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Awareness about BLS (CPR) among medical students: Status and requirements

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Hassan Zaheer at University of Central Punjab
Hassan Zaheer
Zeba Haque at Dow University of Health Sciences
Zeba Haque
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Abstract

To study the awareness on Basic Life Support (BLS) (CPR) in undergraduate medical students. A cross sectional studywas conducted by using responses to a questionnaire regarding BLS by 61 students. The results were analyzed with SPSS version 11.101. Out of 61 students only 9 (14.7%) had taken a BLS (CPR) course while 52 (85.3%) students had not attended any such course. Significantly more number of students had the theoretical knowledge about BLS (76.07% vs 49.18%, p<0.00). Practical knowledge about BLS was scored as having no, some and complete knowledge of the course. Of all the students, 57.3% had no knowledge, among those 34% had heard BLS from somewhere, 22.9% had some knowledge out of which 50% had heard about it. Significantly less number of students had complete knowledge about BLS (4% p<0.05). Among the students who had taken the course, 22% had complete knowledge (p<0.05). Significantly less number of students knew about the skills for BLS (21% p<0.05). Most of the medical students although had not attended the course, still they had some knowledge about BLS. Inclusion of this course in the undergraduate curriculum will increase awareness and application of this valuable life saving maneuver.
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Introduction
Cardiac arrests and accidents are the most common
emergencies with grave consequences but the high mortality
associated with them can be easily prevented most of the
times by some very simple maneuvers and skills. Cardiac or
respiratory arrests are a very common emergency in not just
the adult group but also in the neonatal period. These
emergencies can be easily managed by knowledge and
practice of resuscitation skills. Resuscitation "is the art of
restoring life or consciousness of one apparently dead."1
Resuscitation attempts date way back in time. Early records
from Egyptian mythology and the Bible suggest that mouth-
to-mouth and mouth-to-nose respiration were among the
earliest resuscitative efforts using artificial respiration.2,3
The technique has also been used for many centuries by
midwives in attempts to revive apparently stillborn infants.4
One of the first authenticated cases of recovery following
artificial respiration using the mouth-to-mouth technique
was the resuscitation of a suffocated miner by Tossach in
1744.5Over time, resuscitation skills have evolved into a
proper protocol, which involves cardiopulmonary
resuscitation (CPR) commonly known as Basic Life
Support (BLS). However BLS involves techniques other
than CPR as well but these two are used interchangeably.
Invented in 1960, CPR is a simple but effective
procedure that allows almost anyone to sustain life in the
early critical minutes after cardiac and respiratory arrest.
Since atherosclerotic heart disease is the overall leading
cause of death and trauma is the leading cause of death
among those aged 1-44 years it is crucial that such efforts be
circumstances? Major work rests with the government and
policy makers but the role to be played by health professionals
cannot be ignored. Health education can be a powerful tool with
continued campaign for betterment of the life of people. Is there
any other way to address this issue?
References
1- Moffic S. Is Ecopsychiatry a Specialty for the 21st Century? Psychiatr News 2008;
43: 37.
2- Wilkinson CB, O' Connor WA. Human Ecology and Mental Illness. Am J
Psychiatry 1982; 139 985-90.
3- Central Intelligence Agency. "Pakistan -country profile" [online] 2008 [cited 2008
April 14]. Available from: URL: https://www.cia.gov/library/publications/the-
world-factbook/geos/pk.html.
4- World Bank Report. "Major Socio-Economic Indicators for South Asian
Countries" 2008, pp: 348.
5- IUCN. "Environmental Issues of Pakistan" [online] 2004 [cited 2008 April 7]
Available from : URL: http://edu.iucnp.org/ei.htm.
6- The Economic Times. "Climate change can lead to psychiatric illness: WHO" available at
http://economictimes.indiatimes.com/Planet_SOS/Climate_change_lead_to_psychiatric
_illness date accessed: 9th April, 2008.
7- Environment Protection Agency, Govt. of Pakistan. "Pakistan: Environmental
Issues" [online] 2005 [cited 2008 April 14] Available from: URL:
http://www.iges.or.jp/kitakyushu/mtgs/seminars/theme/uaqm/Presentations/Karac
hi/Karachi.doc.
8- Daily Times. "Housing worsening as urban problem" [online] 2008 [cited 2008
April 7] Available from:URL: www.dailytimes.com.pk/default.asp?page-story_14-
12-2003_pg7_19.
9- Iliyas M. Housing and Health. In: Community Medicine and Public Health. 6th ed.
Karachi: Time Publisher, 2003, pp: 486-7.
Vol. 59, No. 1, January 2009 57
Students’ Corner
Awareness about BLS (CPR) among medical students: status and requirements
Hassan Zaheer,1Zeba Haque2
Jinnah Medical & Dental College (JMDC),1Dow International Medical College (DIMC), Karachi.2
Abstract
Objectives: To study the awareness on Basic Life Support (BLS) (CPR) in undergraduate medical students.
Methods: Across sectional study was conducted by using responses to a questionnaire regarding BLS by 61
students. The results were analyzed with SPSS version 11.101.
Results: Out of 61 students only 9 (14.7%) had taken a BLS (CPR) course while 52 (85.3%) students had not
attended any such course. Significantly more number of students had the theoretical knowledge about BLS
(76.07% vs 49.18%, p<0.00). Practical knowledge about BLS was scored as having no, some and complete
knowledge of the course. Of all the students, 57.3% had no knowledge, among those 34% had heard BLS from
somewhere, 22.9% had some knowledge out of which 50% had heard about it. Significantly less number of
students had complete knowledge about BLS (4% p<0.05). Among the students who had taken the course, 22%
had complete knowledge (p<0.05). Significantly less number of students knew about the skills for BLS (21%
p<0.05).
Conclusion: Most of the medical students although had not attended the course, still they had some knowledge
about BLS. Inclusion of this course in the undergraduate curriculum will increase awareness and application of
this valuable life saving maneuver (JPMA 59:57; 2009).
maintained.6Cardiac arrest results in the cessation of blood
supply to the brain leading to depression of breathing as
well. Thus this combination of no breathing and circulation
causes generalized ischaemia, which in cases of brain
allows a narrow window of ten minutes only. That is if
anything has to be done it has to be done within ten minutes
because after that survival is impossible. This awareness has
placed a growing demand on physicians for expertise in
resuscitation.7
Basic Life Support [BLS] includes both prompt
recognition and immediate support of ventilation and
circulation in case of respiratory or cardiac arrest.8It has a
combination of skills including mouth-to-mouth breathing
to support ventilation and chest compression to normalize
blood circulation to the brain and vital organs. Knowledge
of BLS and practice of simple CPR techniques ensures the
survival of the patient long enough till experienced medical
help arrives and in most cases is itself sufficient for
survival.9
BLS requires nothing as far as resources are
concerned and its importance is undeniable. Proper practice
of the techniques and maneuvers enables a person to
effectively resuscitate a victim. Ideally everyone should
know BLS and CPR but its awareness to medical personnel
should be a pre-requisite for entering into this field. Newly
qualified doctors are expected to take part in resuscitation
from their first day.9In Pakistan very little data is present
which addresses the awareness of the medical personnels
including students, doctors and paramedical staff regarding
this highly effective and easy maneuver. Furthermore the
awareness should not only be limited to the medical
personnel but also to the general population. The objective
of this study was to determine the level of awareness
regarding BLS and knowledge of involved skills and its
practical implementation among medical students.
Methods
An anonymous questionnaire regarding (a)
awareness and (b) skills involved in BLS was used to assess
the levels of awareness to BLS, its practical knowledge and
opinion regarding its importance as a part of undergraduate
medical curriculum. The aspects interrogated were about
the abbreviation of BLS, the process and its requirements,
who need to know it and why and under what conditions a
person may require it. The second questionnaire covered the
skills, and the know how of the maneuver. It interrogated
about the assessment of responsiveness, airway, breathing
and circulation in unconscious patients of different age
groups. It also inquired about how to assist in breathing and
giving chest compressions. The second questionnaire had
questions on participation in any BLS course and opinion
regarding inclusion of BLS in the undergraduate Medical
curriculum. It was a cross sectional study conducted in
Jinnah Medical and Dental College during November and
December of 2006. Atotal sample of 86 students was
selected by systematic sampling in which every 5th student
was selected and they were asked to fill up the
aforementioned questionnaires. Analysis of the results was
done using SPSS version 11.0.
Results
Asignificant number of students were aware of the
general idea of BLS which was assessed by the correct
responses. Alarge number of students knew about the
abbreviation, purpose and importance of the maneuver
(first, second and last question) (p<0.001) (Table). Only
10.9% students replied incorrectly (p<0.001).
On the contrary, a big number of students responded
incorrectly to the questions on the skills involved in BLS
(CPR). On an average only 18%, (p<0.001) provided
correct answers. Of all 36.66% students did not know about
BLS and the rest gave wrong answers.
Figure depicts the graphical representation of the
student's idea about the importance of learning basic life
support course and its inclusion in the undergraduate
curriculum. It shows that about half of the students had
heard about the BLS course. The figure shows that
significantly more number of students had never attended
58 J Pak Med Assoc
Table: Awareness of the Students Regarding the
Course and Skills involved in BLS.
The values are expressed in percentages N=86
Response
Questions asked Correct Incorrect Did not know
(a) Awareness of the Students Regarding BLS Course
What does BLS stand for? 72.1* 15.2 12.8
What is BLS? 73.3* 8.2 18.6
What are the requirements for BLS? 67.4* 17.4 15.1
Who needs to know BLS? 65.1* 19.8 15.1
Who requires BLS? 46.5 16.3 37.2
Why to learn BLS? 75.6* 9.3 15.1
(b) Awareness of the Students Regarding Skills of BLS Course
How would you assess the responsiveness
in an unconscious adult patient? 20.9 55.8* 23.3
How would you check airway in a
victim requiring BLS (CPR)? 30.2 21.0 48.8*
How would you check for breathing
in an unconscious patient? 11.6 67.5* 20.9
How would you check for circulation
in an adult victim? 5.8 66.3* 27.9
While assisting in breathing to an
unconscious patient…. 20.9 18.6 60.5*
How would you give chest
compressions to an adult victim? 18.6 41.9* 39.5*
* p<0.001 compared to correct answer
any course regarding BLS or CPR arranged by any
organization/hospital. However significantly higher student
population insisted to have it included in the undergraduate
curriculum (68 out of 86, p<0.001).
Discussion
The results of the study showed that medical
students in the aforementioned sample lagged behind in
cognitive awareness of BLS though they were aware of the
importance of the skills and considered it important to be a
part of the curriculum. Awareness of BLS was present in
66.6% students, but skills were found in 18% only. Our
study emphasized on the cognitive approach to general
perception and skills of BLS. Practical application is
difficult to assess through a questionnaire as cognitive
abilities are superior to technical skills.
Alarge number of study participants (79%) were of
the opinion that training of Basic Life Support should be a
part of the undergraduate curriculum. It is also a fact that
after graduation training of resuscitation skills is difficult.
Busy residency schedules and lack of resources act as
barriers. Doctors still are expected to learn resuscitation
skills in the clinical setting, where there is little opportunity
to correct poor techniques.9Given this situation, and the
fact that many junior doctors are not competent in carrying
out effective cardiopulmonary resuscitation,10,11perhaps
training in advanced life support should become a
standardized and mandatory component of all medical
school undergraduate curriculums.9
Besides BLS there are six other resuscitation courses
along with BLS which also need to be taught at an
undergraduate level. These are courses in first aid, basic
trauma life support (BTLS) and advanced cardiac, trauma,
paediatric and neurologic life support (ACLS, ATLS, PALS
and ANLS). These courses can be integrated in the
curriculum and taught over the period of medical education
years which will ensure doctors with effective resuscitation
skills by the end of graduation. The BLS course done can go
on to ACLS and other advanced courses. On successful
completion of the BTLS and ATLS courses the student will
be able to use the basic and advanced life support skills
essential in resuscitating the traumatized patient.12 Also
resuscitation skills need to be refreshed after some time, and
short courses can be offered to personnel who already have
taken a course previously to spare the funding and assure
effective revision. As found by Cooper et al there was
significant improvement in the knowledge and skills of
people who have taken BLS course six months ago after
taking a short ILS(Immediate Life Support) course.13
From our study we conclude that lack of awareness
regarding BLS among medical students is a serious issue
that needs to be addressed promptly. BLS and other
resuscitation skills should be a part of the undergraduate
curriculum and students should master the skills during
their studies. More research is warranted in our set up also
involving other medical personnel and to determine an
appropriate and efficient course design.
References
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Allied Health, 2nd ed, Saunders, Toronto, 1978; 878.
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Baskett TF. Resuscitation 2007. 72; 8-10.
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undergraduate medical programs, CMAJ, 1991; 145: 23-7. (Annual Report,
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medical schools: questionnaire survey. BMJ 2001; 323:22-3.
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quality to ensure survival Curr Opin Crit Care. 2008; 14:299-304.
10. Skinner D, Camm A, Miles S. Cardiopulmonary skills of preregistration house
officers. BMJ 1985; 290: 1549-50.
11. Casey WF. Cardiopulmonary resuscitation: a survey among junior hospital
doctors. J R Soc Med 1984; 77: 921-24.
12. Goldstein D H, Beckwith R K: Asurvey of resuscitation training in Canadian
undergraduate medical programs, CMAJ, 1991; 145: 23-7.
13. Cooper S, Johnston E, Priscott D. Immediate life support (ILS) training
Impact in a primary care setting? Resuscitation 2007; 72:92-9.
Vol. 59, No. 1, January 2009 59
Figure: Opinion of the students towards importance of BLS Course.
... Group (1), and 38% of group (2). ...
... The letter C "symbolizes circulatory support," according to the American Heart Association, with regard to cardiopulmonary resuscitation, followed by 83% of group (2). Then 61% of group (1). ...
... Then, the relationship between the number of correct answers and attendance at rst aid training courses was studied using a one-way analysis of variance test, the results of which indicate the existence of a signi cant and signi cant relationship with a statistical effect of attending training courses on the number of correct answers and the degree of knowledge about cardiopulmonary resuscitation, as the knowledge among students who They underwent more training courses than students who did not attend any training courses. This is consistent with the ndings of a study conducted in Karachi, Pakistan in 2009 (Zaheer & Haque, 2009) that undergraduate medical students who had no prior training had poorer knowledge compared to students who had prior training. ...
A comparative study between the knowledge of first-year medical students and final-year medical students in clinically diagnosing cardiac arrest and performing basic cardiorespiratory resuscitation in adults at Al-Sham Private University.
Preprint
Full-text available
  • Jun 2024
Objective: This study was conducted to evaluate the level of knowledge of medical students at Al-Sham Private University regarding diagnosing clinical cardiac arrest and performing basic cardiorespiratory resuscitation in adults. Materials and Methods: A pre-tested structured questionnaire was administered to medical students of all years. Students were asked to answer the questionnaire, which included questions related to performing basic cardiac resuscitation in adults. Results: 300 samples were collected and divided into 3 groups. Each group includes two academic years of medicine. The questionnaire included 20 questions related to the steps of cardiopulmonary resuscitation and the most important details related to it. Descriptive studies of the data indicate that 68% of group 3 underwent a first aid course, while 37% of the group 1 attended first aid training, followed by 34% in group 2, The performance of Group 3 students was better than that of Group 1 and 2 with regard to performing CPR steps Conclusion: Knowledge of basic CPR in adults was insufficient among almost all first- and second-year medical students included in the study, Mandatory CPR training should be imposed at the university to ensure that students are equipped with the necessary skill
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... A study conducted in Karachi, Pakistan, in 2009 also indicated that medical undergraduate students with no prior course training had poor knowledge as compared to the students with prior training. 10 Previous studies in Pakistan showed poor knowledge of CPR among practicing doctors, dentists, and nurses among the big institutions of the largest city of Pakistan. 11 Another study in Pakistan's twin cities concluded that doctors had incomplete knowledge of CPR. 12 Although most of the previous studies showed a positive attitude, the knowledge about practical skills of BLS and CPR was reported to be poor and unsatisfactory from students to serving doctors and Para-medical staff. ...
... 14 Another study from Karachi reported that the medical students lagged behind in cognitive awareness with very low skill level; however the study reported very positive attitude concerning the importance of BLS. 10 The working health care professionals from Karachi and twins' cities Rawalpindi and Islamabad also reported to have insufficient knowledge regarding CPR during the course of their practical life. 11,12 The study from India found inadequate awareness and knowledge in undergraduate students. ...
Knowledge, attitude, and awareness of cardiopulmonary resuscitation among university enrolled medical and non-medical students of Pakistan: An online study
Article
Full-text available
  • Feb 2024
Objective To evaluate the awareness, attitude and knowledge of cardiopulmonary resuscitation (CPR) among university-enrolled medical and non-medical undergraduate students of Pakistan. Methods Cross-sectional online survey-based study was conducted across institutes in Pakistan from December, 2022 to January, 2023. The study involved university-enrolled undergraduate students across the country. The structured questionnaire was disseminated via Google forms. For statistical analysis, SPSS version 20 was used to analyze the data by applying independent sample t-tests and ANOVA. Results A total of 249 responses were received. After the exclusion of two responses, the overall awareness score of participants was found to be 2.49 ± 1.33, attitude score of 4.09 ± 1.74, and knowledge score of 3.51 ± 2.13. Female respondents, medical students, unmarried (single), private institutes, and respondents with educated parents achieved relatively higher scores. The overall difference in awareness scores among different regions of Pakistan was also significant (p <0.05). Gender, region, and parental literacy rate also showed effects on participants’ basic life support (BLS) and CPR knowledge (p <0.05). Conclusions Overall knowledge and awareness were unsatisfactory and inadequate in university-enrolled undergraduate students, with no one getting a complete score on very basic knowledge questions. Significant differences in awareness, attitude, and knowledge among different regions, genders, and parental literacy rates were found.
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... [6] The introduction of a BLS course, according to Zaheer et al., will raise awareness and application of this crucial life-saving technique. [7] Therefore, all medical and paramedical staff members should be required to complete BLS and advanced cardiovascular life support training programs. If medical students share the newly acquired knowledge with their relatives and friends, teaching BLS to medical undergraduates may prove to be a great way to impact the community as a whole. ...
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... 4 However, the results are quite the opposite and disappointing because insufficiently trained personnel exist. 10 The data collected from Pakistan also suggests that the public has a poor understanding related to CPR. [11][12][13] This lack of knowledge can bring serious consequences and give birth to medico-legal complications. On the contrary, unacceptable techniques and insignificant knowledge can become counter-productive as they may cause CPR-related injuries. ...
Public perception and willingness towards bystander cardiopulmonary resuscitation (CPR) training and performance in Pakistan
Article
Full-text available
  • Jan 2023
Background/Aim: Bystander cardiopulmonary resuscitation (CPR) during out of-hospital cardiac arrest increases both survival rates and neurological recovery, but in Pakistan, an alarmingly low 2.3 % of these individuals receive bystander CPR. This study was designed to identify the reasons that affect the perception and willingness of the public toward bystander CPR training and performance in Lahore, Pakistan. Methods: A CPR master trainer from the USA visited various organisations from 1 December 2022 to 31 January 2023, to conduct training sessions. Before and after the training, a questionnaire was distributed among respondents to fill in. The subjects were asked to answer questions about their perception and willingness to perform bystander CPR. Results: Out of 401 participants, 240 completed the survey, with a response rate of 59.85 %. The majority of them were males [146 (60.8 %)], 215 (89.6 %) were below the age of 40, 107 (44.6 %) were graduated, 182 (75.8 %) never participated in any CPR training, mainly due to their ignorance towards the importance of bystander CPR (52.8 %) and 152 (63.3 %) were eager to participate in the CPR training course. Furthermore, the leading problem in providing bystander CPR was lack of technique or fear of possible harm that can be proved fatal (48.8 %), followed by concerns related to involvement in any legal procedure (10.0 %). Conclusions: Bystander CPR is still uncommon in Pakistan. Participants were reluctant to perform bystander CPR because of various concerns and fears. Lack of proper skill and causing additional harm were the main reasons associated with this. Hence, while improving CPR training and public education, these findings must be considered.
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... Perceived barriers to BLS competency-including a lack of adequate education and reinforcement. They should be addressed in order to improve BLS knowledge and skills among (8) (9) healthcare trainees . In Zaheer et al. study found that medical students were poor and dental students were poorer in terms of knowledge about the individual components of BLS. ...
ROLE OF AWARENESS AND TRAINING ON BASIC LIFE SUPPORT AMONG MEDICAL AND NON-MEDICAL STUDENTS
Article
Full-text available
  • Nov 2023
The aim of the study was to assess the level of knowledge of Basic Life Support (BLS) among the students and assess the role of awareness and training on BLS knowledge. An online 15 multiple choice questions were prepared via Google forms and sent to 200 students. The knowledge skills were assessed based on the score number of corrected answers. Female students have significant adequate knowledge than male. Non-medical students have poor knowledge than medical students. There was no significant difference of knowledge whether students aware or trained on BLS or not. Hence, BLS should be incorporated in to the curriculum of all the students. Training has to be reinforced among the students at regular intervals to retain the skills.
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... A survey found that most nurses had intermediate-fair knowledge (Asadi et al., 2021). Some studies showed that remaining healthcare professionals lacked sufficient CPR knowledge (Roshana et al., 2012;Osinaike et al., 2007;Zaheer & Haque, 2009). 58.3% of those who responded to the questionnaire received a total score of less than 50%, which indicates insufficient knowledge of BLS (Irfan et al., 2019). ...
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... It is necessary to educate students on the primary care of accidents and diseases so that they can be a catalyst for upgrading the health care delivery system. 15,16,17,18,19,20,21,22,23 Objectives • To assess and compare the knowledge & practice of under graduate nursing students related to first aid and BLS before and after administration of SATP. • ...
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... 15 A study conducted in Pakistan on undergraduate medical students revealed that they had a positive attitude towards the inclusion of BLS courses in the curriculum and agreed to it being included in the undergraduate medical curriculum. 16 BLS is an important emergency protocol and lack of knowledge is responsible for a huge number of deaths reported every year in Pakistan. Since there are not a handful of studies assessing the knowledge of BLS in healthcare professionals of Peshawar, we conducted our study in Khyber Teaching Hospital, Peshawar to fill this gap. ...
Factors affecting knowledge and attitude of healthcare workers towards basic life support in Khyber Teaching Hospital, Peshawar, Pakistan: a cross-sectional analysis
Article
Full-text available
  • Sep 2023
Objective This study was conducted to assess the knowledge and attitude of healthcare workers towards basic life support (BLS) in Khyber Teaching Hospital, Peshawar, and to investigate the factors affecting them. Design Cross-sectional study. Setting This study was carried out in a tertiary care hospital in Peshawar, Pakistan. Participants 201 healthcare professionals were recruited for this study through simple convenience sampling which included house officers (HOs), trained medical officers, postgraduate residents, professors, specialty registrars and nurses. Healthcare professionals who were reluctant to give consent were excluded from the study. Results Among the chosen participants, only 16.4% had good knowledge whereas 63% had a good attitude towards BLS. Knowledge of participants was found to be positively associated with less time elapsed between the training sessions (p=0.041). On the other hand, factors such as age(p=0.004), designation (p=0.05), number of BLS sessions attended (p=0.012) and the time elapsed since the last BLS session attended (p=0.015), were positively associated with the attitude of healthcare professionals. Conclusion The level of knowledge and attitude towards BLS by healthcare professionals was suboptimal. Those individuals who had attended BLS training sessions frequently had better knowledge and attitude as compared with their counterparts.
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http://hdl.handle.net/10603/511969
Thesis
  • Sep 2023
The healthcare sector is one of the important service sectors. Human resources are of huge importance in the healthcare sector, in which patients expect a high degree of personalized and customized services, which are possible only if the manpower, is skilled and psychologi- cally fit. Achieving a dedicated employee is a difficult task, which begins with the recruit- ment process and then involves retaining the staff member for a long period. An employee must establish a balance between his/her job and personal life. This may appear to be an easy proposition, but in reality, can be hard to achieve. This can be due to many factors such as dissatisfaction in the workplace, environment, and stress in the workplace, or to some other reasons that may lead to a decision to leave the job. Human Resource Management (HRM) principles are shifting from traditional to modern approaches, allowing organizations to ex- periment with innovative working styles. Employees are viewed as assets rather than liabili- ties. Employees with new abilities may not be ready to work longer hours or on more difficult tasks. Rather, they anticipate a form of employment that is intrinsically inspiring and permit innovative employment methods in the organization. Human Resource Management (HRM) now encompasses new dimensions, like psychological capital, work-life balance, employee job attitudes, and employee welfare activities, which were previously overlooked. As a result of the complex and growing nature of Human Resource Management (HRM), there is a total transformation in work, employee attitude, and manager-employee interactions. These new developments have highlighted the necessity of these constructs for employees' intrinsic mo- tivation in the workplace. The study on these constructs has been conducted in several devel- oped countries and various businesses. However, just a few studies from emerging economies and poor countries have been published in reputable journals. It's worth noting that scholars in India, particularly in Jammu and Kashmir, haven't paid much attention to psychological capital, work-life balance, and job attitude. The nature of work in the health care sector in Jammu & Kashmir is different from the other parts of the country. This study helps to identi- fy the gaps in psychological capital, work-life balance, and job attitude concerns that may occur among employees in Jammu and Kashmir. Even though a large amount of research is done, no such research has been undertaken in Jammu and Kashmir healthcare sectors on these constructs. XIV As a result, the current research study was designed to investigate the causal relationship be- tween psychological capital, work-life balance, job attitude, and the mediating role of work- life balance taking into account the global and regional context. Furthermore, this study fo- cused on healthcare workers in Jammu and Kashmir's public and private healthcare institu- tions, a group that includes doctors, technicians, and healthcare managers about whom little research has been done. After doing a literature review, the researcher found that there is no current model or research framework that effectively examines psychological capital, work- life balance, organizational commitment, job satisfaction, and turnover intention all at the same time. Based on the current literature, a conceptual study model has been proposed to examine the causal relationship between psychological capital, work-life balance, and the job attitude of healthcare professionals. Structural Equation Modelling was used to test this rela- tionship. The study of these factors is presented more in detail in five chapters, as follows. • The first chapter (Introduction): This chapter examines the changing nature of Human Resource Management, laying the groundwork for understanding the im- portance and extent of psychological capital, work-life balance, and job attitude. The chapter provides a summary of the study's reasoning as well as its goals and objec- tives. It also explains why a study of Jammu and Kashmir's healthcare sector was conducted. The chapter concludes with a description of the study's research agenda. • Second chapter: This chapter presents in detail the existing literature regarding psy- chological capital, work-life balance, and job attitude in the field of human resource management. This chapter forms the foundation of the whole thesis and is the motiva- tor to undertake this research work. Furthermore, research on the causal relationship between psychological capital and work-life balance is available, Finally, in light of the preceding literature review, this chapter addresses research gaps. • Third chapter: This chapter explains the research methodology adopted to undertake the study. The chapter shows the path moved throughout the study. Without a struc- tured methodology, this study would not have been possible. The study objectives, hypotheses formulation, instrument creation, sampling process, data collection, relia- bility, and validity of the scale are highlighted in this chapter. It is followed by the de- sign of the theoretical study model. • Chapter Four: This chapter describes the data analysis used in this study forms the basis of the outcome of my research. It presents several tables that were created with the help of static tools like SPSS25 and AMOS 19 The first portion of the analysis XV provides a profile of the respondents. The measurement model is calculated in the same chapter to determine scale reliability and validity. The standardized structural model fit was determined after that, and path analysis was used to test the study hy- potheses. This chapter also summarises the current study's findings. • Fifth chapter: This chapter summarises the study's contributions both practical and theoretical. This chapter further discusses the significance of the findings for manage- rial action. In addition, this chapter discusses limitations and advises aspiring re- searchers about future study directions. In the end, recommendations are given which can be followed by the employer and the employee to maintain better psychological capital and work-life balance to enhance positive job attitudes and reduce employee turnover
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A survey of resuscitation training in Canadian undergraduate medical programs
Article
Full-text available
  • Aug 1991
To establish a national profile of undergraduate training in resuscitation at Canadian medical schools, to compare the resuscitation training programs of the schools and to determine the cost of teaching seven resuscitation courses. Mail survey in 1989 and follow-up telephone interviews in 1991 to update and verify the information. The undergraduate deans of the 16 Canadian medical schools. The mail survey asked five questions: (a) Is completion of a standard first aid or cardiopulmonary resuscitation (CPR) course a requirement for admission to medical school? (b) Are these courses and those in basic and advanced cardiac, trauma and neurologic life support for children and adults provided to undergraduate students? (c) During which undergraduate year are these courses offered? (d) Is their successful completion required for graduation? and (e) Who funds the training courses? The medical schools placed emphasis on the seven courses differently. More than half the schools required the completion of courses before admission or taught some courses but did not require the completion of the courses for graduation. On average, fewer than three of the seven courses were taught, and the completion of fewer than two was required for graduation. About half of the courses were funded by the universities. The annual projected maximum cost of teaching the seven courses was $1790 per medical student. The seven resuscitation courses have not been fully implemented at the undergraduate level in Canadian medical schools.
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Cardiopulmonary Resuscitation: A Survey of Standards among Junior Hospital Doctors
Article
  • Dec 1984
The theoretical knowledge of cardiopulmonary resuscitation of 50 junior hospital doctors was examined, and an attempt made to assess their practical ability to manage a collapsed patient. Major defects were found in both the doctors' theoretical knowledge and their practical abilities. Only 8% were able to manage a cardiopulmonary arrest adequately. Suggestions are made as to how standards might be improved.
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[Basic Life Support: the primary ABC(D) of cardiopulmonary resuscitation]
Article
  • Sep 1996
Basic Life Support [BLS] includes both prompt recognition and immediate support of ventilation and circulation in case of respiratory or cardiac arrest. The major objective of BLS is to provide oxygen to the heart and the brain and to sustain tissue viability until definitive electrical or medical treatment [Advanced Cardiac Life Support = ACLS] can restore spontaneous circulation. BLS focuses on the primary survey A B C [D]: Airway [to open the airway]-Breath [to assess the presence or absence of spontaneous breathing and to provide ventilation]-Circulation [to assess pulselessness and to perform chest compression-Defibrillation [might perhaps no longer belong solely to ACLS because of the widespread availability of Automade External Defibrillators]. The key for successful ACLS, especially defibrillation, is the prompt initiation of correct rescue breathing, and correct chest compressions in a patient with a cardiac arrest. Promptly and optimally performed BLS is most effective and one major key to save life, thus, both family physicians and specialists must be able to administer optimal BLS-survival will be poor if one link in the chain of survival is inadequate!
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The Resuscitation Greats
Article
  • May 2000
  • RESUSCITATION
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