Effect of the BOPPPS-RCDP in Basic Life Support Training for Newly Graduated Registered Nurses: A Mixed-Methods Study

Effect of the BOPPPS-RCDP in Basic Life Support Training for Newly Graduated Registered Nurses: A Mixed-Methods Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of the BOPPPS-RCDP in Basic Life Support Training for Newly Graduated Registered Nurses: A Mixed-Methods Study Shirong Wu, Linqi Gan, Chuanren Ling, Haihui Fang, Guizhen Zeng, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6467343/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Basic Life Support (BLS) is an essential emergency skill for healthcare professionals. Newly Graduated Registered Nurses (NGRNs) often encounter challenges in clinical practice due to their lack of clinical experience. Standardized operational training can enhance the emergency response capability and clinical emergency response of NGRNs. Objectives: This study explores the application of BOPPPS-RCDP to the training of NGRNs-BLS, aiming to (1) compare the effect of BOPPPS-RCDP with that of BOPPPS training, and (2) explore the experiences and views of NGRNs and instructors on the integrated model and (3) provide evidence-based recommendations for improvements to BLS training in nursing education. Study design: This study employed an explanatory sequential mixed-methods design, involving conducting semi-structured interviews with both students and instructors. Methods: The 80 participants were randomly divided into the control group and the intervention group in a 1:1 ratio. The control group adopted the traditional teaching method, while the intervention group added the RCDP teaching method to the traditional teaching method. The researchers conduct a semi-structured interview among students and instructors according to the semi-structured interview guidelines to gain an in-depth understanding of the subjective feelings of NGRNs and training instructors. Results: The results of quantitative analysis showed that the BOPPPS-RCDP group had significantly improved theoretical knowledge and practical skills compared with the BOPPPS model alone ( P < 0.05). Except for compression depth, chest recoil rate, and theoretical test scores, all measured indicators demonstrated statistical significance ( P < 0.05), indicating that the BOPPPS-RCDP model is more effective in enhancing training outcomes. Qualitative findings show that most of the NGRNs and instructors believe that BOPPPS-RCDP can effectively promote the acquisition of BLS skills. Conclusion: The BOPPPS-RCDP model has been shown to effectively facilitate the rapid acquisition of BLS skills among NGRNs, thereby enhancing both the training outcomes and participant satisfaction. This model represents an innovative educational approach with significant potential for advancing BLS education within nursing practice. basic life support training BOPPPS new graduated registered nurses rapid cycle deliberate practice Figures Figure 1 Figure 2 Figure 3 Introduction Newly Graduated Registered Nurses (NGRNs) frequently encounter challenges when applying theoretical knowledge to clinical practice [ 1 , 2 ] . Clinical teaching is the key to promote students ' seamless transition from theoretical knowledge to professional environment [ 3 ] . Effective basic life support (BLS) refers to the adoption of a series of simple and effective first aid measures in emergency situations such as cardiac arrest or respiratory arrest, so as to maintain the patient 's vital signs and create opportunities for further medical treatment. Its effectiveness depends on the proficiency and personal ability of the operator [ 4 ] . The core point of BLS is to start high-quality cardiopulmonary resuscitation (CPR) as soon as possible, and use automatic external defibrillator (AED) quickly. At the same time, BLS is also a key medical intervention in cardiac or respiratory arrest, including airway management , rescue breathing and chest compressions . BLS aims to sustain vital organ perfusion through manual chest compressions and ventilatory support until advanced life support can be administered [ 5 , 6 ] . Proficiency in BLS is the basic requirement of NGRNs [ 7 ] . Hospitals must provide standardized and high-quality training to nursing staff to improve professional standards and enhance emergency response capabilities [ 8 ] . A study has shown that [ 9 ] effective BLS training can enhance nurses' confidence and improve their ability to apply CPR in realistic clinical settings. Despite two years of structured clinical training experience [ 10 ] , NGRNs still face persistent deficiencies in the current national standardized training system [ 11 , 12 ] . In addition, the current training methods mainly focus on theory and skills, which often lead to poor results and fail to promote students ' active participation [ 13 ] . Therefore, there is an urgent need for a more efficient and effective NGRNs training program. The BOPPPS teaching model originated in the Canadian higher education instructor training system and classroom teaching. It divides the teaching process into six different parts: Bridge-in, Objective, Pre-test, Participatory Learning, Post-test and Summary [ 14 ] . Before the class, the instructor evaluates the nurses ' understanding by predicting and identifying the key knowledge, so as to guide and adjust the teaching methods [ 15 ] . Participatory learning enables nurses to recognize and address their weaknesses, thereby improving post-test scores and having a deeper understanding of the subject [ 16 ] . By prioritizing learner-centered engagement and iterative feedback mechanisms, the BOPPPS model fosters active participation in the learning process while establishing bidirectional communication channels between students and educators. Empirical evidence demonstrates that when integrated with complementary pedagogical strategies, the BOPPPS framework demonstrates statistically significant enhancements in instructional efficacy ( P < 0.05) and measurable improvements in learners ' competency acquisition [ 17 ] . Specifically, this model is combined with team-based learning (TBL) to promote cooperation and interaction while meeting students ' personalized learning needs, and ultimately improve the self-learning and critical thinking ability of nursing students [ 18 ] . Rapid cycle deliberate practice (RCDP) is a new teaching method, including repeated practice, specific feedback and gradual improvement of muscle memory [ 19 ] . Training breaks down skills into smaller parts, making learning easier. At the end of each part, learners can get immediate feedback, which helps them practice correctly and improve their skills in each cycle [ 20 , 21 ] . This method not only improves learners ' professional knowledge, but also helps to memorize key knowledge and skills [ 19 , 22 ] to improve learners ' confidence in a relatively short period of time and maintain training effectiveness in the long term [ 23 ] . Research shows that RCDP has significant effectiveness in improving learners ' theoretical knowledge, clinical professional skills and teamwork ability compared with traditional simulation-based training methods [ 24 ] . Nurses must learn key steps and standardized procedures when starting a career or learning new technologies. BOPPPS and RCDP teaching method have been applied to medical teaching and training, and good teaching feedback has been obtained [ 25 , 26 ] . Research shows that the mixed BOPPPS teaching mode can effectively improve the comprehensive quality of students [ 27 , 28 ] . At present, there is no research on the application of RCDP in clinical skills training for nurse [ 29 ] , and there is no research on the combination of BOPPPS and RCDP. Therefore, the main purpose of this study is to explore the effect of BOPPPS teaching mode combined with RCDP teaching mode on the BLS training of NGRNs. Through the exploration of this teaching mode, we hope to provide an effective teaching and training method. Methods and Study Design Study design A mixed research method combining quantitative and qualitative research was used to establish a control group and an intervention group. The study was approved by the hospital, and all NGRNs provided informed consent before participating in the study. All training is conducted in a clinical skills centre in a comprehensive learning hospital using a simulator (Resuscitation Anne QCPR, Norwegian, USA). Participants and Inclusion and Exclusion Criteria Students In this study, 80 nurses in the 2021 and 2022 sessions of 2023 were selected as the research objects to investigate the effectiveness of BOPPPS teaching method and BOPPPS-RCDP teaching method applied to NGRNs-BLS training. Inclusion Criteria: (1) Newly graduated registered nurses or (2) Clinical nursing staff. Exclusion Criteria: (1) More than 3 months of emergency or intensive care unit (ICU) nursing experience; (2) Pregnant; (3) Chest compression operation cannot be performed due to physical or medical reasons. Faculty staff members A core project committee was established, comprising 1 head nurse and 3 senior nurses (including 2 AHA-certified BLS/ACLS instructors), responsible for quality supervision and operation management of the training program. Two postgraduate researchers were tasked with questionnaire development and data collection protocols. The instructor selection criteria included: (1) ≥10 years of clinical experience (2) Successful completion of standardized AHA training curricula (3) Certification as qualified instructors Eight certified instructors delivered structured pedagogical interventions , including: Didactic instruction (core theoretical frameworks) Skill demonstrations (AHA guideline-compliant techniques) Small-group practice sessions (scenario-based simulations) Interventions This study involved 80 NGRNs. Participants were randomly divided into BOPPPS group and BOPPPS-RCDP group according to the ratio of 1:1. They were divided into 8 groups, each group consisted of 1 instructor, 5 students and an Anne model. Trainees take turns as the main operator, while others observe or provide assistance. The control group and the intervention group used the BOPPPS teaching mode to complete the course in the same time. The BOPPPS training model is divided into six stages (Figure.1). In this study, it is divided into the following six stages: Before class: 1. Bridge-in(B) Instructors begin their educational journey by outlining the teaching process, clarifying the importance of basic life support (BLS) training, and stimulating the interest of NGRNs. 2. Objectives(O) The learning objectives phase distinctly articulates that the primary aim of the training is to equip participants with the proficiency to perform high-quality cardiopulmonary resuscitation (CPR) skills. 3. Pretest (P) A pretest is conducted to gauge the current knowledge and comprehension of the students prior to the commencement of instruction. This evaluation informs adjustments to the teaching content and methodologies. Both theoretical knowledge and practical BLS skills are assessed through written tests and simulated practical scenarios. In the classroom: 4. Participatory learning(P) This constitutes the heart of the teaching approach, fostering active engagement, exploration, and independent learning among students through a variety of activities and interactive exercises. It enables NGRNs to play a practical role in their education, improving skills acquisition and retention. The control group: The training adopts the traditional teaching method of teacher-led and students ' independent practice. It included a 30-minute lecture based on the 2015 and 2020 American Heart Association (AHA) guidelines, and a 90-minute CPR virtual exercise in a simulated scenario. NGRNs are encouraged to practice themselves until they can perform high-quality CPR within a 2-minute window, or until they are exhausted and unable to continue practice. Intervention group: This training integrated the RCDP teaching method into the participatory learning phase. The training instructor strictly follows the standardized operation process and divides the core skills of cardiopulmonary resuscitation into four different operation steps according to the dimensions of the subjective evaluation scale (see Figure 2.): A, B, C and D. It includes: A) identifying cardiac arrest and initiating CPR; B) chest compression; C) electrical defibrillation; D) balloon ventilation, assessment, and evaluation. In the process of teaching implementation, students complete part A in pairs, and there is a period of time for instructors to evaluate their implementation and correct mistakes. After that, they continued to do parts A and B, stopped to receive feedback and recorded their progress. Finally, the whole process operation is completed by cyclic progressive training (as shown in Figure 3.). In the process of this repeated cycle, students participate in peer assessment of each other 's skills, and mentors provide additional insights and guidance to strengthen learning. 5. Posttest (P) At this stage, nurses need to independently complete the same theoretical test and operational test as the pretest, but the mentors of each group exchange during the operational test to make the assessment results more objective and real. 6. Summary (S) The instructor reviews the training process according to each group 's results to deepen the NGRNs ' impressions of CPR skills. At the same time, a course experience questionnaire is issued to improve the next training plan. Data measurement The main outcome was the intergroup differences in performance parameters in the Anne model after 5 CPR cycles: (a) appropriate rate: percentage of chest compressions performed between 100 and 120 times per minute, (b) appropriate depth: percentage of chest compression depth between 5 and 6 cm, (c) appropriate chest recoil: the percentage of full chest recoil after each compression, (d) chest compression fraction(CCF) : the percentage of time that chest compressions were provided, and (e) adequate ventilation: qualified ventilation as a percentage of total ventilation. The secondary results of the study used a series of measurement methods to assess NGRNs, including BLS subjective score sheets, theoretical test scores, and course experience questionnaires. The BLS subjective score sheet was expertly designed using evidence-based nursing concepts and aligned with AHA guidelines. It consists of scores for A = Recognise cardiac arrest and start CPR. (1. Assessing environment + 2. Judging consciousness + 3. Judging respiratory and pulse + 4. Start the EMS); B = Chest compressions (5. Chest compressions); C = Electrical defibrillation (6. Electrical defibrillation) ; D = Balloon ventilation, Examination and evaluation (7. Balloon ventilation + 8. Examination and evaluation) ( Supplementary material 1 ). At the same time, according to the relevant literature and relatively mature questionnaires, a self-designed course experience questionnaire ( Supplementary material 3 ) was used to evaluate the teaching method, effect and overall experience with a 5-point Likert scale. Data collection Quantitative phase The primary evaluation criteria were objective scores. QCPR model was used to score the electronic display screen of resuscitation Anne to obtain an objective score, provide immediate and accurate feedback, and display the corresponding value after recording the operation. The second criterion was the subjective score ( Supplement material 1 ), which was assessed by the same group of examiners using a standardized assessment form based on the performance of the subjects in the BLS assessment. Qualitative phase: Semi-structured interview We prepared high-quality recording equipment to capture the interview content and ensured the accuracy and completeness of the information. We arranged a quiet and comfortable interview environment for each participant individually to provide privacy and a relaxed atmosphere. Interviews are expected to last between 30 and 60 minutes. Through semi-structured interviews, subjective perceptions of NGRN and training instructors were collected to explore the differences in student learning experiences and instructor training effects between the BOPPPS teaching model and the BOPPPS-RCDP teaching model. NGRNs were selected from the BOPPPS-RCDP group and voluntarily shared their learning experiences and insights, while also inviting training instructors willing to share suggestions and opinions to participate in the interviews. The sample size was determined based on the saturation of information provided by the respondents. The project core team conducted interviews with the participants. In order to fully understand the teaching effectiveness of combining BOPPPS with RCDP and the authentic experiences of students, the research team initially conducted preliminary interviews with two students. The final interview outline is as follows ( Table 1 and Table 2 ). Table 1 Interview guide (For NGRNs) 1.What do you think about the application of BOPPPS-RCDP model in BLS training? 2.Do you think your study situation has changed? 3.What are BLS training recommendations for BOPPPS-RCDP teaching? Table 2 Interview guide (For instructors) 1. What kind of teaching method do you prefer? 2. What do you think needs to be further improved in the teaching reform of BOPPPS-RCDP? Data analysis Data analysis was conducted using the SPSS 25.0 statistical software package. Quantitative data were described using frequencies and percentages(％). Normally distributed quantitative data were described using mean ± SD (x ± s), while non-normally destributed quantative data were described using median (interquartile range) [M(P25,P75)]. Depending on the nature of the data, between-group comparisons were performed using t-tests, chi-square tests, or non-parametric test, or non-parametric tests, with a significance level set at α=0.05. After the interview, the recording was transcribed verbatim within 24 hours. Subsequently, Colaizzi 's seven-step analysis method was used to analyze the data, including the following steps: familiarizing with the data, identifying important statements, forming meanings, clustering topics, developing detailed descriptions, constructing basic structures, and seeking verification of the basic structure [30] . The two researchers coded the interview data respectively. To preserve academic rigor, any differences encountered by the researchers are discussed and resolved at the research group meeting to ensure the scientific credibility of the conclusions. Nvivo14.0 software was used to organize, analyze and encode the data. Results Participant characteristics A total of 80 NGRNs who met the inclusion and exclusion criteria were equally assigned to the control group or the intervention group. The average age of the participants was 23 years old, 81.2% were female, 68.8% had a bachelor 's degree, 76.3% had a BMI within the normal range, and 62.5% had participated in CPR training in the past 6 months. In the past year, only 15% of nurses have performed CPR on real people. There was no significant difference in demographic characteristics or baseline chest compression skills between the two groups ( Table 3 ). Table 3 Demographic characteristics of the participants in the two groups (n= 80) (MD ± SD)/n (%) Variables Total BOPPPS Group (n= 40) BOPPPS-RCDP Group (n= 40) Z/X 2 P value 1. Age（year） 22.55±0.62 22.53±0.96 22.63±0.74 2.115 0.150 2. Gender Male 15(18.8%) 8(20.0%) 7(17.5%) 0.082 0.775 Female 65(81.2%) 32(80.0%) 33(82.5%) 3. Educational level College degree 21(26.2%) 9(22.5%) 12(30.0%) 1.389 0.539 Bachelor degree 55(68.8%) 28(70.0%) 27(67.5%) Master's degree 4(5.00%%) 3(7.5%) 1(2.5%) 4. BMI Underweight 14(17.5%) 6(15.0%) 8(20.0%) 1.972 0.377 Normal weight 61(76.3%) 30(75.0%) 31(77.5%) Overweight 5(6.2%) 4(10.0%) 1(2.5%) 5. CPR training in the past year No 30(37.5%) 16(40.0%) 14(35.0%) 0.213 0.644 Yes 50(62.5%) 24(60.0%) 26(65.0%) 6. Previous experience with Chest Compression on real patient No 68(85.0%) 32(80.0%) 36(90.0%) 1.569 0.348 Yes 12(15.0%) 8(20.0%) 4(10.0%) Quantitative findings Comparing the scores of BOPPPS group and BOPPPS-RCDP group before and after training, we found that the ventilation pass rate, theoretical test score and individual subjective score of nurses in BOPPPS group were significantly improved after training ( P < 0.05), but other indicators did not change much. In contrast, the BOPPPS-RCDP group had significant improvements in depth of compression, frequency of compression, CCF, ventilation, and theoretical test scores after training ( P < 0.05). Only full chest recoil did significantly improve ( Table 4 ). Overall, this study suggests that BOPPPS training of NGRNs can significantly improve some indicators and compare the CPR scores of the two groups after training. Except for depth, total chest recoil and theoretical test scores, all indicators were statistically significant ( Table 4 ). Finally, we issued a course experience questionnaire after the training. The analysis shows that BOPPPS-RCDP group is obviously superior to BOPPPS group in teaching methods, teaching effects, teaching feelings and other key aspects ( Table 5 ). Table 4 Comparative analysis of indexes pretest and posttest among two group nurses [M(P25,P75)] Variables Time BOPPPS Group BOPPPS-RCDP Group Z P value Objective compression score Appropriate depth (%) Pretest 19.65(5.14,38.97) 22.81(8.13,42.13) 0.558 0.577 Posttest 30.43(5.68,52.36) 38.31(20.05,56.24) 1.453 0.146 Z 1.335 3.051 P -value 0.182 0.002 Appropriate rate (%) Pretest 63.41(13.02,95.95) 68.08(34.57,93.67) 0.409 0.683 Posttest 59.58(22.46,96.04) 92.25(82.01,97.88) 2.882 0.004 Z 0.161 3.118 P -value 0.872 0.002 Fully recoiled chest(%) Pretest 100.00(100.00,100.00) 100.00(100.00,100.00) 1.157 0.247 Posttest 100.00(100.00,100.00) 100.00(100.00,100.00) 0.479 0.632 Z 0.357 0.204 P -value 0.721 0.838 CCF (%) Pretest 66.00(51.50,79.25) 61.00(50.50,80.00) 0.101 0.919 Posttest 63.00(50.75,77.00) 71.00(66.00,83.50) 2.113 0.035 Z 0.336 2.320 P -value 0.737 0.020 Appropriate ventilation(%) Pretest 59.00(39.75,74.00) 59.00(46.50,70.75) 0.472 0.637 Posttest 71.00(68.00,80.00) 77.50(70.25,82.75) 2.119 0.034 Z 4.599 3.425 P -value <0.001 <0.001 Subjective score A Pretest 13.00(12.00,16.00) 15.00(12.25,18.00) 1.574 0.116 Posttest 19.00(16.00,21.00) 21.00(20.00,22.00) 3.769 <0.001 Z 4.744 5.353 P -value <0.001 <0.001 B Pretest 26.00(20.25,28.00) 27.00(22.00,28.75) 0.747 0.455 Posttest 28.50(26.00,31.00) 30.50(30.00,33.00) 3.980 <0.001 Z 2.054 4.596 P -value 0.040 <0.001 C Pretest 7.00(6.00,10.00) 7.00(5.25,10.00) 0.316 0.752 Posttest 10.00(8.00,10.00) 12.00(10.00,13.00) 4.307 <0.001 Z 3.752 5.209 P -value <0.001 <0.001 D Pretest 13.00(10.00,17.50) 16.00(12.00,18.00) 1.103 0.270 Posttest 18.00(16.00,19.00) 19.00(18.00,20.00) 3.133 0.002 Z 3.588 4.787 P -value <0.001 <0.001 Theory test score Pretest 67.00(59.00,72.00) 67.75(62.00,73.75) 0.650 0.516 Posttest 74.00(71.00,76.00) 74..00(72.25,77.00) 0.768 0.442 Z 4.120 4.855 P -value <0.001 <0.001 (CCF = chest compression fraction; A = 1. Assessing environment + 2. Judging consciousness +3. Judging respiratory and pulse + 4. Start the EMS; B = 5. Chest compressions; C = 6. Electrical defibrillation; D = 7. Balloon ventilation + 8. Examination and evaluation) Table 5 Comparison of the modified course experience questionnaire between the BOPPPS group and the BOPPPS-RCDP group Group Dimension Teaching method Teaching effect The feeling of learning Total points Control group 20.00(16.00,20.00) 19.00(16.00,20.00) 10.00(8.00,10.00) 47.50(40.00,50.00) Experimental group 20.00(19.25,20.00) 20.00(20.00,20.00) 10.00(10.00,10.00) 50.00(48.50,50.00) z 2.262 2.700 2.771 2.412 p 0.024 0.007 0.006 0.016 Qualitative findings from interviews with NGRN NGRNS felt that the BOPPPS-RCDP teaching method helped them build a better learning mindset and enabled them to learn skills more systematically. Three of the participants shared their insights. N1: “I think the BOPPPS-RCDP training method helps me form a good learning mindset in the process of learning BLS skills. Through the six steps of BOPPPS, I can learn this skill more systematically.” N2: “The BOPPPS-RCDP teaching method allows me to gradually master BLS skills by decomposing knowledge modules and practicing repeatedly. Every step of progress gives me a sense of achievement and makes me more confident to continue to learn.” BOPPPS teaching method can stimulate students ' interest in learning and induce students to have a strong learning motivation. By combining BOPPPS with RCDP teaching method, students are guided to practice repeatedly and feedback in time to achieve the purpose of mastering BLS skills. N2: “Through the BOPPPS introduction link, I stimulated my curiosity about learning and consciously began to actively think about problems, and gradually made my understanding of BLS skills deeper.” N3: “Integrating RCDP into BOPPPS teaching not only enhances our memory of CPR operation, but also enhances our muscle memory through repeated circular exercises, which helps me achieve better results in the post-test.” According to NGRNs, the BOPPPS-RCDP teaching method breaks the limitations of the traditional teaching method ' instructor 's monologue ', which mainly emphasizes ' what students have learned ', rather than blindly listening to the instructor 's explanation. Instructors observe the students ' participation and dynamically adjust the teaching rhythm, deepen the students ' impression through this instant feedback, so as to improve the learning efficiency. N4: “At the end of each practice, timely feedback of the shortcomings, and then repeated practice to strengthen, can effectively strengthen my mastery of skills.” N5: “By constantly reviewing old knowledge and learning new skills, I can master BLS skills faster. This teaching method has effectively improved my learning efficiency.” N1: “Through the BOPPPS-RCDP teaching method, we are no longer learning alone, but teamwork. In the interaction and discussion with peers to learn from each other, share experience, improve my skills, but also enhance my learning confidence and team spirit, which inspired me to learn more deeply.” NGRNs agreed that the BOPPPS-RCDP teaching method can complement each other in the process of teamwork, and it can also strengthen teamwork spirit, so as to achieve the purpose of in-depth learning. This is completely different from the traditional teaching method in which instructors impart knowledge in one way and students ' participation is low. This new learning method can arouse their interest in learning. N1: “Through the BOPPPS-RCDP teaching method, we are no longer learning alone, but teamwork. In the interaction and discussion with peers to learn from each other, share experience, improve my skills, but also enhance my learning confidence and team spirit, which inspired me to learn more deeply.” Participants indicated that performing CPR multiple times can bring great help to their learning and practice, but multiple operation exercises make participants feel physically tired, so it is recommended to reduce the number of presses in participatory learning, such as two cycles at a time. Qualitative Finding from interviews with instructors The BOPPPS-RCDP model constructs a multi-dimensional knowledge equity implementation mechanism through hierarchical cognitive deconstruction and dynamic adaptive design. The BOPPPS teaching method emphasizes goal orientation and instant feedback, while the RCDP method focuses on research and practice. Combining the advantages of the two methods, it may reduce students ' cognitive load in terms of knowledge equity through hierarchical teaching, modular deconstruction, immediate feedback, so as to adapt to the needs of different learners. Instructor 1 Indicates: “As an educator committed to maintaining high teaching standards and ensuring equality, the BOPPPS-RCDP model ensures that the same learning content is provided to each student by following uniform training standards. It also ensures that each student benefits from a certain amount of training time. This approach is not only about fairness, but also about making the best use of our limited time to teach basic life support skills to each student as thoroughly as possible.” The improved BOPPPS-RCDP model decomposes the BLS skill system into small modules by integrating the modular cognitive deconstruction strategy, which significantly reduces the instantaneous cognitive needs of NGRNs. Greatly improve the learning efficiency. At the same time, based on the real-time feedback system, students ' errors can be corrected immediately, which is more conducive to students ' mastery of skills. Therefore, compared with the traditional teaching method, the instructors prefer the BOPPPS-RCDP teaching method. In the interview, one of the instructors mentioned: “Compared with the traditional teaching method, I prefer the new teaching mode of BOPPPS-RCDP, because the BOPPPS-RCDP teaching mode requires each student to actively participate in the complete A-B-C-D cycle practice. This method is conducive to improving learning motivation and learning efficiency. It requires students to fully participate in and take advantage of practical learning opportunities. I found that this teaching method increased my enthusiasm for teaching and improved my satisfaction with BLS teaching. Therefore, I believe that the BOPPPS-RCDP method is more efficient in training.” About BOPPPS-RCDP teaching method, instructor 1 put forward some suggestions for improvement. Instructor 1 Indicates: “The BOPPPS-RCDP teaching model is an efficient learning method, but it should avoid excessive reliance on repeated exercises. After each exercise, students can increase their reflection on learning, and encourage or relax activities appropriately during the exercise process.” Discussion This study adopts a novel teaching strategy that combines the BOPPPS and RCDP methods into the BLS training of NGRNs, aiming to evaluate the learning effect of this comprehensive teaching method and collect insights from NGRNs and training instructors on the effectiveness of this teaching model. To date, this study represents the first known application of the BOPPPS-RCDP joint method. The results show that the BOPPPS-RCDP comprehensive training program may be more effective than the BOPPPS individual training program in promoting NGRNs to quickly master BLS proficiency and develop teamwork skills in a short period of time. BOPPPS-RCDP can effectively promote the acquisition of skills in NGRNs By comparing the effects of BOPPPS-RCDP teaching mode and traditional BOPPPS teaching mode on nurses ' theoretical ability and practical ability, this study found that both groups had the ability to improve, but the effect of BOPPPS-RCDP group was significantly improved. This difference may be due to the lack of standardized training process in the traditional BOPPPS teaching method, requiring nurses to practice all BLS skills at the same time, which may cause a high cognitive load on learners, especially newly graduated registered nurses, due to the mismatch of learning ability [ 31 ] . The BOPPPS-RCDP group is based on the RCDP theory, through modular skill decomposition and instant feedback [ 32 , 33 ] , it effectively reduces the cognitive load of learners and promotes the internalization of skills. In addition, effective simulation teaching strategies, such as deliberate practice and the use of teaching feedback, also played an important role in the BOPPPS-RCDP group. Compared with BOPPPS alone, RCDP has proved to be effective in various skill teaching scenarios, making BOPPPS-RCDP more conducive to the improvement of nurses ' cardiopulmonary resuscitation skills. After training, the group receiving BOPPPS-RCDP guidance obtained higher class assessment scores than the BOPPPS group. This can be attributed to the innovativeness of BOPPPS-RCDP as a novel learning method, which brings excellent learning outcomes, higher satisfaction and improves students ' confidence [ 29 , 34 ] . Feedback from NGRNs and instructors According to the results of interviews with NGRNs and instructors, the BOPPPS-RCDP teaching method is more conducive to the rapid acquisition of BLS skills. NGRNs report that this approach helps them learn skills faster and helps them remember them better. They pointed out that the combination of theoretical knowledge and practice through this method improved the overall learning experience, and they agreed that this was crucial to their future clinical practice. Although some NGRNs indicated physical fatigue due to the participation of learning, most people acknowledged the value of the BOPPPS-RCDP method and praised its effectiveness. Instructors also expressed a positive view that the BOPPPS-RCDP model helps students quickly master skills. This study adopts a standardized training program to ensure the consistency of the training content and the fixity of the training time, so that each student can obtain the same level of guidance and complete the training in the prescribed practice cycle. This structured training model enables instructors to efficiently carry out BLS skills training within a given time frame, thereby significantly improving the overall training effect. In addition, instructors generally observe that after adopting this teaching method, students ' participation in class is obviously improved, and their understanding and mastery of teaching materials are more in-depth and thorough. Limitations and future development directions This study has the following limitations, which need to be carefully considered : First, due to the unique cultural and organizational background of the research institution, it may limit the extrapolation validity of the research results, so this factor should be included in the interpretation results. Second, the educational intervention only implemented a single 4-hour intensive training, which was difficult to fully reflect the long-term effect of the BOPPPS-RCDP model. Thirdly, this study adopts quasi-experimental design, which cannot control all the variables that affect the results, so this potential bias needs to be considered when evaluating the results. In order to overcome the above limitations and improve the validity and reliability of the research results, rigorously designed randomized controlled trials should be carried out and sufficient sample size should be ensured. This kind of experiment helps to verify the robustness of the preliminary research results, and provides a more comprehensive perspective and basis for understanding the long-term effects of BOPPPS and RCDP learning methods in the field of nursing education. Conclusion The research shows that the BOPPPS-RCDP model not only improves the theoretical knowledge of NGRNs, but also improves their practical skills. This teaching method can improve the learning effect of NGRNs, it enable them to more effectively internalize and apply the knowledge they have learned, and also significantly improve their clinical nursing ability. In the future, BOPPPS-RCDP teaching method should be considered as a feasible and effective strategy in nursing education to improve the education level and clinical ability of nurses. In addition, it will be useful to extend the BOPPPS-RCDP method to other areas of health care education. Declarations Ethics approval and consent to participate This study did not involve human or animal subjects, and thus, no ethical approval was required(Supplementary material 4). In accordance with the ethical principles outlined in the Declaration of Helsinki, all participants provided informed consent before participating in the study. The anonymity and confidentiality of the participants were guaranteed, and participation was completely voluntary. Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Consent for publication Not applicable. Data availability statement The data that support the findings of this study are available from the corresponding author,[QYD], upon reasonable request. CRediT authorship contribution statement SW: Methodology, Data curation, Writing - original draft. Writing – review & editing. LQG: Writing – review & editing. CRL: Supervision, Writing - review & editing. HHF: Supervision, Investigation. GZZ: Supervision, Data curation. ZHM: Supervision, Software. ELW: Supervision, resources. ZSL: Supervision, resources. BHD: Project administration, Methodology. QYD: Supervision, Funding acquisition, Writing-review & editing. Funding statement This work was supported by the Guangdong Key Laboratory of Emergency Research of Traditional Chinese Medicine (No: 2023B1212060062),Guangdong Province Teaching Quality and Teaching Reform Project: Reform and practice of BOPPPS combined RCDP theory in BLS standardized teaching. Acknowledgment We are very grateful to the instructors of this training session. At the same time, we would like to extend special thanks to the newly hired nurses for their active participation and support in the research. References Pennbrant, S., et al., Mastering the professional role as a newly graduated registered nurse. Nurse Educ Today, 2013. 33 (7): p. 739-45. Parker, V., et al., New graduate nurses' experiences in their first year of practice. Nurse Educ Today, 2014. 34 (1): p. 150-6. Kenny, A., et al., Evaluation of a rural undergraduate nursing student employment model. Collegian, 2021. 28 (2): p. 197-205. Dragnes Brix, L., et al., Enhancing nursing students' self-reported self-efficacy and professional competence in basic life support: the role of virtual simulation prior to high-fidelity training. Teaching and Learning in Nursing, 2025. 20 (1): p. e236-e243. Olasveengen, T.M., et al., European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation, 2021. 161 : p. 98-114. 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Bi, M., et al., Comparison of case-based learning and traditional method in teaching postgraduate students of medical oncology. Med Teach, 2019. 41 (10): p. 1124-1128. Lee, M.M.D., Improving New Graduate Nurse Retention With a Transition to Emergency Nursing Practice Program. J Emerg Nurs, 2024. 50 (2): p. 178-186. Horsfall, J., M. Cleary, and G.E. Hunt, Developing a pedagogy for nursing teaching-learning. Nurse Educ Today, 2012. 32 (8): p. 930-3. Chen, L., et al., Effect of the BOPPPS model combined with case-based learning versus lecture-based learning on ophthalmology education for five-year paediatric undergraduates in Southwest China. BMC Med Educ, 2022. 22 (1): p. 437. Xu, Z., et al., Application of the hybrid BOPPPS teaching model in clinical internships in gynecology. BMC Med Educ, 2023. 23 (1): p. 465. Ma, X., et al., Effect of blended learning with BOPPPS model on Chinese student outcomes and perceptions in an introduction course of health services management. 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Orchanian-Cheff, Rapid Cycle Deliberate Practice in Healthcare Simulation: a Scoping Review. Med Sci Educ, 2021. 31 (6): p. 2105-2120. Yan, D.H., M.B. Slidell, and A. McQueen, Using rapid cycle deliberate practice to improve primary and secondary survey in pediatric trauma. BMC Med Educ, 2020. 20 (1): p. 131. Abelairas-Gómez, C., et al., Rapid cycle deliberate practice approach on resuscitation training: A systematic review. Resuscitation Plus, 2024. 18 : p. 100648. Li, Y., et al., Application effect of BOPPPS teaching model on fundamentals of nursing education: a meta-analysis of randomized controlled studies. Front Med (Lausanne), 2024. 11 : p. 1319711. Li, S., et al., Impacts of blended learning with BOPPPS model on Chinese medical undergraduate students: a comprehensive systematic review and meta-analysis of 44 studies. BMC Med Educ, 2024. 24 (1): p. 914. Li, Z., et al., Effects of BOPPPS combined with TBL in surgical nursing for nursing undergraduates: a mixed-method study. BMC Nursing, 2023. 22 (1): p. 133. Lemke, D.S., et al., Rapid-cycle deliberate practice improves time to defibrillation and reduces workload: A randomized controlled trial of simulation-based education. AEM Educ Train, 2021. 5 (4): p. e10702. Wirihana, L., et al., Using Colaizzi's method of data analysis to explore the experiences of nurse academics teaching on satellite campuses. Nurse Res, 2018. 25 (4): p. 30-34. Rogers, B.A. and A.E. Franklin, Cognitive load experienced by nurses in simulation-based learning experiences: An integrative review. Nurse Education Today, 2021. 99 : p. 104815. Magee, M.J., C. Farkouh-Karoleski, and T.S. Rosen, Improvement of Immediate Performance in Neonatal Resuscitation Through Rapid Cycle Deliberate Practice Training. J Grad Med Educ, 2018. 10 (2): p. 192-197. Yip, H.C., et al., Telementoring for endoscopic submucosal dissection in vivo training. Dig Endosc, 2023. 35 (1): p. 140-145. Gross, I.T., et al., Rapid Cycle Deliberate Practice (RCDP) as a Method to Improve Airway Management Skills - A Randomized Controlled Simulation Study. Cureus, 2019. 11 (9): p. e5546. Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial1Subjectivescoresheet.docx Supplementarymaterial2GeneralInformationQuestionnaire.docx Supplementarymaterial3TheMaastrichtClinicalTeachingQuestionnaire.docx Supplementarymaterial4DecisionofExemptionfromReview.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6467343","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471357681,"identity":"e045153c-89d9-43ab-9eaa-25ae91736718","order_by":0,"name":"Shirong Wu","email":"","orcid":"","institution":"the second clinical medical college of Guangzhou University Of Chinese Medecine","correspondingAuthor":false,"prefix":"","firstName":"Shirong","middleName":"","lastName":"Wu","suffix":""},{"id":471357683,"identity":"b4ffdff1-77bd-46e5-9684-65279bc59bd6","order_by":1,"name":"Linqi Gan","email":"","orcid":"","institution":"the second clinical 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02:53:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6467343/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6467343/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84778587,"identity":"163b1d65-e73b-46c2-a6f6-9b04d2b4480b","added_by":"auto","created_at":"2025-06-17 09:17:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":72174,"visible":true,"origin":"","legend":"\u003cp\u003eThe BOPPPS model is divided into the above six stages: Bridge-in、Objectives、Pre-test、Participatory learning、Post-test、Summary.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6467343/v1/62d36deafa6ce126a486a208.png"},{"id":84778590,"identity":"221a7e99-1bd0-4ee1-a2e2-21f7eb912255","added_by":"auto","created_at":"2025-06-17 09:17:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":259704,"visible":true,"origin":"","legend":"\u003cp\u003eFour steps of cardiopulmonary resuscitation:\u003c/p\u003e\n\u003cp\u003eIdentification and initiation of cardiac arrest → Chest compressions → Electrical defibrillation → Balloon ventilation → Examination and evaluation\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6467343/v1/a6d81c6ddf3d1da67aff8f49.png"},{"id":84778588,"identity":"ed2b41fb-ad41-4972-96f2-41e19f1df455","added_by":"auto","created_at":"2025-06-17 09:17:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":101641,"visible":true,"origin":"","legend":"\u003cp\u003eRapid deliberate cycle practice: set clear goals → break down difficult points targeted training → high-intensity repetition → immediate feedback correction → cyclic reinforcement until muscle memory/conditioning is formed.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6467343/v1/f3813dc4ae7e6af91b3601c6.png"},{"id":87234076,"identity":"c6fd3153-58de-4bd7-b175-60cde678da02","added_by":"auto","created_at":"2025-07-21 20:31:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1874258,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6467343/v1/bc749c07-e0ab-45c7-9d80-28e1a03eecb3.pdf"},{"id":84780331,"identity":"b5e084c6-4e57-4838-ad8e-3fbf10f147af","added_by":"auto","created_at":"2025-06-17 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09:17:59","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":14874,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial3TheMaastrichtClinicalTeachingQuestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-6467343/v1/c2da96798425f32ccde32661.docx"},{"id":84778595,"identity":"b490b82c-7ef1-4530-8ff1-fda93b77fb31","added_by":"auto","created_at":"2025-06-17 09:17:59","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":365339,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial4DecisionofExemptionfromReview.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6467343/v1/348ccb0474dd608f7ec88aed.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of the BOPPPS-RCDP in Basic Life Support Training for Newly Graduated Registered Nurses: A Mixed-Methods Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNewly Graduated Registered Nurses (NGRNs) frequently encounter challenges when applying theoretical knowledge to clinical practice\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Clinical teaching is the key to promote students ' seamless transition from theoretical knowledge to professional environment\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Effective basic life support (BLS) refers to the adoption of a series of simple and effective first aid measures in emergency situations such as cardiac arrest or respiratory arrest, so as to maintain the patient 's vital signs and create opportunities for further medical treatment. Its effectiveness depends on the proficiency and personal ability of the operator\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. The core point of BLS is to start high-quality cardiopulmonary resuscitation (CPR) as soon as possible, and use automatic external defibrillator (AED) quickly. At the same time, BLS is also a key medical intervention in cardiac or respiratory arrest, including \u003cb\u003eairway management\u003c/b\u003e, \u003cb\u003erescue breathing\u003c/b\u003e and \u003cb\u003echest compressions\u003c/b\u003e. BLS aims to sustain vital organ perfusion through manual chest compressions and ventilatory support until advanced life support can be administered\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Proficiency in BLS is the basic requirement of NGRNs\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Hospitals must provide standardized and high-quality training to nursing staff to improve professional standards and enhance emergency response capabilities\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA study has shown that\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e effective BLS training can enhance nurses' confidence and improve their ability to apply CPR in realistic clinical settings. Despite two years of structured clinical training experience\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, NGRNs still face persistent deficiencies in the current national standardized training system\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. In addition, the current training methods mainly focus on theory and skills, which often lead to poor results and fail to promote students ' active participation\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Therefore, there is an urgent need for a more efficient and effective NGRNs training program.\u003c/p\u003e \u003cp\u003eThe BOPPPS teaching model originated in the Canadian higher education instructor training system and classroom teaching. It divides the teaching process into six different parts: \u003cb\u003eBridge-in, Objective, Pre-test, Participatory Learning, Post-test and Summary\u003c/b\u003e\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Before the class, the instructor evaluates the nurses ' understanding by predicting and identifying the key knowledge, so as to guide and adjust the teaching methods\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Participatory learning enables nurses to recognize and address their weaknesses, thereby improving post-test scores and having a deeper understanding of the subject\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. By prioritizing learner-centered engagement and iterative feedback mechanisms, the BOPPPS model fosters active participation in the learning process while establishing bidirectional communication channels between students and educators. Empirical evidence demonstrates that when integrated with complementary pedagogical strategies, the BOPPPS framework demonstrates statistically significant enhancements in instructional efficacy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and measurable improvements in learners ' competency acquisition\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Specifically, this model is combined with team-based learning (TBL) to promote cooperation and interaction while meeting students ' personalized learning needs, and ultimately improve the self-learning and critical thinking ability of nursing students\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRapid cycle deliberate practice (RCDP) is a new teaching method, including repeated practice, specific feedback and gradual improvement of muscle memory\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Training breaks down skills into smaller parts, making learning easier. At the end of each part, learners can get immediate feedback, which helps them practice correctly and improve their skills in each cycle\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. This method not only improves learners ' professional knowledge, but also helps to memorize key knowledge and skills\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e to improve learners ' confidence in a relatively short period of time and maintain training effectiveness in the long term\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Research shows that RCDP has significant effectiveness in improving learners ' theoretical knowledge, clinical professional skills and teamwork ability compared with traditional simulation-based training methods\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Nurses must learn key steps and standardized procedures when starting a career or learning new technologies.\u003c/p\u003e \u003cp\u003eBOPPPS and RCDP teaching method have been applied to medical teaching and training, and good teaching feedback has been obtained\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Research shows that the mixed BOPPPS teaching mode can effectively improve the comprehensive quality of students\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. At present, there is no research on the application of RCDP in clinical skills training for nurse\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e, and there is no research on the combination of BOPPPS and RCDP. Therefore, the main purpose of this study is to explore the effect of BOPPPS teaching mode combined with RCDP teaching mode on the BLS training of NGRNs. Through the exploration of this teaching mode, we hope to provide an effective teaching and training method.\u003c/p\u003e"},{"header":"Methods and Study Design","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA mixed research method combining quantitative and qualitative research was used to establish a control group and an intervention group. The study was approved by the hospital, and all NGRNs provided informed consent before participating in the study. All training is conducted in a clinical skills centre in a comprehensive learning hospital using a simulator (Resuscitation Anne QCPR, Norwegian, USA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and Inclusion and Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudents\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, 80 nurses in the 2021 and 2022 sessions of 2023 were selected as the research objects to investigate the effectiveness of BOPPPS teaching method and BOPPPS-RCDP teaching method applied to NGRNs-BLS training. \u003cstrong\u003eInclusion Criteria:\u003c/strong\u003e (1) Newly graduated registered nurses or (2) Clinical nursing staff. \u003cstrong\u003eExclusion Criteria:\u003c/strong\u003e (1) More than 3 months of emergency or intensive care unit (ICU) nursing experience; (2)\u0026nbsp;Pregnant; (3) Chest compression operation cannot be performed due to physical or medical reasons.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFaculty staff members\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA core project committee was established, comprising 1 head nurse and 3 senior nurses (including 2 AHA-certified BLS/ACLS instructors), responsible for quality supervision and operation management of the training program. Two postgraduate researchers were tasked with questionnaire development and data collection protocols.\u003c/p\u003e\n\u003cp\u003eThe instructor \u003cstrong\u003eselection criteria\u003c/strong\u003e included:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(1) \u0026ge;10 years of clinical experience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(2) Successful completion of standardized AHA training curricula\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(3) Certification as qualified instructors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEight certified instructors delivered \u003cstrong\u003estructured pedagogical interventions\u003c/strong\u003e, including:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eDidactic instruction\u003c/strong\u003e (core theoretical frameworks)\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSkill demonstrations\u003c/strong\u003e (AHA guideline-compliant techniques)\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSmall-group practice sessions\u003c/strong\u003e (scenario-based simulations)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eInterventions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study involved 80 NGRNs. Participants were randomly divided into BOPPPS group and BOPPPS-RCDP group according to the ratio of 1:1. They were divided into 8 groups, each group consisted of 1 instructor, 5 students and an Anne model. Trainees take turns as the main operator, while others observe or provide assistance. The control group and the intervention group used the BOPPPS teaching mode to complete the course in the same time. The BOPPPS training model is divided into six stages (Figure.1). In this study, it is divided into the following six stages:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBefore class:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. \u003cem\u003eBridge-in(B)\u003c/em\u003e Instructors begin their educational journey by outlining the teaching process, clarifying the importance of basic life support (BLS) training, and stimulating the interest of NGRNs.\u003c/p\u003e\n\u003cp\u003e2. \u003cem\u003eObjectives(O)\u003c/em\u003e The learning objectives phase distinctly articulates that the primary aim of the training is to equip participants with the proficiency to perform high-quality cardiopulmonary resuscitation (CPR) skills.\u003c/p\u003e\n\u003cp\u003e3. \u003cem\u003ePretest\u003c/em\u003e\u003cem\u003e(P)\u003c/em\u003e A pretest is conducted to gauge the current knowledge and comprehension of the students prior to the commencement of instruction. This evaluation informs adjustments to the teaching content and methodologies. Both theoretical knowledge and practical BLS skills are assessed through written tests and simulated practical scenarios.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIn the classroom:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e4. \u003cem\u003eParticipatory learning(P)\u003c/em\u003e This constitutes the heart of the teaching approach, fostering active engagement, exploration, and independent learning among students through a variety of activities and interactive exercises.\u0026nbsp;It enables NGRNs to play a practical role in their education, improving skills acquisition and retention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eThe control group:\u003c/em\u003e\u003c/strong\u003e The training adopts the traditional teaching method of teacher-led and students \u0026apos; independent practice.\u0026nbsp;It included a 30-minute lecture based on the 2015 and 2020 American Heart Association (AHA) guidelines, and a 90-minute CPR virtual exercise in a simulated scenario. NGRNs are encouraged to practice themselves until they can perform high-quality CPR within a 2-minute window, or until they are exhausted and unable to continue practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eIntervention group:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eThis training integrated the RCDP teaching method into the participatory learning phase. The training instructor strictly follows the standardized operation process and divides the core skills of cardiopulmonary resuscitation into four different operation steps according to the dimensions of the subjective evaluation scale (see Figure 2.): A, B, C and D. It includes: A) identifying cardiac arrest and initiating CPR; B) chest compression; C) electrical defibrillation; D) balloon ventilation, assessment, and evaluation. In the process of teaching implementation, students complete part A in pairs, and there is a period of time for instructors to evaluate their implementation and correct mistakes. After that, they continued to do parts A and B, stopped to receive feedback and recorded their progress. Finally, the whole process operation is completed by cyclic progressive training (as shown in Figure 3.). In the process of this repeated cycle, students participate in peer assessment of each other \u0026apos;s skills, and mentors provide additional insights and guidance to strengthen learning.\u003c/p\u003e\n\u003cp\u003e5. \u003cem\u003ePosttest (P)\u003c/em\u003e At this stage, nurses need to independently complete the same theoretical test and operational test as the pretest, but the mentors of each group exchange during the operational test to make the assessment results more objective and real.\u003c/p\u003e\n\u003cp\u003e6. \u003cem\u003eSummary (S)\u003c/em\u003e The instructor reviews the training process according to each group \u0026apos;s results to deepen the NGRNs \u0026apos; impressions of CPR skills. At the same time, a course experience questionnaire is issued to improve the next training plan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData measurement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe main outcome was the intergroup differences in performance parameters in the Anne model after 5 CPR cycles: \u003cstrong\u003e(a)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eappropriate rate:\u0026nbsp;\u003c/strong\u003epercentage of chest compressions performed between 100 and 120 times per minute, \u003cstrong\u003e(b)\u003c/strong\u003e \u003cstrong\u003eappropriate depth:\u0026nbsp;\u003c/strong\u003epercentage of chest compression depth between 5 and 6 cm, \u003cstrong\u003e(c)\u003c/strong\u003e \u003cstrong\u003eappropriate chest recoil:\u0026nbsp;\u003c/strong\u003ethe percentage of full chest recoil after each compression, \u003cstrong\u003e(d)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003echest compression fraction(CCF)\u003c/strong\u003e: the percentage of time that chest compressions were provided, and \u003cstrong\u003e(e)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eadequate ventilation:\u0026nbsp;\u003c/strong\u003equalified ventilation as a percentage of total ventilation. The secondary results of the study used a series of measurement methods to assess NGRNs, including BLS subjective score sheets, theoretical test scores, and course experience questionnaires. The BLS subjective score sheet was expertly designed using evidence-based nursing concepts and aligned with AHA guidelines. It consists of scores for \u003cstrong\u003eA\u003c/strong\u003e = Recognise cardiac arrest and start CPR. (1. Assessing environment + 2. Judging consciousness + 3. Judging respiratory and pulse + 4. Start the EMS); \u003cstrong\u003eB\u003c/strong\u003e = Chest compressions (5. Chest compressions); \u003cstrong\u003eC = Electrical defibrillation\u0026nbsp;\u003c/strong\u003e(6. Electrical defibrillation)\u003cstrong\u003e; D\u0026nbsp;\u003c/strong\u003e= Balloon ventilation, Examination and evaluation (7. Balloon ventilation + 8. Examination and evaluation) (\u003cstrong\u003eSupplementary material 1\u003c/strong\u003e). At the same time, according to the relevant literature and relatively mature questionnaires, a self-designed course experience questionnaire (\u003cstrong\u003eSupplementary material 3\u003c/strong\u003e) was used to evaluate the teaching method, effect and overall experience with a 5-point Likert scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative phase\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary evaluation criteria were objective scores. QCPR model was used to score the electronic display screen of resuscitation Anne to obtain an objective score, provide immediate and accurate feedback, and display the corresponding value after recording the operation. The second criterion was the subjective score (\u003cstrong\u003eSupplement material 1\u003c/strong\u003e), which was assessed by the same group of examiners using a standardized assessment form based on the performance of the subjects in the BLS assessment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative phase: Semi-structured interview\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe prepared high-quality recording equipment to capture the interview content and ensured the accuracy and completeness of the information. We arranged a quiet and comfortable interview environment for each participant individually to provide privacy and a relaxed atmosphere. Interviews are expected to last between 30 and 60 minutes. Through semi-structured interviews, subjective perceptions of NGRN and training instructors were collected to explore the differences in student learning experiences and instructor training effects between the BOPPPS teaching model and the BOPPPS-RCDP teaching model. NGRNs were selected from the BOPPPS-RCDP group and voluntarily shared their learning experiences and insights, while also inviting training instructors willing to share suggestions and opinions to participate in the interviews. The sample size was determined based on the saturation of information provided by the respondents. The project core team conducted interviews with the participants. In order to fully understand the teaching effectiveness of combining BOPPPS with RCDP and the authentic experiences of students, the research team initially conducted preliminary interviews with two students. The final interview outline is as follows (\u003cstrong\u003eTable 1\u003c/strong\u003e and \u003cstrong\u003eTable 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Interview guide (For NGRNs)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003e1.What do you think about the application of BOPPPS-RCDP model in BLS training?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003e2.Do you think your study situation has changed?\u003c/p\u003e\n \u003cp\u003e3.What are BLS training recommendations for BOPPPS-RCDP teaching?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eInterview guide (For instructors)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003e1. What kind of teaching method do you prefer?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003e2. What do you think needs to be further improved in the teaching reform of BOPPPS-RCDP?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was conducted using the SPSS 25.0 statistical software package. Quantitative data were described using frequencies and percentages(％). Normally distributed quantitative data were described using mean \u0026plusmn; SD (x \u0026plusmn; s), while non-normally destributed quantative data were described using median (interquartile range) [M(P25,P75)]. Depending on the nature of the data, between-group comparisons were performed using t-tests, chi-square tests, or non-parametric test, or non-parametric tests, with a significance level set at \u0026alpha;=0.05.\u003c/p\u003e\n\u003cp\u003eAfter the interview, the recording was transcribed verbatim within 24 hours. Subsequently, Colaizzi \u0026apos;s seven-step analysis method was used to analyze the data, including the following steps: familiarizing with the data, identifying important statements, forming meanings, clustering topics, developing detailed descriptions, constructing basic structures, and seeking verification of the basic structure\u003csup\u003e[30]\u003c/sup\u003e. The two researchers coded the interview data respectively. To preserve academic rigor, any differences encountered by the researchers are discussed and resolved at the research group meeting to ensure the scientific credibility of the conclusions. Nvivo14.0 software was used to organize, analyze and encode the data.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 80 NGRNs who met the inclusion and exclusion criteria were equally assigned to the control group or the intervention group. The average age of the participants was 23 years old, 81.2% were female, 68.8% had a bachelor \u0026apos;s degree, 76.3% had a BMI within the normal range, and 62.5% had participated in CPR training in the past 6 months. In the past year, only 15% of nurses have performed CPR on real people. There was no significant difference in demographic characteristics or baseline chest compression skills between the two groups (\u003cstrong\u003eTable 3\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Demographic characteristics of the participants in the two groups (n= 80) (MD \u0026plusmn; SD)/n (%)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"104%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eBOPPPS Group\u003c/p\u003e\n \u003cp\u003e(n= 40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eBOPPPS-RCDP\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGroup (n= 40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eZ/X\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1. Age（year）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e22.55\u0026plusmn;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e22.53\u0026plusmn;0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e22.63\u0026plusmn;0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e2. Gender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e15(18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e8(20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e7(17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.775\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e65(81.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e32(80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e33(82.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 16px;\"\u003e\n \u003cp\u003e3. Educational\u003c/p\u003e\n \u003cp\u003elevel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eCollege degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e21(26.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e9(22.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e12(30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.539\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e55(68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e28(70.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e27(67.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eMaster\u0026apos;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e4(5.00%%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e3(7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1(2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e4. BMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e14(17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e6(15.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8(20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.377\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNormal weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e61(76.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e30(75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e31(77.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e5(6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e4(10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1(2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5. CPR training in the past year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e30(37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e16(40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e14(35.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e50(62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e24(60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e26(65.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e6. \u0026nbsp;Previous experience with Chest Compression on real patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e68(85.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e32(80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e36(90.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e1.569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e12(15.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e8(20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4(10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative findings\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComparing the scores of BOPPPS group and BOPPPS-RCDP group before and after training, we found that the ventilation pass rate, theoretical test score and individual subjective score of nurses in BOPPPS group were significantly improved after training (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05), but other indicators did not change much. In contrast, the BOPPPS-RCDP group had significant improvements in depth of compression, frequency of compression, CCF, ventilation, and theoretical test scores after training (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). Only full chest recoil did significantly improve (\u003cstrong\u003eTable 4\u003c/strong\u003e). Overall, this study suggests that BOPPPS training of NGRNs can significantly improve some indicators and compare the CPR scores of the two groups after training. Except for depth, total chest recoil and theoretical test scores, all indicators were statistically significant (\u003cstrong\u003eTable 4\u003c/strong\u003e). Finally, we issued a course experience questionnaire after the training. The analysis shows that BOPPPS-RCDP group is obviously superior to BOPPPS group in teaching methods, teaching effects, teaching feelings and other key aspects (\u003cstrong\u003eTable 5\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e Comparative analysis of indexes pretest and posttest among two group nurses [M(P25,P75)]\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eBOPPPS Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eBOPPPS-RCDP Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"20\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eObjective\u003c/p\u003e\n \u003cp\u003ecompression\u003c/p\u003e\n \u003cp\u003escore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAppropriate depth (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19.65(5.14,38.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e22.81(8.13,42.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.558\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.577\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePosttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e30.43(5.68,52.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e38.31(20.05,56.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAppropriate rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e63.41(13.02,95.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e68.08(34.57,93.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePosttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e59.58(22.46,96.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e92.25(82.01,97.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFully recoiled chest(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e100.00(100.00,100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e100.00(100.00,100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePosttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e100.00(100.00,100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e100.00(100.00,100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.721\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.838\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCCF (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e66.00(51.50,79.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e61.00(50.50,80.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.919\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePosttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e63.00(50.75,77.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e71.00(66.00,83.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.035\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2.320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAppropriate ventilation(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e59.00(39.75,74.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e59.00(46.50,70.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePosttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e71.00(68.00,80.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e77.50(70.25,82.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eSubjective score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e13.00(12.00,16.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e15.00(12.25,18.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePosttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19.00(16.00,21.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e21.00(20.00,22.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e26.00(20.25,28.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e27.00(22.00,28.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.455\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePosttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e28.50(26.00,31.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e30.50(30.00,33.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.980\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.040\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7.00(6.00,10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7.00(5.25,10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePosttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e10.00(8.00,10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e12.00(10.00,13.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e4.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e13.00(10.00,17.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e16.00(12.00,18.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e1.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePosttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e18.00(16.00,19.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e19.00(18.00,20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e3.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.787\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTheory test score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e67.00(59.00,72.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e67.75(62.00,73.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ePosttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e74.00(71.00,76.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e74..00(72.25,77.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.442\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e(CCF = chest compression fraction; A = 1. Assessing environment + 2. Judging consciousness +3. Judging respiratory and pulse + 4. Start the EMS; B = 5. Chest compressions; C = 6. Electrical defibrillation; D = 7. Balloon ventilation + 8. Examination and evaluation)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e Comparison of the modified course experience questionnaire between the BOPPPS group and the BOPPPS-RCDP group\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"662\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 539px;\"\u003e\n \u003cp\u003eDimension\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTeaching method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTeaching effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eThe feeling of learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eTotal points\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e20.00(16.00,20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19.00(16.00,20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10.00(8.00,10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e47.50(40.00,50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eExperimental group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e20.00(19.25,20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e20.00(20.00,20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10.00(10.00,10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e50.00(48.50,50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ez\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2.700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2.412\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative findings\u003c/strong\u003e \u003cstrong\u003efrom interviews with NGRN\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNGRNS felt that the BOPPPS-RCDP teaching method helped them build a better learning mindset and enabled them to learn skills more systematically. Three of the participants shared their insights.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN1: \u0026ldquo;I think the BOPPPS-RCDP training method helps me form a good learning mindset in the process of learning BLS skills. Through the six steps of BOPPPS, I can learn this skill more systematically.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN2: \u0026ldquo;The BOPPPS-RCDP teaching method allows me to gradually master BLS skills by decomposing knowledge modules and practicing repeatedly. Every step of progress gives me a sense of achievement and makes me more confident to continue to learn.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBOPPPS teaching method can stimulate students \u0026apos; interest in learning and induce students to have a strong learning motivation. By combining BOPPPS with RCDP teaching method, students are guided to practice repeatedly and feedback in time to achieve the purpose of mastering BLS skills.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN2: \u0026ldquo;Through the BOPPPS introduction link, I stimulated my curiosity about learning and consciously began to actively think about problems, and gradually made my understanding of BLS skills deeper.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN3: \u0026ldquo;Integrating RCDP into BOPPPS teaching not only enhances our memory of CPR operation, but also enhances our muscle memory through repeated circular exercises, which helps me achieve better results in the post-test.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAccording to NGRNs, the BOPPPS-RCDP teaching method breaks the limitations of the traditional teaching method \u0026apos;\u003cem\u003e\u0026nbsp;instructor \u0026apos;s monologue\u0026nbsp;\u003c/em\u003e\u0026apos;, which mainly emphasizes \u0026apos; \u003cem\u003ewhat students have learned\u0026nbsp;\u003c/em\u003e\u0026apos;, rather than blindly listening to the instructor \u0026apos;s explanation. Instructors observe the students \u0026apos; participation and dynamically adjust the teaching rhythm, deepen the students \u0026apos; impression through this instant feedback, so as to improve the learning efficiency.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN4: \u0026ldquo;At the end of each practice, timely feedback of the shortcomings, and then repeated practice to strengthen, can effectively strengthen my mastery of skills.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN5: \u0026ldquo;By constantly reviewing old knowledge and learning new skills, I can master BLS skills faster. This teaching method has effectively improved my learning efficiency.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN1: \u0026ldquo;Through the BOPPPS-RCDP teaching method, we are no longer learning alone, but teamwork. In the interaction and discussion with peers to learn from each other, share experience, improve my skills, but also enhance my learning confidence and team spirit, which inspired me to learn more deeply.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNGRNs agreed that the BOPPPS-RCDP teaching method can complement each other in the process of teamwork, and it can also strengthen teamwork spirit, so as to achieve the purpose of in-depth learning. This is completely different from the traditional teaching method in which instructors impart knowledge in one way and students \u0026apos; participation is low. This new learning method can arouse their interest in learning.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eN1: \u0026ldquo;Through the BOPPPS-RCDP teaching method, we are no longer learning alone, but teamwork. In the interaction and discussion with peers to learn from each other, share experience, improve my skills, but also enhance my learning confidence and team spirit, which inspired me to learn more deeply.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants indicated that performing CPR multiple times can bring great help to their learning and practice, but multiple operation exercises make participants feel physically tired, so it is recommended to reduce the number of presses in participatory learning, such as two cycles at a time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Finding from interviews with instructors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe BOPPPS-RCDP model constructs a multi-dimensional knowledge equity implementation mechanism through hierarchical cognitive deconstruction and dynamic adaptive design. The BOPPPS teaching method emphasizes goal orientation and instant feedback, while the RCDP method focuses on research and practice. Combining the advantages of the two methods, it may reduce students \u0026apos; cognitive load in terms of knowledge equity through hierarchical teaching, modular deconstruction, immediate feedback, so as to adapt to the needs of different learners.\u003c/p\u003e\n\u003cp\u003eInstructor 1 Indicates: \u003cem\u003e\u0026ldquo;As an educator committed to maintaining high teaching standards and ensuring equality, the BOPPPS-RCDP model ensures that the same learning content is provided to each student by following uniform training standards. It also ensures that each student benefits from a certain amount of training time. This approach is not only about fairness, but also about making the best use of our limited time to teach basic life support skills to each student as thoroughly as possible.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe improved BOPPPS-RCDP model decomposes the BLS skill system into small modules by integrating the modular cognitive deconstruction strategy, which significantly reduces the instantaneous cognitive needs of NGRNs. Greatly improve the learning efficiency. At the same time, based on the real-time feedback system, students \u0026apos; errors can be corrected immediately, which is more conducive to students \u0026apos; mastery of skills.\u0026nbsp;Therefore, compared with the traditional teaching method, the instructors prefer the BOPPPS-RCDP teaching method.\u003c/p\u003e\n\u003cp\u003eIn the interview, one of the instructors mentioned: \u003cem\u003e\u0026ldquo;Compared with the traditional teaching method, I prefer the new teaching mode of BOPPPS-RCDP, because the BOPPPS-RCDP teaching mode requires each student to actively participate in the complete A-B-C-D cycle practice. This method is conducive to improving learning motivation and learning efficiency. It requires students to fully participate in and take advantage of practical learning opportunities. I found that this teaching method increased my enthusiasm for teaching and improved my satisfaction with BLS teaching. Therefore, I believe that the BOPPPS-RCDP method is more efficient in training.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAbout BOPPPS-RCDP teaching method, instructor 1 put forward some suggestions for improvement.\u003c/p\u003e\n\u003cp\u003eInstructor 1 Indicates:\u003cem\u003e\u0026nbsp;\u0026ldquo;The BOPPPS-RCDP teaching model is an efficient learning method, but it should avoid excessive reliance on repeated exercises. After each exercise, students can increase their reflection on learning, and encourage or relax activities appropriately during the exercise process.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study adopts a novel teaching strategy that combines the BOPPPS and RCDP methods into the BLS training of NGRNs, aiming to evaluate the learning effect of this comprehensive teaching method and collect insights from NGRNs and training instructors on the effectiveness of this teaching model. To date, this study represents the first known application of the BOPPPS-RCDP joint method. The results show that the BOPPPS-RCDP comprehensive training program may be more effective than the BOPPPS individual training program in promoting NGRNs to quickly master BLS proficiency and develop teamwork skills in a short period of time.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eBOPPPS-RCDP can effectively promote the acquisition of skills in NGRNs\u003c/h2\u003e \u003cp\u003eBy comparing the effects of BOPPPS-RCDP teaching mode and traditional BOPPPS teaching mode on nurses ' theoretical ability and practical ability, this study found that both groups had the ability to improve, but the effect of BOPPPS-RCDP group was significantly improved. This difference may be due to the lack of standardized training process in the traditional BOPPPS teaching method, requiring nurses to practice all BLS skills at the same time, which may cause a high cognitive load on learners, especially newly graduated registered nurses, due to the mismatch of learning ability\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. The BOPPPS-RCDP group is based on the RCDP theory, through modular skill decomposition and instant feedback\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e, it effectively reduces the cognitive load of learners and promotes the internalization of skills. In addition, effective simulation teaching strategies, such as deliberate practice and the use of teaching feedback, also played an important role in the BOPPPS-RCDP group. Compared with BOPPPS alone, RCDP has proved to be effective in various skill teaching scenarios, making BOPPPS-RCDP more conducive to the improvement of nurses ' cardiopulmonary resuscitation skills. After training, the group receiving BOPPPS-RCDP guidance obtained higher class assessment scores than the BOPPPS group. This can be attributed to the innovativeness of BOPPPS-RCDP as a novel learning method, which brings excellent learning outcomes, higher satisfaction and improves students ' confidence\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eFeedback from NGRNs and instructors\u003c/h2\u003e \u003cp\u003eAccording to the results of interviews with NGRNs and instructors, the BOPPPS-RCDP teaching method is more conducive to the rapid acquisition of BLS skills. NGRNs report that this approach helps them learn skills faster and helps them remember them better. They pointed out that the combination of theoretical knowledge and practice through this method improved the overall learning experience, and they agreed that this was crucial to their future clinical practice. Although some NGRNs indicated physical fatigue due to the participation of learning, most people acknowledged the value of the BOPPPS-RCDP method and praised its effectiveness. Instructors also expressed a positive view that the BOPPPS-RCDP model helps students quickly master skills. This study adopts a standardized training program to ensure the consistency of the training content and the fixity of the training time, so that each student can obtain the same level of guidance and complete the training in the prescribed practice cycle. This structured training model enables instructors to efficiently carry out BLS skills training within a given time frame, thereby significantly improving the overall training effect. In addition, instructors generally observe that after adopting this teaching method, students ' participation in class is obviously improved, and their understanding and mastery of teaching materials are more in-depth and thorough.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eLimitations and future development directions\u003c/h2\u003e \u003cp\u003eThis study has the following limitations, which need to be carefully considered :\u003c/p\u003e \u003cp\u003eFirst, due to the unique cultural and organizational background of the research institution, it may limit the extrapolation validity of the research results, so this factor should be included in the interpretation results.\u003c/p\u003e \u003cp\u003eSecond, the educational intervention only implemented a single 4-hour intensive training, which was difficult to fully reflect the long-term effect of the BOPPPS-RCDP model.\u003c/p\u003e \u003cp\u003eThirdly, this study adopts quasi-experimental design, which cannot control all the variables that affect the results, so this potential bias needs to be considered when evaluating the results.\u003c/p\u003e \u003cp\u003eIn order to overcome the above limitations and improve the validity and reliability of the research results, rigorously designed randomized controlled trials should be carried out and sufficient sample size should be ensured. This kind of experiment helps to verify the robustness of the preliminary research results, and provides a more comprehensive perspective and basis for understanding the long-term effects of BOPPPS and RCDP learning methods in the field of nursing education.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe research shows that the BOPPPS-RCDP model not only improves the theoretical knowledge of NGRNs, but also improves their practical skills. This teaching method can improve the learning effect of NGRNs, it enable them to more effectively internalize and apply the knowledge they have learned, and also significantly improve their clinical nursing ability. In the future, BOPPPS-RCDP teaching method should be considered as a feasible and effective strategy in nursing education to improve the education level and clinical ability of nurses. In addition, it will be useful to extend the BOPPPS-RCDP method to other areas of health care education.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not involve human or animal subjects, and thus, no ethical approval was required(Supplementary material 4). In accordance with the ethical principles outlined in the Declaration of Helsinki, all participants provided informed consent before participating in the study. The anonymity and confidentiality of the participants were guaranteed, and participation was completely voluntary.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author,[QYD], upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRediT authorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSW: Methodology, Data curation, Writing - original draft. Writing – review \u0026amp; editing. LQG: Writing – review \u0026amp; editing. CRL: Supervision, Writing - review \u0026amp; editing. HHF: Supervision, Investigation. GZZ: Supervision, Data curation. ZHM: Supervision, Software. ELW: Supervision, resources. ZSL: Supervision, resources. BHD: Project administration, Methodology. QYD: Supervision, Funding acquisition, Writing-review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Guangdong Key Laboratory of Emergency Research of Traditional Chinese Medicine (No: 2023B1212060062),Guangdong Province Teaching Quality and Teaching Reform Project: Reform and practice of BOPPPS combined RCDP theory in BLS standardized teaching.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are very grateful to the instructors of this training session. At the same time, we would like to extend special thanks to the newly hired nurses for their active participation and support in the research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePennbrant, S., et al., \u003cem\u003eMastering the professional role as a newly graduated registered nurse.\u003c/em\u003e Nurse Educ Today, 2013. \u003cstrong\u003e33\u003c/strong\u003e(7): p. 739-45.\u003c/li\u003e\n\u003cli\u003eParker, V., et al., \u003cem\u003eNew graduate nurses\u0026apos; experiences in their first year of practice.\u003c/em\u003e Nurse Educ Today, 2014. \u003cstrong\u003e34\u003c/strong\u003e(1): p. 150-6.\u003c/li\u003e\n\u003cli\u003eKenny, A., et al., \u003cem\u003eEvaluation of a rural undergraduate nursing student employment model.\u003c/em\u003e Collegian, 2021. \u003cstrong\u003e28\u003c/strong\u003e(2): p. 197-205.\u003c/li\u003e\n\u003cli\u003eDragnes Brix, L., et al., \u003cem\u003eEnhancing nursing students\u0026apos; self-reported self-efficacy and professional competence in basic life support: the role of virtual simulation prior to high-fidelity training.\u003c/em\u003e Teaching and Learning in Nursing, 2025. \u003cstrong\u003e20\u003c/strong\u003e(1): p. e236-e243.\u003c/li\u003e\n\u003cli\u003eOlasveengen, T.M., et al., \u003cem\u003eEuropean Resuscitation Council Guidelines 2021: Basic Life Support.\u003c/em\u003e Resuscitation, 2021. \u003cstrong\u003e161\u003c/strong\u003e: p. 98-114.\u003c/li\u003e\n\u003cli\u003eMagid, D.J., et al., \u003cem\u003ePart 2: Evidence Evaluation and Guidelines Development: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.\u003c/em\u003e Circulation, 2020. \u003cstrong\u003e142\u003c/strong\u003e(16_suppl_2): p. 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Newly Graduated Registered Nurses (NGRNs) often encounter challenges in clinical practice due to their lack of clinical experience. Standardized operational training can enhance the emergency response capability and clinical emergency response of NGRNs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eThis study explores the application of BOPPPS-RCDP to the training of NGRNs-BLS, aiming to (1) compare the effect of BOPPPS-RCDP with that of BOPPPS training, and (2) explore the experiences and views of NGRNs and instructors on the integrated model and (3) provide evidence-based recommendations for improvements to BLS training in nursing education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design: \u003c/strong\u003eThis study employed an explanatory sequential mixed-methods design, involving conducting semi-structured interviews with both students and instructors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The 80 participants were randomly divided into the control group and the intervention group in a 1:1 ratio. The control group adopted the traditional teaching method, while the intervention group added the RCDP teaching method to the traditional teaching method. The researchers conduct a semi-structured interview among students and instructors according to the semi-structured interview guidelines to gain an in-depth understanding of the subjective feelings of NGRNs and training instructors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe results of quantitative analysis showed that the BOPPPS-RCDP group had significantly improved theoretical knowledge and practical skills compared with the BOPPPS model alone (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). Except for compression depth, chest recoil rate, and theoretical test scores, all measured indicators demonstrated statistical significance (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05), indicating that the BOPPPS-RCDP model is more effective in enhancing training outcomes. Qualitative findings show that most of the NGRNs and instructors believe that BOPPPS-RCDP can effectively promote the acquisition of BLS skills.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe BOPPPS-RCDP model has been shown to effectively facilitate the rapid acquisition of BLS skills among NGRNs, thereby enhancing both the training outcomes and participant satisfaction. This model represents an innovative educational approach with significant potential for advancing BLS education within nursing practice.\u003c/p\u003e","manuscriptTitle":"Effect of the BOPPPS-RCDP in Basic Life Support Training for Newly Graduated Registered Nurses: A Mixed-Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-17 09:17:54","doi":"10.21203/rs.3.rs-6467343/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"026dbfc0-3184-4397-8e0f-e8b6f5a16d6b","owner":[],"postedDate":"June 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T20:23:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-17 09:17:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6467343","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6467343","identity":"rs-6467343","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}