NR451 Milestone 2 Design Proposal Complete

13 August 2024

NR451 Milestone 2 Design Proposal Complete

Cardiopulmonary Resuscitation (CPR)

Healthcare is a crucial concern for many, particularly for those at risk of myocardial infarction (MI). Heart disease remains the leading cause of death in the United States, posing a significant threat to public health (Newhouse et al., 2005). According to the American Heart Association (AHA), approximately 356,000 out-of-hospital cardiac arrests (OHCA) occur each year in the United States, underscoring the critical need for effective bystander interventions (AHA, 2020). The importance of bystander CPR in the survival of cardiac arrest patients cannot be overstated. It significantly increases the chances of survival and favorable outcomes, making it essential for nurses to educate patients, families, and the general public on CPR techniques to reduce mortality rates associated with cardiac events.

Change Model Overview

Before the implementation of the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, healthcare professionals lacked a systematic approach to evaluating and implementing evidence-based interventions. Organizations typically did not have structured processes in place to support nurses in developing and assessing nursing interventions, protocols, and policies based on scientific evidence (Newhouse et al., 2005). Prior to evidence-based practice (EBP), healthcare professionals often relied on the advice of more experienced colleagues rather than using the most current research to guide clinical decisions. As recognized by Johns Hopkins University, experience alone is subject to biases and errors, leading to the development of the JHNEBP model. This model provides a powerful, structured approach to problem-solving in clinical settings, specifically tailored to meet the needs of nursing professionals. The JHNEBP model uses a process called PET: Practice Question, Evidence, and Translation, to ensure that the latest research findings are integrated into patient care practices (Johns Hopkins Medicine, 2017).

Practice Question

Step 1: Recruit Interprofessional Team The team of stakeholders will include:

  • Emergency Medicine Physician
  • EMT – Paramedic
  • EMT – Basic/Intermediate
  • Registered Nurse
  • Family Member
  • Randomized Individual (willing to participate)

Step 2: Develop and Refine the EBP Question The research question proposed is: In cardiac arrest patients (P), how does bystander CPR (I) compared to no CPR (C) affect the outcome of a cardiac arrest (O) with no downtime versus extended downtime (T), and how can nurses aid in increasing public awareness and education on CPR?

Step 3: Define the Scope of the EBP This capstone proposal addresses the impact of bystander CPR on cardiac arrest outcomes, focusing on the role of nurses in enhancing public awareness and education. According to the Sudden Cardiac Arrest Foundation, in 2011, approximately 326,200 people in the U.S. experienced out-of-hospital cardiac arrests, with only 10.6% of those treated by emergency medical services surviving (Sudden Cardiac Arrest Foundation, 2014). The American Heart Association projects that by 2030, the prevalence of cardiovascular diseases will increase dramatically, affecting over 23.6 million people (Benjamin et al., 2019). This alarming statistic highlights the growing need for effective bystander interventions like CPR to improve survival rates during OHCA events.

Steps 4 and 5: Determine Responsibility of Team Members

These roles are critical to ensuring the smooth execution of the project:

  • Emergency Medicine Physician: Oversees the project to ensure adherence to AMA guidelines and intervenes in critical procedures such as intubation or tracheostomy when necessary.
  • EMT – Paramedic: Plays a key role in performing CPR, stabilizing the patient, and transporting them to the emergency department.
  • EMT – Basic/Intermediate: Assists with field stabilization, patient transport, IV/IO access, and other essential tasks.
  • Registered Nurse: Provides additional support by administering medications, performing CPR, and ensuring adherence to nursing guidelines for quality care.
  • Family Member: Provides insight into the willingness of individuals to perform CPR on loved ones, which can influence broader public willingness to engage in bystander CPR.
  • Randomized Individual: Participates in initial surveys to gauge public readiness to perform CPR on strangers, offering valuable data on public awareness and willingness.

Evidence

Steps 6 and 7: Conduct Internal/External Search for Evidence and Appraisal of Evidence The evidence used in this research adheres to the JHNEBP protocol, ensuring a robust and systematic approach to clinical decision-making. The JHNEBP model is particularly suited for evaluating both qualitative and quantitative research, providing credible insights that debunk myths and support evidence-based practice (Newhouse et al., 2005).

Steps 8 and 9: Summarize the Evidence Research by Kuramoto et al. (2008) found that only 13% of individuals were willing to perform CPR on a family member, and just 7% were willing to perform it on a stranger. This study underscores the need for education to boost confidence in performing CPR. Additional research by Sasson et al. (2014) identified barriers to learning and performing CPR in low-income, high-risk communities, further emphasizing the necessity of public awareness. Rea et al. (2001) investigated the effectiveness of dispatcher-assisted CPR and found a modest increase in bystander CPR rates, suggesting that guided support can enhance public participation.

Step 10: Develop Recommendations for Change Based on Evidence

The research suggests a pressing need to increase public education and awareness of CPR. While extensive literature highlights the prevalence of OHCA, there is a notable gap in research focusing on how education can improve bystander participation in CPR. Addressing this gap through targeted educational initiatives could significantly improve survival rates during cardiac emergencies.

Translation

Steps 11-14: Action Plan The implementation phase will involve a month of preparation followed by three months of data collection. A structured timeline will be developed to keep the project on track, with surveys and interview questions designed to guide participant responses. Recruitment efforts will include online advertisements and outreach to local schools. Participants will be randomly selected to ensure a representative sample.

Steps 15-16: Evaluating Outcomes and Reporting Outcomes The project’s success will be measured by the level of participation and willingness to perform CPR among the study’s participants. Data will be analyzed quantitatively, and findings will be communicated to stakeholders through meetings and reports. Additionally, the research will be submitted for publication in peer-reviewed journals.

Step 17: Identify Next Steps To scale the project, investment in marketing and education will be necessary. Initially, the project will focus on perfecting a single-site model before expanding to larger operations. The long-term goal is to establish a non-profit organization dedicated to increasing public awareness and education on CPR.

Step 18: Disseminate Findings Findings will be shared internally through presentations and emails. Externally, the research will be submitted for peer review and publication in reputable journals such as those by the American Nurses Association (ANA) or the American Heart Association (AHA). To further increase exposure, a virtual interview on Reddit’s Ask Me Anything platform will be hosted.

Conclusion

Cardiac disease remains a significant public health concern, with out-of-hospital cardiac arrest representing a critical area where bystander CPR can make a life-saving difference. Current data from the Sudden Cardiac Arrest Foundation indicates that approximately 356,000 Americans experience OHCA annually, highlighting the importance of bystander intervention (Sudden Cardiac Arrest Foundation, 2014). Utilizing the JHNEBP model, this proposal seeks to compare outcomes between bystander CPR and no bystander CPR, emphasizing the need for increased public education and awareness. By effectively translating the latest research into practice, healthcare professionals can improve patient outcomes and reduce mortality rates associated with cardiac events.

References:

  • American Heart Association. (2020). Cardiac arrest statistics. Retrieved from https://www.heart.org/en/health-topics/cardiac-arrest/about-cardiac-arrest/cardiac-arrest-statistics
  • Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., … & Muntner, P. (2019). Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, 139(10), e56-e528.
  • Johns Hopkins Medicine. (2017). The Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. Retrieved from https://www.hopkinsmedicine.org/evidence-based-practice/jhn_ebp.html
  • Kuramoto, N., Morimoto, T., Kubota, Y., et al. (2008). Public perception of and willingness to perform bystander CPR in Japan. Resuscitation, 79(3), 475-481.
  • Newhouse, R., Dearholt, S., Poe, S., Pugh, L. C., & White, K. M. (2005). Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. Sigma Theta Tau International.
  • Rea, T. D., Eisenberg, M. S., Culley, L. L., & Becker, L. (2001). Dispatcher-assisted cardiopulmonary resuscitation and survival in cardiac arrest. Circulation, 104(21), 2513-2516.
  • Sasson, C., Meischke, H., Abella, B. S., Berg, R. A., Bobrow, B. J., Chan, P. S., … & Root, E. D. (2014). Barriers to calling 911 and learning and performing CPR in a Latino community. Circulation: Cardiovascular Quality and Outcomes, 7(1), 36-47.
  • Sudden Cardiac Arrest Foundation. (2014). Sudden cardiac arrest: Statistics and data. Retrieved from https://www.sca-aware.org/sca-news/sudden-cardiac-arrest-foundation-releases-2014-report-on-survival-rates