Training Mothers in Infant Cardiopulmonary Resuscitation With an Instructional DVD and Manikin

Materials and Methods

Interventions

Mothers who had never received CPR instruction or who had not received instruction within the past 2 years were assigned to the experimental (CPR training kit) group. Mothers in this group were given the 22-minute instructional DVD and infant manikin and asked to view the DVD and complete the training within 24 hours. Mothers in the comparison group did not receive any CPR materials or manikins. After the 24-hour period, certified CPR instructors returned to the bedside to administer written and practical examinations that assessed the infant CPR skills of all participants. To ensure interrater reliability for validation of participants' proficiency in CPR, research staff independently scored a series of mock CPR proficiency scoring scenarios, which were compared by the statistician and found to be excellent (κ=0.72).

Results

A total of 126 mothers were enrolled. Twenty-two participants were excluded (18 mothers did not complete the CPR kit training, 2 did not want to be evaluated, 1 was too ill for evaluation, and 1 was discharged before the evaluation was completed). Seventy-nine mothers were enrolled in the CPR kit group and 25 in the comparison group. Of the 104 study participants, 99 (95%) were contacted at the 6-month follow-up (POST-2). Not all participants answered all survey questions.

Table 2 shows the prevalence and assessments of previous CPR training by study group. Forty-nine mothers in the CPR kit group (62%) reported prior CPR training before study enrollment. In the CPR kit group, 8 participants (10%) reported being offered CPR training during their current pregnancy and 9 (11%) reported receiving CPR training during their current hospital stay. Findings for the comparison group were similar; 2 participants (8%) reported receiving training during pregnancy, and 3 (12%) reported receiving training during their current hospital stay. Mothers in the conventional group reported a mean time of 10 months since completing conventional CPR training (range, 0-23 months).

Table 3 presents the assessments of current CPR training by study group. Overall, the CPR kit was well received. By comparing mothers in the CPR kit group with those in the comparison group, 57 (72%) and 8 (32%), respectively, rated their training quality as excellent (P=.001), 72 (91%) and 12 (48%) rated their training as very convenient (P=.001), 63 (80%) and 11 (44%) rated their training as very effective (P=.001), and 76 (96%) and 21 (84%) were more confident as caregivers immediately after learning infant CPR (P=.003). Overall in both groups, 84 of 104 mothers (81%) stated at the PRE survey that learning CPR was extremely important, compared with 100 (96%) at the POST-1 survey (P=.001).

Table 1 shows proficiency in skills, as noted by the CPR instructor. Differences were observed between the study groups, with mothers in the CPR kit group scoring statistically significantly higher on 8 of the 12 proficiencies, compared with the mothers in the comparison group. The only proficiency for which the mothers in the kit group scored lower was “check for breathing,” which was performed correctly by 63 (80%) of the participants in the CPR kit group vs 24 (96%) of those in the conventional CPR training group (P=.06). The overall proficiency composite scores were significantly higher in the CPR kit group than in the comparison group, with median scores of 10 and 7, respectively (P<.001).

The perceived importance of infant CPR instruction was measured before instruction (PRE survey) and immediately after proficiency evaluation (POST-1 survey). The perceived importance increased significantly for both study groups, with no between-group differences observed (P=.54). In addition, confidence in performing infant CPR was measured immediately after the proficiency evaluation (POST-1 survey) and 6 months later (POST-2 survey). Nonsignificant declines in confidence were reported for both groups, with no between-group difference (P=.75). After 6 months (POST-2 survey), nearly all participants in the CPR kit group (75 of 76 [99%]) were satisfied with their training while in the hospital, 26 mothers in that group (26 of 76 [34%]) reported watching the DVD again, and 37 of 75 (49%) reported having family members or friends view the DVD, including the infant's father for 16 of 75 participants (21%).

Comment

Training in infant CPR is important for new parents and should be offered as part of prenatal or perinatal care. The present study demonstrates an alternative method of teaching infant CPR that is effective and convenient. If the burden is placed on new parents to seek out educational opportunities, they may forego CPR education altogether. Twenty-two of the 104 mothers (21%) reported being offered CPR training during either their pregnancy or their current hospital stay, which suggests the need for alternative ways to offer infant CPR instruction as part of prenatal or perinatal care.

We confirmed that training using a kit with a 22-minute instructional DVD and infant manikin is an effective and convenient way to teach new mothers infant CPR. They can complete training when most convenient while being able to learn and practice on a manikin at their own pace. Tailoring education to patients' educational and physical needs (medical issues), time constraints, and understanding risk has been previously shown to improve attitudes toward learning and implementing CPR.⁹ New parents' concerns about caring for their child in an emergency, coupled with the convenience of the kit, may motivate them to learn infant CPR. An additional benefit of using the kit is the ability to re-educate oneself at any given time, when confidence begins to decline or when one feels the need to refresh CPR skills. Retraining in the conventional CPR education model requires planning, money, a time commitment, and a location for training. Despite a known decline in retention of CPR skills over time, research has shown that these skills can rapidly be refreshed by prompts (eg, from a 911 operator) or by review of educational material, such as posters, skills reminder cards, or, in this case, the infant CPR kit.¹¹ The kit allows learners to refresh skills whenever they wish, at their convenience and at no additional cost, and the kits can also be shared among family, friends, or other caregivers. One previous study¹² showed that an average of 2.5 persons learned CPR for every CPR kit used.

This study was conducted at a suburban hospital's obstetric unit during dayshift hours on weekdays, when CPR instructors and research coordinators were available. Therefore, our results may not be generalizable. Moreover, the comparison group was small, and results may not be reflective of results with conventional CPR instruction. Additionally, we did not compare the conventional group's PRE- and POST-1 survey responses regarding quality, convenience, and effectiveness to assess whether their answers remained consistent.

A majority of mothers in the CPR kit group (62%) had previously completed CPR training, which enabled participants to compare the CPR kit training with their prior conventional CPR training. Mothers in the comparison group, however, had no other training to compare with their conventional CPR training, so the findings for this group may be biased toward conventional instruction. These limitations suggest that future studies may be more aptly designed by using 3 groups: (1) mothers with current conventional CPR training (ie, completed training within 2 years); (2) mothers with previous conventional CPR training (ie, completed training >2 years ago); and (3) mothers who have never received conventional CPR training.

Our study did not collect any information on study participants' race or ethnicity. Non–English-speaking women were excluded because we lacked consistent access to interpreters and the instructional kit was not available in other languages at the time of the study. The kits are now available in English and Spanish versions, so future investigators may want to evaluate the kit's success across non–English-speaking populations.

Another limitation of our study was that mothers in the experimental group underwent testing (written and practical) immediately after training with the DVD kit, but those in the control group were tested up to 2 years after their initial training, by which time many learned skills may already have been lost. There was marked variability in the training experience of the 18 mothers who self-reported the date and training length of their most recent CPR course. The type of training reported was also variable in regard to location, cost, and class length. These differences must be considered when evaluating the results.

Teaching techniques differed between groups because conventional training is designed using a “watch, then practice” technique. The instructor shows a video that outlines a skill and then the video is paused, giving the learner time to practice the skill with the instructor providing immediate feedback.⁹ The CPR kit uses a slightly different approach—the “practice while you watch” technique—which requires the learner to practice skills while watching the DVD, without an instructor present to provide feedback. Notably, previous research has shown that video (DVD)-based instruction can adequately teach CPR.⁹ No formal evaluation material is available yet for the kit, so written and practical tests tailored to the specific materials were developed by certified CPR instructors. The kit used for this study provided instruction in infant CPR only, not in CPR for children or adults.

Conclusion

Our study suggests that infant CPR training using a kit containing a 22-minute instructional DVD and infant manikin is an effective and convenient way to teach infant CPR to new mothers in an obstetric unit. The advantages associated with this novel teaching tool may benefit new parents and other caregivers using infant CPR in the future. Programs could be developed within private practices or institutions to offer this kit to new parents, providing an alternative to conventional CPR courses that require large time commitments.