Cardiopulmonary resuscitation: attitudes and perceptions of junior doctors

Scott, Glyn; Mulgrew, Emma; Smith, Thomas J.

doi:10.12968/hosp.2003.64.7.2311

Cited by 22 publications

(15 citation statements)

References 11 publications

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“…Residents felt significantly more comfortable about their resuscitation skills and were more confident at the end of the year of mock codes regardless of the level of training. These findings are similar to two studies involving internal medicine resident's perceptions about cardiac arrests (Scott et al 2003;Hayes et al 2007). This improved confidence is likely attributable to the experience of direct patient care as opposed to mock code participation.…”

Section: Discussionsupporting

confidence: 86%

Initiation of a pediatric mock code program at a children's hospital

et al. 2009

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Background: Pediatric cardiopulmonary arrests are rare. Mock codes were instituted to bridge the gap between opportunity and reality. Aim: The goal was to improve medical caregivers' skills in pediatric resuscitation. Methods: All pediatric and internal medicine/pediatric (med/peds) residents were anonymously surveyed pre-and postintervention about confidence level about codes and code skills. Twenty mock codes were conducted during the 1 year intervention period. Statistical comparisons were made between each resident pre-and post-survey, graduating third-year residents (PGY3s) prior to intervention versus PGY3s with mock codes and pediatric versus med/peds residents. Results: All residents significantly improved in their perception of overall skill level during the study ( p < 0.0001). PGY3s were significantly more confident in their skills than PGY2s or PGY1s and PGY2s were significantly more confident than PGY1s both pre-and post-mock codes ( p < 0.0001). Med/peds residents were significantly more confident in their skills than pediatric residents both pre-( p ¼ 0.041) and post-intervention ( p ¼ 0.016). The two skills with the lowest score post-intervention were the ability to place an interosseous line and the ability to manage cardiac dysrhythmias. Conclusions: Pediatric mock codes can improve resident confidence and self-assessment of their resuscitation skills. Data from surveys such as this can be used to design future skill-based educational initiatives.

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Section: Discussionsupporting

confidence: 86%

Initiation of a pediatric mock code program at a children's hospital

et al. 2009

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“…11 This may avoid the situation where a patient requests CPR despite explanation of its futility: the guidelines acknowledge that a doctor cannot be required to give treatment contrary to their clinical judgement and if a doctor feels that the harm of the discussion outweighs the benefits there should be no moral imperative to discuss CPR. 1 6 12 13 Doctors may also experience difficulty discussing these issues (one study showed that 72.8% of doctors find discussions stressful 14 ) and there is a reduction in the documentation of DNAR decisions where patient discussion is mandatory. Although the claimant, Mr Burke, was concerned about doctors withdrawing artificial nutrition and hydration as his degenerative neurological disease progressed, the initial ruling that doing so was unlawful and in breach of his human rights had wider implication which would have included patients demanding CPR against the judgement of health care professionals.…”

Section: Discussionmentioning

confidence: 99%

An audit of “do not attempt resuscitation” decisions in two district general hospitals: do current guidelines need changing?

Harris

Davies

2007

Postgraduate Medical Journal

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Introduction: Doctors in all specialties are involved in making ''do not attempt resuscitation'' (DNAR) decisions; this can be a difficult and challenging process. Guidelines exist to provide an ethical and legal framework for the process and documentation of these decisions. Objective: To audit the documentation of resuscitation decisions in a sample of medical inpatients from two district general hospitals. Method: A retrospective case note audit of 50 medical inpatients, in which a DNAR decision had been made (28 from hospital 1, 22 from hospital 2). Results: Average age was 78.9 years (48% male:52% female). In both hospitals DNAR decisions were usually discussed with relatives (84%), documented in nursing notes (100%) and made by senior team members (90%). Although the decision was usually dated and clearly documented (98%), abbreviations were commonly used in hospital 2 (45.5% vs 0% in hospital 1, p,0.05). Decisions regarding other treatment were not consistently documented (78.6% and 72.7%, respectively) and there was little evidence that decisions were reviewed (14.3% and 31.8%). The decision was rarely discussed with the patient (6% of all patients), although 66% of patients were not in a position to have a discussion. Conclusions: Specific forms for recording DNAR decisions improve the clarity of documentation. Current recommendations to discuss resuscitation with patients are controversial and not followed. However, many patients are not in a position to hold a discussion when the need arises and the guidelines should advocate early discussion during a hospital admission in patients where this is appropriate, prior discussion with family and/or wider use of advanced directives.

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“…[2][3][4][5] Despite completion of these courses, trainees experience significant stress in real-life situations as they feel unprepared to deal with such clinical emergencies. [5][6][7] Increasing trainee numbers, decreasing training hours and an overall impetus to shorten training curriculum have all contributed to an overall reduction in clinical exposure. In order to address this issue, simulation is increasingly used as an educational tool.…”

Section: Introductionmentioning

confidence: 99%

High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training

et al. 2011

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Objective: Despite completing accredited resuscitation training, neonatal trainees often feel unprepared to deal with real-life clinical emergencies. High-fidelity simulator (HFS) technology offers the potential of recreating a realistic stressful clinical environment to aid training and evaluation. To date, there are limited data examining the physiological impact of this training modality in comparison to less costly alternatives. The objective of this study was to compare the effects of low-fidelity simulator (LFS) versus HFS technology on performance levels, objective and subjective measures of stress in neonatal trainees.Study Design: Sixteen neonatal fellows were invited to participate in a prospective randomized study. Subjects were divided into pairs and randomized to LFS or HFS for completion of scenario I. After an interval of 1 month, fellow teams crossed over to complete scenario II using the alternative simulator technology. Technical and non-technical skills were assessed using validated resuscitation scoring tools. Participants recorded subjective stress at sequential time points before and after each simulation. Buccal cortisol was measured at each corresponding time point and comparison between HFS and LFS groups was made.Result: The mean overall resuscitation performance score was 75.8%±10, but there was no difference in performance between HFS and LFS groups. There was also no significant difference in non-technical skills performance between groups. Salivary cortisol increased over the duration of the simulated experience, but there were no differences between the two groups (P ¼ 0.001, two-way repeated measures analysis of variance). We also identified changes in subjective measures of stress (P<0.001, analysis of variance) over time, but again there were no differences between groups.Conclusion: Simulated neonatal resuscitations induce a significant stress response in neonatal trainees; however, we were unable to identify any difference in stress measures between HFS and LFS. These data suggest that HFS technology offers no additional stress-inducing benefit.

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Cardiopulmonary resuscitation: attitudes and perceptions of junior doctors

Abstract: Many junior doctors feel cardiac arrests are unsatisfactorily managed and experience high levels of stress during the procedure, often feeling they are inadequately trained for the task. Juniors also regard ‘do not resuscitate’ orders as decisions for teams, not individuals.

Cited by 22 publications

References 11 publications

Initiation of a pediatric mock code program at a children's hospital

Initiation of a pediatric mock code program at a children's hospital

An audit of “do not attempt resuscitation” decisions in two district general hospitals: do current guidelines need changing?

High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training

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