The effects of music on the cardiac resuscitation education of nursing students

https://doi.org/10.1016/j.ienj.2016.06.007Get rights and content

Highlights

  • Listening to music during CPR education helps the development of mental memory.

  • Musical piece that enabled the students to remember the ideal rhythm for chest compression.

  • Chest compression with music can be easily integrated to the CPR education.

Abstract

Purpose

The purpose of this study is to examine the effects of music on the appropriate performance of the rate and depth of chest compression for nursing students.

Methods

This randomized controlled study was conducted in the School of Nursing in Turkey between November 2014 and January 2015. The study’s participants were second-year nursing school students with no previous formal cardiac resuscitation training (n = 77). Participants were randomly assigned to one of two groups: an intervention group with music and a control group without music. During practical training, the intervention group performed chest compressions with music. The outcomes of this study were collected twice. The first evaluation was conducted one day after CPR education, and the second evaluation was conducted six weeks after the initial training.

Results

The first evaluation shows that the participants in the intervention group had an average rate of 107.33 ± 7.29 chest compressions per minute, whereas the rate for the control group was 121.47 ± 12.91. The second evaluation shows that the rates of chest compression for the intervention and control groups were 106.24 ± 8.72 and 100.71 ± 9.54, respectively.

Conclusion

The results of this study show that a musical piece enables students to remember the ideal rhythm for chest compression. Performing chest compression with music can easily be integrated into CPR education because it does not require additional technology and is cheap.

Introduction

After cardiac arrest, ischemic injuries occur in the brain and heart within the first few minutes. Survival rates after the arrest depend on the immediate and effective application of basic and advanced life support (Paal et al., 2012). Immediate and correctly performed cardiopulmonary resuscitation (CPR) prevents neurological deficits and increases the quality of life of individuals after sudden cardiac arrest (Abella et al., 2005a, Lee and Low, 2010, Paal et al., 2012, Rawlins et al., 2009). Because of this, CPR is an important life-saving technique that increases survival rates by two to three times (Hafner et al., 2012, Hafner et al., 2015, Matlock et al., 2008), especially when chest compression is performed correctly (Abella et al., 2005a, Rawlins et al., 2009).

The American Heart Association (AHA) states that since tissue perfusion during CPR is completely tied to chest compression, such compression should be prioritized in CPR (Berg et al., 2010). The primary condition for increasing a patient’s survival rate and ensuring the efficacy of CPR is to perform chest compression at a constant rate (Hafner et al., 2012, Hafner et al., 2015, Matlock et al., 2008) and to limit the number of discontinuations as much as possible (Rawlins et al., 2009). An inadequate number of chest compressions decreases the survival rate (Woollard et al., 2012), whereas excessive chest compression results in stretching the sternum and negatively influences blood volume returning to the heart (Zhou et al., 2014). Accordingly, CPR guidelines suggest between 100 and 120 chest compressions per minute (AHA, 2015) in order to maintain blood flow after cardiac arrest (Wik et al., 2005).

Existing studies on CPR reveal that it remains ineffective (Hafner et al., 2012, Hafner et al., 2015, Naushaduddin et al., 2010, Paal et al., 2012) due to the fact that the number of chest compressions is lower or higher than the numbers suggested in AHA guidelines (Abella et al., 2005a, France et al., 2006, Hunt et al., 2009, Perkins et al., 2008, Wik et al., 2005, Zhou et al., 2014). Besides, the guidelines of the AHA (2010), Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) have not been transitioned into clinical practice (Hafner et al., 2012, Zhou et al., 2014). A study by Abella et al. (2005b) found that the number of chest compressions per minute for patients with cardiac arrest was below 90. On the other hand, a study by Wik et al. (2005) on paramedics and nurses found the number of chest compressions to be over 120. Therefore, educating health personnel on how to apply effective CPR is extremely important (Rawlins et al., 2009).

The CPR education of nurses who frequently encounter cardiac arrest is exceedingly important and compulsory (Hamilton, 2005). However, the skills gained during CPR education are not long lasting (Hamilton, 2005), and health personnel are not able to, or are not aware of, performing the suggested number of chest compressions (Hafner et al., 2012). Considering this, nurses should be educated with the most recent and appropriate knowledge about resuscitation and be able to put this theoretical knowledge into practice (Sullivan et al., 2015). Since lectures on CPR education are part of undergraduate programmes for nursing students, the CPR-related skills of these students have been frequently observed. However, these studies note that theoretical knowledge and skills are forgotten over time. The case is no different for graduates of nursing programs (Madden, 2006, Dal and Sarpkaya, 2013).

Performing the recommended number of chest compressions per minute during CPR training may be a hard task (France et al., 2006, Rawlins et al., 2009). In order to overcome this difficulty and to find the required rhythm, various techniques have been suggested, including music and the use of metronomes (Hafner et al., 2015, Matlock et al., 2008, Naushaduddin et al., 2010, Paal et al., 2012, Rawlins et al., 2009). For this purpose, popular songs have been used worldwide (Matlock et al., 2008) in the application of CPR. One of these songs used to apply the appropriate rhythm for CPR is entitled “Stayin’ Alive”, by the Bee Gees (Hafner et al., 2015, Rawlins et al., 2009, Woollard et al., 2012). Other music used widely to assist CPR rhythm includes “Nellie the Elephant” and “Macarena” (Oulego-Erroz et al., 2011, Rawlins et al., 2009). Since neither the rhythm nor emphasis changes for these songs, they create the effect of a mental metronome and can be easily remembered (Hafner et al., 2012, Hafner et al., 2015, Matlock et al., 2008, Oulego-Erroz et al., 2011, Rawlins et al., 2009, Woollard et al., 2012).

Various studies exist on the use of music in CPR in the context of the education of medical students, paramedics, and students from non-health-related fields. Hafner et al. (2012) and Matlock et al. (2008) used “Stayin’ Alive” during the CPR training of health personnel and medical students. Both studies show that music helped the participants perform the ideal chest compression rate (Hafner et al., 2012, Matlock et al., 2008). After watching a CPR education video using the music for “Stayin’ Alive”, Naushaduddin et al. (2010) stated that chest compression rates of emergency nurses and doctors were 117.3 per minute. Similarly, a study by Oulego-Erroz et al. (2011) on students aged 13–14 showed that music helped the students reach ideal chest compression rates. Hafner et al. (2015) found that the use of pop music such as “Stayin’ Alive” to establish the appropriate chest compression rhythm was effective among university students. These studies show that music helped the participants perform the ideal chest compression rate. However, no studies on music’s effect on chest compression rates has been conducted among nursing students who received CPR education for the first time. We predict that developing musical memory will be easier for participants who have learned to perform CPR for the first time. This study aims to analyze the short- and long-term impact of musical memory on the appropriate performance of the rate and depth of chest compression for nursing students who receive CPR education for the first time.

Section snippets

Study design and setting

This research was planned and conducted as a randomized controlled trial. The study was conducted in the School of Nursing in Turkey between November 2014 and January 2015. There are different nursing education systems in Turkey. An integrated education model is used in the nursing school where the study was conducted. The curriculum consists of committees. The first-year committees are interested in four basic nursing concepts (e.g., the structure and nature of the human body, society and the

Characteristics of the study subjects

Table 1 demonstrates some of the descriptive characteristics of the participants. All of the participants were female, and their average age was 20. No statistically meaningful difference was found between their body mass indexes, and their smoking and exercise habits (p > 0.05).

Chest compression results

Table 2 shows the rate and depth of chest compressions performed by the nursing students and the evaluations conducted one day (first evaluation) and six weeks (second evaluation) after CPR education. The first evaluation

Discussion

This study analyzed the impact of musical memory during CPR education on the rate and depth of chest compression performed by nursing students in the short and long term. The first evaluation of short-term memory conducted after CPR education showed that most of the students in the intervention group could perform the ideal rate of chest compression (100–120 beats per minute), as suggested by the guidelines. However, more than half of the students in the control group performed higher than the

Conclusion

This study found that a musical piece that enabled students to remember the ideal rhythm for chest compression in an easy way helped them to succeed in performing chest compression at ideal rates in the short and long-term. Besides, the results of the depth of chest compression were satisfactory in both groups. The technique of performing chest compression with music can easily be integrated into CPR education since it does not require additional technology and is not expensive. Besides,

Conflict of interest

There is no personal conflicts of interest.

Funding

No funding.

Ethical approval

Gulhane Military Medical Academy ethical review board – 4193/14.

Clinical resources

American Heart Association (AHA) Highlights of the 2010 American Heart Association Guidelines for CRP and ECC. Available from http://www.guidelines.ecc.org.

Acknowledgment

We would like to thank all the students for the participants’ study. We also wish to thank Dr. Cengizhan AÇIKEL for the statistical analysis of our study.

References (25)

  • X.L. Zhou et al.

    Medical students do not adversely affect the quality of cardiopulmonary resuscitation for ED patients

    Am. J. Emerg. Med.

    (2014)
  • B.S. Abella et al.

    Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest

    JAMA

    (2005)
  • Cited by (0)

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