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-instruction More accurate compressions and ventilations

with video Overall 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 screen

Online report explaining incorrect and correct actions

Remediation with links to answers Test at end of cognitive portion

Must 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

SampleType 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) years 26.1 (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

ventilation2. 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 CourseCPR Skills HeartCode IL

M (SD) M (SD) pVentilations 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