The effectiveness of peer-led debriefing in simulation-based resuscitation training on enhancing cardiopulmonary resuscitation performance in undergraduate nursing students : a randomized equivalence trial

Abstract

Background Prompt identification of cardiac arrest, activation of the emergency response system and high-quality cardiopulmonary resuscitation are known to be critical in determining the chance of survival of the victims experiencing cardiac arrest. Nurses are expected and have the role and responsibility to initiate immediate interventions and demonstrate competency in performing cardiopulmonary resuscitation. Simulation has been adopted as an effective pedagogy in resuscitation training. Debriefing is an important element in simulation education while instructor-led debriefing is considered as a standard practice. With a large number of nursing students in each cohort and a limited number of faculty members, it is challenging to address these issues in simulation-based resuscitation training. The involvement of peers in debriefing in simulation-based resuscitation training has the potential to extend the resources so as to accommodate the challenges. However, the contribution of peer-led debriefing on performance of cardiopulmonary resuscitation is still not clear. Mixed results with regard to the efficacy of peer-led debriefing on cardiopulmonary resuscitation performance were shown among the limited studies. Also, the methodological quality in previous studies may threaten the validity of the findings. Since there is no evidence on the optimal strategy on debriefing by peer learners, research with rigorous design to examine the contribution of peer-led debriefing in resuscitation training is required. Aim This study aims to demonstrate equivalence in enhancement of CPR performance between peer-led debriefing group and instructor-led debriefing group in simulation-based resuscitation training in undergraduate nursing students. Method A randomized equivalence trial was conducted in a local university. A total of 148 undergraduate nursing students were randomized into two groups, either peer-led debriefing group (intervention group) or instructor-led debriefing group (control group). The participants managed the simulated cardiac arrest scenario individually while peer participants or instructor observed and rated their cardiopulmonary resuscitation performance. After the scenario, the peer participants or instructor conducted the debriefing. Then the participants managed the cardiac arrest scenario again. The participants’ cardiopulmonary resuscitation performance was measured by the numerical scoring checklist and the data from the software of the manikin at pre-test and at post-test. Results The findings revealed that the performance score in intervention group was equivalent to that in control group. Equivalence is established with the support of both intention to treat and per protocol analysis. There was a statistically significant reduction in the cardiopulmonary resuscitation performance score following participation in the simulation-based resuscitation training in intervention group (p< .001, 95% CI [-16.22, -5.27]) and in control group (p< .001, 95% CI [-21.25, -9.90]), which indicating better performance in cardiopulmonary resuscitation at post-test. Conclusion This study adds to the literature that peer-led debriefing group is equivalent to the instructor-led debriefing group in terms of cardiopulmonary resuscitation performance enhancement in simulation-based resuscitation training. Implications for practice This study supports the adoption of peer-led debriefing in simulation education, particularly in learning of psychomotor skills. Also, this pedagogy adds benefits in maximizing the usage of resources in simulation education while maintaining learning gains.