International Journal of Biotech Trends and Technology (IJBTT) - Volume 9 Issue 3 – July – Sep 2019

Assessment of Knowledge, Attitude and

Practice towards CPR among Nurses Working
in Wolaita Sodo University Teaching Hospital
Wolaita Sodo, Southern Ethiopia, 2017
MasreshaAssefaDemissie1*, Tilahun Saol2
1. Department of Neonatology and Paediatrics Nursing, College of Health Science and Medicine, Wolaita Sodo
University, Wolaita Sodo, Ethiopia
2.Department of Nursing, College of Health Science and Medicine, WolaitaSodo University, WolaitaSodo,
Ethiopia
Abstract Keywords: Cardiopulmonary resuscitation,
Cardiopulmonary resuscitation (CPR) is the Knowledge, Attitude, practice, Assessment, WSU
restoration of cardiac output and pulmonary
ventilation following cardiac arrest and apnea by I. INTRODUCTION
using artificial respiration and manual closed chest Cardiopulmonary resuscitation (CPR)is an important
compressions or open cardiac massage. Worldwide, medical procedure which is performed in an effort to
there are greater than 17.5 million cardio vascular manually preserved intact brain function until further
deaths each year, and the prevalence of coronary heart measures are taken to restore normal spontaneous
disease is increasing. Thus the assistance provided by blood circulation and breathing in a person in cardiac
the health care team requires speed, efficiency, arrest[1].
scientific knowledge and technical skills to perform the CPR has been and is now utilized as a standard first
needed procedure.The aim of this study was to assess line management for a variety of acute life threatening
knowledge, attitude and practice towards medical conditions where death is likely if immediate
cardiopulmonary resuscitation among nurses working intervention is not carried out ever since the advent of
in Wolaita Sodo teaching hospital, Southern modern CPR, several countries in collaboration with
Ethiopia.A descriptive cross sectional study designed professional bodies or associations (European
was used. Self-administered structured questionnaire Resuscitation Council, American Red Cross, American
conducted among a total 98 nurses working in Wolaita Heart Association, Australian Resuscitation Council,
sodo teaching hospital by using Simple random sample the Heart and Stroke Foundation of Canada, the
(lottery method) technics. Data was collected from Resuscitation Council of Southern Africa and
April 01, 2017 to April 30, 2017. Supervision had done Resuscitation Councils among many others) have come
on daily basis. The Data were first checked manually up with standardized guidelines and/or algorithms for
for completeness and then coded and entered in to conducting CPR [2].
EpiData version 3.1. The entered data were Now a day cardiopulmonary arrest is a major public
transferred to SPSS version 20. The data were cleaned health problem [1, 2] and many patients sustained
by visualizing, calculating frequencies and sorting. cardiac arrest in two years [3]. It is more common in
Frequencies and proportions were computed for low socio-economic areas [4–5] .Cardiopulmonary
description of the study population. Among 98 arrest is one of the most common unfortunate incidents
participants 55 (56%) are BSc nurse and the rest 43 that may occur in and out of the health facilities [6–
(44%) are diploma nurse. of all participants 44 10]. Cardiopulmonary resuscitation (CPR) is a
(44.9%) those who have training and the rest lifesaving technique [11] and consists of chest
54(55.1%) are not trained on CPR. The untrained compression and rescue breathing [12]. The quality of
participants have scored poorly as compared to cardiopulmonary resuscitation depends on the
trained participants in theoretical knowledge and sufficiency of the knowledge of health professionals
practice of CPR And Most of the participants of both and facilities [13–16]. Increasing survival of patients
trained and untrained group were having very good from cardiopulmonary arrest requires improvement in
attitude towards CPR. Knowledge and practice skills resuscitation education [17].A study conducted in India
of CPR were not adequate in participants. A showed that the knowledge of nursing students and
significant Portion of trainees do not acquire adequate interns about basic life support (BLS) was very poor
knowledge in a single session of training. An organized [18].Throughout the world by 2020 it also predicts that
curriculum for BLS and its protocolized training is the the number of fatalities from these conditions
need of the hour in medical education. Worldwide, there are greater than 17.5million
cardiovascular deaths each year, and the prevalence of

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 International Journal of Biotech Trends and Technology (IJBTT) - Volume 9 Issue 3 – July – Sep 2019

coronary heart disease is increasing [3].Individuals in professionals including specialists, General

the community at least the health professionals should practitioners, Health officers, Nurses, Lab technicians
know how to perform CPR as they encounter such and pharmacists. Of them total numbers of nurses are
situation very often, health professionals are expected 122 (48 BSc and 74 diploma nurses).
to be competent to resuscitate from their first posting. The study was conducted in WolaitaSodo University
In the United States BLS training has been Teaching Hospital from April 01, 2017 to May 30,
recommended for all health professionals since 1966 2017 GC.
especially for those who are involved in resuscitation.
Demand for courses of BLS/CPR is ever increasing B. Study design
worldwide. However in developing countries there is Descriptive cross sectional study design was used.
still no standard of resuscitation training is not routing.
Up to present few reports have addressed current level C. Study Population
of awareness and knowledge in the area among Health All selected Nurses working in WolaitaSodo
Professionals in developing countries [15-16]. Cardiac University Teaching Hospital
arrests are more common than you think, and they can
happen to anyone at any time. Nearly 383,000 out-of- D. Sample size determination and sampling
hospital sudden cardiac arrests occur annually, and 88 technique
percent of cardiac arrests occur at home. Determined by single proportion population formula
Many victims appear healthy with no known heart (𝑍 2 .𝛼 2) 𝑝(1−𝑝)
𝑛= by using 70%prevalence of anemia,
disease or other risk factors. According to the Road 𝑑2
Traffic Safety Annual Report, there has been a steady 95% confidence interval, 5% margin of errorand 10%
annual overall increase (with minor reversals in some non-response rate
years) in the number of road and traffic accidents that (1.96)2 𝑥 (0.7(1 − 0.7))
𝑛=
have been occurring Botswana. In 2007, about 3% (0.05)2
(497) of the total number of people involved in such 𝑛 = 322
accidents (19,487) were killed, and about 39% (7,639) Since the source populations were less than 10,000, by
were listed as casualties. Some of these, as well as an using finite population correction formula the final
𝑛
unknown number of adults and children encountering sample size was: =nf= 𝑛 nf==98 and 10% of sample
1+
other medical accident and/or surgical emergencies, 𝑁
might have required CPR interventions. Thus many
size is added for non-respondent rate
patients’ lives and well-being might depend on Health
Professionals’ CPR knowledge and skills [17].Because
E. Data collection tools and procedure
Cardio pulmonary resuscitation is a lifesaving The study was conducted using self-administered
procedure, performed to preserve patients to life until questionnaire or format which was prepared in English.
further management is going to follow.Study that was Then, questionnaire was given to the participants. The
undertaken by a university clinical team in London questionnaire was designed to obtain information
showed that the retention of knowledge and skills which help for the study.
during and after training in CPR is difficult and
requires a more systematic training, as well as methods F. Data quality control
that will ensure better retention of skills and During data collection, regular supervision and follow
information. [19].The aim of this study was to assess up was made by the data collectors and supervisors.
the knowledge, attitude and practice towards CPR The data was cross checked for completeness and
among diploma &BSc nurse nurses working in consistency of collected data on daily basis. Once the
WolaitaSodo Teaching hospital. data had been collected and checked for completeness,
consistency and accuracy, it was sorted, categorized
II. METHODS AND MATERIALS and summarized. Then, entered the data into the
computer using developed data entry format, coded for
A. Study Area and period each category of variables and again was cross checked
WolaitaSodo University Teaching Hospital is situated for errors.
at Wolaita Sodo town found in East to the town. The
town has one governmental and one private hospital
G. Data processing and analysis
and three health centers. It is 165km far from Hawassa, Data was first checked manually for completeness and
SNNPR and 396km from Addis Ababa Ethiopia. then coded and entered in to Epinfo version 3.1. The
Wolaita Sodo University Teaching Hospital is entered data was transferred to SPSS version 20 for
established in 1920 E.C as a Zonal Hospital in Wolaita further processing. The data was cleaned by
zone, Sodo town. visualizing, calculating frequencies and sorting. The
The total numbers of beds in the hospital were 255, data was analyzed by using SPSS version 20 statistical
which is on medical, pediatrics, surgical, gynecology software. Frequencies and proportions were computed
and obstetrics ward. The total number of staffs in the for description of the study population in relation to
hospital was 437. Out of these 257 were health socio-demographic and other relevant variables.

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 International Journal of Biotech Trends and Technology (IJBTT) - Volume 9 Issue 3 – July – Sep 2019

Finally the results were presented in the form of tables, No 54(55.1)

figures and sentence (text). Times of training
<1year 2(2)
H. Ethical consideration 1-2 years 8(8.2)
Ethical clearance was obtained from Wolaita sodo >2years 34(34.7)
University Ethical Review Bored and for
confidentiality of information a written consent also B. Participants’ knowledge about CPR
was given to the participants and the information As table shown below Among 98 participants 92.9 %
obtained should be used only for the study purpose. (n=91) had information about CPR 97 %( n=95) had
The instruments and procedures was not cause any information about ABC or CAB order. Around 38.8 %(
harm to the study subjects, the community, the data n=38) didn’t know the reason why they apply CPR and
collectors and supervisors to be involved in the study. only 28.5 %( n=28) know defibrillation is involved in
CPR. From the respondents only 55.1 %( n =54)
III. RESULTS answered correct depth of CC.
Table 2,Participants knowledge on about CPR (n
A. Socio-demographic characteristics = 98) in WSUTH, SNNP Region, May, 2017
As table shown below from the total of 98 participants Variables Frequency %
57% (n=56) were male, 43 %( n=42) were female and Have had any information about CPR
59% (n=58) age group of 25-29 yrs. The level of
qualification in participants is BSc 44 %( n=43) and Yes 91(92.9)
the rest 56 %( n=55) are diploma nurses and around No 7(7.1)
52% (n=51) of participants’ service year was 6-10 Where did you get the information
years and 44.9 % of them had training on CPR.
pre-service training 35(35.7)
Table 1,Socio-demographic characteristics of In service training 35(35.7)
respondents (n = 98) in WSUTH, SNNP Region, Others 21(21.5)
May, 2017
Have you know about ABC& CAB
Variables Frequency (%)
Yes 95(97)
Sex
No 3(3)
Male 56 (57)
For which cardiac arrest CPR applied 1st
Female 42(43)
Age Correct answer 59(60.2)
20-24 10(10.2) Incorrect answer 30(30.6)
25-29 58(59.2) I don’t know 9(9.2)
30-34 17(17.3) How much depth you compress the chest
35-40 9(9.2) Correct answer 54(55.1)
>40 4(4.1) Incorrect answer 37(37.8)
Qualification I don’t know 7(7.1)
Diploma 55(56) How you put hand on sternum
BSc 43(44) Correct answer 61(62.2)
Service year Incorrect answer 27(27.6)
<5 37(37.8) I don’t know 10(10.2)
6-10 51(52)
>10 10(10.2)
Had training on CPR
Yes 44(44.9)

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 International Journal of Biotech Trends and Technology (IJBTT) - Volume 9 Issue 3 – July – Sep 2019

100 88
90
80 70
70
60 47
50 32 34
40 25 29 28
30 18
20 9
10
0

Figure 1, Participants’ response for what is involved in CPR in WSUTH

In the above graph illustrated participants answered n=36) correctly answered while 54.1%(n=53)
about what is involved in CPR. So, CC involvement answered incorrectly for compression and breathing
89.9%(n=88), diuretics 18.3%(n=18), Iv drugs ratio for two rescue and 43.9%(n=43) answered
32.6%(n=32) , vasopressin 34.6%(N=34), Mouth- correctly while 39.8%(n=39) incorrectly answered and
mouth 71.4%(n=70) NGT 25.5%(n=25), suction rests do not know compression ventilation ratio for
47.9%(n=47),intubation 29.5%(n=29) and for neonate.
defibrillation 28.5%(n=28),surgery 9.2%(n=9)
respondents answered. Table4, Participants’ practice about CPR (n = 98)
in WSUTH, SNNP Region, May, 2017
C. Participants’ Attitude toward CPR
As shown on the table below among 98 participants Variables Frequency (%)
were asked about the importance of CPR 25.5 % Have you ever applied CPR
(n=25) disagreed while 74.5 %( n=73) agreed. On the Yes 81(82.7)
other hand 28.6 %( n=28) disagreed and 71.4 %( n=70) No 17(17.3)
agreed on prolongation of life. On w/c part of the chest applies it
Correctly answered 23(28.4)
Table 3,Participants Attitudes on about CPR (n = 98) Incorrectly 52(64.2)
in WSUTH, SNNP Region, May, 2017 answered
Variables Frequency (%) I don’t Know 6(7.4)
Is CPR important On w/c surface do you apply
Agree 73(74.5) Correctly answered 47(58)
Incorrectly 32(39.5)
Disagree 25(25.5) answered
Does it prolong life I don’t Know 2(2.5)
Agree 70(71.4) Compression-ventilation ratio for one rescue
Disagree 28(28.6) Correctly answered 58(59.2)
Can patient survive after CPR performed Incorrectly 33(33.7)
Agree 69(70.4) answered
Disagree 29(29.6) I don’t know 7(7.1)
How much for two rescue persons
D. Participants’ practice on CPR Correctly answered 36(36.7)
As shown table 5.4 below, Out of 98 participants 82.7 Incorrectly 53(54.1)
%( n=81) were applied CPR and 17.3% (n=17) never answered
applied it. From participants who applied CPR 28.4 %( I don’t know 9(9.2)
n=23) correctly applied CC and 64.2 %( n=52) were Compression and ventilation ratio in
wrongly applied and 7.4 %( n=6) do not remember neonate
how they apply. About 58 %( n=47) applied CPR on Correctly answered 43((43.9)
firm surface while 39.5 %( n=32) were applied on Incorrectly 39(39.8)
smooth surface and the remained didn’t remember answered
where they applied CPR. Also 59.2 %( n=58) answered I don’t Know 16(16.3)
correctly while 33.7%(n=33) for one rescue
compression and breathing ratio for adult and 36.7 %(

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 International Journal of Biotech Trends and Technology (IJBTT) - Volume 9 Issue 3 – July – Sep 2019

IV. DISCUSSION Raja PerempaunZaina 11, Kota Kelantan Malaysia

This study was to explore the present knowledge of w/n asked” How many cardiac arrest cases have you
nurse staffs toward CPR so as to make a plan for CPR attended throughout your working period ?” 35(50%)
training. The result of this study shown that most of said they had attended more than 5cases, 23(32.9%)
study participant has not received enough and had attended fewer than 5 cases and 12(17.1%)
satisfactory training as they were not able to retain admitted that they had never attended any cardiac
information relevant to applying CPR. This conclusion arrest before. Only 10(14.3%) respondents said that
stems indicate s from 98 participants n=23 were trained they were confident of managing resuscitation cases.
and n=13 were trained two years ago. And the other The majority of the participants (48, 68.8%) had
thing a great percentage of the respondents didn’t undergone BLS training, but only 8(11.4%) had been
answered correctly to the questions on the last trained in ACLS. As many as 42(60%) of the
guideline of European Resuscitation Council(ERC) participants admitted that they had never handled a
and AHA that were relevant to the appropriate ratio of defibrillator before. It was found that questions that
thoracic compression to ventilation. address the fundamental facts of BLS were answered
In study conducted by Soo-II oh etal.[20] 47 correctly by more than 70% of the participants.
professional nurses were tested on their skill of CPR 3 Although this doesn’t necessarily mean that the
times at an interval of 4 months. From the results, it participants had good theoretical knowledge, it does
was confirmed that re-education clearly affects nurse’s imply that the participants should up to date with their
knowledge and skills by maintaining their knowledge BLS knowledge. This is further supported by the fact
and enhancing their skills. that 68.8% of our participants undergone BLS.
A good example of this is represented by the result of The current study revealed that the questions that
the study done by preuschetal. [21] w/c stressed the address the fundamental BLS were answered correctly
importance of training even experienced staffs with the by more than 60% of the participants. But there is still
goal of adopting the guideline for resuscitation and defect it in important component of CPR/BLS for
applying them properly in time it become necessary example out of 98, 34.6% agreed on need of
and there is also strong association b/n training on CPR vasopressin only 30.6%(n=30) correctly answered for
and information about CPR (P=000). the interval to administer adrenaline during CPR,
As to questions on CC in adult, all of the participants 29.5%(n=29) for intubation and 28.5%(n=28) for
had knowledge about CC is important component of defibrillation. Only 77.6 %(n=76) know rate of rescue
CPR but n=52 were wrongly applied and only n=54 breath per cycle although this does not necessarily
answered correct depth of CC. It shows they were not mean that the participants had good theoretical
administered high quality of CPR. According to AHA knowledge .Still the difference is b/c of training
high quality CPR and early defibrillation were increase refreshments.
survival rate of the victims. Early defibrillation within V. CONCLUSION
3-5 minutes of collapse can produce survival rate of The dynamic nature of resuscitation demonstrated the
49-75%. [22] need for continues up dates for those already that
The finding was similar that of studies conducted in trained and newly graduated and join Hospitals or
health professionals of the Kist Medical Collage other health facilities needs integration of course in
Hospital, these study shown that half of the curriculum in health care training institution so that all
respondents could identify that the right location of the students receive the training for health professionals to
hands for CC is center of the chest b/n two be able to deliver essential service that they provide
nipples.However, only 30% of the participants knew and in order to retain the respect that the public best
that the recommended depth of CC in an adult even if own on them is imperative that they are seen to be
they knew appropriate CC in neonate. But the current competent in what they do. So this research document
study shows that from 98 participants, only 43.9% has shown the disparity between the expected and the
responded correct depth of CC in neonate w/n actual performance of health professionals in our
performing CPR. Hospital. Finally, the average health professionals lack
There was a little difference b/n two studies is b/c of adequate knowledge and practice in CPR.
among the respondents there were anesthiologist and
other health professionals who had training on BLS & ACKNOWLEDGMENT
ALS within six months [23] as stated by cooper etal First of All, I would like to express our heartfelt
there was significant improvement in knowledge and appreciation and sincere thanks to Wolaita
skills of people who have taken BLS course 6 months SodoUniversity Nursing department for their
ago after taking a short course. Therefore, above support.Also I would like to thankmy friends for their
reference and my finding also recommend periodical guidance and constructive ideas in preparing the
re-informant by such refreshers training to attain research.
adequate CPR skills and to maintain continued
competency in techniques [24].
In line with other studies conducted in junior Doctors
in Hospital University Sains Malaysia and Hospital

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 International Journal of Biotech Trends and Technology (IJBTT) - Volume 9 Issue 3 – July – Sep 2019

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