Reflective accounts

Reflective account – in-hospital resuscitation

A CPD article improved Christine Mason’s knowledge of recognising and responding to patients in cardiac arrest.

A CPD article improved Christine Mason’s knowledge of recognising and responding to patients in cardiac arrest

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice?

The CPD article outlined the response sequence required for cardiac arrest in an in-hospital environment and discussed effective cardiopulmonary resuscitation (CPR) and defibrillation.

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What did you learn from the CPD activity, feedback and/or event and/or experience in your practice?

The article stated that the survival rate following in-hospital cardiac arrest remains low. It emphasised the importance of early recognition of cardiac arrest and responding immediately.

An algorithm outlined the immediate response sequence required for a patient who has collapsed. The ABCDE (airway, breathing, circulation, disability, exposure) approach should be used to assess the patient’s condition, and they should be reassessed regularly for changes in their presentation.

The article discussed several measures to improve the effectiveness of defibrillation. I have learned that transthoracic impedance is the resistance to electrical current flow across the chest wall, which can affect defibrillation. Ways to reduce transthoracic impedance include shaving any chest hair, avoiding breast tissue and applying adhesive defibrillator pads smoothly.

The article stated that minimising the pauses in chest compressions before and after defibrillation to within 5 seconds improves the patient’s chance of survival.

How did you change or improve your practice?

This article has improved my confidence and guided my practice in providing emergency care.

As a mental health nurse in an inpatient unit for older people with dementia, I often care for patients with comorbid physical illnesses. They are frequently unable to say they feel unwell, so it is essential for healthcare staff to be able to recognise changes in clinical presentation and to respond promptly and appropriately.

Reading the article has prompted me to consider how to improve a patient’s chances of survival following cardiac arrest. This will involve ensuring the CPR technique I deliver is optimised, using a ratio of chest compressions to ventilations of 30:2 for adults.

Chest compressions should be at a rate of 100-120 per minute and at a depth of 5-6cm.

If a bag-valve-mask device is used to deliver ventilations, a tidal volume of 500-600mL is optimal to inflate the lungs.

I plan to consider potential barriers to carrying out effective CPR in hospital, such as pressure-relieving mattresses and ergonomic difficulties.

I will work closely with the organisation’s resuscitation officer to consider staff training to enhance safety and check understanding of the response sequence required for a patient who has collapsed.

How is this relevant to the Code? Select one or more themes: Prioritise people, Practise effectively, Preserve safety, Promote professionalism and trust

One of the themes of The Code is to preserve safety. It states that nurses must work within the limits of their clinical competence, and the article reminded me to practise within my capabilities.

The Code emphasises that nurses must ask for help from suitably qualified or experienced clinicians where necessary. I will do this by working with the resuscitation officer, and by using their expertise to enhance my knowledge and improve clinical outcomes for older people with dementia.

Christine Mason is a mental health nurse at Elizabeth Court in Stevenage, Hertfordshire

This reflective account is based on NS857 Simpson E (2016) In-hospital resuscitation: recognising and responding to adults in cardiac arrest. Nursing Standard. 30, 51, 50-61. The questions are the same as those on the NMC templates that UK nurses and midwives must use for revalidation.

Write your own reflective account

You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. To write a reflective account for Nursing Standard, use the NMC reflective accounts form

Complete the four questions about the CPD article you have just read, writing about 800 words in total. Details of how to submit your reflective account are available here

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