Nurse-initiated defibrillation: are nurses confident enough?

Area of Science:

• Emergency Medicine
• Nursing Education
• Cardiology

Background:

• Nurses play a critical role in managing cardiac arrest.
• Prompt recognition of shockable rhythms like ventricular fibrillation (VF) and ventricular tachycardia (VT) is crucial for effective defibrillation.
• Assessing nurses' proficiency in identifying these rhythms and performing defibrillation is essential for improving patient outcomes.

Purpose of the Study:

• To evaluate the capability of emergency department nurses in identifying VF and VT on ECGs.
• To assess nurses' willingness and ability to perform immediate defibrillation upon confirming cardiac arrest.
• To determine the impact of focused in-house training on nurses' skills and confidence in managing shockable rhythms.

Main Methods:

• Prospective cohort study conducted in a Hong Kong teaching hospital's emergency department.
• Nurses completed pre- and post-training questionnaires assessing ECG interpretation and defibrillation decision-making.
• Scoring system awarded points for correct ECG identification and defibrillation choices.

Main Results:

• Post-training, there was a significant improvement in defibrillation decision-making scores (p=0.014) and overall performance (p=0.046).
• While ECG rhythm identification scores showed no significant change, nurses' confidence in managing shockable rhythms increased, with 67% reporting greater confidence.
• The focused training positively impacted nurses' practical skills in managing cardiac arrest scenarios.

Conclusions:

• Brief, focused in-house training effectively enhances nurses' defibrillation decision-making skills.
• The training also boosts nurses' confidence in managing patients with life-threatening cardiac arrhythmias.
• Further training initiatives should focus on improving both rhythm identification and timely defibrillation actions.