Abstract
Introduction
Sudden cardiac arrest (SCA) remains a significant cause of in-hospital mortality and morbidity in Ghana, with increasing incidence in the Central Region of Ghana. Although nurses are continuously present at patients’ bedsides, their ability to recognize and manage cardiac arrest using basic life support (BLS) is under scrutiny.
Objective
The study evaluated the impact of a structured BLS training programme on nurses’ knowledge and practical application of BLS.
Methods
A one-group pretest-posttest quasi-experimental design was used. Using a simple random sampling technique (lottery method), 101 nurses were selected. A seven-point Likert scale questionnaire adapted from the American Heart Association (AHA) 2020 guidelines was used to assess BLS knowledge, while practical skills were evaluated using the BLS task checklist from the Nursing and Midwifery Council of Ghana. Data were analyzed using Wilcoxon signed-rank test and linear regression.
Results
Significant post-training increases were observed in BLS knowledge (W = 4753, p < .001; 95% CI: 1.25 to 1.59) and BLS practice (W = 5151, p < .001; 95% CI: 63.50 to 65.50). In the regression analyses, pretest knowledge was positively associated with posttest knowledge (β = 0.74, p < .001). However, pretest practice and posttest knowledge showed negative regression coefficients in models predicting posttest practice. These regression findings were interpreted cautiously because of restricted variability and possible ceiling effects in posttest scores.
Conclusion
In-service BLS training significantly enhanced both the knowledge and practical skills of nurses. Routine implementation of such programme should be organized at regular interval.
Keywords: basic life support, cardiopulmonary resuscitation, nurses, inservice training, clinical competence, nursing education
Introduction
Basic Life Support (BLS) is a critical life-saving intervention, yet numerous studies report inadequate knowledge and skills among nurses worldwide (Abuejheisheh & Darawad, 2024; Alsabri et al., 2024; Chaudhary et al., 2023; Izquierdo-Condoy et al., 2024; Spinelli et al., 2021). Although structured training significantly improves competency, maintaining proficiency over time remains a persistent challenge. In the United States, Izquierdo-Condoy et al. (2024) identified deficiencies in cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use among nurses, recommending periodic retraining. Abuejheisheh and Darawad (2024) similarly found that despite nurses’ pivotal roles in managing in-hospital cardiac arrests (IHCAs), performance remained suboptimal, underscoring the importance of ongoing education. Evidence from Europe and Asia, including studies by Spinelli et al. (2021), Alsabri et al. (2024), and Chaudhary et al. (2023), reinforces the need for refresher programmes to sustain practice. In Africa, Akinbodewa et al. (2022) demonstrated marked improvements in knowledge and practice following structured BLS training.
In a teaching hospital in Ghana, Damprane et al. (2026) reported that majority of the nurses working in the emergency unit had adequate knowledge of BLS. Another study in Ghana by Quao et al. (2025) suggested that the emergency staff at the Korle-Bu teaching hospital had below par BLS practice but became better after training. Whiles the studies of Damprane et al. (2026) and Quao et al. (2025) were conducted in teaching hospitals outside the Central Region of Ghana, they are among the few studies in Ghana done on BLS using quantitative methods. Other studies which were qualitatively done, including the study of Amoako-Mensah et al. (2023), revealed gaps in knowledge, stigma, and underutilization of available resources hinder effective resuscitation. In a district hospital within the Central Region of Ghana, 21 failed BLS attempts were recorded in 2022 despite the availability of equipment. Although BLS content is included in nursing curricula, the persistent theory-practice gap weakens application (Kumar et al., 2021; Saifan et al., 2021; Tambunan, 2024). Furthermore, recommendations for biannual BLS training (McAuliffe & Gledhill, 2022) are often not implemented, particularly in non-tertiary hospitals where staffing limitations exacerbate the problem. In a hospital within the Central Region of Ghana, for example, only four emergency nurses served the entire facility, severely constraining resuscitation capacity.
While prior studies consistently demonstrate short-term improvements in BLS knowledge and skills following training, important gaps remain insufficiently addressed, particularly within low-resource healthcare settings. There is limited evidence on how baseline competencies shape post-training outcomes, including whether nurses with varying initial knowledge and skill levels benefit differently from structured interventions. Also, the relationship between knowledge and practice remains poorly understood, especially regarding whether improvements in theoretical knowledge translate into practical competence following training. Furthermore, evidence from sub-Saharan Africa, particularly non-tertiary and resource-constrained hospital settings, remains scarce despite contextual differences in staffing, infrastructure, and training opportunities. This study therefore examines not only changes in BLS knowledge and practice following training but also the predictive role of baseline competencies and the evolving relationship between knowledge and practice in a district hospital context in Ghana.
Review of Literature
Recent studies show that nurses’ competency in BLS is shaped by several factors, including educational preparation, clinical exposure, refresher courses, workplace support, and opportunities for simulation-based learning. However, evidence from different countries indicates that many nurses still have gaps in both BLS knowledge and practical CPR skills. In Palestine, Abuejheisheh and Darawad (2024) found that nurses demonstrated poor retention of BLS knowledge despite previous training, stressing the importance of regular refresher programs and continuous competency assessment. Likewise, a systematic review and meta-analysis conducted by Alsabri et al. (2024) reported moderate-to-low BLS knowledge levels among healthcare workers in Arab countries, with noticeable differences across professions and healthcare settings. Similar concerns have been reported in studies from Nigeria, Nepal, Malaysia, India, and Ghana, where nurses and healthcare workers showed insufficient theoretical understanding and inconsistent CPR practices (Akinbodewa et al., 2022; Chaudhary et al., 2023; Sachdeva, 2020a). The association between knowledge and practice is a critical aspect of resuscitation competency. Possessing theoretical knowledge alone may not always translate into effective performance during real emergency situations. Andriyani et al. (2019) reported that nurses working in critical and emergency care settings demonstrated better CPR performance when they had higher levels of BLS knowledge, suggesting a positive relationship between cognitive understanding and clinical practice. Similarly, Damprane et al. (2026) found that nurses who had prior emergency care training and higher knowledge scores performed CPR more effectively in emergency departments. Izquierdo-Condoy et al. (2024) also noted that nurses’ preparedness and proficiency in life support were significantly associated with previous training experiences, indicating that baseline competency may influence future performance outcomes.
A growing body of evidence supports the effectiveness of structured BLS and CPR training programs in improving nurses’ knowledge and practical skills. Kose et al. (2019) demonstrated significant improvements in both knowledge and BLS practice among nursing students following structured BLS training. Similar outcomes have been reported with blended learning and simulation-based approaches. Jamil and Merisdawati (2022) observed that blended learning significantly improved nursing students’ BLS knowledge, while Yoshida et al. (2022) reported improvements in both cognitive understanding and psychomotor skills after blended learning interventions. In addition, high-fidelity simulation training has been associated with better emergency response competence, communication, and self-confidence among nurses and nursing students (Mehdi et al., 2026; Pérez-Fuentes et al., 2026; Wang et al., 2026). Evidence from clinical settings further supports the value of BLS training among practicing nurses. Baizulda et al. (2025) reported that a nurse-led BLS training program significantly improved newly recruited nurses’ knowledge and practical skills. Similarly, Rante et al. (2025) found notable improvements in clinicians’ competencies in cardiac arrest management following BTCLS training. Other educational interventions focusing on emergency cardiovascular care and myocardial infarction screening also demonstrated positive effects on nurses’ knowledge and practice after training (Fadlalmola et al., 2023; Sania et al., 2022). Moreover, Chen et al. (2023) highlighted the usefulness of gamified CPR training in enhancing interprofessional emergency care competence among registered nurses.
Although training programs improve immediate competency, maintaining knowledge and skills over time remains a challenge. AL-Helih et al. (2023) observed differences in CPR competency retention between nurses working in critical care and general care units, suggesting that frequent exposure to emergency situations may help sustain competence. Similarly, Abuejheisheh and Darawad (2024) found that longer intervals since previous training were associated with lower BLS knowledge retention. Kim and Roh (2026) further demonstrated that booster training programs improved long-term retention of competency, emphasizing the need for ongoing reinforcement and periodic refresher education. The literature also identifies several organizational and contextual factors that influence nurses’ BLS practice. Dermer et al. (2023) reported that limited training opportunities, lack of confidence, inadequate exposure to cardiac arrest situations, and insufficient institutional support negatively affected nurses’ BLS experiences. McAuliffe and Gledhill (2022) similarly identified both barriers and facilitators related to mandatory BLS training within interprofessional environments. Qualitative studies conducted in Ghana and the United Arab Emirates further highlighted the influence of workplace culture, teamwork, confidence, and the persistent theory-practice gap on resuscitation performance (Amoako-Mensah et al., 2023; Saifan et al., 2021; Tambunan, 2024). In addition to technical competence, psychological and motivational factors also play an important role in resuscitation performance. Najafi et al. (2024) found that nurses’ motivation significantly influenced their willingness and readiness to perform CPR, while Mohammadi et al. (2022) emphasized the importance of moral sensitivity in CPR-related decision-making. Effective communication, teamwork, and psychomotor abilities have also been recognized as essential elements of successful BLS performance (Jang & Kim, 2026; Shabani et al., 2025).
Despite substantial evidence supporting the effectiveness of BLS training, important gaps remain in the literature. Most previous studies have primarily focused on measuring improvements before and after training, with limited attention given to how baseline knowledge and practice influence post-training outcomes. In addition, only a few studies have examined the relationship between knowledge and practice both before and after BLS training within the same group of nurses. Existing evidence suggests that prior training, clinical exposure, and initial competency levels may affect training responsiveness and skill retention. However, these relationships remain underexplored, especially in low- and middle-income healthcare settings. Therefore, the present study addresses these gaps by evaluating the impact of BLS training on nurses’ knowledge and practice, examining whether baseline knowledge and practice is associated with post-training outcomes, and assessing the relationship between knowledge and practice before and after BLS training. Findings from this study may help inform the development of more effective and targeted BLS educational strategies to strengthen nurses’ preparedness for cardiac arrest care and improve patient outcomes.
Research Objectives
1. To evaluate the impact of BLS training on nurses’ knowledge and practice of BLS.
2. To examine how baseline knowledge and practice is associated with post-training outcomes and to assess the relationship between knowledge and practice before and after BLS training
Research Questions
1. What is the impact of BLS training on nurses’ knowledge and practice of BLS?
2. To what extent do baseline knowledge and baseline practice associate with post-training knowledge and practice outcomes among nurses?
Methods
Study Design
This study employed a one-group pretest-posttest quasi-experimental design to evaluate the effectiveness of BLS training among nurses in a hospital within the Central Region of Ghana. The design ensured ethical inclusivity by providing training to all participants.
Study Setting
The study was conducted in a district hospital within thin the Central Region of Ghana. The hospital serves as the main referral center for two districts due to two major reasons. Firstly, the other hospitals in the two districts do not have adequate resources for emergency and advanced healthcare interventions like BLS. Secondly, the two districts are far from the nearest teaching hospital. Department within the hospital include accident and emergency unit, medical ward, surgical ward, children’s ward, isolation unit, maternity ward, and out-patient department (OPD). The hospital has over 500 capacity conference room which served as the space for the study. The hospital has nursing staff of different cadre including enrolled nurses, registered general nurses who have diploma qualification, and registered general nurses with degree qualification. Females form the of the nursing staff in the hospital. Also, the hospital has nurse specialist like emergency nurses, critical care nurses, nurse anesthetics, public health nurses. It should be emphasized that the emergency nurses were only four (4) who were all not on the same shift at a point. The hospital also serves as a teaching center for healthcare students like nursing students who come from different nursing training institutions for their clinical placements. National service personnel, including nurses, are also posted to the hospital but they are scheduled to complete their service within one (1) year.
Sample Size
The total population consisted of 139 government-employed nurses. Using the Yamane’s formula, a sample size of 103 was calculated and selected via simple random sampling (lottery method). This was done on 6th November 2023. It was done in the hospital by assigning numbers to them based on their roster schedule. The numbers were written on small pieces of papers, folded, and thoroughly mixed in a transparent plastic bowl. The corresponding name on the roster schedule to the selected number meant the nurse has been selected for the study. This was done until 103 nurses were selected. However, two (2) of the sampled participants were absent during the study due to their leave schedule. Thus, the final sample size for the study was 101.
Inclusion Criteria
Nurses employed at selected hospital during the study period. Nurses with more than one-year work experience. Willingness to provide informed consent.
Exclusion Criteria
Nurses on leave during data collection. Student nurses and national service personnel. National service personnel were excluded from the study because they had less than one (1) year of work experience.
Institutional Review Board Approval
Ethical approval was obtained from an academic institutional review board. Written informed consent was obtained from all participants, who retained the right to withdraw at any point without penalty. All data were stored securely and accessible only to the research team.
Study Instruments
The study instrument consisted of BLS knowledge questionnaire and BLS practical component task checklist. However, demographic features like gender, years of work experience, and unit or ward of work were also included.
Knowledge was assessed with a 20-item questionnaire adapted from the 2020 American Heart Association (AHA) BLS guidelines, rated on a 7-point Likert scale (1 = very strongly disagree to 7 = very strongly agree). Example of items on the BLS knowledge questionnaire included: “During cardiac arrest, the heart stops beating, the person does not respond, and the person is not breathing normally”; “100-120 chest compressions should be performed every minute during CPR”; and “The chest should be compressed to a depth of at least 5 cm in adults during CPR.” Content validity of the questionnaire was assessed by an emergency physician specialist and emergency nurse specialists. Construct validity was assessed by comparing the items on the questionnaire to reliable documents like the 2020 American Heart Association (AHA) BLS guidelines. The reliability test after pretesting the instrument yielded a Cronbach’s α of 0.899 and McDonald’s Omega (ω) of 0.914. Also, the intraclass correlation coefficient (ICC) suggested high consistency (ICC3, k=0.902, 95% CI [0.849-0.944) across the 20 raters (Shrout & Fleiss, 1979). BLS practice was evaluated using the Ghana Nursing and Midwifery Council (NMC) cardiopulmonary resuscitation (CPR) component task checklist, which consists of 23 items assessing key procedural steps. The checklist is routinely used in national nursing licensure examinations to assess clinical competence. In this study, the checklist was applied in its original form without modification. Some of the items include “Makes sure patient is lying in supine position on a firm, flat surface”; “Initiates chest compressions”; and “Pushes at a depth of about 4-5cm.” The component task checklist is rate on four (4) scale; rate 1 means “The basic technique was not done well”, rate 2 means “The technique was performed correctly but with hesitation” rate 3 means “The technique was performed correctly without hesitation”, and rate 4 means “Technique, speed, and style excellent.” Because the component task checklist has been a standard tool used by the NMC to assess the competency of nurses during their licensing practical examination in Ghana, its validity was not assessed. However, the reliability test revealed appropriate internal consistency of the checklist items with both Cronbach’s α and McDonald’s Omega (ω) of 0.94.
Although formal psychometric properties of the checklist are not widely reported in the published literature, its use in regulatory assessments reflects established institutional validation processes. To enhance consistency in this study, all assessors underwent structured training prior to data collection, and practical assessments were conducted independently using standardised scoring criteria.
Content validity of the questionnaire was assessed through expert review involving an emergency physician specialist and emergency nurse specialists with direct clinical and training experience in BLS. The review focused on item clarity, relevance, and contextual appropriateness within the Ghanaian healthcare setting. The questionnaire was adapted from the 2020 American Heart Association (AHA) BLS guidelines, which provide internationally standardised content. As such, the expert review was intended to ensure contextual suitability rather than to re-establish foundational content validity using quantitative indices such as the Content Validity Index (CVI) or Content Validity Ratio (CVR). Construct validity was supported through alignment of the questionnaire items with the AHA 2020 BLS guidelines, ensuring that the items adequately represented key domains of BLS knowledge. Given that the instrument was designed for outcome assessment in a quasi-experimental study rather than for scale development, empirical validation techniques such as factor analysis were not conducted.
Data Collection Procedures
Data collection took place in the hospital’s conference room. Data were collected over five weeks (November 13-December 11, 2023) by five trained research assistants (four emergency nurses and one emergency physician specialist). Assistants completed a three-day preparatory workshop covering study protocols and instrument use. The research assistants were trained in the hospital’s conference room. Details of the BLS training programme can be accessed via the URL (https://www.tidierguide.org/#/gen/_liX1DW7O2).
Day 1: Participants completed the baseline knowledge assessment online (30-minute limit).
Day 2: Pretest BLS skills were evaluated using the NMC checklist and two CPR manikins (low fidelity manikins).
Day 3: On the third day, the BLS training was done. It started with the lecture presentation and video demonstration by the Emergency Physician Specialist which lasted for about 2 hours and 30 minutes. It was followed by another 5 hours and 30 minutes session which was on hands-on CPR practice using low fidelity manikin and it was done by both the Emergency Physician Specialist and the four Emergency Nurse Specialists.
Days 4-5: Posttest knowledge and skills assessments were conducted, mirroring the pretest procedures.
All skills assessments were independently scored by trained emergency nurses using standardized NMC rubrics hosted in Google Forms to enhance objectivity and consistency. Anonymous codes ensured confidentiality and Wilcoxon signed-rank test analysis. To promote consistency in scoring, research assistants received standardised training on the application of the checklist, and assessments were conducted independently using predefined scoring criteria.
Statistical Analysis
Data were entered into Microsoft Excel, stored securely with password protection, and analyzed using jamovi software (version 2.7.12). The Shapiro-Wilk test indicated significant departures from normality for both knowledge (W = 0.865, p < .001) and practice (W = 0.919, p < .001), consistent with the observed ceiling effects in post-test scores. Given this violation, the Wilcoxon signed-rank test was treated as the primary inferential method for comparing pre- and post-intervention outcomes. Paired-sample t-tests were additionally conducted as sensitivity analyses, given the relatively large sample size (N = 101) and the robustness of parametric tests under moderate deviations from normality. Consistency between the non-parametric and parametric results was used to assess the stability of the findings. Descriptive statistics summarised baseline characteristics. Effect sizes were reported using rank-biserial correlation for non-parametric tests and Cohen’s d for parametric comparisons. Hierarchical linear regression analysis was conducted to examine associations between baseline and post-intervention measures. Multicollinearity was assessed using tolerance and variance inflation factor (VIF). Both tolerance and VIF suggested absence of collinearity (Field, 2024; Kutner et al., 2005). Anlysis was done using Jamovi statistical software (version 2.7.12).
Results
Out of 103 sample size, 101 participated and this his gives a response rate of 98.1%. A total of 101 nurses participated in the study (Table 1). The majority were female (n=69, 68.3%). Most respondents had fewer than 6 years of work experience, with 37.6% reporting 1-2 years and 24.8% reporting 3-5 years. Fewer participants had 6-9 years (22.8%) or more than 9 years (14.8%) of experience. Nurses were distributed across several units, with the largest proportions working in the medical ward (22.8%), surgical ward (18.8%), and accident and emergency unit (17.8%).
Table 1.
Demographic Characteristics of Respondents (N = 101)
| Variable | Category | n | % |
|---|---|---|---|
| Gender | Male | 32 | 31.7 |
| Female | 69 | 68.3 | |
| Years of work experience | 1–2 years | 38 | 37.6 |
| 3–5 years | 25 | 24.8 | |
| 6–9 years | 23 | 22.8 | |
| Above 9 years | 15 | 14.8 | |
| Unit/Department/Ward | Accident and Emergency Unit | 18 | 17.8 |
| Medical Ward | 23 | 22.8 | |
| Surgical Ward | 19 | 18.8 | |
| Children’s Ward | 4 | 4.0 | |
| Isolation Area | 8 | 7.9 | |
| Maternity | 14 | 13.9 | |
| Out-Patient Department (OPD) | 15 | 14.8 |
Table 2 showed data on the central tendencies of participants’ knowledge and practice of BLS. Before the intervention, respondents had a mean knowledge score of 5.17 (mildly agree), with a median of 5.45 and a mode of 2.00, indicating that while the average and median scores were moderate, the most frequently occurring score was quite low. After the intervention, the mean knowledge score increased to 6.71 (approximately, very strongly agree), with the median at 6.75 and mode at 6.70, indicating a strong shift towards higher and more consistent scores. Notably, the posttest scores clustered closely around the maximum of 7.00, with the minimum score still relatively high at 5.75 unlike the pretest scores with minimum score of 1.20 and a maximum score of 7.00. Regarding practice of BLS, in the pretest, the mean practice score was 19.17, with both the median and mode at 19, and a narrow range (Min: 19, Max: 24). After the intervention, the mean score increased to 83.57, with a median of 84 and a mode of 85. The scores ranged from 74 to 89, reflecting much higher performance levels.
Table 2.
Knowledge and Practice before and after BLS Training (N = 101)
| Variable | Test | Mean ± SD | Median | Mode | Min-Max | SE |
|---|---|---|---|---|---|---|
| Knowledge | Pretest | 5.17 ± 1.28 | 5.45 | 2.0 | 1.20–7.00 | 0.13 |
| Posttest | 6.71 ± 0.26 | 6.75 | 6.70 | 5.75–7.00 | 0.03 | |
| Practice | Pretest | 19.17 ± 0.66 | 19.0 | 19.0 | 19–24 | 0.07 |
| Posttest | 83.57 ± 4.19 | 84.0 | 85.0 | 74–89 | 0.42 |
Table 3 shows the differences in respondents’ knowledge and practice of BLS before and after the intervention. The results from the paired-sample t-tests were consistent with those obtained from the Wilcoxon signed-rank tests, supporting the robustness of the findings despite non-normality. For knowledge, the difference between posttest and pretest scores was statistically significant (W = 4753, p < .001; 95% CI = 1.25 to 1.59). This indicates that the observed improvement was likely attributable to the training. The average increase in knowledge scores was 1.40 points. The rank-biserial correlation was -1.00. The negative sign reflects the order in which the paired variables were entered into the analysis, as the comparison was based on pretest minus posttest scores. Since posttest knowledge scores were generally higher than pretest scores, this value indicates that the paired differences were almost entirely in the direction of improvement. However, because values close to ±1.00 may occur when nearly all paired differences fall in the same direction, the effect size was interpreted cautiously alongside the Wilcoxon test result, mean difference, confidence interval, and tied pairs.
Table 3.
Difference Between Respondents’ Knowledge and Practice of BLS
| Variable | Mean difference ± SE | Test statistic (W) | 95% CI for mean difference | P Value | Effect size |
|---|---|---|---|---|---|
| Knowledge | 1.40 ± 0.11 | 4753 | 1.25, 1.59 | < .001 | -1.00* |
| Practice | 64.50 ± 0.44 | 5151 | 63.50, 65.50 | < .001 | -1.00* |
Similarly, the improvement in practice scores was highly significant (W = 5151, p < .001; 95% CI = 63.50 to 65.50). The mean difference in practice scores from pretest to posttest was 64.50 points. The effect size for this change was also very large (rank biserial correlation, r = 1.00), suggesting that the training programme may have resulted in substantial improvements in respondents’ practical BLS skills. The rank-biserial correlation was -1.00. The negative sign reflects the order in which the paired variables were entered into the analysis, as the comparison was based on pretest minus posttest practice scores. Since posttest practice scores were higher than pretest practice scores, this value indicates that the paired differences were almost entirely in the direction of improvement. However, the effect size was interpreted cautiously because values close to ±1.00 may occur when nearly all paired differences fall in the same direction.
Table 4 presents the hierarchical regression analysis examining participants’ gender, department, and BLS knowledge (pretest) as predictors of their BLS knowledge (posttest). Model 1 explained a very small proportion of the variance in the participants’ BLS posttest knowledge (adjusted R2=0.001) with neither gender (p=0.15) nor department (p=0.27) being significant. However, the participants’ BLS pretest knowledge improved model 2 (R2=0.52). BLS pretest knowledge emerged as the strongest predictor (β=0.74, p<.001). While department was statistically significant (p=0.01), gender (0.68) remained non-significant.
Table 4.
Hierarchical Multiple Linear Regression Coefficients of Predictors of BLS Posttest Knowledge
| Model | Variables | Adjusted R2 | Change in adjusted R2 | Unstandardised coefficients | β | p | Tolerance | VIF | |
|---|---|---|---|---|---|---|---|---|---|
| B | SE | ||||||||
| 1 | (Constant) | 0.001 | - | 6.57 | 0.07 | - | < .001 | - | - |
| Gender | - | - | 0.09 | 0.06 | 0.33 | 0.15 | 0.93 | 1.08 | |
| Department | - | - | 0.09 | 0.08 | 0.35 | 0.27 | 0.99 | 1.01 | |
| 2 | (Constant) | 0.52 | 0.48 | 5.86 | 0.09 | - | < .001 | - | - |
| Gender | - | - | -0.09 | 0.04 | -0.07 | 0.68 | 0.90 | 1.11 | |
| Department | - | - | 0.15 | 0.06 | 0.58 | 0.01 | 0.98 | 1.02 | |
| Knowledge pretest | - | - | 0.15 | 0.02 | 0.74 | < .001 | 0.94 | 1.07 | |
Note. Dependent variable is knowledge posttest scores, independent variable is knowledge pretest scores.
Table 5 shows the hierarchical regression results for gender, department, and BLS pretest practice. In Model 1, gender and department explained very little variance in posttest practice scores, and neither gender (p = .14) nor department (p = .82) was statistically significant. In Model 2, the inclusion of pretest practice improved the model slightly. Pretest practice showed a negative regression coefficient (B = -2.29, β = -0.36, p < .001), indicating that higher baseline practice scores were associated with lower posttest practice scores within this model. Given the narrow range of pretest practice scores and the high clustering of posttest practice scores, this result should be interpreted cautiously and may reflect restricted range or regression-to-the-mean effects rather than a meaningful inverse relationship.
Table 5.
Hierarchical Multiple Linear Regression Coefficients of Predictors of BLS Posttest Practice
| Model | Variables | Adjusted R2 | Change in adjusted R2 | Unstandardised coefficients | β | p | Tolerance | VIF | |
|---|---|---|---|---|---|---|---|---|---|
| B | SE | ||||||||
| 1 | (Constant) | -0.04 | - | 82.88 | 1.17 | - | < .001 | - | - |
| Gender | - | - | 1.47 | 0.98 | 0.35 | 0.14 | 0.93 | 1.08 | |
| Department | - | - | 0.31 | 1.35 | 0.07 | 0.82 | 0.99 | 1.01 | |
| 2 | (Constant) | 0.07 | 0.11 | 127.34 | 13.22 | - | < .001 | - | - |
| Gender | - | - | 0.25 | 1.00 | 0.06 | 0.80 | 0.87 | 1.15 | |
| Department | - | - | 1.17 | 1.30 | 0.28 | 0.37 | 0.98 | 1.02 | |
| Practice pretest | - | - | -2.29 | 0.68 | -0.36 | 0.00 | 0.90 | 1.12 | |
Note. Dependent variable is practice posttest scores, independent variable is practice pretest scores.
Table 6 presents hierarchical regression analysis examining the effects of gender, department, and BLS pretest knowledge on BLS pretest practice. In Model 1, gender and department explained 13% of the variance in the BLS pretest practice. Gender was a significant predictor (β=−0.80, p<.001). In Model 2, the explanation power was better (adjusted R2=0.16) after pretest knowledge was introduced. Gender (p< .001) remained a strong and significant predictor, while department became statistically significant (p=0.03). Pretest knowledge was marginally significant (p=0.05).
Table 6.
Hierarchical Multiple Linear Regression Coefficients of Predictors of BLS Pretest Practice
| Model | Variables | Adjusted R2 | Change in adjusted R2 | Unstandardised coefficients | β | p | Tolerance | VIF | |
|---|---|---|---|---|---|---|---|---|---|
| B | SE | ||||||||
| 1 | (Constant) | 0.13 | - | 19.38 | 0.17 | - | < .001 | - | - |
| Gender | - | - | -0.53 | 0.14 | -0.80 | < .001 | 0.93 | 1.08 | |
| Department | - | - | 0.38 | 0.20 | 0.57 | 0.06 | 0.99 | 1.01 | |
| 2 | (Constant) | 0.16 | 0.03 | 18.90 | 0.29 | - | < .001 | - | - |
| Gender | - | - | -0.60 | 0.14 | -0.90 | < .001 | 0.90 | 1.11 | |
| Department | - | - | 0.42 | 0.19 | 0.63 | 0.03 | 0.98 | 1.02 | |
| Knowledge pretest | - | - | 0.10 | 0.05 | 0.20 | 0.05 | 0.94 | 1.07 | |
Note. Dependent variable is practice postest scores, independent variable is knowledge pretest scores.
Table 7 presents the hierarchical regression analysis involving gender, department, and BLS posttest knowledge. In Model 1, gender and department explained almost no (adjusted R2=−0.04) variance in the BLS posttest practice. Neither variable significantly predicted the posttest practice. In Model 2, the model improved (adjusted R2=0.15). BLS posttest knowledge was a significant predictor (β=−0.44, p<.001). Again, the negative coefficient beta coefficient reflects the direction of the statistical association and should not be interpreted as an indication of improvement magnitude. Gender was also statistically significant (p=0.02).
Table 7.
Hierarchical Multiple Linear Regression Coefficients of Predictors of BLS Posttest Practice
| Model | Variables | Adjusted R2 | Change in adjusted R2 | Unstandardised coefficients | β | p | Tolerance | VIF | |
|---|---|---|---|---|---|---|---|---|---|
| B | SE | ||||||||
| 1 | (Constant) | -0.04 | - | 82.88 | 1.17 | - | < .001 | - | - |
| Gender | - | - | 1.47 | 0.98 | 0.35 | 0.14 | 0.93 | 1.08 | |
| Department | - | - | 0.31 | 1.35 | 0.07 | 0.82 | 0.99 | 1.01 | |
| 2 | (Constant) | 0.15 | 0.18 | 130.31 | 10.29 | - | < .001 | - | - |
| Gender | - | - | 2.09 | 0.90 | 0.50 | 0.02 | 0.92 | 1.09 | |
| Department | - | - | 0.96 | 1.23 | 0.23 | 0.44 | 0.98 | 1.02 | |
| Knowledge posttest | - | - | -7.22 | 1.56 | -0.44 | < .001 | 0.96 | 1.04 | |
Note. Dependent variable is posttest practice score. Main independent variable is posttest knowledge score, controlling for gender and department.
Discussions
Differences in Knowledge and Practice Before and After BLS Training
Given the non-normal distribution and evidence of ceiling effects in post-test scores, the findings should be interpreted with caution. However, the consistency between non-parametric and parametric analyses strengthens confidence in the observed patterns. This study suggests significant improvements in both knowledge and practice of BLS following the structured training. Knowledge scores increased from a mean of 5.17 to 6.71, with reduced variability, indicating a more consistent understanding across participants. Practice scores rose more dramatically, from 19.17 to 83.57, reflecting substantial gains in hands-on proficiency. Both improvements suggested statistical significance (p < .001) with large effect sizes (r = 1.00). The large effect sizes for both knowledge and practice suggest that the changes may not been just statistically significant but also practically important. However, it is important to interpret these results carefully. Because the study used a quasi-experimental pretest-posttest design without a control group and thus, the BLS training alone may not have caused the improvements. Though the effect sizes suggest that the structured training played a major role, other factors may also have contributed to this outcome. For example, familiarity with the study instruments, short-term memory effects, or increased comfort with the assessment process may also have influenced the outcome.
The low baseline knowledge and practice scores observed in this study are not surprising. Previous studies have consistently reported inadequate BLS preparedness among nurses in different settings (Dermer et al., 2023; Sachdeva, 2020b). Similar patterns have been documented in Ghana and other low- and middle-income countries, suggesting that these gaps reflect broader systemic challenges in continuing professional development rather than isolated institutional issues. For instance, Quao et al. (2025) found low baseline BLS knowledge among Ghanaian nurses before structured training. Outside Ghana, Baizulda et al. (2025), Jang and Kim (2026), Rante et al. (2025), and Kose et al. (2019) have reported similar pre-training deficiencies. All these findings emphasize limited baseline competence in BLS as a global issue and stress the importance of structured BLS training programmes.
Another important consideration is retention of BLS knowledge and practice. Many studies suggest that BLS knowledge and practice improve immediately after training, but retention over time can be challenging. Kim and Roh (2026) suggested that although structured resuscitation education produces strong short-term gains, skills often decline within months if refresher training is not provided. Supporting this, Wang et al. (2026) reported that blended learning approaches with periodic reinforcement were more effective for long-term retention than single-session interventions. Because the present study measured outcomes immediately after training, it reflects short-term effectiveness rather than long-term competence. This distinction is important when comparing these findings with studies that include follow-up assessments.
A strength of this study is the inclusion of effect sizes and confidence intervals, which provide a clearer picture of how meaningful the improvements were. Earlier studies, such as Jang and Kim (2026) and Pérez-Fuentes et al. (2026), often reported statistical significance without quantifying the magnitude of change. In this study, the inclusion of effect sizes complements statistical significance testing by providing a clearer indication of practical relevance. However, the primary contribution lies in examining how baseline knowledge and skills relate to post-training outcomes and how the knowledge–practice relationship evolves following structured training. However, comparisons across studies must still be made carefully, as scoring systems, assessment tools, sample sizes, and training models vary. For example, high-income countries often high-fidelity assessment tools (Mehdi et al., 2026; Wang et al., 2026), whereas implementation in Ghana may be limited by fewer simulation resources and irregular refresher programmes (Damprane et al., 2026).
Relationship Between Knowledge and Practice Before and After BLS Training
The findings of this study suggests that baseline BLS knowledge and practical competence were strongly associated with post-training performance than demographic factors such as gender or department. Participants who had better pretest knowledge and prior hands-on exposure were more likely to achieve better post-intervention knowledge and practice outcomes. The improvement in the regression models after including baseline competencies suggests that prior preparedness plays an important role in how well learners absorb new information, participate in simulation activities, and apply theoretical concepts during practical performance. In addition, the significant relationship between posttest knowledge and posttest practice reemphasises the close connection between cognitive understanding and psychomotor skill execution in BLS training (Shabani et al., 2025; Yoshida et al., 2022).
These findings are consistent with previous studies that identified baseline knowledge as an important influencers of post-training BLS competence (Fadlalmola et al., 2023; Jamil & Merisdawati, 2022; Sania et al., 2022). From a competency-based and experiential learning perspective, learners with stronger foundational knowledge may find it easier to understand emergency care concepts and apply them more confidently during practical sessions (Cheng et al., 2020). The significant effect of department after controlling for baseline knowledge may reflect differences in clinical exposure, especially among participants working in units such as Accident and Emergency where opportunities to observe or participate in emergency care are more common (Andriyani et al., 2019; Chen et al., 2023; Najafi et al., 2024). Similar findings have been reported among healthcare professionals with previous clinical and resuscitation experience (Chen et al., 2023; Najafi et al., 2024). However, evidence regarding gender differences in BLS performance remains inconsistent. While some studies have reported differences in confidence and psychomotor performance between males and females, others found no significant differences after structured simulation-based training (AL-Helih et al., 2023; Najafi et al., 2024). These differences across studies may be related to variations in training methods, learning environments, assessment approaches, and sociocultural contexts (AL-Helih et al., 2023; Álvarez et al., 2021). The relatively low explanatory power observed in some practical performance models also suggests that BLS competency is influenced by several other factors beyond baseline knowledge and demographics, including learner motivation, self-confidence, quality of instruction, simulation exposure, and opportunities for repeated practice and refresher training (Chen et al., 2023; Dermer et al., 2023; Mohammadi et al., 2022; Najafi et al., 2024).
The findings have important educational and clinical implications, particularly within the Ghanaian healthcare context where evidence on relational factors of BLS competency remains limited. The strong association between baseline knowledge and practice highlights the importance of pre-training assessment to identify learners who may require additional support or practical reinforcement. Importantly, this study adds to the limited Ghanaian literature by simultaneously examining relationship between both BLS knowledge and practical performance using hierarchical regression analysis. Unlike many previous studies that focused mainly on knowledge outcomes, this study demonstrates the close relationship between theoretical understanding and practical competence within the same framework. The findings therefore provide useful context-specific evidence that can inform the development of more targeted in-service BLS training programmes and workforce preparedness strategies aimed at improving emergency response and patient outcomes in Ghana.
Strengths and Limitations of the Study
The study’s strength lies in its quantification of impact using effect size (rank biserial correlation) alongside Wilcoxon signed-rank test, which demonstrates both statistical and practical significance of BLS training outcomes. Its novelty within the Ghanaian and broader African context, where effect size-based evaluations of BLS training are scarce, underscores its role as a pioneering contribution to emergency care research and practice. Though this study did not include a control group due to associated ethical issues, the pretest-posttest design ensured that the pretest measurements served as comparison for the same group.
The use of a one-group pretest–posttest design without a comparison group limits internal validity, as alternative explanations such as testing effects, prior exposure to BLS content, short-term recall, and increased familiarity with assessment procedures cannot be ruled out. As such, the observed changes should be interpreted as associations rather than causal effects. Outcomes were assessed immediately after the intervention, reflecting short-term changes without providing evidence on retention of knowledge and practical skills over time. The sequencing of knowledge assessment prior to practice evaluation may also have influenced participants’ performance by providing cues relevant to the practical tasks. In addition, unmeasured individual-level factors, including prior training exposure and engagement during the intervention, may have contributed to variability in responses. Generalisability of the findings is limited, as the study was conducted in a single hospital setting. The clustering of post-intervention scores near the upper limit of the measurement scales suggests the presence of a ceiling effect, which may have reduced variability in the data and limited the sensitivity of the analysis to detect more nuanced differences among participants, particularly in the post-test phase. In addition, formal quantitative assessment of content validity (CVI/CVR) and empirical construct validation (e.g., factor analysis) were not conducted, which may limit the depth of psychometric evaluation of the instrument. In addition, formal psychometric evaluation of the BLS practice checklist, including inter-rater reliability assessment, was not conducted within this study, which may limit the precision of measurement consistency.
Implications of the Study
Ensuring that nurses are proficient in BLS has far-reaching implications for patient outcomes. During cardiac arrest, where rapid intervention could mean the difference between life and death, the presence of well-trained nurses significantly enhances the likelihood of survival. When BLS training combines both theoretical understanding and practical skill development, it may foster greater confidence and competence among nurses. This, in turn, may improve their responsiveness and effectiveness during cardiac arrest. Furthermore, the consistent reinforcement of these BLS through ongoing competency assessments could contribute to sustained clinical readiness and patient safety. Over time, such practices could cultivate a culture of high reliability in emergency care, ultimately leading to improved healthcare outcomes at both individual and institutional levels.
Conclusions
This study found significant short-term increases in nurses’ BLS knowledge and practical skills following a structured in-service training programme. However, because the study used a one-group pretest-posttest design without a comparison group, these findings should be interpreted as associations observed after the intervention rather than definitive evidence of causal effectiveness. The findings suggest that structured BLS training may be useful within routine in-service education, particularly in resource-constrained district hospital settings. Baseline BLS knowledge and practice were also associated with post-training performance, highlighting the importance of assessing nurses’ initial competence before training and providing targeted support where needed.
It is recommended that further studies using controlled designs and longer follow-up periods are needed to determine whether such training produces sustained improvements in BLS competence. Also, BLS certification and the biannually recertification in Ghana should be made compulsory for all nurses. Resources for conducting BLS should be provided in adequate quantity to avoid delay in BLS initiations. Moreover, resources like high fidelity manikin should be made available for proper trainings and simulations regarding BLS. BLS in-service training should be organized at regular interval to maintain nurses’ BLS competency. Additionally, nursing educators in Ghana should reconsider restructuring the curriculum to give more attention to BLS related-course. Efforts to train more emergency nurses should be intensified in Ghana. Nurse administrators in Ghana should focus more on strategies that may help bridge theory-practice gap which has been evidenced in this study. Replicating the study in Ghana using high fidelity manikin is recommended. Within the Ghanaian setting, it is strongly recommended that studies that measure the retention of BLS knowledge and practice, post training, should be done.
Supplemental Material
Supplemental Material for Impact of Basic Life Support Training Program on Nurses’ Knowledge and Practice by Ebenezer Quayson, Irene Korkoi Aboh, Rita Opoku-Danso in Sage Open Nursing.
Supplemental Material for Impact of Basic Life Support Training Program on Nurses’ Knowledge and Practice by Ebenezer Quayson, Irene Korkoi Aboh, Rita Opoku-Danso in Sage Open Nursing.
Supplemental Material for Impact of Basic Life Support Training Program on Nurses’ Knowledge and Practice by Ebenezer Quayson, Irene Korkoi Aboh, Rita Opoku-Danso in Sage Open Nursing.
Supplemental Material for Impact of Basic Life Support Training Program on Nurses’ Knowledge and Practice by Ebenezer Quayson, Irene Korkoi Aboh, Rita Opoku-Danso in Sage Open Nursing.
Supplemental Material for Impact of Basic Life Support Training Program on Nurses’ Knowledge and Practice by Ebenezer Quayson, Irene Korkoi Aboh, Rita Opoku-Danso in Sage Open Nursing.
Supplemental Material for Impact of Basic Life Support Training Program on Nurses’ Knowledge and Practice by Ebenezer Quayson, Irene Korkoi Aboh, Rita Opoku-Danso in Sage Open Nursing.
Acknowledgments
We are grateful to all responders in the study for their time and cooperation.
Author Contributions: Ebenezer Quaysn (EQ): Conceptualization; Data curation; Formal analysis; Methodology; Writing-original draft. Rita Opoku-Danso (RO-D): Conceptualization; Formal analysis; Methodology;Project administration; Supervision; Validation; Writing-original draft; Writing-review & editing. Irene Korkoi Aboh (IKA): Project administration; Supervision; Validation; Writing-original draft; Writing-review & editing. All authors read and approved the final manuscript.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Supplemental Material: Supplemental material for this article is available online.
ORCID iDs
Ebenezer Quayson https://orcid.org/0009-0001-8121-0274
Irene Korkoi Aboh https://orcid.org/0000-0001-5634-4564
Rita Opoku-Danso https://orcid.org/0000-0001-5281-1006
Ethical Considerations
Ethical approval to conduct the study was obtained from the Institutional Review Board of the University of Cape Coast (protocol ID: UCCIRB/CHAS/2023/142).
Consent to Participate
Informed consent was obtained from all respondents prior to participation.
Data Availability Statement
The dataset generated and/or analyzed during the study is available in the Mendeley Data repository, DOI: 10.17632/4bzvjwzxs2.1.*
References
- Abuejheisheh A. J., Darawad M. W. (2024). A national cross-sectional study on the retention of basic life support knowledge among nurses in Palestine. BMC Nursing, 23(1), 828. 10.1186/s12912-024-02502-x [DOI] [PMC free article] [PubMed] [Google Scholar]
- Akinbodewa A., Gbala M., Ige O., Akinkunmi F., Odanye A. (2022). Knowledge of basic life support among doctors and nurses attending a refresher course in a teaching hospital in Southwest Nigeria. Nigerian Medical Journal, 63(4), 304–311. 10.60787/NMJ-63-4-77 [DOI] [PMC free article] [PubMed] [Google Scholar]
- AL-Helih Y., AL-Ruzzieh M., AL-Yatim S., Alawneh M., Haija S. A. A., Odeh F. (2023). Cardiopulmonary resuscitation (CPR) competency retention among registered nurses in critical care versus general care unit. medRxiv, 16(8), 259, 2023–10. 10.1101/2023.10.16.23297121 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Alsabri M. A. H., Elsayed S. M., Elshanbary A. A., Zaazouee M. S., Alqeeq B. F., Zehra S. A., Al-Sayaghi K. M., Alkubati S. A., Alrubaiee G. G. (2024). Knowledge, attitude and perceptions of healthcare workers in Arab countries regarding basic life support: A systematic review and meta-analysis. Archives of Academic Emergency Medicine, 12(1), Article e32. 10.22037/aaem.v12i1.2223 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Amoako-Mensah E., Achempim-Ansong G., Gbordzoe N. I., Adofo C. E., Sarfo J. O. (2023). Perceptions of nurses regarding the quality of adult cardiopulmonary resuscitation in Ghana: A qualitative study. BMC Nursing, 22(1), 220. 10.1186/s12912-023-01388-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Andriyani S. H., Setyorini F. A., Dewi E., Pratiwi A. (2019). Nurse’Knowledge and their performance on cardiopulmonary resucitation (CPR) in critical and emergency care Unit. IJNP (Indonesian Journal of Nursing Practices), 3(1), 52–57. 10.18196/ijnp.3193 [DOI] [Google Scholar]
- Baizulda A., Amangeldiyeva A., Metchenova G., Maratkyzy A., Yeleussiz A., Tasbulatov A., Cruz J. (2025). Effectiveness of a nurse-led training program in improving the knowledge and skills in basic life support among newly hired nurses at the University Medical Center. Journal of Taibah University Medical Sciences, 20(5), 728–736. 10.1016/j.jtumed.2025.09.009 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chaudhary G. P., Sah K., Malla J., Das N., Chaudhary S., Chaudhary I., Pandey J. (2023). Knowledge regarding basic life support among healthcare workers of the hospital of Nepal. Journal of Healthcare Engineering, 2023, Article 9936114. 10.1155/2023/9936114 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chen T. S., Hsieh P. L., Tung C. C., Wu C. H., Cheng Y. C. (2023). Evaluation of registered nurses’ interprofessional emergency care competence through the gamification of cardiopulmonary resuscitation training: a cross-sectional study. BMC medical education, 23(1), 359. 10.1186/s12909-023-04332-y [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cheng A., Magid D. J., Auerbach M., Bhanji F., Bigham B. L., Blewer A. L., et al. Part 6: Resuscitation Education Science: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 2020; 142(16_suppl_2), S551-S579. 10.1161/CIR.0000000000000903 [DOI] [PubMed] [Google Scholar]
- Damprane A. O., Nyanor I., Sampah A. K., Achempim-Ansong G., Adjei N., Arhin B., Forson P. K. (2026). Knowledge and practice of adult cardiopulmonary resuscitation among nurses in the Emergency Department of a tertiary hospital in Ghana. African Journal of Emergency Medicine, 16(1), Article 100947. 10.1016/j.afjem.2026.100947 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dermer J., James S., Palmer C., Christensen M., Craft J. (2023). Factors affecting ward nurses' basic life support experiences: An integrative literature review. International Journal of Nursing Practice, 29(5), Article e13120. 10.1111/ijn.13120 [DOI] [PubMed] [Google Scholar]
- Fadlalmola H., Tubaishat A., Habiballa M. (2023). The impact of training program on nurses' knowledge and skills of myocardial infarction screening by using electrocardiogram. Critical Care Nursing Quarterly, 46(2), 165–175. 10.1097/CNQ.0000000000000449 [DOI] [PubMed] [Google Scholar]
- Field A. (2024). Discovering statistics using IBM SPSS statistics. Sage publications limited. [Google Scholar]
- Izquierdo-Condoy J. S., Arias Rodríguez F. D., Duque-Sánchez E., Alegría N. N., Rojas Cadena M., Naranjo-Lara P., Mendoza A. P., Jima-Sanmartín J., Casanova D. A., García B., Giraldo N. C. (2024). Assessment of preparedness and proficiency in basic and advanced life support among nursing professionals: A cross-sectional study. Frontiers in Medicine, 11, Article 1328573. 10.3389/fmed.2024.1328573 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jamil M., Merisdawati M. (2022). Effectiveness of blended learning basic life support (BLS) training on knowledge of nursing students. Jurnal Kesehatan Mesencephalon, 8(1), 11–15. 10.36053/mesencephalon.v8i1.326 [DOI] [Google Scholar]
- Jang K., Kim S. H. (2026). Structured Team Training to Improve Resuscitation Performance and Communication in Nursing Students: A Nonrandomized Intervention Study. The Clinical Teacher, 23(2), Article e70352. 10.1111/tct.70352 [DOI] [PubMed] [Google Scholar]
- Kim S. H., Roh Y. S. (2026). Effects of a theory-based advanced life support booster training program on competency retention in nursing students: A randomized controlled trial. Nurse Education in Practice, 92, Article 104754. 10.1016/j.nepr.2026.104754 [DOI] [PubMed] [Google Scholar]
- Kose S., Akin S., Mendi O., Goktas S. (2019). The effectiveness of basic life support training on nursing students’ knowledge and basic life support practices: A non-randomized quasi-experimental study. African Health Sciences, 19(2), 2252–2262. 10.4314/ahs.v19i2.51 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kumar A., Avishay D. M., Jones C. R., Shaikh J. D., Kaur R., Aljadah M., Kichloo A., Shiwalkar N., Keshavamurthy S. (2021). Sudden cardiac death: Epidemiology, pathogenesis and management. Reviews in Cardiovascular Medicine, 22(1), 147–158. 10.31083/j.rcm.2021.01.207 [DOI] [PubMed] [Google Scholar]
- Kutner M. H., Nachtsheim C. J., Neter J., Li W. (2005). Applied linear statistical models: McGraw, Irwin. [Google Scholar]
- Álvarez Á. L., Espejo T. V., Köllmer L. L., Menor C. G., Rodríguez R. L., Zarataín G. F. (2021). The efficacy of an integrated care training program for primary care nurses for the secondary prevention of cardiovascular risk. Enfermería Clínica (English Edition), 31(5), 303–312. 10.1016/j.enfcle.2020.10.009 [DOI] [PubMed] [Google Scholar]
- McAuliffe M. J., Gledhill S. E. (2022). Enablers and barriers for mandatory training including basic life support in an interprofessional environment: An integrative literature review. Nurse Education Today, 119, Article 105539. 10.1016/j.nedt.2022.105539 [DOI] [PubMed] [Google Scholar]
- Mehdi A., Slimane N. B., Azzouz N., Trifi A., Marhbene T., Abdellatif S. (2026). Effects of high-fidelity simulation in the management of cardiac arrest among emergency and critical care nurses: A randomized trial. International Journal of Africa Nursing Sciences, 24, Article 101008. 10.1016/j.ijans.2026.101008 [DOI] [Google Scholar]
- Mohammadi F., Habibzadeh H., Aghakhani N. (2022). Factors affecting the formation of nurses’ moral sensitivity in cardiopulmonary resuscitation settings: A qualitative study. Nursing ethics, 29(7-8), 1670–1682. 10.1177/09697330221090597 [DOI] [PubMed] [Google Scholar]
- Najafi M., Yadollahi S., Maghami M., Azizi-Fini I. (2024). Nurses’ motivation for performing cardiopulmonary resuscitation: a cross-sectional study. BMC nursing, 23(1), 181. 10.1186/s12912-024-01853-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pérez-Fuentes M. D. C., Molero Jurado M. D. M., Romanos-Rodríguez A., Martos Martínez Á., Gómez-Gómez F. J., Aguado-Campos J. (2026). Self-efficacy and Communication in Health Personnel After Simulation Training in Cardiopulmonary Resuscitation: A Quasi-experimental Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 63, Article 00469580251411471. 10.1177/00469580251411471 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Quao N. S. A., Opare J. N., Adom-Asomaning A. A., Adomako E., Appiah Y. D., Obuobisah M. A. (2025). Enhancing emergency care: Capacity building in Basic Life Support (BLS) for accident and emergency staff at a Ghanaian Emergency Department. Emergency Medicine International, 2025(1), Article 6860643. 10.1155/emmi/6860643 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rante A., Rasyid D., Dg Salimung H., M W. (2025). Effect of BTCLS Training on Emergency Department Clinicians’ Competencies in Cardiac Arrest Management: A Single-Group Pretest–Posttest Study at Pongtiku General Hospital. Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 9(1), 77–87. 10.56338/mppki.v9i1.8447 [DOI] [Google Scholar]
- Sachdeva S. (2020. a). A study to assess knowledge and practice of basic life support among nurses working in tertiary care hospital, New Delhi, India. Nursing & Care Open Access Journal, 7(2), 48–52. 10.15406/ncoaj.2020.07.00217 [DOI] [Google Scholar]
- Sachdeva S. (2020. b). Knowledge and awareness of basic life support among nursing professionals. Journal of Education and Health Promotion, 9, 160.32793756 [Google Scholar]
- Saifan A., Devadas B., Daradkeh F., Abdel-Fattah H., Aljabery M., Michael L. M. (2021). Solutions to bridge the theory-practice gap in nursing education in the UAE: A qualitative study. BMC Medical Education, 21(1), 490. 10.1186/s12909-021-02919-x [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sania S., Ali S., Ali J. (2022). The impact of educational training on nurses to improve knowledge about practices regarding patient safety after cardiac catheterization. Pakistan Journal of Health Sciences, 3(6), 140–144. 10.54393/pjhs.v3i06.303 [DOI] [Google Scholar]
- Shabani M., Heidarimoghadam R., Faradmal J., Babamiri M. (2025). Identify the cognitive, psychomotor and sensory-perceptual abilities required for the role of pre-hospital emergency medical personnel. Work, 80(4), 1607–1616. 10.1177/10519815241295907 [DOI] [PubMed] [Google Scholar]
- Shrout P. E., Fleiss J. L. (1979). Intraclass correlations: uses in assessing rater reliability. Psychological bulletin, 86(2), 420–428. 10.1037/0033-2909.86.2.420 [DOI] [PubMed] [Google Scholar]
- Spinelli G., Brogi E., Sidoti A., Pagnucci N., Forfori F. (2021). Assessment of the knowledge level and experience of healthcare personnel concerning CPR and early defibrillation: An internal survey. BMC Cardiovascular Disorders, 21(1), 195. 10.1186/s12872-021-02009-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tambunan E. H. (2024). Theory-practice gap during clinical learning: A descriptive qualitative study of nursing students' experiences and perceptions. Journal of Caring Sciences, 13(2), 74–81. 10.34172/jcs.33251 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wang J., Sun J., Song J., Li N., Lv K., Pu K. (2026). The effectiveness of high-fidelity simulation training in emergency and critical care nursing education for undergraduate nursing students: A systematic review and meta-analysis. Nurse Education in Practice, 92, Article 104731. 10.1016/j.nepr.2026.104731 [DOI] [PubMed] [Google Scholar]
- Yoshida Y., Uno T., Tanaka H., Hakosaki I., Shigeta K., Yano R. (2022). Cognitive changes with psychomotor skill acquisition through blended learning among nursing students: A qualitative study. Nurse Education in Practice, 65, Article 103486. 10.1016/j.ijnsa.2026.100547 [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplemental Material for Impact of Basic Life Support Training Program on Nurses’ Knowledge and Practice by Ebenezer Quayson, Irene Korkoi Aboh, Rita Opoku-Danso in Sage Open Nursing.
Supplemental Material for Impact of Basic Life Support Training Program on Nurses’ Knowledge and Practice by Ebenezer Quayson, Irene Korkoi Aboh, Rita Opoku-Danso in Sage Open Nursing.
Supplemental Material for Impact of Basic Life Support Training Program on Nurses’ Knowledge and Practice by Ebenezer Quayson, Irene Korkoi Aboh, Rita Opoku-Danso in Sage Open Nursing.
Supplemental Material for Impact of Basic Life Support Training Program on Nurses’ Knowledge and Practice by Ebenezer Quayson, Irene Korkoi Aboh, Rita Opoku-Danso in Sage Open Nursing.
Supplemental Material for Impact of Basic Life Support Training Program on Nurses’ Knowledge and Practice by Ebenezer Quayson, Irene Korkoi Aboh, Rita Opoku-Danso in Sage Open Nursing.
Supplemental Material for Impact of Basic Life Support Training Program on Nurses’ Knowledge and Practice by Ebenezer Quayson, Irene Korkoi Aboh, Rita Opoku-Danso in Sage Open Nursing.
Data Availability Statement
The dataset generated and/or analyzed during the study is available in the Mendeley Data repository, DOI: 10.17632/4bzvjwzxs2.1.*