Cardiorespiratory fitness for emergency nursing performance: Association with initial response time and clinical decision-making performance
DOI: https://doi.org/10.33024/min.v9i7.4065
Cardiorespiratory Fitness Clinical Decision-Making Performance Emergency Department Nurse Harvard Step Test In-Hospital Cardiac Arrest Response Time
Abstract
Background: Emergency department (ED) nurses must respond quickly and make accurate clinical decisions in life-threatening situations. Although technical skills and experience are known to influence emergency performance, the role of cardiorespiratory fitness has received limited attention, especially among Indonesian emergency nurses.
Purpose: To determine the relationship between cardiorespiratory fitness, response time, and clinical decision-making performance among ED nurses.
Method: This cross-sectional correlational study included all 28 ED nurses at Jember Klinik Hospital using total sampling. Cardiorespiratory fitness was measured with the Harvard Step Test and estimated VO₂max. Response time was assessed during a standardized in-hospital cardiac arrest simulation as the interval from scenario completion to the first chest compression. Clinical decision-making performance was evaluated using a standardized vignette based on the American Heart Association 2020 cardiac arrest algorithm. Spearman rank correlation was used, with p < 0.05 considered significant.
Results: Most nurses had good cardiorespiratory fitness (42.9%), optimal response time (53.6%), and good clinical decision-making performance (50.0%). Cardiorespiratory fitness was significantly associated with faster response time (r = –0.612; p = 0.001), indicating that fitter nurses initiated emergency actions more rapidly. A significant positive association was also found between cardiorespiratory fitness and clinical decision-making performance (r = 0.584; p = 0.001), suggesting that higher fitness levels were linked to better performance during the cardiac arrest simulation.
Conclusion: Cardiorespiratory fitness was significantly associated with faster emergency response and better clinical decision-making performance among ED nurses. These findings suggest that fitness assessment and structured physical conditioning programs should be considered in occupational health and professional development strategies to strengthen emergency care quality and patient safety.
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References
Alibazi, R. J., Kidgell, D., Zoghi, M., & Jaberzadeh, S. (2020). What are the Acute Effects of Aerobic Exercise on Fractionated Response Time: A Systematic Review and Meta-analysis. Journal of Science in Sport and Exercise, 2(2), 97–112.
Almarwani, A. M., & Alzahrani, N. S. (2023). Factors affecting the development of clinical nurses’ competency: A systematic review. Nurse education in practice, 73, 103826.
American College of Sports Medicine. (2021). ACSM’s guidelines for exercise testing and prescription (11th ed.). Wolters Kluwer.
Bauermeister, S., & Bunce, D. (2016). Aerobic Fitness and Intraindividual Reaction Time Variability in Middle and Old Age. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 71(3), 431–438.
Cantelon, J. A., & Giles, G. E. (2021). A Review of Cognitive Changes During Acute Aerobic Exercise. Frontiers in Psychology, 12.
Chu, C., Huang, I., Hillman, C. H., Chen, N., Yu, J., Hung, C., Chen, F., & Chang, Y. (2024). The relationship between cardiorespiratory fitness and inhibitory control following acute stress: An ERP study. Psychophysiology, 61(9).
Di Muccio, F., Ruggeri, P., Brandner, C., & Barral, J. (2022). Electrocortical correlates of the association between cardiorespiratory fitness and sustained attention in young adults. Neuropsychologia, 172, 108271.
Heuel, L., Otto, A.-K., & Wollesen, B. (2024). Physical exercise and ergonomic workplace interventions for nursing personnel—effects on physical and mental health: a systematic review. German Journal of Exercise and Sport Research, 54(2), 291–324.
Gates, M., Wingert, A., Featherstone, R., Samuels, C., Simon, C., & Dyson, M. P. (2018). Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review. BMJ Open, 8(9), e021967.
Gerber, M., Räber, D., Looser, V. N., & Ludyga, S. (2026). The moderating role of cardiorespiratory fitness in adolescents’ physiological and psychological responses to real-life academic stress. Psychology of Sport and Exercise, 83, 103058.
Jacob, S., Rasool, S., Ali Khan, S., & Arif, S. (2025). Fitness to practice: A concept analysis. Physical Education, Health and Social Sciences, 3(2), 570–572. https://doi.org/10.63163/jpehss.v3i2.345.
Kao, S., Baumgartner, N., Nagy, C., Fu, H., Yang, C., & Wang, C. (2022). Acute effects of aerobic exercise on conflict suppression, response inhibition, and processing efficiency underlying inhibitory control processes: An ERP and SFT study. Psychophysiology, 59(8).
Kim, Y.-N. (2022). The Influence Factors on Nursing Work Performance by Clinical Nurses. Journal of the Korea Academia-Industrial Cooperation Society, 23(1), 594–602.
Looser, V. N., Ludyga, S., & Gerber, M. (2023). Does heart rate variability mediate the association between chronic stress, cardiorespiratory fitness, and working memory in young adults? Scandinavian Journal of Medicine & Science in Sports, 33(5), 609–618.
Ludyga, S., Gerber, M., Brand, S., Holsboer‐Trachsler, E., & Pühse, U. (2016). Acute effects of moderate aerobic exercise on specific aspects of executive function in different age and fitness groups: A meta‐analysis. Psychophysiology, 53(11), 1611–1626.
Luque-Casado, A., Perakikis, P., Hillman, C. H., Kao, S.-C., Llorens, F., Guerra, P., & Sanabria, D. (2016). Differences in Sustained Attention Capacity as a Function of Aerobic Fitness. Medicine & Science in Sports & Exercise, 48(5), 887–895.
Matsugaki, R., Kuhara, S., Saeki, S., Jiang, Y., Michishita, R., Ohta, M., & Yamato, H. (2017). Effectiveness of workplace exercise supervised by a physical therapist among nurses conducting shift work: A randomized controlled trial. Journal of Occupational Health, 59(4), 327–335.
Ministry of Health of the Republic of Indonesia. (2019). Pedoman penyelenggaraan pelayanan gawat darurat di rumah sakit. Ministry of Health of the Republic of Indonesia.
Mohamed, S., & Ghalab, A. (2022). Effect of Physical Activity and Health Behavior on Staff Nurses’ Job Performance. International Egyptian Journal of Nursing Sciences and Research, 2(2), 118–132.
Mohebb, Z., Fazel Dehkordi, S., Sharif, F., & Banitalebi, E. (2019). The effect of aerobic exercise on occupational stress of female nurses: A controlled clinical trial. Investigación y Educación En Enfermería, 37(2).
Niu, S., Lin, C., Chen, P., Fan, Y., Huang, H., & Chiu, H. (2021). Immediate and lasting effects of aerobic exercise on the actigraphic sleep parameters of female nurses: A randomized controlled trial. Research in Nursing & Health, 44(3), 449-457.
Oggionni, G., Rizzi, M., Bernardelli, G., Malacarne, M., Pagani, M., & Lucini, D. (2025). The Association Between Cardiorespiratory Fitness Directly Assessed by the Cardiopulmonary Stress Test and the Perception of Stress. Journal of Clinical Medicine, 14(19), 7120.
Sagherian, K., Steege, L. M., Geiger-Brown, J., & Harrington, D. (2018). The Nursing Performance Instrument: Exploratory and Confirmatory Factor Analyses in Registered Nurses. Journal of Nursing Research, 26(2), 130–137.
Panchal, A. R., Bartos, J. A., Cabañas, J. G., Donnino, M. W., Drennan, I. R., Hirsch, K. G., Kudenchuk, P. J., Kurz, M. C., Lavonas, E. J., Morley, P. T., O’Neil, B. J., Peberdy, M. A., Rittenberger, J. C., Rodriguez, A. J., Sawyer, K. N., & Berg, K. M. (2020). Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 142(16 2), S366–S468.
Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2020). Fundamentals of nursing (10th ed.). Elsevier.
Prakash, P., Nayak, K. R., Babu, A. S., Devi, E. S., Chaudhuri, S., Pai, D. R., & Krishnan S, V. (2026). Impact of Cardiopulmonary Resuscitation Health Care Workers’ Physical Health Parameters on Cardiopulmonary Resuscitation Performance Quality in Simulated Manikin-Based Settings—A Systematic Review. JACEP Open, 7(3), 100395.
Schilling, R., Herrmann, C., Ludyga, S., Colledge, F., Brand, S., Pühse, U., & Gerber, M. (2020). Does cardiorespiratory fitness buffer stress reactivity and stress recovery in police officers? A real-life study. Frontiers in psychiatry, 11, 594.
Subih, M., Al-Amer, R., Bani Saleh, E. G., & Thultheen, I. N. (2024). Predictors of Clinical Performance Among Emergency Nurses: A Cross-Sectional Study. SAGE Open Nursing, 10.
Tan, M. W., Lim, F. P., Siew, A. ling, Levett-Jones, T., Chua, W. L., & Liaw, S. Y. (2021). Why are physical assessment skills not practiced? A systematic review with implications for nursing education. Nurse Education Today, 99, 104759.
World Health Organization. (2018). Emergency care systems for universal health coverage: Ensuring timely care for the acutely ill and injured. World Health Organization.
Wu, C., Nien, J., Lin, C., Li, R., Chu, C., Kao, S., & Chang, Y. (2022). Cardiorespiratory fitness is associated with sustained neurocognitive function during a prolonged inhibitory control task in young adults: An ERP study. Psychophysiology, 59(11).
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