title: Assessment of CPR-D skills of nurses in Göteborg, Sweden and Espoo, Finland: teaching leadership makes a difference.
abstract: BACKGROUND
  Construction of an effective in-hospital resuscitation programme is challenging. To document and analyse resuscitation skills assessment must provide reliable data. Benchmarking with a hospital having documented excellent results of in-hospital resuscitation is beneficial. The purpose of this study was to assess the resuscitation skills to facilitate construction of an educational programme.
  
  
  METHODS
  Nurses working in a university hospital Jorvi, Espoo (n=110), Finland and Sahlgrenska University Hospital, Göteborg (n=40), Sweden were compared. The nurses were trained in the same way in both hospitals except for the defining and teaching of leadership applied in Sahlgrenska. Jorvi nurses are not trained to be, nor do they act as, leaders in a resuscitation situation. Their cardiopulmonary resuscitation (CPR) skills using an automated external defibrillator (AED) were assessed using Objective Structured Clinical Examination (OSCE) which was build up as a case of cardiac arrest with ventricular fibrillation (VF) as the initial rhythm. The subjects were tested in pairs, each pair alone. Group-working skills were registered.
  
  
  RESULTS
  All Sahlgrenska nurses, but only 49% of Jorvi nurses, were able to defibrillate. Seventy percent of the nurses working in the Sahlgrenska hospital (mean score 35/49) and 27% of the nurses in Jorvi (mean score 26/49) would have passed the OSCE test. Statistically significant differences were found in activating the alarm (P<0.001), activating the AED without delay (P<0.01), setting the lower defibrillation electrode correctly (P<0.001) and using the correct resuscitation technique (P<0.05). The group-working skills of Sahlgrenska nurses were also significantly better than those of Jorvi nurses.
  
  
  CONCLUSIONS
  Assessment of CPR-D skills gave valuable information for further education in both hospitals. Defining and teaching leadership seems to improve resuscitation performance.
authors.affiliation: Uusimaa EMS, Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Finland. marja.makinen@helsinki.fi
authors.forename: M
authors.initials: M
authors.lastname: Mäkinen
authors.forename: S
authors.initials: S
authors.lastname: Aune
authors.forename: L
authors.initials: L
authors.lastname: Niemi-Murola
authors.forename: J
authors.initials: J
authors.lastname: Herlitz
authors.forename: T
authors.initials: T
authors.lastname: Varpula
authors.forename: J
authors.initials: J
authors.lastname: Nurmi
authors.forename: A B
authors.initials: AB
authors.lastname: Axelsson
authors.forename: A-B
authors.initials: AB
authors.lastname: Thorén
authors.forename: M
authors.initials: M
authors.lastname: Castrén
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education*; D047548:Defibrillators; D004521:Educational Measurement; D004554:Electric Countershock; D005387:Finland; D006801:Humans; D007857:Leadership; D009726:Nurses; D013548:Sweden; D013663:Teaching