Basic Life Support for Nurses, KAREN MARDEGAN

Appendices 212 | P a g e yes no 1.7. Following completion of the program, if you were now required to perform BLS in an emergency: Do you think you could? How confident do you feel? 12345 (1 = not confident 5 = very confident) 1.8. Have you practised in preparation for the assessment today yes no (other than in the training sessions)? 2.0. BASIC LIFE SUPPORT KNOWEDGE 2.1. Define Respiratory Arrest: ________________________________________________________________________________________________ 2.2. List four (4) Causes of Respiratory Arrest: 2.3. Define Cardiopulmonary Arrest: ____________________________________________________________________________________________ 2.4. List four (4) causes of Cardiac Arrest: 2.5. List 5 potential complications of performing cardiopulmonary resuscitation: Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 213 | P a g e 2.6. What are the three main drugs most commonly used in cardiac arrest situations? THANK YOU FOR YOUR PARTICIPATION Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendix F3 Answers to BLS Knowledge Questions Basic life support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 215 | P a g e Define Respiratory Arrest: Absence of breathing, no breathing. List four (4) causes of Respiratory Arrest: (any combination) Obstruction, foreign body, blockage of airway, anaphylaxis Respiratory disease (ie asthma, bronchospasm, epiglottis) Drug overdose Trauma to chest, cardiac arrest Define Cardiopumonary Arrest: Absence of breathing (no breathing) and no pulse. List four (4) causes of Cardiac Arrest: (any combination) Arrhythmias / abnormal heart rhythm, or Ventricular Tachycardia, Ventricular Fibrillation, Asystole, Pulseless Electrical Activity Chest trauma, drug overdose, respiratory arrest Cardiac disease (AMI, heart failure), electrolyte imbalance (K+, Mg+ or Ca++) Electric shock, electrocution List five (5) potential complications of performing cardiopulmonary resuscitation: (any combination) Broken teeth, fractured liver, spleen, ribs, sternum, bruising Pneumothorax Aspiration, aspiration pneumonia, Gastric distention, regurgitation CPR not performed correctly/adequately What are the three most common drugs used in cardiac arrest situations: Adrenaline Atropine Lignocaine Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendix G Training Time Basic life support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 217 | P a g e BLS CD Time Allocation Per Participant Subject Number: Date Start Time Finish Time Time (hrs) An example: Subject Number: 33 Date Start Time Finish Time Time (hrs) 18/6/01 1100 1200 1 18/6/01 1230 1315 45 min TOTAL 1.45hrs Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendix H1 Traditional Program Evaluation Form Basic life support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 219 | P a g e An Alternative Approach to the Delivery of Education for Health Professionals6. Traditional Format Participant’s Program Evaluation Subject no:_______ 1. EVALUATION OF LECTURE AND PRACTICAL DEMONSTRATION/PRACTISE PROGRAM 1. 1. Contents: Please rate the following evaluation criteria using the numeric scale: (1 strongly disagree 5 = strongly agree) The breadth of the content was appropriate 12 3 4 5 12 3 4 5 Content was up-to-date 12 3 4 5 Content was appropriate to my learning needs for the topic 12 3 4 5 12 3 4 5 Content was useful in assisting me to acquire the knowledge & skills required 12 3 4 5 Learning material was relevant to my clinical practise 12 3 4 5 Simulations/scenarios were appropriate to learning 12 3 4 5 topic and contents Simulations were useful in facilitating and reinforcing learning of knowledge and skills required Complexity of content of learning materials was at the appropriate level 1.2 Structure of Lectures/Practical demonstration: Please rate the following evaluation criteria using the numeric scale: (1 = strongly disagree 5 = strongly agree) The organisation of topics and their contents was 12 3 4 5 appropriate The sequencing of content was appropriate to my 12 3 4 5 learning needs The sequencing of content was appropriate to 12 3 4 5 progressive learning and skills acquisition 6 Project Title changed after data collection to: Basic Life Support training for nurses: evaluating an alternative CD-based approach. Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 220 | P a g e The structure of content was suitable for independent 12 3 4 5 learning The structure was useful in maintaining my learning 12 3 4 5 focus and interest The structure ( i.e. progressive learning and interactive 12 3 4 5 learning-assessment-feedback) was useful in facilitating mastery learning. Feedback was appropriate in both timing and content 12 3 4 5 1.3. Practise session: If you participated in a practise session, please rate the following evaluation criteria using the numeric scale: (1 = strongly disagree 5 = strongly agree) Contents of the practise session was appropriate 12 3 4 5 The sequencing & pace of the session was 12 3 4 5 appropriate to my learning needs The session was useful in complimenting lectures 12 3 4 5 The session were useful in facilitating learner 12 3 4 5 participation and interaction with the educator & others I found the session helpful 12 3 4 5 1-4. Overall Quality of Lectures: Please rate the following -evaluation criteria using the numeric scale: (1 very low 5 = very high) Quality of the lectures and demonstrations 12 3 4 5 My satisfaction with the lectures and demonstrations 12 3 4 5 1.5. Overall Quality of Practical Session: Please rate the following evaluation criteria using the numeric scale: (1 very low 5 very high) Quality of the practical session 12 3 4 5 My satisfaction with the practical session 12 3 4 5 1.6. Overall Quality of the program: Please rate the following -evaluation criteria using the numeric scale: (1 very low 5 = very high) Quality of the lectures and demonstrations 12 3 4 5 My satisfaction with the lectures and demonstrations 12 3 4 5 1.7. Assessment component: The content of the assessment was appropriate 12 3 4 5 for the learning topic and contents The assessment was useful in facilitating and 12 3 4 5 reinforcing learning of knowledge and skills THANK YOU FOR YOUR PARTICIPATION ! Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendix H2 CD Program Evaluation Form Basic life support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 222 | P a g e An Alternative Approach to the Delivery of Education for Health Professionals7. CD Format Participant’s Program Evaluation Subject no:_______ Please tick the most appropriate response and/or respond as indicated: 1. EVALUATION OF CD ROM PACKAGE 1.1. Schedule: Was access to the CD Rom package adequate? yes no If no please specify_____________________________________________________________________ Was the maximum time allocation (2hrs) to view the CD Rom package: Too long Adequate Too short 1.2. Contents: Please rate the following evaluation criteria using the numeric scale: (1 = strongly disagree 5 = strongly agree) Breadth of the content was appropriate 12345 Content is up-to-date 12345 Content was appropriate to my learning needs 12345 for the topic Content was useful in assisting me to acquire 12345 the knowledge & skills required Learning material was relevant to my clinical 12345 practise Simulations/ scenarios were appropriate to learning 12345 topic and contents Simulations were useful in facilitating and reinforcing 12345 learning of knowledge and skills required The content of the assessment module was appropriate 12345 for the learning topic and contents The assessment module was useful in facilitating and 12345 reinforcing learning of knowledge and skills Complexity of content of the learning package was 12345 at the appropriate level 7 Project Title changed after data collection to: Basic Life Support training for nurses: evaluating an alternative CD-based approach. Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 223 | P a g e 1.3. Structure of CD Rom Package: Please rate the following evaluation criteria using the numeric scale: (1 = strongly disagree 5 = strongly agree) The organisation of topics and their contents was 12345 appropriate The sequencing of content was appropriate to my 12345 learning needs The sequencing of content was appropriate to 12345 progressive learning and skills acquisition The structure of content was suitable for independent 12345 learning The structure was useful in maintaining my learning focus 12345 and interest The structure (i.e. progressive learning and interactive learning-assessment-feedback) was useful in 12345 facilitating mastery learning 1.4. Presentation and Visualisation (User Interface) of CD Rom Package: Please rate the following evaluation criteria using the numeric scale: (1 = strongly disagree 5 = strongly agree) The package was easy to use 12345 I found it easy to navigate from topic to topic in the 12345 Package The package maintained contextual relations between 12345 interrelated screens (e.g. from topic to subtopics, from contents to simulations or assessment, between assessment and feedback, etc) The technical complexity and set up of the package 12345 presented no problem for me 1.5 Overall Quality of CD Rom Package: Please rate the following evaluation criteria using the numeric scale provided: (1 = very low 5 = very high) The quality of the package 12345 My satisfaction with the package 12345 1.6. Assessment component: 12 3 4 5 12 3 4 5 The content of the assessment was appropriate for the learning topic and contents The assessment was useful in facilitating and reinforcing learning of knowledge and skills Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 224 | P a g e 1.7. Comparison of CD Rom Package to Face-to-Face Lecture/demonstration program: From your past experiences in face-to-face lectures, how do you rate the CD Rom package in comparison to face-to-face education delivery mode. Quality: No difference in effectiveness CD Rom package is of poorer quality CD Rom package is more superior quality CD Rom package is far superior in quality Uncertain Effectiveness: No difference in effectiveness CD Rom package is less effectiveness CD Rom package is more effective CD Rom package is far superior in effectiveness Uncertain 1.8. Support of CD Rom Package Is further support required to supplement the CD Rom package: yes no If additional support was required to compliment delivery of CD Rom education material, what would be your preference? Face-to-face interaction Electronic tutorials and emails via hospital network Electronic tutorials and emails via Internet No preference Unable to comment Other: please specify ___________________________________ If additional support were to be provided as electronic tutorials and emails, what is your preferred mechanism of access ? At work only From home via Internet access Both at work and from home THANK YOU FOR YOUR PARTICIPATION! Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendix H3 Internal Consistency of the Program Evaluation forms. Basic life support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 226 | P a g e Table H2.1: Cronbach’s alpha test for scale internal consistency for the CD & Traditional Program Evaluation forms. PROGRAM EVALUATION FORMS Questions relating to: No. of Items: α Program Content 8 0.911 CD 6 0.856 Traditional Program Structure 2 0.924 CD 0.892 Traditional Program Assessment 0.844 CD 0.915 Traditional 0.739 Program Quality & Satisfaction 2 0.738 CD 18 Traditional 0.960 0.920 OVERALL FOR THE SECTIONS CD 0.905 Traditional 0.954 COMPLETE FORMS 31 CD 28 Traditional Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendix I Pilot Study Procedure Basic life support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 228 | P a g e Participants Second year nursing students (n=20) from a major university in Melbourne Australia who had no previous BLS training (novices) participated in the pilot study. There were no exclusion criteria but demographic data were collected allowing for description of the participants and identification of any previous BLS training undertaken (see Appendix F1). Recruitment. Once permissions to conduct the study and access the participants had been obtained, as in the main study, the principal investigator approached two hundred 2nd year nursing students as a group during a scheduled session and invited them to participate. Those who wished to take part completed the study consent form (see Appendix B1). Twenty 2nd year nursing students, (from the same population as Novice cohort A in the main study) were recruited into the pilot study (see Figure 3.1). Participant assignment. Consistent with the main study, a rational method was used to allocate participants into the Traditional and CD training groups. Ten were assigned, based on their pre- existing university grouping, to each of the two training groups and attended training (the university requirement). Only eight of the ten who consented to participate (80%) from the BLS CD group and four of the ten (40%) for the Traditional BLS program group actually attended Post Test 1, and only seven of the 10 who consented to participate (70%) from the BLS CD group, and three of the ten (30%) for the Traditional BLS program group attended Post Test 2 (see Figure 3.3). This high attrition rate was thought to be due to the assessments not being part of the university program and it being conducted outside class time. To avert this problem in the main study, the BLS assessments were included as a university program requirement which assisted recruitment and participation. BLS training program and post tests. The BLS training and post test procedures were the same as for the main study. There were minor differences in assessment timing due to scheduling arrangements and availability of participants in the pilot and main study. The pilot study group attended Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 229 | P a g e Post Test 1 at two weeks and Post Test 2 at 10 weeks post training, where as in the main study, the post tests were conducted at one week and then again at eight weeks after training. Training methods and measures. The intervention (CD and Traditional BLS training programs) and the measures (questionnaire, BLS assessment form/automated manikin, and program evaluations) were as described above for the main study. Pilot participants, as with Novice Cohort A participants in the main study, being beginners (novice learners), received two hours of viewing/practice (CD Group) or presentation-demonstration/practise (Traditional Group) instruction time. Completion of a BLS training program (which did not include a BLS skill assessment) was a compulsory university course requirement for nursing students in the pilot study. Therefore (in contrast to the main study), completion of the questionnaire, BLS assessment and program evaluations for the pilot study was conducted outside class time, and the questionnaire, which was condensed for post test 2 in the main study, was completed in its entirety before both the first and second BLS post tests in the pilot study. The small numbers involved in the pilot study allowed for BLS assessments to be performed solely by the researcher, who was an accredited BLS instructor. Analysis of assessor reliability was therefore not required in the pilot study. The results and implications of this pilot study to the main study have been presented in the body of this thesis. Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendix J1 Descriptive Statistics for BLS Skill Basic life support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 231 | P a g e Table J14.1: The descriptive scores for BLS skill competence of the Novice, Practising Nurses and Combined cohorts overall at Post Test 1 and Post Test 2. COHORT BLS SKILL COMPETENCE TRAINING GROUPS CD Traditional M SD range M SD range POST TEST 1 NOVICE (n = 91) (n = 96 ) Competent 29.8 2.82 21-32 30.1 2.54 21-32 PRACTISING NURSES Competent (n = 53) (n = 54) COMBINED 31.2 1.33 27-32 31.6 0.79 29-32 Competent (n = 144) (n = 150) 30.3 2.46 21-32 30.6 2.21 21-32 POST TEST 2 NOVICE (n = 55) (n = 51 ) Competent 29.4 2.79 19-32 28.9 3.32 19-32 PRACTISING NURSES Competent (n = 23) (n = 12) 30.5 2.17 23-32 30.5 1.51 27-32 COMBINED (n = 78) (n = 63) Competent 29.8 2.66 19-32 29.3 3.10 19-32 Note: competence represents 100% performance on 32 mandatory skills Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 232 | P a g e CD Novice Post Test 1 60 TRAD 50 40 Frequency 30 20 10 0 20 22 24 26 28 30 32 20 22 24 26 28 30 32 BLS Skill: score out of 32 mandatory skills Novice Post Test 2 CD TRAD 25 20 Frequency 15 10 5 0 15 20 25 30 35 15 20 25 30 35 BLS Skill: score out of 32 mandatory skills Figure J14.1 Histogram of BLS skill scores for the Novice cohort at Post Test 1 and Post Test 2 Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 233 | P a g e Practising Nurses Post Test 1 CD TRAD 40 30 Frequency 20 10 0 28 30 32 26 28 30 32 26 BLS Skill: score out of 32 mandatory skills Practising Nurses Post Test 2 CD TRAD 12 10 8 Frequency 6 4 2 0 22.5 25 27.5 30 32.5 22.5 25 27.5 30 32.5 BLS Skill: score out of 32 mandatory skills Figure J14.2 Histogram of BLS skill scores for the Practising Nurses cohort at Post Test 1 and Post Test 2 Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 234 | P a g e Combined Post Test 1 CD TRAD 100 80 Frequency 60 40 20 0 20 22 24 26 28 30 32 20 22 24 26 28 30 32 BLS Skill: score out of 32 mandatory skills Combined Post Test 2 CD TRAD 40 30 Frequency 20 10 0 15 20 25 30 35 15 20 25 30 35 BLS Skill: score out of 32 mandatory skills Figure J14.3 Histogram of BLS skill scores for the Combined Novice and Practising Nurses cohort at Post Test 1 and Post Test 2 Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendix J2 Descriptive Statistics for BLS Knowledge Basic life support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 236 | P a g e Table J24.1: The descriptive scores for BLS knowledge of the Novice, Practising Nurses and Combined cohorts overall at Post Test 1 and Post Test 2. COHORT BLS KNOWLEDGE TRAINING GROUPS CD Traditional range M SD range M SD POST TEST 1 NOVICE (n = 72) (n = 55 ) Score 2.6 0.89 1-5 2.1 1.01 0-5 PRACTISING NURSES (n = 32) (n = 34) Score 3.8 1.07 2-6 3.7 1.13 1-6 COMBINED (n = 104) (n = 89) Score 2.9 1.09 1-6 2.7 1.28 0-6 POST TEST 2 NOVICE (n = 42) (n = 39 ) Score 2.2 0.83 0-4 2.1 0.67 1-3 PRACTISING NURSES (n = 19) (n = 12) Score 3.9 1.27 1-6 3.7 1.21 1-6 COMBINED (n = 61) (n = 51) Score 2.7 1.28 0-6 2.4 0.94 1-5 Note: Score represents the mean number of correct answers on 6 BLS knowledge questions Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 237 | P a g e CD Novice Post Test 1 40 TRAD 30 Frequency 20 10 0 024 6 0246 BBLLSSKKnnoowwlleeddggee:: oovveerraallll ssccoorree oouutt ooff 66 qquueessttiioonnss Novice Post Test 2 CD TRAD 25 20 Frequency 15 10 5 0 -1 0 1 2 3 4 5 -1 0 1 2 3 4 5 BBLLSSKKnnoowwleleddggee::oovveerraallll ssccoorree oouutt ooff 66 qquueessttiioonns Figure J24.1 Histogram of BLS knowledge scores for the Novice cohort at Post Test 1 and Post Test 2. Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 238 | P a g e Practising Nurses Post Test 1 CD TRAD 12.5 10.0 Frequency 7.5 5.0 2.5 0.0 246 024 6 0 BBLLSSKKnnoowwlleeddggee::oovveerraallllssccoorreeoouuttooff66qquueessttiioonnss Practising Nurses Post Test 2 CD TRAD 6 Frequency 4 2 0 0246 0246 BLS KBnLoSwKlendogwel:edogvee:raolvl esrcaollrescoouret oofu6t oqfu6estions Figure J24.2 Histogram of BLS knowledge scores for the Practising Nurses cohort at Post Test 1 and Post Test 2. Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 239 | P a g e Combined Post Test 1 CD TRAD 50 40 Frequency 30 20 10 0 -2 0 2 4 6 8 -2 0 2 4 6 8 BBLLSS KKnnoowwlleeddggee:oovveerarallllssccoorereoouut toof f66qquueesstitoionnss Combined Post Test 2 CD TRAD 25 20 Frequency 15 10 5 0 -2 0 2 4 6 8 -2 0 2 4 6 8 BLS KBnLoSwlKendogwe:leodvgereaollvsecroarllesocuotroefo6uqt uoefs6tions Figure J24.3 Histogram of BLS knowledge scores for the Combined Novice and Practising Nurses cohort at Post Test 1 and Post Test 2. Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendix J3 Descriptive Statistics for Participants‘ Rating of the BLS Training Programs Basic life support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 241 | P a g e Table J34.1: The descriptive scores for the Participants mean rating of the CD and Traditional BLS programs for the Novice, Practising Nurses and Combined cohorts. PARTICIPANTS’ RATING OF TRAINING PROGRAM COHORT TRAINING GROUPS CD Traditional M SD range M SD range NOVICE (n = 89) (n = 81 ) Score 3.8 0.76 1-5 4.2 0.66 1-5 PRACTISING NURSES (n = 35) (n = 38) Score 4.3 0.48 3-5 4.6 0.402 3-5 COMBINED (n = 124) (n = 119) Score 3.9 0.724 1-5 4.3 0.619 1-5 Note: Score represents the mean rating of the training program on a 5 point ordinal scale (1 = strongly disagree to 5 = strongly agree). Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 242 | P a g e 20 Novice CD TRAD 15 Frequency 10 5 0 1.00 2.00 3.00 4.00 5.00 1.00 2.00 3.00 4.00 5.00 Program Evaluation: overall mean score Practising Nurses CD TRAD 20 15 Frequency 10 5 0 3.00 3.50 4.00 4.50 5.00 3.00 3.50 4.00 4.50 5.00 Program Evaluation: overall mean score Figure J34.1 Histogram of Participants’ Program Evaluation scores for the Novice cohort, Practising Nurses cohort and Combined cohort. (continued over page) Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 243 | P a g e CD Combined 40 TRAD 30 Frequency 20 10 0 1.00 2.00 3.00 4.00 5.00 1.00 2.00 3.00 4.00 5.00 Program Evaluation: overall mean score Figure J34.1 continued Histogram of Participants’ Program Evaluation scores for the Novice cohort, Practising Nurses cohort and Combined cohort. Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendix K BLS Skill: Specific Skills Results Basic life support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 245 | P a g e Table K4.1: Chi-square tests of difference between the CD and Traditional training methods in specific BLS skills competence at Post Test 1 for the Combined Novice and Practising Nurses cohort. SPECIFIC BLS SKILLS COMPETENCE POST TEST 1 INITIAL RESPONSE SKILLS TRAINIING GROUPS CD (n = 144) Traditional (n = 150) n% n% χ2 p Check for Danger 143 99.3 150 100 - NA Competent 1 0.7 00 Not Competent Check Response 143 99.3 150 100 - NA Competent 1 0.7 00 Not Competent Call Help 100 69.4 122 87.1 Competent 44 30.6 18 12.9 13.03 0.000 Not Competent Correct Positioning 133 92.4 140 93.3 Competent 11 7.6 10 6.7 0.105 0.746 Not Competent Initial Response Skills (overall) Competent 133 92.4 142 94.7 Not Competent 11 7.6 8 5.3 0.646 0.422 Note: 1. Specific skill results are combined for skills which are repeated in the assessment; 2. Inability to perform analysis of difference (due to small cell counts) in the Novice & Practising Nurses cohorts necessitated only combined results being presented; 3. Competence represents correct performance of skill; NA= not applicable due to small cell count; df = 1; Bonferroni adjustment p ≤ 0.001 (continued over page) Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 246 | P a g e Table K4.1 continued SPECIFIC BLS SKILLS COMPETENCE POST TEST 1 VENTILATION SKILLS TRAINING GROUPS CD (n = 144) Traditional (n = 150) n% n% χ2 p Check/Open Airway Competent 136 94.4 143 95.3 Not Competent 8 5.6 7 4.7 0.120 0.729 Check Breathing 138 95.8 147 98.0 Competent Not Competent 6 4.2 3 2.0 NA Give 2 Breaths 127 88.2 142 94.7 Competent Not Competent 17 11.8 8 5.3 3.956 0.047 Inflates Chest Effectively 140 97.2 140 93.3 Competent Not Competent 4 2.8 10 6.7 2.450 0.118 Ventilation Skills (overall) Competent 136 94.4 143 95.3 Not Competent 8 5.6 7 4.7 0.120 0.729 Note: 1. Specific skill results are combined for skills which are repeated in the assessment; 2. Inability to perform analysis of difference (due to small cell counts) in the Novice & Practising Nurses cohorts necessitated only combined results being presented; 3. Competence represents correct performance of skill; NA= not applicable due to small cell count; df = 1; Bonferroni adjustment p ≤ 0.001 (continued over page) Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 247 | P a g e Table K4.1 continued SPECIFIC SKILLS COMPETENCE POST TEST 1 CIRCULATION SKILLS TRAINING GROUPS CD (n = 144) Traditional (n = 150) n %n % χ2 p Check Pulse 125 86.8 139 92.7 Competent 19 13.2 11 7.3 2.754 0.097 Not Competent Commence CPR 143 99.3 147 98.0 NA Competent 1 0.7 3 2.0 Not Competent Correct technique 133 92.4 143 95.3 Competent 11 7.6 7 4.7 1.129 0.288 Not Competent Correct Ratio 141 97.9 146 97.3 Competent Not Competent 3 2.1 4 2.7 NA Correct Rate 138 95.8 143 95.3 Competent 6 4.2 7 4.7 0.043 0.835 Not Competent Correct Depth Compression 128 88.9 137 91.3 Competent 16 11.1 13 8.7 0.494 0.482 Not Competent Reassess Patient Every 1-2mins 141 93.4 149 95.3 NA Competent 3 6.6 1 4.7 Not Competent Circulation Skills (overall) Competent 134 93.1 143 95.3 Not Competent 10 6.9 7 4.7 0.700 0.403 Note: 1. Specific skill results are combined for skills which are repeated in the assessment; 2. Inability to perform analysis of difference (due to small cell counts) in the Novice & Practising Nurses cohorts necessitated only combined results being presented; 3. Competence represents correct performance of skill; NA= not applicable due to small cell count; df = 1; Bonferroni adjustment p ≤ 0.001 (continued over page) Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 248 | P a g e Table K4.1 continued SPECIFIC SKILLS COMPETENCE POST TEST 1 HEALTH PROFESSIONAL SKILLS TRAINING GROUPS p CD (n = 144) Traditional (n = 150) Note Time+ Competent n % n % χ2 76 52.8 93 62.4 Not Competent 68 47.2 56 37.6 2.787 0.095 Insert Guedel Airway 136 94.4 144 96.0 Competent Not Competent 8 5.6 6 4.0 0.392 0.531 Correct use of One-way Valve Mask (Concord) 132 91.7 139 92.7 Competent Not Competent 12 8.3 11 7.3 0.102 0.750 Correct use of Bag-Mask Device (Air-Viva) 135 93.8 124 82.7 Competent Not Competent 9 6.3 26 17.3 8.605 0.003 Demonstrate Change Over+ Competent 132 91.7 133 88.7 Not Competent 12 8.3 17 11.3 0.744 0.388 Post Arrest Management/Responsibilities+ 106 73.6 111 74.0 Competent Not Competent 38 26.4 39 26.0 0.006 0.940 Health Professional Skills (overall) 114 79.2 118 78.7 Competent Not Competent 30 20.8 32 21.3 0.011 0.916 Note: 1. Specific skill results are combined for skills which are repeated in the assessment; 2. Inability to perform analysis of difference (due to small cell counts) in the Novice & Practising Nurses cohorts necessitated only combined results being presented; 3. Competence represents correct performance of skill; Bonferroni adjustment p ≤ 0.001; df = 1; + = non - mandatory skill Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 249 | P a g e Table K4.2: Chi-square tests of difference between the CD and Traditional training methods in specific BLS skills competence at Post Test 2 for the Combined Novice and Practising Nurses cohort. SPECIFIC SKILLS COMPETENCE POST TEST 2 INITIAL RESPONSE SKILLS TRAINING GROUPS CD (n = 78) Traditional (n = 63) n % n% χ2 p Check for Danger 78 100 63 100 - NA Competent 0 0 00 Not Competent Check Response 76 97.4 61 96.8 - NA Competent 2 2.6 2 3.2 Not Competent Call Help 57 73.1 35 55.6 Competent 21 26.9 28 44.4 4.719 0.030 Not Competent Correct Positioning 70 89.7 57 90.5 Competent 8 10.3 6 9.5 0.021 0.885 Not Competent Initial Response Skills (overall) Competent 71 91.0 55 87.3 Not Competent 7 9.0 8 12.7 0.508 0.476 Note: 1. Specific skill results are combined for skills which are repeated in the assessment; 2. Inability to perform analysis of difference (due to small cell counts) in the Novice & Practising Nurses cohorts necessitated only combined results being presented; 3. Competence represents correct performance of skill; NA= not applicable due to small cell count; df = 1; Bonferroni adjustment p ≤ 0.001 (continued over page) Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 250 | P a g e Table K4.2 continued SPECIFIC SKILLS COMPETENCE POST TEST 2 VENTILATION SKILLS TRAINING GROUPS CD (n = 78) Traditional (n = 63) n%n% χ2 p Check/Open Airway 72 92.3 58 92.1 Competent Not Competent 6 7.7 5 7.9 0.003 0.957 Check Breathing 75 96.2 58 92.1 Competent Not Competent 3 3.8 5 7.9 - NA Give 2 Breaths 66 84.6 49 77.8 Competent Not Competent 12 15.4 14 22.2 1.083 0.298 Inflates Chest Effectively 73 93.6 60 95.2 Competent Not Competent 5 6.4 3 4.8 - NA Ventilation Skills (overall) Competent 71 91.0 56 88.9 Not Competent 7 9.0 7 11.1 0.178 0.673 Note: 1. Specific skill results are combined for skills which are repeated in the assessment; 2. Inability to perform analysis of difference (due to small cell counts) in the Novice & Practising Nurses cohorts necessitated only combined results being presented; 3. Competence represents correct performance of skill; NA= not applicable due to small cell count; df = 1; Bonferroni adjustment p ≤ 0.001 (continued over page) Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 251 | P a g e Table K4.2 continued SPECIFIC SKILLS COMPETENCE POST TEST 2 CIRCULATION SKILLS TRAINING GROUPS CD (n = 78) Traditional (n = 63) n% n% χ2 p Check Pulse 56 71.8 58 92.1 Competent 22 28.2 5 7.9 9.248 0.002 Not Competent Commence CPR 78 100 63 94.0 - NA Competent 00 4 6.0 Not Competent Correct technique 72 92.3 59 93.7 - NA Competent 6 7.7 4 6.3 Not Competent Correct Ratio 76 97.4 59 93.7 Competent Not Competent 2 2.6 4 6.3 - NA Correct Rate 70 89.7 56 88.9 Competent 8 10.3 7 11.1 0.027 0.870 Not Competent Correct Depth Compression 63 80.8 57 90.5 Competent 15 19.2 6 9.5 2.591 0.107 Not Competent Reassess Patient Every 1-2mins 75 96.2 57 90.5 NA Competent 3 3.8 6 9.5 Not Competent Circulation Skills (overall) Competent 70 89.7 57 90.5 Not Competent 8 10.3 6 9.5 0.021 0.885 Note: 1. Specific skill results are combined for skills which are repeated in the assessment; 2. Inability to perform analysis of difference (due to small cell counts) in the Novice & Practising Nurses cohorts necessitated only combined results being presented; 3. Competence represents correct performance of skill; NA= not applicable due to small cell count; df = 1; Bonferroni adjustment p ≤ 0.001 (continued over page) Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 252 | P a g e Table K4.2 continued SPECIFIC SKILLS COMPETENCE POST TEST 2 HEALTH PROFESSIONAL SKILLS TRAINING GROUPS Note Time+ CD (n = 78) Traditional (n = 63) Competent n% n% χ2 p 36 46.2 24 38.1 Not Competent 42 53.8 39 61.9 0.926 0.336 Insert Guedals Airway 73 93.6 60 95.2 Competent Not Competent 5 6.4 3 4.8 - NA Correct use of One-way Valve Mask (Concord) 69 88.5 53 84.1 Competent Not Competent 9 11.5 10 15.9 0.562 0.454 Correct use of Bag/Mask Device (Air-Viva) 71 91.0 43 68.3 Competent Not Competent 7 9.0 20 31.7 11.673 0.001 Demonstrate Change Over+ Competent 73 93.6 62 98.4 Not Competent 5 6.4 1 1.6 - NA Post Arrest Management/Responsibilities+ 53 67.9 43 68.3 Competent Not Competent 25 32.1 20 31.7 0.001 0.969 Health Professional Skills (overall) 60 76.9 45 71.4 Competent Not Competent 18 23.1 18 28.6 0.553 0.457 Note: 1. Specific skill results are combined for skills which are repeated in the assessment; 2. Inability to perform analysis of difference (due to small cell counts) in the Novice & Practising Nurses cohorts necessitated only combined results being presented; 3. Competence represents correct performance of skill; NA= not applicable due to small cell count; df = 1; Bonferroni adjustment p ≤ 0.001; + = non - mandatory skill Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendix L BLS Knowledge: Specific Questions Results Basic life support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 254 | P a g e Table L4.1: Chi-square tests of difference between the CD and Traditional training methods in each BLS knowledge question at Post Test 1 for the Combined Novice and Practising Nurses cohort. BLS KNOWLEDGE POST TEST 1 KNOWLEDGE QUESTIONS TRAINING GROUPS Define respiratory arrest CD (n = 104) Traditional (n = 89) Correct Incorrect n % n% χ2 p 0.060 Causes of respiratory arrest 87 83.7 57 72.2 0.347 Correct 17 16.3 22 27.8 3542 0.152 Incorrect 0.863 27 26.0 18 20.2 0.747 Define cardiac arrest 77 74.0 71 79.8 0.883 0.766 Correct 0.187 Incorrect 25 24.0 14 15.7 79 76.0 75 84.3 2.053 Causes of cardiac arrest 20 19.2 18 20.2 Correct 84 80.8 71 79.8 0.030 Incorrect Potential complications of CPR 18 17.3 17 19.1 Correct Incorrect 86 82.7 72 80.9 0.104 3 main drugs used in arrests 36 34.6 29 32.6 Correct 68 65.4 60 67.4 0.089 Incorrect Overall Correct 36 34.6 23 25.8 Incorrect 68 65.4 66 74.2 1.739 Note: 1. Correct represents BLS knowledge question answered correctly; 2. Overall is calculated using the mean of the replied. Bonferroni adjustment p ≤ 0.001; df = 1 Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 255 | P a g e Table L4.2: Chi-square tests of difference between the CD and Traditional training methods in each BLS knowledge question at Post Test 2 for the Combined Novice and Practising Nurses cohort. BLS KNOWLEDGE POST TEST 2 KNOWLEDGE QUESTIONS TRAINING GROUPS Define respiratory arrest CD (n = 61) Traditional (n = 51) Correct Incorrect n % n% χ2 p 0.583 49 80.3 43 84.3 0.873 12 19.7 8 15.7 0.30 0.831 0.373 Causes of respiratory arrest 20 32.8 16 31.4 0.430 Correct 41 67.3 35 68.6 0.025 0.055 Incorrect 0.974 Define cardiac arrest 18 29.5 16 31.4 0.046 Correct 43 70.5 35 68.6 0.795 Incorrect 0.622 3.682 Causes of cardiac arrest 15 24.6 9 17.6 0.001 Correct Incorrect 46 75.4 42 82.4 Potential complications of CPR 9 14.8 5 9.8 Correct 52 85.2 46 90.2 Incorrect 3 main drugs used in arrests 16 26.2 6 11.8 Correct 45 73.8 45 88.2 Incorrect Overall 19 29.7 15 29.4 Correct Incorrect 42 70.3 36 70.6 Note: 1. Correct represents BLS knowledge question answered correctly; 2. Overall is calculated using the mean of the replies. Bonferroni adjustment p ≤ 0.001; df = 1 Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendix M Participants‘ Rating of the BLS Training Programs: Specific Questions Results Basic life support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 257 | P a g e Table M4.1: Chi-square tests of difference for participants’ rating of the program content questions for the Combined Novice and Practising Nurses cohort. PARTICIPANTS’ RATING OF TRAINING PROGRAM CONTENT CONTENT QUESTIONS TRAINING GROUPS CD (n = 124) Traditional (n = 119 ) p n % n % χ2 Breadth of the content was appropriate 94 75.8 106 89.1 Strongly agree/agree Strongly disagree/disagree/neutral 30 24.2 13 10.9 7.34 0.007 Content is up-to-date 115 92.7 114 95.8 Strongly agree/agree Strongly disagree/disagree/neutral 9 7.3 5 4.2 1.045 0.307 Content was appropriate to my learning needs for the topic Strongly agree/agree 87 70.2 109 91.6 Strongly disagree/disagree/neutral 37 29.8 10 8.4 17.89 0.000 Content was useful in assisting me to 81 65.3 111 93.3 acquire the knowledge & skills required Strongly agree/agree Strongly disagree/disagree/neutral 43 34.7 8 6.7 28.62 0.000 Learning material was relevant to my 104 83.9 110 92.4 clinical practice Strongly agree/agree Strongly disagree/disagree/neutral 20 16.1 9 7.6 4.24 0.039 Note: Inability to perform analysis of difference (due to small cell counts) in the Practising Nurses cohort necessitated only combined results being presented; df = 1; Bonferroni adjustment p ≤ 0.001 (continued over page) Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 258 | P a g e Table M4.1 continued PARTICIPANTS’ RATING OF TRAINING PROGRAM CONTENT PROGRAM CONTENT TRAINING GROUPS Questions CD (n = 124) Traditional (n = 119) n % n % χ2 p Simulations/ scenarios were appropriate to learning topic and contents Strongly agree/agree 91 73.4 104 87.4 Strongly disagree/disagree/neutral 33 26.6 15 12.6 7.52 0.006 Simulations were useful in facilitating and 71 57.3 102 87.9 reinforcing learning of knowledge and skills required Strongly agree/agree Strongly disagree/disagree/neutral 53 42.7 14 12.1 28.02 0.000 Complexity of content of the learning 89 71.8 110 92.4 package was at the appropriate level 35 28.2 9 7.6 17.48 0.000 Strongly agree/agree Strongly disagree/disagree/neutral Content Overall 91 73.4 108 90.8 Strongly agree/agree Strongly disagree/disagree/neutral 33 26.6 11 9.2 12.36 0.000 Note: Inability to perform analysis of difference (due to small cell counts) in the Practising Nurses cohort necessitated only combined results being presented; df = 1; Bonferroni adjustment p ≤ 0.001 Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 259 | P a g e Table M4.2: Chi-square test of difference for participants’ rating of the program structure questions for the Combined Novice and Practising Nurses cohort. PARTICIPANTS’ RATING OF TRAINING PROGRAM STRUCTURE PROGRAM STRUCTURE TRAINING GROUPS Questions CD (n = 124) Traditional (n = 119) n % n% χ2 p The organisation of topics and their contents was appropriate Strongly agree/agree 89 71.8 104 87.4 Strongly disagree/disagree/neutral 35 28.2 15 12.6 9.067 0.003 The sequencing of content was appropriate to my learning needs Strongly agree/agree 83 66.9 111 93.3 Strongly disagree/disagree/neutral 41 33.1 8 6.7 26.17 0.000 The sequencing of content was appropriate to progressive learning and skill acquisition Strongly agree/agree 79 63.7 110 92.4 Strongly disagree/disagree/neutral 45 36.3 9 7.6 28.99 0.000 The structure of content was suitable for independent learning Strongly agree/agree 75 60.5 100 84.0 Strongly disagree/disagree/neutral 49 39.5 19 16.0 16.71 0.000 The structure was useful in maintaining my learning focus and interest Strongly agree/agree 66 53.2 99 83.2 Strongly disagree/disagree/neutral 58 46.8 20 16.8 25.02 0.000 The structure (i.e. progressive learning and interactive learning / assessment / feedback) was useful in facilitating mastery learning Strongly agree/agree 57 46.0 94 79.0 Strongly disagree/disagree/neutral 67 54.0 25 21.0 28.15 0.000 Structure Overall Strongly agree/agree 75 60.5 103 86.6 Strongly disagree/disagree/neutral 49 39.5 16 13.4 21.06 0.000 Note: Inability to perform analysis of difference (due to small cell counts) in the Practising Nurses cohort necessitated only combined results being presented; df = 1; Bonferroni adjustment p ≤ 0.001 Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach

Appendices 260 | P a g e Table M4.3: Chi-square tests of difference for participants’ rating of the program assessment questions for the Combined Novice and Practising Nurses cohort. PARTICIPANTS’ RATING OF TRAINING PROGRAM ASSESSMENT PROGRAM ASSESSMENT TRAINING GROUPS Questions CD (n = 124) Traditional (n = 119) n % n% χ2 p The content of the assessment was appropriate 94 75.8 106 89.1 for the learning topic and contents Strongly agree/agree Strongly disagree/disagree/neutral 30 24.2 13 10.9 7.34 0.007 The assessment was useful in facilitating and reinforcing learning of knowledge and skills Strongly agree/agree 95 76.6 109 91.6 Strongly disagree/disagree/neutral 29 23.4 10 8.4 10.12 0.001 Assessment Overall 94 75.8 107 89.9 Strongly agree/agree Strongly disagree/disagree/neutral 30 24.2 12 10.1 8.46 0.004 Note: Inability to perform analysis of difference (due to small cell counts) in the Practising Nurses cohort necessitated only combined results being presented; df = 1; Bonferroni adjustment p ≤ 0.001 Table M4.4: Chi-square tests of difference for participants’ rating of the program quality & satisfaction questions for the Combined Novice and Practising Nurses cohort. PARTICIPANTS’ RATING OF TRAINING PROGRAM QUALITY & SATISFACTION PROGRAM QUALITY & TRAINING GROUPS SATISFACTION CD (n = 124) Traditional (n = 119) Questions n % n % χ2 p The quality of the program 102 82.3 105 88.2 Very high/high Very low/low/neutral 22 17.7 14 11.8 1.72 0.190 My satisfaction with the program 70 56.5 87 73.1 Very high/high Very low/low/neutral 54 43.5 32 26.9 7.37 0.007 Quality & Satisfaction Overall Very high/high 85 68.5 96 80.7 Very low/low/neutral 39 31.5 23 19.3 4.69 0.030 Note: Inability to perform analysis of difference (due to small cell counts) in the Practising Nurses cohort necessitated only combined results being presented; df = 1; Bonferroni adjustment p ≤ 0.001 Basic life Support training for nurses: Karen Mardegan evaluating an alternative CD-based approach