Evaluate the Effectiveness of First Aid E-book Intervention on First Aid Knowledge, Self-efficacy, and Skills Among New Nurses

1. Introduction Paramedics are the first-line medical personnel on the emergency scene and can help in effectively treating the medical condition in the first few minutes. For instance, Cardiopulmonary resuscitation (CPR) can improve the chances of survival of cardiac arrest patients (Partiprajak & Thongpo, 2016 ; P. Y. Hsieh et al., 2021). CPR is an attempt to restore spontaneous circulation through chest compressions when the patient is not breathing and the heart is beating (Suseel et al., 2019). Crucially, the ability to perform effective CPR immediately requires repeated first aid training (Roh & Issenberg, 2014 ; Moon & Hyun, 2019). However, among clinical skills, new nurses find it most difficult to perform CPR (Liou et al., 2020). If new recruits lack professional training or confidence in their abilities, the quality of first aid provided by them may be affected (Ihunanya et al., 2020). Therefore, it is imperative to implement a well-designed training program that effectively equips clinical nurses with the necessary first aid knowledge and skills. (P. Y. Hsieh et al., 2021).
2. Method 2.1 Design and participants This study used an experimental two-group pre- and post-test design. Three repeated measures were taken: pre-test (T0), immediate post-test (T1), and one-month post-test (T2). The one-month post-test was used to detect new nursing care personnel's retention of first aid knowledge, self-efficacy, and first aid skills. G power 3.1.9.2 version was used to estimate the number of samples using repeated measures ANOVA. The effect size was set to 0.3 (Kotrlik & Williams, 2003), alpha value was set to 0.05, detection power was 0.8, and correlation value was 0.5. The measurement was repeated thrice. As such, the total number of samples required should be 62 bits. Considering an estimated attrition rate of 10% or 7 people, the total number of cases accepted was 70. The main investigator explained the purpose and process of the study to the new nurses in each ward and invited them to participate in the study. Data was collected between August 2021 and October 2021. The sample inclusion criteria were that participants were newly recruited nurses within two years with a basic first aid BLS certificate. Meanwhile, those who were unable to perform CPR due to hand injuries were excluded. A computer was used to randomly assign the 70 eligible new nurses in the medical center to the experimental and control groups, with 35 each.

2.2 Study protocol The experimental group took a one-hour e-book course plus one month of first aid e-book intervention and routine training, whereas the control group received only one month of routine training. Effectiveness indicators were measured at pre-test (T0), immediate post-test (T1), and one-month post-test (T2). In order to assess the effectiveness of the first aid e-book intervention, the first aid skill Objective Structured Clinical Examination (OSCE) evaluation form was utilized alongside self-efficacy questionnaires for first aid knowledge and first aid ability. This comprehensive approach aimed to evaluate the effectiveness of the intervention.

2.3 Research tool The research tools included the basic demographic data sheet, first aid knowledge questionnaire, first aid self-efficacy scale, first aid skills OSCE evaluation form, and system usability scale (SUS).

2.3.1 Demographic basic data sheet The demographic basic data sheet was exclusively utilized during the pre-test (T0) phase. It encompassed details such as gender, age, education level, clinical experience, previous participation in first aid training courses, and the number of times the participants had engaged in first aid activities.

2.3.2 First aid knowledge questionnaire The first aid knowledge questionnaire was based on the 2020 American Heart Association First Aid Guidelines Update (Cummins & Hazinski, 2020), and American Heart Association Cardiopulmonary Resuscitation and Cardiovascular Emergency Guidelines (Craig-Brangan & Day, 2020). The questionnaire included five items with a total of 20 questions to test the new nurses' concept and understanding of first aid: first aid assessment and initial treatment (four questions), maintenance of airway and circulation (four questions), interpretation and treatment of abnormal heart rhythm (five questions), teamwork and abnormal handling (six questions), and communication and coordination with the patient's family members (one question). Each question is 5 points and measured on a five-point scale, with the total score being 0 to 100 points for 20 questions. The higher the score, the better was the awareness of first aid. The self-made first aid knowledge questionnaire, assessed by three experts, demonstrated a Content Validity Index (CVI) of 0.93, indicating a high level of content validity. The Cronbach's α value of the internal consistency reliability of the scale was 0.713, indicating an acceptable level of internal consistency.