The influence of post-resuscitation debriefing and clinical learning environment on CPR quality and resuscitation self-efficacy among emergency department healthcare workers
Article Sidebar
Main Article Content
Abstract
Background: CPR quality and resuscitation self-efficacy are critical for successful cardiac arrest management. Structured debriefing and supportive learning environments are hypothesized to enhance these outcomes.
Purpose: This study aimed to evaluate the associations between post-resuscitation debriefing and the clinical learning environment with CPR quality and resuscitation self-efficacy.
Methods: A quasi-experimental study with a one-group pretest-posttest design was conducted at the Emergency Department of Undata Hospital. All eligible healthcare workers (n = 51) were recruited using total sampling. Data on post-resuscitation debriefing, clinical learning environment, CPR quality, and resuscitation self-efficacy were collected using validated questionnaires and observation sheets. Bivariate analysis was performed using Spearman's rank correlation test. Multiple linear regression analysis was conducted to identify predictors of CPR quality and resuscitation self-efficacy, controlling for age, work experience, and profession. Statistical significance was set at p < 0.05.
Results: Post-resuscitation debriefing was significantly associated with CPR quality (rho = 0.412, p = 0.003) and resuscitation self-efficacy (rho = 0.523, p < 0.001). The clinical learning environment was also significantly associated with CPR quality (rho = 0.456, p = 0.001) and resuscitation self-efficacy (rho = 0.389, p = 0.005). Multiple linear regression analysis identified post-resuscitation debriefing as the strongest predictor of CPR quality (beta = 0.398, p = 0.002) and resuscitation self-efficacy (beta = 0.467, p < 0.001), after controlling for confounding variables.
Conclusion: Structured post-resuscitation debriefing and a positive clinical learning environment are significantly associated with improved technical skills and professional confidence among healthcare workers. Implementing standardized debriefing may be an effective strategy for enhancing resuscitation performance in emergency settings.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
The Indonesian Nursing Journal is committed to the principles of Open Access to ensure the global exchange of knowledge. All articles published in this journal are licensed under the Creative Commons Attribution 4.0 International (CC BY 4.0) license.
Under this license, users are free to:
Under the following terms:
Attribution: You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
This licensing framework ensures that authors retain copyright while allowing the public to utilize the research to the fullest extent possible, fostering innovation and collaboration in the field of nursing and healthcare.
Creative Commons Attribution 4.0 International License
References
[1] M. H. Wyckoff et al., "2021 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; neonatal life support; education, implementation, and teams; first aid task forces; and the COVID-19 working group," Circulation, vol. 145, no. 9, pp. e645--e721, 2022.
[2] S. Giri et al., "Improving role allocation for cardiopulmonary resuscitation (CPR) in the emergency department: a quality improvement project," BMJ Open Qual., vol. 13, no. 3, e002437, 2024.
[3] A. Donoghue, T.-C. Hsieh, A. Nishisaki, and S. Myers, "Tracheal intubation during pediatric cardiopulmonary resuscitation: a videography-based assessment in an emergency department resuscitation room," Resuscitation, vol. 99, pp. 38--43, 2016.
[4] D. A. Kolb, Experiential Learning: Experience as the Source of Learning and Development, 2nd ed. Upper Saddle River, NJ: Pearson Education, 2015.
[5] A. Bandura, "Social cognitive theory: An agentic perspective," Annu. Rev. Psychol., vol. 52, no. 1, pp. 1--26, 2001.
[6] International Liaison Committee on Resuscitation (ILCOR), "International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations," Resuscitation, vol. 170, pp. e1--e100, 2021.
[7] D. P. Edelson et al., "Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest," Resuscitation, vol. 71, no. 2, pp. 137--145, 2006. [Note: Original Edelson debriefing study is D. P. Edelson et al., "Improving in-hospital cardiac arrest process and outcomes with performance debriefing," Arch. Intern. Med., vol. 168, no. 10, pp. 1063--1069, 2008. See ref. [26] below.]
[8] C. Skare et al., "Video performance-debriefings and ventilation-refreshers improve quality of neonatal resuscitation," Resuscitation, vol. 132, pp. 140--146, 2018.
[9] F. Annese and R. Versari, "Non-technical skills in cardio-respiratory arrest: a literature review," SCENARIO: Official Italian Journal of ANIARTI, no. 1, pp. 45--56, 2025.
[10] A. Hirakawa et al., "Real-time feedback, debriefing, and retraining system of cardiopulmonary resuscitation for out-of-hospital cardiac arrests: a study protocol for a cluster parallel-group randomized controlled trial," Trials, vol. 19, no. 1, p. 510, 2018.
[11] K. Abulebda, M. Auerbach, and F. Limaiem, "Debriefing techniques utilized in medical simulation," StatPearls, Treasure Island, FL: StatPearls Publishing, 2023.
[12] J. T. Bradley et al., "Teamwork and communication in cardiopulmonary resuscitation: A qualitative analysis of the 2020 AHA guidelines," J. Emerg. Nurs., vol. 47, no. 4, pp. 612--620, 2021.
[13] A. C. Cheng et al., "Debriefing methods and learning outcomes in simulation-based medical education: A systematic review," Simul. Healthc., vol. 15, no. 3, pp. 167--175, 2020.
[14] R. O. Cummins et al., "American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care," Circulation, vol. 142, no. 16, pp. S366--S468, 2020.
[15] M. A. Chan, "Clinical Learning Environment Inventory (CLEI): Development and validation," J. Nurs. Educ., vol. 40, no. 6, pp. 267--273, 2001.
[16] A. Bandura, "Guide for constructing self-efficacy scales," in Self-Efficacy Beliefs of Adolescents, F. Pajares and T. Urdan, Eds. Greenwich, CT: Information Age Publishing, 2006, pp. 307--337.
[17] Y. S. Roh, S. B. Issenberg, H. S. Chung, and S. S. Kim, "Development and psychometric evaluation of the Resuscitation Self-efficacy Scale for nurses," J. Korean Acad. Nurs., vol. 42, no. 7, pp. 1079--1086, 2012.
[18] D. A. Schon, The Reflective Practitioner: How Professionals Think in Action. New York: Basic Books, 1983.
[19] A. Cheng et al., "Data-informed debriefing for cardiopulmonary arrest: A randomized controlled trial," Resusc. Plus, vol. 14, p. 100401, 2023.
[20] P. Benner, From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley, 1984.
[21] K. G. Lauridsen et al., "Cardiopulmonary resuscitation coaching for resuscitation teams: A systematic review," Resusc. Plus, vol. 21, p. 100868, 2025.
[22] A. Edmondson, "Psychological safety and learning behavior in work teams," Admin. Sci. Quart., vol. 44, no. 2, pp. 350--383, 1999.
[23] D. Papanagnou, "Understanding learner trauma in the emergency medicine clerkship: An analysis of self-efficacy and psychological safety in the clinical learning environment," Ph.D. dissertation, Teachers College, Columbia Univ., New York, NY, 2024.
[24] Y. Pu et al., "Self-efficacy as a mediator in the relationship between clinical learning environment and core nursing competence of intern nursing students: A multicentre cross-sectional study," BMJ Open, vol. 15, no. 5, p. e094858, 2025.
[25] C. R. Rogers, Freedom to Learn: A View of What Education Might Become. Columbus, OH: Charles E. Merrill, 1969.
[26] D. P. Edelson et al., "Improving in-hospital cardiac arrest process and outcomes with performance debriefing," Arch. Intern. Med., vol. 168, no. 10, pp. 1063--1069, 2008.