Eun Jung Kim; Kyeong Ryong Lee

doi:10.7475/kjan.2015.27.2.146

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Relationship between Non-technical Skills and Resuscitation Performance of Nurses' Team in in-situ Simulated Cardiac Arrest

Eun Jung Kim¹, Kyeong Ryong Lee²

Korean Journal of Adult Nursing 2015;27(2):146-155.
Published online: April 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.2.146

¹Division of Nursing, Research Institute of Nursing Science, HallymUniversity, Chuncheon

²Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea

Corresponding author: Kim, Eun Jung Division of Nursing, Research Institute of Nursing Science, Hallym University, 1 Hallymdaehak-gil, Chuncheon 200-702, Korea. Tel: +82-33-248-2725, Fax: +82-33-248-2734, E-mail: ejerkim@hallym.ac.kr

• Received: November 20, 2014 • Accepted: March 27, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
The aim of this descriptive study was to explore the relationship between non-technical skills (NTSs) andcardiopulmonaryresuscitation(CPR)performanceof nurses' teams insimulatedcardiacarrest inthehospital.
Methods
Thesample was 28teams of nurses inoneuniversity hospital located in Seoul. A high fidelity simulator was used toenact simulated cardiacarrest. The nurse teams were scored by raters using both the CPR performance checklist and the NTSs checklist. Specifically the CPR performance checklist included critical actions; time elapsed to initiation of critical actions, and quality of cardiac compression. The NTSs checklist was comprised of leadership, communication, mutual performance monitoring, maintenance of guideline, and task management. Data were collected directly from manikin and video recordings.
Results
There was a significant difference between the medians of the NTSs and CPR performance (Mann WhitneyU=43.5, p=.014). In five subcategories, communication (p=.026), mutual performance monitoring (p=.005), and maintenance of guideline (p=.003) dif-feredsignificantlywithCPR performance inmedians. Leadership(p=.053) andtaskmanagement (p=.080) were not significantlydifferent withCPR performance.
Conclusion
Thefindings indicate that NTSsof teams inaddition to technical skills of individual rescuers affect the outcome of CPR. NTSs development andassessment should be considered an integral part of resuscitation training.
Key Words: Cardiopulmonary resuscitation; Leadership; Team behavior; Patient simulation

Table 1.

Nurses' CPR Performance Scales

Items	Critical action	Range of scores	Scale
Items	Critical action	Range of scores	0	1	2	3
Assessment	Check unresponsiveness	0~1	no	yes
	Call for help	0~1	no	yes
	Check pulse	0~1	no	yes
Start CPR	Time to initiate chest compression	0~2	60 sec ＞	30~60 sec	30 sec ＜
	Apply back board	0~2	no	incorrect	correct
	Initiate BVM ventilation	0~2	no	incorrect	correct
	Connect to oxygen	0~2	no	incorrect	correct
Quality of CPR	Mean rate of correct compression rate (%)	0~3	NC	50% ＜	50~80%	80% ＞
	Mean rate of correct placement of hands (%)	0~3	NC	50% ＜	50~80%	80% ＞
	Mean rate of correct compression depth (%)	0~3	NC	50% ＜	50~80%	80% ＞
	Mean rate of full chest recoil (%)	0~3	NC	50% ＜	50~80%	80% ＞
	30 compression and 2 ventilation	0~2	NC or BVM	incorrect	correct
	Hands off time^†	0~2	2 min ＞	1~2 min	1 min ＜
Defibrillation	Check ECG rhythm	0~2	no	incorrect	correct
	Give a shock (defibrillation)	0, 2	no		yes
	Select a shock energy and charge	0~1	no or incorrect	correct
	Place the defibrillator paddle in AP	0~1	no	yes
	Clear the victim before delivering a shock	0~1	no	yes
	Time to deliver first shock	0~2	no shock	2min ＞	2 min ＜
Drug	Administer epinephrine	0~1	no	yes

CPR=cardiopulmonary resuscitation; BVM=bag valve mask; ECG=electrocardiography; NC=no compression; AP=appropriate position;

^†Total compression interruption time during 5 minutes.

Table 2.

Non-technical Skills Rating during 5 minutes Simulated Cardiac Arrest (N=28)

Variables	Behavior marker	None	Incomplete or untimely	Complete & timely
Variables	Behavior marker	n (%)	n (%)	n (%)
Leadership	Clearly identified in team	2 (7.1)	12 (42.9)	14 (50.0)
	Communicate efficiently	6 (21.4)	15 (53.6)	7 (25.0)
	Delegate (distribute) tasks	6 (21.4)	12 (42.9)	10 (35.7)
	Manage workload and resource	11 (39.3)	4 (14.3)	13 (46.4)
Communication	Use closed loop communication (check-back)	9 (32.1)	5 (17.9)	13 (46.4)
Communication	Call for help appropriate/think out loudly	8 (28.6)	7 (25.0)	13 (46.4)
Mutual performance monitoring	Unnecessary hand-off time corrected	19 (67.9)	4 (14.3)	5 (17.9)
	Hyper- or hypoventilation corrected	23 (82.1)	3 (10.7)	2 (7.1)
	Check & speak out the rhythm	8 (28.6)	5 (17.9)	15 (53.6)
	Knowledge sharing, situation monitoring	12 (42.9)	5 (17.9)	11 (39.3)
Maintaining of standards and guideline	Defibrillation is performed safely	10 (35.7)	5 (17.9)	13 (46.4)
	Change person performing chest compression	7 (25.0)	4 (14.3)	17 (60.7)
	every 2 min.
	Ensuring cardiac rhythm after 5 cycles	9 (32.1)	7 (25.0)	12 (42.9)
Task management	Back-up behavior provided as needed (support other team members)	2 (7.1)	7 (25.0)	19 (67.9)
Task management	All team members contribute with behavior	2 (7.1)	3 (10.7)	23 (82.1)

Table 3.

Nurses' CPR Performance Scores during 5 minutes Simulated Cardiac Arrest (N=28)

Variables	Critical action	Scale				M±SD (possible range)
		0	1	2	3
		n (%)	n (%)	n (%)	n (%)
Assessment	Check unresponsiveness	0 (0.0)	28 (100.0)			2.50±0.58
	Call for help	1 (3.6)	27 (96.4)			(0~3)
	Check pulse	13 (46.4)	15 (53.6)			(0~3)
Start CPR	Time to initiate chest compression	3 (10.7)	5 (17.9)	20 (71.4)		5.57±1.83
	Apply back board	6 (21.4)	7 (25.0)	15 (53.6)		(0~8)
	Initiate BVM ventilation	1 (3.6)	16 (57.2)	11 (39.3)
	Connect to oxygen	9 (32.1)	1 (3.6)	18 (64.3)
Quality of CPR	Mean rate of correct compression rate (%)	5 (17.9)	21 (75.0)	3 (10.7)	4 (14.3)	11.28±1.36
	Mean rate of correct placement of hands (%)		4 (14.3)	7 (25.0)	17 (60.7)	(0~16)
	Mean rate of correct compression depth (%)		13 (46.4)	9 (32.1)	6 (21.4)
	Mean rate of full chest recoil (%)		6 (21.4)	22 (78.6)	28 (100.0)
	30 compression and 2 ventilation		21 (75.0)	2 (7.1)
	Hands off time^†
Defibrillation	Check ECG rhythm	7 (25.0)	6 (21.4)	15 (53.6)		6.07±3.05
	Give a shock (defibrillation)	5 (17.9)	21 (75.0)	23 (82.1)		(0~9)
	Select a shock energy and charge	7 (25.0)	20 (71.4)
	Place the defibrillator paddle in AP	8 (28.6)	20 (71.4)
	Clear the victim before delivering a shock	8 (28.6)	23 (82.1)
	Time to deliver first shock	5 (17.9)
Drug	Administer epinephrine	15 (53.6)	13 (46.4)			NA
Total scores						27.32±4.59

CPR=cardiopulmonary resuscitation; BVM=bag valve mask; ECG=electrocardiography; AP=appropriate position; NA=not applicable;

^†Total compression interruption time during 5 minutes.

Table 4.

Association NTSs and CPR Performance during 5 minutes Simulated Cardiac Arrest (N=28)

Variables	Groups	CPR performance Median (IQR)	Mann- Whitney U	Z	p
Total NTSs	Better (n=16)	29.5 (27.0~31.8)	43.5	-2.447	.014
Total NTSs	Worse (n=12)	25.0 (23.0~28.8)	43.5	-2.447	.014
Leadership	Better (n=14)	29.5 (26.8~31.3)	56.0	-1.938	.053
Leadership	Worse (n=14)	25.5 (22.8~29.3)	56.0	-1.938	.053
Communication	Better (n=15)	30.0 (27.0~32.0)	49.5	-2.220	.026
Communication	Worse (n=13)	26.0 (24.0~28.5)	49.5	-2.220	.026
Mutual performance monitoring	Better (n=18)	30.0 (26.75~32.0)	31.5	-2.816	.005
Mutual performance monitoring	Worse (n=10)	25.0 (21.5~28.3)	31.5	-2.816	.005
Maintaining of standards and guideline	Better (n=17)	30.0 (27.0~32.0)	30.5	-2.975	.003
Maintaining of standards and guideline	Worse (n=11)	25.0 (23.0~28.0)	30.5	-2.975	.003
Task management	Better (n=19)	29.0 (25.0~32.0)	50.0	-1.753	.080
Task management	Worse (n=9)	26.0 (21.0~29.0)	50.0	-1.753	.080

NTSs=non-technical skills; CPR=cardiopulmonary resuscitation; IQR=interquartile range.

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Relationship between Non-technical Skills and Resuscitation Performance of Nurses' Team in in-situ Simulated Cardiac Arrest

Korean J Adult Nurs. 2015;27(2):146-155. Published online April 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.2.146

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Relationship between Non-technical Skills and Resuscitation Performance of Nurses' Team in in-situ Simulated Cardiac Arrest

Korean J Adult Nurs. 2015;27(2):146-155. Published online April 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.2.146

Relationship between Non-technical Skills and Resuscitation Performance of Nurses' Team in in-situ Simulated Cardiac Arrest

Table 1.

Nurses' CPR Performance Scales

Items	Critical action	Range of scores	Scale
Items	Critical action	Range of scores	0	1	2	3
Assessment	Check unresponsiveness	0~1	no	yes
	Call for help	0~1	no	yes
	Check pulse	0~1	no	yes
Start CPR	Time to initiate chest compression	0~2	60 sec ＞	30~60 sec	30 sec ＜
	Apply back board	0~2	no	incorrect	correct
	Initiate BVM ventilation	0~2	no	incorrect	correct
	Connect to oxygen	0~2	no	incorrect	correct
Quality of CPR	Mean rate of correct compression rate (%)	0~3	NC	50% ＜	50~80%	80% ＞
	Mean rate of correct placement of hands (%)	0~3	NC	50% ＜	50~80%	80% ＞
	Mean rate of correct compression depth (%)	0~3	NC	50% ＜	50~80%	80% ＞
	Mean rate of full chest recoil (%)	0~3	NC	50% ＜	50~80%	80% ＞
	30 compression and 2 ventilation	0~2	NC or BVM	incorrect	correct
	Hands off time^†	0~2	2 min ＞	1~2 min	1 min ＜
Defibrillation	Check ECG rhythm	0~2	no	incorrect	correct
	Give a shock (defibrillation)	0, 2	no		yes
	Select a shock energy and charge	0~1	no or incorrect	correct
	Place the defibrillator paddle in AP	0~1	no	yes
	Clear the victim before delivering a shock	0~1	no	yes
	Time to deliver first shock	0~2	no shock	2min ＞	2 min ＜
Drug	Administer epinephrine	0~1	no	yes

CPR=cardiopulmonary resuscitation; BVM=bag valve mask; ECG=electrocardiography; NC=no compression; AP=appropriate position;

^†Total compression interruption time during 5 minutes.

Table 2.

Non-technical Skills Rating during 5 minutes Simulated Cardiac Arrest (N=28)

Variables	Behavior marker	None	Incomplete or untimely	Complete & timely
Variables	Behavior marker	n (%)	n (%)	n (%)
Leadership	Clearly identified in team	2 (7.1)	12 (42.9)	14 (50.0)
	Communicate efficiently	6 (21.4)	15 (53.6)	7 (25.0)
	Delegate (distribute) tasks	6 (21.4)	12 (42.9)	10 (35.7)
	Manage workload and resource	11 (39.3)	4 (14.3)	13 (46.4)
Communication	Use closed loop communication (check-back)	9 (32.1)	5 (17.9)	13 (46.4)
Communication	Call for help appropriate/think out loudly	8 (28.6)	7 (25.0)	13 (46.4)
Mutual performance monitoring	Unnecessary hand-off time corrected	19 (67.9)	4 (14.3)	5 (17.9)
	Hyper- or hypoventilation corrected	23 (82.1)	3 (10.7)	2 (7.1)
	Check & speak out the rhythm	8 (28.6)	5 (17.9)	15 (53.6)
	Knowledge sharing, situation monitoring	12 (42.9)	5 (17.9)	11 (39.3)
Maintaining of standards and guideline	Defibrillation is performed safely	10 (35.7)	5 (17.9)	13 (46.4)
	Change person performing chest compression	7 (25.0)	4 (14.3)	17 (60.7)
	every 2 min.
	Ensuring cardiac rhythm after 5 cycles	9 (32.1)	7 (25.0)	12 (42.9)
Task management	Back-up behavior provided as needed (support other team members)	2 (7.1)	7 (25.0)	19 (67.9)
Task management	All team members contribute with behavior	2 (7.1)	3 (10.7)	23 (82.1)

Table 3.

Nurses' CPR Performance Scores during 5 minutes Simulated Cardiac Arrest (N=28)

Variables	Critical action	Scale				M±SD (possible range)
		0	1	2	3
		n (%)	n (%)	n (%)	n (%)
Assessment	Check unresponsiveness	0 (0.0)	28 (100.0)			2.50±0.58
	Call for help	1 (3.6)	27 (96.4)			(0~3)
	Check pulse	13 (46.4)	15 (53.6)			(0~3)
Start CPR	Time to initiate chest compression	3 (10.7)	5 (17.9)	20 (71.4)		5.57±1.83
	Apply back board	6 (21.4)	7 (25.0)	15 (53.6)		(0~8)
	Initiate BVM ventilation	1 (3.6)	16 (57.2)	11 (39.3)
	Connect to oxygen	9 (32.1)	1 (3.6)	18 (64.3)
Quality of CPR	Mean rate of correct compression rate (%)	5 (17.9)	21 (75.0)	3 (10.7)	4 (14.3)	11.28±1.36
	Mean rate of correct placement of hands (%)		4 (14.3)	7 (25.0)	17 (60.7)	(0~16)
	Mean rate of correct compression depth (%)		13 (46.4)	9 (32.1)	6 (21.4)
	Mean rate of full chest recoil (%)		6 (21.4)	22 (78.6)	28 (100.0)
	30 compression and 2 ventilation		21 (75.0)	2 (7.1)
	Hands off time^†
Defibrillation	Check ECG rhythm	7 (25.0)	6 (21.4)	15 (53.6)		6.07±3.05
	Give a shock (defibrillation)	5 (17.9)	21 (75.0)	23 (82.1)		(0~9)
	Select a shock energy and charge	7 (25.0)	20 (71.4)
	Place the defibrillator paddle in AP	8 (28.6)	20 (71.4)
	Clear the victim before delivering a shock	8 (28.6)	23 (82.1)
	Time to deliver first shock	5 (17.9)
Drug	Administer epinephrine	15 (53.6)	13 (46.4)			NA
Total scores						27.32±4.59

CPR=cardiopulmonary resuscitation; BVM=bag valve mask; ECG=electrocardiography; AP=appropriate position; NA=not applicable;

^†Total compression interruption time during 5 minutes.

Table 4.

Association NTSs and CPR Performance during 5 minutes Simulated Cardiac Arrest (N=28)

Variables	Groups	CPR performance Median (IQR)	Mann- Whitney U	Z	p
Total NTSs	Better (n=16)	29.5 (27.0~31.8)	43.5	-2.447	.014
Total NTSs	Worse (n=12)	25.0 (23.0~28.8)	43.5	-2.447	.014
Leadership	Better (n=14)	29.5 (26.8~31.3)	56.0	-1.938	.053
Leadership	Worse (n=14)	25.5 (22.8~29.3)	56.0	-1.938	.053
Communication	Better (n=15)	30.0 (27.0~32.0)	49.5	-2.220	.026
Communication	Worse (n=13)	26.0 (24.0~28.5)	49.5	-2.220	.026
Mutual performance monitoring	Better (n=18)	30.0 (26.75~32.0)	31.5	-2.816	.005
Mutual performance monitoring	Worse (n=10)	25.0 (21.5~28.3)	31.5	-2.816	.005
Maintaining of standards and guideline	Better (n=17)	30.0 (27.0~32.0)	30.5	-2.975	.003
Maintaining of standards and guideline	Worse (n=11)	25.0 (23.0~28.0)	30.5	-2.975	.003
Task management	Better (n=19)	29.0 (25.0~32.0)	50.0	-1.753	.080
Task management	Worse (n=9)	26.0 (21.0~29.0)	50.0	-1.753	.080

NTSs=non-technical skills; CPR=cardiopulmonary resuscitation; IQR=interquartile range.

Table 1. Nurses' CPR Performance Scales

CPR=cardiopulmonary resuscitation; BVM=bag valve mask; ECG=electrocardiography; NC=no compression; AP=appropriate position;

†

Total compression interruption time during 5 minutes.

Table 2. Non-technical Skills Rating during 5 minutes Simulated Cardiac Arrest (N=28)

Table 3. Nurses' CPR Performance Scores during 5 minutes Simulated Cardiac Arrest (N=28)

CPR=cardiopulmonary resuscitation; BVM=bag valve mask; ECG=electrocardiography; AP=appropriate position; NA=not applicable;

†

Total compression interruption time during 5 minutes.

Table 4. Association NTSs and CPR Performance during 5 minutes Simulated Cardiac Arrest (N=28)

NTSs=non-technical skills; CPR=cardiopulmonary resuscitation; IQR=interquartile range.

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Relationship between Non-technical Skills and Resuscitation Performance of Nurses' Team in in-situ Simulated Cardiac Arrest

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