Association of cardiopulmonary resuscitation psychomotor skills with knowledge and self‐efficacy in nursing students

Effective cardiopulmonary resuscitation (CPR) skills are essential for better patient survival, but whether these skills are associated with knowledge of and self‐efficacy in CPR is not well known. The purpose of this study was to assess the quality of CPR skills and identify the association of the psychomotor skills with knowledge and self‐efficacy at the time of CPR skills training. A convenience sample of 124 nursing students participated in a one‐group posttest‐only study. The quality of CPR psychomotor skills, as assessed by structured observation using a manikin, was suboptimal. Nursing students who performed correct chest compression skills reported higher self‐efficacy, but there was no association between CPR psychomotor skills and total knowledge. Rigorous skills training sessions with more objective feedback on performance and individual coaching are warranted to enable mastery learning and self‐efficacy.     

Improving nurse computer proficiency with a tri‐focal educational intervention

Use of the electronic health record is expanding rapidly. Nurses are primary users of this technology and more than half rate their own computer skills to be below average. Nurses at this ambulatory genitourinary oncology practice recognized a need to improve information technology (IT) skills in the nursing team. An assessment was undertaken of nurses working in the unit by means of a confidential survey. The survey questioned nurses' ability to perform unit‐specific tasks as well as offering a free text component to identify further educational needs. Survey responses identified a need to improve computer proficiency. A nurse‐led, unit‐specific, educational intervention was developed to address this need and improve nurses IT skills. Unit‐specific competencies were identified as well as basic computer skills. The intervention was targeted at adult learners and addressed different styles of learning. A PowerPoint presentation was developed utilizing a step‐by‐step pictorial and written instruction to guide the nurse to complete the intended task. This was presented in small groups to allow visual and auditory learning. The PowerPoint presentation was also e‐mailed to each staff member for reference and personal learning. Finally, multiple opportunities for hands on learning were offered in small groups or one‐on‐one to allow kinesthetic learning to take place. Post‐survey results demonstrated an increase in unit‐specific competencies and improved overall confidence in IT skills. This was a small group of nurses N = 53, pre‐survey responses (N = 32) and post‐survey responses (N = 14) were low but within expected norms for surveys. A unit‐specific peer led intervention can improve IT skills in nurses and open a dialogue about computer skills     

High engagement,high quality: A guiding framework for developing empirically informed asynchronous e‐learning programs for health professional educators

E‐learning involves the transfer of skills and knowledge via technology so that learners can access meaningful and authentic educational materials. While learner engagement is important, in the context of healthcare education, pedagogy must not be sacrificed for edu‐tainment style instructional design. Consequently, health professional educators need to be competent in the use of current web‐based educational technologies so that learners are able to access relevant and engaging e‐learning materials without restriction. The increasing popularity of asynchronous e‐learning programs developed for use outside of formal education institutions has made this need more relevant. In these contexts, educators must balance design and functionality to deliver relevant, cost‐effective, sustainable, and accessible programs that overcome scheduling and geographic barriers for learners. This paper presents 10 guiding design principles and their application in the development of an e‐learning program for general practice nurses focused on behavior change. Consideration of these principles will assist educators to develop high quality, pedagogically sound, engaging, and interactive e‐learning resources.     

Confidence‐weighted testing: A descriptive study of Japanese nursing students

Nurses' lack of self‐confidence in their own nursing skills is one of the main reasons that novice nurses leave the profession in Japan. Nursing education must help students gain self‐confidence in their nursing skills in order to allow more novice nurses to stay in their profession. In this study, we evaluated whether confidence‐weighted testing feedback actually improves students' self‐confidence in their basic nursing skills. Confidence‐weighted testing, which provides quantifiable results, might allow students to objectively assess their skill‐related self‐confidence. Sixty‐seven first‐year nursing students took two confidence‐rating examinations on the knowledge and practical skills related to pulse and blood pressure measurement of immobile patients. Feedback was given to each participant after the first examination. After the first examination with confidence‐weighted testing feedback, students showed higher levels of self‐confidence in their practical skills, but not in knowledge. The improvement of self‐confidence in practical skills suggests that there is still room for improvement in confidence‐weighted testing feedback in knowledge. Further research is required to identify more effective feedback methods to improve students' self‐confidence levels in knowledge using the results of confidence‐weighted testing.     

Generalization of Anger‐Coping Skills from Day‐Service to Residential Settings

Objective To evaluate the extent to which anger management training provided within a learning disabilities day service generalizes to residential settings. Method Eleven day‐service users participated in one of two anger management groups. Treatment was delivered by day‐service staff and an assistant psychologist, using a standard cognitive‐behavioural therapy (CBT) package shown to be effective in earlier studies. Evaluation was by the Provocation Index and the Profile of Anger‐Coping Skills, which measure, respectively, the potential to react in an angry manner, and the utilization of eight different anger‐coping skills. Results Participants showed a decrease in anger and an increase in anger‐coping skills, which was maintained at 6‐month follow‐up. Similar changes were reported by day‐service key‐workers and by residential carers (and by the participants themselves). At the level of the group, key‐workers and home carers did not differ significantly, at any time, in their ratings of anger, aggregate coping skills or individual coping skills. Within each setting, profiles of coping skills differed between individuals but were relatively stable across the 6‐month follow‐up period. However, there was no significant correlation between the profiles of coping skills reported for individual service users in the two settings. Conclusions The results confirm that group‐based CBT is an effective treatment for people with learning disabilities and anger management problems. Therapeutic gains are maintained for at least 6 months and generalize across settings. Different anger‐coping skills may be used by different people, or by the same person in different environments. A Manual for the group is available on request.     

Effects of case‐based learning on communication skills,problem‐solving ability,and learning motivation in nursing students

The purpose of this study was to explore the effects of case‐based learning on communication skills, problem‐solving ability, and learning motivation in sophomore nursing students. In this prospective, quasi‐experimental study, we compared the pretest and post‐test scores of an experimental group and a nonequivalent, nonsynchronized control group. Both groups were selected using convenience sampling, and consisted of students enrolled in a health communication course in the fall semesters of 2011 (control group) and 2012 (experimental group) at a nursing college in Suwon, South Korea. The two courses covered the same material, but in 2011 the course was lecture‐based, while in 2012, lectures were replaced by case‐based learning comprising five authentic cases of patient–nurse communication. At post‐test, the case‐based learning group showed significantly greater communication skills, problem‐solving ability, and learning motivation than the lecture‐based learning group. This finding suggests that case‐based learning is an effective learning and teaching method.     

Procedures Can Be Learned on the Web: A Randomized Study of Ultrasound‐guided Vascular Access Training

Objectives: Web‐based learning has several potential advantages over lectures, such as anytime–anywhere access, rich multimedia, and nonlinear navigation. While known to be an effective method for learning facts, few studies have examined the effectiveness of Web‐based formats for learning procedural skills. The authors sought to determine whether a Web‐based tutorial is at least as effective as a didactic lecture for learning ultrasound‐guided vascular access (UGVA). Methods: Participating staff emergency physicians (EPs) and junior emergency medicine (EM) residents with no UGVA experience completed a precourse test and were randomized to either a Web‐based or a didactic group. The Web‐based group was instructed to use an online tutorial and the didactic group attended a lecture. Participants then practiced on simulators and live models without any further instruction. Following a rest period, participants completed a four‐station objective structured clinical examination (OSCE), a written examination, and a postcourse questionnaire. Examination results were compared using a noninferiority data analysis with a 10% margin of difference. Results: Twenty‐one residents and EPs participated in the study. There were no significant differences in mean OSCE scores (absolute difference = ?2.8%; 95% confidence interval [CI] = ?9.3% to 3.8%) or written test scores (absolute difference = ?1.4%; 95% CI = ?7.8% to 5.0%) between the Web group and the didactic group. Both groups demonstrated similar improvements in written test scores (26.1% vs. 25.8%; p = 0.95). Ninety‐one percent (10/11) of the Web group and 80% (8/10) of the didactic group participants found the teaching format to be effective (p = 0.59). Conclusions: Our Web‐based tutorial was at least as effective as a traditional didactic lecture for teaching the knowledge and skills essential for UGVA. Participants expressed high satisfaction with this teaching technology. Web‐based teaching may be a useful alternative to didactic teaching for learning procedural skills.     

Enhancing nursing students' skills in vital signs assessment by using multimedia computer-assisted learning with integrated content of anatomy and physiology

Due to constraints of increasing number of nursing students and a disproportionate shortfall of faculty members in nursing schools, it was necessary to supplement traditional lecture or lecture-demonstration with on-line multimedia materials and/or multimedia compact discs for enhancing learning. The authors have developed a computer-assisted learning (CAL) multimedia on vital signs with animation and audio features for teaching in the classroom based on the 5Es inquiry cycle. When the CAL was tried on second-year undergraduates in two comparable schools, all groups of students gained significantly higher performance skills regardless of whether the groups were subjected to CAL/lecture or CAL/lecture/demonstration. However, they did not gain in factual knowledge.     

Comparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students

OBJECTIVE: To evaluate new instructional methods for teaching high school students cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) knowledge, actions and skills. METHODS: We conducted a cluster-controlled trial of 3 instructional interventions among Seattle area high school students, with random allocation based on classrooms, during 2003-04. We examined two new instructional methods: interactive-computer training and interactive-computer training plus instructor-led (hands-on) practice, and compared them with traditional classroom instruction that included video, teacher demonstration and instructor-led (hands-on) practice, and with a control group. We assessed CPR and AED knowledge, performance of key AED and CPR actions, and essential CPR ventilation and compressions skills 2 days and 2 months after training. All outcomes were transformed to a scale of 0-100%. RESULTS: For all outcome measures mean scores were higher in the instructional groups than in the control group. Two days after training all instructional groups had mean CPR and AED knowledge scores above 75%, with use of the computer program scores were above 80%. Mean scores for key AED actions were above 80% for all groups with training, with hands-on practice enhancing students' positive outcomes for AED pad placement. Students who received hands-on practice more successfully performed CPR actions than those in the computer program only group. In the 2 hands-on practice groups the scores for 3 of the outcomes ranged from 57 to 74%; they were 32 to 54% in the computer only group. For the outcome of continuing CPR until the AED was available scores were high, 89 to 100% in all 3 training groups. Mean CPR skill scores were low in all groups. The highest mean score for successful ventilations was 15% and for compressions, 29%. The pattern of results was similar after 2 months. CONCLUSIONS: We found evidence that interactive computer based self instruction alone was sufficient to teach CPR and AED knowledge and AED actions to high school students. All forms of instruction were highly effective in teaching AED use. In contrast to AED skills, CPR remains a set of difficult psychomotor skills that is challenging to teach to high school students as well as other members of the lay public.     

Point‐of‐Care Ultrasound Education

This article reviews the current technology, literature, teaching models, and methods associated with simulation‐based point‐of‐care ultrasound training. Patient simulation appears particularly well suited for learning point‐of‐care ultrasound, which is a required core competency for emergency medicine and other specialties. Work hour limitations have reduced the opportunities for clinical practice, and simulation enables practicing a skill multiple times before it may be used on patients. Ultrasound simulators can be categorized into 2 groups: low and high fidelity. Low‐fidelity simulators are usually static simulators, meaning that they have nonchanging anatomic examples for sonographic practice. Advantages are that the model may be reused over time, and some simulators can be homemade. High‐fidelity simulators are usually high‐tech and frequently consist of many computer‐generated cases of virtual sonographic anatomy that can be scanned with a mock probe. This type of equipment is produced commercially and is more expensive. High‐fidelity simulators provide students with an active and safe learning environment and make a reproducible standardized assessment of many different ultrasound cases possible. The advantages and disadvantages of using low‐ versus high‐fidelity simulators are reviewed. An additional concept used in simulation‐based ultrasound training is blended learning. Blended learning may include face‐to‐face or online learning often in combination with a learning management system. Increasingly, with simulation and Web‐based learning technologies, tools are now available to medical educators for the standardization of both ultrasound skills training and competency assessment.     

Helping Babies Breathe: Global neonatal resuscitation program development and formative educational evaluation

Objectives

To develop an educational program designed to train health care providers in resource limited settings to carry out neonatal resuscitation. We analyzed facilitator and learner perceptions about the course, examined skill performance, and assessed the quality of instruments used for learner evaluation as part of the formative evaluation of the educational program Helping Babies Breathe.

Methods

Multiple stakeholders and a Delphi panel contributed to program development. Training of facilitators and learners occurred in global field test sites. Course evaluations and focus groups provided data on facilitator and learner perceptions. Knowledge and skill assessments included pre/post scores from multiple choice questions (MCQ) and post-training assessment of bag and mask skills, as well as 2 objective structured clinical evaluations (OSCE).

Results

Two sites (Kenya and Pakistan) trained 31 facilitators and 102 learners. Participants expressed high satisfaction with the program and high self-efficacy with respect to neonatal resuscitation. Assessment of participant knowledge and skills pre/post-program demonstrated significant gains; however, the majority of participants could not demonstrate mastery of bag and mask ventilation on the post-training assessment without additional practice.

Conclusions

Participants in a program for neonatal resuscitation in resource-limited settings demonstrated high satisfaction, high self-efficacy and gains in knowledge and skills. Mastery of ventilation skills and integration of skills into case management may not be achievable in the classroom setting without additional practice, continued learning, and active mentoring in the workplace. These findings were used to revise program structure, materials and assessment tools.     

Self‐rated preparedness of Australian prevocational hospital doctors for emergencies

Objective: To determine perceived preparedness of Australian hospital‐based prevocational doctors for resuscitation skills and management of emergencies, and to identify differences between doctors who perceive themselves well prepared and those who perceive themselves poorly prepared for emergencies, in demographics and exposure to desired learning methods. Methods: Questionnaire consisting of a mix of graded Likert scales and free‐text answers distributed to 36 Australian hospitals for secondary distribution to hospital medical officers. Results: From 2607 questionnaires posted, 470 (18.1%) were returned. Thirty‐one per cent (95% confidence interval [CI] 26–35%) felt well prepared for resuscitation and management of emergencies, 41% (CI 37–45%) felt adequately prepared and 28% (CI 24–32%) felt they were not well prepared. Those who felt well prepared reported that they had experienced more exposure to a range of educational methods, including consultant contact, supervisor feedback, clinical skills, high fidelity simulator sessions and unit meetings. Well‐prepared and poorly prepared doctors had similar opinions of the usefulness of various learning methods, but the poorly prepared group more frequently expressed a desire for increased exposure to contact with registrars and consultants, clinical skills sessions and hospital and unit meetings. There were no differences in gender, age or country of origin (Australia vs international medical graduates) between those who felt well or poorly prepared. Conclusions: Many prevocational hospital doctors feel inadequately prepared for the management of emergencies. Perceived preparedness is associated with more exposure to particular educational activities. Increasing exposure to learning of emergencies in undergraduate and prevocational years could reduce the number of junior doctors who feel poorly prepared for emergencies.     

Teaching medical students to resuscitate children: An innovative two‐part programme

Objective: The objective of the present study was to design and evaluate a novel, ‘blended learning’ approach to the teaching of paediatric resuscitation to medical students. Methods: Participants were recruited from the Graduate Medical Program at the University of Sydney. The course incorporated an initial e‐learning module and a subsequent practical component. The e‐learning module taught basic and advanced life support. Students then attended a 90 min practical session, which focussed on team work and the psychomotor components of resuscitation. Improvement in knowledge was measured by a multiple choice question (MCQ) test. The MCQ was completed prior to beginning the whole course, after completion of the e‐learning module and again at follow up 8 months later. Students also completed an evaluation survey. Results: Twenty‐one students participated. There was a significant objective increase in knowledge from pre‐course to post e‐learning scores, median scores (interquartile range) from 12/23 (10.5 to 13.5) to 21/23 (20 to 22.5), P < 0.001. This significant increase in knowledge was still apparent at follow up 8 months later. Median MCQ score at follow up was 17/23 (14 to 18.5), P < 0.002. Students self‐rated significant improvements in their knowledge, confidence and ability to perform basic and advanced life support for the whole course and between individual components (P < 0.001). Conclusions: A novel paediatric resuscitation course for medical students was developed and evaluated. This demonstrated significant objective improvements in student knowledge throughout the course, at course completion and at 8 month follow up. There were also significant subjective improvements in knowledge, confidence and ability to perform paediatric resuscitation.     

Comparison of instructor‐led versus peer‐led debriefing in nursing students

Despite its widespread support, the most effective simulation‐based debriefing method has little evidence to support its efficacy. In this study, we compared the effect of peer‐led and instructor‐led debriefing among nursing students. The study was conducted with a non‐equivalent control group using a pretest–post‐test design. A convenience sample of third‐year nursing students was used for the study, where 65 students enrolled in a 2‐week clinical placement rotation were randomly assigned to the instructor‐led group or peer‐led group. The quality of cardiopulmonary resuscitation skills, satisfaction with simulation, and quality of debriefing in the peer‐led group were compared to those in the instructor‐led group. Group differences at each testing interval were analyzed using independent t‐test. Nursing students in the instructor‐led debriefing group showed better subsequent cardiopulmonary resuscitation performance, more satisfaction with simulation experience, and higher debriefing scores compared to the peer‐led group. From our study, instructor‐led debriefing is an effective method in improving skills performance, inducing favorable satisfaction, and providing better quality of debriefing among nursing students.     

Effectiveness of a simulation-based educational program in a pediatric cardiac intensive care unit

Optimal staff performance of resuscitation skills is best achieved through regular effective training. However, providing this teaching in a busy high-acuity pediatric cardiac intensive care unit (ICU) had become a challenge due to time and logistical constraints. A program to effectively and efficiently teach ICU nurses the skills necessary in patient resuscitation was developed using simulation training to better meet staff learning needs. Training via simulation provides an ideal learning environment with hands-on experience with the roles required in patient resuscitation. A simulation training program incorporating simulation training was developed for ICU nursing staff. All staff nurses in the ICU were required to attend over a year's time. The program involved mock resuscitation scenarios in which participants performed various resuscitation roles, followed by video review and group debriefing. All participants completed a survey prior to and immediately following participation in the training and again at 1 year. Data collected included self-report of knowledge, skill, and comfort related to patient resuscitation. Data revealed statistically significant improvement in scores pre and post training and at 1 year for self-reported knowledge, skills, and comfort related to resuscitation. Nursing staff reported that simulation training in resuscitation skills was helpful and positively impacted their knowledge, comfort, and skills. Feedback from nursing staff continues to be very positive, and performance of actual resuscitations on the unit has improved anecdotally.     

The effects of teaching basic cardiopulmonary resuscitation--a comparison between first and sixth year medical students

The purpose of this study was to check if medical students of one of the Universities of Medical Sciences in Poland are prepared to do basic cardiopulmonary resuscitation. The research was undertaken on groups of 50 first year students and 50 sixth year students at the time when they take an exam. To have wider insight into students' ability to perform basic cardiopulmonary resuscitation, quantitative and qualitative methods were used. Students' knowledge of resuscitation was checked by a written test including open questions, their skills of doing resuscitation were checked on manikins. Students also completed a questionnaire. The results showed that first year medical students have a better knowledge of basic cardiopulmonary resuscitation compared with sixth year students. The skills of advanced cardiopulmonary resuscitation are better in sixth year students compared with first year students. The study showed that skills of ventilation and chest compressions need more practice. The students' own estimation of the ability to perform cardiopulmonary resuscitation both in the first and sixth years is very high, but it does not correlate with their knowledge and skills. Our conclusions indicate the need to improve the programme of teaching cardiopulmonary resuscitation with a refresher course in theory and skills at least once a year.     

Retention of Basic Cardiac Life Support content: the effect of two teaching methods

Does the method of instruction affect retention of Basic Cardiac Life Support (BCLS) knowledge and skill? This was the primary question addressed in a study conducted in a university school of nursing. The teaching methods studied were a lecture-demonstration-return demonstration method and a self-paced method. The sample consisted of 63 baccalaureate nursing students who were assigned to one of the two teaching methods. American Heart Association instructional materials and cognitive and performance tests were used with both treatment groups. Initial mastery and retention were tested during week two and eight respectively. Cognitive knowledge was retained at a mastery level by both groups at eight weeks. In addition, there was no difference in retention of performance skills based on teaching methods. However, neither group was able to demonstrate retention of performance skills at a mastery level. Additional data indicate the self-paced subjects spent less time in BCLS learning activities. While the self-paced instructional package was more costly on a one-time basis, repeated applications would decrease the cost/student.     

Readiness for self‐directed learning among nursing students in Thailand

This study took place in Thailand where didactic and lecture‐driven teaching styles are beginning to transform into student‐centered methods. At Chiang Mai University Faculty of Nursing in Thailand, the readiness of 272 undergraduate students to undertake self‐directed learning was investigated using two instruments: a demographic data questionnaire and Guglielmino's Self Directed Learning Readiness Scale. The study found that the overall self‐directed learning readiness of participants was at a high level in the categories of openness to learning opportunities, self‐concept as an effective learner, initiative and independence in learning, informed acceptance of responsibility for one's own learning, creativity, and the ability to use basic study and problem‐solving skills. The findings provide encouragement to nurse educators to further apply self‐directed learning in nursing courses, to improve teaching and learning methods, and promote life‐long learning for nurses within Thailand and elsewhere.     

Effect of simulation on knowledge,self‐confidence,and skill performance in the USA: A quasi‐experimental study

In health care, high‐fidelity simulation has been shown to result in increased student learning outcomes when compared to low‐fidelity simulation. With educational facilities investing significant amounts of money into purchasing high‐fidelity simulators, it is imperative to identify if the midlevel simulator, which is less costly, will result in the same learning outcomes. In this study, we examined the effect of midlevel‐fidelity simulation versus low‐fidelity simulation on Bachelor of Science in Nursing nursing students' knowledge, self‐confidence, and skill performance. A quasi‐experimental design examined the effects of midlevel‐fidelity simulation (n = 37) versus low‐fidelity simulation (case study) (n = 37) in junior‐level nursing students. There was a significant difference for both groups in knowledge and skill performance (measured with a mini Objective Structured Clinical Examination), but not between the groups. Unexpectedly, the case‐study group had a higher level of self‐confidence (self‐reported). The results of this study indicate that further research is needed to support faculties' selection of learning strategies with the lowest cost and highest effectiveness in achieving the desired learning outcomes.     

Basic Life Support Training for undergraduate nursing students: An integrative review

The aim of this review was to identify the role of basic life support training interventions in international undergraduate nursing education, that support optimal acquisition and retention of knowledge, psychomotor skills and resuscitation self-efficacy. Twenty-four articles were identified and analysed using an integrative review approach. Studies were reviewed for quality using a Critical Appraisal Skills Programme checklist. Common objective and standardised methods of basic life support education practice were identified: instructor led, simulation experiences, self-directed learning, skills training combined with clinical practicum, and computer-based training. Evaluation of competency was collected primarily from multiple-choice questionnaires or researcher-designed checklists, with a lack of objective performance data noted. Importantly, current teaching approaches do not guarantee acquisition or retention of basic life support skills. Objective feedback from technologies supporting cardiopulmonary resuscitation training may be useful in acquisition and retention of psychomotor skills, and therefore requires further exploration. Development of robust, psychometrically sound instruments are needed to accurately and consistently measure nursing students' skills performance.