So... How Can We Better Learn CPR?
Submitted by Elaine Puricelli, RN, BSN
This essay is an attempt to heighten awareness of CPR teaching methodology. It is an attempt to explore why we, as nurses, do not have one method of teaching CPR. As we are all aware, CPR skills are paramount in an emergency, so why are we presented with more than one way to learn CPR skills ? To be honest, I fear that the nursing community at large may be missing an important idea all along: CPR while being learned as any other critical skill, as any other aspect of our daily practice, may be getting minimalized. Many institutions offer CPR instruction (BLS, ACLS) via computer learning. Following completion of the computer program-delivered CPR package, skills are then practiced on manikins before a CPR completion card is issued. This manner of “teaching” CPR has become widespread and commonplace. My opinion is that cyber learning of CPR pales in comparison to in-person, classroom-directed learning of such vitally important concepts on the subject of cardiopulmonary resuscitation. I have to preface this writing by mentioning that I am not a CPR instructor, to date. I have a tremendous respect for CPR instructors!
In my nursing career, since the late-1980’s, CPR has been an expected skill as a nurse. Healthcare provider CPR is the expectation. When I first learned CPR skills, the American Heart Association’s (AHA) provider manual for basic life support (BLS) was gospel (rightfully so). Fast-forwarding to the present, I am aware of the value of the gift I am given by knowing the American Heart Association’s paradigms, as a registered nurse. I am proud to have my American Heart Association’s BLS card in my wallet as I have always done as a professional nurse. Of course, ongoing BLS training is in keeping with the requirements of my workplace and my own expectation of professional competence. AHA’s advanced cardiac life support skills (ACLS) are just as revered.
My point in writing this essay is to state my personal opinion that in-person, classroom-delivered BLS training is superior to two-dimensional, computer-delivered BLS training. I have read literature, that indicates some interest in this subject other than my personal feelings about BLS training. Perhaps in my case, this is generation-related as I remember my early days of BLS training. Those early days evidenced in-person, classroom-environment skills days as the norm. Once the proverbial call went out that CPR/BLS training was forcing a deadline in the facility where we worked, many nurses scrambled to locate AHA BLS manuals. Also in my early training days the CPR/BLS usually meant sharing the healthcare provider manual as there were always at least two manuals circulating somewhere on our nursing unit. The rush began to commit the AHA’s BLS skills to memory so that we could hit the ground running on skills day so to speak, ready for practicum. The method would vary, but typically we had one to two CPR instructors afloat in our facility. I can remember the days when the nurse would arrive at a large room within the facility and begin the BLS written test with hopes of a passing grade, then onto the practical elements skills amongst the CPR instructors. At least there were humans in attendance when one was tested for both conceptual and demonstrated BLS skills. It was an achievement to receive the BLS card for a specified time period and an expectation. The same was true for ACLS skills days.
More recently I have noticed the cyber-learning trend with CPR skills . I feel that the online CPR learning is now the norm for our BLS training and I fear that this type of learning, with or without having first read the AHA BLS manual, promotes short-term conceptual learning due to simply learning by rote – a memorization of concepts learned in order to pass a BLS written test. Online learning for BLS skills is followed by practical testing in order to give the learner a hands-on connection to BLS skills. We are usually advised that the CPR manikins are somewhat akin to human CPR subjects and we then begin our practical CPR skills.
My confession is that I seek out in-person, classroom-based CPR training. I always set aside a day off from work for in-class training. The order of learning on CPR day is the same: The BLS video begins and proceeds allowing time to stop and practice the clinical concept taught on the video. I have been fortunate in that my in-person instructors have experience and are there to teach! Typically my in-person instructor breaks the skills into their practical and logical function so that the learner knows why a skill is a progression. For example, acknowledging scene safety and why this is paramount in a rescue situation prior to the beginning of the physical assessment of the victim; no resuscitation in play until the scene is known to be safe. I would love to enter a world where a CPR instructor, BLS or otherwise, spends the training day by not only proceeding with the BLS training film, but approaches this training time as a method for having the learner adopt CPR concepts because the learner LEARNED CPR concepts. The scenario on training day could be set with the incorporation of the BLS film (and pause points) and bullet (therefore talking points) points on a white board as a standard of information delivery. Did CPR concepts stray from being learned concepts? Do learners experience a CPR training day as an exercise in rote learning? I would love to see CPR instructors allot time within the in-person learning day to present this vital information as a conceptual exercise: I would love for the students presents in the CPR classroom to come away from training day fully vested in CPR skills due to concepts learned.
For example, did the CPR student ponder the BLS bullet point of why time is allowed between chest compressions because the student remembered reading the concept in the BLS manual, or because the student remembered hearing the answer on the video? Ideally, well in my opinion, the BLS student should be taught the conceptual reason for the brief time between compressions. The student, if a nurse, may remember from his/her nursing education that the in diastole, the coronary arteries fill with blood as opposed to filling during systole. The BLS provider who is using CPR in an emergency will need to know why CPR timing is specific. The point in this writing is that a learned concept is much more valuable than a concept identified then remembered by the student for the sake of a possible upcoming test question: I just exactly described learning by rote in the latter part of this sentence. This is not to say that the CPR instructor present in the classroom did not verbally review BLS concepts.
My experience has been that the CPR instructor directs the class to pause, as per the BLS instructional film, practice the skill and also use this time to discuss any questions or confusion. Never disregard the in-person CPR instructor on training day, the instructor is a font of knowledge. As a nurse I know that a concept LEARNED for the sake of its conceptual value becomes a concept learned until it is be pre-empted by later science, then re-learned conceptually. Perhaps this learning style is easier when one is a nursing student or a student of any other discipline. A nursing student, for example, is aware he/she is in a learning mode while in school. I have a strong feeling about learning important healthcare skills for the sake of their conceptual value. Perhaps I am the only still-practicing nurse who feels like a classroom environment for CPR training is important. Learned information is information retained for a period longer than information learned by rote and that rule will never change. Efficient ways of teaching “basic” skills to the masses may or may not be the push to engage learners in cyber CPR renewals. I also wonder if there is a lack of CPR instructors, a shortage, so to speak; perhaps that’s the motivation for cyber CPR learning. I feel strongly that nothing is more valuable to the nurse than concepts learned and committed to memory.
CPR skills are vitally important in the workplace and in most public settings. Can we as a nursing community declare that we value our resuscitation skills to the point where we choose to seek out a skills day, or an education day in which to learn or retrain our CPR concepts and skills with a leader, a CPR instructor present so as not to short-change our capacity to learn in a meaningful way? I fear that the idea of going to skills day with the knowledge that a day will be spent learning CPR for the sake of engraining its concepts presents as a time challenge for some rather than seeing this idea as meaningful and needed as much as any other clinically important skill.