Sudden cardiac arrest is one of the leading causes of death in Europe, with 84 cases per 100,000 inhabitants each year. Once cardiac arrest has occurred, early initiation of CPR and early defibrillation depends on bystanders and can lead to survival rates as high as 50-70%. This is a challenging activity that requires high levels of self-efficacy from the bystanders.
In the field of cognitive theory, the term self-efficacy describes the way people choose to react during stressful situations - whether they decide to initiate challenging activities, which indicates high levels of self-efficacy or they avoid implicating in such an activity, which is correlated with low self-efficacy levels. Intervening in an incident of cardiac arrest is quite stressful and challenging. Training in CPR should include teaching techniques that ensure both good knowledge retention and increase of self-efficacy.
The study included medical and nurse students. Preclinical 3rd year medical students(n=266), in University of Crete, participate compulsory in the BLS course, having no prior training in resuscitation. This group was compared with preclinical 2nd year nurse students (n=99) from the Technological Educational Institution of Crete who participate voluntarily in the same course, after attending lectures in their first aid course during third semester. The course is a BLS provider ERC certified session, including demonstrations and hands-on practice in groups, based on low-fidelity simulation scenarios. Participants were evaluated using continuous assessment. The 365 students that participated at the past 2 years courses, were asked to complete an anonymous self-efficacy questionnaire prior and immediately after their training.
The questionnaire was designed using the Bandura’s “Guide for Self-efficacy Tests” and was modified using the Visual Analogue Scale. The questions have the form “I feel…” and included all basic steps of the BLS sequence:1.Approach with care 2.Check for response 3.Check for normal breathing 4.Call the EMS 5.Start chest compressions 6.Use an AED. The answers have the form : Not confident (0%) - Somewhat confident (25%) - Confident (50%) - Very confident (75%) - Extremely confident (100%) and had a colorized symbol according to the level of confidence represented, from blue – not confident to red – extremely confident. (Fig. 1)
All 365 participants completed successfully the course, according to the continuous assessment performed by ERC certified instructors. The questionnaires’ analysis revealed enhancement of the self-efficacy levels in all steps of the algorithm after the course in both groups. The highest variation in total concerned the AED utilization with 90% feeling less than 50% confident prior and only 4% after the course. Nurse students were found to have increased self-efficacy levels before the course possibly due to their prior education.
Use of AED is regarded as the most challenging step of the algorithm. The simulation-based hands-on BLS/AED course enhanced self-efficacy levels of all students,regardless of their previous experiences implying that such courses can lead to more frequent initiation of the CPR algorithm during cardiac arrest events.