From classroom to emergency: knowledge acquisition and retention following nurse-led simulation-based BLSD education in secondary schools
Abstract
Introduction: Out-of-Hospital Cardiac Arrest (OHCA) remains a major public health challenge in which early Cardiopulmonary Resuscitation (CPR) and automated external defibrillator (AED) use are critical determinants of survival. Despite international recommendations promoting Basic Life Support and Defibrillation (BLSD) education in schools, first-aid training is not systematically implemented in Italian secondary education. This study evaluated the effectiveness of a nurse-led simulation-based BLSD training program in improving theoretical knowledge and medium-term retention among high school students.
Materials and Methods: a total of 430 final-year students attended an Italian Resuscitation Council (IRC)-based BLSD course including interactive lectures, realistic simulations, and structured debriefing. Knowledge was assessed using a standardized 20-item questionnaire administered before training (T0), immediately after training (T1), and four months later without prior notice (T2).
Results: mean correct responses increased from 42.34% at T0 to 77.02% at T1 (p < 0.001). At follow-up, scores remained significantly higher than baseline (70.44%; p < 0.001), despite a moderate decline compared with immediate post-training results. No gender-related differences emerged.
Conclusions: simulation-based BLSD education appears effective in promoting both knowledge acquisition and medium-term retention in adolescents. These findings support the potential value of nurse-led BLSD training programs in secondary schools and suggest that their integration into school curricula may represent an important educational and public health strategy.
References
- 1. Gräsner JT, Lefering R, Koster RW, et al. EuReCa ONE – 27 Nations, ONE Europe, ONE Regis-try: A prospective one-month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitatio. 2016;105:188-95.
- 2. Gräsner JT, Wnent J, Herlitz J, et al. Survival after out-of-hospital cardiac arrest in Europe – results of the EuReCa TWO study. Resuscitation 2020;148:218-26.
- 3. Perkins GD, Lockey AS, Breckwoldt J, et al. European Resuscitation Council Guidelines 2021: adult basic life support. Resuscitation 2021;161:98-114.
- 4. Greif R, Lockey AS, Breckwoldt J, et al. European Resuscitation Council Guidelines 2021: Educa-tion for resuscitation. Resuscitation 2021;161:388-407
- 5. Kolb DA. Experiential learning: experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall; 1984
- 6. Mitchell AA, Ivimey-Cook ER. Technology-enhanced simulation for healthcare professionals: A meta-analysis. Front Med 2023;10:1149048.
- 7. Watts PI, McDermott DS, Alinier G, et al.; INACSL Standards Committee. Healthcare Simulation Standards of Best Practice™: Simulation design. Clin Simul Nursing 2021;58:14–21.
- 8. Saragih ID, Suarilah I, Hsiao CT, et al. Interdisciplinary simulation-based teaching and learning for healthcare professionals: A systematic review and meta-analysis of randomized controlled trials. Nurse Educ Pract 2024;76:103920.
- 9. Decker S, Alinier G, Crawford SB, et al. Healthcare Simulation Standards of Best Practice™: the debriefing process. Clin Simul Nurs 2021;58:27–32.
- 10. Duff JP, Morse KJ, Seelandt J, et al. Debriefing methods for simulation in healthcare: a systemat-ic review. Simul Healthc 2024;19:S112–21.
- 11. Jeffries PR. The NLN Jeffries Simulation Theory. 2nd ed. Philadelphia (PA): Wolters Kluwer; 2021
- 12. Perkins GD, Handley AJ, Koster RW, et al. European Resuscitation Council Guidelines for Re-suscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscita-tion 2015;95:81-99.
- 13. Böttiger BW, Semeraro F, Altemeyer KH, et al. KIDS SAVE LIVES: School children education in resuscitation for Europe and the world. Eur J Anaesthesiol 2017;34:792-6.
- 14. Plant N, Taylor K. How best to teach CPR to schoolchildren: a systematic review. Resuscitation 2013;84:415-21.
- 15. Olasveengen TM, Semeraro F, Ristagno G, et al. European Resuscitation Council Guidelines 2021: basic life support. Resuscitation 2021;161:98-114.
- 16. Wammes JD, Jonker TR, Fernandes MA. Drawing improves memory: The importance of multi-modal encoding context. Cognition 2019;191:103955.
- 17. Cook DA, Hatala R, Brydges R, et al. Technology-enhanced simulation for health professions ed-ucation: a systematic review and meta-analysis. JAMA 2011;306:978-88.
- 18. Nas J, Te Grotenhuis R, Bonnes JL, et al. Meta-analysis comparing cardiac arrest outcomes be-fore and after resuscitation guideline updates. Am J Cardiol. 2020;125(4):618-629. doi:10.1016/j.amjcard.2019.11.007
- 19. Cao W. A meta-analysis of effects of blended learning on performance, attitude, achievement, and engagement across different countries. Front Psychol 2023;14:1212056.
- 20. Finke SR, Schroeder DC, Ecker H, et al. Gender aspects in cardiopulmonary resuscitation by schoolchildren: A systematic review. Resuscitation 2018;125:70-8.
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