Building Competency with Blended Learning: A Multi-site Pre-licensure Nursing Education Study with HeartCode™ BLS
Building Competency with Blended Learning:
A Multi-site Pre-licensure Nursing Education Study with
HeartCode™ BLS
Research Team
Marilyn H. Oermann, PhD, RN, FAAN, ANEFSuzan E. Kardong-Edgren, PhD, RNTamara Odom-Maryon, PhDYeongmi Ha, MSN Jacqueline Keegan McColgan, MS, RN, CNEDebbie Hurd, MS, RNNancy Rogers, MA, RNCarol Haus, PhD, RN, CNEDawn R. Kuerschner, MS, APN, NNP-BC,
RNC, CNESharon W. Dowdy, PhD, RNJoan Fedor-Bassemier, MSN
and other members of research team
The project was coordinated through the National League
for Nursing. Funding was provided by the American
Heart Association and Laerdal Medical Corporation.
Acknowledgements
Need for CPR Skills
• Required before clinical experiences
• Nurses most likely to find patient
in need of CPR• Ability to perform is critical• Patient survival improves with
high quality and immediate CPR
Research with student nurses
• Madden 2006 in IrelandN=55Tested after instructor led courseCould not pass CPR skill assessment at any point in studySignificant skill deterioration at 10 weeks
Video- Self-instruction
• Batchellor et al. (2002) findingsincreased accuracy with ventilations and compressions with video self-instruction
• Einspruch et al. (2007) findingsCPR retention equal between IL and video course
Voice Activated Manikin (VAM)
• Immediate verbal feedbackCompress fasterVentilate more slowly
Instructor-led courses
• Preset course pace• Instructors cannot accurately assess
performance or correct errors• Lynch, Einspruch, Nichol, &
Aufderheide (2008)13 instructorsaccurately rated ventilations skills but not chest compressions or hand placement
Purpose of this study
• Evaluate effectiveness of Heartcode BLS with VAM for nursing students
• One arm of larger four arm study
Methods
• Experimental design• Schools randomly assigned to IL or
Heartcode BLS• 10 programs around the US• Site coordinators trained at WISER
Center• Site coordinators could not instruct• Power analysis completed to ensure
proper sample size
Site coordinators
• Hired instructors• Managed students• Maintained manikins• Managed data• Uploaded data
Heartcode BLS: Part 1
• Computer-based didactic component
• Video lessons teach BLS• Case scenarios
Student assesses and decides on treatmentPatient responds accordinglyAdaptive computer cognitive testing
Heartcode BLS Part 1
• Debriefing screens• Must pass with 84%• Students took between
30-75 minutes to complete
Back story
• All completed at school for this study• Print completion form with number• Tremendous backups and angst for
students, instructors, and faculty• Training site concerns…something
new• Instructors wary…
In reality…you can do Part 1 at home…
Heartcode Part 2
• Practice on VAM manikin• Upon cycle completion, practice or
test• Must pass psychomotor portion of
BLS course
Back story
• Baby manikins very difficult• Prior experience folks did not
listen• English as Second Language
students difficulty• Older, very heavy or very light• Reality is…some cannot do it
Assessment of CPRPsychomotor Skills Post Course Completion
• Immediately post certification• Assessed using Laerdal PC Skill
Reporting System• 3-minutes each of
compressions, ventilations, and single rescuer CPR
Type of Program N (%)
Diploma 81 (13.8)
Associate 258 (43.8)
Baccalaureate 250 (42.4)
HeartCode BLS Instructor-led BLS Course
258 (43.8%) 331 (56.2%)
30.5 (SD=9.0) years
26.1 (SD=8.6) years, p=<0.001
Sample
Laerdal PC SkillReporter system
• Ongoing logs and study• Monitor display of
compression, ventilation, hand compression
• Visible to site coordinators• Data uploaded electronically
to statistician
Measures
• Numbers of ventilations performed correctlyVolume between 500-800 mlInflation flow rate <800 ml/secondAirway open during inflation/ventilation
• # Compressions performed correctlyDepth between 38-51 mmComplete releaseCorrect hand position
Study Findings
• Heartcode and VAM students had better CPR skills than students from IL course
Differences between CoursesType 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) 0.004Incorrect 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
Heartcode BLS group
• More ventilations without errors (p=.03)
• More correct compressions (p=.002)
• More accuracy with single rescuer CPR (p<.001)
Heartcode with VAM
• Significantly more effective• More ventilations, compressions,
and singular rescuer CPR without errors than students who had standard IL course
Advantages of Heartcode BLS
• Self paced and interactive• Concept review till mastery• Convenience• Case studies for concept
application• Extensive debriefing and feedback• Could review throughout nursing
program…• Faculty can use!
Disadvantages of Heartcode BLS
• Cost?• Use of IL traditionally
Every school needs a VAM
Managing this multi-site study
• 14 site coordinators• Managing randomization• Technology rich• Complexity of study and
length of time• Use of WIKI to
communicate• Discovery of data
management system
But wait…there’s more!
• Study continues for 12 months• Continuous vs biennial
certification• 2 manuscripts in submission…• Stand by…