CPR, BLS, ACLS Contract Project Proposal: March 22, 2019

This project proposal addresses the critical need for improved CPR, BLS, and ACLS skills among nurses to enhance patient outcomes in cardiac arrest situations. The proposal highlights the global prevalence of cardiovascular diseases and emphasizes the importance of early recognition and immediate intervention. It outlines objectives focused on enhancing knowledge, skills, and competence in CPR techniques, guideline updates, DC techniques, medication use, and understanding of cardio-pulmonary and vascular systems. The project reviews the literature, emphasizing the impact of CPR quality on survival rates, the need for tailored resuscitative efforts, and the importance of nurses' role in providing life support. It discusses the implications for nursing practice, the significance of formal training, and the need for improved knowledge and practical skills. The proposal also covers BLS and ACLS procedures, the use of AEDs, and the management of respiratory and cardiovascular issues. The project aims to address gaps in knowledge and practice, ensuring that nurses are well-equipped to handle cardiac arrest emergencies in various settings. The project also provides a detailed overview of the DC technique and the importance of the knowledge of anatomy and physiology.

CPR, BLS AND ACLS
CONTRACT PROJECT PROPOSAL
MARCH 22, 2019
STUDENT ID
COURSE ID

Contents
INTRODUCTION.................................................................................................................................2
OBJECTIVES.......................................................................................................................................2
ISSUE RELEVANCE AND IMPLICATIONS.....................................................................................3
LITERATURE REVIEW......................................................................................................................4
EVALUATION OF THE PROJECT BASED ON LITERATURE FINDINGS....................................9
CONCLUSION...................................................................................................................................12
REFERENCES....................................................................................................................................12

INTRODUCTION
There are more than 135 million deaths associated with cardiovascular diseases
annually across the globe. The coronary heart disease prevalence is also one a rise. There has
been incident of out of hospital heart failure and the prevalence ranges from 20 to 140 per
100000 individuals (Benjamin et al., 2017). It demonstrate the cardiac arrest to be the most
fatal health issue as it claims more life as compare to breast cancer, colorectal cancer,
influenza, auto accident, pneumonia, firearms, HIV etc. Cardio Pulmonary Resuscitation
(CPR) is known to be a major lifesaving intervention and one of the best ways for
resuscitation of cardiac arrest patients. The survival of the patient from cardiac arrest is
mainly depending on its early recognition and taking immediate intervention against it. A
both clinical and animal study shows that the CPR quality at the time of resuscitation is
having a huge impact over the survival rates (Yannopoulos et al., 2015). The method is
somewhat inefficient as it only provides 10% to 30% of the normal blood flow towards heart
and about 40% of the blood flow towards brain even if the process is carried out according to
the guidelines (Hoffman & Katz, 2016). The highlighted inefficiency of CPR shows the
requirement of highly trained rescuers for delivering the best quality of CPR as possible.
OBJECTIVES
Objective 1
Improvement of knowledge in CPR technology as correct CPR facilitation improves the
survival rate.
Objective 2
Keeping update on CPR guidelines change due to 5 yearly change by concerned authorities.
Objective 3

Improving knowledge on appropriate use of DC technique
Objective 4
Improve knowledge on advance life support care medications used during cardiac arrest
Objective 5
Improvement in anatomy and physiology knowledge on cardio-pulmonary and vascular
system, so that as a nurse the optimum care can be facilitated to the patients of cardio-
vascular conditions.
Objective 6
Improvement in BLS care knowledge, that in turn will help me to develop as a responsible
and accountable nursing professional with skill and competence for facilitation of life support
care during cardiac arrest either in or out of hospital settings.
ISSUE RELEVANCE AND IMPLICATIONS
Due to the nature of nursing profession, they are the first one to find out sudden
cardiac arrest in hospital settings. Thus, they are the first one’s who will be facilitating CPR.
But research in CPR knowledge evaluation indicates, despite expectations of healthcare
consumers that nurses will deliver appropriate emergency intervention in team or as an
individual, the realistic fact remains discouraging (Andrews et al., 2018). Nurses either lack
proper knowledge or skills to address cardiac arrest issues through Basic Life Support or
Advance Cardiac Life support protocol against International guidelines and
recommendations. Thus, the current project proposal is targeted towards improvement in
knowledge, skills, and competence towards CPR, BLS and ACLS facilitation in appropriate
emergency situations.

As a nursing student and future student the current has significant implications
towards practice. As a future registered nurse one might encounter in-house cardiac arrest (in
hospital) or out of the hospital setting patients. In such cases, having proper formal training,
enhanced and improved knowledge, practical skills and confidence can help the patient and
improve the survival rate. Thus, the proposal targeted towards improvement of knowledge
and practical skills for CPR facilitation is a must for every aspiring nursing individual.
LITERATURE REVIEW
A poor quality of CPR intervention is a preventable harm (Kleinman et al., 2015). In
healthcare setting, the performance variability of the clinicians has highly affected the ability
to reduce the complications in healthcare and there has been standardized approach taken to
improve the better outcome of the patient. The use of such quality improvement is on a rise
and approach has shown an optimized outcome on various occasions. Despite of such
evidences available, the health care organization uses these techniques for cardiac arrest on
regular basis by monitoring the quality of CPR and the outcomes achieved. The unacceptable
disparity still remains in the resuscitation quality along with the opportunities available to
save more such people live. The infant, children and adults have various needs in terms of
CPR. The makeup, bone structure, physiology and the danger faced by the children are quite
different from adults and therefore the CPR techniques used for them are different as well.
The bones of children are more flexible as compare to adults and it is more likely get bend
rather than break as it happens in adults. The tongues are also larger in proportion as compare
to their mouth with a narrower air passage. Therefore, the need of CPR among the children is
more as compare to the adults. Majority of the techniques used for the children of one to eight
years are similar to that of the techniques used for adults (Kourek et al., 2018).

Currently, there is an existence of large gaps between the CPR knowledge, their
quality and the implementation that leads to some preventable death due to cardiac arrest.
Tailoring of certain resuscitative efforts are taken for each patient. There are diversified
settings where the cardiac arrest occurs that varies with resources available and the
epidemiology. Yet there are solution available to improve the quality of CPR in each setting.
Most of the healthcare givers are well trained in BLS. It is one of the basic step in patient
stabilization. The initial goal of the caregiver is to get stabilization of patient’s condition until
the patient can be taken to the nearby hospital. The technique can be well conducted without
using any drug, medical equipment or any invasive procedures. It also consist of several
techniques such as cardiopulmonary resuscitation or using head tilt technique for the patient
to open the airways. It mainly includes the administration of CPR for children, infant and
adults. It provides support to the unconscious and conscious choking of victims. AEDs
(Automated external defibrillators) are used for the victims in emergencies. The importance
of bag valve mask, breathing barriers and two rescuer CPR (Pratipajak and Thongpo, 2016).
ACLS mainly includes more sophisticated procedures and techniques like use of IV
access, use of ECG and use of several emergency drugs. The technique includes the
management and recognition of respiratory and cardiovascular issues. It demonstrates the
importance of managing airways. It provides the ways to manage the stroke and coronary
syndromes. It provides the ways to serve the team member and; leader of resuscitation team.
Generally, the nurses are the first person to respond to cardiac arrest and provide life support
while waiting for the support team to arrive at the spot. The nurses working in the cardiac
units are more likely to get involved in CPR as compare to other department because of the
interest and their relevance in the unit. In coronary care, the nurses act as the key to success
in the entire system. CPR is considered as the ultimate hope for survival and generally
involves cardiac compression along with mouth to mouth ventilation that maintains the

circulation until the normal circulation and ventilation gets restored using some important
therapies (Plagisou et al., 2015).
There are variety of factors associated with the competency of CPR and one of the
major factor is the instruction of CPR. The nurses not just acquire the CPR skills and
knowledge but they also have the competency to respond confidently in a life threatening
situation. In any given critical situation, the staff people such as registered nurse and doctors
don’t have efficient knowledge about CPR with time. There are several professional affirms
about knowing the importance of the CPR guidelines but they never reports about the lack of
theoretical knowledge of the guidelines (Kelly et al., 2015). In November 2015, there were
several changes incorporated in the American Heart Association 2015 guidelines that
involved approximately 250 reviewers from about 39 countries. There were few
considerations about the ECC and CPR were shown in the updated guidelines on the basis of
division of care and the environment where the victim exist. Within intra hospital
environment, the nursing professional are the first person to face the situation of emergency
and it becomes quite fundamental that such professional must undergo a proper theoretical
and practical training session to have a proper attitude, knowledge and skills to promote the
resuscitation to the patient (Panchal et al., 2018).
The direct current cardio version is known to be one of the best and efficient
techniques for restoring the sinus rhythm of the patient with atrial fibrillation. This process is
mainly performed under anaesthesia condition but reports suggest that it can be performed
more effectively and safely under sedation condition. There are some other category of staff
who possess the cognitive and technical skills required for the elective cardioversion
performance and the sedation administration in the advanced life support to the cardiac arrest
patient. The success rate of direct current cardio version varies from 75 to 93% and is
inversely associated with the duration of the atrial fibrillation, left atrial size and chest wall

impedance. Indeed the rate of success generally varies based on time point where the success
rate is well defined. In a serious of about 1800 cardio version, the rate of success where the
AF duration was less than 30, 30 to 90, and greater than 180 was about 84, 77, 66 percent
respectively. Presence of atrial fibrillation for more than five years the rate of success was
about only 50 percent. When the DC cardio version is optional, the patients are required to
fast for about 8 hours in order to prevent any possibilities of aspiration. The procedure is
quite painful, the use of analgesia and general anaesthesia or sedation is required. The
personnel maintaining the equipment must be present at the sight to see if the process is going
on smoothly. The electrodes require for the technique are placed anterio-posteriorly or
antero-laterally. After the synchronization of the QRS complex is achieved and gets
conformed in the monitor, the patient is administered with a shock. The energy levels that are
most appropriate varies with the ways tachyarrhythmia is getting treated. Thus, the above
brief description of DC technique implicates the complexity of procedure and importance of
knowing the technique and getting mastery over the technique (Soar et al., 2015).
Cardiac arrests are emergency situations that can lead to grave situations and death of
patients. In such cases, the healthcare professional especially the nursing professionals are
expected to be well equipped with knowledge of Basic and Advance cardiac life support care
skills. Research shows extensive medical knowledge and practice is required to gain mastery
over the ACLS care (Links et al., 2015). Although normal human individuals and nurses can
facilitate BLS, ACLS require proper subject knowledge, protocol knowledge, guidelines and
emergency care use of instruments for facilitating ACLS care. However, recent findings
implicates there is a gap between ACLS knowledge acquired during academic years and
practical. In this situation as a nursing individual, learning the techniques and mastering the
techniques are two important aspects in emergency clinical care. Whether a nurse facilitates

clinical care in hospital or out of hospital settings, ACLS care facilitation require structured
and formal knowledge (Travers et al., 2015).
Cardiac arrest involves the cardio-vascular system as well as cardio-pulmonary
systems. In such cases, the nurses are expected to have proper understanding of physiology,
anatomy and pathology of the conditions. Pathophysiological and anatomical knowledge are
fundamental to nursing care as the nurses can extrapolate the findings to prognosis and
outcome based on the severity of the situations (Craft et al., 2017). Whether it is treatment, or
research or emergency care knowledge of pathophysiology is an essential component of
nursing study and care. Translation of academic theory regarding physiology can form the
base for understanding the symptoms and manifestations of conditions in real clinical
scenario. Therefore, literature suggest knowledge of cardio-vascular physiology is highly
imperative for prevention of cardiac arrest (Birks et al., 2018).
Comparative to ACLS that is highly specific BLS is considered as a common skill and
knowledge for healthcare facilitating professionals. As they might encounter serious and
emergency cases of cardiac arrests, during their routine life it is expected to have proper
knowledge of BLS and support system (Abolfotouh et al., 2017). As per American Heart
Association guideline, the student and teacher must be facilitated training and knowledge on
BLS. Research in this domain implicates although nurses are well aware of BLS protocol,
and has a positive attitude they lack significant knowledge regarding BLS implementation in
hospital setting and out of hospital setting. The study recommends inclusion of proper
strategy to improve BLS knowledge (Aloush et al., 2018).

EVALUATION OF THE PROJECT BASED ON LITERATURE FINDINGS
The clinical project proposal and the approach need qualitative evaluation against the
literature findings. Therefore, in this section each objectives mentioned will be evaluated
based on the literature findings.
Objective 1 – Enhancement of correct CPR knowledge as a nursing student
Literature evidence for objective 1 - The research in context of Australian student
nurse on correct CPR technique is limited. Not much research has been carried out in
Australian context. The study by Josipovic, Webb & McGrath (2009) reported that nursing
and chiropatric students have significant gaps in CPR/BLS knowledge in context of correct
technique. Although, nurse students outshines chiropatric students, this can be due to
fundamental difference in curriculum and practice standards. Thus, it implicates knowing the
correct technique of CPR either for Basic life support or Advance cardiac life support is the
first point to be learnt as a student nurse.
Objective 2 – CPR guidelines knowledge and update on changes.
Evaluation – Firstly, CPR guidelines changes every 5 year to address the emerging
problems at various levels. Secondly, small changes occur every year that must be known and
implemented. As a nursing professional abiding by such guidelines helps in error prevention
and saving critical life in emergency situation. In 2018, as per Australian Resuscitation
Council (ARC) three changes was brought to ARC guideline 11.1, ANZCOR guideline 12.1,
ANZCOR guideline 13.1 in context of equipment check. Similarly, in 2019 February
guideline 11.1 page 8 underwent changes for consistency. Thus, it implicates the necessity for
keeping update regarding the CPR, BLS and ACLS guidelines.
Objective 3 – Increasing knowledge on DC shock

Evaluation – As global consensus, patients having cardiac arrest must be defibrillated
within three minutes of arrest implicating fast intervention from nurses and knowing the
exact technique. Prompt defibrillation technique can improve the survival rate by 80%.
Therefore as a nursing student, it is essential to know how exactly defibrillation
cardiopulmonary resuscitation shock is given. The study by Husebo et al., (2012)
demonstrated nursing students unable to score high in D-CPR technique presentation in a
simulation environment. In 2017, (Mohmoud & Ahmed) demonstrated effectiveness of CPR
programs on D-shock technique knowledge and performance by two nursing teams.
Therefore, improving knowledge on this technique is highly essential and rightly included in
the proposal.
Objective 4 - Improvement in Cardiac life support medications.
Evaluation – Cardiac life support medications are integral to CPR protocol for
increasing the survival rate among patients. In emergency situations, due to high stress and
limited time period, without proper knowledge and training medication error can be high.
Error can be due to wrong medication, dosage error, wrong site administration, storage of
medications and other aspects. Therefore, as a future CPR specialist not only the protocol or
technique is important. It is imperative to know the medications. Therefore, studying of
medications, relevant evidence based literatures is highly imperative for improvement in CPR
knowledge.
Objective 5 – Knowledge of Anatomy and physiology of cardio-vascular systems for
proper cardiac life support enhancement.
Evaluation- Administration of medication or intervention via any medical technique
demands early diagnosis and identification of the issue. However, it can only be feasible
when healthcare professionals have thorough knowledge on anatomy and physiology of any

body systems. The knowledge on anatomy and physiology helps in understanding the
pathology, aetiology, symptomatic manifestation and linking with diagnostic test results to
reach conclusions. The thesis by Stuart (2014) submitted to University of Missouri showed
significant gaps in theory and practice as far as knowledge of cardio-vascular system is
concerned among bachelor of nursing science students. Similarly, another study by Chow et
al., (2017) reported despite higher knowledge in cardio-vascular systems nurses have high
misconceptions while addressing cardiac patients. Therefore, they recommended changes in
curriculum. The study was carried out in Hong Kong, which needs an evaluation against
Australian curriculum. However, as a fundamental fact anatomy and physiology knowledge
is essential for nursing students to understand the condition and interventions required for
addressing the issue.
Objective 6 – Improving BLS knowledge for helping out individuals suffering from
cardiac arrest outside hospital settings.
Evaluation – The cases of out of hospital cardiac arrest is high in number globally.
Many times, paramedics has to provide BLS and ACLS support for out of hospital cardiac
arrest scenarios. As a nursing individual one can encounter any such scenario in day to day
life. In such scenario’s saving the patient life is only feasible through knowledge on BLS and
alternative approach when no medical support exist. As per Sanghvi et al., (2015), out of
hospital cardiac arrest cases attended by paramedics shows high survival rate if BLS is
facilitated. The by-stander CPR quality has been reported of high standard as far out of
hospital cardiac arrest is considered (Fernando, 2018). Therefore, being a nurse student it is
imperative to understand the BLS protocols and know how to provide BLS care in out of
hospital context.