Al Gharibi KA, Arulappan J Repeated simulation experience on self-confidence, critical thinking and competence of nurses and nursing students – an integrative review. Sage Open Nursing. 2020;

Alconero-Camarero AR, Sarabia-Cobo CM, Catalán-Piris MJ, González-Gómez S, González-López JR Nursing students' satisfaction: a comparison between medium- and high-fidelity simulation training. Int J Environ Res Public Health. 2021; 18:(2)

Almousa O, Prates J, Yeslam N Virtual reality simulation technology for cardiopulmonary resuscitation training: an innovative hybrid system with haptic feedback. Simul Gaming. 2019; 50:(1)6-22

Arnold JJ, Johnson LM, Tucker SJ, Malec JE, Henrickson SE, Dunn WF Evaluation tools in simulation learning: performance and self-efficacy in emergency response. Clinical Simulation in Nursing. 2009; 5:(1)e35-e43

Aoyama M, Tamura Y, Ishikawa Y, Yada M, Miyawaki I Confidence-weighted testing: A descriptive study of Japanese nursing students. Nurs Health Sci. 2013; 15:(4)504-509

Bandura A Social learning theory.Englewood Cliffs (NJ): Prentice Hall; 1977

Bandura A Human agency in social cognitive theory. Am Psychol. 1989; 44:(9)1175-1184

Baniasadi T, Ayyoubzadeh SM, Mohammadzadeh N Challenges and practical considerations in applying virtual reality in medical education and treatment. Oman Med J. 2020; 35:(3)

Bruce SA, Scherer YK, Curran CC, Urschel DM, Erdley S, Ball LSA A collaborative exercise between graduate and undergraduate nursing students using a computer-assisted simulator in a mock cardiac arrest. Nurs Educ Perspect. 2009; 30:(1)22-27

Calder LA, Mastoras G, Rahimpour M Team communication patterns in emergency resuscitation: a mixed methods qualitative analysis. Int J Emerg Med. 2017; 10:(1)

Cheng A, Kessler D, Mackinnon R Reporting guidelines for health care simulation research: Extensions to the CONSORT and STROBE Statements. Simulation in Healthcare. 2016; 11:(4)238-248

Cioffi J, Purcal N, Arundell F A pilot study to investigate the effect of a simulation strategy on the clinical decision making of midwifery students. J Nurs Educ. 2005; 44:(3)131-134

Coghlan D, Brannick T Doing action research in your own organisation, 4th edn. : Sage Publications; 2014

Dick-Smith F, Power T, Martinez-Maldonado R, Elliott D Basic Life support Training for undergraduate nursing students: An integrative review. Nurse Educ Pract. 2021; 50

European Resuscitation Council. Key messages: Basic life support. 2021. https// (accessed 20 March 2024)

Gordon CJ, Buckley T The effect of high-fidelity simulation training on medical-surgical graduate nurses' perceived ability to respond to patient clinical emergencies. J Contin Educ Nurs. 2009; 40:(11)491-498

Guze PA Using technology to meet the challenges of medical education. Trans Am Clin Climatol Assoc. 2015; 126:260-270

Hamad A, Jia B How virtual reality technology has changed our lives: An overview of the current and potential applications and limitations. International Journal of Environment Research and Public Health. 2022; 19:(18)

Handeland JA, Prinz A, Ekra EMR, Fossum M The role of manikins in nursing students' learning: A systematic review and thematic metasynthesis. Nurse Educ Today. 2021; 98

Higham H, Baxendale B To err is human: use of simulation to enhance training and patient safety in anaesthesia. Br J Anaesth. 2017; 119:(1)i106-i114

Jeffries PR Simulation in nursing education: from conceptualisation to evaluation, 2nd edn. : National League for Nursing; 2012

Kardong-Edgren S, Breitkreuz K, Werb M, Foreman S, Ellertson A Evaluating the usability of a second-generation virtual reality game for refreshing sterile unrinary catheriszation skills. Nurse Educ. 2019; 44:(3)137-141

Kim J, Park JH, Shin S Effectiveness of simulation-based nursing education depending on fidelity: a meta-analysis. BMC Med Educ. 2016; 16:(1)

Massoth C, Röder H, Ohlenburg H High-fidelity is not superior to low-fidelity simulation but leads to overconfidence in medical students. BMC Med Educ. 2019; 19:(1)

Mather C, McCarthy R Exploring the effects of a high-fidelity environment on nursing students' confidence and performance of CPR. Nurs Stand. 2021; 36:(2)76-82

McGhee S, Bradley P, McCommish A Immersive virtual reality: potential use in an undergraduate nursing & midwifery program in Scotland. Studies in Learning, Evaluation, Innovation and Development. 2011; 8:49-59

Kolb's learning style and experiential learning cycle. 2023. https//

Mutlu B, Yılmaz OE, Dur S The effect of high- and low-fidelity simulators in learning heart and lung sounds by undergraduate nurses: a randomized controlled trial. Contemp Nurse. 2019; 55:(4-5)351-359

Nursing and Midwifery Council. Future Nurse: standards of proficiency for registered nurses. 2018. https// (accessed 20 March 2024)

Nursing and Midwifery Council. Supporting information for standards: Simulated practice learning. 2023. https// (accessed 20 March 2024)

Oermann MH, Kardong-Edgren S, Odom-Maryon T HeartCode BLS with voice assisted manikin for teaching nursing students: preliminary results. Nurs Educ Perspect. 2010; 31:(5)303-308

Onan A, Turan S, Cinar Bulut S, Elcin M, Erbil B The effectiveness of traditional basic life support training and alternative technology-enhanced methods in high schools. Hong Kong J Emerg Med. 2018;

Preston RM, Flynn DJ Observations in acute care: evidence-based approach to patient safety. Br J Nurs. 2010; 19:(7)442-446

Rahmawati I, Sulistiya Ningsih DP The effects of simulation of the basic life support training on nursing students' knowledge. Nurse and Health: Jurnal Keperawatan. 2020; 9:(2)177-183

Resuscitation Council UK. Resuscitation guidelines. 2021. https// (accessed 20 March 2024)

Resuscitation Council UK. Lifesaver VR: Immerse yourself in our innovative CPR training game. 2024. https// (accessed 20 March 2024)

Rushton M Simulation and the student pathway to critical care. British Journal of Cardiac Nursing. 2015; 10:(2)93-98

Rushton MA, Drumm IA, Campion SP, O'Hare JJ The use of immersive and virtual reality technologies to enable nursing students to experience scenario-based, basic life support training—exploring the impact on confidence and skills. CIN: Computers, Informatics, Nursing. 2020; 38:(6)281-293

Sangavi P, Jena AB, Newhouse JP, Zalavsky AM Outcomes of basic versus advanced life support for out of hospital medical emergencies. Ann Intern Med. 2015; 163:(9)681-690

Smith PC, Hamilton BK The effects of virtual reality simulation as a teaching strategy for skills preparation in nursing students. Clin Simul Nurs. 2015; 11:(1)52-58

Smith J, Rushton M Improving student nurses' confidence in managing the acutely ill patient. Br J Nurs. 2018; 27:(3)124-129

Swift L, Henderson A, Wu CJJ Self-confidence in clinical skill: A descriptive study of the perspective of first-year nursing students. Nurse Educ Pract. 2022; 58

Toubasi S, Alosta MR, Darawad MW, Demeh W Impact of simulation training on Jordanian nurses' performance of basic life support skills: A pilot study. Nurse Educ Today. 2015; 35:(9)999-1003

Truszewski Z, Szarpak L, Kurowski A Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses. Am J Emerg Med. 2016; 34:(3)381-385

Watson R Quantitative research. Nurs Stand. 2015; 29:(31)44-48

Yu T, Hua Y, Cen X, Niu S The impact of fidelity-based simulated medical undergraduate education: a systematic review and meta-analysis of randomised controlled trials. Journal of Biomedical Research and reviews. 2021; 4:(2)9-15

Yuan HB, Williams BA, Fang JB The contribution of high-fidelity simulation to nursing students' confidence and competence: a systematic review. Int Nurs Rev. 2012; 59:(1)26-33

Basic life support training: Is student confidence enhanced by advanced levels of simulation?

09 May 2024
Volume 33 · Issue 9



Basic life support (BLS) is a mandatory skill for nurses. The confidence of the BLS provider should be enhanced by regular training. Traditionally, BLS training has used low-fidelity manikins, but more recent studies have suggested the use of high-fidelity manikins and alternative levels of simulation such as virtual reality.


A quasi-experimental study including 125 nursing students. Data on confidence levels in various elements of BLS were collected using pre-validated questionnaires and analysed using SPSSv23.


The study revealed that high-fidelity simulation had a significant impact on the BLS learner's confidence levels.


The study identified the importance of high-fidelity simulation in BLS training in preparing students for clinical practice. This highlights the need for further exploration of simulation technologies, such as virtual reality, to enable students to gain the knowledge, skills, confidence and competence required to enable safe and effective practice.

Basic life support (BLS) is crucial in the event of a cardiac arrest (European Resuscitation Council, 2021; Resuscitation Council UK (RCUK), 2021) and BLS training is of international concern (Dick-Smith et al, 2021). In hospitals, nurses are often the first responders to a cardiac arrest, providing BLS, which is a mandatory skill. Nursing students are involved directly in caring for acutely ill patients (Smith and Rushton, 2018), who are at risk of cardiac arrest, and require training to ensure that they can assist and deliver BLS if required.

The self-confidence of the learners in performing a practical skill is important (Aoyama et al, 2013). Swift et al (2022) acknowledged that the development of self-confidence is not related to just one learning episode, but that self-confidence is the outcome of scaffolded learning that relates to theory and practice. Nurse educators need to find strategies to instil confidence to enable the students to deliver BLS under pressure (Smith and Hamilton, 2015).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content