[[alternative]]A study of nurse’s self-assessment in performance of advanced cardiac life support skills

[[abstract]]背景 護理人員在醫療團隊中常常是病患發生突發狀況，需要急救的目擊者或者為最先到達的專業人員。因此護理人員是否有能力處理緊急狀況，往往關係著病患的預後。高級心臟救命術課程目的在於教育醫療專業人員，使之能夠獲得急救病患時所需的技術與知識。目的 本研究目的為探討護理人員接受高級心臟救命術課程後自評執行急救能力之狀況，以及探討不同基本屬性之護理人員對其自評急救能力之影響，並分析護理人員自評急救能力之預測因素。方法 本研究採橫斷性研究設計(cross-sectional studies)問卷調查法，以醫學中心護理人員自我評估急救能力量表，針對臺北市某醫學中心參與過高級心臟救命術課程一年內之護理人員，採全面普查進行問卷調查。自2011年9月20日至2012年1月10日止，經過醫院IRB審核通過，並取得受試者同意進行資料收集，共發放223份問卷，回收187份，回收率為83.9%，總計有效問卷數為176份，有效問卷回收率為94.1%。研究工具採自擬「護理人員自我評估急救能力量表」，經過專家效度及內在一致性信度檢定，Cronbach’s α值為0.957。結果 本研究結果發現，護理人員自我評估執行急救能力，共計35題，整體平均得分為4.13分(Likert 5分量表)。平均得分最高的項目為「正確執行抽痰技術」(M = 4.66 ± 0.52)；最低的項目為「運用AHA Guidelines的重大變革於急救情境中」(M = 3.47 ± 0.92)。另利用探索式因素分析建構出六個因素，分別為：呼吸道及循環之維持、團隊合作和異常處理、病患與家屬之溝通協調、異常心律之判讀及處置、急救評估及初步處置與護理急救角色功能之展現，六個因素合計共解釋61.72%的變異量。在個人基本屬性與整體自評執行急救能力之差異分析中，不同年齡、護理晉階層級、年資及參與急救課程意願等變項有顯著的差異存在。參與急救課程意願可解釋整體護理人員自我評估執行急救能力22.8%變異量，調整後變異量為16.8%。結論 期望藉由此研究分析護理人員自我評估接受高級心臟救命術課程後執行急救能力，除可提供醫院管理者進一步思考，如何讓醫學中心之護理人員具備應有之急救能力外，建議可加強護理人員自評急救能力較弱的部份，如：運用AHA Guidelines的重大變革於急救情境中、異常心律的處理與判讀方面、協助醫師找出病患急救的原因(5H/5T)與病患及家屬進行溝通與協調之能力。本研究結果發現之六大急救能力，亦可當作評值高級心臟救命術訓練課程之教育訓練成效指標，作為後續急救教育訓練之參考。[[abstract]]Background: As nurses often discover patients who have had a critical situation at first, they should be trained and be able to perform resuscitation skills adequately. The need for effective advanced cardiac life support (ACLS) training is clear, it has never been more important to ensure the competence of healthcare professionals. Goal: This article is a report of a study that analyzes of self-evaluated the performance of ACLS skills, examines the association between demographic data and self-evaluated the performance of ACLS skills, and explores the predictors of self-evaluated resuscitation competency amony clinical nurses. Method: This descriptive and correlational study used a cross-sectional survey of 223 clinical nurses from a medical center in northern Taiwan from Sep. 20, 2011 to Jan. 10, 2012. We use “nurse’s self-assessment and performance of ACLS skills in medical center” scale as an instrument to measure the subjects who had attended ACLS training for one year. Out of 223 questionnaires sent out, 176 were completed in full giving an effective responsive rate was 94.1%.Results: “Nurse’s self-assessment and performance of ACLS skills in medical center” scale, in a total of 35 questions, the overall average score was 4.13 (5-point Likert scale). The item that get the highest average score is “correct execution of suction technology” (M = 4.66 ± 0.52), while the lowest is “Using AHA Guidelines major changes in the resuscitation situations” (M = 3.47 ± 0.92). By items analysis and explorations as well as exploratary factors analysis, extracted into six factors, named for: the ability of maintenance of the respiratory and circulatory, teamwork and exception handling, communication and coordination of the patients and their families, interpretation and disposal of abnormal heart rhythm, resuscitation assessment and initial management, show of the nurse’s role in resuscitation situations. Six factors total explained 61.72% of the variance. Subjects’ demographic and facilities characteristics influenced on subjects’ different dimensions of the self-assessment competence. Significant related factors of subjects’ competence were as follows: age, professional level, practicing years, will of attending in resuscitation training programs. Perception of will that attend in resuscitation training programs were predictors of perceived nursing resuscitation competence, and they accounted 22.8% of its variance, adjusted variance was 16.8%.Conclusion: We expect hospital management can think actively on how to improve nurse’s ability in resuscitation skills and strengthen the weaker part, such as “To use AHA Guidelines major changes in the resuscitation situations”, “interpretation and disposal of abnormal heart rhythm”, “Assist physicians to find out the resuscitation reasons (5H5T)” and “communication and coordination of the patients and their families”. The conclusion not only evaluates the outcomes of ACLS training but also provides the reference for nurses proceeding education