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Cardiopulmonary resuscitation (CPR) is an important skill for any parent to learn, but for those with babies or young children in intensive care who are at high risk for apnea, it is vital. That’s why the children at Sacred Heart Medical Center in Spokane, WA, who are going home on oxygen, on a monitor, or with other medical problems that could cause breathing cessation are not discharged until parents have completed the CPR class. The class is open to anyone, but tends to be filled with parents who have children in the pediatric intensive care unit or neonatal intensive care unit.
Those who are required to take the class don’t always want to cooperate, and this can be a teaching barrier. "It tends to be young moms, and I think they may be intimidated by the older moms," says Connie Mutton, RN, BSN, neonatal case manager at Sacred Heart. To overcome this barrier, Mutton often groups the younger moms together or she will have a young mom do the return demonstration after the rest of the class has left.
Non-English-speaking parents can pose challenges as well. To meet the needs of this group, Mutton and other instructors will arrange classes for parents individually or with other families that speak the same language. When the CPR instructors tried to incorporate non-English speakers into the regular classes with the English-speaking parents, it was confusing for everyone because the interpreter was a distraction, explains Mutton.
To make teaching non-English speaking parents easier, the Medical Center developed a Spanish version of its infant CPR film. There’s also a one-page handout available with step-by-step instructions in Spanish, Russian, and Chinese.
While return demonstration always is important, it’s even more important when teaching through an interpreter, says Katie Gilleran, RN, BSN, pediatric case manager at Sacred Heart Medical Center. It’s the only way that the instructor can know for sure that the concept was clear to the parents. Often, cultural differences must be overcome to get both parents to demonstrate back. For example, sometimes it takes a little more time to get fathers in Hispanic cultures to demonstrate CPR on a doll because they usually don’t do that sort of thing.
Interpreters need to be included in the teaching whenever the child has a complex medical issue, and it is important when teaching CPR to select one that is not only familiar with medical terminology, but CPR if possible. "Frequently with our Spanish-speaking families, I use an interpreter who is actually trying to become a CPR instructor, so I am very comfortable that she is teaching what I am saying," says Gilleran.
Whether the parents speak English or not, it’s important that they practice CPR techniques following the class. Therefore, using a documentation sheet, the CPR instructor checks off all the steps of CPR that the parent is able to do correctly during the return demonstration. For example, whether they can blow correctly or locate the mark to do the decompressions.
The form is sent to the intensive care unit, and a nurse completes it at the bedside with the parents transferring what they learned to their own baby. For example, parents would identify the baby’s nipple line and show where they would place their fingers for CPR. "During this time, the nurse will ask questions such as, If you walk into the room, and your baby is blue, what are you going to do?’ They just keep reinforcing the steps," says Mutton.
Also, parents are told to review the steps daily on their own. Mutton suggests that parents of premature babies ask themselves each morning while they are changing their baby’s diaper, what they will do that day if their baby quits breathing, she explains.
sources For more information about teaching parents CPR, contact:
• Katie Gilleran, RN, BSN, Pediatric Case Manager, Sacred Heart Medical Center, W. 101 8th Ave., Spokane, WA 99220. Telephone: (509) 474-2177.
• Connie Mutton, RN, BSN, Neonatal Case Manager, Sacred Heart Medical Center, W. 101 8th Ave., Spokane, WA 99220. Telephone: (509) 474-2176. E-mail: MuttonC@shmc.org.