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Survey of the awareness level of nurses about last guidelines 2010 of
cardiopulmonary resuscitation (CPR) in educational hospitals.
Reza Pourmirza Kalhori1, Arsalan Naderipour1*, Bijan Sabour1, Afshin Almasi1, Afshin Godarzi1, Maryam Mirzaii1
1. Department of Medical Emergency Medicine ,School of Para medicine , Kermanshah University of Medical Sciences,
Kermanshah, Iran.
A R T I C L E I N F O
Article type:
Original article
Article history:
Received: 9 Jan 2011
Revised: 10 Apr 2012
Accepted: 20 Jun 2012
Keywords:
Awareness
Nurse
Cardiopulmonary resuscitation
A B S T R A C T
Aims: Cardiopulmonary resuscitation (CPR) is the most important skill of
clinical staff and it is necessary for them to be aware of its last changes. This
study had been done to determine the awareness level of nurses of the last
2010 CPR guidelines.
Methods: This descriptive cross-sectional study was conducted with 321
samples, which had been chosen with sample randomly method in
Kermanshah’s hospitals in 2011. The tools for collecting data were a researcher
made questionnaire with face and content and reliability of (r=%74). Data was
analyzed by STATA-11 software and ANOVA, Tukay,Tamhane and Bonferoni
tests.
Results: Level of awareness was classified to: %20.2 excellent, %65.4 good,
%14 moderate and %3 weak. There was no significant statistical correlation
between level of awareness and age, work experience and graduate degree, but
level of awareness was higher in nurses that had experience of passing CPR
training, doing or observing it (p<0.001). The most score of awareness was
related to external cardiac massage.
Conclusion: It is suggested that to teach CPR according to guidelines of 2010
in nurses postgraduate training and to have more emphasis on electroshock
therapy and Automatic External Defibrillation (AED), Laryngeal Mask Airway
(LMA) and combitube intubations, reasons of termination and undoing of CPR
interaoseus injection and induced hypothermia.
Please cite this paper as:
Poormirza K. R., Saboor B., Naderipoor A., Almasi A., Goodarzi A., Mirzaii M.; Survey of the awareness level of nurses
about last guidelines of cardiopulmonary resuscitation (CPR) in educational hospitals. Iranian Journal of Critical Care
Nursing; 2012, 5(13):75-84.
Summer 2012, Volume 5, Issue 13, Pages: 77-86
* Correspondence Author: Arsalan Naderipour
Kermanshah University of Medical Sciences,
Kermanshah, Iran. Tel:+98-8318278081
E-mail: Naderipoura@yahoo.com
Experience of nurses from the emergency department management Poormirza Kalhori R. et. Al. 78
Summer 2012, Volume 5, Issue 13, Pages: 77-86
1. Introduction
The most important clinical staffs’ skill in
saving injuries and patients’ life is CPR. The
first international congress of resuscitation in
1973 regarded this way as a necessary action
for saving life and suggested general teaching
in the world. From 1979, 1985, 1992, 2000,
2005, 2010 up to now the resuscitation program
has been studied and progressed [1]. Perhaps
the most important suggestion in basic
resuscitation program is the usage of foreigner
automatic electroshock by amateurs’ people [2].
In the new resuscitation guideline, about
cardiac massage, it has been emphasized on the
fast and tough pressure at the beginning of the
witness’s resuscitation program. This kind of
massage has to be done at least with the pace of
one hundred times per minute for all the victims
except the infants with less than one month. It
is necessary that after every massage the chest
returns to its first place and cardiac massage
must not be stopped for any different reasons.
The ratio of cardiac massage to the respiratory
ventilation in resuscitation action has been
changed to the ratio of thirty massages to two
respirations in all the ages and in one or two
amateur rescuers and just in professional
rescuers for kids, the ratio of fifteen to two has
been recommended [3]. For the infants of less
than one month in hospital the ratio is three to
one [4].
Respiration must be given in a second in all the
ages and must cause rising of the chest and
hyperventilation must be prevented. In
electroshock therapy one time-shock has been
recommended and immediately after that with
the beginning of cardiac massage, ventilation
must be continued for two minutes. This should
be continued for at least five cycles or two
minutes and the cardiac rhythm must be
controlled again. In the case of using AED
(Automatic External Defibrillation) according
to the maker companies, control permission of
the rhythm after two minutes has been given
[5]. In the new resuscitation it hasn’t been
recommended to use the pace maker for
Asystol and there was an emphasis on the
continuous of resuscitation and medication [3].
The most important medicine in resuscitation is
Epinephrine, but there are some reports about
the possible effect of Vasopressin after the
failure of being cured by Epinephrine and
electroshock [1]. The way of prescription of
resuscitation medicines is intravenous but
interaoseus injection is used as the current
method in the cases that there is no access to
the vein and it is more preferable to
endotracheal method [2]. After that the
successfulness of resuscitation has been proved,
it is recommended to use induced hypothermia
with temperature of 32 to 34 centigrade at a
period time of 12 to 24 hours and to be heated
again after 24 hours [6].
In the new recommendations the resuscitation
of pregnant mothers, resuscitation general
interventions in addition to the replacement of
womb to the left side with sleeping the patient
to the left side to the extent of fifteen to thirty
degrees (that the path of inferior venacava is
open), cardiac massage in a part higher than the
center of sternum, electroshock therapy
according to the remedial guidelines of VT and
VF and sometimes emergency Hysterectomy
are recommended [3, 6]. In the infants that have
cyanosis with pulse more than one hundred,
oxygen must be prescribed from freeway and if
with these actions cyanosis signs are not
disappeared, ventilation with positive pressure
and putting tube in endotracheal must be used.
In the case of needing to cardiac massage , the
number of massage is between one hundred to
one hundred twenty per minute with doing
79 Poormirza Kalhori R. et. Al. Experience of nurses from the emergency department management
Summer 2012, Volume 5, Issue 13, Pages: 77-86
ventilation to the extent of 40-60 times per
minute [3].
Need of awareness of these principles and
correct usage of knowledge in the practicable
form is among teaching obligations to the
nursing students [7] and the occupied nurses [8]
that in addition of foreign country the effect of
education program in learning and awareness of
resuscitation principle has been indicated in
Iran too [9]. In medical university of Oroumieh,
nurses’ dexterity in using electroshock has been
reported at a high level [10]. It is while it has
been reported that in medical university of
Ardebil, high percent of internes were not at an
acceptable level of theory awareness and
practicable skills [11]. Either in Tehran medical
university, the awareness of medical staff about
resuscitation principles is remarkably imperfect
[12]. Persh and colleagues (2010) in Hidenberg
University of Germany reported that awareness
of nurses about resuscitation pattern of 2010 is
little [13]. Nagashima and colleagues (2003) in
Japan studied the awareness of nurses about the
new guidelines of new CPR too and reported
that many of them are not aware of the last CPR
guidelines [14] (Table 1).
Observance of important practicable points that
had been indicated in the last resuscitation
guidelines can add to the successful cases of
resuscitation and it is necessary that all the
people who are active in CPR action use these
suggestions and recommendations in a way,
teach them, observe and manage doing of them
in clinical environment. Regarding the
importance of this issue and mentioning this
point that there was no similar study in
Kermanshah’s medical university up to now ,
and the necessity of this issue that knowing the
awareness and knowledge level of nurses is one
of the most important elements of training need
assessment for regulating postgraduate teaching
program, this survey has been done with the
main goal of “determining the level of
awareness of nurses staff of Kermansha’s
selected hospitals about the last resuscitation
guidelines of 2010.”
2. Methods
This descriptive cross-sectional study had been
done in nurses society of Kermanshah and the
number of samples had been estimated to 330
people, this number was with noticing to the
gained number of the pilot study with the
confidence interval of 95 percent and power of
90 percent for comparing in four groups that
has been chosen with simple randomly form
and with noticing to the nurses list of every
hospital. The most important limitation of the
research was decreasing the number of nurses
in one of the educational centers of
Kermanshah that according to the statistical
estimation 66 people had to be participated in
this study that after referring to this center we
could have sampling from 57 nurses. The
reason of decreasing the number of nurses was
retirement of some of them in the current year.
With informing the statistical counselor and
being sure that the results are not distorted, the
information had been entered in statistical
software. So the final number of samples
reached to 321 people. After collection of the
data, descriptive and presumption analysis had
been done with using STATA-11 statistical
Table 1: 95% of confidence interval for scores of CPR
awareness level in different graduate degree.
Graduate degree Score
Associate diploma 21.61-26.86
BS 25.53-26.73
Discontinued BS 25.38-30.31
MSc 25.38-30.39
Experience of nurses from the emergency department management Poormirza Kalhori R. et. Al. 80
Summer 2012, Volume 5, Issue 13, Pages: 77-86
software. For summarizing the data, counting of
the average and indicators standard deviation
and determining the percent had been used. For
analyzing the data according to quantitative and
qualitative characteristics, two-dimensioned
tables in number and percent form had been
used for investigating the equality of variance
of three groups, ANOVA test and for
comparing the scores of the groups, one-sided
variance analysis and compares test of Piesen
Tukey , Bonferoni and Tamhin had been used
and p<0.05 was regarded significant.
Tools for collecting data were a researcher
made questionnaire included demographic
questions and forty questions about the level of
awareness of CPR. Questions from one to seven
were about the main rules of beginning and
ending CPR, questions from eight to eighteen
were the principles of establishing artificial
ventilation and management of airway,
questions from nineteen to thirty were about
principle of external cardiac massage and
questions from thirty one to forty studied
progressed resuscitation principles. For
determining the face and content validity
questionnaire the ideas of 25 members of board
were used that included: four anesthesia
specialists, two anesthesia with M.S. degree
and sixteen people with M.S. degree of nursing
and three people with midwifery M.S. degree
and for determining reliability with doing
preliminary survey with 29 people chosen by
randomly sampling and by using Alfa
Kronbakh formula had been counted (r=0.74).
The average score of questionnaire was 20.62
(±7.45). According to these distinctions,
acquiring mark was classified like this: from 31
to 40 excellent, from 21 to 30 good and from 11
to 20 moderate and less than 10 weak. About
total validity of the questionnaire regarding
moral considerations, participating in research
was obligatory for staffs and the final results
were in the hand of the manager of selected
hospitals and deputy of treatment, permission
of doing the research has been taken from the
manager of paramedics college, deputy of
research assistant and manager of educational
and treatment centers of research environment
and permission for doing he research was taken
from deputy of educational and had been
communicated to the remedial-hygienic
selected centers of Kermanshah.
3. Results
The average age of the samples was 32.76
(±7.35) years, that the most average age was
related to Imam Khomeini hospital and the least
one was related to Taleghani hospital. The
average of job experience was 9.43 (±8.26)
years. 22.7 percent was men and 77.3 percent
was women. There was no statistical significant
difference between awareness level of men and
women. %6.5 technician, % 86.6 bachelor and
%4 discontinuing bachelor and %2.8 were
master. Although the average distinction of
awareness level in samples with master degree
was higher than other degrees, this finding was
not statistically significant(table). %39.9 of
nurses was working in intensive unit, %20.6 in
internal ward, %19.6 in emergency ward, %7.8
in surgery ward, and %4.4 in CCU. %60.4 of
nurses had the experience of passing CPR
training period that the most one was related to
Imam Reza hospital with %75 and Imam Ali
hospital with %66.7 and the least one was in
Taleghani hospital with %50.8. %80.1 had the
experience of doing CPR that the most one was
in Taleghani hospital with %93.8, and %69.9
had the experience of observing CPR
completely.
Level of awareness of nurses of the last CPR
guidelines was classified to: %20.2 excellent,
81 Poormirza Kalhori R. et. Al. Experience of nurses from the emergency department management
Summer 2012, Volume 5, Issue 13, Pages: 77-86
%65.4 good, %14 moderate and %3 weak. The
average of distinction of awareness level was
26.08 (±5.14) with domain of 6 to 38. Graph
number [1] shows the average of distinction
Table 2: Questionnaire
No Questions Right
answer
Wrong
answer
1 If the patient needs CPR we must wait for the coming of doctor as the leader of resuscitation team. 90.7 9.3
2 Midrise double is a criterion for not starting CPR. 19.6 80.4
3 Leaving CPR to specialist must be continued until returning of vital signs or assurance of certain death of
the patient.
94.7 5.3
4 In the case of the patient’s family request CPR can be stopped. 25.2 74.8
5 If rescuer’s life is in danger, CPR can be stopped. 51.1 48.9
6 Doing CPR in frozen bodies, neck cutting, peripheral cyanosis and situations that there is no hope for
improving the patient, is not necessary.
66.3 33.8
7 According to the neurologic position of patient (decrease level of Consciousness/limbs paralysis) CPR
can be stopped.
7.5 92.5
8 Before starting artificial ventilation, opening airway is necessary. 93.1 6.9
9
The first ventilation in
CPR is with two repeated respirations to the patient
78.8
21.2
10 In CPR current in the hospital using oxygen with high percent is necessary. 67.2 32.8
11 The chest must come up clearly with every artificial respiration. 86.0 14.0
12
At the beginning of
CPR doing hyperventilation is necessary.
29.9
70.1
13 Length of time for artificial respiration is one second in all the ages. 36.8 63.2
14 When the rescuer is one person, doing artificial respiration in mouth to mouth form or from mouth to
mask is more effective than ventilation with bag valve mask.
43.0 57.0
15 Kapnograpghy is the most reliable way of assurance of putting endotracheal tube in windpipe. 46.7 53.3
16
There is no need to laryngoscope for preparation of LMA and combitube.
43.0
57.0
17 The most stopping time of cardiac massage for putting endotracheal tube is 10 seconds. 66.7 33.3
18
At the time of controlling of putting endotracheal tube in windpipe, cardiac massage must be stopped.
38.6
61.4
19 In unwitness cardiac arrest, at first cardiac massage and respiratory ventilation must be given in two
complete minutes.
78.5 21.5
20 After two minutes of complete cardiac massage and respiratory ventilation is the first time for controlling
of existing of pulse in patient.
80.1 19.9
21
The
necessary time for existing or not existing of the pulse in patient is
10
seconds
.
64.1
35.9
22 In the first minutes of witness cardiac arrest, cardiac massage is more important than respiratory
ventilation.
79.4 20.6
23
Cardiac massage must be done to
ugh and fast.
62.6
37.4
24 The least times of cardiac massage are 100 times per minute in all the ages (except infants). 59.8 40.2
25
Ratio of cardiac massage to respiration in all the ages for usual rescuers is
30
to
2
.
72.8
27.2
26 Ratio of cardiac massage to respiration in hospital is 3 to 1 in infants. 47.0 53.0
27 Ratio of cardiac massage to respiration in kids when the rescuers are professional and they are two is 15
to
2
.
70.7 29.3
28 Adults’ chest must be pressed to the extent of 4 to 5 centimeters in every massage. 87.9 12.1
29 For every massage, the place of putting heel of the hand of rescuers is in the middle of chest and between
the lines that attached the head of the chest.
82.6 17.4
30 After every massage it must be permitted that chest returns to its first place completely. 80.1 19.9
31 In the case of Ventricular Fibrillation (VF), shock must be given three times. 29.6 70.4
32
Out of hospital, before using automatic electroshock (AED) CPR must be done for complete two minutes.
68.2
31
.
8
33 If the rescuer doesn’t know energy extent for finishing Ventricular Fibrillation (VF), 200 joule in
Biphasic machine and 360 joule in Monophasic must be chosen.
26.8 73.2
34
If the pulse did not return after electroshock unloading, CPR must be cont
inued for two minutes.
77.9
22.1
35 In the case of Asystole skin pace maker must be used. 43.3 56.7
36 After failure of being cured with Epinephrine and Defibrillation medicine, vazopresin can be used. 49.2 50.8
37 If you couldn’t have venous puncture from the patient, interaoseus injection is recommended. 38.0 62.0
38
The first medicine for controlling Ventricular dysrrhythmias is Amiodaron.
58.6
41.4
39 Dosage of injected interaoseus medicine must be 2-2.5 times of venous dose. 25.0 75.0
40 If CPR was successful in adults induced hypothermia must be used. 36.8 63.2
Experience of nurses from the emergency department management Poormirza Kalhori R. et. Al. 82
Summer 2012, Volume 5, Issue 13, Pages: 77-86
with distinguishing the hospitals in the study.
Because the variance is not equal among the
groups, Valkh test was used instead of F test
that shows significant statistical difference
between the average of distinction of the
hospitals in the study (p=0.001). Piesen
Tamhane comparative test showed that
distinction of awareness level of Imam
Khomeini hospital is less than Imam Reza
hospital (p=0.019), Imam Reza Hospital is less
than Imam Ali Hospital (p<0.001)and
Taleghani and Farabi hospital are less than
Imam Ali (p<0.001). There was not any
statistical significant correlations between
distinction of level of awareness and age , and
job experience and graduate degree but level of
awareness was more in nurses that had the
experience of passing CPR period, doing
resuscitation or observing resuscitation
(p=0.001).
The relative abundance of excellent distinction
was like this: %47 in Imam Ali Hospital, %27.9
in Imam Reza Hospital and %10.7 in Farabi
Hospital and the most relative abundance of
excellent distinction was in nurses of CCU
ward (%57.1). ICU ward (%32) and nurses of
internal ward (%12.1). Statistical test of
ANOVA showed that the difference of
awareness level in different wards is
statistically significant (p<0.001) in a way that
according to comparative statistical test of
Bonferoni, the average of awareness distinction
in intensive unit was more than internal ward
(p= 0.006) in internal ward was less than CCU (
p<0.001). In intensive unit was more than
operation room and emergency room
(p=0.005). Graph number [2] shows the
average of distinctions in the wards of study
separately.
The questionnaire studied four compasses in
CPR content, that included: questions from one
to seven, about main rules of beginning and
ending CPR, questions from eight to eighteen,
about principles of establishing artificial
ventilation and airway
managment, questions
from nineteen to thirty ,
about investigating
principles of external
cardiac massage and
questions from thirty one
to forty studied main
advanced resuscitation.
The most average of
distinction was the
awareness level related to
principles of external
cardiac massage. In
0
10
20
30
40
5
10
15
20
25
30
35
Graph 2: The average of awareness distinction scores from CPR in different unit of
the workplace
83 Poormirza Kalhori R. et. Al. Experience of nurses from the emergency department management
Summer 2012, Volume 5, Issue 13, Pages: 77-86
compass of main rules of beginning and ending
of CPR, there was not significant statistical
difference between treatment centers of the
study. In other compasses the average of
distinctions of awareness level of nurses in
Imam Ali Hospital was statistically significant
more than other treatment centers (p<0.001)
Graph number3 shows the average of
distinction of the samples of the study in
different treatment centers according to the
four-compassed of CPR content. Table number
[2] shows the percent of giving answer of the
samples of the study to the questions of
studying the awareness level of nurses from the
last changes of CPR guidelines in 2010.
4. Discussion
In this study level of nurses’ awareness from
the study from the last changes of resuscitation
actions according to the guidelines of 2010 was
%20.2 perfect, %65.4 good, %14 moderate and
%3 weak. Pasaly and colleagues (2011)
reported that nurses and doctors’ awareness
level of Greece about BLS and ALS principles
is not enough [16]. Persh and colleagues (2010)
in Hidenburg University of Germany reported
lack of knowledge and awareness and necessity
of teaching basic resuscitation actions
according to 2005 pattern [13]. Nagashima and
colleagues (2003) in Japan also reported that
many of nurses are not aware of the last CPR
guidelines and suggested that there is necessity
of more teaching of CPR to nurses [14]. Either
in Iran Pouranaraki and colleagues (1998)
reported that the awareness of medical staff
about CPR principles is not remarkably enough
[12]. Lack of knowledge about CPR is not only
reported among clinical nurses but also it is
among hygiene nurses of China society [17]
and investigation of awareness level of 1054
nurses, doctors and nursing students in India
show extreme lack of awareness about BLS
[18].
In this study there was not statistical significant
difference between awareness level of nurses in
men and women but Entezari and colleagues
(2002) In Ardebil reported that level of CPR
practicable skill in men is significantly more
than women [11]. There was no significant
statistical difference between distinction level
of awareness and age, job experience and
graduate degree in this study that is similar to
the result of Barimnejad and colleagues (2007)
about the lack of positive effect of job
experience in CPR awareness level of nurses
[19] but in Mohsenpour and colleagues’ study
(2009) in Kerman it is reported that
engagement situation and job experience have
positive effect on nurses’ awareness level and
also it is significant [20]. In this survey
awareness distinction level in nurses that had
experience of passing CPR period, having
experience of doing CPR and observing CPR
was statistically more significant, but in
Barimnejad’s study, passing CPR experience
0
1
2
3
4
5
6
7
8
9
10
First Domain Second
Domain
Third Domain Fourth
Domain
Imam Khomini Imam Reza Taleghani
Farabi Imam Ali
Graph 3: The average of distinctions of the samples in
the study in different remedial centers according to four-
compassed content of CPR.
Experience of nurses from the emergency department management Poormirza Kalhori R. et. Al. 84
Summer 2012, Volume 5, Issue 13, Pages: 77-86
had no effect on awareness level [19].
Regarding positive effect of passing CPR
period in this study, this finding is an emphasis
on establishing CPR training workshops at least
in every six months for all the nurses that has
been emphasized in Karami’s study too (2009)
[20].
In this study the most awareness level had been
seen among the nurses who are working in
CCU, ICU and nurses in internal ward that was
statistically significant. This finding of research
was equal to the finding of Mohsenpour and
colleagues’ research in Kerman and it can be
because of more CPR happenings in intensive
unit. In the present study, four compasses were
studied in CPR content that the most awareness
level was in cardiac external massage principles
that confirms findings of Mohsenpour and
colleagues’ research in Kerman [21]. The least
awareness level was in advanced resuscitation
principles that emphasized Pasaly and
colleagues (2011) [16] and Preston and
colleagues (2009) [22]. The most important
reason of lack of nurses’ awareness in this issue
had been introduced lack of enough skill in
investigation and knowing needs of patient by
Preston and colleagues (2009). In doctors that
are graduated recently, this lack of clinical
awareness and competence in progressed
resuscitation principles can be because of lack
of enough training in emergency medicine [23].
Regarding this finding of the research, it is
necessary that teaching progressed resuscitation
principles exists with more emphasis on
postgraduate training of nurses. This research
suggestion for increasing progresses CPR
quality was given in Perkins and colleagues’
study too (2008) [24]. Regarding the
importance of progressed CPR quality it is
suggested that in the case of lacking doctors,
nurses that passed a period in ALS can be used
in resuscitation actions current [25].
Awareness level in main principles of
beginning and ending CPR and principles of
establishing artificial ventilation and air way
management was in acceptable extent in this
study. It is while lack of awareness about BLS
has been reported in different studies
[27,26,18,14,13,12]. Regarding the designing of
questionnaire that in addition to studying CPR
principles, it studies new changes of CPR
according to resuscitation guidelines of 2010,
this finding is expectable and it studies the new
suggestions about 2010 CPR guidelines and
awareness level of the samples in the study in
continues.
In issues related to electroshock therapy and
using AED (questions of 31 to 33), awareness
level of samples of the study was not in
acceptable extent than confirms results of
Barimnejad and colleagues’ study [19] and
also Bakhsha and Behnampoor’s(2006), [28]. It
is suggested that in post graduate training
programs of CPR, more exact teaching in these
issues especially about using AED should be
done. The suggestion had been given in Zantes
and colleagues’ study too (2009) and it has
been said that in post graduate training program
of nurses in BLS and using AED, teaching to
nurses that passed the period is more effective
than doctors [29].Question number 16 of the
questioner indicated preparation of LMA and
Combitube that awareness level of the samples
of the study was not at an acceptable extent
about them. Regarding emphasis on using these
airways of Superaglotic in resuscitation
guidelines of 2010, it seems essential that
necessary teachings about this issue should be
given in nursing postgraduate training. This
suggestion of the researchers has been
confirmed by Vice and colleague’s study
85 Poormirza Kalhori R. et. Al. Experience of nurses from the emergency department management
Summer 2012, Volume 5, Issue 13, Pages: 77-86
(2008) which indicates more effectiveness of
using LMA in compare with AMBU bag for
managing airway by nurses [30]. Questions
from 2 to 6 of the questionnaire were about the
ending and not starting CPR that the awareness
level of the nurses in the study was not in
acceptable extent. It is necessary that like
Morsen and colleagues’ study (2007), nurses be
aware of legal aspects and correct examples of
beginning or ending of CPR in post graduate
training program [31]. Two important questions
of the questioner was using interaoseus
injection instead of endotracheal injection and
induced hypothermia that the awareness level
of the study was in weak extent and it is
necessary that these two important matters to be
thought in postgraduate program of nurses.
Regarding the results of this study, teaching
postgraduate training of nurses in CPR issues
has to be thought according to the last
recommended guidelines in scientific
associations and continuous teaching program
is recommended for increasing awareness level
of nurses [32] in a way that in order to have
permanent learning time interval of every six
months for passing this period is highly
recommended [19].
In this study, awareness level of nurses who
participate in the study from Imam Ali Hospital
was more than other samples from other
hospitals. Regarding this issue that
Kermanshah’s Imam Ali Hospital is an extra
special center of treatment of cardiovascular
diseases, this finding was expectable.
5. Conclusion
Regarding this study nursing postgraduate
training program in CPR issues has to be
thought according to the last recommended
guidelines in scientific associations and there
must be more emphasis on electroshock therapy
and AED, LMA, Comitube and causes for
ending, not starting CPR, interaoseus injection
and induced hypothermia.
6. Acknowledgments
Hereby the researchers would like to thank the
nursing personnel, information technology unit
and management of Kermanshah University of
medical science.
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