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…

Questions

Suzie Kardong-Edgren PhD, RN

sedgren@wsu.edu