Effects of a Hybrid Basic Life Support Program in Improving Nurses’ Cardiopulmonary Resuscitation (CPR) Knowledge, Attitude, and Self-Efficacy
Keywords:
Knowledge, Attitude, Self-efficacy, Basic Life Support, Cardiopulmonary ResuscitationAbstract
Background: Cardiac arrest management relies on Cardiopulmonary Resuscitation (CPR). Nurses are first responders to in-hospital cardiac arrests, making it essential to assess nurses' knowledge, attitudes, and self-efficacy regarding CPR. However, Face-to-face Basic Life Support (BLS) training is often constrained by limited resources and time constraints. A flexible and affordable option for BLS training is hybrid learning, which combines online course materials with in-person hands-on instruction. Significance: The strategy of the Hybrid BLS Program is to enhance emergency preparedness and patient safety. Aim: To evaluate the effectiveness of a Hybrid BLS Program as the Intervention Group (IG) and compare it with a Face-to-face Program as the Control Group (CG). Objectives: To determine nurses’ knowledge, attitudes, and self-efficacy regarding CPR, and to evaluate the effects of the Hybrid BLS Program. Methods: Conducted at Universiti Malaya Medical Centre (UMMC) among 70 nurses, this quasi-experimental study included 35 participants per group. A 58-item questionnaire was used to measure knowledge, attitudes, and self-efficacy before training, immediately after, and 12 weeks later. Limitations: The study's results may have limited applicability because it involved only 70 nurses from a single tertiary facility. Self-report questionnaires may have been affected by social desirability bias, and the 12-week follow-up may not adequately assess long-term retention of CPR knowledge, attitudes, and self-efficacy. Findings: Results indicated moderate knowledge (M = 11.86, SD = 2.63), positive attitudes (M = 76.09, SD = 9.16), and high self-efficacy (M = 84.54, SD = 15.51). Knowledge scores rose after training in both groups, then slightly declined at 12 weeks. The CG mean score increased from 11.57 (SD = 1.82) to 13.42 (SD = 1.75), then dropped to 12.71 (SD = 2.07) at 12 weeks. The IG scores improved from 11.20 (SD = 3.18) to 13.17 (SD = 2.46), then decreased to 12.37 (SD = 1.93) at follow-up. Self-efficacy showed the most substantial gains. The CG increased from 82.43 (SD = 2.64) to 93.09 (SD = 2.12) Post-program, before declining to 89.89 (SD = 2.57) at 12 weeks. The IG demonstrated a similar pattern, rising from 80.66 (SD = 2.63) to 95.71 (SD = 2.12), and then reducing to 89.97 (SD = 2.57). Implications: This study highlights crucial implications for nursing education and practice. Both programs significantly improved nurses’ CPR knowledge, attitude and self-efficacy. This suggests that hybrid learning is an effective alternative to traditional BLS training for nurses.
Keywords: Knowledge; Attitude; Self-efficacy; Cardiopulmonary Resuscitation
References
Abbasi, M., Taghadosi, M., Atoof, F., & Hosseiniara, R. (2025). A quasi-experimental comparison of Kolb and Peyton educational approaches on CPR knowledge and performance among nurses. BMC Medical Education, 25(1), 530. https://doi.org/10.1186/s12909-025-06996-0
Abolfotouh, M. A., Alnasser, M. A., Berhanu, A. N., Al-Turaif, D. A., & Alfayez, A. I. (2017). Impact of basic life-support training on the attitudes of health-care workers toward cardiopulmonary resuscitation and defibrillation. BMC health services research, 17(1), 674.
Abuejheisheh, A. J., Alshraideh, J. A., Amro, N., Bani Hani, S., & Darawad, M. W. (2023). Effectiveness of blended learning BLS module on knowledge and skills: A systematic review of randomized controlled trials. In Heliyon (Vol. 9, Issue 11). Elsevier Ltd. https://doi.org/10.1016/j.heliyon.2023.e21680
Ahmad, N., Wider, W., Kadir, F., Hidrus, A., & Hassan, H. (2023). The effectiveness of modified conventional CPR training among North Borneo University Hospital healthcare providers. Jurnal Ners, 18(2), 124–130. https://doi.org/10.20473/jn.v18i2.44667
Ahmed, S., Ismail, I., Lee, K., & Lim, P. Y. (2021). Systematic review on knowledge and skills level among nurses following CPR (CPR) training. https://doi.org/10.21203/rs.3.rs-951043/v1
Alamri, A. A., & Baker, O. G. (2022). Nurses’ Self-Efficacy Regarding CPR: A. Global Journal of Health Science, 14(6). https://doi:10.5539/gjhs.v14n6p1
Alaryani, Z. D., Alhofaian, A., & Elhady, M. (2021). The relationship between knowledge and self-efficacy of nurses regarding early initiation of CPR and automated defibrillation in Saudi Arabia. Belitung Nursing Journal, 7(5), 387–394. https://doi.org/10.33546/bnj.1670
Alismail, A., Massey, E., Song, C., Daher, N., Terry, M. H., López, D., ... & Lo, T. (2018). Emotional impact of CPR training on high school students. Frontiers in Public Health, 5, 362.
Alkubati, S. A., McClean, C., Yu, R., Albagawi, B., Alsaqri, S. H., & Alsabri, M. (2022). BLS knowledge in a war-torn country: a survey of nurses in Yemen. BMC Nursing, 21(1), 1–13. https://doi.org/10.1186/s12912-022-00923-0
Alsabri MAH, Elsayed SM, Elshanbary AA, et al. Knowledge, Attitude and Perceptions of Healthcare Workers in Arab Countries Regarding Basic Life Support; a Systematic Review and Meta-Analysis. Arch Acad Emerg Med. 2024; 12(1): e32. https://doi.org/10.22037/aaem.v12i1.2223.
Al-smadi, A. M., Bani Hani, S., Shajrawi, A., Ashour, A., Halabi, M., Mousa, A., & Al Smadi, M. M. (2023). Knowledge and practice toward BLS among nurses working with SARS-CoV-2 patients in Jordanian hospitals. Working with Older People, 27(4), 323–334. https://doi.org/10.1108/WWOP-09-2022-0039
Andrews, J., Vaillancourt, C., Jensen, J., Kasaboski, A., Charette, M., Clement, C. M., Brehaut, J. C., Osmond, M. H., Wells, G. A., Stiell, I. G., & Grimshaw, J. (2018). Factors influencing the intentions of nurses and respiratory therapists to use automated external defibrillators during in-hospital cardiac arrest: A qualitative interview study. Canadian Journal of Emergency Medicine, 20,68–79. https://doi.org/10.1017/cem.2016.403
Angute, A., Gachathi, D. M., & Ramani, R. (2023). Association between nurses’ perceived self-confidence in performing family witnessed resuscitation and implementation of the practice at Siaya County Referral Hospital in Kenya. International Journal of Nursing Sciences, 10(1), 117–120. https://doi.org/10.1016/j.ijnss.2022.12.016
Aranda-García, S., Otero-Agra, M., Berlanga-Macías, C., Rodríguez-Núñez, A., Barcala-Furelos, R., Domingo, J., ... & Fernández-Méndez, F. (2024). New communication tool for basic life support training: smart glasses. A quasi-experimental study. Medicina Intensiva (English Edition), 48(2), 77-84.
Aranzábal-Alegría, G., Verastegui-Diaz, A., Quiñones-Laveriano, D. M., Quintana-Mendoza, L. Y., Vilchez-Cornejo, J., Espejo, C. B., ... & Mejia, C. R. (2017). Factors influencing the level of knowledge of CPR in hospitals in Peru. Colombian Journal of Anesthesiology, 45(2), 114-121. https://doi.org/10.1097/01819236-201704000-00007
Bandhu, D., Mohan, M. M., Nittala, N. A. P., Jadhav, P., Bhadauria, A., & Saxena, K. K. (2024). Theories of motivation: A comprehensive analysis of human behavior drivers. Acta psychologica, 244, 104177.
Bathe, J., Daubmann, A., Doehn, C., Napp, A., Raudies, M., & Beck, S. (2024). Online training to improve BLS performance with dispatcher assistance? Results of a cluster-randomised controlled simulation trial. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1), 50. https://doi.org/10.1186/s13049-024-01226-w
Boada I, Rodriguez-Benitez A, Garcia-Gonzalez JM, et al. (2015). Using a serious game to complement CPR instruction in a nurse faculty. Comput Methods Programs Biomed 2015;122:282-91.
Castillo, J., Gomar, C., Rodriguez, E., Trapero, M., & Gallart, A. (2019). Cost minimization analysis for BLS. Resuscitation, 134, 127–132. https://doi.org/10.1016/j.resuscitation.2018.11.008
Chang Y-T, Wu K-C, Yang H-W, Lin C-Y, Huang T-F, Yu Y-C, et al. (2023) Effects of different cardiopulmonary resuscitation education interventions among university students: A randomized controlled trial. PLoS ONE 18(3): e0283099. https://doi.org/10.1371/journal.pone.0283099
Chaudhary, G. P., Sah, K., Malla, J., Das, N., Chaudhary, S., Chaudhary, I., & Pandey, J. (2023). Knowledge regarding BLS among Health Care Workers of the Hospital of Nepal. Journal of Healthcare Engineering, 2023. https://doi.org/10.1155/2023/9936114
Chik, M., Ahmad, A., Kunjukunju, A., Omar, M., Fariza, N., & Yusof, P. (2023). Knowledge and Practice of CPR (CPR) among Registered Nurses. Open Access Journal of Nursing, 6(2), 30–36. https://doi.org/10.22259/2639-1783.0602005
Dermer, J., James, S., Palmer, C., Christensen, M., & Craft, J. (2022). Factors affecting ward nurses’ BLS experiences: An integrative literature review. International Journal of Nursing Practice, 29(5), 1–12. https://doi.org/10.1111/ijn.13120
Faghihi, A., Naderi, Z., Keshtkar, M. M., Nikrouz, L., & Bijani, M. (2024). A comparison between the effects of simulation of basic CPR training and workshops on firefighters’ knowledge and skills: experimental study. BMC Medical Education, 24(1), 178.
Fahajan, Y., Emad, O. J., Albelbeisi, A. H., Albelbeisi, A., Shnena, Y. A., Khader, A., & Kakemam, E. (2023). The effect of a simulation-based training program in BLS on the knowledge of Palestinian nurses: a quasi-experimental study in governmental hospitals. BMC Nursing, 22(1). https://doi.org/10.1186/s12912-023-01552-x
Gyawali, S., Shah, R., & Shah, S. (2024). Knowledge, attitude and practice of BLS among nursing staffs at a tertiary care hospital: Knowledge, attitude, and practice of BLS among nurses. Journal of General Practice and Emergency Medicine of Nepal, 11(17), 72-77. https://doi.org/10.59284/jgpeman262
Hansen, C., Bang, C., Rasmussen, S. E., Nebsbjerg, M. A., Lauridsen, K. G., Bomholt, K. B., ... & Løfgren, B. (2020). BLS training: Demonstration versus lecture–A randomised controlled trial. The American Journal of Emergency Medicine, 38(4), 720-726.
Hasnain, S., Hussan, J., Khan, L., Muhammad, S., Kamal, K., Sawaira, Hayat, U., Abbasi, A., Akhlaq, M.,
Ahmad, A., & Ahmad, K. (2023). Factors affecting knowledge and attitude of healthcare workers towards BLS in Khyber Teaching Hospital, Peshawar: a cross-sectional analysis. BMJ Open, 13(9). https://doi.org/10.1136/bmjopen-2023-073369
Hasselager, A., Bohnstedt, C., Østergaard, D., Sønderskov, C., Bihrmann, K., Tolsgaard, M. G., & Lauritsen, T. L. B. (2019). Improving the cost-effectiveness of laypersons’ paediatric BLS skills training: A randomised non-inferiority study. Resuscitation, 138, 28–35. https://doi.org/10.1016/j.resuscitation.2019.02.032
Hsieh, P. Y., Lin, H. Y., Chang, C. H., Chang, Y. C., Cheng, H. P., Wang, C. Y., Wang, M. L., Wang, H. J., Liu, H. T., Chen, J. S., & Hsiao, F. H. (2021). Effects of situational simulation and online first-aid training programs for nurses in general medical wards: A prospective study. Nurse Education Today, 96. https://doi.org/10.1016/j.nedt.2020.104621
Huang, E. P. C., Chiang, W. C., Hsieh, M. J., Wang, H. C., Yang, C. W., Lu, T. C., ... & Ma, M. H. M. (2019). Public knowledge, attitudes and willingness regarding bystander CPR: A nationwide survey in Taiwan. Journal of the Formosan Medical Association, 118(2), 572-581. https://doi.org/10.1016/j.jfma.2018.07.018
Ikram, Rahman Usman, M., Ullah, F. U., Ullah, I., Fahad, S., T., J., A., N., & Kausar, S. (2024). A Comparative Study of Doctors and Nurses Regarding the Knowledge , Attitude and Practice of BLS in Tertiary Care Hospitals of Peshawar. 3, 688–693. https://doi.org/10.61919/jhrr.v4i1.447
Irfan, B., Zahid, I., Khan, M. S., Khan, O. A. A., Zaidi, S., Awan, S., Bilal, S., & Irfan, O. (2019). Current state of knowledge of BLS in health professionals of the largest city in Pakistan: A cross-sectional study. BMC Health Services Research, 19(1), 1–7. https://doi.org/10.1186/s12913-019-4676-y
Isa, R., Rahmad, N., Mohd, S. N. S., Fauzi, R., & Isa, S. N. I. (2022). Knowledge and Practice of BLS (BLS) Among Registered Nurse at a Private Hospital in Seremban. Malaysian Journal of Nursing, 13(3), 58–64. https://doi.org/10.31674/mjn.2022.v13i03.009
Jaskiewicz, F., Kowalewski, D., Kaniecka, E., Kozlowski, R., Marczak, M., & Timler, D. (2022). Factors influencing self-confidence and willingness to perform CPR among working adults—A quasi-experimental study in a training environment. International Journal of Environmental Research and Public Health, 19(14), 8334.https://doi.org/10.3390/ijerph19148334
Jaskiewicz, F., & Timler, D. (2023). Attitudes of Asian and Polish Adolescents towards the Use of Ecological Innovations in CPR Training. Journal of Clinical Medicine, 12(21), 6939
Khaledi, A., Ghafouri, R., Anboohi, S. Z., Nasiri, M., & Ta’atizadeh, M. (2024). Comparison of gamification and role-playing education on nursing students’ CPR self-efficacy. BMC Medical Education, 24(1), 231. https://doi.org/10.1186/s12909-024-05230-7
Koyuncu, A., Pehlivan, K., Yava, A., Çetindaş, K., Karacan, H. I., & Ulaşli, Z. (2024). New method for autonomous learning of BLS psychomotor skills: Pillow mannequin: Randomized controlled study. Nurse Education Today, 140, 106273.
Malureanu, A.; Panisoara, G.; Lazar, I. The Relationship between Self-Confidence, Self-Efficacy, Grit, Usefulness, and Ease of Use of eLearning Platforms in Corporate Training during the COVID-19 Pandemic. Sustainability 2021, 13, 6633. https://doi.org/10.3390/su13126633
Ming, C. J., Lam, S. K., & Jia, T. Y. (2025). Knowledge and Attitude towards Adult CPR among Nurses in Serdang Hospital: A Cross-sectional Study. Malaysian Journal of Medicine & Health Sciences, 21.
Montoro-Pérez, N., Montejano-Lozoya, R., Rocamora-Rodríguez, C., & Perpiñá-Galvañ, J. (2025). Simulation-Based Educational Practices and Their Relationship with Emotional Intelligence and Stress Coping Skills: An Exploratory Case Study in First Aid Training for Physical Activity and Sports Sciences Students. Trends in Higher Education, 4(3), 50.
Moon, H., & Hyun, H. S. (2019). Nursing students’ knowledge, attitude, self-efficacy in blended learning of CPR: A randomized controlled trial. BMC Medical Education, 19(1). https://doi.org/10.1186/s12909-019-1848-8
Olaussen C, et al. Integrating simulation training during clinical practice in nursing homes: an experimental study of nursing students’ knowledge acquisition, self-efficacy and learning needs. BMC Nurs. 2022;21(1):1–11. https://doi.org/10.1186/s12912-022-00824-2.
Onbasilar, U., von Groote, T., Brülle, R., Booke, H., Schöne, L. M., Strauß, C., ... & Sadjadi, M. (2025). Skill retention after school-based CPR training–a systematic review and meta-analysis. BMC Public Health, 25(1), 3798. (2025) https://doi.org/10.1186/s12889-025-25024-w
Oteir, A., Alqudah, Z., Almhdawi, K., Hourani, Z., Alqudah, A., & Williams, B. (2025). Assessment of CPR knowledge and attitudes among allied health professionals: a correlational study. Disaster and Emergency Medicine Journal.
Panchal, A. R., Bartos, J. A., Cabañas, J. G., Donnino, M. W., Drennan, I. R., Hirsch, K. G., Kudenchuk, P. J., Kurz, M. C., Lavonas, E. J., Morley, P. T., O’Neil, B. J., Peberdy, M. A., Rittenberger, J. C., Rodriguez, A. J.,
Sawyer, K. N., & Berg, K. M. (2020). Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care. In Circulation (Vol. 142, Issue 162). https://doi.org/10.1161/CIR.0000000000000916
Park, J. M. (2006). The effectiveness of competency and retention in CPR through self-directed learning. Unpublished doctoral dissertation, Kyungpook National University. http://dcollection.knu.ac.kr/public_resource
Rajeswaran, L., Cox, M., Moeng, S., & Tsima, B. M. (2018). Assessment of nurses’ cardiopulmonary resuscitation knowledge and skills within three district hospitals in Botswana. African Journal of Primary Health Care and Family Medicine, 10(1), 1–6. https://hdl.handle.net/10520/EJC-f08d7ed3c https://doi.org/10.4102/phcfm.v10i1.1633
Rana, M.A., Iqbal, J., Chaudhary, A., Abdelbaky, A.M., Mostafa, A.M.H., Awad, A.H.A., Elmasry, W.G., Pervaiz, R., Sarwar, T. (2024). Evaluating the impact of practical experience on cpr proficiency: a comparative analysis. Biol. Clin.Sci. Res. J., 2024: 655. doi: https://doi.org/10.54112/bcsrj.v2024i1.655
Ravindra, H. N., Biradar, S., Sarate, S., & Patil, A. (2022). The Effectiveness of a Hands-on Training Programme on BLS for Nursing Professionals. International Journal of Health Sciences, 6(May), 5113–5118. https://doi.org/10.53730/ijhs.v6ns4.9317
Rushton, M., & Pilkington, R. (2024). BLS training: Is student confidence enhanced by advanced levels of simulation?. British Journal of Nursing, 33(9), 411-417. https://doi.org/10.12968/bjon.2024.33.9.411
Sabogal-Rodriguez, C. C. (2024). Effects of the Low-Dose, High-Frequency CPR Education on Nurses’ Competency and Confidence. Nursing & Health Sciences Research Journal, 7(1), 22-49. https://doi.org/10.55481/2578-3750.1188
Sachdeva, S. (2020). A study to assess knowledge and practice of basic life support among nurses working in tertiary care hospital, New Delhi, India. Nurse Care Open Access Journal, 7(2), 48–52. https://doi.org/10.15406/ncoaj.2020.07.00217
Salameh B, Batran A, Ayed A, Zapen M, Ammash A, Taqatqa A, et al. (2018). Comparative assessment of BLS knowledge between professional nurses and nursing students. Arch Med Health Sci 2018;6:54-8. DOI:10.4103/amhs.amhs_107_17
Sasmito, P., Purnamasari, E., Sumartini, S., & Purwanti, N. S. (2024). Determinants factors on Public Health Centre nurses ’ confidence in performing CPR. 06(7), 581–590.
Seman, N., Kamarudin, N. L., Wan Ismail, W. M., & Nordin, R. (2025). Self-Efficacy in Performing CPR (CPR) among Nurses in Acute Care Settings. Malaysian Journal of Medicine & Health Sciences, 21. https://doi:10.47836/mjmhs.21.s5.30
Shah, A., Ullah, F., Noreen, N., Asad, M., & Khan, A. (2022). Knowledge, Attitude and Practices of BLS among Nurses: A Cross-Sectional Study in Malakand Division, Khyber Pakhtunkhwa. Journal of Farkhanda Institute of Nursing And Public Health (JFINPH), 2(2), 19–23. https://doi.org/10.37762/jfinph.66
Silverplats, J., Strömsöe, A., Äng, B., & Södersved Källestedt, M. L. (2022). ‘Attitudes towards cardiopulmonary resuscitation situations and associations with potential influencing factors—A survey among in-hospital healthcare professionals’, PLoS One, 17(7), e0271686. https://doi.org/10.1371/journal.pone.0271686
Tomas, N., & Kachekele, Z. A. (2023). Nurses’ Knowledge, Attitudes, and Practice of CPR at a Selected Training Hospital in Namibia: A Cross-Sectional Survey. SAGE Open Nursing, 9. https://doi.org/10.1177/23779608231216809
Usman, M., Ullah, I., Rahman, F. U., Ullah, I., Fahad, S., Touheed, J., ... & Kausar, S. (2024). A comparative study of doctors and nurses regarding the knowledge, attitude and practice of basic life support in tertiary care hospitals of Peshawar. Journal of Health and Rehabilitation Research, 4(1), 688-693.
Varughese, S., & D’Silva, B. (2018). Knowledge and perspective on CPR among staff nurses. IOSR Journal of Nursing and Health Science, 7(1), 12-14.
Veettil, S. T., Anodiyil, M. S., Khudadad, H., Kalathingal, M. A., Hamza, A. H., Ummer, F. P., & Alnuaimi, A. S. (2023). Knowledge, attitude, and proficiency of healthcare providers in CPR in a public primary healthcare setting in Qatar. Frontiers in Cardiovascular Medicine, 10, 1207918. https://doi.org/10.3389/fcvm.2023.1207918
Veronese, J. P., Wallis, L., Allgaier, R., & Botha, R. (2018). Cardiopulmonary resuscitation by emergency medical services in South Africa: Barriers to achieving high quality performance. African Journal ofEmergency Medicine, 8(1), 6–11. https://doi.org/10.1016/j.afjem.2017.08.005
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Nik Hasmumthaj Nik Hassan, Siti Khuzaimah Ahmad Sharoni , Septa Katmawanti
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
