Iran Journal of Nursing

Introduction
Sudden cardiac arrest is a leading cause of death and an important health problem. It occurs inside and outside the hospital, which necessitates the need for early diagnosis and treatment. In this regard, it is important for nurses to acquire the cardio pulmonary resuscitation (CPR) skills and know the latest changes in the CPR guidelines. The lack of knowledge and information about CPR can seriously affect clinical results and have medicolegal implications. In addition to knowledge, the attitude of the resuscitator can affect the rehabilitation process, since attitude is an essential component of competency. If CPR is performed immediately, it will save human lives in 40-60% of cases, which requires the appropriate skill and practice of resuscitators. The theoretical knowledge of how to perform CPR is necessary to perform it correctly. The nurses with good theoretical CPR knowledge show better CPR practice. Compliance with the instructions mentioned in the latest CPR guidelines can have a direct effect on the success of CPR. Therefore, it is necessary for health service providers, especially nurses and pre-hospital care emergency medical service personnel, to be aware of the latest CPR guidelines and to receive the necessary CPR training to apply the knowledge in clinical practice. The present study aims to investigate the knowledge, attitude, and practice of nurses and emergency medical technicians (EMTs) regarding the 2020 CPR guidelines in Ardabil, Iran.

Materials & Methods
In this descriptive study that was conducted in the autumn of 2022, 360 nurses and EMTs working in hospitals affiliated to the Ardabil University of Medical Sciences were included by stratified random sampling method. The entry criteria were consent to participate in the study and at least 6 months of work experience in the hospital. The exit criteria were unwillingness to participate in the study and incomplete responses to the questions.
Data collection was done using a researcher-made questionnaire. The first part surveys demographic characteristics and the second part, with 63 items, surveys knowledge (items 1-25; one point for correct answers or zero points for wrong answers), attitude (items 25-39 rated on a Likert scale from 0 to 4), and practice (items 40-63 rated on a Likert scale from 0 to 5) regarding the CPR guidelines. The validity of the questionnaire was approved based on the opinions of 10 faculty members. The internal consistency of knowledge, attitude, and practice subscales using Cronbach’s alpha coefficient was obtained as 0.76, 0.9, and 0.8, respectively. The data were analyzed in SPSS software, version 26 using descriptive statistics, Pearson’s correlation test, ANOVA, and t-test.

Results
Participants included 176 females (48.9%) and 184 males (51.1%). The mean age and mean clinical work experience were 32.40±6.05 years (ranged 22-50 years) and 8.09±50.50 years, respectively. Overall, the mean scores of knowledge, attitude, and practice scores were 15.42±4.07, 45.75±8.73, and 95.18±16.65, respectively. The EMTs had higher knowledge, attitude, and practice scores than nurses. Nurses’ scores were 14.01±3.47 (out of 25) in knowledge, 44.11±8.36 (out of 56) in attitude, and 90.33±16.40 (out of 120) in practice, while the EMTs’ scores were 18.66±3.46, 49.52±8.42 and 106.33±10.81, respectively. The nurses from the critical care units had the highest knowledge and attitude scores, and those from the pediatric units had the highest practice scores.
A significant difference was observed in the knowledge, attitude, and practice scores based on gender, where males had higher scores than females (P<0.05). On the other hand, a significant negative relationship was found between the history of CPR performance and educational level and the levels of knowledge, attitude, and practice (P<0.05), while no relationship was found based on age. 

Conclusion
This research showed that the knowledge of nurses and EMTs in Ardabil regarding the 2020 CPR guidelines is not enough, and this needs serious attention and continuous training and education. However, they have acceptable CPR attitude and practice. The knowledge of males was higher than that of females. Considering that most of the treatment staff in hospitals are female, special attention is required to train them and improve their knowledge. The current study showed the lower knowledge, attitude, and practice scores of nurses compared to EMTs, which requires attention to continuous training of nurses, attending regular and periodic CPR training courses, reading the latest CPR instructions, or including the CPR training in the curriculum of nurses. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Ardabil University of Medical Sciences (Code: IR.ARUMS.REC.1401.152).

Funding
This research was funded by Ardabil University of Medical Sciences (Grant No.: 401000326)

Authors' contributions
Conceptualization and project management: Mir Hossein Aghaei and Vahid Aghajafarpour; Investigation: Reza Ebrahim Oghli and Vahid Aghajafarpour; Data analysis: Reza Ebrahim Oghli; Editing and review: Mir Hossein Aghaei.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the Student Research Committee and the Deputy for Research of Ardabil University of Medical Sciences for their financial support, and all the nurses and emergency medical technicians participated in this study for their cooperation. 


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