CHAPTER II REVIEW OF RELATED LITERATURE

This chapter includes studies and articles regarding the different issues associated with the study taken locally and internationally. This is divided into four parts: the annotated review, synthesis, conceptual framework, and paradigm.

Socio-demographic Profile Age Sun Coast Hospital Pharmacy. (2010). Age Specific Competencies and Skills. USA: Sun Coast Pharmacy According to Sun Coast Hospital Pharmacy, age-specific competencies are skills that you use to give care that meets each patients unique needs. Understanding these stages of life is the key to age-specific competencies. Young adults reach physical and sexual maturity. Muscular efficiency is at its peak between the ages of 20-30; Growth of skeletal system continues until age 30, some experience loss in hearing, especially high tones. Young adults mental abilities reach its peak during their twenties; reasoning skills, information recall, verbal skills are used to solve problems. In regards to communication, one must be supportive and honest and respect personal values. Watch body language as a cue for feelings. Adults continue to decline in physical abilities and are at increasing risk for chronic illness and major health problems. They continue to learn and their memory skills and/or speed of learning may decline. Confusion often signals illness or a medication

problem. Expression of feelings, thoughts, avoiding despair, using humor, and staying positive are highly encouraged for this age group. As middle adults begin to age, there is decreased muscle strength and mass. Without regular exercise their endurance declines. Middle adults use life experiences to learn, create, and solve problems. They hope to contribute to future generations, keep a hopeful attitude and focus on strengths, not limitations. As older adults age gradually, there is a natural decline in some physical abilities and senses. They continue to be active learners and thinkers. Their memory skills may start to decline. One must give respect, prevent isolation and encourage acceptance of aging. The article states that in different age group, they have individualized level of knowledge and different acquisition of skills based on their level of understanding. The article also includes that in every age group there are different factors that could affect the ways on how they accept a new learning and there are also challenges that could hinder the acceptance of the new knowledge. This literature was utilized in the analysis and interpretation of the study.

Gender Rogers, K. (2010). Who have better memories: Men or Women? Retrieved last September 19, 2012 from http://www.britannica.com/blogs/2008/02/who-hasa-better-memory-man-or-woman/ Women have the upper hand in storing and recalling verbal episodic memories, whereas men have the upper hand in storing and recalling visuospatial episodic

memories. Scientists have also discovered that women are very adept at remembering the faces of strangers and nearly anything associated with emotion, which may or may not be stored as episodic memory. This literature was utilized in analysis and interpretation of the study.

Salthouse, R. (2008). Understanding Human Development: Dialogues with Lifespan Psychology. Dordretch, The Netherlands; Kluwer Academic Publishers Age differences are reduced in tasks with moderate to large knowledge involvement not because of changes in the predictive value of different factors at different ages but because the average level of one performance determinant (knowledge) tends to increase with age at the same time that the average level of the other performance determinant (speed) tends to decrease. This literature was utilized in analysis and interpretation of the study.

Highest Educational Attainment Labiad, N. (2013). Educational Attainment and Learning Outcomes: Implications for Youth in Labour Market. Lombard, Italy: University of Bergamo. Completing a school year successfully does not guarantee that certain skills and knowledge is acquired or learned. For example, learning outcomes of 15 years of education is not the same in a country with generally high quality of education and in one with lower quality education. Therefore, the question of quality of learning is invaluable; one way to measure such quality in education is the assessment of learning outcomes. The educational attainment indicator needs to be accompanied by the assessment of

learning outcomes. In other words, in addition to considering what is studied and for how long, we should consider what is learned and how well it is learnt. This literature was utilized in the analysis and interpretation of the study.

Education Policy and Data Center (2012). Literacy and Educational Attainment. Connecticut Ave. NW Washington, DC 20009-5721 Literacy levels and educational attainment serve as indicators of the knowledge and skills that a population possesses. While indicators of literacy and educational attainment both capture information about the human capital resources of a population, caution should be used with educational attainment levels which, unlike literacy, do not necessarily testify to mastery of a particular skill or provide information about the quality of education achieved. This literature was utilized in analysis and interpretation of the study.

Barangay Health Worker Department of health. (2011). What is a Barangay Health Worker? Retrieved last October 11, 2013 from http://www.doh.gov.ph/content/what-barangay -health-worker.html According to Republic Act No. 7883 otherwise known as "The Barangay Health Workers' Benefits and Incentives Act of 1995," In Section 3 the term barangay health workers is defined as to a person who has undergone training programs under any accredited government and non-government organization and who voluntarily renders primarily health care services in the community after having been accredited to function

as such by the local health board in accordance with the guidelines promulgated by the Department of Health (DOH). A Barangay Health Worker is qualified to provide primary health care services in the community it is serving based on the guidelines given by the (DOH) such as: giving of first aid, equipment sterilization, assisting in health center activities, collecting vital statistics, maintaining records and making reports, participating in community meetings, assisting in nutrition education, monitoring and feeding, assisting in immunization education, monitoring, and dispensing, assisting in family planning services and assisting in sanitation and hygiene promotion and education. In recognition of their services, all accredited BHWs who are actively and regularly performing their duties shall be entitled to the following incentives and benefits: Hazard Allowance for BHWs exposed to situations, conditions or factors in the work environment or place where foreseeable or unavoidable danger or risks exist which adversely endanger his health or life and/or increase the risk of producing adverse effect on his person in the exercise of his duties, to be validated by the proper authorities in an amount to be determined by the Local Health Board and the local peace and order council of the LGU concerned; Subsistence allowance for BHWs whom render service within the premises of isolated barangay health stations (BHS)in order to make their services available at any and all times equivalent to the meals they take in the course of their duty computed in accordance with the prevailing circumstances as determined by the LGU concerned; Training and education and career enrichment programs (TECEPS)-the DOH in accordance with the Department of Education, and other concerned agencies and nongovernment organizations shall provide opportunities for the following: educational

programs which shall recognize years of primary health care service as credits to higher education in institutions with stepladder curricula that will entitle BHWs to upgrade their skills and knowledge for community work or to pursue further training as midwives, pharmacists, nurse or doctors, continuing education, study and exposure tours, training, grants, field immersion, scholarships, scholarship benefits in the form of tuition fees instate colleges to be granted to one child of every BHW who will not be able to avail of the above programs; and special training programs such as those on traditional medicine, disaster preparedness and other programs that address emergent community health problems and issues; Civil service eligibility a second grade eligibility shall be granted to BHWs who have rendered (5) years continuous service as such, provided that should the BHW become a regular employee of the government, the total number of years served as BHW shall be credited to his/her service in computing retirement benefits; Free legal services legal representation and consultation services shall be immediately provided by the Public Attorneys Office (PAO) in cases of coercion, interference, and in other civil and criminal cases filed by or against BHWs arising out of or in connection with the performance of their duties as such; and Preferential access to loan the agencies providing loan services will set aside one per cent (1%) of their loanable funds for organized BHW groups that have community-based income generating projects in support of health programs or activities.

Cardiopulmonary Resuscitation Body Parts and Functions

National Heart Lung and Blood Institute. (n.d.). How the Heart Works. Retrieved last August 20, 2013 from http://www.nhlbi.nih.gov/health//dci/Diseases /hhw/hhw_all.html The heart is a muscular organ that acts like a pump to continuously send blood throughout your body. It is at the center of the circulatory system. This system consists of a network of blood vessels, such as arteries, veins, and capillaries. These blood vessels carry blood to and from all areas of the body. An electrical system regulates the heart and uses electrical signals to contract the heart's walls. Blood is pumped into the circulatory system upon contraction of the walls of the heart. A system of inlet and outlet valves in the heart chambers work to ensure that blood flows in the right direction. Heart is vital to health and nearly everything that goes on in the body. Without the heart's pumping action, blood cannot circulate within the body. Blood carries the oxygen and nutrients that your organs need to work normally. Blood also carries carbon dioxide, a wasted product, to your lungs to be passed out of the body and into the air. This literature was utilized to formulate the questionnaire.

Rosenberger, E. (2009). The Functions of Red Blood Cells. Retrieved last August 20, 2103 from http://www.helium.com/items/763669-the-functions-of-redblood-cells

Red blood cells, known also as RBCs, have several important roles to play in the body. The primary function of red blood cells is to carry oxygen from the lungs to the tissues around the body. As a secondary function, it is also a key player in getting waste carbon dioxide from tissues to the lungs, where it can be breathed out. A typical RBC is about 6-8 micrometers in diameter, about the same as the width of a spider web strand. An RBC is biconcave in shape. The oxygen carried in the red blood cells is stored in a special protein known as hemoglobin. This literature was utilized to formulate the questionnaire.

Pew Research Center (2013). Publics Knowledge of Science and Technology. Retrieved last September 7, 2013 from http://www.people-

press.org/2013/04/22/publics-knowledge-of-science-and-technology/ A study done by Pew Research Center about the publics knowledge of Science and Technology states that about 7 out of 10 respondents, who have finished education from high school graduate to college graduate, know that the basic function of red blood cells is to carry oxygen to all parts of the body. This literature was utilized in the analysis and interpretation of the study.

Pollak, A. (2011). Emergency Care and Transportation of the Sick and Injured (10th ed.). Canada: Jones and Bartlett Publishers Perfusion is the delivery of blood and oxygen and other essential nutrients to the bodys cells to keep them alive. While delivering these essential components to the bodys cells, waste products such as carbon dioxide are removed from the cell and

eliminated from the body. Adequate perfusion is the responsibility of the perfusion triangle, which consists of three essential components: a functioning pump (the heart), adequate volume (the blood and water), and an intact container (the blood vessels). This literature was utilized to formulate the questionnaire.

University of Rochester Medical Center. (2013). Respiratory System. Retrieved last August 20, 2013 from

http://www.urmc.rochester.edu/Encyclopedia/Content.aspx?ContentTypeID =90&ContentID=P02408 The lungs take in oxygen, which the body's cells need to live and carry out its normal functions. The lungs also get rid of carbon dioxide, a waste product of the cells. The lungs are a pair of cone-shaped organs made up of spongy, pinkish-gray tissue. They take up most of the space in the chest, or the thorax (the part of the body between the base of the neck and diaphragm). The lungs are enveloped in a membrane called the pleura. This literature was utilized to formulate the questionnaire.

Des Jardins, T. (2008). Cardiopulmonary Anatomy & Physiology: Essentials for Respiratory Care (5th e.d.). USA: Delmar Cengage Learning

The term ventilation is defined as the process that moves gases between the external environment and the alveoli. It is the mechanism by which oxygen is carried from the atmosphere to the alveoli and by which carbon dioxide (delivered to the lungs in mixed venous blood) is carried from the alveoli to the atmosphere. This literature was utilized to formulate the questionnaire

Definition Knoop, K. et al. (2012). Atlas of Emergency Medicine (2nd ed.). New York, USA: McGraw Hill According to Knoop, Cardiopulmonary Resuscitation (CPR) is a procedure to support and maintain breathing and circulation for an infant, child, or adolescent who has stopped breathing (respiratory arrest) and/or whose heart has stopped (cardiac arrest). CPR is part of the emergency cardiac care system designed to save lives. Many deaths can be prevented by prompt recognition of cardiopulmonary arrest and notification of the emergency medical system (EMS), followed by early CPR, defibrillation (which delivers a brief electric shock to the heart in attempt to get the heart to beat normally), and advanced cardiac life support measures. When performed by a layperson, CPR is designed to support and maintain breathing and circulation until emergency medical personnel arrive and take over. When performed by healthcare personnel, it is used in conjunction with other basic and advanced life support measures. CPR must be

performed within four to six minutes after cessation of breathing to prevent brain damage or death. CPR consists of rescue breathing, which delivers oxygen to the victim's lungs, and external chest compressions, which help circulate blood through the heart to vital organs. In this article, cardiopulmonary resuscitation is basically a procedure to restore the breathing or circulation of the victim. Rescue breathing, which provides oxygen to a person's lungs and chest compressions, which keep the person's blood circulating are performed in CPR. CPR can be lifesaving, but it is best performed by those who have been trained in an accredited CPR course. This literature was utilized to formulate the questionnaire. Berg, R. et. al. (2010). American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Retrieved last August 20, 2013 from http://circ.ahajournals.org/content/122/18_supplfull Recognition of cardiac arrest is not always straightforward, especially for laypersons. Any confusion on the part of a rescuer can result in a delay or failure to activate the emergency response system or to start CPR. Precious time is lost if bystanders are too confused to act. Therefore, these adult BLS Guidelines focus on recognition of cardiac arrest with an appropriate set of rescuer actions. Once the lay bystander recognizes that the victim is unresponsive, that bystander must immediately activate or send someone to activate the emergency response system. Once the healthcare provider recognizes that the victim is unresponsive with no breathing or no normal breathing such as gasping, the healthcare provider will activate the emergency response system. After activation, rescuers should immediately begin CPR.

Early CPR can improve the likelihood of survival, and yet CPR is often not provided until the arrival of professional emergency responders. Chest compressions are an especially critical component of CPR because perfusion during CPR depends on these compressions. Therefore, chest compressions should be the highest priority and the initial action when starting CPR in the adult victim of sudden cardiac arrest. The phrase push hard and push fast emphasizes some of these critical components of chest compression. High-quality CPR is important not only at the onset but throughout the course of resuscitation. Early CPR can improve the likelihood of survival, and yet CPR is often not provided until the arrival of professional emergency responders. Chest compressions are an especially critical component of CPR because perfusion during CPR depends on these compressions. Therefore, chest compressions should be the highest priority and the initial action when starting CPR in the adult victim of sudden cardiac arrest. The phrase push hard and push fast emphasizes some of these critical components of chest compression. High-quality CPR is important not only at the onset but throughout the course of resuscitation. This literature was utilized to formulate the questionnaire.

Larmon, B., et al. (n.d). Basic Life Support Skills. Toronto, Canada: Prentice Hall According to Larmon, the steps in CPR (compressions, airway, and breathing) should be used whenever someone is not breathing and when the heart is not beating. After two rescue breaths are given, 30 chest compressions should be started right away. Someone can stop breathing and/or have cardiac arrest from: heart attacks, strokes (when the blood flow to a part of the brain suddenly stops), choking on something that blocks

the entire airway near-drowning incidents (when someone is underwater for too long and stops breathing), a very bad neck, head, or back injury, severe electrical shocks (like from touching a power line), very sick from a serious infection, too much bleeding, severe allergic reactions, swallowing a drug or chemical. In this article, CPR is done to patients usually with heart attack. CPR promotes airway, breathing and circulation. CPR is not for patients without signs of life or when the brain matters are exposed from inside out, and are decapitated. This literature was utilized to formulate the questionnaire.

American Heart Association. (2012). BLS for Healthcare Providers. Texas, Dallas: American Heart Association The American Heart Association (AHA) has adopted, supported, and helped develop the concept of emergency cardiovascular care (ECC) for many years. The term Chain of Survival provides a useful metaphor for the elements of the ECC systems concepts. The five links in the adult Chain of Survival are: Immediate recognition of cardiac arrest and activation of the emergency response system; Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions; Rapid defibrillation; Effective advance life support and Integrated post cardiac arrest care. Although basic life support is taught as a sequence of distinct steps to enhance skills retention and clarify priorities, several actions should be accomplished simultaneously when multiple rescuers are present. The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) recommend a change in

the basic life support sequence of steps from A-B-C (Airway, Breathing, Chest compressions) to C-A-B (Chest compressions, Airway, Breathing) for adults, children, and infants. The change in CPR sequence requires reeducation of everyone who has ever learned CPR. This was done to improve survival rates of the victims. In the A-B-C sequence, chest compressions were often delayed while the rescuer opened the airway to give mouth to mouth breaths, retrieved a barrier device, or gathered and assembled ventilation equipment. By changing the sequence to C-A-B, rescuers can start chest compressions sooner, and the delay in giving breaths should be minimal. This literature was utilized to formulate the questionnaire. Chris (2011). CPR Guidelines for American Heart Association and American Red Cross. Retrieved last October 11, 2013 from http://inhomecpr.com/in_home_cpr_news/cpr-guidelines-for-americanheart-association-and-american-red-cross/

American Heart Association

1) Make sure the scene is safe before approaching the victim; 2) Check to see if the person responds by tapping the victim and shouting, Are you OK?; 3) If the person

doesnt respond, get help. Have you and someone else call 911 and get an AED (automated external defibrillator) if available; 4) Check for breathing. The breathing

should be normal, not gasping. If the person is not breathing or only gasping, they need CPR; 5) Begin CPR with 30 chest compressions. Push down at least 2 inches. The rate

of compressions is at least 100 compressions a minute. After each compression let the

chest come back up to its normal position; 6)

Open the airway with a head tilt-chin lift

and give 2 breaths; 7) Continue giving 30 compression and 2 breaths until the person starts to respond, you are too exhausted to continue, the scene becomes unsafe, an AED arrives or EMS (Emergency Medical Services) arrives.

American Red Cross

1) Make sure the scene is safe before approaching the victim; 2) Check to see if the person responds by tapping the victim and shouting, Are you OK?; 3) If the person

doesnt respond, get help. Have you and someone else call 911 and get an AED (automated external defibrillator) if available; 4) Check for breathing by performing a head tilt-chin lift. Look, listen and feel for breathing for no more than 10 seconds. Occasional gasps are not breathing; 5) quickly scan for severe bleeding; 6) Begin CPR

with 30 chest compressions. Push down at least 2 inches for an adult. The rate of compressions is at least 100 compressions a minute. After each compression let the chest come back up to its normal position; 7) Open the airway with a head tilt-chin lift and give 2 breaths; 8) Continue giving 30 compression and 2 breaths until you find an obvious sign of life, you are too exhausted to continue, the scene becomes unsafe, an AED arrives or EMS (Emergency Medical Services) arrives.

Differences: The primary difference is how breathing is assessed. The AHA has eliminated, look, listen and feel for breathing from its guidelines. The responder

checks for breathing, but how this is done is not specifically stated. The ARC still instructs, Look, listen and feel for breathing. The ARC continues to include the step of quickly scanning for severe bleeding after checking for breathing. The AHA does not include this step.

Indication Berg, R.A. et. al. (2010). Part 5: Adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation According to the author, if a lone rescuer finds an unresponsive adult or witnesses an adult who suddenly collapses, after ensuring that the scene is safe, the rescuer should check for a response by tapping the victim on the shoulder and shouting at the victim. The trained or untrained bystander should activate the emergency response system. After activation of the emergency response system, all rescuers should immediately begin CPR. Checking for pulse needs to be performed first. It should not take the rescuer more than ten seconds to check for pulse. When no pulse is felt within that time period, chest compressions must be performed. Effective chest compressions are essential for providing blood flow during CPR. Providing effective chest compressions means you

must push hard and push fast. It is reasonable for laypersons and healthcare providers to compress the adult chest at a rate of at least 100 compressions per minute with a compression depth of at least 2 inches/5 cm. Rescuers should attempt to minimize the frequency and duration of interruptions in compressions to maximize the number of compressions delivered per minute. A compression-ventilation ratio of 30:2 is recommended. Assuming the person has a pulse and is breathing, the recovery position means placing the person on his or her side. This allows for the person not to choke on saliva and helps keep the airway open. The downside arm may be raised to support the head. This literature was utilized to formulate the questionnaire.

Abe, T. (2011). Time-Based Partitioning Model for Predicting Neurologically Favorable Outcome among Adults with Witnessed Bystander Out-of-Hospital CPA. Retrieved last August 19, 2013 from

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0 028581 When an adult suddenly collapses, whoever is nearby should activate the emergency system and begin chest compressions (regardless of training). Trained lay rescuers who are able and healthcare providers should provide compressions and ventilations. Contrary to the belief of too many in this situation, CPR is not harmful. Inaction is harmful and CPR can be lifesaving. However, the quality of CPR is critical. Chest compressions should be delivered by pushing hard and fast in the center of the chest or sternum and should be of adequate rate and depth. Rescuers should allow

complete chest recoil after each compression and minimize interruptions in chest compressions. They should also avoid excessive ventilation. If and when available, an automated external defibrillator (AED) should be applied and used without delaying chest compressions. With prompt and effective provision of these actions, lives are saved every day. This literature was utilized to formulate the questionnaire.

American Heart Association. (2013). Hands-Only CPR. Retrieved last September 1, 2013 from http://www.heart.org/HEARTOR/CPRAndECC/HandsOnlyCPR/ /LearnMore_UCM_440810_jsp Continue to provide hard and fast chest compressions with minimal interruptions to the best of ability. Giving high-quality chest compressions at least 100 times per minute is hard work. Most people will get tired after only a few minutes of delivering any type of CPR. If someone else is nearby, ask that person to take over chest compressions after about two minutes, or about 200 compressions. Continue pushing hard and fast in the center of the chest until help arrives. If the victim speaks, moves, or breathes normally while youre giving chest compressions, hands-only CPR can be stopped. This literature was utilized to formulate the questionnaire.

Related Studies

Anderson, G. et al. (2009). CPR and First Aid Skill Retention Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. Retrieved last February 8, 2013 from http://www.worksafebc.com/contact_us/research/es01470.asp This study states that many necessary skills of CPR and first aid are forgotten shortly after certification in laypersons. The purpose of this study is to determine the decline in first aid and CPR skills and knowledge to those who are required to respond to emergency situations within workplaces. There is a reduction in CPR skills and knowledge, and is most likely influenced by the repetition of training in those that had recertified their first aid one or more times. First aid and CPR skill-based components appeared to deteriorate in a more predictable fashion following training. In the choking scenario, skill in compressions after the victim became unconscious showed deterioration after 30 days. In the CPR scenario, poor performance of skills was linked to time since last training for correctly land marking for chest compressions; controlling the airway for ventilations; a pre-CPR safety check variable; periodic checks for breathing, head positioning, and patient placement; and, number of chest compressions for CPR cycles one to four. Skills such as hand placement and abdominal thrusts in the choking scenario and number of compressions and ventilations attempted in CPR cycle five to eight were performed poorly since last training. The results of the study suggest that repetition may be more important to skill and knowledge retention than the length of time since the last training. Strategies for increasing the repetition of the skills and knowledge should be explored. Many skills deteriorate rapidly over the course of the first 90 days.

This literature was utilized in the analysis and interpretation of the study.

Josipovic, P. et al. (2009). Basic life support knowledge of undergraduate nursing and chiropractic students. Australian Journal of Advanced Nursing, 26(4), 58-63 The aim of this study was to examine retention of CPR/BLS knowledge of third year nursing and fourth year chiropractic students following instruction and assessment of CPR/BLS skills and knowledge as part of their undergraduate degree program. The design of the study was non experimental exploratory survey to determine perceived ability and knowledge of CPR/BLS following completion of CPR/BLS instruction. The result showed that majority of students (78%) felt they were well prepared to perform CPR/BLS. However, there were deficiencies in both groups with regards to knowledge of current guidelines. Chiropractic students were less likely to identify the correct compression rate compared to the nursing group (Spearmans rho 0.669, p.001) with 95% of the chiropractic students not able to identify the correct rate. Nursing students scored themselves highly for self-rated knowledge and ability to perform CPR. Chiropractic students tended to score themselves at a lower rating in these areas than the nursing students; however the differences were not statistically significant. This literature was utilized in the analysis and interpretation of the study.

Oermann, M. (2010). Professor Oermanns Nursing Study Points to Changing the Way We Teach CPR. Retrieved last December 23, 2012 from

http://nursing.unc.edu/news-events/items?tag=Marilyn%20Oermann

The chances for patient survival are improved with immediate and high quality CPR, making it an especially important skill for nurses, who are often the first responders to cardiac arrests in hospitals. The results of this study provide evidence for how nursing students and other health providers can maintain their basic life support (BLS) skills. Staff nurses and other health care professionals were also included in this large interdisciplinary study. The study began in 2008 wherein different approaches to teaching and learning BLS were tested by students at 10 schools of nursing with associate, diploma, or baccalaureate programs. Students who practiced their CPR psychomotor skills on voice advisory mannequins for only six minutes a month either maintained or improved their skills over the 12-month period. Students who did not practice beyond their initial BLS training had a significant loss of skills, some as early as three months after completing it. This literature was utilized in the analysis and interpretation of the study.

Sharma, R., Attar, N. (2012). Adult Basic Life Support (BLS) Awareness and Knowledge among Medical and Dental Interns Completing Internship from Deemed University. Deralakatte, Mangalore: Nitte University Journal of Health Science A descriptive study was conducted by using a questionnaire comprising of 19 questions to collect the data pertaining to demographic details, awareness and knowledge of BLS, attitude towards BLS among all the medical and dental interns. As a conclusion of the study: Performing BLS and attending BLS work shop plays a vital role in attaining BLS knowledge by both medical and dental interns. There is an absolute clear need for

review of basic life support (BLS) education. There is a need for structured training of BLS and BLS must be included in the medical and dental academic curriculum. This will go a long way in improving the outcome of BLS delivery by interns (the future health care providers), thus immensely benefitting the society and also boosting the morale of the interns from both medical and dental streams. This literature was utilized in the analysis and interpretation of the study.

Rice, K. (2013). American Safety & Health Institute: CPR Skills Retention Help Your Students Remember. Retrieved last August 20, 2013 from

http://www.hsi.com/Blog/bid/98743/CPR-Skills-Retention-Help-YourStudents-Remember According to this author, CPR, AED, and first aid skills are often forgotten as time passes. The more we forget, the less likely we are to have the confidence to respond in an emergency. The Occupational Safety and Health Administration (OSHA) put it this way: First-aid responders may have long intervals between learning and using CPR and AED skills. Numerous studies have shown a retention rate of 6-12 months of these critical skills. The American Heart Associations Emergency Cardiovascular Care Committee encourages skills review and practice sessions at least every 6 months for CPR and AED skills. Instructor-led retraining for life-threatening emergencies should occur at least annually. Retraining for non-life-threatening response should occur periodically. The key to skills retention is being re-exposed again to course content. A randomized trial of participants in a public access defibrillation program was done in

2008 and was published in Resuscitation. Three trial groups were retested at either 6 or 12 months after their initial training and it was found that skill retention decreased significantly in the three groups and was lowest after 12 months if no 6-month retests were done. In trainees who did undergo retesting at 6 months, skills did not deteriorate at 12 months. This literature was utilized in the analysis and interpretation of the study.

Johnston, T.C., Clark, M.J., Dingle, G.A., & Sanders, E.L. (n.d). Levels of cardiac knowledge and cardiopulmonary resuscitation training among older people in Queensland. Australasian Journal on Ageing, 23(2), 91-96 The aim of the study was to determine levels of cardiac knowledge and cardiopulmonary resuscitation (CPR) training in older people in Queensland, Australia. The study was done through a telephone survey of 4,490 adults which examined the knowledge of the respondents regarding coronary heart disease risk factors, heart attack symptoms, as well as respondents rates and recency of training in CPR. Older participants, aged 60 years and over, were approximately one and a half times more likely than the 3039 year-old reference group to have limited knowledge of heart disease risk factors (OR = 1.53), and low knowledge of heart attack symptoms (OR = 1.60). Older participants had significantly lower rates of training in CPR, with almost three quarters (71.7%) reporting that they had never been trained. Older people who had completed CPR training were significantly less likely to have done so recently. This literature was utilized in the analysis and interpretation of the study.

Custers, E.J. (2008). Long Term Retention of Basic Science Knowledge: A Review Study. Retrieved last September 21, 2013 from

http://www.ncbi.nlm.nih.gov/pubmed/18274876 A review of long-term retention of basic science knowledge is presented. First, it is argued that retention of this knowledge has been a long-standing problem in medical education. Next, three types of studies are described that are employed in the literature to investigate long-term retention of knowledge in general. Subsequently, first the results of retention studies in general education are presented, followed by those of studies of basic science knowledge in medical education. The results of the review, in the general educational domain as well as in medical education, suggest that approximately two-third to three-fourth of knowledge will be retained after one year, with a further decrease to slightly below fifty percent in the next year. Finally, some recommendations are made for instructional strategies in curricula to improve long term retention of the subject matter dealt with. This literature is used in the analysis and interpretation of data.

Broomfield, R. (n.d). A Quasi-Experimental Research to Investigate the Retention of Basic Cardiopulmonary Resuscitation Skills and Knowledge by Qualified Nurses Following a Course in Professional Development. Middlesbrough, England: University of Teesside College of Health The research was undertaken with the intention of testing six null hypotheses regarding the retention of basic cardiopulmonary resuscitation (CPR) skills and knowledge of registered nurses. The hypotheses were formulated from the broad aims of

the research, which were to investigate conclusions reached by other researchers highlighting the speed with which retention of CPR skills and knowledge deteriorates, and to investigate the need for regular updating in CPR. The research was quasiexperimental in nature. The findings of the research reflect similar results to previous research undertaken and discussed in the literature review, suggesting that retention of skills and knowledge quickly deteriorates if not used or updated regularly. Therefore this research supports the importance of CPR refresher courses on a regular basis.

Synthesis Knoop defined Cardiopulmonary Resuscitation (CPR) as a procedure that supports and maintain breathing and circulation for an infant, child, or adolescent who has stopped breathing or whose heart has stopped. AHA and Hemphil, recommended changes such as the sequencing of steps from A-B-C (Airway, Breathing, Compression) to C-A-B (Compression, Airway, Breathing) and to start CPR with 30 compressions rather than 2 ventilations that would lead to improved outcomes. Steps on performing CPR was expounded by Abe and Berg if a lone rescuer finds an unresponsive adult, after ensuring that the scene is safe, the rescuer should check for a response by tapping the victim on the shoulder and shouting at the victim. Bystander should activate the emergency response system. After activation of the emergency response system, all rescuers should immediately begin CPR. Larmon enumerated the possible scenarios to perform CPR such as someone who stop breathing or have cardiac arrest. Sun coast hospital pharmacy explained age groups and their specific competencies ad skills. Roger explained that men have storing and recalling on

visuospatial episodic while women have in storing and recalling verbal episodic memories. Labiad study showed that completing a school year successfully does not guarantee that certain skills and knowledge is acquired or learned. What is studied and for how long should be considered and also what is learned and how well it is learnt. According to Education Policy and Data Center, literacy levels and educational attainment serve as indicators of the knowledge and skills that a population possesses For the related studies that would support the analysis of the data. Anderson suggested that repetition may be more important to skill and knowledge retention than the length of time since the last training. Oermann, Sharma & Rice agreed that there should be continuous training. Josipovic suggested that there should be a standard training and updates to CPR trainings.

Conceptual Framework

This study is based on Jerome Bruners Constructivist theoretical framework, wherein learners engage in discovery learning, obtaining knowledge by themselves. They select and transform information, construct hypotheses, and make decisions, relying on a cognitive structure to do so. In order for discovery to occur learners require background preparation in the form of a cognitive structure that provides meaning and organization to experiences and allows the individual to "go beyond the information given". Bruner's framework is based on the theme that learners construct new ideas or concepts based upon existing knowledge. Learning is an active process. Facets of the process include selection and transformation of information, decision making, generating hypotheses, and making meaning from information and experiences. Bruner's theories emphasize the significance of categorization in learning. "To perceive is to categorize, to conceptualize is to categorize, to learn is to form categories, to make decisions is to categorize." Interpreting information and experiences by similarities and differences is a key concept. Bruner emphasized teaching as a means of enhancing cognitive development, hence the task of the teacher is to translate information to be learned into a format appropriate to the learner's current state of understanding. The instructor should try and encourage students to discover principles by themselves, and both learners and teachers should engage in an active dialog, also known as Socratic learning. Curriculum should be organized in a spiral manner so that the student continually builds upon what they have already learned.

Bruners work circled around four key themes. First is where Bruner emphasized the role of structure in learning and how it may be made central in teaching. The second key theme is where he introduced the ideas of readiness for learning and spiral curriculum. Bruner believed that any subject could be taught at any stage of development. Spiral curriculum refers to the idea of revisiting basic ideas over and over, building upon them and elaborating to the level of full understanding and mastery. The third theme states that intuitive and analytical thinking should both be encouraged and rewarded. And lastly, Bruner focused on the learners motivation when it comes to learning. He felt that ideally, interest in the subject matter is the best stimulus for learning. Level of Knowledge refers to the scores that the barangay health workers obtained in answering the researcher made questionnaire; grouped as definition, indication, method and body parts and functions. Body Parts and Functions is a component of the level of knowledge on CPR which refers to statements describing parts of the human body, its purpose and its relevance when performing Cardiopulmonary Resuscitation; Definition is a component of the level of knowledge on CPR which refers to statements which explain the meaning, concept and process of Cardiopulmonary Resuscitation; Method is a component of the level of knowledge on CPR that refers to statements which explains the series of steps or actions in performing correct Cardiopulmonary Resuscitation; Indication is a component of the level of knowledge on CPR that refers to statements which specifies or suggests the instances where there is a need to perform Cardiopulmonary Resuscitation. Barangay health worker refers to the frontline health care worker who was trained under the health department of the local government and/or the Department of Health; the

barangay health workers are mainstays in the barangay health center where they provide basic health care services to their respective constituents.

Conceptual Paradigm

Level of Knowledge as to Socio-demographic Profile Age Gender Highest educational attainment Occupation Previous basic life support training attended Level of Knowledge as to Components Body parts and functions Definition Indication Method

Very High Level of Knowledge High Level of Knowledge Moderate Level of Knowledge Low Level of Knowledge Very Low Level of Knowledge No Knowledge

Figure 1. Conceptual Paradigm. Level of Knowledge on Cardiopulmonary Resuscitation of the Barangay Health Workers in a selected district in Makati.