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
Debbie Hurd, MS, RN
Nancy Rogers, MA, RN
Springfield Technical Community College, Springfield, MA
Collin County Community College, McKinney, TX
Carroll Community College, Westminster, MD
Leandro A. Resurreccion, MSN, RN
Catherine Snelson, MSN, APRN
Oakton Community College, Des Plaines, Il
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 critical

Research 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 practice

Lack of feedback during learning

Lack of consistency in and quality of CPR instruction

Complexity of CPR skills
Research Evidence
 Limited
research with nursing students
 Madden (2006): Retention of CPR skills of
students (n=55) in Ireland



Students acquired CPR knowledge and skills
following instructor-led (IL) course
Could not pass CPR skill assessment at any time
in study
Displayed significant deterioration of skills at
10-week posttest
Research Evidence
 Kardong-Edgren
& Adamson (2009): Assessed
videotapes of students performing CPR 22
weeks after passing CPR course

No student could correctly perform CPR
 Leighton
& Scholl (2009): Simulation of adult
with unexpected cardiac arrest

Students 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 errors
Lynch, 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 video
self-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 to
IL 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 retention
 Quality 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 BLS
Part 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



scenarios
Students assess patients and decide on treatment
Simulated patients respond
Microsimulation technology
HeartCode BLS: Part 1
 Debriefing


screen
Online report explaining incorrect and correct actions
Remediation with links to answers
 Test

cont.
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 test

Pass psychomotor portion of BLS course
Need for Research
 No
studies have examined HeartCode BLS
or use of VAMs for CPR training with
nursing 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 students

Students 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.
2.
HeartCode BLS or
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 format
CPR skill assessed by instructor observing students
perform CPR on manikin
Sample
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
Assessment of CPR
Psychomotor 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 screen
Monitor displays visible only to site coordinators
 Data
on performance of CPR skills sent
electronically to statistician
Measures
1.
Number of ventilations performed correctly



2.
Volume between 500-800 ml
Inflation flow rate < 800 ml/second
Airway open during inflation part of ventilation
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
CPR Skills
Ventilations with no errors
Compressions with no errors
Incorrect hand position during compressions
Ventilations with no errors during single
rescuer CPR
Number of compressions with no errors
during single rescuer CPR
Type of CPR Course
HeartCode
IL
M
(SD)
M
(SD)
p
16.1
(14.2)
7.6
(11.8)
0.03
147.0 (108.3)
83.8 (108.3)
0.004
51.5 (100.2)
0.03
25.1
(68.8)
5.2
(4.9)
3.0
(3.6)
0.001
119.8
(72.4)
62.3
(70.4)
<0.001
Discussion
 HeartCode
BLS with practice on sensored
Resusci Anne manikins


Significantly more effective
Students 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 application
of concepts
 Debriefing built into program for
immediate 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 course
Practice as needed
Use to maintain CPR skills
 Disadvantages


English as second language
Students over- and underweight
“Every School
Needs a VAM”
Managing this Multi-site Study
 Schools
of nursing throughout US
 14-site coordinators
 Technology rich study
 Complexity of protocol
Managing this Multi-site Study
 Work
as research team
 Need for communication of
important information
Development of Wiki
Our Wiki
Uses of Wiki
 Communicate


information to team members
Share resources, forms, and other documents
Foster collaboration
 Share
experiences with study implementation
(recruitment, issues, how resolved)
Uses of Wiki
 Repository





for information related to study
Study protocol
Calendars with data collection dates
IRB and consent forms
Data 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 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: 10.2202/1548-923X.1787
http://www.bepress.com/ijnes/vol6/iss1/art6