Influence of High-Fidelity Manikin-Based Simulation on Nursing Students' Basic Cardiac Life Support Ability and Motivation

Abstract

Introduction: One of the competencies that nursing students must have while dealing with cardiac arrest is the capacity to perform critical life support, namely basic cardiac life support (BCLS).Having the abilities and motivation to perform BCLS is a complex process and often goes beyond the planned laboratory session's timeframe.The study aims to determine the intervention's impact on nursing students' ability and motivation to conduct BCLS.Methods: This study employed a quasi-experimental design with a prepost-test control group and was carried out in July 2023 at the Emergency Skills Lab with fourth-year undergraduate nursing students.In this study, the sample size for the control and intervention groups was 52 for each group, selected using a simple random sampling technique.The independent variable was high-fidelity manikin-based human patient simulation based on Kolb's experiential learning theory, while the dependent variables were BCLS abilities measured using a mega code checklist and student motivation measured using a valid and reliable motivation questionnaire.Data were examined using the independent sample t-test.Results: The independent t-test results for the motivation variable showed a significant difference (p = 0.004), indicating a significant difference in motivation among students before and after being exposed to high-fidelity manikin-based human patient simulation based on Kolb's experiential learning theory in performing BCLS.Conclusion: High-fidelity manikin-based Human Patient Simulation is an educational paradigm in healthcare that involves using manikins that closely resemble real patients in realistic scenarios.It can be used as an alternative teaching method to boost BCLS performance and motivation.

INTRODUCTION
Nursing students spend most of their days in colleges and healthcare facilities where they may encounter medical emergencies such as cardiac arrest or unforeseen accidents.One of the competencies that nursing students must possess in managing cardiac arrest is the ability to perform critical life support, notably Basic Cardiac Life Support (BCLS).BCLS is a life-saving method that includes rapidly identifying a heart attack, initiating an emergency response system, performing adequate cardiopulmonary resuscitation (CPR), and applying defibrillation promptly

Study design
The

Population and sample
The participants in this study were fourthyear nursing undergraduates.The sample size was determined using the mean difference method between two groups, with the same sample size and standard error as in prior

Instruments
The ability to conduct BCLS was assessed

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. Performing BCLS effectively can reduce mortality and morbidity in various emergencies, both within the hospital (In-Hospital Cardiac Arrest -IHCA) and outside the hospital (Out of Hospital Cardiac Arrest -OHCA).Cardiac arrest is responsible for >49.1% of all deaths.Quick intervention within 3-5 minutes of OHCA onset saves lives [2], [3].Time-saving is considered "lifesaving," a philosophy adopted by emergency services, meaning that a person's survival depends on the speed and timeliness of actions [3]-[5].As technology advances, the emergence of learning media is necessary to support nursing students further, especially in performing BCLS.Educators must be able to integrate various teaching methods with the appropriate theoretical foundation to enhance students' skills and motivation in performing BCLS.The crucial role of the laboratory, through simulation methods using high-fidelity manikins, is an advanced technological teaching method that provides the opportunity to practice in a safe learning environment until competence is achieved using standardized scenarios [4].Through simulation, the kinesthetic learning process, which involves observing and directly performing the required skills, significantly impacts one's ability to take action [5], [6].The impact of laboratory education with the assistance of high-fidelity manikin-based human patient simulation based on Kolb's experiential learning theory needs to be reevaluated and empirically proven for its effectiveness in improving students' skills and motivation in performing BCLS.David Kolb's Experiential Learning Theory is a theory of learning that creates a process in which knowledge and motivation to acquire a skill are achieved through transforming experiences with a more holistic approach [7].Kolb stated that learning involves acquiring abstract concepts that can be applied flexibly in various situations.In Kolb's theory, the impetus for the development of new concepts is provided by new experiences.Applying Kolb's learning theory benefits students, educators, and entrepreneurs.One of the significant reasons for using the experiential learning theory approach is the shift in constructivist pedagogy, emphasizing the importance of competency attainment (knowledge, attitudes, and skills) acquired through experiential learning or learning by doing [10].Another aspect to consider is that experience plays a more significant role in students' autonomy and self-directed learning.The four learning cycles, namely concrete experience, reflective observation, abstract conceptualization, and active experimentation, can transform learning into an effective process.Despite the crucial role of experience in education, some studies suggest that the expected benefits of student learning have not been optimally realized [8].Having the abilities and motivation to perform BCLS is a complex process and often goes beyond the planned laboratory session's timeframe.Based on Kolb's experiential learning theory, skills construction consists of four main phases: stimulation, reflection, abstraction, and experimentation.The findings of this study may assist in solving the challenge of increasing the number of nursing students proficient in performing BCLS using simulation methods based on Kolb's experiential learning theory to reduce mortality and morbidity in various emergencies.Based on the description above, the researcher is interested in conducting a study on the influence of high-fidelity manikin-based human patient simulation based on Kolb's experiential learning theory on the ability and motivation of nursing students to perform basic cardiac life support skills.
research design was quasi-experimental, with a pre-post-test control group conducted in July 2023 among fourth-year nursing undergraduate students at the Emergency Skills Lab.During the research, the treatment group was given a high-fidelity manikinbased human patient simulation based on Kolb's experiential learning theory, while the control group was given a simulation with conventional operational procedure guidance.
using the American Heart Association's mega code checklist, with the Concordance Correlation Coefficient = 0.96 and the Interclass Correlation Coefficient = 0.97.The trainer will assess the participants through the mega code checklist by ticking the participants' activities.The results of measuring the mega code, namely: good (80-100), fair (60-79), and less (<60).Student motivation is measured using the Student Motivation Scale identified by Rubin, Palmgreen, and Sypher, then modified by Rodgers, a self-reported state motivation assessment.This instrument was a selfreported 12-item questionnaire designed to assess the impact of course content on motivation.The item responses were from 1 being unmotivated to 7 being highly motivated.The reliability coefficients for the version of the Student Motivation Scale utilized in this study ranged from 0.95 to 0.96.Data analysis Data were analyzed using SPSS version 20.0, which included descriptive data analysis to obtain the frequency distribution of each variable.The inferential data analysis used in this study was an independent sample t-test.Before evaluating the data, the Kolmogorov-Smirnov and Levene tests were performed to ensure normality and homogeneity.Ethical clearance This study was ethically approved by the Ethics Committee of the Bali Institute of Technology and Health, Indonesia, with certificate number 04.0293/KEPITEKES-BALI/IV/2023 dated April 27, 2023.Following an explanation and instructions on the research technique, all respondents voluntarily consented and participated in the study.The research procedure adhered to the provisions of the Declaration of Helsinki for research involving human participants.

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. They may feel more connected to the importance of BCLS and be motivated to understand and master the skill.Providing Realistic Context: Kolb's experiential learning theory emphasizes experience as the foundation of learning.Simulations provide a real context in which participants can apply their knowledge and BCLS skills, motivating active learning as they see the direct relevance of their learning.Deep Reflection:Kolb's theory includes reflection as an essential component of learning[25],[26].Simulations provide experiences that participants can reflect upon, enhancing their understanding of BCLS procedures and motivating them to improve their skills continually[27],[28]. Boosting Confidence: Participating in realistic simulations and practicing BCLS in situations resembling reallife scenarios can boost participants' confidence.With increased confidence, they may be more motivated to respond to emergencies and perform BCLS effectively in real life.Opportunity for Feedback: In simulations, participants receive direct performance feedback.This feedback can help them understand areas where they need to improve their skills, serving as a source of motivation as they can see their personal growth and efforts to improve.IMPLICATIONS The implications of the research are that learning through a method assisted by highfidelity manikin-based human patient simulation based Kolb's experiential learning theory can be an additional reference or piece of literature to increase the competency achievements of nursing students, especially in growing skills and motivation in carrying out BCLS.Teaching BCLS skills through high-fidelity manikinbased human patient simulation based on Kolb's experiential learning theory can build the competencies students must achieve in carrying out BCLS.Increasing knowledge and skills about BCLS can foster a positive attitude.Students become more confident in new roles and relationships when assisting patients experiencing cardiac arrest.LIMITATIONS This research has tried as hard as possible to get the best results.However, there are still limitations, namely that this research only carried out measurement evaluations once at the posttest, and no follow-up was carried out again.CONCLUSION The study's findings demonstrated that highfidelity manikin-based human patient simulation based on Kolb's experiential learning theory substantially impacted student motivation and BCLS performance abilities.The application of experiential learning theory enables students to learn at every step.Most importantly, the students were able to demonstrate how they may apply it in future practice.

Table 2
Motivation and skill in the Intervention and Control Group

Table 3
Normality test and Homogeneity test

Table 4
The difference in the influence of high-fidelity manikin-based human patient simulation on nursing students' BCLS ability and motivation