Assessment of the knowledge and skills in caring for life threatening arrhythmias among nurses working in critical care settings at Muhimbili national hospital, Dar-es salaam, Tanzania

Abstract

Background: Life threatening arrhythmias are those arrhythmias that if not intervened on immediately can cost a patient‟s life. This study identified ventricular tachycardia, ventricular fibrillation, pulseless electrical activity, complete heart block, and asystole as types of life threatening arrhythmias. The AACN Synergy Model was used in this study which provided an important framework for nursing practice. It determines nurses‟ competencies through a theoretical ability to detect, manage, and monitor, in conjunction with usage of a resource system available in detecting and correcting specific types of life threatening arrhythmias. Research related to nurses‟ knowledge and skilled assessment in caring for life threatening arrhythmias in the critical care setting remains limited. There has been no study in Tanzania about nurses‟ knowledge and skills related to caring for life threatening arrhythmias. Objective: To assess knowledge and skills in caring for life threatening arrhythmias among nurses working in critical care settings at Muhimbili National hospital. Material and Methods: A descriptive cross-sectional study design was employed. Data were collected using a semi-structured questionnaire and observation skills from a convenient sample of 141 nurses working in critical care settings at Muhimbili National Hospital (Main ICU, EMD, CCU, Cardiothoracic ICU and HDU (Ward 1). The study was approved by institutional review board of Muhimbili University of Health and Allied Sciences. Permission to conduct the study was obtained from MNH authority prior to data collection. Data were analyzed by using SPSS version 20.0 Results were summarized using frequencies and percentages, and presented using figures, tables and text. Results: Majority of the participants (60%) were identified as having high knowledge. Participants had high knowledge in interpreting EKG strips on asystole, where by 82.3% scored correctly and also demonstrated more knowledge by 95% in its nursing care. On the other hand, observational skills in caring for life threatening arrhythmias among study participants were generally poor. Skill deficit was observed in skin preparation before application of electrode by 94.3% and also in ability to interpret abnormality found in standardized EKG by 88.7%. Significant association was found between level of education and skills and knowledge in caring for life threatening arrhythmias. Barriers identified in acquiring high knowledge and skills regarding caring for life threatening arrhythmias included: stress caused by overwhelming workload (68.8%), followed by inadequate cardiac monitors or machines that detect life threatening arrhythmias compared to patients‟ number 60.3 % and lack of mandatory training on caring for life threatening arrhythmias (51.1%). Conclusions: The current study revealed that nurses working in the critical care settings have high knowledge on caring for life threatening arrhythmias. However low skills observation identified, might be due to poor emphasis on practicing procedures. Availability of resources monitors, defibrillators and 12-lead EKG and guidelines were found to be adequate, although generally the usage was observed to be minimal. The identified barriers in acquiring high knowledge and skill in caring for life threatening arrhythmias were: stress caused by overwhelmed workload and lack of mandatory training on caring for life threatening arrhythmias, affected the implementation of optimal care. Recommendations: Efforts should be made to encourage nurses to engage in translation of their knowledge into practical skills. This can be done by designing and implementing a continuous professional practical skills program on life threatening arrhythmias for nurses caring in critical care settings at MNH. The special focus should be based on the methods of teaching, use of guidelines/ algorithms, protocols and charts for proper practice. The ministry of health should find a way to modify infrastructures within the regional hospitals so that every hospital should have highly equipped and trained nurses in critical care settings thus minimize referral cases to MNH. A similar study using mixed methods is recommended and also involving more than one hospital in order to gain more insight on the knowledge and skills of nurses in caring for life threatening in critical care settings.