Neonatal Resuscitation Program Cognitive Knowledge Acquisition Validation after Change in Instruction Method

Saturday, 7 November 2015

Donna M. Fletcher, BSN, RNC-OB
Clinical Care Services and Nursing Resource Float Pool, Cedars-Sinai Medical Center, Los Angeles, CA, USA



            The Neonatal Resuscitation Program (NRP) followed the trend of many clinical competency programs, such as Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and Pediatric Advance Life Support (PALS), that moved away from instructor-led to computer-based learning supported by instructor-facilitated skills review and testing.  The change in teaching methods has been supported by scholarly evidence.  Evidence-based research indicated blended-learning has been an effective format for teaching clinical skills.  The BLS, ACLS and PALS programs use a computer-based, interactive progressive program with video scenarios for content and skills instruction with instructor-facilitated skills review and testing.  The NRP or Neonatal Advanced Life Support (NALS) training course uses a self-directed reading with computer-based testing and optional DVD of skills video clips for content and skills learning, followed by the instructor-led skills review and testing.  The purpose of this research study was to validate whether the change from an instructor-led course to a self-directed computer-based course equally supported cognitive content acquisition for nurses taking the NALS course.


 A quantitative, retrospective, data review of NALS test scores from 2010 to 2013 was conducted to compare nurse competency scores following the instructor-led and self-directed computer based courses.  A comparative independent-samples t test analysis was used to compare the mean passing score from each group.  The instructor-led group had n-327 with the mean passing score of 94.08 and standard deviation of 3.927.  The self-directed computer-based group had n-382 with the mean passing score of 93.21 and standard deviation of 3.344.  The significance or p value from both the Levene’s test for equality of variances and the t-test for equality of means was 0.002


The results from the comparison of the two groups of data indicated that the cognitive content acquisition of the instructor-led group was higher as indicated by the passing score group mean of 94.08 than was the cognitive content acquisition of the self-directed computer-based group with the passing score mean of 93.21.  Data analysis showed a statistical significant p-value of 0.002 indicating a .2% chance that the higher mean score for the instructor-led method occurred by chance.  The researcher’s null hypothesis stated that there is no difference in cognitive knowledge acquisition of course content in participants who receive Neonatal Advance Life Support training by an instructor-led or self-directed computer-based instruction method.  This research showed there was a statistically significant difference in the test score mean between the instructor-led and self-directed computer-based instruction method; therefore, the null hypothesis was rejected. 


Based on the research analysis the researcher concluded that, in the current self-directed computer-based cognitive content instruction format of the NRP course, student cognitive knowledge acquisition of course content was significantly better with the instructor-led method.  Although the evidence does not support the NRP instruction method change to the self-directed computer-based format, data does not conclusively suggest this program should return to the previous instructor-led method.  A limitation of this study was a lack of available data to compare the BLS, ACLS, and PALS computer-based, interactive progressive scenario program instruction format with the NRP instruction formats.  Several implications of these findings for clinical leaders and clinical educators were noted.  Data indicated the importance of instructor engagement with course participants during the course, particularly during the skills review and integrated skills testing component, to confirm content knowledge and translation into clinical competence to ensure quality, safe patient care.   Findings also suggested the importance ongoing competency assessment in the clinical setting to ensure continued content understanding and maintenance of skills for neonatal resuscitation.  Finally, study data highlighted the importance of securing the necessary financial and human resources required to support interactive progressive computer-based NALS course content, particularly with respect to instructor engagement in skills review to ensure application of content knowledge and achievement of required certifications.