CPR training for parents of high-risk neonates improves family adjustment at home

Cardiopulmonary (CPR) training can relieve stress for parents and improve
survival outcomes for infants at high risk for cardiopulmonary arrest, a new
study has found. The training is most effective when delivered in the format
that includes CPR training combined with continued telephone support by a
health care professional, said Kathleen Dracup, RN, DNSc, lead author of the
study, professor and dean of the UCSF School of Nursing.

Though parents of infants hospitalized in the neonatal intensive care unit are
routinely taught CPR as part of the preparation for transition home, few data
existed about the manner in which CPR should be taught to parents, explained
Dracup. “The manner of teaching CPR is important because changes in healthcare
financing have translated into higher infant-staff ratios in neonatal and
pediatric intensive care units, making it more difficult to do one-to-one CPR
instruction,” she said.

In the study, which appears in the September issue of Critical Care Medicine
(the journal for The Society of Critical Care Medicine), researchers also
analyzed the psychosocial consequences of teaching CPR to ethnically diverse
parents. They measured parents’ levels of adjustment to caring for a high-risk
newborn, anxiety and depression. “On the one hand, parents feel reassured by
receiving CPR training because it provides them with concrete skills to use in
an emergency,” Dracup said. On the other hand, other research has indicated
that CPR training may increase the stress parents already feel, by reminding
them that their infant may experience a sudden cardiac arrest at home, she
explained.

The researchers compared the effects of three different types of CPR training
on parental anxiety and adjustment: CPR given by an instructor, CPR video with
no instructor present, and CPR given by an instructor, combined with a social
support intervention. Anxiety decreased significantly over time in all groups
except the CPR-Video group, she explained. Overall, the CPR-social support
group fared best with regard to adjustment and anxiety reduction, followed by
the CPR-instructor group, she said.

The CPR-instructor and CPR-social support groups were modeled after standard
CPR classes offered in community settings. The CPR-social support group was
different in that the instructor began the class with a brief discussion of the
feelings involved in bringing home an infant with special health needs. In this
group, CPR training was followed by a 30-minute discussion among participants
about fears related to learning CPR and about caring for the infant at home. 
The social support intervention was continued in the form of weekly telephone
calls for one month and then monthly for another five months by the same
clinical nurse specialist who taught the initial CPR class.

The findings of the six-month study, support the positive effects of helping
parents prepare for a home emergency by teaching CPR, either in combination
with social support or in the more traditional format with an instructor, said
Dracup.  “Our findings demonstrate that CPR training does not add to the burden
facing parents of high-risk newborns when they take their children home.”

At the one year follow-up after CPR training, 13 cardiac arrests occurred at
home. In all 13 cases, infants were successfully resuscitated, she said.

Co-investigators on this study include Debra K. Moser, RN, associate professor
in the Ohio State University College of Nursing; Lynn V. Doering, RN, assistant
professor in the UCLA School of Nursing; Peter M.Guzy, MD, PhD, UCLA professor
of medicine and cardiology; and Teresa Juarbe, RN, PhD, UCSF assistant
professor of family health care nursing. This research was supported by a grant
from the National Institute of Nursing Research.