COHORT STUDY TO EVALUATE NURSING TEAM PERFORMANCE IN A THEORETICAL TEST AFTER TRAINING IN CARDIOPULMONARY ARREST

O objetivo deste estudo foi avaliar o conhecimento teórico da equipe de enfermagem quanto ao atendimento a vítimas de parada cardiorrespiratória (PCR) antes, imediatamente após e decorridos seis meses de treinamento. Usou-se o método estudo de coorte, conduzido em um hospital especializado em cardiologia, Porto Alegre, RS (novembro/2005 a maio/2006). Incluíu-se enfermeiros (35 no pré-teste, 34 no pós e o mesmo número após seis meses), técnicos e auxiliares (232 no pré, 227 no pós e 104 após seis meses). Aplicou-se um questionário nos três períodos, considerando-se ‘conhecimento satisfatório’ 75% de acertos. Os resultados mostraram, no pré-teste, que 62,9% dos enfermeiros atingiram o percentual considerado satisfatório, no pós, 94,1% e decorridos seis meses, 64,7%. Entre os técnicos e auxiliares, no pré, 36,2% atingiram o percentual considerado satisfatório, no pós, 79,3% e 62,5% decorridos seis meses. Conclui-se que o treinamento em PCR melhora o conhecimento da equipe logo após o treinamento, havendo redução do escore de acertos após 6 meses.

A recent study, which aimed to evaluate the human factors that could affect the quality of cardiopulmonary resuscitation care, found that health professionals fail to provide basic life support and defibrillation within an appropriate minimum period of time.In addition, lack of leadership and inadequate task distribution were associated with the team's poor performance (3) .Other studies have also evaluated how well the professionals maintain the knowledge and skills learned during CPA training courses.Those studies report that, if the skills are not systematically practiced or reviewed after training, the professionals' performance diminishes proportionally with time (4)(5) . is considered to be satisfactory (6) .

Statistical analysis
The

Sample characteristics
Of all the nurses working at the institution For the other questions, the performance on the theoretical test did not differ between evaluation periods.Other data are shown in Table 1.For nurses, the mean score was 6.8±1.6 in the pre-training test, 7.9±0.9 in the post-test, and 6.7±1.6 after six months, from a total of 9 points (p=0.001).This difference was significant between the pre and post periods (p=0.006), and between the post-test and six-month test period (p=0.001).Data are shown in Figure 1.As for technicians and assistants, the mean score in the pre-test was 7.6±1.8,against 9.6±1.5 in the post-test, and 9.3±1.8(p<0.001) after six months, out of a total 12 points.This difference was significant between the pre and post (p<0.001)periods, and between the pre-training and six-months-later periods (p<0.001), as shown in Figure 2. the stronger their participation (7) .
As to the performance in the theoretical test, the literature has presented similar results.A study that evaluated the knowledge and practical skills in basic life support of 19 nurses, after three hours of a recycling course, showed an initial improvement, with a significant reduction in knowledge after 10 weeks.
The findings were attributed to the fact that, if the skills are not practiced or used regularly, there is a decrease in what was learned (4) .Another study, which The results showed better performance shortly after the training course, but a significant reduction in performance two and a half months later; nevertheless, there were improvements in the results compared to the pre-test, which suggests a positive knowledge assimilation (5) .
Although only the theoretical knowledge of the nursing team was evaluated, this study's findings are in agreement with these and other studies that show that the professional's knowledge retention is harmed in a three-month period, significantly decreasing within 6 to 12 months after the training course.Hence, it is stressed that the knowledge and skills acquired during a training program reduce with time (6,(8)(9) .On the other hand, perhaps the team that attended the training course did not seek, on its own, strategies to maintain the skills acquired in the training course.
Authors of a 2004 study evaluated if the frequency of an Immediate Life Support course affected the nurses' performance.In this study, the authors collected data in every instance of CPA care over the preceding twelve months, before and after implementing the course.The study results showed that the nurses felt confident during the CRA care delivered shortly after the course but that, with time, they felt incapable of performing the competencies without supervision (10) .These results reinforce the need for systematic and more frequent training since, in fact, the acquired knowledge is reduced and abilities are lost if they are not practiced.
Among the nurses from intensive care units, the mean score in the pre-and post-training period was significantly higher compared to those working in hospitalization units.This difference did not occur after six months of training.Among technicians and assistants, the professionals from intensive care units only had a higher mean score than those working in hospitalization units in the test held six months after the training course (p<0.001).These data suggest that professionals from critical units work with more unstable patients and that, therefore, there is a greater chance of being involved in CPA situations.
In this environment, these professionals can practice their abilities and competencies.

(
n=52), 35 took part in the pre-test, and 34 in the post-test and in the test six moths later.They answered the questionnaire in the three evaluation periods.These professionals' average age was 32±7.3 years.Of all nursing technicians and assistants (n=362) working at the institution, 232 took part in the pre-test, 227 in the post-test, and 104 in the test held six months after the training course.These professionals' average age was 35.6±8.2 years.There were more women than men.Among the nurses working in clinical and surgical hospitalization units during the training period (n=32), 17 answered the pre-test, 18 the post-test, and 12 answered the test six months after the training course.Of all nurses from the intensive care unit (n=20), 14 participated in the pre-test, 13 in the posttest, and 19 in the test held six months later.In terms of the total number of nursing technicians and assistants working at the institution (n=362), 167 worked in clinical and surgical hospitalization units, 106 of which answered the pre-test, 98 answered the post-test, and 57 answered the test six months later.Of the 195 professionals working in intensive care units, 125 participated in the pre-test, 129 in the post-test, and 47 in the test six months after training.Nurses' performance on the theoretical test In the nurse group, the questions that showed different frequencies of correct answers in the theoretical test held before training, after training, and six months later referred to the joules load in the first defibrillation, the compression/ventilation ratio, and the number of compressions per minute.
Comparing nursing technicians and assistants in terms of their performance on the theoretical test, it was observed that there was a significant difference in the frequency of correct answers to every question was observed in the pre-test, post-test, and in the test six months later.The team's performance immediately after the training course was better in ten out of twelve questions.Six months later, six questions showed a reduction in the score compared to the post-training period and, in six others, the percentage with 75% was greater.The other data are shown in

Figure 1 -
Figure 1 -Mean correct answers among nurses in the theoretical test before training, after training, and six months later (ANOVA)

Figure 2 -
Figure 2 -Mean score among technicians and assistants in the theoretical test before training, after training, and six months later (ANOVA) tested a similar strategy, investigated at what point nursing students acquired and assimilated knowledge in cardiopulmonary resuscitation.Tests were performed before a four-hour training course about cardiopulmonary resuscitation, and two and a half months after the course.
Study limitations Some limitations should be highlighted in the present study.Since the training course was a goal established by the studied institution's scientific nursing commission, there was no interest in identifying the team that answered the questionnaire.This made it less feasible to perform individual analyses during the studied periods.CONCLUSIONS This study showed that the nurses' performance on the CPA theoretical test was worse than before the training course.After training, 90% of those professionals achieved the recommended score for a satisfactory performance, but the score reduced after six months.The nursing assistants had a similar performance to that of nurses in the tests before training, after training, and six months later.These results support the data from the literature, showing there is a need to maintain continuous training in cardiopulmonary resuscitation.Institutions should invest in regular training programs, implementing theoretical and practical sessions, with an increased exposure to possible CPA cases.Furthermore, professionals should seek research strategies with a view to improving and maintaining their own performance over time.It is believed that additional studies, comparing different time periods after the training course and evaluating individual performances, if necessary, would provide valuable information.
analyses were done using Statistical Package for Social Sciences (SPSS) 12.0.The categorical variables were expressed in percentages or absolute value, as continuous variables, and as means ± standard deviation.To compare continuous Cohort study to evaluate nursing team performance… Brião RC, Souza EN, Castro RA, Rabelo ER

Table 1 -
Nurses' performance in the theoretical test before training, after training, and six months later.Porto

Table 2 -
Nursing technicians' and assistants' performance on the theoretical test before training, after training, and six months later.Porto Alegre, November, 2005 to February, 2006