Cardiac arrest is a major public health phenomenon, affecting millions of people worldwide every year. It is considered one of leading causes of death in many countries, including developing ones where healthcare systems are often ill-equipped to respond rapidly to this type of emergency. American Health Association (2020) [1] , around 356,000 cardiac arrest occur each year outside hospitals in the United States, which survival rates still low despite medical advances. In addition, this alarming figure reflects a similar reality in other parts of the world, including Africa, where emergency care infrastructures are often limited; therefore, cardiac arrest still a critical situation. However, rapid well-executed interventions such as cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) are widely recognized as vital measures for restoring blood flow and preventing brain damage (Nolan et al., 2019) [2] .

Furthermore, in many developing countries including Burundi, resources and technologies required for those interventions are not always accessible; therefore, the lack of adequate and regular training for healthcare professionals, particularly nurses, further compromised the quality of cardiac arrest care [3] .

Nursing theories offer interesting conceptual frameworks for structuring and improving clinical practice in emergency situations. Virginia Henderson’s theory, is one of nursing theories focused on meeting patient’s basic needs and which could prove crucial in a context where rapid assessment of vital needs is required (Henderson, 2017) [4] [5] . Similarly, Dorothea Orem’s patient autonomy theory, while difficult to apply in emergency situations, encourages a proactive approach to care management (Orem, 2018) [6] [7] . Finally, Jean Watson’s theory, with its emphasis on compassion and human support, could improve the quality of interaction between caregivers and patients in crisis situations (Watson, 2019) [8] .

Study objective was to evaluate the comparative effectiveness of nursing theories of Virginia Henderson, Dorothea Orem and Jean Watson during the management of cardiac arrest and then, to propose recommendations for improving nursing practice [9] .

As assumptions, Virginia Henderson’s theory is less widely used than those of Dorothea Orem and Jean Watson in management of cardiac arrest; Jean Watson’s theory is seen as the most effective for emotional support of intensive care patients and their families in the event of cardiac arrest; and then, an appropriate continuing education based on the integration of three theories would significantly improve the skills and quality of nursing care in the management of cardiac arrest [10] [11] .

The findings showed that, a total of 234 nurses were registered; among them, HPRC recovered 149 nurses representing 63.68%, and CPLR recovered 85 nurses, or 36.32% of the total. Concerning age distribution based on the age, the results showed: a domination at 48.29% of nurses with 35 - 44 years old, 29.91% with 45 - 54 years old, 21.37% of nurses with 25 - 34 years, and only 0.43% of nurses aged of ≥55 old; in addition, our findings show that 63.50% of interviewed were female gender, and 36.50 were male gender; also many nurses of staff in all institutions have a secondary school level (A2), or 44.44%, it follows Bachelor/license level (A0), or 29.49%; and then all services in which must be affected nurses of each level were assessed during our consultancy, as well as: operating theaters, surgery, internal medicine, pediatric, resuscitation, emergency, Gyneco-obstetric ( Table 1 ).

Odds ratio analysis revealed that the main difficulties encountered variable is the only significant one in the model (OR = 2357.58, p = 0.017), indicating that these difficulties exponentially increase the adoption of nursing theories. Low level of satisfaction, practice and other contextual variables has been revealed without statistical significance (p > 0.05).

Table 2 shows that HPRC count many nurses as CPLR, or 63.68 (p = 0.075); according to age, our findings show that a big number of interviewed had 35 - 44 years, or 48.29% (p = 0.093), it follows those with 45 - 54 years, or 29.91% (p = 0.042); according to possession level of training in cardiac resuscitation, many interviewed of staff have not received any training in cardiac resuscitation, highlighting a potential need to strengthen skills in this area, or 85.90% (p = 0.092) while 14.10 (p = 0.064) had been trained on the same phenomenon; concerning Knowledge and using of nursing theories during nursing care in cardiac resuscitation, 217 interviewed implemented Virginia Henderson’s theory fluently, or 92.73% (p = 0.072), at the second level comes Dorothea Orem nursing theory, or 4.27% (p = 0.057) and then Florence Nightingale’s theory, or 3% (p = 0.031).

Nursing theories such as those of Benner and Henderson, are essential frameworks for structuring and guiding clinical practice in the management of cardiac arrest. Those theories enable systematic approaches to assessing, intervening and managing patients on an ongoing basis, helping to improve clinical outcomes and reduce mortality [12] [13] . Benner’s theory of competency development argues that clinical experience enables nurses to guess through five stages of competence as well as; novice, advanced beginner, competent, proficient and expert. A study by Wang et al. (2021) [14] showed that nurses are the expert level detect signs of clinical deterioration earlier, anticipate patients’ needs and initiate critical interventions more effectively thereby increasing patients’ chances of survival. Training programs based on nursing theories, such as those evaluated by Lee et al. (2022) [15] [16] , have demonstrated a significant improvement in cardiopulmonary resuscitation (CPR) skills, particularly in rapid decision-making, team coordination, and application of resuscitation protocols [17] .

Henderson’s patient-centered theory defines the nurse’s role as that of helping the patient perform activities essential to the health that can’t be achieved alone. In the context of cardiac arrest, that theory emphasizes the importance of immediate supportive care and continuous monitoring. A study of Phelan and McCarthy (2018) [18] [19] demonstrated that its application in intensive care units (ICU) improves not only physiological care, but also emotional and psychological support for families. This contributes to a more healing-friendly environment. Martinez and Rivera (2021) [20] [21] also found that this approach reduces post-cardiac arrest complications and the length of ICU hospitalizations [22] .

In community settings, the integration of these theories into training programs has also shown convincing results. According to Jones and Thomas (2019) [23] [24] , training based on Benner’s theory enables participants to rapidly develop practical CPR skills, reducing response times and increasing survival rates from out-of-hospital cardiac arrest. Similarly, Dupont and Lefevre (2023) [25] [26] revealed that Henderson approach improves post-cardiac arrest management by helping caregivers address patients’ holistic needs [27] .

In fact, integrating Benner and Henderson’s theories into cardiac arrest optimizes nurses’ skills, strengthens clinical decision-making, and ensures high-quality care, whether in hospital or community settings [28] [29] . Their application contributes to standardizing practices, coordinating interventions and providing more patient-centered care, all of which are crucial to responding effectively to health emergencies [30] [31] .

This study highlights the importance of nursing theories as practical frameworks in order to improving clinical outcomes and to enhancing healthcare professionals’ skills in managing cardiac arrest which has put out in short time of one month; from July 15 to August 14, 2024.

The integration of nursing theories in the management of cardiac arrest, such as that of Florence Nightingale, Dorothea Orem, Benner and Virginia Henderson improves clinical practice in nursing care and contributes team responsiveness and patients’ outcomes. Systematic application of these theories has demonstrated improved emergency preparedness and quality of care.

The requirements are aimed at strengthening training, standardizing practices and improving resource management. It is recommended to introduce continuous training programs in cardiopulmonary resuscitation (CPR), including practical simulations; to implement standardized protocols, to ensure adequate staffing and critical equipment. Promoting inter-professional collaboration and ongoing evaluation of practices are also essential to optimize interventions.

In terms of training, it is recommended that nursing theories be integrated into educational programs, and that practical workshops based on clinical scenarios be organized. For researchers, longitudinal; they have to implement studies on the impact of nursing theories on patients’ survival and quality of life, as well as comparisons between different theoretical models, are recommended.

We’d like to thank first, the Public Health Ministry and the Fight against AIDS for its support in nursing program of higher training and acceptance to participating in data collection at different institutes/hospitals, even public or private. Secondly, we thank the Hope Africa University for helping us in order to fulfill the outcomes. Finally, thanks to all stakeholders for the sacrifice and morality in implementing and enhancing all the practices possible till that we complete our mission.