情景式教学法在社区居民心肺复苏培训中的应用

[目的]探讨情景式教学法对社区居民心肺复苏培训效果的影响,为心肺复苏知识普及提供理论依据及实践指导。[方法]采用随机抽样方法抽取长春市朝阳社区的居民60人,按照随机分组的方法分成对照组和试验组,每组30人。试验组应用情景教学法进行培训,除进行理论知识讲座外,进行情景设计,现场情景模拟示教;对照组按照传统的模式,以健康教育形式为主进行理论知识讲座培训。培训结束后,比较两组心肺复苏知识及技能评分情况。[结果]培训前两组心肺复苏理论知识、技能操作及格率差异无统计学意义(均P0.05),培训后两组理论知识、技能操作及格率、培训满意度比较差异均有统计学意义(均P0.05)。[结论]运用情景式教学进行心肺复苏培训,易于为社区居民接受,有利于心肺复苏技术的推广普及。     

iCPR: a new application of high-quality cardiopulmonary resuscitation training

Objectives

The present study evaluates a new CPR feedback application for the iPhone (iCPR) designed to improve chest compression performance tested in a cardiac arrest simulation to evaluate performance and acceptance by healthcare professionals and lay people.

Methods

We built an application specifically dedicated to self-directed CPR training through a tutorial that includes a simple feedback module to guide training in order to improve the quality of chest compressions. We tested it in a sample of 50 users to evaluate the effect of iCPR on performance and it is acceptance. The participants were randomly assigned to one of the study groups and were asked to perform a trial of 2 min of chest compressions (CC), to answer a predefined set of questions and then to perform two more minutes of CC. The first group performing the sequence of CC with iCPR - questions - CC without feedback, and the second the sequence CC without feedback - questions CC with iCPR.

Results

The mean compression rate was 101 ± 2.8 min⁻¹ when CC were performed with iCPR and 107.8 ± 20.5 min⁻¹ when performed without iCPR (p < 0.01). Overall, the participants considered iCPR useful to maintain CC at the desired rate of 100 compressions per minute.

Conclusions

The iCPR feedback tool was able to significantly improve the performance of chest compressions in terms of the compression rate in a simulated cardiac arrest scenario. The participants also believed that iCPR helped them to achieve the correct chest compression rate and most users found this device easy to use.     

Impact of cardiopulmonary resuscitation training on resuscitation.

Restoration of adequate spontaneous circulation after "arrest" and cardiopulmonary resuscitation (CPR) of 546 patients before and 460 patients after initiation of a CPR training course in a 500-bed city hospital is reported. Between January 1972 and June 1976, adequate circulation after CPR was present in 38.6% of patients before and 50.4% after training ICU nurses and house physicians in modern resuscitation techniques. Factors crucial to resumption of adequate circulation are: (1) CPR training of all hospital personnel so that effective CPR can be started immediately after recognition of an arrest situation, (2) production of a palpable pulse with closed chest cardiac massage, and (3) prompt effective therapy so that the time interval between arrest and resumption of adequate spontaneous circulation is short.     

急诊护士心肺复苏术培训的新进展

心肺复苏术是一项具有社会普遍价值的、在发病现场实用性很强的医疗急救技术。虽然已经在全社会进行推广培训,但现今在实际推广培训过程中存在很多不足,远未达到预期目标。本文就急诊护士培训内容和方法的新进展进行综述。     

Simultaneous sternothoracic cardiopulmonary resuscitation: a new method of cardiopulmonary resuscitation

No existing device for cardiopulmonary resuscitation (CPR) is designed to exploit both the "cardiac pump" and the "thoracic pump" effect simultaneously. The purpose of this study was to measure the haemodynamic effect of a new simultaneous sternothoracic cardiopulmonary resuscitation (SST-CPR) device that could compress the sternum and constrict the thoracic cavity simultaneously in a canine cardiac arrest model. After 4 min of ventricular fibrillation, 24 mongrel dogs were randomized to receive standard CPR (n=12) or SST-CPR (n=12). SST-CPR generated a new pattern of the aortic pressure curve presumed to be the result of both sternal compression and thoracic constriction. SST-CPR resulted in significantly higher mean arterial pressure than standard CPR (68.9+/-16.1 vs. 30.5+/-10.0 mmHg, P<0.01). SST-CPR generated higher coronary perfusion pressure than standard CPR (47.0+/-11.4 vs. 17.3+/-8.9 mmHg, P<0.01). End tidal CO(2) tension was also higher during SST-CPR than standard CPR (11.6+/-6.1 vs. 2.17+/-3.3 mmHg, P<0.01). In this preliminary animal model study, simultaneous sternothoracic cardiopulmonary resuscitation generated better haemodynamic effects than standard, closed chest cardiopulmonary resuscitation.     

数字密码教学法在心肺复苏规范化培训中的应用

目的：探讨数字密码教学法在心内科轮转护士心肺复苏规范化培训中的应用。方法：选择2016年1月-2018年12月于心内科轮转的78名护士作为研究对象,采用随机数字表法分为观察组与对照组各39名。对照组采取传统心肺复苏教学方法,观察组在此基础上采用数字密码教学法。评估并比较两组护士培训结束后的理论、操作考核成绩、操作失误情况及对培训的满意度。结果：培训后观察组护士的理论及操作考核成绩均优于对照组,总体操作失误率低于对照组,对培训的满意度高于对照组,差异均有统计学意义（P<0.05）。结论：数字密码教学法能有效降低轮转护士在实施心肺复苏时的失误率,提高轮转护士对心肺复苏这一技能的掌握。     

Towards new models of teaching and researching nursing: the research practitioner

This paper discusses role development to bring research closer to the clinical setting and describes a strategy for advancing research in clinical practice.     

集中示教结合视频指导模式在心肺复苏技能培训中的应用

目的探索适用于临床护士的心肺复苏术（CPR）技能培训模式。方法将2011年参加心肺复苏培训护理人员600人纳入本研究,按随机数字法分为传统教师授课模式、视频指导自学模式、集中示教结合视频指导模式3组,每组200人,授课1周后分别采用CPR操作技能评分表及运用心肺复苏训练模拟人对护士进行考核。结果集中示教结合视频指导模式组心肺复苏操作的各项要点考核得分：病情评估（19．21±1．43）分、胸外按压（19．14±2．18）分、开通气道（10．36±0．96）分、人工呼吸（10．32±1．63）分、效果评估（3．68±0．51）分、综合评价（8．90±1．10）分及考核均值（91．33±5．00）分、操作合格率（94．5％）均明显高于传统教师授课模式组[（18．73±2．01）分,（17．00±3．09）分,（9．06±1．10）分,（9．84±1．48）分,（3．35±0．71）分,（7．34±1．44）分,（86．56±6．84）分,89．5％]和视频指导自学模式组[（18．50±2．34）分,（16．84±3．19）分,（8．96±1．14）分,（9．77±1．57）分,（3．29±0．75）分,（7．27±1．48）分,（86．00±7．40）分,88．5％],集中示教结合视频指导模式组与其他两组比较,差异具有统计学意义（P〈0．05）;而传统教师授课模式组与视频指导自学模式组相比较,差异无统计学意义（P〉0．05）。结论集中示教结合视频指导模式能够有效增强培训效果。     

PBL教学法在上海市急诊专科护士抢救室实践培训中的应用研究

目的 探讨将PBL教学法与急诊工作特点相结合,应用于急诊专科护士抢救室实践培训中的效果.方法 根据抢救室工作特点及要求,结合查阅文献、访谈急诊专科护士、研究小组讨论等,设计出急诊救护过程中涉及的关键问题量表,以此量表为调查工具,采用Delphi法对15名专家进行2轮咨询,最终形成急诊救护过程中的关键问题,即PBL教学法的12个核心问题.结果 专家咨询的判断系数(Ca)为0.84,熟悉程度(Cs)为0.94,权威系数(Cr)为0.89,均＞0.7,说明本研究结果可信度较高,可应用于临床.研究小组通过先培训带教者及学员,后临床应用的方式,将此PBL式培训方法应用于实践.结论 此培训方法的应用,使学员思路清晰、学习目的更明确,培养了临床师资,同时也促进了急诊专科护士临床实践考核由传统的理论、技论考核,扩展至情景模拟式考核.     

心肺复苏互动反馈培训效果的meta分析

目的：评价采用互动反馈方式进行心肺复苏培训(CPR)的效果。方法：检索Pubmed、EMbase、Cochrane library、中国生物医学文献数据库、中国知网 、万方及维普数据库,采用主题词与自由词相结合的方式,搜索国内外公开发表的所有相关研究,检索时限为从建库至2021年1月。对符合纳入标准的文献进行meta分析。结果：纳入8个随机对照研究,用互动方式进行心肺复苏培训的与传统教学法相比,能够提高学员的CPR的技能掌握和考核成绩,标准均数差（SMD）为0.763,95%CI（0.189,1.338）,差异有统计学意义（P<0.01）;而对知识的掌握没有显著的提高,标准均数差（SMD）为0.69,95%CI（-0.136,1.515）,差异无统计学意义。结论：采用互动方式进行心肺复苏培训与传统教学法相比能够提高学员的CPR的培训效果。     

Ethical considerations behind the limitation of cardiopulmonary resuscitation in Hungary--the role of education and training

INTRODUCTION: Although the long term success of cardiopulmonary resuscitation (CPR) is still less than hoped for, its value cannot be questioned when carried out appropriately in selected cases. Resuscitation frequently brings only short-term success, and several patients suffer severe consequences also causing an economic, medical and ethical burden to society. The issue of limitation of resuscitation, including Do Not Attempt Resuscitation (DNAR) and the termination of resuscitation has been surveyed in many European countries using a structured questionnaire. In Hungary no such comprehensive study has been conducted yet. The goal of this investigation was to recognise the ethical factors limiting resuscitation in Hungary. METHODS: We contacted 72 doctors personally during 2003, who were working actively at an intensive care unit (ICU) and asked them to answer a structured questionnaire in strict anonymity. We investigated the role of different ethical issues in beginning and suspending resuscitation efforts in conjunction with medical experience, sex, ideology, and education using a five point visual analogue scale. The answers given were categorised to autonomy, futility, obtainable quality of life, resource utilization, and to "another" category detailed later on. The questionnaire and the plan of this investigation was approved by the Semmelweis Medical University's Ethical Committee (SE-TUKEB 109/2003). RESULTS: The decision not to attempt resuscitation was mostly dictated by the opinion of the head of department and the doctor in charge of the patient (3.53 +/- 1.30), and after this the presumed obtainable quality of life (3.13 +/- 1.40), objective futility (3.11 +/- 0.94), and patient autonomy (2.02 +/- 1.63). The other objective (0.57 +/- 1.59), and subjective (1.04 +/- 1.21) factors, as well as resource utilization (0.29 +/- 0.66) played a less important role. The decision to terminate resuscitation efforts was mostly dictated by the objective futility criteria (3.39 +/- 0.88), obtainable quality of life (3.31 +/- 1.50), subjective futility (3.19 +/- 1.47), and autonomy (1.57 +/- 1.67) to a smaller extent. Among the doctors who participated in an appropriate-an internationally accredited (ERC/RC(UK)/AHA)-Advanced Life Support (ALS) training-the frequency of the appearance of the principle of modern bioethics-such as autonomy-was significantly higher and the same tendency could be observed in those who completed their studies at the medical university in the last 5 years. CONCLUSIONS: The results underline the original presumption that the Hungarian resuscitation practice is at first influenced by professional (or "thought to be professional") standpoints. The quality of life, and patient autonomy plays an important role in the decision making about limitation of resuscitation efforts. Current CPR education emphasizes the importance of ethical considerations, and this could be observed clearly in the answers.     

预备役官兵心肺复苏认知调查及培训效果

目的：了解预备役官兵对徒手心肺复苏术（ CPR）知识和技能的掌握情况,并分析CPR知识培训后的效果。方法采用自行设计的问卷调查表对150名预备役官兵在培训前、后CPR知识及技能掌握情况进行调查。结果本次调查发放问卷150份,4份填写不完整,回收有效问卷146份,有效回收率97．3％。培训前25．3％预备役官兵对CPR知识缺乏,45．2％获得CPR知识的途径主要来源于电视、报刊;8．9％从专业书籍中获取;20．5％听他人说。17．1％会正确CPR操作。培训后100％官兵掌握了判断意识丧失和心跳停止的方法;98．6％会判断呼吸停止;94．5％掌握了呼吸心跳停止处理措施;73.3％掌握了心肺复苏的基本步骤;72．6％会实施人工呼吸;87．7％能准确按压心脏的部位;87．7％掌握胸外心脏按压的胸骨下限的深度。146名预备役官兵CPR知识培训后各项知识知晓率均高于培训前,差异均有统计学意义（P＜0．05）。结论通过培训,预备役官兵CPR认知和技能得以提升,提高了特殊群体对CPR知识和技能掌握的程度,以期保证“第一时间”施救的成功率。     

Relationships between role models and role perceptions of new graduate nurses

This study was conducted to examine relationships between role models and role perceptions of new graduate nurses. The sample consisted of the 25 senior nursing students in a generic baccalaureate nursing program who were administered questionnaires 1 month prior to graduation and 3 months after beginning employment. Results indicated that: (a) a majority of faculty role models of new graduate nurses are replaced by work-related role models in the first 3 months of employment, (b) the most important role model characteristic was clinical experience/performance, and (c) role perception orientations of new graduate nurses are overwhelmingly professional prior to graduation, but become more bureaucratic after exposure to work-related models. This study validates the findings of similar research conducted over the past 25 years. Further research is needed into factors that lead to the perpetuation of a bureaucratic work environment and bureaucratic nurses, in spite of professionally oriented nursing education.     

情景教学法配合缺陷设置在护生心肺复苏培训中的应用

心肺复苏(CPR)技能是抢救心脏骤停唯一有效的方法.对心跳、呼吸骤停病人如果在4 min内进行有效的CPR,抢救成功率约为50%,4 min～6 min为10%,如超过6 min仅为4%[1].     

Web-based video and feedback in the teaching of cardiopulmonary resuscitation

Knowledge and skills relating to cardiopulmonary resuscitation tend to be lost over time. The combination of simulation sessions with online video records and online feedback allows for an enduring record of skills sessions to assist students in retaining and revising their learning. This paper reports a qualitative evaluation of such a combination used in inter-disciplinary sessions for volunteer nursing and medical students. Methods included focus groups and free text questionnaires; data were gathered from fourteen students and three teachers. Students had used the online material in a variety of personal ways, and found that the addition to their learning was significant. Their memories of the simulation sessions and of the feedback received immediately afterwards were incomplete, and repeated viewing enabled them to identify good and poor practice with more confidence, and to reflect more carefully on their own and others' practice. Teachers found it easier to give more detailed feedback when given the chance to watch the video than immediately after the session. All felt that the sessions would ideally be embedded in the curriculum.     

两种心肺复苏训练方法的效果比较

[目的]比较两种不同心肺复苏训练方法教学效果。[方法]将我院二年级中专护生随机分为干预组和对照组各100人,干预组采用北京医模科技有限公司心肺复苏训练及考核系统（JW4101）进行训练;对照组采用北京日正华瑞科技发展有限公司心肺复苏模型PP2300进行训练。统一进行操作考试。[结果]干预组操作成绩为（85.35±3.84）分,对照组操作成绩为（81.23±5.12）分,干预组操作成绩高于对照组（P〈0.05）。[结论]心肺复苏训练方法的不同可以影响学生学习能力。     

本科护生施行成人心肺复苏术训练成效的研究

目的对本科护生施行成人心肺复苏术（Cardiopulmonary Resuscitation，CPR）训练成效进行了研究，试图找出多数护生操作中易犯的错误，为今后CPR教学改革提供参考。方法以安妮电子模拟人为工具，对54．g实习期本科护生进行CPR考核与训练。考核标准依据美国心脏学会（AHA）公布的准则。结果本科护生对在校学习过CPR基本遗忘，通过强化训练，技能达成率有较大提高。训练中“开放气道”“每次吹气使胸廓抬高”“心脏按压幅度”等操作是难点。结论更新教材、采用功能先进的模拟人定期强化训练，并对难点技能进行重点教学是提高护生CPR操作成效的关键。