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03 October 2000

CPR Training for Parents of High-Risk Neonates Improves Family Adjustment at Home

Finds Managed Care Not Always Better for Preventive Medicine
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. However, 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.

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