Awareness of basic life support among medical and nursing students at Tabuk University

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1 Basic Research Journal of Medicine and Clinical Sciences ISSN Vol. 5(3) pp March 2016 Available online http// Copyright 2015 Basic Research Journal Full Length Research Paper Awareness of basic life support among medical and nursing students at Tabuk University Sarah Naif Alsayil 1, Sarah Mohammed Alzahran 1, Waad Mohammed Alhawiti 1 1 Faculty of Medicine, Tabuk University, Saudi Arabia. *Correspondence author sara-naif-92@hotmail.com Accepted 16 March, 2016 ABSTRACT Objectives: To assess the awareness about BLS and CPR among medical and nursing students. Subjects and Methods: A cross-sectional study was carried out among 141 randomly chosen students from Medical and Nursing Colleges at Tabuk University. An anonymous online survey on BLS was conducted on the social networks. The Statistical Package for Social Sciences (SPSS) was used for data analysis. Results: More than half (59.6%) of the medical and nursing students had insufficient knowledge of BLS. A minority of the participants (14.2%) had no BLS training at all and 42.6% had training for more than two years, 30.5% did not agree to educate the public about CPR and 71.6% losing the confidence to perform CPR. Conclusions: Awareness of BLS among medical and nursing students at Tabuk University is insufficient and needs to be improved. Keywords: BLS, Medical, Nursing students, awareness INTRODUCTION Basic life support (BLS) is defined as medical procedures that can be applied in the case of an emergency to save lives. It is provided to victims of life-threatening injuries or illnesses until they can be given accurate medical care at the hospital. [1] BLS procedures include Cardiopulmonary Resuscitation (CPR), artificial ventilation, bleeding control and basic airway management (Abbas et al., 2011). It is provided by health care providers (physicians, paramedics, and emergency) and even could be given by lay persons who have received BLS training (Jones et al., 2012). American Heart Association (AHA) recognizes and encourages early CPR and defibrillation to maximize victim s survival rates also, it promotes public awareness of BLS to assure quick response achieved in the case of an emergency (Spencer et al., 2011). The students of medical and nursing colleges are the future health care providers in the community which makes their awareness and knowledge of BLS crucial so as to increase patients' chances of survival (Abbas et al., 2011; Chandrasekaranet al., 2010). At the same time, they can promote the public awareness of BLS through public education which will ultimately increase the whole community awareness and chances of survival of community members (Chandrasekaranet al., 2010; Papadima et al., 2010) Various studies have been carried out to access the level of knowledge and attitude towards BLS among health care providers, which reflects its importance in the emergency care of the patients.it has been reported that BLS awareness was destitute among health professionals like doctors and nurses of medical, dental, homeopathy and nursing colleges medical, dental, homeopathy and nursing colleges (Chandrasekaranet al., 2010). Also, authors observed a low prevalence of

2 Sarah et al. 54 current training and lack of basic CPR knowledge and, therefore, recommended comprehensive CPR program (Papadima et al., 2010). Recent medical school graduates reported a lack of self-confidence in their ability to perform standard procedures upon entering residency training. Implementation of a faculty of medicine procedure course to increase exposure to procedures may address this challenge (Promes et al., 2009). There is an observation that teenagers can learn and perform basic life support skills with reasonable accuracy and can retain these skills for longer periods, thus CPR training has been recommended to be provided to youth from early teenage life during their study programs (Naqvi et al., 2011). It has been strongly recommended to include BLS programs in undergraduate. They also suggested that inclusion of this course in the undergraduate curriculum will increase awareness and application of this important life-saving maneuver (Zaheer et al., 2009). Researchers have found that the overall attitude towards CPR was positive among students of Saudi Arabia. However, the authors found the knowledge on the topic to be insufficient and, therefore, emphasized more focus be placed on the improvement of CPR skills. Also, they suggested more studies to be carried to assess knowledge and attitudes towards CPR in the community (Al-Turki et al., 2008; Alanazi et al., 2014; Almesned et al., 2014). No studies have yet been conducted on health care students of Tabuk University to access the level of current knowledge and attitude towards training and application of BLS. Therefore, we intended to carry out the present study to be added to the literature on this essential subject. Subjects and methods A cross-sectional survey-based-on-questionnaire was conducted at Tabuk University, Kingdom of Saudi Arabia throughout the month of September2014 among undergraduate medical and nursing students. Ethics approval was obtained from the ethical committee of the University of Tabuk. Completion of the questionnaire was voluntary and anonymous. Consent to participate in the study was determined by the completion and return of the questionnaire. An anonymous online survey on BLS was conducted on the social networks like Twitter, What s app, Facebook, and colleges website. The identification of internet protocol (IP) address was utilized to prevent a single respondent from filling the survey more than one time. The survey contained 20 questions on BLS and was prepared using the advanced cardiac life support manual posted in Indian Journal of anesthesia 2010 by some modifications. The questionnaire was previously used and validated by a study conducted in India with a vast number of respondents. [4] Seventeen questions were investigating the knowledge of BLS among participants while the other three concerned with the timing of the last training, confidence in performing CPR and their opinion regarding who should learn BLS. The results were analyzed using a key answer prepared from the advanced cardiac life support manual. Regarding knowledge questions, a score of "1" was given to correct answers while a score of "0" was given to incorrect answers. The total score was computed for each participant and median score was identified, it was 5 out of 17. Those scored at or below the median value were considered as having "insufficient knowledge" while those scored above the median value were considered having "sufficient knowledge." Statistical Package for Social Sciences (SPSS) software, version 22was utilized for data entry and analysis. Chi-square test was applied to test for difference between those having sufficient and insufficient knowledge. A p-value equal to or less than 0.05 was considered as significant level. RESULTS The study included 141 students recruited from both of medical (n=102) and nursing (n=39) collages. Among them, 44% did not identify the correct meaning of the abbreviation of BLS, 66.7% failed to identify looking for safety as the first step in BLS, and majority of the participants (90.8%) failed to identify activating Emergency Medical Services (EMS) as the course of action to take immediately after confirming the unresponsiveness of an adult. Forty-four percent of the participants did not identify the correct location for chest compressions in an adult, 68.8% did not identify the exact location for chest compressions in an infant and80.1% did not determine the correct alternatives to mouth-tomouth ventilation. Almost three-fourths (75.2%) of the participants did not identify the proper rescue breathing technique for infants, 66.7% did not identify the correct depth of chest compression for an adult, 66% did not identify the right depth of chest compression for a child, and 66% did not identify the correct chest depth of chest compression for a neonate. Most of the participants (72.3%) did not identify the correct rate of chest compression for adults and children, 73.8% did not identify the correct chest compression and ventilation ratio in newborn, and 73.8% did not determine the right ratio of compression-ventilation in a neonate. More than three-quarters of them (76.6%) did not identify the correct meaning of the abbreviation Automated External Defibrillator (AED), and 59.6% did not define the exact meaning of the abbreviation EMS. Majority of the participants (89.4%) failed to identify confirming the

3 55. Basic Res. J. Med. Clin Sci Table 1. Knowledge of BLS among participants Questions Correct answers No. % What is the abbreviation of BLS? Basic Life Support When you find someone unresponsive in the middle of the road, what Look for safety will be your first response? If you confirm somebody is not responding to you even after shaking Activate EMS and shouting at him, what will be your immediate action? What is the location for chest compression? Mid chest What is the location for chest compression in infants? One finger breadth below the nipple line If you do not want to give mouth-to-mouth CPR, the following can be No CPR done EXCEPT How do you give rescue breathing in infants? Mouth-to-mouth and nose Depth of compression in adults during CPR 2½ 3½ cm Depth of compression in Children during CPR One-half to one-third depth of chest Depth of compression in neonates during CPR One-half to one-third depthof chest Rate of chest compression in adult and Children during CPR 100 / min In a new born, the chest compression and ventilation ratio is 3: What does abbreviation AED stand for? Automated External Defibrillator What does abbreviation EMS stand for Emergency Medical Services If you and your friend are having food in a canteen and suddenly your friend starts expressing symptoms of choking, what will be your first response? confirm foreign body aspiration by talking to him You are witnessing an infant who suddenly started choking while he was playing with the toy; you have confirmed that he is unable to cry (or) cough, what will be your first response? You are witnessing an unresponsive adult victim who has been submerged in fresh water and just removed from it. He has spontaneous breathing, but he is unresponsive. What is the first step? Back blows and chest compression of five cycles each then open the mouth and remove foreign body only when it is seen Keep him in recovery position Table 2. Factors associated with BLS knowledge among participants Specialty Medicine (n=102) Nursing (n=39) Academic level Third (n=36) Fourth (n=29) Fifth (n=26) Sixth (n=22) Seventh (n=28) Last BLS training No (n=20) months (n=61) >2 years (n=60) Confidence in performing CPR No (n=101) Yes (n=39) BLS knowledge Insufficient N=84 62 (60.8) 22 (56.4) 19 (52.8) 17 (58.6) 17 (65.4) 17 (77.3) 14 (50.0) 15 (75.0) 32 (52.5) 37 (61.7) 60 (58.8) 24 (61.5) Sufficient N=57 p-value* 40 (39.2) 17 (43.6) (47.2) 12 (41.4) 9 (34.6) 5 (22.7) 14 (50.0) (25.0) 29 (47.5) 23 (38.3) (41.2) 15 (38.5) * Chi-square test CPR: Cardiopulmonary resuscitation severity of obstruction as the course of action to take with a suspected foreign body obstruction victim, 42.6% failed to identify the correct technique for removal of a foreign body from an infant and87.2% failed to determine the role of the recovery position in a spontaneously breathing, unresponsive victim. Table 1 and 2 Figure 1 shows that more than half of the participants (59.6%) had insufficient knowledge regarding BLS. A minority of the participants (14.2%) had no BLS training at all and 42.6% had training since more than two years,

4 Sarah et al. 56 Figure 1. Knowledge level regarding BLS among participants Figure 2. Who should learn BLS: Participants` opinion 30.5% did not agree to educate the public about CPR (Figure 2) and 71.6% losing the confidence to perform CPR. DISCUSSION It is essential that every individual in the community be aware of Basic Life Support to save lives as well as improve the quality of community health. At least, the future doctors and nurses are expected to be well aware of it, as they will frequently face lifethreatening situations, and the awareness and knowledge of BLS will be useful to them. The present study revealed that more than half of medical and nursing students (59.6%) had insufficient awareness of BLS, and even 44% of them did not identify the correct meaning of the abbreviation of BLS. In another study conducted among final year undergraduate medical, dental, and nursing students in India, also, the majority of the students (70%) had a fair knowledge of the basics of BLS such as the terms and abbreviations used in BLS (Srinivas et al., 2014). Also, this study in accordance with others (Chandrasekaran et al., 2010; Srinivas et al., 2014) emphasized the cognitive approach to the general attitude and skills of Basic Life Support, early recognition of acute coronary syndrome and stroke. The satisfactory knowledge score, although not significant was higher among nursing compared to medical students, this explained why doctors were mostly not confident in carrying out effective CPR. The same finding has been reported by others (Chandrasekaran et al., 2010; Casey et al., 1984). Interestingly, the training in BLS did not improve the awareness level significantly. Thus, the quality of training should be reconsidered. Also, It is essential to standardize training in Basic life support and make it a mandatory of all medical and nursing school undergraduate curricula. Fortunately, most of the students in the present study agreed that all public should be trained in BLS. Spreading awareness and teaching the basics of advanced life support to the medical and nursing students as well as

5 57. Basic Res. J. Med. Clin Sci teaching BLS to the community should be emphasized by concerned authorities in our country. Among limitations of the current study, we could not assess for the practical skills of basic life support. The cross-sectional nature of the survey did not allow studying the causality. Conclusively, nobody had complete knowledge on BLS even up 80%.The results of this study indicate that awareness of Basic Life Support (BLS) among medical and nursing students in Tabuk University is insufficient and needs to be improved. We suggest that the addition of a BLS course to the undergraduate curriculum every year, along with regular reassessment, will increase awareness and knowledge of this valuable life-saving skill set. Recommend BLS training to be an integral part of high school and college study programs so as to ensure that young students could grasp enough knowledge about BLS and have the capability to help the people in emergency situations and disasters. ACKNOWLEDGEMENT We would like to acknowledge the research committee, Faculty of Medicine, University of Tabuk for financial support, and Dr. Hyder Osman Mirghani, Assistant Professor of Internal Medicine and Endocrine for supervising this research. REFERENCES AbbasA, Bukhari SI, Ahmad F (2011). Knowledge of first aid and basic life support amongst medical students: a comparison between trained and un-trained students. J. Pak. Med. Assoc. 61(6): Alanazi A, Alsalmeh M, Alsomali O, Almurshdi A, Alabdali A, Al-Sulami M (2014). Poor Basic Life Support Awareness among Medical and College of Applied Medical Sciences Students Necessitates the Need for Improvement in Standards of BLS Training and Assessment for Future Health Care Providers. Middle-East J. Sci. Res. 21 (5): Almesned A, Almeman A, Alakhtar AM, AlAboudi AA, Alotaibi AZ, Al- Ghasham YA (2014). Basic life support knowledge of healthcare students and professionals in the Qassim University. Int. J. Health Sci. (Qassim). 8(2): Al-TurkiYA, Al-Fraih YS, Jalaly JB, Al- Maghlouth IA, Al-Rashoudi FH, Al-Otaibi AF (2008). Knowledge and attitudes towards cardiopulmonary resuscitation among university students in Riyadh, Saudi Arabia. Saudi Med. J. 29(9): Casey WF (1984). Cardiopulmonary resuscitation: A survey among junior hospital doctors. J R Soc Med. 77: Chandrasekaran S, Kumar S, Bhat SA (2010). Awareness of basic life support among medical, dental, nursing students and doctors." Indian J. Anaesthesia. 54(2): 121. Jones CM, Owen A, Thorne CJ, Hulme J (2012). Comparison of the quality of basic life support provided by rescuers trained using the 2005 or 2010 ERC guidelines. Scand J. Trauma. Resusc. Emerg. Med. 9: 20: 53. NaqviS., Siddiqi R, Hussain SA, Batool H, Arshad H (2011). School children training for basic life support. J. Coll Physicians Surg Pak. 21(10): Papadima A, Pappas AB, Lagoudianakis EE, Kotzadimitriou A, Markogiannakis H, Filis K (2010). Cardiopulmonary resuscitation by chest compression alone: a reality check. Hellenic J. Cardiol. 51(1): Promes SB, Chudgar SM, Grochowski CO, Shayne P, Isenhour J, Glickman SW (2009). Gaps in procedural experience and competency in medical School graduates. AcadEmerg Med. 16 (Suppl 2):S Spencer B, Chacko J, Sallee D (2011). American Heart Association. The 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiac care: an overview of the changes to pediatric basic and advanced life support. Crit. Care Nurs. Clin. North Am. 23(2): Srinivas H T, Kotekar N, Rao SR (2014). A survey of basic life support awareness among final year undergraduate medical, dental, and nursing students. Int. J. Health Allied Sci. 3:91-4 Zaheer H, Haque Z (2009). Awareness about BLS and CPR among medical students: status and requirements. J. Pak. Med. Assoc. 59(1): 57-9.