INDONESIAN JOURNAL OF 

 NURSING 
PRACTICES 

 
52 

 IJNP (Indonesian Journal of Nursing Practices) 
Vol 3 no 1 Juni 2019 : 52-57 

 
 

 

Selvya Hesti Andriyani1, Fitri 

Ariana Setyorini1, Enita Dewi1, 
Arum Pratiwi1 
1
Universitas Muhammadiyah Surakarta 

 
Korespondensi: Selvya Hesti Andriyani 

Email: selvyahesti@gmail.com 
 

 

Nurse’ Knowledge and  Their  
Performance on Cardiopulmonary  
Resucitation  (CPR)  in Critical and  
Emergency Care Unit 

Info Artikel 
Online 

ISSN 
 
DOI  

 

 
: http://journal.umy.ac.id/index.php/ijnp 
: 2548 4249 (Print) 

: 2548 592X (Online) 
: 10.18196/ijnp.3193  

Abstract 
Background: Knowing the important relation between knowledge 
and skill is important because it reflexes the action that nurses do to 

save people life.  
Objective: This research aimed to determine the relationship 
between the nurse's knowledge level and their performan ce on 

cardiopulmonary resuscitation in critical and emergency care unit.  
Method: The study was quantitative descriptive with the cross-
sectional design used sequential sampling with 30 nurses in critical 
and emergency care unit. The data were analyzed using the Fisher 

Exact Test. Data was taken from questioner and observational 
assessment using a standard operating procedure which was 
developed by a hospital.  
Results: The results of this study found that there were 63.3% 

respondents which all of them had poor knowledge also poor 
performance on doing cardiopulmonary resuscitation.  
Conclusion: There is a relation between nurse’s knowledge level and 

the nurse’s performance on undertaking cardiopulmonary 
resuscitation. The more knowledge they have the better 
performance they have on cardiopulmonary resuscitation. Routine 
training and evaluation may be useful to increase nurses’ knowledge 

and skills. 
 
Keywords: Nurse, Knowledge, Skills, Cardiopulmonary Resuscitation 

(CPR), Emergency 

 

INTRODUCTION 
There is some common problem that was facing 
health care services in Indonesia. One of them is 
giving high-quality health services with reachable 
cost. The availability and quality of health care 
services depend on the values and response from 
the client itself. It is because of the quality of 
services and satisfaction of client are used as a 
measurement about how is the quality of health 
care services itself in the hospital they visited 
(Wardani, 2013). Therefore, all health care 
providers are involved to determine how good 
health services that they give in a hospital. 
 

Health care providers that involve are including 
doctors, nurses, nutritionist, pharmacist, and other 
professional health care provider. However, the 
quantity of nurses is the hi ghest than in other 
professions. Nurses are the one who works with 
the patient for 24 hours divided into 3 working 
shifts are morning, afternoon, and night shift 
(Indonesian Health Minister, 2017). From this 
condition, can be assumed that nurses contribution 
hold hope in raising the quality of health services in 
a hospital. It can be said that nurses services are 
one of the main concern of a hospital based on 
their skill and knowledge that appropriate with the  
development of science and technology.   
 

http://journal.umy.ac.id/index.php/ijnp
http://u.lipi.go.id/1477106461
http://issn.pdii.lipi.go.id/issn.cgi?daftar&1478151103&1&&
http://journal.umy.ac.id/index.php/ijnp/article/view/6646


  VOL. 3 NO. 1 JUNI 2019  

 
53 

Between skill and knowledge, knowledge is holding 
more dominant role rather than skill. However, 
even though knowledge is more dominant than 
skill, but still both of them are related to each 
other. It is because, someone performance is a 
reflection of the knowl edge they have through 
education, training or experience during their 
working time. One of the basic knowledge and skil l  
that must be mastered by nurses is performing 
emergency nursing care, for example, is 
cardiopulmonary resuscitation (Hanafi, 2007). It is 
important because the emergency case can happen 
to anyone anywhere regardless of whoever and 
wherever they are. So that the quality of nurs e s  i n  
emergency care is one of the factors that 
determine either someone can still alive or not 
(Hazinki, 2015). 
 
Cardiopulmonary resuscitation (CPR) is an 
emergency procedure that helps to support and 
maintain breathing and circulation in a client with 
has cardiac arrest (sudden heart stop) (Mayo 
Clinic). In a hospital, especially in Emergency and 
Critical Care Unit, cardiopulmonary resuscitation i s  
very important because, in both rooms, the 
number of morbidity and mortality are high. 
According to the American Heart Association (AHA) 
(2010), too few victims of cardiac arrest receiving 
standard CPR. As known, CPR quality must b e  h i gh  
and that victims require excellent post-cardiac 
arrest care by organized teams with members wh o  
function well together. Education and frequent 
refresher training are likely the keys to improving 
resuscitation performance. The AHA has 
established that initiation of CPR during cardiac 
arrest will increase the short and long term 
outcomes for patient survival (AHA, 2005c). 
Unfortunately, the quality of CPR performed by the 
public and health care providers alike is deficient 
resulting in a low (10%) survival rate after CPR 
(Alspach, 2005).  
 
A person with cardio-pulmonary resuscitation (CPR) 
training can sustain an ailing person's heart and 
brain for a short time (Farah, 2007). Therefore, th e  
nurses who work on it have to be really mastering 
CPR because time is the main point who hold 
someone living. Fast and right CPR method is the 
point on saving someone in the emergency case 
especially in cardiac arrest condition. 
 
 

METHODS 
This research design used Quantitative descrip tiv e 
with a cross-sectional design approach. The 
research took place in the Emergency and Critical 
Care Unit in Moewardi Hospital of Surakarta. The 
sample was taken by the sequential sampling 
method. The criteria of the samples are nurses who 
work in Emergency and Critical Unit. The next was 
nurses who performed CPR,  and nurses with 
minimum graduated from the diploma of nursing. 
The last was nurses who were not an internshi p o r 
orientation nurses. As a result, the total samples 
that involved were 30 nurses who work in 
Emergency and Critical Room of the hospital.  
 
The instruments that were used were questioner 
form, which contains 24 multiple choice ques tio n s 
which used to assess nurses knowledge and nurse s  
skill is assessed by using a checklist that contains 13 
items of SOP (Standard Operating Procedure that 
provided by Moewardi Hospital). This checklist was  
observed by the researcher through systematic 
observation. To determinate the score, the 
researcher used score 1 for the right answer, and 
score 0 for a false answer.  
 
The 24 multiple choice questions have contain ed  a 
definition, purposes, indication, contraindication, 
CPR procedure, and termination of the proced u re.  
For the checklist that being used is contain 13 
items. 
 
This research was done on May-July 2011 and it 
took 4 rooms, those are critical room (ICU and 
ICVCU) and emergency care unit (Triage and ICU). 
Later on, the data was processed through 4 steps, 
those were editing, coding, e ntry data, and 
tabulating. The next was that the data analyz e d  b y  
Univariate and Bivariate. 
 
RESULTS 
The research that has been done, the result that 
obtained is below : 
 
A. Characteristics of respondents 
In this research, total respondents are 30 nurses 
who work in Emergency and Critical Unit Care,  an d  
the table 1 described characteristics of 
respondents based on their gender, ages, 
education level and working period. 
 
 



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54 

Table 1 Characteristics of respondents 
Characteri s ti c Frequency Percentage 

(%) 
Gender: 

-Man 
-Woman 

 

16 
14 

 

53.3 
46.7 

Ages : 

24-35 
>35 

 

25 
5 

 

83.3 
16.7 

Educati on Level : 
Di pl oma  

DIV 
Bachel or 

 
27 

1 
2 

 
90 

3.3 
6.7 

Worki ng Experi ence: 
1-5 years  

6-10 years  
11-15 years  

 
17 

7 
6 

 
  56.7 

  23.3 
  20 

In table 1 showed that the frequency of man is 
more than women (53.3%). The total of man 
respondents is more probably because man 
strength is needed more according to their physical 
is stronger than women. Based on ages, it can be 
seen on the table that ages of respondents mo s tly  
are in the ages of 24-25 years old, it means that in 
this hospital, nurses that work in Emergency and 
Critical Unit Care are in productive ages, where 
physically is really needed to give fast and right 
nursing care. According to the education level,  th e  
nurses are mostly graduated from Diploma in 
nursing. It can be defined that, most of the Diploma 
graduation do not continue their study into 
Bachelor degree and prefer to work directly. 
Professional nurses are defined as a nurse that 
develop his knowledge through high educatio n  b y  
completing minimum education in diploma of 
nursing. The next is the working period, most of the 
respondents are having a working period around 1-
5 years. It is because the hospital recruits new 
employ. The presence of senior nurses, which have  
a working period of more than 10 years can give 
working experience to the new nurses which still 
lack experience related to cardiopulmonary 
resuscitation. The length of working experi en ce i s  
showing someone performance, and influencing 
their readiness in doing given tasks. The 
expectation is the longer someone working 
experience the better performance they may h av e  
(Kuhnigh, 2004). 
 
B. Univariate analysis methods 
1).Respondents distribution based on their 
knowledge on cardiopulmonary resuscitation (CPR) 

Division of knowledge category is divided into  tw o  
that are good and poor level. They are good if the 
result > mean or respondents which has value 19-
34. On the other side, there is less category if the 
result <means of respondents has value 0-18.The 
result from 30 respondents who fill 24 questione rs  
obtain the result as below (table 2): 
 
Table 2. Respondents distribution based on their 
knowledge related to cardiopulmonary 
resuscitation in Critical and Emergency Care Unit 

Knowl edge Frequency Percentage 

(%) 
Good 

Poor 
Total  

7 

23 
30 

23.3 

76.7 
100 

 
23 respondents are categorized in a group which 
has poor knowledge (76.7%), while the 
respondents who have good knowledge is lesser 
(23.3%). From 23 respondents who categorize less 
knowledge, 14 of them have the working period for 
1-5 years. While, 9 out of 23 respondents, has 
enough working period that more than 5 years. 
 
2). Respondents distribution based on their skills in  
performing cardiopulmonary resuscitation (CPR). 
 In this research, the result of observing 30 skills 
respondent is shown in the table below (table 3):  
Table 3. Respondents distribution based on their 
skills on performing cardiopulmonary 
resuscitation (CPR) in Critical and Emergency Care 
Unit 

Ski l l  Frequency Percentage 
(%) 

Good 

Poor 
Total  

9 

21 
30 

30 

70 
100 

Table 2 shows that most of the respondents (21 
nurses) skill on performing cardiopulmonary 
resuscitation include in the poor category (70%), 
while the rest of them, 9 respondents, are 
categorized in good skill. Unfortunately, 2 of 9 
respondents which in good skill category are still 
having poor knowledge about CPR. Skills that h av e  
by respondents not only from education but also 
from experience. 
 
Respondents that performing CPR refer to Standard 
Operational Procedure (SOP). The SOP is contained  
13 items that used as a reference to evaluate either 



  VOL. 3 NO. 1 JUNI 2019  

 
55 

the respondents performing CPR good and righ t o r 
not. If 13 items can be done rightly, it means 
respondents have performed right nursing care, 
but if there are any of 13 items that can not be 
done, it means that respondents do not give right 
nursing care. Therefore, from those 13 items SOP 
of CPR can show that respondents still not able to 
perform CPR well because most of them are stil l  i n  
poor skill category. 
 
C.  Bivariate analysis method 
The bivariate analysis method is used to merge 
between nurses (respondents) knowledge and their 
skills on performing CPR in Critical and Eme rge n cy  
Unit Care in Moewardi Hospital of Surakarta. 
Statistic experiment that is used to analyze is the 
Fisher Exact analysis tool. Researcher merging 
nurses knowledge and their skills as the table 
below (table 4): 
 
Table. 4 Relation between respondents 
knowledge and their skills on performing CPR in 
Critical and Emergency Unit Care in one of the 
hospitals in Solo. 

Knowl
edge 

CPR Ski l l  
Total  

p* 

 

Good Poor  

n % n % n %  

Good 5 16,7 2 6,7 7 23,3 0,0
14 

 
Poor 4 13,3 19 63,3 23 76,7  
Total  9 30 21 70 30 100  

p* obtained use of Fisher Exact Test analysis 
method 
 
Table 4 demonstrates from 7 (23.3%) respondents 
who have good knowledge, 5 of them (16.7%) are 
having good skills on performing CPR while the 
other 2 of them (6.7%) are having poor skill on it. 
From 23 respondents (76.7%) who have poor 
knowledge, 4 of them (13.3%) are performing CPR 
well. While, the rest of it, 19 respondents (63.3%) 
are in a poor category on performing CPR. 
 
The result from counting used Fisher Exact analysi s  
tools with SPSS 16.00 for Windows program is also 
displayed in table 4. the outcome is obtained 
significant values (p-value) 0,014 the conclusio n  o f  
the test is rejecting H0 because p-value values is 
smaller than0,05 (0,014<0,05), so can be concluded 
that there is relation between nurses knowledge 
level and their skills on performing 
cardiopulmonary resuscitation in Critical and 
Emergency Care Unit in one of the hospitals in Solo. 

From 30 respondents that analyzed, there are 19 of 
them which have poor knowledge and poor skill 
also on performing CPR. Nursing care that referre d  
to SOP that must be done rightly, in real practice, 
some of SOP steps are still neglected. That was 
obtained according to the observation of 
researcher to respondents who performed CPR, 
where there are 3 out of 13 items in the checklist 
that most of them did not do. Those are items no 3, 
5 and 8. Every nurse must have good knowledge 
and skills related to CPR because that is a vital 
procedure that must be mastered by professional 
nurses. 
 
DISCUSSIONS 
Patient emergency care is one of the hospital 
services that required fast, proper, and accurate 
service to prevent death and deformity. One of the  
quality service indicators is response time, where 
this indicator is a process to achieve an outcome 
indicator that is life sustainability (Halim, 2016). 
 
Cardiopulmonary resuscitation knowledge i s a vital  
modal for nurses who work in Critical and 
Emergency Care Unit. In the same research from 
Hermawan (2011), with the title Relation Betw ee n 
Nurses About Critical Respiratory with Attitu d e o n  
Handling Breath Failure on Neonatal in Intensive 
Care Unit In PKU Muhammadiyah Delanggu Klaten.  
Where the result is there is a relation between 
nurses knowledge about critical respiratory and 
their attitude on handling breath failure on 
neonatal who has critical breathing condition. 
 
Knowledge level can be diffe rent because of  s o me  
factors, one of it is educational background. It is 
because the respondents obtain information 
through education and experience on it. The 
relationship between education level w i th  n u rs e s  
knowledge is a knowledge level that has an imp a ct 
on increasing clients knowledge about their health. 
Other factors that also effect is working period, 
motivation on the study, and lack of training gi v e n  
by hospital about cardiopulmonary resuscitation. 
 
On the other side, from analysis data above 
obtained 7 respondents (23.3%) who have good 
knowledge, there is 5 of them (16.7%) also have 
good skills. According to Notoadmojo (2007) 
explain that knowledge is one of the dominant 
factors that create someone action, so from that 
theory also explain about why there are 3 



   INDONESIAN JOURNAL OF 

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PRACTICES 

 
56 

respondents (6.7%) that have good knowledge b u t 
still have poor skills. Research result of Thamrin 
(2010) about Image of Nurses and Midwives 
Knowledge about Cardiopulmonary Resuscitation 
on Neonatal in RSIA Siti Fatimah Makassar. The 
result showed that most of them (57,5%) nurses 
respondents have good knowledge. Nurses and 
midwives knowledge about cardiopulmonary 
resuscitation on neonatal is important where 
knowledge is a basic foundation on creating nurses  
and midwives attitude on performing 
cardiopulmonary resuscitation fast and right.  The 
outcome of Thamrin research is in line with this 
research where someone (nurses) knowled ge w i ll 
have an impact on their attitude and their skills in 
performing CPR. 
 
Based on table 3, which explain about nurse's skill s 
quality in CPR, the result of performing 
cardiopulmonary resuscitation is valued by doing 
observation toward respondents while filling a 
checklist when they performing CPR. Later on the 
outcome will be divided into 2 categories, first is 
categorize good if the result of value >mean or 
respondents get value 10-13. The second is 
categorize poor if they have value <mean or 0-9. 
 
From 9 respondents (30%) who have good skills, 
there is 4 of them (13,3%) who have poor 
knowledge. It showed that only knowledge does 
not ensure that someone can perform 
cardiopulmonary resuscitation well. An outcome of 
the research displayed that 2 out of 4 of them have  
working experience for 5 years, the other one 
respondent has been working for 8 years, and the 
rest has worked for 15 years. Besides experience 
and knowledge, according to Oman and Bell in 
Bastable (2002), there are some other factors that 
influence someone skills. Those are health  s tatu s ,  
environmental stimuli, and anxiety level. That 
research outcome is in line with the research of 
Kuhnigk (2004), with the title Skills and Self Value 
on Cardiopulmonary Resuscitation from Nurses in 
Hospital. From those research are obtained that 
CPR skills from respondents are different in 
education level, professional experience, on d o i n g 
CPR either in the past or working in the hospital.  
 
The limitations of this research are: 1. research 
methods using descriptive so that the result is 

limited on nurses who work in Critical and 
Emergency Care Unit in one of the hospitals in Solo  
and the result cannot be generalized for nurses 
from others hospital. 2. this research only limit on 
the relation between nurses knowledge and their 
skill on cardiopulmonary resuscitation. 3. changes 
of statistic test from Kendall Tau-b become Fisher 
Exact analysis tool is because there is no any 
respondents who have poor knowledge and skill, 
 
CONCLUSIONS 
Respiratory and cardiac arrest inpatient can occur 
suddenly and unpredictable, by knowing sign s  an d  
symptoms fast and early appropriate aid 
procedure, it can help to prevent worsening of  th e  
patient condition and give maximal chance f o r th e  
patient to recover. Therefore it is very important 
that nurses understanding about CPR and it needs 
poor knowledge also so that CPR can be done 
rightly, and fast on giving aid to the patient with 
respiratory and cardiac arrest. 
 
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