Abstract
High-quality cardiopulmonary resuscitation (CPR) directly influences cardiac arrest survival, yet many hospitals struggle to achieve consistent performance. Although simulation-based training is widely used, confidence may not reliably align with proficiency for physically demanding CPR skills. Save a Pulse, a Rapid Response nurse-led in-situ simulation program, was developed to strengthen nurses' cardiac arrest response using structured team training and objective feedback. This study aimed to assess nurses' confidence and CPR performance using a multimethod assessment of self-reported confidence, facilitator observations, and SimPAD® metrics.
This 13-month pretest-posttest study occurred across 23 inpatient units at a large academic hospital. Shockable and nonshockable scenarios were facilitated followed by structured debriefing. Nurses completed pre/post confidence surveys; matched pairs were analyzed (n=190). Facilitators assessed team performance across seven domains (met/not met, n = 112 events). SimPAD®devices captured compression depth, rate, recoil, and flow fraction. Paired t-tests compared confidence scores; Cohen's d estimated effect size. Descriptive statistics summarized performance.
Post-simulation confidence increased significantly (t = -14.38, p< .001, d=1.11). However, performance revealed substantial gaps. Facilitator observations showed recognition and response met criteria in 79% of sessions, but communication in 15%, airway management in 17%, and overall performance in 38%. SimPAD® data displayed deficits in compression mechanics: median adequate depth 24% (IQR 2–45%, range 0–92%), adequate rate 71% (IQR 50–83%), mean flow fraction 63% (target >80%), and recoil 84% (IQR 72–93%). The wide variability in depth indicated that confidence gains did not translate to consistent technical proficiency.
While simulation improves psychological readiness, competence in CPR’s technical skills and team-based behaviors require targeted strategies. Compression depth requires sustained force, precise body mechanics, and real-time feedback. Notably, communication was met in only 15% of sessions, a shortcoming that compromises coordinated resuscitation efforts. Effective team performance under stress demands structured communication protocols and focused team drills beyond scenario exposure. This nurse-led model is a feasible and adaptable approach across diverse global settings to strengthen resuscitation readiness and improve patient outcomes.
Notes
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Sigma Membership
Alpha Alpha Lambda at-Large, Beta Upsilon
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Cohort
Research Approach
Quantitative Research
Keywords:
Implementation Science, Simulation, Patient Simulation, Interprofessional Initiatives, Confidence, Task Performance and Analysis
Recommended Citation
Morrison, Kimberly; Oh, Anna; Alzawad, Zainab; Morita, Staeci; Garvey, Sean; and Lee, Soo Young, "Save a Pulse: Bridging Nurse Confidence and Team Performance through In-Situ Simulation" (2026). International Nursing Research Congress (INRC). 81.
https://www.sigmarepository.org/inrc/2026/presentations_2026/81
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-07-28
Save a Pulse: Bridging Nurse Confidence and Team Performance through In-Situ Simulation
Toronto, Ontario, Canada
High-quality cardiopulmonary resuscitation (CPR) directly influences cardiac arrest survival, yet many hospitals struggle to achieve consistent performance. Although simulation-based training is widely used, confidence may not reliably align with proficiency for physically demanding CPR skills. Save a Pulse, a Rapid Response nurse-led in-situ simulation program, was developed to strengthen nurses' cardiac arrest response using structured team training and objective feedback. This study aimed to assess nurses' confidence and CPR performance using a multimethod assessment of self-reported confidence, facilitator observations, and SimPAD® metrics.
This 13-month pretest-posttest study occurred across 23 inpatient units at a large academic hospital. Shockable and nonshockable scenarios were facilitated followed by structured debriefing. Nurses completed pre/post confidence surveys; matched pairs were analyzed (n=190). Facilitators assessed team performance across seven domains (met/not met, n = 112 events). SimPAD®devices captured compression depth, rate, recoil, and flow fraction. Paired t-tests compared confidence scores; Cohen's d estimated effect size. Descriptive statistics summarized performance.
Post-simulation confidence increased significantly (t = -14.38, p< .001, d=1.11). However, performance revealed substantial gaps. Facilitator observations showed recognition and response met criteria in 79% of sessions, but communication in 15%, airway management in 17%, and overall performance in 38%. SimPAD® data displayed deficits in compression mechanics: median adequate depth 24% (IQR 2–45%, range 0–92%), adequate rate 71% (IQR 50–83%), mean flow fraction 63% (target >80%), and recoil 84% (IQR 72–93%). The wide variability in depth indicated that confidence gains did not translate to consistent technical proficiency.
While simulation improves psychological readiness, competence in CPR’s technical skills and team-based behaviors require targeted strategies. Compression depth requires sustained force, precise body mechanics, and real-time feedback. Notably, communication was met in only 15% of sessions, a shortcoming that compromises coordinated resuscitation efforts. Effective team performance under stress demands structured communication protocols and focused team drills beyond scenario exposure. This nurse-led model is a feasible and adaptable approach across diverse global settings to strengthen resuscitation readiness and improve patient outcomes.
Description
Save a Pulse, a nurse-led in-situ simulation program, significantly increased nurses' confidence in cardiac arrest response (d=1.11). However, objective performance data revealed persistent gaps: only 24% of compressions achieved adequate depth (range 0–92%) and communication met criteria in 15% of sessions. Findings show that confidence gains alone do not ensure CPR proficiency, supporting targeted training for physically demanding CPR skills and team–dependent resuscitation skills.