Using a smartphone app to aid training for high quality chest compression : a mixed method study

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Using a smartphone app to aid training for high quality chest compression : a mixed method study

 

Author: Cheung, Hor Wan Annemarie
Title: Using a smartphone app to aid training for high quality chest compression : a mixed method study
Degree: D.H.Sc.
Year: 2016
Subject: CPR (First aid) -- Study and teaching.
First aid in illness and injury -- Study and teaching.
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: 284 pages : illustrations
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2961712
URI: http://theses.lib.polyu.edu.hk/handle/200/8946
Abstract: Background: Cardiopulmonary resuscitation (CPR) contributes to survival after cardiac arrests. However, the worldwide bystander CPR rate was low, and the skills decayed as short as one week after training. A CPR smartphone app, iCompress, was newly developed to aid CPR training and to provide ample audiovisual prompts and feedback to users, together with the capacity to evaluate chest compression performance and allow future comparison. Aims and objectives: This study aimed to evaluate the quality of chest compression performed by novice nurse trainees with the aid of iCompress in instructor-led CPR training. The primary objectives were to examine the differences in chest compression depth and rate by the nurse trainees with or without iCompress, the retention of skills, and to explore the perception and learning experience of the trainees using iCompress. Design and method: A sequential mixed-method design was adopted, with 98 student nurses being randomized into the intervention group and other 98 in the control. The intervention group took the instructor-led CPR course with iCompress as the training aid, while the control group was trained without iCompress. All participants undergone a 1-minute chest compression-only CPR on a resuscitation manikin immediately before (T0) and after training (T1). Another skills test took place after a 4-week self-practice (T2) with (intervention group) or without (control group) iCompress. During the training process and skills tests, chest compression performance of the participants was measured by the Laerdal PC SkillReporting system. The quantitative data were analyzed with Generalized Estimating Equations (GEE), a semi-parametric regression technique, and other statistical tests as necessary. Subsequently, two follow-up focus group discussions (N=16) were held at T2 to qualitatively explore the learning experience in both groups. Based on the Kolb's experiential learning model, directed content analysis was then performed to generate findings and triangulate with the quantitative results for more comprehensive evaluation and understanding of the use of iCompress in CPR training.
Results: Significant improvement for chest compression depth was found in both study groups at T1. Nevertheless, at T2, the intervention group compressed significantly deeper (M = 50.64, SD = 3.72 vs M = 48.72, SD = 4.03, p = .01), with higher adequate chest compression depth percentage (M = 85.02, SD = 20.81 vs M = 61.67, SD = 36.74, p < .001), and higher correct percentage (M = 83.03, SD = 21.24 vs M = 56.56, SD = 36.64, p < .001) than the control. Focus group discussions revealed that they felt exhausted in performing chest compression. Participants expressed their preference in control over learning, with opportunities to develop professionalism. They also valued the presence of an instructor during training. The intervention group regarded iCompress easy to use, and tended to concentrate more on the feedback and prompts of the app for their learning during skills practice alone; while the control group was more influenced by the surrounding environment and enjoyed group learning. Discussion: iCompress provides concrete experience which may enhance longer retention of chest compression skill, permits reflective observation on performance, abstract conceptualization on new knowledge and planning for learning refinement, as well as the active experimentation in performing chest compression. It is recommended as a teaching aid in the instructor-led CPR course, and for refresher self-practice. In addition to the improvement in chest compression depth of the control group at all skills tests, there was still an inadequate mean compression depth (less than the recommendation of 50 - 60mm). This suggests the need for better learning strategies in improving such learning for this group, and iCompress is a promising tool in that regard. Nevertheless, the most effective compression depth varied in the literature; a review of the CPR guidelines may be warranted. The application of iCompress in real cardiac arrests should also be explored. Conclusion: iCompress is a promising teaching and learning feedback device that aids CPR skills acquisition and retention. Further studies should be conducted to empirically investigate the outcomes in utilizing iCompress for CPR during cardiac arrest emergencies.

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