1. INTRODUCTION:

Cardiopulmonary resuscitation (CPR) competency has been defined as having a cognitive knowledge and the psychomotor skills to enable health practitioners to perform CPR in a cardiac-arrest situation¹. Because emergency situations are unpredictable, new nurses who are confronted with emergency situations become quite embarrassed.

Because the nurses take care of patients the nearest place in the hospital, often the nurse is the first on the scene when an emergency occurs. Therefore, the nurse should respond promptly to provide CPR, but studies reported that many of the nurses did not perform CPR when they confronted cardiac arrest². If CPR is performed within 4 minutes and the treatment is administered within 8 minutes, the patient survival rate is 43%³. Immediate action is quite important. The behavior of the person who witnessed the situation for the first time is very important, and confidence in the results of the expected behavior is also important, along with the knowledge, skill, and attitude to act.

The ability to respond quickly and effectively to a CPR situation rests on nurses’ confidence in emergency procedures¹. Students’ university education has a marked impact on their behavior in emergency situations, providing them with the ability to address emergencies as a new nurse. For the last decade, a basic life support (BLS) program has been widely provided to undergraduate nursing students⁴.

BLS education has been identified as one critical factor that aligns with knowledge and competence of CPR in nursing education⁵. For the past decade, educators have made efforts to improve CPR-related nursing education in Korea. Adopted by American Heart Association (AHA) in 2005, the BLS for health providers program has been well distributed and the number of centers conducting BLS training has increased continuously ⁶. In addition, the number of healthcare providers who received BLS training rapidly increased from 193 in 2005 to 27,816 by 2014⁶.

The function of BLS education is to ensure nursing students acquire CPR knowledge and skills, and to enhance the ability of undergraduate nursing students to respond competently and confidently to a life-threatening cardiac-arrest situation^4,7. Undoubtedly, public expectation is high that all nurses will be competent to perform CPR in the event of cardiac arrest⁷. Although nurses’ ability to perform CPR is a critical determinant of patient survival in a cardiac-arrest situation, evidence indicates that nurses lack competence in the performance of CPR⁴.

Previous researchers found that nursing students’ quality of CPR psychomotor skills were below AHA guidelines during simulations of cardiac arrest^8,9. Suboptimal education is one factor associated with this poor performance. Dissatisfaction in training programs results in inactive participation of students¹⁰. International guidelines on BLS training focus on individual students’ learning needs and styles to ensure active engagement and effective empowerment of nursing students’ acquisition of BLS skills¹¹.

With clear objectives, design characteristics of BLS training programs significantly affect positive evaluations¹¹. Students’ learning satisfaction is crucial to achieve a competent level of engagement in a learning activity¹². Integration of factors related to positive evaluations of programs would ensure active engagement of students in BLS training, leading to better learning progress.

Self-efficacy is one’s perceived capability to perform a particular behavior in a given circumstances¹³. CPR-related self-efficacy correlates with nursing students’ quality of performance-their perceived capability—which is an important predictor of resuscitation proficiency in practice¹⁴. A previous study revealed the association between the quality of CPR skills and self-efficacy; knowledge and skills obtained from mastery learning effectively improved the self-efficacy of nursing students ⁵.

Most previous studies evaluated the effects of CPR-related interventions by comparing data of pretests and posttests. In addition, outcome variables concentrated on some aspects such as knowledge and skills of CPR. However, in this study, we tried to understand the relationship between self-efficacy and satisfaction with CPR education, which is a cognitive variable that yields effective CPR. We also wanted to identify variables that affect self-efficacy and satisfaction with education. The issue of undergraduate nursing students’ learning satisfaction of BLS programs and CPR self-efficacy remain unexplored in Korea. Thus, it is reasonable to assume that the findings from this investigation provide key information for future nursing education in cardiopulmonary resuscitation.

2. PURPOSE OF THE STUDY:

The purpose of this study was to investigate the effects of BLS education on learning satisfaction and self-efficacy in the CPR performance of undergraduate nursing students.

3. METHOD:

Students at three 4-year nursing schools in three different districts in Korea completed a cross-sectional survey. Using convenience sampling, 105 undergraduate nursing students who took a professional-led BLS training course within a year took part. All participants signed informed-consent forms and agreed to participate in the study.

3.1. Measures:

Demographical data obtained included age, gender, grade, BLS certification (year and center where they took the BLS program), and any other CPR training or education attended.

Self-efficacy was measured with a basic CPR self-efficacy measuring instrument, the CPR Self-Efficacy Scale. The scale measures the self-efficacy of study participants using a self-report questionnaire¹⁵. The tool consists of 11 items. With a maximum score of 55, higher scores indicate higher level of self-efficacy of undergraduate nursing student in performing CPR.

BLS learning satisfaction: Assessment of the degree of learning satisfaction with the BLS program accrued using a 10-item self-report questionnaire¹⁶. Scores indicate the degree of satisfaction with a learning program and higher scores indicate greater satisfaction, with a maximum score of 50.

3.2. Statistical Analysis:

Data were analyzed using Statistical Package for Social Sciences (SPSS 21.0, SPSS Inc., Chicago, IL, USA) and statistical significance was determined at p < .05. We compared demographic variables to the dependent variables of learning satisfaction and CPR-related self-efficacy. Pearson’s correlations identified relationships among continuous variables. Last, we used hierarchical regression to examine the extent to which variables aligned with the CPR-related self-efficacy of undergraduate nursing students.

4. RESULTS:

4.1. Demographic Characteristics of Participants:

Scores of learning satisfaction and CPR-related self-efficacy according to study participants’ demographic factors are shown in Table 1. The mean age of study participants was 23.28 ± 3.16 and 75 students (71.4%) were in the third year. The majority of students were female (92.4%) and the mean number of CPR educations was 1.57. No difference emerged in grade-based self-efficacy and BLS satisfaction. No significant difference arose in self-efficacy and BLS satisfaction, according to demographical characteristics of study participants.

4.2. Correlation of General Characteristics and Educational Characteristics

The relationship between study variables is shown in Table 2. A statistically significant correlation emerged between BLS education satisfaction and CPR self-efficacy with r = .784 (p < .01).

Table 1: Demographical Characteristics of Study Participants (n = 105)

				CPR self-efficacy score				BLS learning satisfaction score
	Categories	M/n	±SD/%	M	±SD	t/F	p	M	±SD	t/F	p
Age		23.28	±3.16
Gender	Male	8	7.6%	37.62	8.94	-0.193	.851	36.75	12.61	-0.077	.941
Gender	Female	97	92.4%	38.26	8.28	-0.193	.851	37.10	11.56	-0.077	.941
Religion	Yes	44	41.9%	37.49	8.48	-0.743	.459	37.93	11.23	.641	.523
Religion	No	61	58.1%	38.72	8.18	-0.743	.459	36.46	11.87	.641	.523
Study year	3	75	71.4%	38.35	9.34	0.267	.790	37.35	12.32	0.377	.707
Study year	4	30	28.6%	37.87	4.94	0.267	.790	36.40	9.64	0.377	.707
Experience of other types CPR education	Yes	62	59.0%	37.90	9.29	-0.668	.506	37.50	11.90	0.223	.824
Experience of other types CPR education	No	43	41.0%	39.00	6.38	-0.668	.506	37.00	10.77	0.223	.824
Number of CPR education		1.57	±0.49

Note. CPR = cardiopulmonary resuscitation, BLS = basic life support

4. DISCUSSION:

Rapid CPR directly links to survival in an emergency situation such as cardiac arrest. Nurses are often the first person in clinical practice to encounter patients who requires CPR; thus, their ability to cope with emergencies is crucial. This ability relates to nurses’ self-efficacy, which is beyond the knowledge and skills of CPR. Educators have developed various strategies in efforts to strengthen CPR self-efficacy of nursing students throughout school curriculums. Currently, many nursing colleges provide undergraduate nursing students with BLS courses and most students graduate with a BLS provider certificate. The knowledge and skills of CPR, acquired from school, influences confidence levels and attitudes when coping with emergencies as a nurse after graduation¹⁷. CPR education is vital for clinical or community nurses.

College students in the health department reported that basic CPR training is essential, recognized as one of the most important trainings in the nursing curriculum¹⁸. However CPR education in nursing college students empathizes knowledge and skills rather than learning satisfaction and self-efficacy at the completion of the education program. A better understanding of the factors affecting the quality of CPR education will increase its effectiveness, leading to positive outcomes for patients.

Findings from this study indicated that the majority of undergraduate nursing students in Korea received BLS training in their third and fourth year of school. Students in their senior year in particular, must have critical thinking skills regarding clinical situations, preparing for their expected role as a new nurse. Learning satisfaction associates with level of critical thinking¹⁹. In addition, CPR education must focus on students’ capability to control real situations because nursing students will address patients as soon as they become nurses²⁰. Along with the development of teaching methods to increase leaning satisfaction, further education incorporating CPR in real life may effectively improve CPR self-efficacy of undergraduate nursing students.

In this study, no correlation emerged between self-efficacy and learning satisfaction, according to general characteristics. Perhaps the reason for this is that participants were only in the third and fourth years of

study. In Korea, all nursing students in Years 3 and 4 have completed the fundamental nursing curriculum; thus, they are considered to be similar in skill and level of critical thinking.

Unexpectedly, findings indicated no statistically significant association between repeated education and CPR-related self-efficacy, although a previous study with clinical nurses emphasized the importance of frequent education. Repeated exposure to CPR simulations can significantly improve CPR-related self-efficacy, enabling nurses to better response in emergency situations²¹. Examining only undergraduate nursing students may not effectively reveal the impact of education frequency, as nursing students may not seek other sources of education outside their university. However, six of 10 students experienced other types of CPR education. To improve capabilities for urgent responses in emergency situations, efforts are needed to improve students’ accessibility to various education courses.

This study revealed that the BLS learning satisfaction is the greatest determinant of CPR self-efficacy in undergraduate nursing students. A study reported that student’ overall satisfaction and self-efficacy related²². In addition, students’ satisfaction with learning is a very important variable, as it affects loyalty, ensuring a positive attitude toward the program^23,24. Student learning satisfaction builds on their trust in the learning curriculum as well as internal motivation²⁵. Thus, the strong association between learning satisfaction and self-efficacy can be interpreted as participating students’ trust that learning promotes a good attitude with active participation in the program, which ultimately boosts confidence.

Although this study did not measure the level of performance of students attending BLS education, outcomes likely point to better performance of CPR among students with higher learning satisfaction and CPR-related self-efficacy. Finding from previous studies showed that a positive relationship emerged between self-efficacy and level of CPR skills ⁹. A study by Part and colleagues²⁶ reported that level of self-efficacy improved CPR performance. Learners with high self-efficacy tend to set high goals. Having clear objectives, learners devote themselves to a firm sense of purpose. When self-efficacy is low, in contrast, students are more passive, exhibiting weak judgment, which leads to failure in goal achievement²⁷. Future studies that investigated the relationships among learning satisfaction, CPR-related self-efficacy, and CPR performance in nursing students may enhance robustness of the current findings.

According to the theory of self-efficacy²⁸, the best way to reinforce the belief in self-efficacy is through continuous learning reinforcement. In other words, self-efficacy that allows people to believe in their own knowledge and skills and take action can be very important. This study also revealed a significant correlation between self-efficacy and educational satisfaction. These results showed that the higher the satisfaction in BLS education, the higher the self-efficacy; also, continuing BLS education raises one’s satisfaction level. Self-efficacy not only improves CPR performance, but also the performance of other nursing skills in general 20. In unpredictable special emergencies such as cardiac arrest, it is important that nurses can act, believing themselves to have the necessary knowledge and techniques and the ability to put them into action.

This study had limitations. First, we did not evaluate the associations between self-efficacy and actual CPR-performance techniques; rather, we evaluated nurses’ satisfaction with their BLS education. This study was not a direct evaluation of practical aspects but an analysis of relevant factors that impact practical aspects. Thus, the question remains, what are the actual factors that enable students to achieve higher levels of performance in the course of a learning program? and are students satisfied with their practice level? Participants in this study were limited to those who attended a BLS program within the last year. Longitudinal study of degradation of self-esteem is needed, considering a 2-year time frame for the renewal of licenses.

We have following suggestions: (a) to generalize the results of the research, it is necessary to expand the number of participants; (b) various approaches to CPR-related variables are needed. In other words, a need persists to further explore the factors that influence CPR education, and (c) current clinical situations are difficult for students to experience safely and with abundant practice. Therefore, various CPR-training methods and curriculum development should be carried out to proffer practical training.

5. CONCLUSION:

This study identified the current status of CPR-related education for undergraduate nursing students in Korea. Education for real-life CPR may effectively improve CPR self-efficacy and the competency of undergraduate nursing students. The effectiveness of CPR training and practical training should ultimately improve the ability of emergency-coping competence. As found in this study, a relation exists between self-efficacy and learning satisfaction. Thus various strategies to improve satisfaction should include the subjective evaluation of the learning environment and technology, in a broad sense. A person who gives a positive evaluation will have positive self-efficacy. A multidisciplinary effort to improve emergency-response skills requires a curricular approach. Activities as a separate process, apart from regular courses, are also important. For students majoring in nursing, access to an appropriate curriculum will enhance their expertise.

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Received on 21.06.2017 Modified on 29.06.2017

Research J. Pharm. and Tech. 2017; 10(7): 2265-2270.

DOI: 10.5958/0974-360X.2017.00401.2

Variables	Student factors				CPR education factors
Variables	B	β	t	p	B	β	t	p
Age	.438	.168	1.628	.107	.199	.076	1.154	.251
School year	-1.413	-.078	-.753	.453	-.584	-.032	-.482	.631
Number of CPR education					-.599	-.036	-.562	.575
BLS learning satisfaction					.559	.780	12.447	.000
R²	.026				.621
Adjusted R²	.007				.606
F(p)	1.362 (.261)				40.556(< .001)

Acquisition of CPR-related Self-efficacy through BLS Program among Undergraduate Nursing Students in Korea

Table 1: Demographical Characteristics of Study Participants (n = 105)

Table 2: Correlation Matrix of Continuous Variables

Table 3: Multiple Hierarchical Regression of Factors Influencing CPR Self-Efficacy in Undergraduate Nursing Students

	Age	Number of CPR education	BLS learning satisfaction	CPR self-efficacy
Age	1
Number of CPR education	.094	1
BLS learning satisfaction	.099	.129	1
CPR self-efficacy	.144	.072	.784**	1