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Literature Review and Annotated Bibliography: Importance of Improving Health Providers CPR Skills, Knowledge and Confidence

Info: 2310 words (9 pages) Nursing Literature Review
Published: 23rd Mar 2021

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Tagged: CPR


According to Engle (2019), an annotated bibliography is a list of citations to books, articles, and documents. Each citation is followed by a brief descriptive and evaluative paragraph, the annotation. “The purpose of the annotation is to inform anyone who reads the annotated bibliography, of the relevance, accuracy, and quality of the sources they have cited”. Below is the annotated bibliography on “The importance of American Heart Association’s (AHA’S) Resuscitation Quality Improvement (RQI) Program for Basic Life Support ( BLS) and Advanced Cardiovascular Life support(ACLS) training in  improving  the competence of healthcare providers  in CPR skills, CPR knowledge  and CPR confidence”.

Annotated Bibliography

Kleinman, M. E., Brennan, E. E., Goldberger, Z. D., Swor, R. A., Terry, M., Bobrow, B. J., .&

Rea, T. (2015). Part 5: adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation132(18_suppl_2), S414-S435.

The article discusses the importance of high-quality CPR in improving cardiac resuscitation outcomes. Through the use of resources such as observational studies, technology and updated AHA guidelines, CPR quality can be consistently measured, managed, and developed to reliably enhance patient and rescuer performance.

Bhanji, F., Mancini, M. E., Sinz, E., Rodgers, D. L., McNeil, M. A., Hoadley, T. A., &  Nadkarni, V. M. (2010). Part 16: Education, implementation, and teams: 2010               American Heart Association guidelines for cardiopulmonary resuscitation and               emergency cardiovascular care. Circulation122(18_suppl_3), S920-S933.

Research indicates that BLS and ACLS skill knowledge swiftly deteriorates following primary training. In order to offset this outcome, alternate strategies that favor CPR prompts and feedback must be considered, as well as a focus on skill proficiency rather than training intervals as the standard within resuscitation education.

Bhanji, F., Donoghue, A. J., Wolff, M. S., Flores, G. E., Halamek, L. P., Berman, J. M., ... &

Cheng, A. (2015). Part 14: education: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation132(18_suppl_2), S561-S573.

The process behind the development and improvement of AHA guidelines surrounding BLS and Emergency Cardiovascular Care (ECC) quality has historically been meticulous and multifactorial. Groups such as the AHA Emergency Cardiovascular Care (ECC) Committee and the Liaison Committee on Resuscitation (ILCOR) are able to cultivate guidelines by investigating factors such as relevance, influence and the possibility of gaining new evidence since the 2010 guidelines.

Oermann, M. H., Kardong-Edgren, S. E., Odom-Maryon, T., & Roberts, C. J. (2014). Effects of

 Practice on competency in single-rescuer cardiopulmonary resuscitation. Medsurg


The purpose of this study was to examine the effectiveness of brief practice of single rescuer BLS on VAMs (voice advisory manikin) in retaining skills compared to a control group with no practice beyond their initial training. This study was a randomized, controlled trial with 606 students in 10 schools of nursing. Brief, frequent practice on manikins with automated feedback is an effective strategy for nurses to maintain skills. This article discusses the effectiveness of optimizing single-rescuer CPR skill retention by incorporating brief practice on voice advisory manikins. Research shows that nurses and other providers executing brief practice on manikins that provide feedback can be directly tied to enhanced skill maintenance and higher performance competency.

Sutton, R. M., Niles, D., Meaney, P. A., Aplenc, R., French, B., Abella, B. S.,  & Nadkarni, V.

 (2011). Low-dose, high-frequency CPR training improves skill retention of in-hospital

 Pediatric providers. Pediatrics128(1), e145-e151.

This article introduces the idea of a low-dose, high frequency training to help optimize CPR skill retention for in-hospital pediatric providers. Study participants were assigned groups following different training approaches with booster training in each category. Using CPR feedback defibrillators, CPR quality was quantitatively measured and compared. Results showed skill retention was highly optimized with booster training and within the instructor-led training groups.

 Sutton, R. M., Nadkarni, V., & Abella, B. S. (2012). “Putting it all together” to improve  resuscitation quality. Emergency Medicine Clinics30(1), 105-122.

This article evaluates focused and multifaceted approaches to improve provision of care during CPR. Some of these approaches include improving the training prior to cardiac events, supervising CPR quality throughout resuscitation attempt, and offering quantitative feedback after cardiac event to further enhance provider performance.

Neumar, R. W., Eigel, B., Callaway, C. W., Estes III, N. M., Jollis, J. G., Kleinman, M. E., ... &

Sendelbach, S. (2015). American Heart Association response to the 2015 Institute of Medicine report on strategies to improve cardiac arrest survival. Circulation132(11), 1049-1070.

This article highlights the AHA’s RQI program as a novel response to the Institute of Medicine’s (IOM) reports urging for changes to improve cardiac arrest survival. The report set forward the initiative to amend guidelines and introduce programs alongside the AHA, in order to optimize cardiac arrest outcomes.

Dudzik, L. R., Heard, D. G., Griffin, R. E., Vercellino, M., Hunt, A., Cates, A., & Rebholz, M.

(2019). Implementation of a low-dose, high-frequency cardiac resuscitation quality improvement program in a community hospital. The Joint Commission Journal on Quality and Patient Safety45(12), 789-797.

The Resuscitation Quality Improvement (RQI) program was introduced by the AHA in 2015 as a response to increase cardiac arrest survival rates by transitioning the CPR training for in-hospital providers into a competency-based standard. A qualitative and quantitative study was conducted to assess CPR performance with implementation of the RQI. Results revealed that CPR skill quality and provider confidence was significantly improved post-RQI implementation.

Sullivan, N. (2015). An integrative review: Instructional strategies to improve nurses’ retention

 Of cardiopulmonary resuscitation priorities. International journal of nursing education

scholarship12(1), 37-43.

CPR skill retention for nurses continues to be a challenge within a hospital setting and requires a proficient training model for optimal response to a cardiac event. A cohesive review was constructed to evaluate training methods focused on instilling CPR priorities to achieve optimal outcomes in such high-stress environments. Evidence indicate that employing brief, recurring CPR attempts simulated with  both high and low fidelity scenarios demonstrates the best potential for skill retention in nurses.

 Roh, Y. S., & Issenberg, S. B. (2014). Association of cardiopulmonary resuscitation

 psychomotor skills with knowledge and self‐efficacy in nursing students. International

journal of nursing practice20(6), 674-679.      

The objective of this study was to investigate the link between psychomotor skills and the knowledge of skills in influencing quality of CPR performance. This quantitative study assessed the execution of CPR skills on a manikin by a select sample of nursing students and tested if there was an association between overall knowledge of skills and skill confidence. While results showed no significant evidence supporting the association, it demonstrated the importance of feedback and individualized training in obtaining mastery of skills.

Anderson, R., Sebaldt, A., Lin, Y., & Cheng, A. (2019). Optimal training frequency for

acquisition and retention of high-quality CPR skills: A randomized trial. Resuscitation135, 153-161.

The goal of this study was to determine the ideal CPR training frequency for optimal skill retention. The study categorized training intervals into 1-month, 3-month, 6-month and 12-month periods during which participants completed two-minute CPR practice accompanied by feedback and coaching. Results favored shorter frequency training sessions for better skill retention as monthly practice sessions demonstrated the best CPR performance out of all other groups. The article also mentions about the ILCOR review in 2010 which posed novel additions and recommendations for the amelioration of CPR training and education. Some of the changes include using high-fidelity manikins rather than standard at training centers, incorporating CPR feedback devices for enhanced skill performance, and shorter training intervals for optimal skill retention.

Stiell, I. G., Brown, S. P., Christenson, J., Cheskes, S., Nichol, G., Powell, J., & Vaillancourt,

C.(2012). What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation?Critical care medicine40(4), 1192.

The study investigated the 2010 CPR guideline recommendations for CPR compression depth to optimize performance in out-of-hospital cardiac arrest (OOHCA) cases. A quantitative analysis was conducted to evaluate the link between increasing compression depth from to 50mm and patient survival outcomes. Although results favor the association between compression depth and rate, the evidence was not significant enough to support the recommendations and requires further investigation,

Cheng, A., Nadkarni, V. M., Mancini, M. B., Hunt, E. A., Sinz, E. H., Merchant, R. M., &

Bigham, B. L. (2018). Resuscitation education science: educational strategies to improve outcomes from cardiac arrest: a scientific statement from the American Heart Association. Circulation138(6), e82-e122.

CPR training efficacy and effective implementation are persistent challenges that influence cardiac arrest survival outcomes. These two key factors often determine skill retention and performance quality among providers and necessitates thoroughness and improvement for enhanced patient outcomes. Therefore, the AHA assembled a review that tackles important elements of education and implementation, such as practice sessions, practice intervals, feedback, proficient trainers, innovative educational approaches, and thoughtful implementation.

Hernández-Padilla, J. M., Suthers, F., Granero-Molina, J., & Fernández-Sola, C. (2015). Effects

Of two retraining strategies on nursing students’ acquisition and retention of BLS/AED skills: A cluster randomised trial. Resuscitation93, 27-34.

The purpose of this study was to evaluate the difference between two retraining approaches to BLS/AED skill learning and retention amongst nursing students. After being assigned to either instructor or student mediated retraining groups, a student’s generalized skill competency was measured with the help of tools like questionnaires, standardized tests and a self-efficacy scale. Results revealed that the student-directed approach for retraining sessions was more successful at maintain skill retention and efficacy amongst students over time.

American Heart Association. (2020). Resuscitation Quality Improvement Program (RQI). https://cpr.heart.org/en/cpr-courses-and-kits/rqi

The Resuscitation Quality Improvement (RQI) Program is the performance improvement program delivered by AHA which consists of quarterly training to support mastery of high-quality CPR skills and it offers spaced learning in quarterly sessions and audio visual coaching with real time feedback and structured debriefings. Eventually healthcare providers will have the increased CPR knowledge, confidence and competency which will contribute to higher  cardiac arrest survival rates.


Sudden cardiac arrest remains a leading cause of death in the United States. BLS is the foundation for saving lives after cardiac arrest and high-quality CPR improves survival from cardiac arrest. The Resuscitation Quality Improvement (RQI) program was introduced by the AHA in 2015, which delivers quarterly training to support mastery of high-quality CPR skills and audio visual coaching with real time feedback structured debriefings. It improves CPR skill, CPR knowledge and CPR confidence of the healthcare providers which eventually increase the cardiac arrest survival rates.


  • Engle, M (2019). How to Prepare an Annotated Bibliography: The Annotated Bibliography.
    • Retrieved from https://guides.library.cornell.edu/annotatedbibliography

This student written literature review is published as an example. See How to Write a Literature Review on our sister site UKDiss.com for a writing guide.


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Cardiopulmonary resuscitation is a “combination of oral resuscitation (mouth-to-mouth breathing), which supplies oxygen to the lungs, and external cardiac massage (chest compression), which is intended to normalise cardiac function and blood circulation.

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