Comparing Real-Time Feedback Modalities to Support Optimal Cardiopulmonary Resuscitation for Undergraduate Nursing Students: A Quasi-Experimental Cross-Over Simulation Study

Learning practical nursing skills in simulation centers - A narrative review

Background

Practical skills are complex procedures integrating communication and caring, as well as technical and manual aspects. Simulation at a simulation/skills center offers a wide range of learning activities and aims to imitate patient situations.

Objectives

To investigate the international research literature on practical skills learning in simulation/skills centers in nursing education. Research questions: 1. What are the range and type of practical skills studied? 2. What learning activities are focused on in the studies included in the review? 3. What are the learning outcomes and how are they assessed?

Design

Narrative review.

Methods

We searched electronically and included studies from Medline Ovid, CINAHL, Eric, Embase, Academic Search Premiere, and Cochrane. Unique indexing terms and search strategies were developed for each database. The criteria for inclusion were bachelor nursing students as the study population and practical nursing skills learning in simulation/skills centers. We used Rayyan QCRIt for the initial screening and the Mixed Method Appraisal Tool for quality assessment. We used a narrative approach to synthesize the diverse range of studies.

Findings

One hundred and twenty-one studies from 26 countries published between January 2013 and March 2022 were included. The amount of quantitative research was overwhelming (n = 108). A total of 50 different practical skills were represented. The studies focused on which learning modalities resulted in the best learning outcomes. Only 8.5% (n = 7) of the included studies concerned students' learning processes. Skill performance (n = 101), knowledge (n = 57), confidence (n = 34), and satisfaction (n = 32) were the main learning outcomes measured.

Discussion

The quality assessment indicated that 10 of the studies achieved 100% on the mixed method appraisal tool criteria. In many of the studies with quasi-experimental and randomized controlled trial designs, the intervention group received some form of educational treatment while the control group received no treatment. The choice of no treatment for the control group in pedagogical research seems to disregard the inherent purpose and effect of teaching and learning.

Conclusion

Heterogeneity in the use of learning modalities and measuring instruments precludes the possibility of building on other research. Technical skills were the preferred choice of skill, while skills that involved a fair measure of communication and collaboration were only sparingly studied. Students' learning processes were barely touched on in the included studies. More focus should be placed on this area in further research, since the choice of learning modalities may affect the students' learning processes in significant ways.

Keep Me in the Loop: Real-Time Feedback with Multimodal Data

This paper describes the CPR Tutor, a real-time multimodal feedback system for cardiopulmonary resuscitation (CPR) training. The CPR Tutor detects training mistakes using recurrent neural networks. The CPR Tutor automatically recognises and assesses the quality of the chest compressions according to five CPR performance indicators. It detects training mistakes in real-time by analysing a multimodal data stream consisting of kinematic and electromyographic data. Based on this assessment, the CPR Tutor provides audio feedback to correct the most critical mistakes and improve the CPR performance. The mistake detection models of the CPR Tutor were trained using a dataset from 10 experts. Hence, we tested the validity of the CPR Tutor and the impact of its feedback functionality in a user study involving additional 10 participants. The CPR Tutor pushes forward the current state of the art of real-time multimodal tutors by providing: (1) an architecture design, (2) a methodological approach for delivering real-time feedback using multimodal data and (3) a field study on real-time feedback for CPR training. This paper details the results of a field study by quantitatively measuring the impact of the CPR Tutor feedback on the performance indicators and qualitatively analysing the participants’ questionnaire answers.

Basic Life Support Training for undergraduate nursing students: An integrative review

The aim of this review was to identify the role of basic life support training interventions in international undergraduate nursing education, that support optimal acquisition and retention of knowledge, psychomotor skills and resuscitation self-efficacy. Twenty-four articles were identified and analysed using an integrative review approach. Studies were reviewed for quality using a Critical Appraisal Skills Programme checklist. Common objective and standardised methods of basic life support education practice were identified: instructor led, simulation experiences, self-directed learning, skills training combined with clinical practicum, and computer-based training. Evaluation of competency was collected primarily from multiple-choice questionnaires or researcher-designed checklists, with a lack of objective performance data noted. Importantly, current teaching approaches do not guarantee acquisition or retention of basic life support skills. Objective feedback from technologies supporting cardiopulmonary resuscitation training may be useful in acquisition and retention of psychomotor skills, and therefore requires further exploration. Development of robust, psychometrically sound instruments are needed to accurately and consistently measure nursing students' skills performance.