CPR Knowledge, Self-Efficacy, and Clinical Preparedness Among Nurses Across Diverse Healthcare Settings in Saudi Arabia: A Mixed-Methods Cross-Sectional Study
This mixed-methods study in Saudi Arabia reveals that while CPR knowledge positively correlates with self-efficacy among nurses, significant preparedness gaps across healthcare settings are driven more by psychological factors, clinical exposure, and institutional support than by knowledge deficits alone, highlighting a critical need for simulation-based training and routine debriefing in outpatient and primary care environments.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When a person's heart stops beating, the next few minutes are a race against time. Every minute that passes without effective chest compressions and rescue breathing reduces the chance of survival by a significant amount. In almost every hospital and clinic, the first person to notice a patient collapsing is a nurse. What that nurse does in those first moments is critical. However, there is a difference between knowing the steps of a rescue and believing you can actually perform them under pressure. Knowing the rules is a matter of memory; believing you can act is a matter of confidence. This study explores that gap, looking at how well nurses in Saudi Arabia know the life-saving steps of cardiopulmonary resuscitation, or CPR, and, more importantly, how confident they feel when facing a real emergency.
Researchers set out to understand why this confidence varies so much depending on where a nurse works. They looked at four very different environments: the high-stress critical care units where cardiac arrests happen frequently, the general hospital wards where patients are recovering from surgery or illness, the outpatient clinics where people come for routine checkups, and the primary health centers that serve as the first point of contact for the community. The team wanted to see if a nurse's confidence was simply a result of how much they knew, or if the environment itself played a bigger role. They also wanted to hear directly from the nurses about what makes them feel ready or what holds them back.
To find the answers, the researchers gathered data from 227 nurses across the Eastern Province of Saudi Arabia. They asked the nurses to take a written test to measure their knowledge of CPR guidelines and to fill out a survey that measured their self-confidence in performing the task. At the same time, the researchers interviewed 22 nurses from these different settings to get a deeper look at their experiences. The goal was to combine the hard numbers from the tests with the personal stories from the interviews to get a complete picture of preparedness.
The results showed a clear pattern. Nurses working in critical care units, where they see cardiac arrests often, were the most knowledgeable and the most confident. They scored the highest on both the knowledge test and the confidence survey. In contrast, nurses working in outpatient clinics and primary health centers, where cardiac arrests are rare, had lower scores. They knew less about the specific details of the procedure and felt much less sure of themselves. The study found that while knowing the steps was important, it only explained a small part of why some nurses felt confident and others did not. A nurse could know the theory perfectly but still feel paralyzed by fear if they had never actually practiced the skill in a real situation.
One of the most revealing findings was that the type of workplace mattered, but not in the way one might expect. Even within the same type of hospital unit, nurses felt very differently about their abilities. Two nurses working in the same ward could have vastly different levels of confidence. The researchers found that the key factor was not the job title or the hospital building, but how often the nurse had actually been part of a real resuscitation event. A nurse who had helped save a life recently felt much more capable than a nurse who had not seen an emergency in years, even if they both had the same training certificate.
The interviews revealed the reasons behind these feelings. For nurses in busy critical care units, confidence came from repeated practice and a supportive team environment. They described a culture where mistakes were treated as learning opportunities, and where doctors would guide them through the steps during an actual emergency. This "learning while doing" built their confidence quickly. In contrast, nurses in clinics and primary care centers described a culture of fear. They worried about making a mistake or being blamed if things went wrong. Some felt they were not allowed to start CPR without a doctor's direct order, which made them hesitate. They also noted that their training was often just about getting a certificate to renew their license, rather than practicing the skills until they felt natural.
The study also uncovered a surprising psychological factor. Some nurses described a sense of spiritual strength or faith that gave them confidence during a crisis, a feeling that standard confidence surveys often miss. This suggests that for many, the ability to act in an emergency is tied to something deeper than just technical skill. Furthermore, the researchers found that simply participating in a practice drill, or "mock code," did not guarantee better performance. The quality of the drill mattered more than just showing up. If the practice was rushed or not taken seriously, it did not help the nurses feel more prepared.
The researchers concluded that the gap in preparedness cannot be fixed by just teaching nurses more facts. The current system, which relies heavily on written tests and periodic certification, is not enough to ensure that nurses in every setting feel ready to act. The study suggests that to build true confidence, training needs to change. Nurses in clinics and primary care centers need more simulation-based training that mimics real emergencies, and hospitals need to create a culture where nurses feel safe to act without fear of blame. Most importantly, every hospital unit should have a routine practice of reviewing what happened after a resuscitation event, so that every nurse, regardless of their setting, can learn and grow from the experience. The findings show that confidence is built through experience and support, not just through a certificate on a wall.
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