Building Competency with Blended Learning : A Multi-site Pre-licensure Nursing Education Study with HeartCode BLS

Research Team Marilyn H. Oermann, PhD, RN, FAAN, ANEF Suzan E. Kardong-Edgren, PhD, RN Tamara Odom-Maryon, PhD Yeongmi Ha, MSN Jacqueline Keegan McColgan, MS, RN, CNE Debbie Hurd, MS, RN Nancy Rogers, MA, RN Carol Haus, PhD, RN, CNE Dawn R. Kuerschner, MS, APN, NNP-BC, RNC, CNE Sharon W. Dowdy, PhD, RN Joan 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 Ireland N=55 Tested after instructor led course Could not pass CPR skill assessment at any point in study Significant skill deterioration at 10 weeks

Video- Self-instruction Batchellor et al. (2002) findings increased accuracy with ventilations and compressions with video self- instruction Einspruch et al. (2007) findings CPR retention equal between IL and video course

Voice Activated Manikin (VAM) Immediate verbal feedback Compress faster Ventilate more slowly

Instructor-led courses Preset course pace Instructors cannot accurately assess performance or correct errors Lynch, Einspruch, Nichol, & Aufderheide (2008) 13 instructors accurately 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 treatment Patient responds accordingly Adaptive computer cognitive testing

Heartcode BLS Part 1 Debriefing screens Must pass with 84% Students took between 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 CPR Psychomotor 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 (%) Diploma81 (13.8) Associate258 (43.8) Baccalaureate250 (42.4) HeartCode BLS Instructor-led BLS Course 258 (43.8%)331 (56.2%) 30.5 (SD=9.0) years26.1 (SD=8.6) years, p=<0.001 Sample

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 correctly Volume between ml Inflation flow rate <800 ml/second Airway open during inflation/ventilation # Compressions performed correctly Depth between mm Complete release Correct hand position

Study Findings Heartcode and VAM students had better CPR skills than students from IL course

Differences between Courses Type of CPR Course CPR SkillsHeartCodeIL M(SD) p Ventilations with no errors16.1 (14.2)7.6 (11.8)0.03 Compressions with no errors147.0 (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

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

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

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

Study continues for 12 months Continuous vs biennial certification 2 manuscripts in submission… Stand by…

Questions Suzie Kardong-Edgren PhD, RN