CHAPTER II
REVIEW OF RELATED LITERATURE
In this section of the study, we will delve into the comprehensive review of related
literature and studies pertaining to the effectiveness of BLS training among profesionals' level of
self efficacy, knowledge and skills. This critical examination aims to provide a solid foundation
for our research, offering insights into the existing body of knowledge in this domain.
Basic Life Support
Basic Life Support (BLS) training is a fundamental component of healthcare and
emergency response, aimed at equipping professionals with the necessary skills to respond
effectively in life-threatening situations. It generally refers to the type of care that first-
responders, healthcare providers and public safety professionals provide to anyone who is
experiencing cardiac arrest, respiratory distress or an obstructed airway. It requires knowledge
and skills in cardiopulmonary resuscitation (CPR), using automated external defibrillators (AED)
and relieving airway obstructions in patients of every age (American Red Cross, 2023).
After undergoing comprehensive training programs, both healthcare and non-healthcare
individuals will acquire essential Basic Life Support (BLS) skills and techniques. These
programs aim to ensure that individuals from diverse backgrounds can confidently respond to
medical emergencies, potentially saving lives in critical situations.
Chest Compressions: Chest compressions are a fundamental component of BLS.
Research by American Heart Association (AHA) guidelines has consistently emphasized the
importance of high-quality chest compressions. Trained individuals should aim for a
compression depth of at least 2 inches in adults and a rate of 100-120 compressions per minute
(AHA, 2020).
Rescue Breaths: In conjunction with chest compressions, rescue breaths are essential in
BLS. The AHA recommends a compression-ventilation ratio of 30:2 for adults. This ratio may
differ for infants and children, emphasizing the importance of adapting BLS techniques based on
age (AHA, 2020).
Automated External Defibrillators (AEDs): AEDs play a vital role in BLS, particularly
for cases of ventricular fibrillation and ventricular tachycardia. Research has demonstrated the
effectiveness of AEDs in improving survival rates (Hazinski et al., 2018).
High-Quality BLS Training: The performance of BLS techniques relies heavily on
proper training and ongoing practice. Studies emphasize the need for regular BLS training,
which can significantly impact the competence and confidence of healthcare providers
(Maconochie et al., 2020).
Dispatcher-Assisted BLS: Dispatcher-assisted BLS, when emergency medical
dispatchers provide instructions over the phone, has been shown to improve the quality of BLS
and increase the likelihood of survival (Perkins et al., 2015).
Self Efficacy
Self-efficacy, as defined by Albert Bandura, is an individual's belief in their own ability
to perform a specific task or achieve a particular goal effectively (Bandura, 1977). It plays a
crucial role in various aspects of life, including basic life support (BLS).
In the context of basic life support, self-efficacy is the confidence that a person has in
their ability to provide critical, life-saving interventions during emergency situations, such as
cardiopulmonary resuscitation (CPR) or using automated external defibrillators (AEDs).
Individuals with higher self-efficacy in BLS are more likely to initiate and continue these life-
saving procedures effectively when faced with a cardiac arrest emergency.
For example, someone with high BLS self-efficacy will be more likely to start CPR
promptly and correctly, maintain an adequate compression rate and depth, and use an AED
confidently and effectively, even in a high-stress situation. On the other hand, someone with low
BLS self-efficacy may hesitate or avoid taking action during an emergency, potentially
compromising the chances of the victim's survival.
One of the many health care staff that must be equipped and well-versed with BLS is
nurses. Now, nursing students learn basic theoretical knowledge and gain basic skills about basic
life support during nursing education. However, skills training on basic life support practices
may be insufficient. Nursing students with inadequate skills on basic life support practices may
experience anxiety and a lack of self-esteem related to this practice. Training on basic life
support increase nursing students' knowledge and provide that they implement evidence-based
basic life support practices. Previous studies demonstrated that basic life support training
significantly improved nursing students' knowledge, practice skills, attitudes, and self-
efficacy. Also, training on basic life support would increase nurses' self-esteem related to basic
life support practices and contribute to anxiety management (Selmin Kose et al., 2019).
Training programs and educational interventions in basic life support often aim to
enhance self-efficacy by providing individuals with the knowledge, skills, and practice necessary
to feel confident in their ability to respond effectively in life-threatening situations (Schwarz et
al., 2019). By increasing self-efficacy in BLS, individuals are more likely to take quick and
appropriate actions, thus improving the chances of a positive outcome during cardiac arrest
emergencies.
In summary, self-efficacy in basic life support refers to an individual's belief in their
capability to perform life-saving actions during emergencies like CPR and AED use. This self-
belief significantly influences their willingness and ability to respond effectively in critical
situations, ultimately impacting the chances of survival for the victim.
Knowledge
Knowledge in Basic Life Support (BLS) refers to the understanding and application of
essential life-saving techniques and principles used in emergency situations to sustain or restore
a person's basic life functions, such as breathing and circulation. It encompasses a range of skills
and information, including cardiopulmonary resuscitation (CPR), the use of automated external
defibrillators (AEDs), recognizing signs of cardiac arrest, and responding appropriately to
choking or respiratory distress.
According to The American Heart Association (2018), knowledge in BLS is a critical
skill set that can empower individuals to respond effectively during life-threatening emergencies.
It enables laypeople and healthcare professionals alike to provide immediate assistance to
someone in need, potentially saving lives before professional medical help arrives. BLS
knowledge is straightforward to acquire through training courses, online resources, and
educational programs, making it accessible to a broad audience. This knowledge equips
individuals with the confidence and competence to act swiftly and decisively in emergency
situations, fostering a sense of responsibility and community safety.
While BLS knowledge is undeniably valuable, there are potential downsides to consider.
First and foremost, the efficacy of BLS techniques depends on the skill and confidence of the
responder, which may vary widely. In some cases, well-intentioned but inadequately trained
individuals may inadvertently worsen a victim's condition. There is also a risk of performing
BLS incorrectly, which can lead to injuries such as broken ribs or damage to the victim.
Additionally, some individuals may feel overwhelmed or hesitant to intervene in emergencies
due to fear or lack of knowledge, potentially delaying assistance from arriving professionals.
In summary, knowledge in Basic Life Support is a valuable and potentially life-saving
skill that empowers individuals to respond effectively in emergencies. However, its effectiveness
depends on proper training and the confidence of the responder. There are potential risks
associated with incorrect implementation or hesitation, highlighting the need for ongoing
education and awareness in BLS.
Skill
Undoubtedly, Basic Life Support (BLS) is a skill that cannot be acquired through mere
observation. It is a set of fundamental life-saving skills and techniques designed to provide
immediate care to individuals experiencing cardiac arrest or other life-threatening emergencies.
These skills are typically administered by first responders, healthcare professionals, or
bystanders until advanced medical assistance [Link] you are in the healthcare field or
not, obtaining proficiency in BLS necessitates a dedicated investment of time and training. This
training is essential for mastering the precise techniques required to effectively administer BLS
and provide assistance to individuals or groups in critical need of it. Furthermore, BLS is not the
kind of skill that one can acquire and then neglect, as proficiency can diminish over time without
ongoing training and practice.
Now according to American Heart Association (2020), Resuscitation Council UK (2021)
and American Red Cross (2020), there is a positive and negative perspective on acquiring BLS
skill. The positive perspectives are as follows:
Rapid Response: BLS equips individuals with the ability to respond promptly to life-
threatening situations. By recognizing the signs of cardiacarrest and knowing how to administer
CPR, BLS can significantly increase the chances of survival for the victim.
Widespread Accessibility: BLS training is widely available and can be learned by
individuals with various backgrounds and levels of medical knowledge. This empowers more
people to potentially save lives, making it a valuable skill for communities.
Improved Outcomes: When performed correctly, BLS interventions can improve outcomes
and minimize the risk of brain damage or other serious complications in individuals experiencing
cardiac arrest or respiratory distress.
Now for the negative side, Training Requirements: Learning and maintaining proficiency
in BLS techniques require time and effort. Some individuals may find it challenging to commit
to regular training, potentially leading to skills deterioration over time.
Stressful Situations: Administering BLS in real-life emergencies can be emotionally and
mentally taxing. Bystanders may hesitate or panic when faced with a critical situation, affecting
their ability to provide effective care.
Limited Scope: BLS is designed for immediate response and stabilization. It may not
address underlying medical conditions causing the emergency, and more advanced medical care
is often needed for a comprehensive solution.
In conclusion, Basic Life Support is a critical set of skills that can save lives in emergencies.
While it has several positive aspects, including rapid response and improved outcomes, it also
comes with challenges such as training requirements and the stress of administering care in high-
pressure situations.
Synthesis Gap
Despite the importance of Basic Life Support (BLS) training and its potential to save
lives, there is a significant gap in research and understanding regarding the long-term retention
and practical application of BLS skills among individuals who have completed training
programs. While many studies emphasize the benefits of initial BLS training, there is limited
research on the effectiveness of ongoing skill retention and the real-world application of BLS
techniques over time.
References:
1. American Heart Association (AHA). (2020). "Highlights of the 2020 American
Heart Association Guidelines for CPR and ECC." Retrieved from
[Link]
f
2. Resuscitation Council (UK). (2021). "Quality Standards for Cardiopulmonary
Resuscitation Practice and Training." Retrieved from
[Link]
3. American Red Cross. (n.d.). "Basic Life Support (BLS) Training." Retrieved from
[Link]
4. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change.
Psychological Review, 84(2), 191-215.
5. Schwarz, D., Bayer, G., Weber, R., Hohenstein, C., Tetzlaff, J. E., Spies, C., ... & Fitzner,
C. (2019). Educational efficiency of a basic life support course for dental students: A
prospective, controlled clinical trial. PLOS ONE, 14(6), e0218460.
doi:10.1371/[Link].0218460.
6. Hazinski, M. F., et al. (2018). Part 1: Executive Summary: 2015 American Heart
Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care. Circulation, 132(18 Suppl 2), S315-S367.
7. Maconochie, I. K., et al. (2020). 2020 International Consensus on Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care Science With Treatment
Recommendations: Summary From the Basic Life Support; Advanced Life Support;
Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams;
and First Aid Task Forces. Circulation, 142(16 Suppl 1), S41-S91.
8. Perkins, G. D., et al. (2015). European Resuscitation Council Guidelines for
Resuscitation 2015: Section 2. Adult basic life support and automated external
defibrillation. Resuscitation, 95, 81-99.