急診護理人員執行心肺復甦術品質及其相關因素

Cardiopulmonary Resuscitation Performance Quality and Its Related Factors in Nursing Staff at Emergency Department

心肺復甦術（cardiopulmonary resuscitation, CPR）是急診室護理人員幾乎每天都需要執行的技術，且其執行的品質將影響病人的存活率；但國內各家醫院卻無標準固定時間進行技術評核及複習，且未使用客觀評估工具評值護理人員CPR之執行品質。藉由探討急診護理人員執行CPR的品質與技術保留情形，及其相關因素，以提供臨床教育訓練之建議。本研究採用縱貫式、相關性研究設計，以立意取樣，於北部某醫學中心急診室進行三次收案，時間為CPR技術評估前及評估後3及6個月後。資料收集內容包括基本資料及工作年資調查表及使用數位式模擬教具及電腦收集CPR技能相關數據。結果發現，整體急診護理人員（N＝77）執行高品質CPR技術不理想，僅一人達到高品質CPR的要求，其中以手部暫停時間（5.2％）和壓放比值（7.8％）的通過率最低。現況分析影響高品質CPR的因素結果顯示，男性手部暫停時間通過率優於女性；工作年資越長以及年齡越大，壓放比值通過率越高；急救訓練次數越多，壓胸速率通過率越高。此外，經過6個月後，CPR技術的保留，隨時間的增加而流失，尤其在壓胸速率，壓放比值和手部暫停時間等項目，而影響CPR技術保留的因素是護理進階層級（N level），進階層級越高，壓胸深度通過率越高。本文建議使用數位式模擬教具，以瞭解臨床人員執行CPR之品質，並建議每6個月定期的訓練和評核CPR技術。

Nurses at emergency room perform cardiopulmonary resuscitation (CPR) skill almost every day, and the quality of CPR delivered is a key determinant of patient survival. However, there was no general standardized time interval to evaluate and review CPR skills, and many hospitals did not use objective assessment tools to evaluate CPR quality among nurses in Taiwan. To investigate the quality and skill retention of CPR performed by nurses at emergency room and to explore its related factors. This longitudinal and correlational study with purposive sampling was performed in the emergency department of a medical center located in northern Taiwan to collect three times of data before CPR skill evaluation and 3 and 6 months after CPR skill evaluation. Data collection included the basic demographic characteristics and CPR quality digital analog aids and computer technology. The overall emergency nurses (N=77) in the implementation of high-quality CPR technique is not ideal, only one person can achieve high-quality CPR technique, with the hand-off time (5.2%) and the compression release ratio (7.8%) being the lowest. The result related to high-quality CPR showed that, male nurses had less hand-off time passing rate compared to female nurses. The longer seniority years of career and the older the age, the higher the passing rate of press release ratio. The more basic life support training received, the more passing rate in chest compression rate. In addition, the CPR skills diminished by time. After 6 months, most nurses failed to maintain proper chest compression rate, ideal compression-release ratio and less hand-off time. The factor associated with CPR skills retention was N level. The higher of N level, the more passing rate in chest compression depth. It is suggested to use digital analog aids and computer to evaluate nursing staff CPR quality. Regular CPR training and evaluation per six months is recommended in clinical settings.