e18. https://doi.org/10.1177/1474515114562130
    連結：
13. Johnson, M., Peat, A., Boyd, L., Warren, T., Eastwood, K., & Smith, G. (2016). The impact of quantitative feedback on the performance of chest compression by basic life support trained clinical staff. Nurse Education Today, 45, 163–166. https://doi.org/10.1016/j.nedt.2016.08.006
    連結：
14. Kaminska, H., Wieczorek, W., Matusik, P., Czyzewski, L., Ladny, J. R., Smereka, J., Filipiak, K. J., & Szarpak, L. (2018). Factors influencing high-quality chest compressions during cardiopulmonary resuscitation scenario, according to 2015 American Heart Association guidelines. Kardiologia Polska, 76(3), 642–647. https://doi.org/10.5603/KP.a2018.0003
    連結：
15. Ko, Y.-C., Yang, C.-W., Lin, H.-Y., Chiang, W.-C., Hsieh, M.-J., & Ma, M. H.-M. (2021). A non-inferiority randomised controlled trial comparing self-instruction with instructor-led method in training of layperson cardiopulmonary resuscitation. Scientific Reports, 11(1), Article 991. https://doi.org/10.1038/s41598-020-79626-y
    連結：
16. Majer, J., Jaguszewski, M. J., Frass, M., Leskiewicz, M., Smereka, J., Ładny, J. R., Robak, O., & Szarpak, Ł. (2019). Does the use of cardiopulmonary resuscitation feedback devices improve the quality of chest compressions performed by doctors? A prospective, randomized, cross-over simulation study. Cardiology Journal, 26(5), 529–535. https://doi.org/10.5603/CJ.a2018.0091
    連結：
17. Merchant, R. M., Topjian, A. A., Panchal, A. R., Cheng, A., Aziz, K., Berg, K. M., Lavonas, E. J., & Magid, D. J. (2020). Part 1: Executive summary: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 142(16, Suppl. 2), S337–S357. https://doi.org/10.1161/CIR.0000000000000918
    連結：
18. Picard, C., Yang, B. G., Norris, C., McIntosh, S., & Douma, M. J. (2021). Cardiopulmonary resuscitation feedback: A comparison of device-measured and self-assessed chest compression quality. Journal of Emergency Nursing, 47(2), 333–341.e1. https://doi.org/10.1016/j.jen.2020.10.003
    連結：
19. Riggs, M., Franklin, R., & Saylany, L. (2019). Associations between cardiopulmonary resuscitation (CPR) knowledge, self-efficacy, training history and willingness to perform CPR and CPR psychomotor skills: A systematic review. Resuscitation, 138, 259–272. https://doi.org/10.1016/j.resuscitation.2019.03.019
    連結：
20. Ro, Y. S., Shin, S. D., Song, K. J., Hong, S. O., Kim, Y. T., Lee, D.-W., & Cho, S.-I. (2016). Public awareness and self-efficacy of cardiopulmonary resuscitation in communities and outcomes of out-of-hospital cardiac arrest: A multi-level analysis. Resuscitation, 102, 17–24. https://doi.org/10.1016/j.resuscitation.2016.02.004
    連結：
21. Roh, Y. S., Issenberg, S. B., Chung, H. S., & Kim, S. S. (2012). Development and psychometric evaluation of the resuscitation self-efficacy scale for nurses. Journal of Korean Academy of Nursing, 42(7), 1079–1086. https://doi.org/10.4040/jkan.2012.42.7.1079
    連結：
22. Saqe-Rockoff, A., Ciardiello, A. V., & Schubert, F. D. (2019). Low-fidelity, in-situ pediatric resuscitation simulation improves RN competence and self-efficacy. Journal of Emergency Nursing, 45(5), 538–544.e1. https://doi.org/10.1016/j.jen.2019.02.003
    連結：
23. Sasson, C., Haukoos, J. S., Eigel, B., & Magid, D. J. (2014). The HANDDS program: A systematic approach for addressing disparities in the provision of bystander cardiopulmonary resuscitation. Academic Emergency Medicine, 21(9), 1042–1049. https://doi.org/10.1111/acem.12455
    連結：
24. Vahedian-Azimi, A., Zehtabchi, S., & Miller, A. C. (2021). Real-time audiovisual feedback during CPR: A clarification, meta-analysis update, and caution for interpretation. Resuscitation, 158, 295–297. https://doi.org/10.1016/j.resuscitation.2020.09.043
    連結：
25. Wagner, M., Bibl, K., Hrdliczka, E., Steinbauer, P., Stiller, M., Gröpel, P., Goeral, K., Salzer-Muhar, U., Berger, A., Schmölzer, G. M., & Olischar, M. (2019). Effects of feedback on chest compression quality: A randomized simulation study. Pediatrics, 143(2), Article e20182441. https://doi.org/10.1542/peds.2018-2441
    連結：
26. Wang, J.-C., Tsai, S.-H., Chen, Y.-H., Chen, Y.-L., Chu, S.-J., & Liao, W.-I. (2018). Kinect-based real-time audiovisual feedback device improves CPR quality of lower-body-weight rescuers. The American Journal of Emergency Medicine, 36(4), 577–582. https://doi.org/10.1016/j.ajem.2017.09.022
    連結：
27. Yamaguchi, R., Makino, Y., Chiba, F., Torimitsu, S., Yajima, D., Inokuchi, G., Motomura, A., Hashimoto, M., Hoshioka, Y., Shinozaki, T., & Iwase, H. (2017). Frequency and influencing factors of cardiopulmonary resuscitation-related injuries during implementation of the American Heart Association 2010 guidelines: A retrospective study based on autopsy and postmortem computed tomography. International Journal of Legal Medicine, 131(6), 1655–1663. https://doi.org/10.1007/s00414-017-1673-8
    連結：
28. 賴重宇（2018）．臺灣地區心跳停止住院病患存活情形回溯型分析研究〔碩士論文，國防醫學院〕．臺灣博碩士論文知識加值系統。https://hdl.handle.net/11296/3vk25p [Lai, C.-Y. (2108). Survival of hospitalized cardiac arrest patients in Taiwan: A retrospective and nationwide study [Master’s thesis, National Defense Medical Center]. National Digital Library of Theses and Dissertations in Taiwan. https://hdl.handle.net/11296/3vk25p]