Presentation on theme: "Multi-site Nursing Education Study: HeartCode™ BLS with Voice Activated Manikin for Teaching Nursing Students and Using a Wiki to Manage Research."— Presentation transcript:
1Multi-site Nursing Education Study: HeartCode™ BLS with Voice Activated Manikin for Teaching Nursing Students and Using a Wiki to Manage Research
2Research Team and Sites Marilyn H. Oermann, PhD, RN, FAAN, ANEF & Yeongmi Ha, MSNUniversity of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NCSuzan E. Kardong-Edgren, PhD, RN, Tamara Odom-Maryon, PhD & Denise A. Smart, DrPH, RNWashington State University, College of Nursing, Spokane, WABeth F. Hallmark, MSN, RN & Sharon Wilson Dowdy, PhD, RNGordon Inman College of Health Sciences and Nursing Belmont University, Nashville, TN Jacqueline K. McColgan, MS, RN, CNE Springfield Technical Community College, Springfield, MADebbie Hurd, MS, RN Collin County Community College, McKinney, TXNancy Rogers, MA, RN Carroll Community College, Westminster, MDLeandro A. Resurreccion, MSN, RN Oakton Community College, Des Plaines, IlCatherine Snelson, MSN, APRN Kent State University, Kent, OHCarol Haus, PhD, RN, CNE West Penn Hospital School of Nursing, Pittsburgh, PADawn R. Kuerschner, MS, APN, NNP-BC, RNC, CNE Oakton Community College, Des Plaines, IlJerrilee LaMar, PhD, RN, BC& Joan Fedor-Bassemier, MSN University of Evansville, Evansville, INMonica Nelson Tennant, MSN, CCNS Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GAAcknowledgementThe project was coordinated through the National League for Nursing. Funding was provided by the American Heart Association and Laerdal Medical Corporation.
3Need for CPR SkillsNursing students need understanding of CPR and ability to perform CPR psychomotor skillsStudents may complete CPR course prior to entering nursing program or beginning their clinical practiceAbility to perform CPR is criticalResearch evidence: Chances for patient survival improve with immediate and high quality CPR
4Lack of Retention of CPR Knowledge and Skills CPR skill deteriorates more rapidly than knowledgeReasons for poor retentionInsufficient practice of CPRToo much time between course and actual practiceLack of feedback during learningLack of consistency in and quality of CPR instructionComplexity of CPR skills
5Research 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 time in studyDisplayed significant deterioration of skills at 10-week posttest
6Research EvidenceKardong-Edgren & Adamson (2009): Assessed videotapes of students performing CPR 22 weeks after passing CPR courseNo student could correctly perform CPRLeighton & Scholl (2009): Simulation of adult with unexpected cardiac arrestStudents recently had BLS course and were certifiedMost could not implement BLS actions in correct order during simulation
7Instructor-led CPR Courses Most commonIssuesPace of course preset: Limited practice timeInstructors may not accurately assess performance or correct errorsLynch, Einspruch, Nichol, & Aufderheide (2008): lay persons trained in CPRCPR skills assessed by 13 certified instructors and on manikins with Laerdal PC SkillReporting™ softwareInstructors rated accurately ventilation skills, but not chest compressions or hand placement
8Video Self-instruction Batcheller et al. (2000): 202 lay persons randomly assigned to IL course or video self-instructionMore accurate compressions and ventilations with videoOverall performance also better in video groupEinspruch, Lynch, Aufderheide, Nichol, & Becker (2007): Retention of CPR skill same with video self-instruction compared to IL course
9Voice 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 improvesCPR skill acquisition and retentionQuality of CPRProtected students’ privacy (headphones)Enhanced students’ concentration during CPR practice and testing because they limited interruptions and distractions.
10HeartCode BLS American Heart Association (AHA) Self-directed, electronic course for obtaining basic life support (BLS) certification2 partsPart 1: Knowledge of BLSPart 2: CPR psychomotor skillsCompleted with either AHA-certified instructoror voice-activated mannequin (VAM)
11HeartCode BLS: Part 1 Computer-based didactic component Video lessons that teach BLSGuide students through BLS algorithms and skillsCase scenariosStudents assess patients and decide on treatmentSimulated patients respondMicrosimulation technology
12HeartCode BLS: Part 1 cont. Debriefing screenOnline report explaining incorrect and correct actionsRemediation with links to answersTest at end of cognitive portionMust score 84% to passStudy students performed computerized portions in nursing computer lab and skills portions in nursing skills lab.
13HeartCode BLS: Part 2Learn 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
14Is taking the standard, IL CPR course Need for ResearchNo studies have examined HeartCode BLS or use of VAMs for CPR training with nursing studentsLimited skill development with IL courseRapid loss of CPR knowledge and skillsIs taking the standard, IL CPR courseworth it?
15Purpose of StudyEvaluate effectiveness of HeartCode BLS with VAM for teaching nursing studentsStudents learned and practiced CPR psychomotor skills on VAMsPart of larger multi-arm studyMulti arm study on effects of brief practice sessions with VAM on CPR skill retention for nursing students, nurses, and other healthcare providers
16Methods Experimental design 10 schools randomly assigned to 2 types of CPR training:HeartCode BLS orStandard 4-hour instructor-led BLS Healthcare Provider courseStudents completed type of CPR training randomly assigned to their school
18Types of CPR Training HeartCode BLS with VAM system or Standard IL BLS courseCoordinators contacted certified instructors in their geographic areas to present coursePracticed on regular manikins provided by instructorNone were VAMsKnowledge test in paper and pencil formatCPR skill assessed by instructor observing students perform CPR on manikinAll participants were randomly assigned to control or study groups.
19Sample Type of Program N (%) Diploma 81 (13.8) Associate 258 (43.8) 81 (13.8)Associate258 (43.8)Baccalaureate250 (42.4)HeartCode BLSInstructor-led BLS Course258 (43.8%)331 (56.2%)30.5 (SD=9.0) years26.1 (SD=8.6) years, p=<0.001Nearly all students (n=526, 89.3%) had CPR certificationNo differences in previous CPR training between groupsOnly sign difference was age
20Assessment of CPR Psychomotor Skills After passing BLS courses and receiving AHA certification, students’ CPR skills assessed using Laerdal PC SkillReporting System3-minutes each of compressions, ventilations, and single rescuer CPR
21Laerdal PC SkillReporter System Kept ongoing logsProvided monitor display of each compression and ventilationIncorrect hand placement shown with “hand” icon on screenMonitor displays visible only to site coordinatorsData on performance of CPR skills sent electronically to statisticianLogs of compressions, ventilations, and one person CPR. During one person CPR, logged time students had “hands off” of victim’s chest when performing ventilations
22Monitor was visible to site coordinator only so students could not alter performance based upon visual feedback from screen.
23Measures Number of ventilations performed correctly Volume between mlInflation flow rate < 800 ml/secondAirway open during inflation part of ventilationNumber of compressions performed correctlyDepth between mmCompletely releasedCorrect hand positionMany other measures done but for this phase of study focus was quality of CPR skills
24Site Coordinators 1-2 per school Roles Preparation of Coordinators Implement protocolSet up and use VAMsCollect and transmit dataManage project at sitePreparation of CoordinatorsFace-to-face meeting at simulation centerPeriodic conference callsDevelopment and use of wiki
25FindingsStudents who had HeartCode BLS and practiced on VAM had better CPR skills than students who had standard IL courseHeartCode BLS groupMore ventilations without errors (p = 0.03)More compressions done correctly (p = 0.002)More accuracy with single rescuer CPR (p < 0.001)
26Differences in CPR Skills between HeartCode BLS and IL Courses Type of CPR CourseCPR SkillsHeartCodeILM (SD)pVentilations with no errors16.1 (14.2)7.6 (11.8)0.03Compressions with no errors147.0 (108.3)83.8 (108.3)0.004Incorrect hand position during compressions25.1 (68.8)51.5 (100.2)Ventilations with no errors during single rescuer CPR5.2 (4.9)3.0 (3.6)0.001Number of compressions with no errors during single rescuer CPR119.8 (72.4)62.3 (70.4)<0.001Students in HeartCode BLS: gave a mean of 32.9 (SD=14.9) ventilations and 16.1 (SD=14.2) had no errors (ie, had the correct volume and flow rate with the airway opened properly). In comparison, students in IL group gave 20.9 (SD=23.9) ventilations, but only 7.6 (SD=11.6) of those had no errors.There were similar findings with quality of compressions. Students who practiced with VAM were more accurate: of their (SD=29.2) compressions, (SD=108.3) had no errors. Students in the IL group, however, had only 83.8 (SD=108.3) out of a total of (SD=59.4) compressions with no errors.In the IL group, students often used incorrect hand positions during compressions, for example, placing their hands too high or low on the chest or too far to the right or left of the chest. There was a significant difference between the groups in the number of compressions with incorrect hand positionsDifferences in performance also were apparent during single rescuer CPR. Students who had HeartCode BLS VAM performed significantly more ventilations (p = 0.001) and compressions (p < 0.001) with no errors, in comparison to students who had the IL course and practiced on those manikins
27DiscussionHeartCode 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 courseStudents in traditional IL coursePassed courseWere certified in BLSBUT could not perform CPR as well as students who practiced on VAMs
28Advantages of HeartCode BLS Part 1 Self-paced and interactiveReview concepts until achieve masteryAt time convenient for studentsSimulated case scenarios for application of conceptsDebriefing built into program for immediate feedbackFor review as students progressed through nursing program
29Disadvantages of HeartCode BLS Part 1 CostUse of IL course by tradition
30Voice Activated Manikins AdvantagesImmediate feedback on performance and how to correct itFeedback more specific than in IL coursePractice as neededUse to maintain CPR skillsDisadvantagesEnglish as second languageStudents over- and underweight
31“Every School Needs a VAM” 1. Detect when learner incorrectly performing CPR skill2. Give immediate verbal feedback3. Prompt student on what to do differently
32Managing this Multi-site Study Schools of nursing throughout US14-site coordinatorsTechnology rich studyComplexity of protocol
41Read More about our Wiki Kardong-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: / X.1787