Narges Mirjalili
1,a, Tayebeh Negahban Bonabi
2,b, Masoomeh Barkhordary Sharifabad
3,c, Ali Ansari Jaberi
4,d,*1MSc Medical Surgical Nursing Student, Nursing & Midwifery School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
2Assistant Prof. Department of Community Health Nursing, Nursing & Midwifery School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
2PhD of Community Health Nursing, Social Determinants of Health Research Centre, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
3 MSc Department of Nursing, School of Medical Sciences, Yazd Branch, Islamic Azad University, Yazd, Iran
4MSc Department of Mental Health Nursing, Nursing & Midwifery School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
4MSc of Mental Health Nursing, Social Determinants of Health Research Centre, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
a[email protected], b[email protected], c[email protected],
*Corresponding author
Keywords: Cardio-pulmonary resuscitation; Peer; Clinical skills; Nursing students training.
Abstract. According to important of applying appropriate educational methods for promotion student’s knowledge, skill and perceived self efficacy in encountering cardio arrest. The aim of this study was comparing the effects of peer and teacher education on nursing student's perceived self-efficacy of CPR. So 50 nursing student selected randomly and equally divided in two matched groups (peer and teacher) and then trained in CPR according 2015 protocol. Their perceived self-efficacy in CPR immediately and one month after intervention was measured. Data were analyzed using Chi-square, t-test and repeated measurement (p=0.05). According to the finding the mean score of perceived self-efficacy in CPR in peer-educated group was significantly higher than in teacher group, immediately and one month after the intervention (p<0.001).
1. Introduction
According to the report by American Cardiology Association, cardiac arrest ranks as the fifth cause of mortality after cardiovascular diseases, cancer, chronic diseases of lower respiratory tract, and unintentional injuries and is approximately the cause of one-twentieth of deaths. Averagely, one American is affected by cardiac arrest every 40 s while one individual dies of it every 4 min [1]. Despite amazing advancements in the application of modern technology and programs of effective prompt interventions at the time of cardiac arrest, the survival and discharge rate of such patients is unfortunately low in various health-care centers [2-4]. Some studies have reported a difference rate of
%42 in survival rate of patients with equal conditions and specifications undergoing cardiopulmonary resuscitation in various hospitals [5]. Unfortunately, there are no accurate statistics
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on the survival rate of patients after CPR; however, various results in the hospital setting from 19.1% to 11.8% are available [6, 7]. One probable justification for the diversity in the consequences of CPR is the potency of the CPR team in providing prompt appropriate response to cardiac arrest as the first link to survival loop after CPR [8, 9]. Nurses are the key members of the CPR team. They monitor the patients meticulously and vigilantly for the detection of any primary warning signs of cardiac arrest during the whole period of hospitalization and are the prime attendants at the cardiac arrest scene who manage the life rescue operation and coordinate the CPR process [10, 11]. Nonetheless, the reality is that nurses possess insufficient knowledge and skills of CPR [12, 13]. On the other hand, the perceived self-efficacy for CPR operations plays a key role in the conversion of knowledge to practical behavior, so that it determines the method by which the personnel face the scene of cardiac arrest to organize and handle the appropriate measures during the CPR process [14,
15]. Some evidence has demonstrated that persons who are equipped with sufficient knowledge on CPR, yet have low self-efficacy, may still fail in performing CPR successfully [16]. Since self-efficacy in CPR is correctable through training [17], a revision of methods used in teaching CPR and the application of appropriate effective teaching methods are rendered as mandatory key components in this field [14, 18]. Recently, the use of peers in teaching clinical skills to BS students has been rendered as an acceptable convention in teaching health-care sciences. This reduces the costs and is considered as an effective method of modifying learning in psychomotor and cognitive domains leading to increased self-confidence of trainees in clinical settings [19, 20]. Nevertheless, some controversies on the effectiveness of the application of this teaching method have been reported in the literature available [21, 22]. Moreover, some review studies have recommended that more research be done to investigate the pedagogic consequences of this method [23]. Hence, regarding the vital importance of the teaching of prompt suitable response to a cardiac arrest scene in BS nursing curriculum, the present study embarked on comparing the effects of training by educators and training by trained peers on the rate of perceived self-efficacy of nursing students in CPR. The results could be applied in better presentation of the CPR course.
2. Methodology
In this experimental study, 50 participants were selected from among 150 senior BS students of nursing who were studying at Islamic Azad University, Yazd Branch, on the basis of inclusion criteria. They had enrolled for “Nursing of Medical Emergencies” course. These students were matched for age, gender, and overall mean and randomly assigned into two groups of 25. The inclusion criteria were: not having passed the formal CPR training course or program, not participating in a similar research, and no experience of working in hospital. Also, the exclusion criteria were: absence in training and exam sessions. In this study, peer was defined as a classmate with conditions like good educational performance, inclination for participating in the study, and sufficient ability for interacting with and transmitting knowledge to others. The peer student was selected and sent to Yazd EMS (Emergency Medical Services) to pass the formal CPR training program to obtain the required certificate. The teacher team were also trained both theoretically and practically by the same trainer who had taught the peers. The teaching materials and protocol were the same for both groups and consisted of basic and advanced CPR principles of 2015 protocol of ACA. Training was performed on mannequin for both groups in separate sessions. The length of training was five 60-min sessions. The data collection instruments included the Demographic Information Questionnaire and the Standard Perceived CPR Self-Efficacy Questionnaire developed by Roh et al. (2012). This inventory consisted of 4 subcategories of debriefing, recognition, reporting and rescuing, and responding & recording including 17 items with a five-point Likert scale ranging from “I’m completely sure, I’m sure, I’m neutral, and I’m not sure” to I’m completely unsure”. Using Cronbach’s α coefficient, the validity and reliability of this instrument were estimated to be 0.82 for “recognition”, 0.88 for “debriefing and recording”, 0.87 for “responding and rescuing”, and 0.83 for “reporting”. The overall reliability coefficient of the instrument was reported to be 0.91 [24].
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The research design was approved by the Committee of Ethics at the university and informed written consent was obtained from the students. Then, the sampling was initiated. In the pre-test, both groups filled the questionnaire relating to nurses’ perceived CPR self-efficacy under the same conditions. Subsequently, the training program was completed for both groups. Immediately following and 1 month after the implementation of training, i.e., intervention, the same questionnaire was completed again by both groups under the same conditions. To observe the rights of the students trained by peers, it was determined at the beginning of the research design to repeat the training program for these students by the educators in the case of any demand, though there was no demand for this. The gleaned data were analyzed with SPSS16 using Chi-square test, t-test, and repeated measurement (p=0.05).
3. Results
In this research, no students were excluded from the study (subject attrition=0). The mean and SD of age was 21.63±0.91. More than half of the participants in each group were female. The samples in both groups were matched for important intervening variables such as age (t-test for independent groups, p=0.84), gender (Chi-square, p=0.87), and overall mean score (t-test for independent groups, p=0.12). A comparison of mean scores of nursing students’ perceived CPR self-efficacy before, immediately after, and 1 month after intervention indicated that the students’ mean score on this variable was greater before intervention for the educator-trained group compared to the peer-trained group though the difference was not statistically significant. However, the mean score was significantly greater in the peer-trained group immediately and 1 month after intervention compared to the teacher-trained group (t-test for independent groups, p=0.05 and p=0.001).
A survey of the differences in subscales mean scores in pretest indicated no significant difference in the mean of the perceived score between the two groups. Also, a comparison of the mean scores of subscales immediately after intervention in both groups demonstrated that the mean score was significantly greater only for “responding and rescuing” in the peer-trained group immediately after intervention compared to the teacher-trained group (p=0.02). Moreover, a comparison of the mean scores of subscales in both groups 1 month after intervention revealed that except for “reporting”, there were significant differences among the subscales so that the mean score of perceived self-efficacy in the peer-trained group was greater than that of the teacher-trained group for “recognition” (p=0.03), “reporting” (p=0.005), and “responding and rescuing” (p=0.001).
The results of paired t-test for comparing mean scores of subscales of self-efficacy in teacher-trained group before intervention with immediately after and 1 month after intervention suggested significant differences in all subscales before intervention, immediately and 1 month after intervention so that the mean score of perceived self-efficacy in all subscales was greater immediately after and 1 month after intervention compared to before intervention (recognition, responding and rescuing, and reporting, p=0.001, and reporting, p=0.002) while the difference between mean scores of subscales immediately after and 1 month after intervention was significant only for “responding and rescuing”. The mean score was smaller 1 month after intervention compared to immediately after intervention (p=0.001). Additionally, a comparison of the mean scores of subscales of perceived self-efficacy in the peer-trained group before intervention with immediately after and 1 month after intervention indicated a significant difference for all subscales before intervention compared to immediately and 1 month after intervention so that for all subscales, the mean score of perceived self-efficacy was greater immediately and 1 month after intervention compared to before intervention (paired t-test, p=0.001). Nonetheless, the difference in mean scores between immediately after intervention and 1 month after intervention was significant only for the subscale “responding and rescuing” so that the mean score 1 moth after intervention was smaller than that immediately after intervention (p=0.026).
The results of repeated measurements indicated that the scores of perceived self-efficacy were significantly different during the time interval in the two groups so that the self-efficacy score was greater in peer-trained group compared to the teacher-trained group.
4. Discussion and conclusion
The findings of this study confirmed the positive effect of peer teaching to promote nursing students’ perceived CPR self-efficacy in clinical settings. Some previous studies have reported the usefulness of the use of various training methods and peer-oriented learning in clinical training
[25-28]. Also, the results of a study on the application, advantages, and preferences of the use of “peer-assisted teaching” in teaching clinical skills in the field of health sciences have reported students’
feeling of more comfort when taught by their peer teacher, reduced anxiety, and receiving useful and non-threatening feedback. Moreover, the students participating in the learning process by their peer had experienced an improvement in psychomotor skills, critical thinking, care performance, patient education, gaining independence in clinical performance, and a high level of knowledge [29]. Even though several studies have approved the appropriacy of educational consequences of the use of peer-assisted teaching [30,31] and peer teaching, some literature reports controversial results in this respect. A meta-analysis by Yu et al., reported equal rate of achieving learning goals by medical students taught by peers and by those taught by faculty members. The researchers in the study above have introduced the potential merits of learning by peer teaching, yet, they have characterized the long-term effects of this method in medical education as unknown or uncertain [32]. In another study, the researchers stated that under conditions that the learners’ personality features and learning styles are not compatible with this method and the students have spent less time with the clinical trainer, a weak learning occurs; so, it is necessary to accommodate the students before implementing this method [33]. There are a few studies in the current literature investigating the efficacy of the use of this method in teaching CPR clinical skills. The study by Roh et al. compared the nursing students’ CPR skills in the educator-trained group and peer-trained group and concluded that the educator-trained group acquired better skills of CPR performance compared to the other group [34]. In another study, the junior medical students who were exposed to peer teaching sessions, enjoyed the beneficial effect of peer companionship on their cognitive and emotional power and educational progress; besides, the peer-oriented students showed a stronger self-efficacy for continuing their education [35].
As conclusion a successful teaching definitely depends on the creation of a nonthreatening climate of learning and placing the learners on a floor of sympathy and providing constructive feedback. These considerations may be fulfilled in a better way by a peer than a teacher. However, more comprehensive and accurate research is needed before the application of this method in BS educational syllabus for assessing the suitability of this method for various subject matters, size of teaching groups, newness or repetitiveness of the subject matters and collation of the learners’ and peers’ personal and educational preferences. Furthermore, the researchers of this study recommend more exploratory qualitative research to acquire live experiences of the students who participate in the medical education system as learners or as teachers in the peer-oriented teaching.
Acknowledgement
This study was distilled from a MSc thesis of medical surgical nursing and financially supported by Rafsanjan University of Medical Sciences. (Code: ir.rums.rec.1395.10).
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