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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

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Building competency with blended learning a multi site pre licensure nursing education study with heartcode bls

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

Research team
Research Team

Marilyn H. Oermann, PhD, RN, FAAN, ANEFSuzan E. Kardong-Edgren, PhD, RNTamara Odom-Maryon, PhD

Yeongmi Ha, MSN

Jacqueline Keegan McColgan, MS, RN, CNEDebbie Hurd, MS, RNNancy Rogers, MA, RNCarol 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

Building competency with blended learning a multi site pre licensure nursing education study with heartcode bls


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
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
Research with student nurses

  • Madden 2006 in Ireland


    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
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
Voice Activated Manikin (VAM)

  • Immediate verbal feedback

    Compress faster

    Ventilate more slowly

Instructor led courses
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
Purpose of this study

  • Evaluate effectiveness of Heartcode BLS with VAM for nursing students

  • One arm of larger four arm study


  • 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
Site coordinators

  • Hired instructors

  • Managed students

  • Maintained manikins

  • Managed data

  • Uploaded data

Heartcode bls part 1
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 11
Heartcode BLS Part 1

  • Debriefing screens

  • Must pass with 84%

  • Students took between 30-75 minutes to complete

Back story
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…

Heartcode part 2
Heartcode Part 2

  • Practice on VAM manikin

  • Upon cycle completion, practice or test

  • Must pass psychomotor portion of BLS course

Back story1
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
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

Laerdal pc skillreporter system
Laerdal PC SkillReporter system

  • Ongoing logs and study

  • Monitor display of compression, ventilation, hand compression

  • Visible to site coordinators

  • Data uploaded electronically to statistician


  • Numbers of ventilations performed correctly

    Volume between 500-800 ml

    Inflation flow rate <800 ml/second

    Airway open during inflation/ventilation

  • # Compressions performed correctly

    Depth between 38-51 mm

    Complete release

    Correct hand position

Study findings
Study Findings

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

Heartcode bls group
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
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
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
Disadvantages of Heartcode BLS

  • Cost?

  • Use of IL traditionally

Building competency with blended learning a multi site pre licensure nursing education study with heartcode bls

Every school needs a VAM

Managing this multi site study
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
But wait…there’s more!

  • Study continues for 12 months

  • Continuous vs biennial certification

  • 2 manuscripts in submission…

  • Stand by…



Suzie Kardong-Edgren PhD, RN