Evidences about the Skills of Nursing Professionals Regarding the Protocol in Basic Life Support

Rebeca Chaves Cruz1, Raymari Dias Almeida1, Francisco Mayron Morais Soares2, Carlos Lucas Damasceno Pequeño3, Maria Flaviana Alencar4, Kiarelle Lourenço Penaforte5, Ítalo Rigoberto Cavalcante Andrade6, Maria Lurdemiler Saboia Mota7, Julyana Gomes Freitas8 1 Nurse, Graduate Student of Intensive Care Nursing. University of Fortaleza, UniforFortaleza, Ceará, Brazil. 2 Graduate Student of Nursing, Scholarship Holder of Scientific Initiation Pibit/Cnpq University of Fortaleza, Unifor Fortaleza, Ceará, Brazil. 3 Graduate Student of Nursing, Scholarship Holder of Scientific Initiation Funcap/Bict *. 4 Graduate Student of Nursing, Scholarship Holder of Scientific Initiation Probic/Bict *. 5 Nurse, Master of Public Health At The Federal University of Ceará. Professor of Nursing Graduate At The *. 6 Nurse, Master of Colective Health, Unifor Professor of Nursing Graduate At The *. 7 Assistant Nurse of The General Hospital of Fortaleza, Doctorate In Pharmacology From The Faculty of Medicine of The Federal University of Ceará. Professor of Nursing Graduate At The *. 8 Nurse Doctor In Nursing From The Federal University of Ceará. Professor of Nursing Graduate At The *. *: University of Fortaleza, Unifor Fortaleza, Ceará, Brazil.


Introduction
Health professionals working within the scope of urgency and emergency, especially nursing professionals, need a theoretical and practical knowledge and skills in order to assure the highest possible level of safety, reducing the risks that threaten the life of the patient.
Cardiorespiratory Arrest (CRA) can be defined by the sudden cessation of efficient ventricular activity and respiration.It consists of four types: asystole, atrial ventricular, pulseless ventricular tachycardia and pulseless electrical activity [1].Shortly after the occurrence of CRCA, cardiopulmonary and cerebral resuscitation (CPCR) is performed to artificially keep the arterial flow to the brain and other organs considered vital [2].
For the American Heart Association -AHA (2015) [3], care for patients with cardiopulmonary and cerebral arrest (CPCA) should be divided into two aspects: Basic Life Support (BLS) and Advanced Life Support (ALS).The first involves a set of sequential techniques that correspond to chest compressions, airway opening, artificial respiration and defibrillation, the latter being very often used by first responders in such cases.The second consists of keeping the first support plus medication administration and treatment of the cause of CPCA.
In most situations, health professionals, especially nurses, are always the ones who turn out giving first aid, requiring the team the organization, emotional balance, technical-scientific domain and correct distribution of the functions in their ways [4].
Following this line, Gonzalez et al (2013) [5] estimates that there are approximately 200,000 CRA per year in Brazil, half of which are in a hospital environment, and the other half in out-of-hospital settings (at home or on the street).
The technical-scientific knowledge of the healthcare team should always being updated, due to the quick changes in regard to attending a CRCA.One way of improving it is through permanent education, which can be understood as the constant search for learning, as one of the actions that enables the development of the change process and which aims at the professional qualification of nursing [6].
Given the above, it is understood the following aspects as being of the most relevance: the emergency care for the cases of patients who are being treated with CRCA; The role of the nurse with his/ her technical-scientific skill in attending to this type of patient in the place where the occurrence happened.Recognizing this, we guided our research with the following question: "What is the knowledge of nursing professionals about basic life support?" The objective was to analyze the available scientific evidences about the skills of nursing professionals regarding the protocols of care in Basic Life Support.

Methods
There was conducted an integrative review.This research method allows the synthesis of multiple published studies and the general conclusions with respect to a particular area of study [7].This type of research is an Evidence-Based Practice (PBE) instrument, whose origin was linked to the work of the epidemiologist Archie Cochrane.This practice uses classification systems of evidence characterized in a hierarchical mode, depending on the methodological approach adopted by the research [8].
In all, six evidences are classified: Level 1: Evidence resulting from the meta-analysis of multiple controlled and randomized clinical studies; Level 2: Evidence obtained in individual studies with an experimental design; Level 3: Evidence from quasi-experimental studies; Level 4: Evidence from descriptive (non-former-experimental) studies or qualitative approach; Level 5: Evidence from case or experience reports; Level 6: Evidence based on the opinions of specialists [8].
To construct this review, the method was developed in six stages:

Results
There was verified an increase of publications related with trainings and courses related to the theme of care on practical assistance of the nurse in the analyzed years.Among the studies there was observed a predominance of the quantitative design, an approach that has as objective to bring to light data, indicators and observable tendencies, generating confident measures.Among those countries with the origins of the researches, Brazil is in first regarding publication terms; what suggests a national interest in studying the theme.
Among these publications, nineteen of them have the objective of analyzing nurses' knowledge about CPR and BLS (Table 1).Two aim to guide the attendance to a CPR (Table 2), two ordinances related to the SADU (Table 2), an article which relates care after a CRP with the NIC interventions (Table 3), an article that aims to implement a training program in relation to a CRP and the BLS (Table 1), an article that aims to review changes in the CPR (Table 3), an article that aims to assess the costs of continuing education for the nursing team (Table 3).
In Table 4 we present the difficulties found in the researches and demonstrated by the authors in their results.Clinical epidemiological study conducted in teaching hospital.
To evaluate nursing care to patients in cardiopulmonary arrest.4 The actions of the nursing staff in patient care in patient care in cardiopulmonary emergency stop.
Qualitative research, convergent healthcare type.
To build with the nursing staff in an emergency unit an instrument for cardiopulmonary resuscitation.These nurses affirmed that they were qualified to perform cardiorespiratory resuscitation; however, limitations were identified in their knowledge about this subject.
Downgrading of professionals within some parts of the guideline of the AHA.
Proof of the efficacy of these therapies is still lacking in controlled and randomized studies.Further research needs to be done and thus a fundamental evaluation of the therapeutic benefits of non-drug therapies for the treatment of dementia still can not be done.Respondents showed gaps of knowledge about how to detect the cardiopulmonary arrest, the sequence of the BLS as a whole.
The study showed that the difficulties are recurrent in the matter of periodic updating in the theme, due to overload of work and lack of incentive of the institution.
The study shows that music therapy can be effective in reducing symptoms in subjects with advanced degrees of dementia and stimulating a communicative relationship between patient and therapist.Major deficiencies were related to the initial airway approach, post-resuscitation care and external cardiac massage technique.
Difficulties were evidenced to the sequence of attitudes in the chain of survival for adults.
According to the results obtained, the levels of Alzheimer's hormones are different from those of Musicoterapia, which reveals that music therapy is responsible not only for the improvement in the patients' behavior, but also to provide several psychological benefits.The study demonstrated that the nurses are prepared to offer the initial care, but presented difficulties in the advanced life support, which reflects the need for training and periodic updates.
High weekly work hours, double work hours, poor pay, and demotivation act as a limiting factor to the availability of time to attend courses, including those offered by the work institution.
The use of improvised music therapy was identified.The study concludes with the suggestion that managers should extend the actions of the music therapist to maintain the well-being of the internees in nursing homes.We identified gaps in nursing care in cardiopulmonary arrest regarding technical-scientific knowledge, mainly related to the practical aspect, and related to the difficulty of working in a dynamic and organized team, assuming each one the role to which it was assigned.It also showed that having and recognizing the nurse as a leader that directs the care in a correct and quality way, as well as having instruments that standardize the care to the serious patient, help in the safe and excellent care.

Author
Fragility in patient care in PCP, such as the lack of preparation and organization of the team and also of continuing education.
A series of recommendations have been established to facilitate the use of these techniques in the context of nonpharmacological therapies.

Discussion
The knowledge of the professionals about SBV evidenced in literature In the urgency and emergency sector, being qualified for health professionals is fundamental for the adequate care of critically ill patients, directly influencing on the survival and sequelae [9].The effectiveness of the systematic training of CRA in the theoretical and practical knowledge of the nursing team is fundamental, being important for basic and advanced care.Therefore, continuous and systematic education strategies are important to keep the good performance of the team in the CRA care [10].
This worry with the proper subject is of great value, since the first contact of the health professional with the patient who underwent a CRA is the realization of a CPR, both in the out-of-hospital and inhospital settings, which will require the professional knowledge of the BLS, so as to avoid risky errors to the patient.Thus, these professionals need to have the updated technical knowledge and the practical skills developed to contribute more effectively to the CPR maneuvers [10].
The needs of theoretical knowledge and technical skills, according to the practice in the pre-hospital care, refer to the most frequent occurrences or procedures, the situations that require decision making, readiness and skill, in a moment of high stress or care of a specific population, which reinforces the need for programs aimed at the development of skills in this area [11].
In the face of this search of Roshana et al (2012) [12] emphasizes that there is a serious problem in relation to the retention of skills and outdated information for professionals, but at the same time that demonstrates the readiness of the professionals to perform the BLS even with the shortage of their knowledge.
Such knowledge about BLS is acquired at undergraduate level and through training/updating, promoted by the institutions or that the professionals themselves will look for.
About BLS difficulties highlighted in the literature and the solutions presented by the authors For the author Costa et al (2012) [13] continuing education is a tool that comes to help in updating in the professional.For him the worker feels more secure in a family environment, reducing anxiety levels and facilitating the learning process.It also shows that in his study he showed that the long hours of class interfere in the capacity for learning, and the alternative is to take classes at different times.
In order to prove the benefits of continuous updating/education on BLS, we bring the research of Roshana et al (2012) [12], where after the first questionnaire where the professionals were outdated, training was applied to them on CPR, which significantly influenced in the knowledge of the professionals and in the result of the second questionnaire.
Lima et al. ( 2009) [10], in their study with nursing professionals from a tertiary-level hospital evaluated the impact of a permanent Basic Life Support (BLS) and Advanced Life Support (SAV) training program on team knowledge of Nursing.Failures were initially verified both in theoretical knowledge and in the practical skills of nursing professionals in CPR maneuvers.
As a result, the research by the author Lima et al (2009) [10] verified a significant impact on the level of knowledge of nursing professionals after training in BLS and SAV.This fact proves by the percentage gain of knowledge of 91% in the total sample, reaching 131% in the group of nursing assistants.
In this sense, there is a need for training about the subject, since the professionals involved find it difficult to deal with this emergency, it is up to the nurse to update and be prepared to train the professionals of the teams, since success is directly related to the performance immediate and effective [1].

Conclusions
There is still a lot to learn about CPR, because success in care comes from quality care in a timely manner and a well-trained staff.Standardization in the management of CPR is a fundamental point in the survival of post-CRP patients.Thus, the health professional should be up to date on the new published guidelines, especially managers and multipliers, through a decentralized vision of health promotion for the benefit of the client.
The standardization of CPR conducts helps in adopting the unique language of health professionals to perform the maneuvers effectively.The updating/qualification can be done through continuous and permanent education, being offered by the institutions of work or even, by the own search of the professional, always seeking to encourage the same to be successful, aiming to improve the service provided.Always taking into consideration the ideas of the professional about how it would be a training that had more assiduity of the students (professional nurse), creating a standardization of attendance based always on the updates on the subject.
The nurse training programs for the PCR/CPR service are a way to bring their practical reality closer to the knowledge that is being produced on the subject, and also contribute to the standardization and standardization of PCR/CPR care in the institution researched.

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Table 1 .
Description of the level of evidence, title, author, journal/year, study type and purpose.Fortaleza, CE, Brazil, 2016.
To identify the knowledge of hospital nurses from the Vale do Paraíba, São Paulo, Brazil, about cardiorespiratory arrest and to prepare a theoretical guide for care in this emergency.

Table 2 .
Characterization of the title, source, journal/year, study type and purpose.Fortaleza, CE, Brazil, 2016.

Table 3 .
Characterization of the level of evidence, title, author, periodic / year, type of study and objective.Fortaleza, CE, Brazil, 2016.