Nursing2006 Volume 36, Number 11

N E W S U P D A T E S R E S E A R C H

c l i n ic a l

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CARDIAC ARREST no shock given before transporta-

Three-point test predicts tion
cardiac arrest not witnessed by
CPR futility EMT personnel.
Canadian researchers have devised In 776 cases where all three crite-
a three-point test to help emer- ria were met, only 4 patients (0.5%)
gency medical technicians (EMTs) survived. This survival rate is well
in the field determine whether below 1%, which is generally accept-
they should continue or end ed as indicating medical futility.
cardiopulmonary resuscitation When researchers applied two more
(CPR) efforts for a patient in car- criteriaparamedic arrival time of
diac arrest. more than 8 minutes and cardiac ar-
ILLUSTRATIONS BY MICHAEL TRINSEY

Survival rates for patients suffer- rest not witnessed by a bystander

ing out-of-hospital cardiac arrest
are very low. Among 1,240
patients in the Canadian study
who suffered a cardiac arrest out-
side a hospital, just 41 (3%) sur-
vived. From a retrospective analy-
sis, researchers say their termina-
tion of resuscitation (TOR) rule accurately predicted
when CPR would be futile.
All patients in the study were adults who experienced
cardiac arrest outside a hospital. They were treated in the
field according to standard guidelines and transported to
the hospital. Afterward, EMTs filled out a form that col-
lected data on each case. Based on this data, researchers
found that three criteria reliably predicted the futility of
resuscitation efforts:
no return of spontaneous circulation before transporta-
tion
the survival rate was 0%.
Researchers say that applying the
TOR rule in the field would signifi-
cantly reduce the number of pa-
tients taken to the hospital. Prevent-
ing unnecessary hospital transfers
frees EMTs and ED personnel to
help other patients, reduces the risk of accidents and
other hazards related to transport, and allows families to
come to terms with the death outside the hospital setting.
An editorial accompanying the study calls for addition-
al research to answer two key questions: How long should
CPR continue before a determination of no spontaneous
circulation is made, and how should TOR be modified
for special patients, such as an infant or someone whos
hypothermic?
Sources: Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest, The
New England Journal of Medicine, LJ Morrison, et al., August 3, 2006; Cardiac resuscitation
When is enough enough? The New England Journal of Medicine, GA Ewy, August 3, 2006.

PATIENT INTERACTIONS
Getting good at
delivering bad news
More facilities are offering
workshops to health care
professionals who want to
be better at delivering bad
news and handling diffi-
cult discussions. One pro-
tocol for delivering bad
news to patients is called
SPIKES, which stands for
these six key elements.
Setting up the interview:
Pick a private location.
Perception: Assess how Emotions: Address the
the patient views her med- patients emotions with
ical situation. empathetic responses.
Invitation: Ask her if she Strategy/Summary:
wants to know more. Review the basics of what
Knowledge: Give her youve told the patient and
information and warn her include her in treatment
before giving bad news. decisions.

www.nursing2006.com Nursing2006, November 33

clinical SURVEY RESPONSES
Hair removal gets a hearing

R
O
U N D
A variation of this proto-
col, SPIKES RN, provides a
template for nurses who
need to have a potentially
difficult conversation with
a physician about breaking
bad news to a patient.
Another workshop,
called the Program to En-
S
Nurses who recently visited our Web site answered
donation, and disclosure of this question: Do you use razors for hair removal
medical error. on preoperative patients?
For more on SPIKES, visit
The University of Texas
MD Anderson Cancer
Center Web site at http://
www.mdanderson.org/
Cancer_Pro/Pro_Education
and click on communica- Total responses: 637

hance Relational and Com- tion skills for medical pro- Research shows that shaving before surgery is asso-
munication Skills (PERCS), fessionals. For more in- ciated with more wound infections than removing
was developed at Childrens formation on PERCS, visit hair with clippers or not removing hair at all.
Hospital Boston. Using role- the National Association of Visit http://www.nursingcenter.com/poll to
playing with actors, this Childrens Hospitals and answer our monthly survey question and view results
day-long workshop helps Related Institutions Web from other surveys.
clinicians improve in- site at http://www.nachri.
teractions with children and org and search for PERCS.
their families on such sensi- Reference: SPIKESA six-step protocol for HEART FAILURE condition or the need for
delivering bad news: Application to the
tive topics as end-of-life patient with cancer, The Oncologist, WF Nurse-led care treatment changes.
treatment decisions, organ Baile, et al., August 2000. After 9 months, patients
improves outcomes with nurse-managed care
PATIENT TEACHING Patients with heart failure reported slight limitations
whose outpatient care is in physical functioning,
Health instructions: Too confusing? directed by nurses enjoy compared with marked
Most adults need help understanding health care instruc- better quality of life than limitations reported by self-
tions, according to a new report from the National Center patients who manage managed patients. Patients
for Educational Statistics (NCES). Researchers adminis- their own care, new re- with nurse-managed care
tered a series of health literacy tests to about 19,000 search suggests. The had 143 hospitalizations
people age 16 and older. Using the scores, researchers study involved 406 pa- compared with 180 for
divided people into four categories of health literacy: be- tients with left ventricular those who managed their
low basic, basic, intermediate, and proficient. Only 12% systolic dysfunction. own care.
were proficient. About half were African- Researchers conclude
The best possible score was 500 points. Women aver- American and one-third that nurse management can
aged 248 points, and men averaged 242 points. Adults age were Hispanic. Re- improve functioning and
65 and older had lower health literacy than younger adults. searchers randomly as- modestly lower hospitaliza-
Researchers say that many health-related in- signed patients to receive tions in ambulatory care
structions are written at a level thats nurse-led care or standard patients with heart failure.
above the average consumers literacy care (self-management) Source: Effects of nurse management on the
quality of heart failure care in minority
level and contain too much medical for 1 year. Nursing care communities, Annals of Internal Medicine,
JE Sisk, et al., August 15, 2006.
jargon. A simple example is a food involved counseling from
label listing sodium, which a bilingual nurse on diet,
could confuse a consumer look- drug adherence, and SMOKING CESSATION
ing for salt content. symptom management. Helping patients
Find the report, titled The Nurses also called pa-
Health Literacy of Americas tients once every 2 weeks kick the habit
Adults: Results from the 2003 at first, then once a Nurses who offer good ad-
National Assessment of Adult month, then once every 2 vice about smoking cessa-
Literacy, on the NCES Web months. Nurses kept each tion greatly increase the
site at http://nces.ed.gov/ patients primary care likelihood that a smoker
naal/. provider informed about will quit, according to re-
changes in the patients ports published in a spe-

34 Nursing2006, Volume 36, Number 11 www.nursing2006.com