''Studies show that nurses' skills in acute care are often weak. These findings, along with our students' request for more training and a positive attitude from the university administration, encouraged us to renew and improve our procedures for learning CPR,'' says lecturer Seija Tiainen from University of Applied Science in Tampere.

 The new CPR training program step by step

The nursing students are introduced to CPR during a first aid class in their first year. Here they learn theory followed by short, practical excercises performed on manikins. 

Well into their second year, the students are divided into groups of 8-12 peers. A tutor explains the core principles of resuscitation and demonstrates how CPR techniques are performed proficiently.

Student practicing BVM ventilations.

Self-directed learning with corrective feedback: After the demonstration the students are introduced to a self-directed learning environment, where the training is accompanied by corrective voice feedback on hand placement and rate and depth of delivered compressions and ventilations.

Train till proficient: After the students have practiced CPR with corrective voice feedback, they book the amount of training time in the self-directed learning station they think they need to attain an adequate and approved skill level.

Skills assessment: Having completed the training, the students make a second appointment in the self learning environment; this time to have their skills evaluated. The station assesses whether each student is able to meet the passing criteria: deliver a minimum of 75% guideline compliant ventilations and compressions.

Many students are initially under the impression that compressions are fairly easy to deliver, explains Tiainen. They soon discover however that this is not the case. The importance of applying correct technique and rhythm, and to avoid hands-off time during compressions isn't apparent to many students until they realize that they are actually underperforming. The automated voice feedback helps them understand.

''From time to time I team up with students in order to demonstrate how to do it the right way. Sometimes it takes quite some time for them to get it right, but they always do in the end, despite a tough line for approval.''

According to Tiainen the step-by-step-arrangement for acquiring CPR skills is now an established method at the University. ''It all has to do with us wanting to improve the basic life support skills of our nurses. This is also why we evaluate their skills level.''

Higher quality training yields higher quality care

The new program for learning and enhancing resuscitation skills has improved the students' performance level to the extent where the percentage for approval has increased by 5% (to a current 75% passing rate). ''Here, at our school, we have built a path for learning resuscitation. First you learn layperson CPR (in compliance with the Finnish Red Cross protocol), then you learn compression- and bag mask ventilation, and later resuscitation in pairs. All this training takes place in the self-learning station. Lastly, you learn advanced life support, group dynamics and leadership, all during fully immersive event based simulation training including subsequent debriefing,'' says Tiainen.

Simulation scenarios accomodate neomillenial learning styles 

Faculty at Tampere recognize that today's students value direct, active participation and guidance, and that the traditional lecture no longer works as a sole teaching method. In addition to implementing the self learning station, Tampere University has therefore also integrated fully immersive simulation training with the nursing curriculum, starting end of 2009. ''We wanted to bring modern teaching methods alongside the traditional ones - not so that one method would rule, but rather have them compliment each other,'' explains Tiainen.

Simulation across more healthcare disciplines

In the future, paramedics, midwives, nurses and other health care professionals will also have simulation training integrated with their post graduate studies.

''Having started in 2010, this learning method is just in its first steps, and so we keep finding new situations where we want to try simulation. The new curriculum will be completed in 2013, although our current simulations already fit perfectly in. We use simulation as a problem based learning method in oriented and clinical practices.  

In problem based learning (PBL), students learn the basis for practical nursing. They draw a learning task from this and solve it through multiple learning methods. In our experience, simulation based training is a well-functioning tool for administrating and discharging the learning objectives.

Simulation training enables a more holistic training approach

''The PBL method had been in use for ten years and it needed an update,'' says Tiainen. Now we supplement our lectures and workshops with simulation training. The students praise this new method as it provides them with a more holistic learning approach. Instead of concentrating on individual tasks, students now focus more on teamwork, resource management, communication and leadership. The debriefing sessions are also more fruitful due to these new teaching methods. The students are very excited about being able to work hands-on, as they feel this is the best way to learn. Before emarking on simulationtThey must however know the basic curriculum quite well.

Debriefing completes the learning experience in a positive way

''The students approach the simulation tasks with a desire to learn. They are not afraid of making mistakes – and they shouldn’t be – as mistakes tend to generate even better learning outcomes. After a simulation, the students go carefully over their mistakes. There are many ways to do this; handle them from an ethical angle or for example take a protocol view on the mistakes. Although several groups perform the same scenario, students tend to ponder about very different matters during the subsequent debriefing. This is why the debrief sessions turn out very different from time to time and from group to group.

Debriefing completes the learning experience in a positive way and it prepares the future healthcare professionals to bring topics up for discussion in the clinical field, later on. So far there hasn’t been one student saying that ''simulation training doesn’t suit me'' concludes Tiainen.