|
The comparison of the
effect of two different teaching methods of
role-playing and video feedback on learning
Cardiopulmonary Resuscitation (CPR)
Yasamin Hachambachari (1)
Leila Fahkarzadeh (2)
Abdol Ali Shariati (3)
(1) MSC of Nursing, Nursing Department, Arvand
International Unit Ahvaz Jondishapur University
of Medical Sciences, Ahvaz, Iran
(2) Faculty member of Nursing Department, Abadan
School of Medical Sciences, Abadan, Iran
(3) Faculty member of Nursing Department, Ahvaz
University of medical Sciences, Ahvaz, Iran
Correspondence:
Leila Fahkarzadeh
Faculty member of Nursing Department,
Abadan School of Medical Sciences,
Abadan, Iran
Email: fakharzadehl@yahoo.com
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Abstract
Purpose: This
study was conducted with the aim to compare
the effects of two educational methods
of role play and video feedback on learning
CPR.
Background: Cardiopulmonary
resuscitation (CPR) is a vital basic life
support and the first step in response
to cardiopulmonary arrest.Studies have
shown that succeeding in cardiopulmonary
recovery is strongly linked to education
(9) and proper educational methods must
be applied in order to improve the quality
of educating CPR (12).
Method: This
study is a quasi-experimental intervention
study.
The research society
were sixth semester students of nursing
bachelor course in Abadan Faculty of Medical
Sciences, among which, 44 students were
selected via census sampling was the research
sample. The students were familiarized
with basics of CPR during 45 minute theoretical
and half an hour practical training sessions
then they were divided into two groups
of role play and video self-feedback,
and after a month of training via check
lists, they were evaluated with OSCE method.In
the video of the self-feedbackgroup, the
participants were filmed while practicing
and they scored their performance in a
check list based on the video playback.
A questionnaire of 24 questions was used
in order to assess cognitivelearning and
a practical checklist of 15 parts was
used to assess the psychomotor learning
as pre-test and post-test in both groups,
prior to the initiation and one month
after holding the educational workshop.
Data was studied via T-test and Mann Whitney
test.
Findings: The results showed that
the average difference between the scores
of psychomotor learning before and after
training in video self-feedback group
(27/98±615/5) was significantly
higher than the role play group (17/02±374/5)
(p=0/005). Also, the average difference
of the cognitive learning scores before
and after the training in video self-feedback
group (6/50±2/92) was significantly
higher compared to the role play group
(4/04±3/27) (p=0/12).
Conclusion: The video self-feedback
method in comparison to the role play
method is more effective in improving
cognitive and psychomotor learning of
nursing students in basic cardiopulmonary
resuscitation.
Key words: Cardiopulmonary resuscitation,
role play method, video self-feedback
method.
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Today, the potential value of cardiopulmonary
resuscitation (CPR) is at a level that can decrease
death by half if applied properly (1). The faster
the CPR starts, the more successful it will
be and it can be enhanced to 90 % (2, 3).For
each second of delay in initiating the appropriate
treatment, the patient would be one step closer
to death and disability; with the passing of
every minute, 7 to 10% of the subject’s
survival decreases so that after 10 minutes,
the subject’s chance of survival is reduced
to nil (4). Faced with such serious problems,
CPR should be based on scientific principles,
legal standards and human forces whopossess
the appropriate scientific and practical mandates
(5). Nurses are the first people who attend
the hospitalized patients’ bed when there
is cardiopulmonary arrest. They should be skilled
enough in order to perform CPR (6).The ability
to respond quickly and effectively in clinical
situations of cardiopulmonary arrest, to maintain
and save patients is considered as a substantial
and important qualification in the treatment
and care group. The competence of cardiopulmonary
resuscitation, is the indicator of cognitive
domain and psychomotor skills that are implemented
when cardiac arrest occurs requiring cardiopulmonary
resuscitation (7).The results of a study indicate
that, even the presence of a person with higher
skills can have a significant impact on the
outcome of resuscitation.
Nowadays, most of the students of the world
are following the educational methods that can
serve in the development and improvement of
clinical decision making capacities and continuous
and self-centered learning in students (8).
According to the studies, practical education
methods are more effective than the other educational
methods (9). In learning skills, it is only
skill-based practical teaching methods that
can allow trainees to have the practical use
of these skills. (10)The students also, preferred
using experimental methods in a clinical environment
over theoretical methods such as lecturing (9).As
feedback and repetition is a skills learning
necessity, video clip overview is one of the
most valuable educational methods for teaching
skills (11).Nowadays, in teaching skills there
is special attention given to video recording
and overviewing it by interns (12, 13). When
learning any skills, viewing the person by themselves
and watching what exactly they have done and
where they should improve, may be very helpful
(14). Recording allows reviewing all fields
several times and it enables the learner to
watch the video again in following days to learn
more. This method encourages a learner-focused
approach and also enables learners to assess
themselves in a precise, detailed and documented
manner. In this method, the wrong impression
and opposite of what has really happened are
avoided. The accuracy and validity of feedbacksin
this method is very high and is dedicated (15).In
relevant professions to the medical sciences,
the students’ ability in recognizing their
strengths and weaknesses is crucial and the
right self-assessment can be effective in the
growth of a person’s abilities. Self-assessment
is proved to be a useful and dynamic method
in various studies and in Canada and the United
States, self-assessment improvement is considered
as an important factor in the professional evolution
of medical graduates (16). Self-assessment allows
nurses to monitor their clinical performance
in work environment and to revise and improve
it. This approach encourages nurses to take
a more active role in the learning process and
to facilitate it continuously (17).
Role play is another educational method that
is widely used for skills training.In this method,
individuals put themselves in the desired condition
and behave as required. This way, they learn
how to deal with situations and problems in
this specific condition. Using this educational
method, skills are enhanced and the learners
are put in real conditions. In playing the roles,
there are four elements of thinking, feelings,
insight and performance involved and these factors
cause the increase in effectiveness of role
play in skills training. Reviewing the played
role, people think deeply about what happens
in every role play, based on its circumstances.Students
who have learned communication skills through
role play, found it to be a useful method for
repeating, observing, discussing and pretending
the roles to be actual through educational programs
(18). Students who were not experienced in role-play
learning method, found it to be an enjoyable
and useful method and they strongly, emphasized
playing roles in a real manner and with honest
feedback (19). The implementation of role play
educational method, provides active learning,
attitude changing, fostering a sense of confidence,
and creating the ability of offering solutions
(8).
The literature of previous research also studied
the success and effectiveness of both these
educational methods. Powell et al(2010) in a
study aimed to “identify the thoughts and
experiences of nursing students from video self-feedback
on cardiopulmonary resuscitation on the mannequin”,
found that reviewing one’s practice by
students allows them to know their weaknesses
better and to discover the healing fields. The
researcher believes that another benefit of
the project is to involve the students in the
process of assessment (20).In another study,
Zadmehr et al (2015) aimed to “evaluate
the effect of cardiopulmonary resuscitation
training via video self-feedback on the nurses’
awareness and performance” showed that
video self-feedback training, is effective on
the nurses’ performance in CPR (21).
In recent decades, the need to revise the traditional
teaching methods and the use of modern, active
and student-centered learning methods in educational
systems, is understood and these methods have
been widely used in various fields including
medical sciences.It seems that student-centered
methods can lead to increased student’
satisfaction, enhanced learning speed, creating
problem solving skills and continuum of learning
and critical thinking. Role play and video feedback
methods are among the new and student-centered
methods. Various studies have shown positive
impacts of various educational methods on learning
CPR but, few studies have been conducted on
comparison of video feedback method and other
methods and their effects on the students’
learning. Thus, the author decided to conduct
a study with the aim of “Comparing the
effects of role play and video self-feedback
on learning CPR in bachelor course nursing students
of the Abadan Faculty of Medical Sciences”.
It is hoped that the results of this research
can be a step towards more efficient and sustainable
methods in CPR education and training skilled
personnel and ultimately, helping to increasingly
successful CPR.
This study is a quasi-experimental intervention
research that studies the effects of role play
and video self-feedback educational methods
on learning in nursing students.In this study,
independent variables include training methods
(role-play and video self-feedback) and dependent
variables include cognitive learning and psychomotor
learning. The study society consisted of all
sixth semester bachelor course students of Abadan
Nursing Faculty of which, 44 people were selected
via census sampling as the research sample and
were studied during the research. Inclusion
criteria were: having a desire to participate
in the study, participating in hospital basic
CPR workshop for the first time, having no clinical
experience in ICU and emergency and urgent sections,
selecting the nursing in crisis, emergency and
unpredictable events unit during the first semester
of 2016-17. The study samples were placed into
two groups of role-play (22 people) and video
self-feedback (22 people). To conduct the research,
the students were requested to fill in the conscious
satisfaction form then, they were assured about
the confidentiality of the information. Then,
all students took the theoretical pre-test (hospital
basic CPR, based on the questionnaire of cognitive
learning assessment) practical pre-test (basic
CPR in OSCE method) (all the students had 3
minutes to perform the operation of cardiopulmonary
resuscitation on a specialized mannequin afterwards,
their performance was assessed in accordance
withthe practical evaluation check list). Later,
all the students took part in a theoretical
training session (1 hour) and a practical training
session (2 hours) and they were familiarized
with the principles of hospital basic cardiopulmonary
rehabilitation. Then in the form of two groups
of 1 and 2, group 1 played roles, while group
2 were exposed to video self-feedback.Each group
entered a separate training session and were
familiarized with the corresponding training
methods to perform their CPR training accordingly.In
Group 1 and during the training session, the
trainer played the role of cardiopulmonary resuscitator
on a specialized type D mannequin for 3 minutes
based on a pre-designed scenario (QCPR) for
the students, then the students practiced in
this way so that they had 3 minutes to play
the role of cardiopulmonary resuscitator on
a specialized type D mannequin (QCPR) and after
the practice, they were give the assessment
check list and they scored themselves and also,
the mannequin display showed the CPR quality
percentage of each student after they entered
it into the assessment checklist later after
each training session. In the second group (video
feedback), 2 trainers trained the students using
this method, one as the resuscitator that has
3 minutes to perform cardiopulmonary resuscitation
on the specialized Type D mannequin (QCPR),
and the other as the cameraman (he filmed his
colleague’s training using his mobile phone),
respectively. Then the resuscitation trainer
reviewed his film and analyzed his performance
and rated himself in accord to the performance
assessment checklist. And they watched their
percentage of CPR quality on the mannequin’s
display. Then they changedplaces with each other.
After that, the students did the training in
pairs similarly, one in the role of resuscitator
and the other as the cameraman. Both groups
did their training in the clinical skills center
for a month.
Assessment instruments:
The data collection instruments in this study
included: 1) information form containing the
characteristics of research units.2) The questionnaire
of 24 questions in the field of cognitive learning
for the students’ cognitive learning assessment
3) check list, containing 15 correct consecutive
CPR measures to assess the students’ psychomotor
learning. The questionnaire of cognitive learning
assessment, is a researcher made questionnaire
that contains 24 multiple-choice (4 choices)
questions and is designed in accordance with
the latest resuscitation guidelines (American
Heart Association 2015) and its validity and
reliability is verified as well. The amount
of Cognitive learning in nursing students would
be determined with a maximum of 24 and a minimum
of zero score. To determine the amount of students’
cognitive learning in basic CPR, before the
training workshop and a month after that, each
of two groups of students (role-play and video
feedback) were given three minutes to perform
the CPR on special Type D mannequins then, with
using a performance assessment checklist containing
15 practical skills (regarding correct sequential
measures of basic CPR) and Mr. Naderi’s
thesis (Master of Nursing) and in accord to
the protocol 2015 of America Heart Association,
the necessary modifications were performed and
its validity and reliability was obtained and
their psychomotor learning was measured accordingly.
The CPR quality percentage that is evaluated
within the checklist of psychomotor learning
assessment, is measured based on the percentage
that is screened on the mannequin’s display
after the CPR operation. The scoring is done
as giving no scores to the correct performance
and a negative score to a wrong or failing performance
in accord to record measures that are determined
in the checklist. Finally, if everything is
done correctly and completely, there is a zero
score and if all the items are wrong, the (-215)
score is assigned respectively. The categorization
of practical skills would be as follows: 49
percent less (weak) (negative score 107 to 215),
75-50 percent (needs more education) (negative
score of 106 to 53), and higher than 76 percent
is the acceptable level (negative score of 52
and higher). Comparing the mean scores of the
students’ assessment checklist for 2 groups
finally indicates the method that is more effective
in learning CPR.
The visual and content validity of the cognitive
domain questionnaire and checklist of psychomotor
domain were obtained using scientific resources
and texts and by asking the opinions of eight
instructors of the nursing school, and the reliability
of the cognitive learning questionnaire was
calculated through the test-retest method as
77%. To determine the reliability of the psychomotor
field checklist, via assigning two simultaneous
observers, the clinical skills were assessed
for fourteen students in a reconstructed scene
of a given situation at Clinical Skills Center
of the faculty. In order to determine the reliability
of the clinical skills checklist, Pearson’s
correlation coefficient was used and a Pearson
correlation coefficient of 88% was obtained.
Methods of data analysis:
The data was analyzed using the statistical
SPSS Version.16, Mann-Whitney statistical test
and independent T-test. The Mann-Whitney test
was used to check the amounts of cognitive learning
and psychomotor learning in the nursing students,
regarding the basic cardiopulmonary resuscitation
prior to role-play and video self-assessment
training sessions.
To compare the mean of the nursing students’
theoretical scores in cardiopulmonary resuscitation
skill, after the training with both methods
of role-play and video self-feedback, the non-parametric
Mann-Whitney test was used.As in Table 1, a
significant difference was observed between
the average rankings of two groups (p=0/001).
To compare the mean of the nursing students’
theoretical scores in cardiopulmonary resuscitation
skill, before the training with both methods
of role-play and video self-feedback, the independent
T-test was used.As shown in Table 1, no significant
difference was observed between the mean of
the nursing students’ theoretical scores
in cardiopulmonary resuscitation skill, before
training with both methods of role-play and
video self-feedback (p=0/560). In this regard,
the study of the mean of two groups shows that
the average score of role-play was 3.09 ±
14.32 and video self-feedback was 2.52 13.82.
Table 1: Comparison of theoretical scores
of cognitive learning in nursing students in
cardiopulmonary resuscitation skill, before
and after the training with both methods of
role-play and video self-feedback
To compare the mean of the nursing students’
practical scores in cardiopulmonary resuscitation
skill, after the training with both methods
of role-play and video self-feedback, the Mann-Whitney
test was used. As in Table 2, a significant
difference was observed between the average
rankings of two groups (p=0/001). To compare
the mean of the nursing students’ practical
scores in cardiopulmonary resuscitation skill,
before the training with both methods of role-play
and video self-feedback, the Mann-Whitney test
was used. As in Table 2, no significant difference
was observed between the average ranking of
two groups (p=0/112). In order to compare the
average difference between the nursing students’
theoretical and practical scores in cardiopulmonary
resuscitation skill, before and after the training
with both methods of role-play and video self-feedback,
the independent T-test was used (Table 3).
Table 2: Comparison of the mean of practical
scores in the nursing students’ psychomotor
learning in CPR skill, after training with two
methods of role-play and video self-feedback
Table 3: Comparison of the average difference
between the nursing students’ theoretical
and practical scores in cardiopulmonary resuscitation
skill, before and after the training with both
methods of role-play and video self-feedback
In order to compare the average difference
of the nursing students’ theoretical scores
in cardiopulmonary resuscitation skill, before
and after the training with both methods of
role-play and video self-feedback, the independent
T-test was used.As in Table 3, the average difference
of the nursing students’ theoretical scores
in cardiopulmonary resuscitation skill, before
and after the training in the video self-feedback
group, is significantly higher than the role-play
group (p=0/012). The study of the average difference
of theoretical scores in both groups shows the
average difference of the nursing students’
theoretical scores in cardiopulmonary resuscitation
skill, before and after the role-play equals
3.27 ± 4.04 and in the video self-feedback
it equals 2.92 ± 6.50 respectively. To
compare the average difference of the nursing
students’ practical scores in cardiopulmonary
resuscitation skill, before and after the training
with both methods of role-play and video self-feedback,
the Mann-Whitney test was used.As in Table 3,
a significant statistical difference was observed
between the average ranking of two groups (p=0.005
).
The
results
of
current
research
showed
an
increase
in
the
amount
of
the
nursing
students’
cognitive
learning
after
training
through
both
role-play
and
video
self-feedback
methods.In
the
Zahedmehr
and
colleagues’
study
(21)
aiming
at
the
study
of
effect
of
video
self-feedback
training
on
the
nurses’
awareness
and
performance
in
performing
cardiopulmonary
resuscitation,
it
was
shown
that
the
mean
of
awareness
scores
of
each
group,
was
increased
in
the
pre-test
and
post-test.
In
the
Akho
and
colleagues’
study
(22)
for
simulating
the
effect
of
cardiopulmonary
resuscitation
on
the
nursing
students’
acquisition
and
retention
of
knowledge
and
self-efficiency
in
Jordan,increased
awareness
scores
were
reported.
In
most
studies,
the
average
scores
of
awareness
in
each
group
in
the
post-test,
was
significantly
increased
in
comparison
to
the
pre-test,
therefore,
these
results
confirm
that
regardless
of
type
of
training
and
the
applied
method
for
teaching,
education
can
be
considerably
effective
on
increasing
the
nurses’
awareness.
That
is
compatible
with
the
study
results
in
the
field
of
the
effects
of
different
educational
methods
on
nursing
staff’s
awareness
and
knowledge
about
cardiovascular
resuscitation,
such
as
Zahdmehr
(21),
Mohsenpoor
(23),
Mokhtari
(6),
Bakhsha
(24),
and
Adine
(11).
However,
in
the
Managheb
and
colleagues’s
study
(25)
the
results
showed,
the
mean
of
scores
in
the
intervention
group
had
a
significant
statistical
difference
in
comparison
to
the
scores
before
training
(0.000>p),
while
there
was
no
statistically
significant
difference
in
the
control
group
(098/0
p=);
therefore,
the
results
of
Managheb’s
study
shares
similarities
with
the
intervention
group
of
the
current
study.
However,
it
is
different
in
the
control
group
in
terms
of
the
results
of
this
study,
perhaps
due
to
the
reason
that
the
control
group
in
the
Managheb’s
study,
no
new
methods
were
used
for
teaching
to
enhance
the
students’
cognition
after
the
educational
workshop
that
was
held
for
both
groups;
while
in
this
study,
both
groups
took
advantage
of
a
new
educational
method
(methods
of
role-play
and
video
self-feedback).
Comparison
of
the
nursing
students’
cognitive
learning,
before
and
after
training
in
the
two
groups
of
role-play
and
video
self-feedback
showed
that
the
students’
cognitive
learning
after
implementation
of
the
video
self-feedback
method
increased
more
in
comparison
to
the
role-play
method.
In
a
similar
study
that
Zahdmehr
et
al
(21)
conducted,
the
results
showed
that
the
comparison
of
mean
of
awareness
post-test
scores
did
not
show
a
significant
difference
between
the
experimental
and
control
groups,which
is
inconsistent
with
the
results
of
this
study.
The
reason
behind
it
can
be
the
one
month
practicing
opportunity
in
video
self-feedback
method
before
having
the
test,
which
was
given
to
the
students
in
this
study,
as
well
as
assessing
the
students’
awareness
based
on
the
practical
concepts
of
resuscitation.
Comparing
the
average
scores
of
the
nursing
students’
psychomotor
learning
in
basic
cardiopulmonary
resuscitation
before
and
after
training
through
methods
of
role-play
and
video
self-feedback,
showed
significant
statistical
differences.
In
the
study
that
Lee
and
colleagues
(26)
conducted
in
China
in
order
to
study
the
effect
of
evaluation
prior
to
training
and
feedback
on
improving
and
maintaining
the
nursing
students
acquired
skills
on
the
cardiopulmonary
resuscitation,
it
was
shown
that
the
students’
skills
in
the
test
group
was
higher
after
retraining
classes.
Results
of
the
Paul
and
colleagues’
(20)
and
Zahdmhr
and
colleagues’
study
(21)
showed
that
the
video
feedback
boosts
the
students
and
nurses’
performance
level
in
cardiopulmonary
resuscitation
skill,which
is
similar
to
the
results
of
the
current
study.
The
results
of
the
Hazavei
et
al
(27)
and
Managheb
and
colleagues’
study
(28)
showed
that
an
increase
was
observed
in
the
people’s
average
performance
in
skills
after
training
with
educational
method
of
role-play.,which
is
consistent
with
our
study.
The
results
of
most
studies
have
revealed
similar
results
to
our
study
indicating
that
the
educational
intervention
has
improved
the
nurses’
performance
in
cardiopulmonary
resuscitation.
In
this
regard,
the
study
results
from
the
Adine
(11),
Nouri
et
al
(29),
Hosseini
et
al
(1),
Mokhtari
et
al
(6),
Bakhsha’s
et
al
(24)
studies
are
compatible
with
our
study.
Comparing
the
average
difference
of
the
nursing
students’
psychomotor
learning
scores
in
cardiopulmonary
resuscitation
before
and
after
the
training
showed
that
the
video
self-feedback
group
(5/615
±
98/27)
was
significantly
higher
than
role-play
group
(5/374
±
2.17)
(005/0
=p).
In
a
study
by
Paul
et
al
(20),
the
results
showed
that
all
the
students
believed
that
their
review
of
their
practical
performance,
enables
them
to
know
their
weaknesses
better
and
to
discover
improvement
fields.
In
another
study
by
Yu
M
S
(30),
the
results
showed
that
the
test
group
students
had
better
results
in
competence,
communication
skills
and
motivation
compared
to
the
control
group
in
post-test
that
was
held
8
weeks
after
the
pre-test.
It
seems
that
the
self-awareness
of
one’s
performance
via
reviewing
the
videotape,
increases
the
competence
in
performing
clinical
skills.The
results
of
Managheb’s
et
al
study(25)
showed
that
the
difference
of
average
scores
in
learning
clinical
skills
in
the
group
that
were
provided
with
the
video
feedback,
was
considerably
significant
in
comparison
to
the
group
that
did
not
receive
any
kind
of
feedback
about
its
performance
(000
/
0>p)
and
also
it
showed
that
not
only
the
video
feedback
improves
the
interns’
abilities
in
taking
descriptions
and
physical
examination,
but
also
it
increases
the
accuracy
of
diagnosis
and
treatment
as
well.
In
a
study
that
was
conducted
by
Nicholas
Potos
(31),
the
test
group
had
significantly
higher
test
results
therefore,
Potosi
and
colleagues
advised
using
the
mannequins
together
with
audio
and
visual
feedback
in
training
basic
CPR.
Practicing
and
feedback
are
the
most
important
principles
of
learning
skills
and
the
video
feedback
method
is
the
simplest
practicing
method
and
the
most
complete
feedback
method.
Additionally,
students
in
this
method
can
assess
themselves
and
perform
the
self-learning
via
reviewing
the
recordings.
Studies
also
have
shown
that
the
best
way
to
improve
performance,
is
to
have
the
individuals
assess
themselves
(Namadi
Vosoughi).
This
self-assessment,
through
increased
awareness
and
commitment
to
change,
allows
nurses
to
consider
their
clinical
practice
in
the
workplace
and
to
take
action
in
order
to
improve
it.
The
study
also
confirms
the
fact
that
the
video
self-feedback
training
is
an
effective
method
in
clinical
skills
training.
It
is
hoped
that
this
research
is
a
step
toward
improving
clinical
skills.
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[Tasire
3
ravesheamoozeshye
sokhanrani,
bazivaifayenaghsh
bar
|
