Download - Research Team and Sites
Multi-site Nursing Education Study: HeartCode™ BLS with Voice Activated Manikin for Teaching Nursing Students and Using a Wiki to Manage Research
Multi-site Nursing Education Study: HeartCode™ BLS with Voice Activated Manikin for Teaching Nursing Students and Using a Wiki to Manage Research
Research Team and Sites
Marilyn H. Oermann, PhD, RN, FAAN, ANEF & Yeongmi Ha, MSN University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC
Suzan E. Kardong-Edgren, PhD, RN, Tamara Odom-Maryon, PhD & Denise A. Smart, DrPH, RN
Washington State University, College of Nursing, Spokane, WA
Beth F. Hallmark, MSN, RN & Sharon Wilson Dowdy, PhD, RN Gordon Inman College of Health Sciences and Nursing Belmont University, Nashville, TN
Jacqueline K. McColgan, MS, RN, CNE Springfield Technical Community College,
Springfield, MA Debbie Hurd, MS, RN Collin County Community College, McKinney, TX
Nancy Rogers, MA, RN Carroll Community College, Westminster, MD
Leandro A. Resurreccion, MSN, RN Oakton Community College, Des Plaines, Il
Catherine Snelson, MSN, APRN Kent State University, Kent, OH
Carol Haus, PhD, RN, CNE West Penn Hospital School of Nursing, Pittsburgh, PA
Dawn R. Kuerschner, MS, APN, NNP-BC, RNC, CNE Oakton Community College, Des Plaines, Il
Jerrilee LaMar, PhD, RN, BC& Joan Fedor-Bassemier, MSN University of Evansville, Evansville, IN
Monica Nelson Tennant, MSN, CCNS Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA
Acknowledgement
The project was coordinated through the National League for Nursing. Funding was provided by the American Heart Association and Laerdal
Medical Corporation.
Need for CPR Skills Nursing students need understanding
of CPR and ability to perform CPR psychomotor skills
Students may complete CPR course prior to entering nursing program or beginning their clinical practice
Ability to perform CPR is criticalResearch evidence: Chances for patient
survival improve with immediate and high quality CPR
Lack of Retention of CPR Knowledge and Skills CPR skill deteriorates more rapidly
than knowledge Reasons for poor retention
Insufficient practice of CPR Too much time between course and actual
practiceLack of feedback during learningLack of consistency in and quality of CPR
instructionComplexity of CPR skills
Research Evidence Limited research with nursing students Madden (2006): Retention of CPR skills
of students (n=55) in IrelandStudents acquired CPR knowledge and
skills following instructor-led (IL) courseCould not pass CPR skill assessment at any
timein study
Displayed significant deterioration of skills at10-week posttest
Research Evidence Kardong-Edgren & Adamson (2009):
Assessed videotapes of students performing CPR 22 weeks after passing CPR courseNo student could correctly perform CPR
Leighton & Scholl (2009): Simulation of adult with unexpected cardiac arrestStudents recently had BLS course and were
certified Most could not implement BLS actions in correct
order during simulation
Instructor-led CPR Courses Most common Issues
Pace of course preset: Limited practice time Instructors may not accurately assess
performance or correct errorsLynch, Einspruch, Nichol, & Aufderheide
(2008): 826 lay persons trained in CPR CPR skills assessed by 13 certified instructors
and on manikins with Laerdal PC SkillReporting™ software
Instructors rated accurately ventilation skills, but not chest compressions or hand placement
Video Self-instruction Batcheller et al. (2000): 202 lay persons
randomly assigned to IL course or videoself-instructionMore accurate compressions and ventilations
with videoOverall performance also better in video
group Einspruch, Lynch, Aufderheide, Nichol, &
Becker (2007): Retention of CPR skill same with video self-instruction compared toIL course
Voice Activated Manikin (VAM)
Provides immediate verbal feedback about performance and how to correct it“Compress faster” “Ventilate more slowly”
Systematic review by Yeung et al. (2009): Practice with VAM improves CPR skill acquisition and
retentionQuality of CPR
HeartCode BLS
American Heart Association (AHA) Self-directed, electronic course for
obtaining basic life support (BLS) certification
2 parts Part 1: Knowledge of BLSPart 2: CPR psychomotor skills
Completed with either AHA-certified instructor or voice-activated mannequin (VAM)
HeartCode BLS: Part 1 Computer-based didactic component Video lessons that teach BLS
Guide students through BLS algorithms and skills
Case scenariosStudents assess patients and decide on
treatment Simulated patients respondMicrosimulation technology
HeartCode BLS: Part 1 cont.
Debriefing screenOnline report explaining incorrect and correct
actionsRemediation with links to answers
Test at end of cognitive portionMust score 84% to pass
HeartCode BLS: Part 2 Learn and practice CPR psychomotor
skills on sensored Resusci AnneTM adult and infant manikins (VAMs)
At end of cycle manikin asks if want to continue practicing or use completed cycle as CPR skills testPass psychomotor portion of BLS course
Need for Research No studies have examined HeartCode
BLSor use of VAMs for CPR training withnursing students
Limited skill development with IL course
Rapid loss of CPR knowledge and skills
Is taking the standard, IL CPR course worth it?
Purpose of Study Evaluate effectiveness of HeartCode
BLS with VAM for teaching nursing studentsStudents learned and practiced CPR
psychomotor skills on VAMs Part of larger multi-arm study
Methods Experimental design 10 schools randomly assigned to 2
types of CPR training: 1. HeartCode BLS or 2. Standard 4-hour instructor-led BLS
Healthcare Provider course Students completed type of CPR
training randomly assigned to their school
Types of CPR Training HeartCode BLS with VAM system or Standard IL BLS course
Coordinators contacted certified instructors in their geographic areas to present course
Practiced on regular manikins provided by instructor None were VAMs
Knowledge test in paper and pencil formatCPR skill assessed by instructor observing
students perform CPR on manikin
Sample
Type of ProgramType of Program N (%)N (%)
Diploma 81 (13.8)
Associate 258 (43.8)Baccalaureate 250 (42.4)
HeartCode BLSHeartCode BLS Instructor-led BLS CourseInstructor-led BLS Course258 (43.8%) 331 (56.2%)
30.5 (SD=9.0) years26.1 (SD=8.6) years,
p=<0.001
Assessment of CPRPsychomotor Skills After passing BLS courses and
receiving AHA certification, students’ CPR skills assessed using Laerdal PC SkillReporting System
3-minutes each of compressions, ventilations, and single rescuer CPR
Laerdal PC SkillReporter System Kept ongoing logs Provided monitor display of each
compression and ventilation Incorrect hand placement shown with
“hand” icon on screenMonitor displays visible only to site
coordinators Data on performance of CPR skills sent
electronically to statistician
Measures1. Number of ventilations performed
correctly Volume between 500-800 ml Inflation flow rate < 800 ml/second Airway open during inflation part of
ventilation
2. Number of compressions performed correctly Depth between 38-51 mm Completely released Correct hand position
Site Coordinators 1-2 per school Roles
Implement protocol Set up and use VAMs Collect and transmit
data Manage project at
site
Preparation of Coordinators Face-to-face meeting at
simulation center Periodic conference calls Development and use of
wiki
Findings Students who had HeartCode BLS and
practiced on VAM had better CPR skills than students who had standard IL course
HeartCode BLS group More ventilations without errors (p = 0.03)More compressions done correctly (p =
0.002)More accuracy with single rescuer CPR (p <
0.001)
Differences in CPR Skills between HeartCode BLS and IL Courses
Type of CPR Course
CPR Skills HeartCode IL
M (SD) M (SD) p
Ventilations with no errors 16.1 (14.2) 7.6 (11.8) 0.03
Compressions with no errors 147.0 (108.3) 83.8 (108.3) 0.004
Incorrect hand position during compressions 25.1 (68.8) 51.5 (100.2) 0.03
Ventilations with no errors during single rescuer CPR
5.2 (4.9) 3.0 (3.6) 0.001
Number of compressions with no errors during single rescuer CPR
119.8 (72.4) 62.3 (70.4)<0.001
Discussion HeartCode BLS with practice on sensored
Resusci Anne manikinsSignificantly more effectiveStudents performed more ventilations,
compressions, and single rescuer CPR without errors than students who had standard IL course
Advantages of HeartCode BLS Part 1 Self-paced and interactive Review concepts until achieve mastery At time convenient for students Simulated case scenarios for
applicationof concepts
Debriefing built into program forimmediate feedback
For review as students progressed through nursing program
Disadvantages of HeartCode BLS Part 1 Cost Use of IL course by tradition
Voice Activated Manikins Advantages
Immediate feedback on performance and how to correct it
Feedback more specific than in IL coursePractice as needed Use to maintain CPR skills
DisadvantagesEnglish as second languageStudents over- and underweight
““Every School Every School Needs a VAM”Needs a VAM”
Managing this Multi-site Study Schools of nursing throughout US 14-site coordinators Technology rich study Complexity of protocol
Work as research team Need for communication of
important information
Managing this Multi-site Study
Development of Wiki
Our Wiki
Uses of Wiki Communicate information to team
membersShare resources, forms, and other
documentsFoster collaboration
Share experiences with study implementation (recruitment, issues, how resolved)
Uses of Wiki Repository for information related to
studyStudy protocolCalendars with data collection dates IRB and consent formsData collection tools Information to implement study
Study Documents on Wiki
Uses of Wiki Avoid repetitive questions from large
group Prepare abstracts and manuscripts
Add and edit documents on Wiki
Wiki Page for Writing Manuscripts
Read More about our WikiKardong-Edgren, S.E., Oermann, M.H., Ha, Y., Tennant, M.N., Snelson, C., Hallmark, E., Rogers, N., & Hurd, D. (2009). Using a wiki in nursing education and research. International Journal of Nursing Education Scholarship, 6(1), Article 6. DOI: 10.2202/1548-923X.1787
http://www.bepress.com/ijnes/vol6/iss1/art6