Research Team and Sites

1. Multi-site Nursing Education Study: HeartCode™ BLS with Voice Activated Manikin for Teaching Nursing Students and Using a Wiki to Manage Research

2. 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, MSNUniversity 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.

3. 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

4. Lack of Retention of CPR Knowledge and Skills • CPR skill deteriorates more rapidlythan 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

5. 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 timein study • Displayed significant deterioration of skills at10-week posttest

6. 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

7. 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

8. Video Self-instruction • Batcheller et al. (2000): 202 lay persons randomly assigned to IL course or videoself-instruction • More accurate compressions and ventilationswith 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

9. 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

10. 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)

11. 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

12. 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

13. 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

14. 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?

15. 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

16. Methods • Experimental design • 10 schools randomly assigned to 2 types of CPR training: • HeartCode BLS or • Standard 4-hour instructor-led BLS Healthcare Provider course • Students completed type of CPR training randomly assigned to their school

18. 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

19. Sample

20. 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

21. 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

23. Measures • Number of ventilations performed correctly • 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

24. 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

25. 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)

26. Differences in CPR Skills between HeartCode BLS and IL Courses

27. Discussion • HeartCode BLS with practice on sensoredResusci Anne manikins • Significantly more effective • Students performed more ventilations, compressions, and single rescuer CPR without errorsthan students who had standard IL course

28. 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

29. Disadvantages of HeartCode BLS Part 1 • Cost • Use of IL course by tradition

30. 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

31. “Every School Needs a VAM”

32. Managing this Multi-site Study • Schools of nursing throughout US • 14-site coordinators • Technology rich study • Complexity of protocol

34. Managing this Multi-site Study • Work as research team • Need for communication ofimportant information Development of Wiki

35. Our Wiki

36. 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)

37. 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

38. Study Documents on Wiki

39. Uses of Wiki • Avoid repetitive questions from large group • Prepare abstracts and manuscripts • Add and edit documents on Wiki

40. Wiki Page for Writing Manuscripts

41. 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