10 Strategic Points
Broad Topic Area
|“Use of Capnography during Resuscitation of Patients in CCU” |
The topic area of this Direct Practice Involvement (DPI) Project includes any improvements that can be made in the coronary care unit (CCU) on the basis of capnography being one of the possible methods to monitor the well-being of patients. The process of resuscitation is complex, and medical staff members have to be prepared to take any necessary steps, as well as recognize the various scenarios of threat development. This DPI project helps to develop a framework that ensures control over the levels of end-tidal carbon dioxide (ETCO2) is possible. Cardiac outputs of patients in a CCU setting and decreased mortality rates have to be investigated. In addition, special attention should be paid to the level of awareness of capnography among nurses, and their readiness to apply this technique to the patients in the CCU.
Background of the Problem/Literature Gap
Review of Literature Topics with Key Concepts
Cardiac Arrest and Cardiopulmonary Resuscitation (The Lazarus Phenomenon)
Definition of Capnography
Clinical Indicators of Capnography
Types of Capnography
Nursing Knowledge of Capnography
Outcomes of Capnography on Nurses and Patients
|While the analysis of the literature shows that capnography is a valuable technique in measuring the concentration of CO2, its implementation in the coronary care unit remains a poorly investigated issue despite its potential benefits such as the improvement of care quality and monitoring of patients’ well-being.|
|In the patients of a coronary care unit (P), how can the implementation of time cartographers (I) compare to non-use of this intervention (C) and influence the efficacy of a resuscitation process and the transition to ROSC (O)?|
|The collection of data for this DPI project depends on a properly defined sample. It is expected to identify clearly such aspects of work as the location of the setting, the population to work with, and the number of people to be involved in the research. At this moment, the following decisions are made: |
Location: New Jersey;
Population: Two neighborhood cities which are characterized by an equal distance from the nearest primary care provider with a coronary care unit (with 15 beds in the unit and 109 beds in the whole hospital);
Sample: 80 participants will be included in the study to investigate the worth of capnography as the main method to control the level of ETCO2 during a period of six months. Ten registered nurses from the CCU will be staffed to promote the intervention.
|There are two types of variables that will be used for this DPI project. On the one hand, there is one independent variable that should not be changed during the project. On the other hand, there are several dependent variables that have to be checked during and after the intervention. |
Independent variable: a capnography tool.
Dependent variables: the recovery dynamics after cardiac arrests, the level of patient satisfaction about the quality of care, and the efficacy of ETCO2 level monitoring.
Methodology and Design
|This project will be based on a quantitative methodology that is supported by a randomized controlled trial. This study design includes the participation of people who will be divided into two groups: experimental and control. It is expected that there will be a difference between the results obtained from the experimental group (the participants should undergo the intervention) and the control group (the participants do not receive the intervention). A qualitative process evaluation will be carried out in the chosen trial. |
It should help to identify the peculiarities of the intervention (a capnography tool is applied) through a strong understanding of the chosen process and its progress within the frames of the trial. The peculiar feature of quantitative research methods in nursing research is the possibility to succeed in three different tasks. First, it is necessary to investigate the pre-trial achievements and study results (focusing on the results of the literature review). The second step is the analysis of the intervention process (introducing a capnography program to the chosen experimental group). Finally, the third step is the determination of the connection between the changes (the dynamics of the recovery process in CCU patients).
This experimental design has to be measured quantitatively, meaning that no new ideas and approaches are introduced. The task is to take the already known technique (capnography) and apply it to a certain group of people (CCU patients in one of the local hospitals). In the end, it is expected to receive accurate measurements of the ETCO2 levels in the patients with cardiac arrests and compare the results of their monitoring process in regard to the possibility of reducing the number of fatal outcomes and increase the quality of care. The latter can be defined through the level of satisfaction of patients who receive care during the intervention. In this project, a qualitative experimental research design should allow the researcher to prove the idea that capnography is characterized by positive effects on CCU patients.
|The purpose of this qualitative research that is undertaken with a randomized controlled trial is to understand the possible efficacy of capnography to monitor resuscitation processes and promote the recovery dynamics among patients in the coronary care unit in New Jersey.|
Data Collection Approach
|The peculiar feature of the data collection approach in this project is the necessity to gather the material during the implementation of the intervention. Eighty patients will be divided into two groups. 40 of them will receive capnography as the main method to monitor the ETCO2levels. The other 40 patients will receive standard monitoring at the CCU setting. |
The information about patients and their health conditions will be gathered from their cards after informed consent is obtained. The main inclusion criteria for patients are the diagnosis of cardiac arrest, hospitalization, and their presence in the CCU setting at the moment of the intervention. The exclusion criteria are rehabilitation, previously stated high levels of ETCO2, and the already survived Lazarus phenomenon.
Observation and monitoring are the chosen data collection methods in this study. Special portable capnography will be offered to the team to monitor any changes. An envelope with the final decision as to whether to use capnography or not is opened before the intervention, and the method of monitoring is followed. The primary outcome measure will include the status of patients (well-being) after the implementation of the intervention. The secondary outcome measure will be patient satisfaction with the technique and the level of knowledge of capnography among nurses.
The CCU staff should give their approval to check what they know about capnography before the intervention. Then, training on the interpretation of capnography must be received, and the NKCT will help to check the changes in nurse awareness of the technique. The nurses, who participate in this intervention, in their turn, will be obliged to take the Nurses’ Knowledge about Capnography Test (NKCT) to evaluate their level of knowledge (Kiekkas et al., 2016). This test should be taken before the intervention (pre-test) and after the intervention (post-test) so that the researcher can define the progress that is associated with the adoption of the technique.
Data Analysis Approach
|The data analysis approach should be based on prior information about patients and the repeated measures design that is chosen for this trial. Eighty patients have to be observed fully, 100%, to detect the difference in their well-being. The data has to be entered into Excel, and the analysis will be developed using SPSS statistical software. All tests to compare the levels of ETCO2must be 2-sided with a specially identified p-value of <0.05 from the available patient characteristics and indicators. It is the only statistically significant factor in the study analysis. A Chi-square test will be used to indicate the main characteristics. Fifty percent of the nursing staff will be invited to monitor data as a part of a committee. |
The goal of the data analysis is to test the idea that capnography is an effective tool to monitor significant factors of patients and to predict the development of a critical situation when ROSC will be inevitable. The level of nurses’ awareness of capnography and its effects on patients’ well-being will be analyzed using the results of the NKCT. A paired t-test can be appropriate to meet the goal of the study. Taking into consideration a small sample, a non-parametric approach will help to clarify the relationship between the variables. For example, the Wilcoxon signed-rank test will help to compare the outcomes among two related samples, match them, and identify the differences.
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