Academic literature on the topic 'Nurse-initiated defibrillation'

The patient was dying after undergoing aggressive treatment for a malignancy. Patient and family wanted "everything" to be done and the patient was transferred to the ICU for treatment of acute respiratory failure. The next day the patient's condition deteriorated further. The family decided against chest compressions or defibrillation; however, other aggressive treatment was continued. A "chemical code" was initiated and the patient was ventilated. The family was informed. As they stood in the hall outside the unit, the patient's wife asked if she could be with her husband. A nurse explained what she would see and accompanied her to the bedside. She stood at the head of the bed, stroked her husband's head and spoke softly in his ear. The patient's son came to the bedside and said his last words to his father. The wife was present when treatment was stopped and the patient was pronounced dead. She said to the nurse who had accompanied her, "You have given me the greatest gift possible--you allowed me to be with my husband at the end."

IntroductionManagement of out-of-hospital cardiac arrests (OHCAs) in France is performed by a particular prehospital system based on medicalisation of mobile intensive care units composed of an emergency physician and a nurse with all the required devices for advanced care. It follows the European recommendations which advocate for the use of early point-of-care focused echocardiography (EPOCE) in the prehospital setting. An ability of EPOCE may be to predict the absence of return of spontaneous circulation (ROSC) in cases of absence of cardiac motion. We thus intended to investigate this predictive value with a prospective multicentre study. This paper describes the study protocol, while the first patients were recruited in December 2018.MethodsACE is a prospective multicentre (n=8) prognostic study. Briefly, as soon as OHCA is diagnosed and advanced life support (ALS) is initiated, EPOCE will be performed during the automated external defibrillator’ analysis period. The physician will assess detectable motion within the heart and reversible causes of OHCA. However, as the prognostic value of absence of cardiac motion is not currently validated, the results of EPOCE will not be used to withdraw ALS, and the decision to withdraw life support will be done following the European Resuscitation Council recommendations during our study.AnalysisThe primary endpoint is the positive predictive value of absence of cardiac motion for the absence of final ROSC. The secondary endpoints are predictive characteristics of EPOCE asystole on morbimortality 30 days after OHCA, description of reversible cause and analysis of the EPOCE technique.Ethics and disseminationACE was approved by an ethical committee (2018-AO1491-54). While ACE is adapted to the French prehospital system, its results will be translatable to other organisations if inter-rater variability is not found.Trial registration numberNCT03494153.

The time from onset of a cardiac arrest to defibrillation is crucial hence access to and use of a defibrillator by all nurses essential. The purpose of this study was to use an established theoretical framework to examine and describe the defibrillation practices and beliefs of rural registered nurses in the Australian state of Queensland. The Theory of Reasoned Action (TRA) and Theory of Planned Behaviour (TPB) guided the research processes for this two phase study. In the first phase, focus group (n = 13) discussions identified the salient beliefs of the population. By eliciting nurses' beliefs, the subsequent quantitative study (n = 434) was conducted to determine the influences of these beliefs on nurses' use or non-use of defibrillators. The results showed that: (1) less than half of the cohort of participants were permitted to defibrillate; (2) the defibrillation beliefs of those nurses permitted to defibrillate were significantly more positive than those not permitted to do so; (3) the direct measures of TPB and selected variables external to the model predicted a significant portion of the variance in the measure of nurse-initiated defibrillation intention; and, (4) subjective norm emerged as the strongest predictor of intention. In conclusion, Queensland rural hospital nurses and employers still have some distance to travel down the path of nurse-initiated defibrillation. The TPB is a viable framework on which to base interventions designed to promote defibrillation by rural nurses. Understanding the role of social norms is of central importance to ensure all nurses can initiate the chain of survival expeditiously whenever the need arises.