The effect of simulation-based education on nursing students’ knowledge and performance of adult basic cardiopulmonary resuscitation: A randomized clinical trial

  • Tahereh Habibli School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
  • Tahereh Najafi Ghezeljeh ORCID Mail Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
  • Shima Haghani Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
simulation-based education; adult basic cardiopulmonary resuscitation; knowledge; performance; nursing; students


Background & Aim: Cardiopulmonary arrest as a life-threatening condition needs urgent interventions to protect individuals’ life and prevent irreversible damages to vital organs. This study aimed to investigate the effect of simulation-based education on the knowledge and performance of nursing students of adult basic life support cardiopulmonary resuscitation (BLS-CPR).
Methods & Materials: This study used a pretest-posttest study with a control group. It was conducted at Iran University of medical sciences, Tehran, Iran, in 2017. In this study, 49 nursing students at the sixth education semester were assigned using the simple random allocation into two groups of intervention (n=28) and control (n=21). Initially, the conventional BLS education was provided to the two groups of intervention and control using the conventional method. Next, the intervention group received simulation-based education. The knowledge and performance of the students before, immediately after, and three months after the intervention were assessed using a modified knowledge assessment questionnaire and a modified performance evaluation checklist about BLS in adults.
Results: The students’ knowledge in the intervention group immediately after (p<0.001) and three months after the intervention (p<0.05) were significantly higher than the control group. The mean scores of performance immediately after (p<0.001) and three months after the intervention (p<0.001) were significantly higher than the control group.
Conclusion: Simulation-based education increased the knowledge and performance of nursing students in the field of BLS-CPR. According to the results, integrating conventional training with simulation-based education can be effective in learning BLS among nursing students. 


1. Charlier N, Van Der Stock L, Iserbyt P. Peer-assisted learning in cardiopulmonary resuscitation: the jigsaw model. The Journal of emergency medicine. 2016 Jan 1;50(1):67-73.
2. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, De Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD. Executive summary: heart disease and stroke statistics—2015 update: a report from the American Heart Association. circulation. 2015 Jan 27;131(4):434-41.
3. Mäkinen M, Niemi-Murola L, Kaila M, Castrén M. Nurses’ attitudes towards resuscitation and national resuscitation guidelines—nurses hesitate to start CPR-D. Resuscitation. 2009 Dec 1;80(12):1399-404.
4. Alijanpour E, Amri-maleh P, Khafri S, Razzaghi F. Assessment of different cardio-pulmonary resuscitation teaching approach on quality of education in medical student, Babol 2011. Medical Journal of Mashhad University of Medical Sciences. 2014;56(6):376-82.
5. Greif R, Lockey AS, Conaghan P, Lippert A, De Vries W, Monsieurs KG, Ballance JH, Barelli A, Biarent D, Bossaert L, Castrén M. European resuscitation council guidelines for resuscitation 2015: section 10. Education and implementation of resuscitation. Resuscitation. 2015 Oct 1;95:288-301.
6. Berger C, Brinkrolf P, Ertmer C, Becker J, Friederichs H, Wenk M, Van Aken H, Hahnenkamp K. Combination of problem-based learning with high-fidelity simulation in CPR training improves short and long-term CPR skills: a randomised single blinded trial. BMC Medical Education. 2019 Dec;19(1):180.
7. Heidarzadeh H, Forouzi, M A, Kazemi M, Jahani Y. Comparing the effect of two methods of cardiopulmonary resuscitation education including computer-based stimulation and mannequin stimulation on nursing students knowledge and satisfaction. Journal of Medical Education Development 2015;8:12-20.
8. McCoy CE, Rahman A, Rendon JC, Anderson CL, Langdorf MI, Lotfipour S, Chakravarthy B. Randomized Controlled Trial of Simulation vs. Standard Training for Teaching Medical Students High-quality Cardiopulmonary Resuscitation. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health. 2019 Jan;20(1):15-22.
9. Lee SJ, Kim SS, Park YM. First experiences of high‐fidelity simulation training in junior nursing students in K orea. Japan Journal of Nursing Science. 2015 Jul;12(3):222-31.
10. Everett-Thomas R, Turnbull-Horton V, Valdes B, Valdes GR, Rosen LF, Birnbach DJ. The influence of high fidelity simulation on first responders retention of CPR knowledge. Applied Nursing Research. 2016 May 1;30:94-7.
11. Podlinski LA. The Effect of Simulation Training on Nursing Students' Content Exam Scores: Walden University 2016.
12. Jeffries PR. Simulation in nursing education: From conceptualization to evaluation. 2012.
13. Aqel AA, Ahmad MM. High‐fidelity simulation effects on CPR knowledge, skills, acquisition, and retention in nursing students. Worldviews on Evidence‐Based Nursing 2014;11:394-400,
14. Sahu S and Lata I. Simulation in resuscitation teaching and training, an evidence based practice review. J Emerg Trauma Shock. 2010 Oct-Dec; 3(4): 378–384. doi: 10.4103/0974-2700.7075815.
15. Lioce L, Meakim CH, Fey MK, Chmil JV, Mariani B, Alinier G. Standards of Best Practice: Simulation Standard IX: Simulation Design. Clinical Simulation In Nursing 2015;11:309-15, 10.1016/j.ecns.2015.03.005
16. Delasobera BE, Goodwin TL, Strehlow M, Gilbert G, D'Souza P, Alok A, et al. Evaluating the efficacy of simulators and multimedia for refreshing ACLS skills in India. Resuscitation 2010;81:217-23,
17. Gerdprasert S, Pruksacheva T, Panijpan B, Ruenwongsa P. Development of a web-based learning medium on mechanism of labour for nursing students. Nurse education today 2010;30:464-9, 10.1016/j.nedt.2009.10.007.
18. Ackermann AD. Investigation of learning outcomes for the acquisition and retention of CPR knowledge and skills learned with the use of high-fidelity simulation. Clinical Simulation in Nursing 2009;5:213-22,
19. shahrestanaki YA. The effect of basic cardiopulmonary resuscitation training on knowledge and skills of firefighters. Iran University of Medical Sciences 2013.
20. Kolb D. Experiential learning as the science of learning and development. Englewood Cliffs, NJ: Prentice Hall 1984.
21. Todd KH, Braslow A, Brennan RT, Lowery DW, Cox RJ, Lipscomb LE, et al. Randomized, controlled trial of video self-instruction versus traditional CPR training. Annals of emergency medicine 1998;31:364-9.
22. Fernández-Ayuso, D.a , Fernández-Ayuso, R.a , Del-Campo-Cazallas, C.a , Pérez-Olmo, J.L.b , Matías-Pompa, B.c , Fernández-Carnero, J.d e g , Calvo-Lobo, C.f The modification of vital signs according to nursing students' experiences undergoing cardiopulmonary resuscitation training via high-fidelity simulation: Quasi-experimental study (2018) Journal of Medical Internet Research, 20 (8), art. no. e11061. doi: 10.2196/11061.
23. Esfehani JKz, Mehrabi H, Ranjbar H, M Shoghi , mohammadi SZ. The effect of multi-media educational software on learning basic principles of Cardio-Pulmonary Resuscitation (CPR) in Nursing Students. iranian journal of critical care nursing 2014;7:160-7.
24. Gates MG, Parr MB, Hughen JE. Enhancing nursing knowledge using high-fidelity simulation. The Journal of nursing education 2012;51:9-15, 10.3928/01484834-20111116-01.
25. Tiffen J, Graf N, Corbridge S. Effectiveness of a low-fidelity simulation experience in building confidence among advanced practice nursing graduate students. Clinical Simulation in Nursing 2009;5: 113-7,
26. Akhu-Zaheya LM, Gharaibeh MK, Alostaz ZM. Effectiveness of Simulation on Knowledge Acquisition, Knowledge Retention, and Self-Efficacy of Nursing Students in Jordan. Clinical Simulation in Nursing 2013;9:335-42,
27. Bloom B, MD E, Furst EJ, WH H, DR K. Taxonomy of educational objetives: the classification of educational goals. handbook I: cognitive domain New York, US: D Mckay. 1956.
28. Adams AJ, Wasson EA, Admire JR, Pablo Gomez P, Babayeuski RA, Sako EY, et al. A Comparison of Teaching Modalities and Fidelity of Simulation Levels in Teaching Resuscitation Scenarios. Journal of surgical education 2015;72:778-85,
29. Tuoriniemi P, Schott-Baer D. Implementing a high-fidelity simulation program in a community college setting. Nursing education perspectives 2008;29:105-9.
30. Dal U, Sarpkaya D. Knowledge and psychomotor skills of nursing students in North Cyprus in the area of cardiopulmonary resuscitation. Pakistan journal of medical sciences. 2013 Jul;29(4):966.
31. Oermann MH, Kardong-Edgren SE, Odom-Maryon T. Effects of monthly practice on nursing students' CPR psychomotor skill performance. Resuscitation 2011;82:447-53,
32. Celik E. The evaluation of nurses about CPR knowledge, Master's thesis. Halic University Institute of Health Sciences 2008.
33. Nicol P, Carr S, Cleary G, Celenza A. Retention into internship of resuscitation skills learned in a medical student resuscitation program incorporating an Immediate Life Support course. Resuscitation. 2011 Jan 1;82(1):45-50.
How to Cite
Habibli T, Najafi Ghezeljeh T, Haghani S. The effect of simulation-based education on nursing students’ knowledge and performance of adult basic cardiopulmonary resuscitation: A randomized clinical trial. NPT. 7(2):87-96.
Original Article(s)