|Year : 2018 | Volume
| Issue : 1 | Page : 54-58
Comparative assessment of basic life support knowledge between professional nurses and nursing students
Basma Salameh, Ahmad Batran, Ahmad Ayed, Mohammad Zapen, Ali Ammash, Abdelsalam Taqatqa, Mohammad Nasar, Doha Naser
Department of Nursing, Arab American University of Jenin, Jenin, Palestine
|Date of Web Publication||11-Jun-2018|
Dr. Basma Salameh
Department of Nursing, Arab American University of Jenin, Jenin
Source of Support: None, Conflict of Interest: None
Background and Aim: It is equally important to highlight the necessity of teaching basic life support (BLS) to undergraduate nursing students so they can be equipped with BLS knowledge and skills to be able to handle critical cases during their training and in their future practice. This study aimed to assess the knowledge of BLS on the part of nursing professionals and students at the Arab American University of Jenin. It also sought to identify any link between BLS knowledge and such related factors as gender, age, education level, years of experience, etc. Materials and Methods: A cross sectional descriptive was conducted among 150 registered nurses from 4 governmental hospitals in districts covering the north, south and middle of Palestine, and 150 nursing students from the Arab-American University in Jenin in the period between 24 April 2017until 1 June 2017. Data was collected using a structured questionnaire developed by researchers and AHA BLS instructors, who are responsible for collecting information regarding basic knowledge on BLS resuscitation. Results: The result of this study acknowledges that registered nurses have higher average BLS knowledge score (56.7%) compared to nursing students at AAUJ (48.6%). Also, a highly significant difference between both groups in regards to BLS knowledge (p=0.001) was established. Conclusion: Nurses show a higher level of BLS knowledge than do nursing students. Evaluating knowledge in BLS theory and practice is necessary to mitigate possible disability or death caused by a time lag in resuscitation. The inclusion of BLS in nursing curriculum is essential.
Keywords: Basic life support, knowledge, Palestine
|How to cite this article:|
Salameh B, Batran A, Ayed A, Zapen M, Ammash A, Taqatqa A, Nasar M, Naser D. Comparative assessment of basic life support knowledge between professional nurses and nursing students. Arch Med Health Sci 2018;6:54-8
|How to cite this URL:|
Salameh B, Batran A, Ayed A, Zapen M, Ammash A, Taqatqa A, Nasar M, Naser D. Comparative assessment of basic life support knowledge between professional nurses and nursing students. Arch Med Health Sci [serial online] 2018 [cited 2019 Feb 22];6:54-8. Available from: http://www.amhsjournal.org/text.asp?2018/6/1/54/234083
| Introduction|| |
Accidents and cardiac arrests account for the majority of emergencies, just as they often come with grave consequences. Immediate action, proper skills, and most importantly, basic life support (BLS) knowledge are usually required to handle such emergencies. BLS is an initial medical procedure given patients in severe life-threatening emergencies to keep them alive until the arrival of certified medical professionals. Administering BLS early enough increases a victim's chances of surviving a cardiac arrest. Cardiopulmonary resuscitation (CPR) also has a related purpose, to restore partial flow of oxygen to the brain and heart. While CPR alone cannot restart the heart, it delays the death of tissues, thereby extending the window of opportunity for the victim until proper medical help arrives. These processes depend on good timing for the effective delivery of CPR. Time is the greatest determiner of the fate of a cardiac arrest victim. The first 10 min immediately after an arrest are crucial and are often referred to as the “Golden minutes” or the “Golden 10” because if nothing is done within that time, the victim is not likely to survive.
In communities, hospitals are supposed to have nurses and doctors that are highly competent in providing BLS and CPR, not forgetting the medical students as they too are on their way to becoming medical experts within a short time., However, this is not so as “many junior doctors and nurses are not competent in carrying out effective CPR,” thus endangering the lives that they should be saving. Competent administration of BLS/CPR can have a lasting impact a person's lives. In addition, carrying out resuscitation poorly may have devastating outcomes.
In Jordan, Akhu-Zaheya et al. also carried out another quasi-experimental study in 2013 to dig into the impact of high-fidelity basic life support (BLS) simulation on the acquisition of knowledge, retention of knowledge, and self-efficacy among nursing students in Jordan. This study concluded that students that learned with high-fidelity simulation performed better in acquired and retained BLS knowledge and in self-efficacy perception, suggesting that simulation is key to knowledge improvement and self-efficacy among nursing students. The study recommended the use of the most realistic technologies available in training nursing students to improve patients' safety.
Another study conducted in Ethiopia to examine the skill levels and attitude of graduate health professionals in carrying out CPR. Four hundred and sixty-one participants were included in the study out of which 123 were nurses. Only 43 of the nurses indicated that they had sufficient attitude skills to perform a CPR. The nursing graduates in this study were found to have a poor mean skill score. Khan et al. carried out a study in India to examine the knowledge and practice of CPR and to assess the results of educational intervention among the nursing students and professionals. At the end of the study, a significant increase was found in BLS/CPR knowledge and practices after the training of both the groups. This meant that educational intervention not only affected their practice but also updated their knowledge as well.
Vausedvan et al. carried out a study to assess and compare the knowledge of BLS resuscitation algorithm possessed by medical and nursing students in India. This study revealed that only 14% of nursing students and 31.1% of medical students, respectively, had poor knowledge. It also showed that nursing students with experience in BLS resuscitation had significantly higher knowledge compared to those who had none. Moreover, only 18.3% of medical students knew the sequence of procedures for doing BLS is CAB while 59.3% of nursing students gave the correct response to the question. This study concluded that nursing students were better at BLS than medical students, with the majority of participants reporting that they failed due to a lack of proper training.
Alsayil et al.'s study assessed the awareness of BLS and CPR among medical and nursing students at Tabuk University in Saudi Arabia. About 56.4% of nursing students reported insufficient knowledge of BLS. Nearly, 90.5% of both nursing and medical students could not identify activating Emergency Medical Services as the course of action to take immediately after confirming the unresponsiveness of an adult. It was also suggested, like in other studies, that there is a need for further training and awareness of BLS. Third World countries such as Palestine depend highly on nurses in their hospitals, they are usually first to discover a patient with cardiac arrest. Therefore, their knowledge of and ability to perform CPR is an important determiner of the success of outcomes in cardiac arrest patients. The more effective nurses are in providing BLS, the higher the survival rates. This study will, therefore, help to identify where the gap between nursing theory and clinical practice lies. It is aimed at assessing nurses and nursing student's knowledge of BLS to help in communicating results and recommendations to stakeholders so as to produce highly competent nurses. Furthermore, the study is aimed at identifying what relationships exist between the knowledge of BLS and different sociodemographic factors.
| Materials and Methods|| |
A cross-sectional descriptive study was carried out among nursing students and registered nurses to assess their knowledge of BLS.
Sample and settings
Second, third, and fourth year nursing students of Arab American University, Jenin (AAUJ) and registered nurses working in four government hospitals in districts covering the north, south, and middle of Palestine in the period from April– to May were sampled.
On approval from the Faculty of Nursing at the AAUJ, and the Ministry of Health, the convenience sampling technique was used in this study. Participation was voluntary. A total of 150 nursing students and 150 registered nurses were sampled. Selection of participants was done conventionally. Only the AAUJ was chosen because it is the only university that started to integrate BLS into its curriculum in 2016 as mandatory for all students starting from their 2nd year. It is also the nursing faculty at the AAUJ established in 2016, making the AAUJ the only university that has an American Heart Association (AHA)-certified center for providing BLS, advanced cardiac life support, and pediatric advanced life support. First-year students were excluded from the study because they lack the theoretical knowledge regarding the major course in nursing.
Information was collected using a questionnaire originally constructed by researchers and reviewed by three experienced professors from the Nursing Faculty Department, who are certified BLS instructors through AHA. They provided the researcher with recommendations; thus, modifications were made to the questionnaire before they were distributed to the participants.
The first of the two-part questionnaire asked about personal demographic characteristics (data) such as age, gender, previous experience, educational level, years of experience, academic level, and unit of work. The second part consisted of 20 multiple-choice questions to evaluate the objectives, mainly focusing on assessing knowledge regarding BLS among nursing students and registered nurses. The 20 self-structured questions were obtained from the BLS course manual and modified for the purpose. Before data collection, the questionnaire was tested by distributing a copy each to 5 nursing students at the Arab American University and their feedbacks suggested that the questionnaire needed to be modified and made easier to understand and filled in a short time.
Permission was obtained from the Dean of the Faculty of Nursing and the Ministry of Health in Palestine. Approval from the Faculty of Nursing at AAUJ was also received. All those who participated were told the objectives of the research and assured of their right to confidentiality and anonymity.
After collection, the questionnaires were codified and processed statistically using the Statistical Package for the Social Science (SPSS) version 20 (Inc., Chicago, IL, USA), which depends on the insertion of the questionnaire information as variable values; descriptive and statistical measurements (t-test and ANOVA) were used to support the result of the study.
| Results|| |
[Table 1] show that the average age of the studied sample is 36.6 years, more than half (56%) were female, around one-fifth (19%) of the nurses were working in the Intensive Care Unit (ICU), while 2% worked in the Coronary Care Unit (CCU). Most of the nurses had BLS license and less than half (42.7%) of them have had their BLS license for more than 2 years. The majority (70%) of the participants had a nursing bachelor's degree, and around a third (32%) of the nurses obtained their BLS license from the institution where they work. At the same time, the same percentage (32%) of them obtained it from the AAUJ. The average of the BLS knowledge scores was 56.7% among nurses.
|Table 1: Assessment of the base data characteristics of the studied sample (n=150)|
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In [Table 2], 21.54 ± 1.54 years was the average age of the nursing students studied, 54.7% were female, 56.7% had a BLS license, and 49.3% of them have had their BLS license for <2 years. According to the educational level, it was found that 52% of them were 2nd-year students and around half (48.7%) of them obtained their BLS license from the AAUJ. The average of BLS knowledge scores was 48.6% among students.
|Table 2: Assessment of the base data characteristics of the studied sample (n=150)|
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[Table 3] revealed that an ANOVA test was performed, and highly statistically significant differences were found between nurses' level of education and the total mean of BLS knowledge scores was 5.40 (P = 0.005); bachelors group had the highest mean (58.81). Furthermore, statistically significant differences were found between wards of nurses work, and the total mean of BLS knowledge scores was 4.29 (P = 0.001). The CCU had the highest mean (71.67), followed by the Emergency Department with a mean of 65.29, and then by ICU with a mean of 61.55. Moreover, no significant differences were found between students' educational level and the total mean of BLS knowledge scores (P = 0.518), just as no statistically significant differences were found between nurses' work experience and total mean of BLS knowledge scores (P = 0.092).
|Table 3: Difference means between the different variables with basic life support knowledge scores (n=150)|
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[Table 4] revealed that an independent t-test was performed, with highly statistically significant differences between nurses group and student group. With total mean of BLS knowledge scores of 4.90 (P = 0.001), the nurses have the highest mean (56.67).
|Table 4: Difference in means between the participants with basic life support knowledge scores (n=300)|
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| Discussion|| |
From the study, it is established that registered nurses have higher knowledge in BLS than nursing students at AAUJ. Based on statistical tests performed, there was a highly significant difference between both the groups regarding BLS knowledge (P = 0.001), corroborating the study by Khan et al. Even though their study was interventional and included pre- and postevaluation of knowledge in both the groups, nurses still had a higher mean in knowledge regarding CPR and BLS questions (preintervention) than nursing students. Surprisingly, no significant relationship was established between students' educational level and total mean of BLS knowledge scores (P = 0.518). In fact, 58.9% of 2nd-year nursing students had a BLS license, 27.5% of 3rd-year students, and 21.9% of 4th-year students had it as well. However, it must be admitted that the BLS course at the AAUJ has recently (2016) become mandatory for nursing students in their second and 3rd years, and even though 4th-year nursing students were the least likely to have a BLS license, their mean in the knowledge of BLS is the highest. In addition, 4th-year students have an accumulated knowledge of BLS from various sources (Critical courses, Emergency, Pediatrics.), and most importantly, from clinical training in hospitals. Fourth-year nursing students, unlike other students, do their internships at hospitals and are exposed to real critical life-and-death situations.
The study also showed a highly statistically significant difference that was found between nurse's level of education and the total mean of BLS knowledge scores (P = 0.005). Nurses with a bachelor's degree had the highest mean (58.81) as corroborated by Marzooq and Lyneham's study. To clarify, nurses with a diploma degree only study for 2 years, taking courses that are slightly different from those in a bachelor's degree in nursing. A nursing bachelor's degree, on the other hand, gives students better opportunities to perform BLS. However, a nursing diploma gives students only 2 years to train and obtain theoretical knowledge. Diploma degrees may also lack BLS and first aid courses.
Moreover, the mean score of the BLS knowledge of nurses with bachelor's degree was higher than that of the only seven nurses who had master's degree. This is mainly because master's programs are field-specific, with students often losing interest in other specialties, and we have also established that nurses have a problem retaining the knowledge and performance of BLS. Adult Learning Theory states that “when adults are motivated to learn, retention is greater over time.” Since this also applies to nurses, a lack of motivation and satisfaction might be responsible for their lack of knowledge retention.
One may then conclude that, the more experienced nurses are, the more knowledgeable about BLS they should be. This was the third hypothesis the researchers examined, and unfortunately, no statistically significant differences were found between nurses' work experience and the total mean of BLS knowledge scores (P = 0.092). We also established that the more the years of experience the nurses had, the less their mean knowledge of BLS score was. Nurses with < 5 years of experience had the highest mean (61.04) of BLS knowledge while those with more than 10 years' experience had the lowest mean (54.7). Bajracharya and Nagarkotil's  study corroborated this by concluding that there is no link between nurses' knowledge and academic qualification and experience (P > 0.005).
Finally, the results of the current study found a statistically significant differences existed between the wards nurses' work and the total mean of BLS knowledge scores (P = 0.001). CCU had the highest mean (71.67) followed by the Emergency Department with a mean of 65.29, and then by ICU with a mean of 61.55. These findings contradicted the study by Bajracharya and Nagarkotil, which found that only 2% of high-care unit nurses in their teaching hospital had sufficient knowledge of BLS and CPR. However, this study states that nurses working in the ICU, CCU, and ED are more exposed to critical situations (cardiac arrests, choking, etc.,) and are expected to respond more quickly. As a result, nurses working in these wards are required to have a BLS license unlike those working in other wards. In addition, training and exposure to real situations increase both the skill and confidence of a nurse.
| Conclusion|| |
Registered nurses appeared to have more knowledge in BLS than nursing students at AAUJ. However, the mean score of both nurses and students were almost similar. In addition, with regard to BLS knowledge, there was no significant difference between nurse's experience and the academic level of nursing students. The gap between nurses and students' knowledge of BLS needs to be filled. Moreover, continuous evaluation of knowledge of BLS and practice is needed to provide answers to the consequences of inadequate knowledge of BLS. Nurses who have been working for 10 years or more are unable to retain their basic and advanced resuscitation skills for long. An improvement in BLS skill retention is crucial to reduce possible disability and death caused by time lag in resuscitation.
Implications of the study
Overall, this study strengthens the idea that using high fidelity simulation scenarios can enhance and retain both knowledge and skill more than the classical BLS courses. The current data highlight the importance of both integrating of BLS course and updating such course for the registered nurses recurrently.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Vausedvan B, Lucas A, Devi GM, Bhaskar A, Areekal B. Assessment of level of knowledge of basic life support algorithm among medical and nursing students in a tertiary care teaching hospital. Int J Community Med Public Health 2016;3:3520-5.
Khan H, Vora MK, Bose N. An education intervention to assess knowledge and practices about cardiopulmonary resuscitation (CPR) among nurses and nursing students of tertiary care hospital in Gujarat, West India. Eur J Pharm Med Res 2015;2:502-11.
Josipovic P, Webb M, McGrath I. Basic life support knowledge of undergraduate nursing and chiropractic students. Aust J Adv Nurs 2009;26:58-63.
Smith KK, Gilcreast D, Pierce K. Evaluation of staff's retention of ACLS and BLS skills. Resuscitation 2008;78:59-65.
Akhu-Zaheya LM, Gharaibeh MK, Alostaz ZM. Effectiveness of simulation on knowledge acquisition, knowledge retention, and self-efficacy of nursing students in Jordan. Clin Simul Nurs 2013;9:335-42.
Gebreegziabher Gebremedhn E, Berhe Gebregergs G, Anderson BB, Nagaratnam V. Attitude and skill levels of graduate health professionals in performing cardiopulmonary resuscitation. Adv Med Educ Pract 2017;8:43-50.
Sánchez-García AB, Fernández-Alemán JL, Pérez NA, Hernández IH, Valverde RN, Castro DR, et al
. Assessment of the knowledge level and its relevance in terms of CPR in medical personnel of the hospital emergency medical system of the Autonomous Community of the Region of Murcia. Enferm Glob 2015;14:230.
Marzooq H, Lyneham J. Cardiopulmonary resuscitation knowledge among nurses working in Bahrain. Int J Nurs Pract 2009;15:294-302.
Knowles M. The Adult Learner: A Neglected Species. 3rd
ed. Houston, TX: Gulf Publishing; 1996.
Madden C. Undergraduate nursing students' acquisition and retention of CPR knowledge and skills. Nurse Educ Today 2006;26:218-27.
Bajracharya S, Nagarkotil L. Knowledge regarding basic life support among nurses of a tertiary level hospital of Nepal. MJSBH 2016;15:66.
[Table 1], [Table 2], [Table 3], [Table 4]