Undergraduate nursing students' acquisition and retention of CPR knowledge and skills

The ability to respond quickly and effectively to a cardiac arrest situation rests on nurses being competent in the emergency life-saving procedure of cardiopulmonary resuscitation (CPR). The aim of this study was to investigate the extent to which Irish nursing students acquire and retain CPR cognitive knowledge and psychomotor skills following CPR training. A quasi-experimental time series design was used. A pre-test, CPR training programme, post-test, and re-test were conducted. CPR knowledge was assessed by a multiple-choice assessment and psychomotor skills were assessed by observing CPR performance on a Resusci-Anne skill-meter manikin. The findings showed an acquisition in nurses' CPR knowledge and psychomotor performance following a 4h CPR training programme. Despite this, at no point in this study, did any nurse pass the CPR skills assessment. A deterioration in both CPR knowledge and skills was found 10 weeks following CPR training. However, students' knowledge and skills were improved over their pre-training scores, which clearly indicated a positive retention in CPR cognitive knowledge and psychomotor skills. The study findings present strong evidence to support the critical role of CPR training in ensuring that nursing students progress to competent and confident responders in the event of a cardiac related emergency.     

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.     

对中学生进行心肺复苏技能培训的方法与效果

目的探讨对中学生进行心肺复苏知识和技能培训的方法及意义。方法采用多种培训形式相结合的方法对不同年级的200名中学生进行心肺复苏技能培训,在培训前后对中学生心肺复苏知识和技能进行测评。结果200名中学生普遍缺乏心肺复苏知识和技能,通过培训,心肺复苏理论知识考核合格率从培训前7％上升到94．5％,差异有统计学意义（P〈0．05）;心肺复苏操作考核合格率达100％;低年级与高年级的中学生培训后心肺复苏技能考核首次合格率比较,差异无统计学意义（P〉0．05）。结论中学生心肺复苏知识普遍缺乏,建议从初中生抓起,将急救知识及技能纳入九年义务教育课程体系,合适的培训方法能有效地提高中学生心肺复苏技能,同时,争取行政支持,学校与医院联合培训是普及中学生心肺复苏技能的有效途径。     

Evaluation of a cardiopulmonary resuscitation course for secondary schools retention study.

A retention study was implemented in Marshfield, Massachusetts in May 1974 in order to ascertain if cardiopulmonary resuscitation (CPR) skills could be retained by secondary school students who had 15 months previously received training in mouth to mouth resuscitation and cardiac compression. The retention study also addressed itself to the question whether a 28-minute "refresher" film on CPR skills prior to the test would serve to improve performance of CPR skills. (In the initial study, the students had been divided into two groups: those that received both didactic and practice sessions and those who received didactic training only.) All the initial practice group students (178 students who had received both didactic and practical CPR training) were divided equally into "film" and "no film" groups. A small sample of students (38) who had initially learned CPR skills from didactic materials only were also tested. These students were also divided into "film" and "no film" groups. Retention of continuous CPR skills, breaths anc compressions, showed very little loss. Retention of discrete CPR skills which included checking for breathing, opening the airway by tilting the head and lifting the neck, giving three quick breaths, feeling the pulse, and examining the pupil showed considerable loss of learning overtime. The film intervention did little to improve performance of CPR skills. No significant differences in performance were observed between "film" and "no film" groups. The findings of this study with respect to retention of continuous and discrete psychomotor sills closely parallel findings of the three-month retention study. In summary, this study would indicate that training of secondary students in CPR leads to good retention of essential skills. As indicated in the previous study, retention of the ancillary decision-making skills was not satisfactory. Methods for teaching these skills so that they will be retained over time need further development.     

HeartCode BLS with voice assisted manikin for teaching nursing students: preliminary results

The purpose of this study was to evaluate the effectiveness of HeartCode BLS, a self-directed, computer-based course for obtaining basic life support (BLS) certification. For part 2 of the course, students learned and practiced their cardiopulmonary resuscitation (CPR) psychomotor skills on a voice assisted manikin (VAM). Students from 10 schools of nursing were randomly assigned to two types of CPR training: HeartCode BLS with VAM or the standard, instructor-led (IL) course with manikins that were not voice assisted; 264 students trained using HeartCode BLS and 339 had an IL course. When students passed their respective courses and were certified in BLS, their CPR skills were tested using the Laerdal PC SkillReporting System. Students who trained using HeartCode BLS and practiced their CPR skills on VAMs were significantly more accurate in their ventilations, compressions, and single-rescuer CPR than students who had the standard, IL course with regular manikins.     

高仿真模拟人在大学生心肺复苏术培训中的应用效果研究

[目的]评价高仿真模拟人在大学生心肺复苏术培训中的应用效果。[方法]对113名非医学专业大一本科生进行心肺复苏教学,随机分为实验组(高仿真模拟人)56名和对照组(传统模拟人)57名,培训结束即刻和1个月后进行理论和操作测试,并用视觉模拟评分(VAS)评估急救自信心和教学满意度。[结果]培训结束即刻,两组理论成绩相近,但是实验组胸外按压(t=30.49,P0.01)和人工呼吸(t=14.97,P0.01)成绩明显优于对照组,此外,实验组学生表现出更强的急救信心(t=30.49,P0.01),且对教学效果更为满意(t=13.23,P0.01),1个月后实验组理论知识和人工呼吸技能保留较好,而对照组理论和操作成绩均下降显著。[结论]采用高仿真模拟人进行大学生心肺复苏术教学培训可有效提高学生操作能力。     

Evaluation of a cardiopulmonary resuscitation course for secondary schools.

The objective of this study was to test the feasibility of teaching secondary school students to perform cardiopulmonary resuscitation (CPR) according to National Research Council (NRC)--American Heart Association (AHA) standards. Criterion levels specified by AHA call for cardiac compression at a rate of 60 times a minute with two ventilations interposed after 15 cardiac compressions. Translated into numerical performance per minute, this standard equates to 36 compressions and six ventilations per minute. Students were instructed by their usual teachers who received a special educational program in preparation. Both immediate learning and retention of the students after three months were evaluated using a practical and a written test. Teacher performance was evaluated by means of a practical test and a behavior rating. CPR is a motor task involving both continuous and discrete processes. Results of the study corresponded to analogous studies in the psychomotor literature: practice group students' retention of continuous skills (breaths and compressions) was good (little loss of skill), while retention of discrete motor skills (open the airway, check vital signs) was poor. Fifty-five per cent of the practice group in the initial test and 31 per cent in the retention study were able to perform the skills. Retention figures compare favorably with studies in the area of psychomotor learning. The study suggests that it is possible to train secondary school students to perform the ABC's of CPR if they have an opportunity to practice these skills. The study also suggests that the teacher training is an important factor.     

The effectiveness of repeated cardiopulmonary resuscitation training in a school population

At the end of a study program, evaluating the feasibility and the effectiveness of a unique training session on a school population, the majority of the students were asking for additional training opportunities. We therefore set up the present study with the purpose of evaluating skills, knowledge and attitude concerning CPR, after respectively one and two training sessions. 265 students from 4 different school levels were trained. 6 months later 134 answered a questionnaire and were again trained in CPR, 129 students answered the same questionnaire and were tested for their skills in CPR. Ten months later 75 students who had two training sessions answered again the questionnaire and 65 among them were tested for their skills. The two training sessions were identical, given by lay teachers priorly instructed in CPR, and consisted of a video-program and practical demonstration, followed by individual practice on training manikins. Both training sessions lasted 100 min. Evaluation of skills was performed by emergency physicians not involved in the training. Seventeen different items, representing each step in CPR were scored. Repeated training induces significant improvement of total skill scoring, without significant difference between boys and girls, but with improvement of scoring with class level. When looking at the different steps, the improvement in scoring is most impressive in certain steps which scored poorly after one training session, such as backward tilt of the head, a keystone in CPR. The steps concerning mouth-to-mouth breathing and external thoracic compressions reach, 10 months after the second training, an average of 1.6 out of 2 (80% correct) as compared to 1.44 out of 2 (71.9% correct) after one training. Knowledge concerning CPR does not increase significantly after the second training session. The time lapse of 10 months since the second training session may have played a role, although the methodology excluding interactive instruction may also explain this discrepancy. The influence on attitude shows that fear to apply CPR increased significantly after one training session and does not significantly lower after the second training. This attitude seems to be rather person-linked, for no correlation was found with age, theoretical knowledge or practical skill scoring. We have no way of knowing whether the statement concerning fear to apply CPR will correspond with such an attitude when confronted with a concrete emergency situation.     

CPR knowledge and attitude to performing bystander CPR among secondary school students in Norway

Background

Early bystander cardiopulmonary resuscitation (CPR) is essential for survival from out-of-hospital cardiac arrest (OHCA). Young people are potentially important bystander CPR providers, as basic life support (BLS) training can be distributed widely as part of the school curriculum.

Methods

Questionnaires were distributed to nine secondary schools in North Norway, and 376 respondents (age 16-19 years) were included. The completed questionnaires were statistically analysed to assess CPR knowledge and attitude to performing bystander CPR.

Results

Theoretical knowledge of handling an apparently unresponsive adult person was high, and 90% knew the national medical emergency telephone number (113). The majority (83%) was willing to perform bystander CPR in a given situation with cardiac arrest. However, when presented with realistic hypothetical cardiac arrest scenarios, the option to provide full BLS was less frequently chosen, to e.g. a family member (74%), a child (67%) or an intravenous drug user (18%). Students with BLS training in school and self-reported confidence in their own BLS skills reported stronger willingness to perform BLS. 8% had personally witnessed a cardiac arrest, and among these 16% had performed full BLS. Most students (86%) supported mandatory BLS training in school, and three out of four wanted to receive additional training.

Conclusion

Young Norwegians are motivated to perform bystander CPR, but barriers are still seen when more detailed cardiac arrest scenarios are presented. By providing students with good quality BLS training in school, the upcoming generation in Norway may strengthen the first part of the chain of survival in OHCA.     

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.     

Deliberate practice of motor skills in nursing education: CPR as exemplar

Our study explored the effects of deliberate practice on the retention ofcardiopulmonary resuscitation (CPR) psychomotor skills among nursing students. The practice sessions were short, six minutes a session one time a month. Differences in performance between students who had deliberate practice and a control group, with no practice beyond the initial training, were compared every three months for one year. The intervention group performed better than the control over the 12 months. There is a need in nursing education for deliberate practice of relevant and high-use skills for students to improve their performance and gradually develop their expertise.     

骨科护士应急救援护理能力培训的效果分析

目的探讨对骨科护士实施应急救援护理能力规范化培训的实践与效果。方法对骨科中心54名护士进行为期6个月的急救护理理论与操作培训,比较培训前后应急救援护理理论知识及临床实践能力的考核、骨科临床护理质量评分及护士自我效能感得分。结果培训后骨科护士的应急救援护理理论知识、应急救援护理临床实践能力考核成绩及专科临床护理质量、自我效能感均提高(P0.01)。结论应急救援护理能力培训提升了骨科护士的自我效能感,从而进一步提高了骨科护士应急救援综合能力,深化了骨科专科护理内涵质量,是一种行之有效的临床实践方法。     

Cardiopulmonary resuscitation skills of medical professionals

This study examined the theoretical knowledge and practical skills of different medical profession personnel and medical students in Basic Cardiac Life Support (BCLS). Two hundred twenty-four candidates who attended a BCLS course were tested in their theoretical knowledge of BCLS with 15 multiple choice questions (MCQs) as a pre-test. The same questions were included in the post-test but with a different sequence. We also evaluated each candidate during performance of single-rescuer CPR on a recording manikin, using a checklist and the recording strip from the manikin for evaluation of CPR steps and manikin performance respectively. Anesthesiologists and cardiologists demonstrated the best performance in the theoretical knowledge test followed by GPs and paramedics. In contrast, physicians, surgeons, pediatricians and medical students had comparable scores. No candidate performed all CPR steps correctly in the proper sequence. In addition, the manikin performance of all groups was poor. Nevertheless, the course significantly improved the theoretical knowledge (P less than 0.0001) and performance in both CPR steps (P less than 0.0005) and manikin performance (P less than 0.0005). The multivariate discriminant analysis identified that experience and prior CPR training influenced significantly (P less than 0.001) the degree of retention of theoretical knowledge only, but not the actual performance of basic resuscitation. It is concluded that no assumption based on previous clinical knowledge should be made for the expected CPR performance of all doctors, regardless of speciality. Formal training programs in medical schools should be considered. Our data also indicate that training is the only objective way to improve performance of all the candidates including the medical students.     

Comparison of the effectiveness of the virtual simulator and video-assisted teaching on intravenous catheter insertion skills and self-confidence: A quasi-experimental study

BackgroundWith the advancement of technology, methods such as clinical scenarios, role playing, video demonstration and simulation are now used to develop psychomotor skills in nursing education. Virtual reality and video-assisted teaching are useful technologies for the development of skills and self-confidence. In the literature, there is a lack of studies comparing the effects of the two methods.ObjectivesThe aim of study is to compare the effect of the virtual simulator and video assisted teaching on the level of intravenous catheterization skills and self-confidence of nursing students. Thus, students are enabled to develop skills and work efficiently without the need for an instructor.MethodsThis study was a randomized controlled quasi-experimental study. A total of 60 students was included in the study (30 in the virtual simulator group and 30 in the video group). In the virtual simulator group, each student performed an intravenous catheter insertion in the virtual intravenous simulator. In the video group, each student watched a training video on the peripheral intravenous catheterization skill in a classroom setting. Each of the students' level of intravenous catheterization knowledge, psychomotor skill and self-confidence score was evaluated.ResultsPost-test knowledge scores was higher than pretest knowledge scores for both groups. There were no significant difference between the groups in terms of post-test scores. Students' scores of psychomotor skills were found to be higher in the virtual simulator group and self-confidence scores were similar in both groups.ConclusionTeaching with the virtual simulator contributed to the students' skills more than the method used in the video training. Both methods are effective in the development of knowledge and self-confidence related to intravenous catheterization.     

Theoretical knowledge and psychomotor skill acquisition of basic life support training programme among secondary school students

BACKGROUND: The aim of the study is to evaluate the theoretical knowledge and psychomotor skill acquisition of basic life support (BLS) by a group of secondary school students in Nigeria pre and post BLS training. METHODS: This was quasi-experimental study design with 210 participants. They were taught on adult BLS and all the participants practiced BLS on a Resusci-Anne manikin immediately after the training. Data were collected using American Heart Association (AHA) structured questionnaire and psychomotor skills checklist for BLS at baseline, and post BLS training. RESULTS: The pre-training knowledge score was 1.9±1.4. This increased after the BLS training to 11.4±2.4, and the mean difference between the pre and post BLS training scores was 9.48571. Pre-training psychomotor skill score was 0.00±0.00, this increased to 8.9±1.9 after the training, and the mean difference was 8.90000. The knowledge and psychomotor skill difference between pre and post BLS training was significant (P<0.000). CONCLUSION: Most Nigerian secondary school students were not knowledgeable about BLS. Therefore, there is need for the creation of more awareness among the students.     

Paramedic Self‐efficacy and Skill Retention in Pediatric Airway Management

Objectives: The objectives were to determine the effect of pediatric airway management training on paramedic self‐efficacy and skill performance and to determine which of several retraining methods is superior. Methods: A total of 2,520 paramedics were trained to proficiency in pediatric bag‐mask ventilation (BMV) and endotracheal intubation (ETI) on mannequins. Subjects were a convenience sample of 245 (10% of original cohort) presenting for voluntary retraining. A total of 212 of 245 (87%) completed skills testing. Self‐efficacy was measured prior to and following initial training and retraining events. Paramedics were assigned to control (no retraining), videotape presentation, self‐directed learning, or instructor‐facilitated lecture and demonstration retraining. Following retraining, BMV and ETI skills were tested. Results: Paramedics from low‐call‐volume areas reported lower baseline self‐efficacy and derived larger increases with training, but also experienced the most decline between training events. Pass rates for BMV and ETI were 66% (139/211) and 42% (88/212), respectively. However, overall cohort self‐efficacy was maintained over the study period. In ordinal regression modeling, only the lecture and demonstration method was superior to control, with an odds ratio (OR) of achieving higher scores of 2.5 (95% confidence interval [CI] = 1.2 to 5.2) for BMV and 5.2 (95% CI = 2.4 to 11.2) for ETI. Poor performance with ETI but not BMV was associated with time elapsed since training (p = 0.01). Self‐efficacy ratings were not predictive of skill performance. Conclusions: Training provides increases in self‐efficacy, particularly among paramedics from low‐call‐volume areas. A gap exists between self‐efficacy and skill performance, in that self‐efficacy may be maintained even when skill performance declines. Pediatric airway skills decay quickly, ETI skills drop off more significantly than BMV skills, and a lecture and demonstration format seems superior to other retraining methods investigated.     

The impact of Web-delivered education on preceptor role self-efficacy and knowledge in public health nurses

ABSTRACT Objective: Preceptors are an essential component in preparing student nurses to become practicing public health nurses. Preparation for the preceptor role is important for achieving a quality learning experience for students. This study was conducted to explore the relationship between completion of a Web‐delivered preceptor education program and both knowledge of the preceptor role and self‐efficacy to perform in the preceptor role. Design and Sample: This study used a pretest‐posttest, quasi‐experimental design. The participants were experienced public health nurses (n=31) working in one state in the United States. Measures: Pretest and posttest Web‐delivered survey using the preceptor self‐efficacy questionnaire and an instrument assessing knowledge gain. Intervention: A Web‐delivered preceptor education program tailored for public health nurses. Results: The program was associated with improved self‐efficacy scores at both the immediate and the 3‐month posttest, and with increased knowledge of the preceptor role evident at the immediate posttest only. Self‐efficacy scores were independent of knowledge scores. Preceptor age was not correlated with self‐efficacy or knowledge scores. Nurses with higher levels of education demonstrated higher self‐efficacy scores in all 3 measurements. Conclusions: Web‐delivered continuing education targeted to public health nurse preceptors is an effective method to increase confidence and knowledge for the preceptor role.     

企业员工心肺复苏知识的认知现状及技能培训的探讨

目的了解企业员工对心肺复苏（cardiopulmonary resuscitation，CPR）知识的认知及需求状况，探讨对企业员工进行CPR知识与技能培训的方法和意义。方法通过整群抽样的方法，对111名参加CPR培训的企业员工进行问卷调查，了解企业员工对CPR知识的认知现状及需求情况，并比较不同年龄及学历层次者和受过专门CPR培训员工的CPR知识得分情况。结果企业员工心肺复苏知识缺乏，平均得分为（3．36±1．82）分；不同年龄及学历层次的企业员工对CPR知识的掌握情况，无统计学差异；曾接受过培训的企业员工CPR知识测评得分较高（P〈0．01）；企业员工有强烈的学习需求，99．09％的员工认为有必要举办相关培训班。结论企业员工需要通过专门的CPR培训以提高CPR知识和技能，培训形式应多样化，且有必要进行定期的重复培训；企业员工参加CPR培训是普及CPR知识与技能、提高我国现场急救水平、降低院前病死率的一条有效途径。     

对儿童血液肿瘤科护理人员进行能力本位培训的效果评价

目的确定开展能力本位培训对儿童血液肿瘤科护理人员专科知识及技能的影响。方法选择2003年在上海儿童医学中心血液肿瘤科全体临床护理人员26名。根据美国St.Jude儿童研究医院的认证经验和相关文献设立儿童血液肿瘤科护理人员的专科能力本位培训内容与方法;每项项目是重复3次的滚动式标准培训,培训共持续8个月。根据培训内容设计知识试卷和操作评分标准;培训前用知识试卷进行前测,培训结束后用同一张试卷进行后测,比较前测和后测结果。同时培训后用操作评分标准测试操作技能。结果培训后临床护理人员的知识水平比以前有显著提高,P=0.000;培训后护理人员操作第1次合格率为96.2%。结论系统的标准临床专科能力本位培训能显著提高儿童血液肿瘤科护理人员的专科核心能力。