Knowledge regarding Basic Life Support among Health Care Workers of the Hospital of Nepal

Basic life support refers to a sequence of care provided to patients who are experiencing respiratory arrest, cardiac arrest, or airway obstruction. It is a specific level of prehospital medical care provided by the trained responders, including emergency medical technicians, in the absence of advanced medical care to maintain the patient's life. BLS course trains participants to promptly recognize several life-threatening emergencies, give high-quality chest compressions, deliver appropriate ventilations, and provide early use of an AED. According to American Heart Association (AHA) guidelines, every missed minute in applying defibrillation in a cardiac arrest decreases the survival rate by 70%–10%. According to European Resuscitation Council (ERC), early resuscitation and prompt defibrillation (within 1-2 minutes) can result in >60% survival. A quantitative, descriptive study design is used in this study. A purposive sampling technique was used, and the sample size was 95. A self-structuredclose-ended questionnaire was used to assess the level of knowledge of the participants. The finding revealed that among 95 participants, only 12% had adequate, 55% had moderate, and 32% had inadequate knowledge about Basic Life Support. The study showed that knowledge among healthcare workers about basic life support is insufficient for the majority of participants. There is a significant association between dependent and independent variables.


Introduction
Basic Life Support (BLS) refers to a sequence of care provided to patients who are experiencing respiratory arrest, cardiac arrest, or airway obstruction [1]. It is a specifc level of prehospital medical care provided by the trained responders, including emergency medical technicians, in the absence of advanced medical care to minimize the patient's critical condition. BLS course trains participants to promptly recognize several life-threatening emergencies, give highquality chest compressions, deliver appropriate ventilations, and provide early use of an automated external defbrillator (AED) [2]. Basic Life Support (BLS) is a lifesaving intervention in a premedical facility. Adequate knowledge and awareness about BLS and Cardiac pulmonary resuscitation (CPR) are mandatory for the healthcare worker working in a hospital [3,4]. Cardiac arrest or cardiopulmonary arrest can leave the victims with severe morbidities or lead to death if not attended to instantly or treated promptly. Early identifcation and intervention of cardiac arrest victims by performing CPR are the cornerstones of BLS, which helps sustain the patient's life until defnitive medical care arrives and the patient is transferred to a hospital setting for further advanced management. BLS's purpose is to maintain the airway, breathing, and circulation through CPR. CPR is an emergency procedure for the restoration of cardiac and respiratory functions after cardiac arrest [5,6]. It consists of a combination of mouth-to-mouth ventilation and external chest compression that is given to a person thought to have been in cardiac arrest [7]. It is performed by anyone who knows how to do it anywhere and immediately, without equipment and protective devices. It may include considerations of patient transport such as the protection of the cervical spine and avoiding additional injuries through splinting and immobilization [8]. It includes psychomotor skills for performing high-quality cardiopulmonary resuscitation (CPR), using an automated external defbrillator (AED), and relieving an obstructed airway for patients of all ages. American Heart Association (AHA) guidelines suggest that every missed minute in applying defbrillation in a cardiac arrest decreases the survival rate by 7%-10% [9]. According to European Resuscitation Council (ERC), early resuscitation and prompt defbrillation (within 1-2 minutes) can result in >60% survival [10].

Materials and Methods
A descriptive study design was used on the healthcare workers of the hospital. Te sample size was calculated by using the z 2 pq/L 2 formula where z = tabulated value in the 95% level of signifcance (1.96), p = prevalence rate = 52%, q = 1 − p = 1-52/ 100 = 0.48, L = allowable error = 10% = 10/100 = 0.1 the sample size found to be was 96 [11][12][13]. Te study used a technique called purposive sampling. Knowledge of basic life support was the study's dependent variable, and social-demographic factors such as age, gender, religion, place of residence, and educational attainment of healthcare workers with valid work permits were the study's independent variables. Both genders were included in the study, whereas medical ofcers, consultants, and hospital incharge were excluded from the study.
Te self-structured closed-ended questionnaire was used to collect data which contains two parts; part I consists of socio-demographic data such as age, gender, work experience, previous training, and education level, and part II consists of items related to knowledge regarding basic life support. A scoring key was designed where each correct answer was awarded 1 mark and the wrong answer 0. Tus, the item maximum score was 30 and the minimum was 0. Consequently, the highest total knowledge score for health workers was 30. Since health workers should have sufcient knowledge in this very critical area, knowledge scores of above 23 or >75% were considered "adequate" knowledge, scores 15-23 or 50-75% were considered "moderate" knowledge, and scores of below 15 or <50% were considered as "inadequate" knowledge.
Before actual data collection, the instrument was pretested on 10% of the total sample size. Ethical consideration was taken from Purbanchal University and informed consent was designed; confdentiality of the information was maintained throughout the study. Collected data were checked and rechecked for their completeness for missing items before their processing, and that data were edited, coded, and entered into computer base software using SPSSV20 by using both descriptive and inferential statistics [14,15].

Distribution of Sample According to Demographic Data.
Te majority of respondents were of the 30-40 age group which is 52.63% followed by 33.63% of the 20-30 age group and at least 13.68% of the 40-50 age group. Te mean age for the study participants was 33 of 95 respondents, where 85 (89.47%) were females and 10 (10.53%) were males. Our study reveals that 56 (58.95%) respondents were profcient in certifcate level in nursing (PCL Nursing) followed by auxiliary nurse midwife (ANM) 21 (22.11%), followed by health assistant (HA) and community medicine assistant (CMA) 9 (9.47%). Based on work experience, our study demonstrates that the maximum year of experience is of 2-3 years 40 (42.11%), followed by 3-4 years' experience was 25 (26.32%), <1 year was about 17 (17.89%), and 1-2 years' experience was 13 (13.68%). Te majority of participants have not received any training regarding BLS; only 15 (15.79%) respondents have received training and 80 (84.21%) have not received any training. (Table 1). Table 2 represents that more than half of the total respondents 52 (55%) of respondents had moderate knowledge followed by inadequate knowledge with 32%, and adequate knowledge which was 12% (Table 2). Table 3 shows that there is a strong association between the age group and the level of knowledge. P value by the chi-square test was found to be 0.021637 * P value <0.05 considered to be statically significant (Table 3), but it is found that there is no association between gender and level of knowledge. Te P value by the chi-square test was found to be 0.990895. P value >0.05 considered to be statically nonsignifcant. Our study revealed that there is no association between the qualifcation of respondents and their level of knowledge; the P value by the chi-square test was found to be 0.9885 and is nonsignifcant. Table 3 depicts that there is no association between the work experience of respondents and their level of knowledge as the P value by the chi-square test is 0.840103 and it shows that it is nonsignifcant. Te present study demonstrates that there is a strong relationship between the previous training of respondents and their level of knowledge as the P value is 0.026244 which is highly signifcant.

Discussion
According to studies and reports, RTA (Road Trafc Accidents), cut injuries, and sudden cardiac deaths are the major life-threatening risks in Nepal. Te risk of road trafc death is 3 times higher in low-income countries (8.3 deaths per 100,000 populations) when compared to high-income countries [16]. In all of the major trauma and cardiac arrest or emergency cases, BLS support is necessary to save a life in a prehospital facility. Te BLS program is designed to deliver knowledge to a wide range of healthcare professionals about several life-threatening emergencies. It also demonstrates training to provide CPR, use an AED, and relieve choking in a safe, timely, and efective manner to treat those emergencies. It is mandatory for all healthcare professionals to have comprehensive knowledge and skill about BLS [17,18]. Hence, all healthcare institutes should emphasize training the healthcare professionals working in hospitals for the BLS. Journal of Healthcare Engineering Our study included 95 respondents; the majority of respondents were of the 30-40 age group followed by the 20-30 age group and at least the 40-50 age groups. Te mean age of the study participants was found to be 33 years. Tese fndings are comparable to a previously published similar study, which reported that most of their respondents were between 23 and 40 years old. In our study, the comparison of knowledge among the various age groups revealed statistical signifcance [19].
In our study, the majority of respondents were females (89.47%) ( Table 1). Tis fnding was in accordance with the results reported by another researcher from Botswana [20]. In their study on cardiopulmonary resuscitation knowledge and skills of registered nurses, they detected that most of the studied group were females. Another study conducted in India (focused on knowledge and perspective on CPR among staf nurses) declared that most of their study group was female [21]. Te current work revealed no signifcant diferences in BLS knowledge level and gender (Table 3); this was in accordance with a study from Botswana [20].
In the current study, more than half of the respondents, that is, 56 (58.95%), were profcient in the certifcate level in nursing (PCL Nursing) followed by auxiliary nurse midwife (ANM), that is, 21 (22.11%), and then health assistant (HA) and community medicine assistant (CMA), that is, 9 (9.47%). Moreover, our study concluded that there was no association between the BLS knowledge level and academic qualifcation. It is to be noted that our results were supported by an investigation conducted by researchers from Nepal. In their study on knowledge regarding basic life support among nurses of a tertiary-level hospital, there was no association between nurses' knowledge and their academic qualifcation [22].
Based on work experience, our study demonstrates that the maximum year of experience is of 2-3 years 40 (42.11%), followed by 3-4 years' experience was 25 (26.32%), <1 year was about 17 (17.89%), and 1-2 years' experience was 13 (13.68%). Tere are no signifcant diferences in the BLS knowledge level and years of experience. Te majority of participants have not received any training regarding BLS. Only 15 (15.79%) of respondents have received training and 80 (84.21%) have not received any training. In the current study, we found a signifcant association between the knowledge level and previous training (Table 3). Also, our     result is supported by the fndings of diferent studies [23][24][25], which reported that BLS training is highly efective and made statically signifcant.

Conclusion
Te results of this study indicate that knowledge of BLS among health professionals from nursing, health assistants, auxiliary nursing midwives, and community medicine assistant at hospitals is poor which becomes a critical issue and needs to be improved in the future. BSL training and clinical exposure infuence the retention of knowledge; there is a need for all healthcare professionals to have some standard training and assessment. Te research study was conducted to assess the knowledge regarding Basic Life Support and healthcare workers in hospitals. On the basis of the fndings of the study, some recommendations such as a comparative study can be conducted, and a similar study can be conducted to fnd out the efectiveness of awareness and knowledge-sharing programs regarding Basic Life Support.

Data Availability
All the data used to support the result of this research are available from the corresponding author.

Ethical Approval
Te Ethical Review Board (IRB) of Purbanchal University approved this study. Te authors certify that they have obtained all appropriate consent forms. In the form, the sample (s) has/have given his/her/their consent for his/ her/their images and other clinical information to be reported in the journal. Te sample understands that their names and initials will not be published and due eforts will be made to conceal their identity, but anonymity cannot be guaranteed. Te authors are responsible for all aspects of the work to ensure that issues related to the accuracy or integrity of any part of the work are properly investigated and resolved.