Elsevier

Resuscitation

Volume 81, Issue 8, August 2010, Pages 1019-1024
Resuscitation

Simulation and education
Comparison of two instructional modalities for nursing student CPR skill acquisition

https://doi.org/10.1016/j.resuscitation.2010.04.022Get rights and content

Abstract

Aims

The purpose of the study was to compare performance based measures of CPR skills (compressions, ventilations with bag-valve-mask (BVM), and single rescuer CPR) from two types of CPR courses: a computer-based course (HeartCode™ BLS) with voice advisory manikin (VAM) feedback and instructor-led (IL) training with traditional manikins.

Methods

604 nursing students from 10 schools of nursing throughout the United States were randomized by school to course type. After successful course completion, students performed 3 min each of compressions; ventilations with BVM; and single rescuer CPR on a Laerdal Resusci Anne® SkillReporter™ manikin. The primary outcome measures were: (1) compression rate, (2) percentage of compressions performed with adequate depth, (3) percentage of compressions performed with correct hand placement, (4) number of ventilations/min, and (5) percentage of ventilations with adequate volume.

Results

There were no differences in compression rates between the two courses. However, students with HeartCode BLS with VAM training performed more compressions with adequate depth and correct hand placement and had more ventilations with adequate volume than students who had IL courses particularly when learning on hard molded manikins. During single rescuer CPR, students who had HeartCode BLS with VAM training had more compressions with adequate depth and ventilations with adequate volume than students with IL training.

Conclusion

Students who trained using HeartCode BLS and practiced with VAMs performed more compressions with adequate depth and ventilations with adequate volume than students who had IL courses. Results of this study provide evidence to support use of HeartCode BLS with VAM for training nursing students in CPR.

Section snippets

Methods

Ten volunteer schools of nursing from across the United States, including one diploma program, four associate degree programs, and five bachelor of science programs, from 10 different states, were randomized into one of two types of American Heart Association (AHA) basic life support (BLS) Healthcare Provider courses: (1) HeartCode BLS with VAM feedback or (2) standard IL training with traditional manikins (Fig. 1). The AHA-certified instructors brought the manikins that were used for the IL

Participants

This study is nested in a larger yearlong study on CPR skill retention. Sample size calculations were based on detecting medium effect sizes between course type groups and skill retention groups that were defined by the larger yearlong study with 80% power and an overall significance level of 0.05.

There were 604 participants: 264 had the HeartCode BLS course and practiced their CPR psychomotor skills on a VAM, and 340 took the IL course with practice on traditional manikins (IL with Manikin A

Training groups

HeartCode BLS is a self-directed, e-learning course from the AHA based on the same learning objectives and performance criteria as the standard course facilitated by an instructor.27 One significant difference between the HeartCode with VAM and IL courses is that participants do not perform two-rescuer CPR using the HeartCode course although the core skills do not differ. Participants completed Part 1, the online didactic component of the course for cognitive learning, in their school's

CPR psychomotor skills assessment

After participants successfully completed either the IL or the HeartCode BLS training course, their CPR psychomotor skills were immediately assessed using a Laerdal Resusci Anne SkillReporter manikin. Participants from both groups performed 3 min each of compressions, ventilations with BVM, and single rescuer CPR. CPR psychomotor skills performance was evaluated for each group based on the mean compression rate (from each series of compressions), mean percentage of all compressions performed

Data analysis

Data were summarized as means (standard deviation) for continuous measures and as frequencies (%) for categorical measures. To compare demographics between the HeartCode BLS with VAM and IL groups using traditional manikins, the independent t-test and chi-square test were used. To compare differences in CPR performance skills between the HeartCode BLS and IL groups and to explore demographic variables (age, gender, CPR certification, and CPR experience) that might be associated with differences

Results

Although not relevant clinically, age was the only demographic factor found to be different between the HeartCode BLS with VAM and IL groups. Students in the VAM group were a mean of 4.3 (SD = 8.8) years older than the IL group (p < 0.0001). The influence of age as a confounding variable in the analysis of CPR psychomotor skills between the two training groups was found to be non-significant (Table 1).

There was no difference in the number of compressions per min or compression rate between students

Discussion

Evidence suggests that IL CPR courses may not adequately prepare nursing students to perform these skills.23, 24, 25 Voice advisory manikins have proven effective for acquiring CPR skills and improving the quality of CPR and skill retention among other groups of providers.6, 12, 13, 14, 15, 16, 17, 18 Few studies have included nursing students, and none have compared HeartCode with VAM to IL training prior to this research. Yet, CPR is an essential nursing competency and required to begin

Limitations

Selection bias in volunteers may have played a factor in the study results. Students volunteering for the study may have been more highly motivated than the average student entering a nursing program. All instructors of the IL courses were certified, but there was no evaluation of the quality of the CPR training they provided. Some of the CPR instructors were faculty members in the schools of nursing or were hired specifically to teach the IL courses for this research study. Other instructors

Conclusions

Students trained using HeartCode BLS and VAMs performed more compressions with adequate depth, used proper hand placement, and provided more ventilations with adequate volume than students who had IL training. There were skill differences in the IL group based on the type of manikins used by those instructors. Ability to compress with adequate depth and ventilate with adequate volume both needed improvement. The results provide beginning evidence to support the use of HeartCode BLS with VAM for

Conflict of interest statement

We acknowledge the following potential conflict of interest: The American Heart Association (AHA) and Laerdal Medical Corporation supplied the materials and equipment for the study at no cost to the schools of nursing that served as training sites and funded the entire study through a grant to the National League for Nursing (NLN). The project was coordinated through the NLN with funding provided by them to the Principal Investigator (MO) and research team. Representatives from the NLN, AHA,

References (31)

Cited by (57)

  • Comparing the effect of self-instruction with that of traditional instruction in basic life support courses—A systematic review

    2016, Resuscitation
    Citation Excerpt :

    All included studies used pass rate or individual CPR skill performance as their outcomes, and two methods were used to evaluate the skills: instructors’ judgment using checklists and parameters of CPR skills recorded by computers. In most studies, the checklists were utilized to evaluate the learner’s performance by the instructors except that five studies only used the data recorded by computers when the learners received evaluation as the outcome.8,16,17,21,22 Although the checklists used in most studies were declared to be consistent with the guidelines, the checklist form and criteria of passing the skills test were different amongst studies.

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.04.022.

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