How do you think a nursing student feels when, upon entering a room of a patient, he/she assesses that the patient is cyanotic, chest is not moving, and all life signs are absent? If this is a student nurse who has had CPR training, chances are that he/she will feel that heated wave of adrenalin surge through his/her body just as any person might experience in a stressful or exciting moment. But what will separate this student's reaction from one that has not had CPR is the ability to immediately initiate the mechanical means by which he/she may prevent biological death. There will be no loss of time calling for help; there will be no feeling of self-doubt about being a provider of health care. There will not be that overwhelming feeling of helplessness and that sickening feeling as the student thinks, "if only I could have known what to do."
As nursing educators, we have an educational, moral and ethical obligation to prepare our students in the very basics of nursing and health care. No two educators would agree on what a nursing curriculum should have in it in total, but all educators do have a feeling for what "the basics" or fundamentals of nursing are. It is the purpose of this article to help get a consensus of the readers in agreeing to make a certified course in CPR mandatory in the first quarter or semester of the student's nursing sequence. If this is too difficult a request, in the sense that the nursing program you are from does not have a certified CPR instructor, then by utilizing the services of your community's American Heart Association or American National Red Cross, you can use a different approach, but the end product will be the same. . .a student who has had the CPR training. Most local offices of the American Heart Association and/or American National Red Cross have a schedule of regularly taught courses in or near your community. With the letter that goes to each student indicating their acceptance to the nursing program and describing things they need to do before the first day of classes, one of those requests can be that the student bring with them to class the card that is issued after passing the certified and standardized CPR course given by the American Heart Association or the American National Red Cross.
The National Conference on Standards for CPR and ECC is the group of people that sanctioned the document published by The Journal of the American Medical Association, wherein national standards were presented regarding the accepted steps and procedure by which cardio-pulmonary resuscitation is delivered. It is by these standards that a course was designed and instructors trained, to present a united and consistent course nationwide that prepares both professional and lay people to perform CPR. The document referred to above can be located as the supplement to JAMA, February 18, 1974, volume 227, number 7. CPR is continuously updated and changed.
CPR manuals can be obtained from your local Heart Association offices. Instructors who go through the training program are then monitored on an annual basis to ensure that the standards are being met and that the quality of the course is high. As professionals who are required to pass a state board exam to demonstrate a minimum competency in our field of practice, you can appreciate the necessity of having the students taught CPR by instructors who have been trained, monitored for competence and who teach the national standard of doing CPR. It is not recommended that CPR be taught by faculty who have not gone through the instructor certification program offered by the American Heart Association or the American National Red Cross. This is an effort to ensure quality control.
There are many advantages for the student who knows CPR before entering the clinical area for the first time. One of the statements that we, as educators, are constantly expressing to the new students is the concept that as guests in a facility, they are getting practical experience and should become absorbed into the whole team effort of all the various members in the facility by exercising their knowledge and skill. Not being able to assist or do CPR during a code is a very quick way to broaden the gap between the service agency and the students who are learning there. Being prepared, or thinking in a preventive way, is something else the students are asked to start developing within themselves. Given the environment in which the students will be finding themselves, an acute hospital, a convalescent hospital or any clinic situation, it is ridiculous to be in any one of those settings for the number of hours the students are and expect that the need to do CPR will not arise early in their student career. For instance, if you have 400 people attending a football game and 400 people in one of the large urban hospitals, the percentage or chance of a registered nurse needing to use CPR is higher in the hospital just by using random sampling of the number of heart attacks in the two given situations. It is not demonstrating preventive planning to place a student in a high-risk cardiac arrest area and not have him/her know basic CPR. If it will not be taught by the program, then it must be required as a criterion to enter the program after acceptance.
CPR is already mandated by the programs that are training EMTs (Emergency Medical Technicians). According to Title 17, Public Health, State Department of Health, Chapter 4, Preventive Medical Service,
all policemen, sheriffs, deputy sheriffs, members of the California Highway Patrol, ocean and public beach and public swimming pool lifeguards, and firemen in this state, except those whose duties are primarily clerical or administrative, shall be trained to administer first aid and cardio-pulmonary resuscitation according to the standards set forth in this subchapter.
In Title 22 of the Joint Commissions on Accreditation of Hospitals, Health Facilities and Referral Agencies, 70721 Employees, Part E, it is stated: "Appropriate employees shall be given training in methods of hospital infection control and cardiopulmonary resuscitation." It is apparent from these documents that hospitals are only interested in employing people who are prepared to do CPR. If a staff member is hired who cannot perform CPR, that person must complete a CPR course in order to secure their employment. The curricula of different levels of health care providers also reflect the desire to prepare students to be able to handle the emergency situations that, inevitably will confront them out in the field or in an agency. It is also evident that a variety of job descriptions cannot be filled by applicants unless they have proof of their ability to give CPR. Does it not seem reasonable and self-evident that a nursing curriculum should teach CPR to its students so they are prepared, comfortable with CPR early, and more marketable upon graduation? We, as educators, should not be dumping a load of uncertified CPR nurses onto the job market, relying on inservice directors of hospitals to do that which we should be responsible for.
From a survey that was sent out in the Spring of 1976 and the data collected and analyzed by Fall of 1977, the following information was abstracted in reference to faculty opinion concerning whether CPR should be, or is, included in their respective nursing programs' curriculum.
Fifty surveys were sent out to 50 programs of nursing in California, both Baccalaureate and AD programs. There was an 82% survey return.
A. 70% of nursing schools surveyed responded that they feel that CPR taught by the American Heart Association National Standards should be included in their curriculum.
B. 32% responded that they currently are not teaching CPR in their curriculum.
C. 42% felt that CPR training should be taught in the basic or fundamental year.
D. 65% felt that recertification one year after the initial training should also be built into the curriculum.
It is hoped that through the publication of this article, some action will be initiated at different levels, both political and academic.
A. It is proposed that all schools of nursing build into their fundamental quarter/semester the nationally accepted program for CPR that will be taught by certified CPR instructors.
B. Rather than using community resources, it is proposed that one or two faculty members within each nursing program take the American Heart Association or American National Red Cross instructor training so that the school will have faculty prepared to teach the course to the students.
C. It is proposed that the State Board of Nursing mandate that prior to licensure being granted or prior to the student sitting for Boards, that the student nurse submit, with their application for licensure, the copy of their certification card showing that they are current in CPR training.
D. It is proposed that the National League for Nursing mandate, or at least strongly recommend, that CPR be a part of all freshman-level curriculum and that yearly recertification is also built into that program as well.
In this day and age of accountability and high expectations from consumers, anything that we, as nursing educators, can do to produce a student that is more efficient, who has confidence, and who does not require many weeks of orientation to the new facility or environment that they are beginning their career in, is a goal we cannot overlook. With the constant demand for higher student-faculty ratios in the clinical areas for more cost efficiency, it is vital that students have at their disposal the ability to function alone and immediately in an arrest or emergency situation.
Outside of the fact that we expect a minimum level of competency in the facility, it is also the moral and ethical obligation of a student to be able to function within their community, on a street, on a freeway, in a restaurant, and be able to perform CPR which includes the obstructed airway procedure, infant resuscitation, and one- and two-man rescue CPR on fellow humans. As the movie that is shown during the training session for basic CPR ends, the narrator closes with a touching and profound statement. He says that with the knowledge and ability to do CPR and save a life, you are keeping a heart alive that is too good to die. Let us prepare our student nurses right away to be able to do this.