Association of Basic Life Support Training on Cardiopulmonary Resuscitation Knowledge and Skills Among Nursing Students in Palestine

Abstract

Introduction

Cardiac arrest remains a leading cause of sudden mortality worldwide, and survival is highly dependent on the timely initiation of cardiopulmonary resuscitation (CPR) and Basic Life Support (BLS). Nursing students often demonstrate inadequate baseline knowledge and psychomotor skills, highlighting the need for structured educational interventions.

Objective

This study aimed to evaluate changes in CPR knowledge and practical skills among undergraduate nursing students following participation in a structured BLS training program.

Methods

A quasi-experimental one-group pretest–posttest design was conducted among 56 third-year nursing students during the 2024–2025 academic year. Data were collected using a structured knowledge questionnaire and an observational skills checklist based on American Heart Association guidelines. Paired-sample t-tests were used to compare pre- and post-intervention outcomes.

Results

Significant improvements were observed in both knowledge and practical skills following the training program. Mean knowledge scores increased from 42.18 ± 3.01 to 87.64 ± 3.22, while mean skill scores improved from 35.12 ± 4.26 to 88.21 ± 3.67 (p < .001). These findings indicate substantial within-group changes over time.

Conclusion

Participation in the BLS training program was associated with improved CPR knowledge and skills among nursing students. However, due to the quasi-experimental design and absence of a control group, causal inferences cannot be established. Further controlled and longitudinal studies are recommended to evaluate long-term effectiveness and skill retention.

Keywords

basic life support cardiopulmonary resuscitation nursing students knowledge skills

Introduction

Out-of-hospital and in-hospital cardiac arrest remain among the leading causes of sudden mortality worldwide, representing a significant public health challenge despite advances in emergency and critical care services. Survival outcomes are highly time-sensitive and depend on the early recognition of cardiac arrest, prompt initiation of high-quality cardiopulmonary resuscitation (CPR), and timely defibrillation, as conceptualized in the “chain of survival” framework (Lim et al., 2021; Olasveengen et al., 2020; Panchal et al., 2020). Basic Life Support (BLS) constitutes the foundation of this response and includes essential interventions aimed at maintaining circulation and ventilation until advanced care is available. Evidence suggests that effective BLS can substantially increase survival rates following cardiac arrest (Tiwari et al., 2023).

Cardiovascular diseases remain the leading cause of mortality globally, accounting for over 20 million deaths annually, with a considerable proportion resulting from sudden cardiac arrest (Casper, 2023; Rajagopalan et al., 2022). The burden is disproportionately higher in low- and middle-income countries, where limited resources and delayed emergency responses contribute to poorer outcomes. In such contexts, the competence of frontline healthcare providers is critical. Nurses, in particular, play a central role in early recognition and initiation of life-saving interventions (Riley et al., 2022).

Nursing students, as future healthcare providers, must acquire adequate CPR competence during their education. However, accumulating evidence indicates that students often demonstrate insufficient baseline knowledge and psychomotor skills prior to formal training (Abuejheisheh et al., 2023; Al Yazeedi et al., 2025; Kose et al., 2019). This gap highlights the need for structured and evidence-based educational interventions.

Previous studies have consistently demonstrated that structured BLS training improves CPR knowledge and skills across diverse settings. Simulation-based and blended learning approaches have shown particular effectiveness in enhancing competence and confidence (Oermann et al., 2021; Tuzer et al., 2020). Despite these findings, gaps remain in understanding the effectiveness of such interventions within resource-constrained settings, including Palestine.

Nevertheless, despite the demonstrated benefits of BLS training, persistent gaps in CPR competence have been documented. Several studies report that nursing students and even registered nurses possess limited knowledge, poor skill performance, and low confidence in performing CPR, particularly in the absence of regular refresher training (Rajeswaran et al., 2018; Tomas, N., & Kachekele, Z. A. 2023). Cross-sectional studies are useful in identifying these deficits but are limited in their ability to evaluate educational impact, highlighting the need for intervention-based designs that assess learning outcomes over time (Salameh et al., 2018).

From a methodological perspective, evaluating both cognitive (knowledge) and psychomotor (skills) domains within a single study is essential to provide a comprehensive assessment of CPR competency. Knowledge alone does not guarantee effective performance in real-life cardiac arrest situations, whereas skill-based assessments ensure that theoretical understanding is translated into accurate and timely clinical action (Oermann et al., 2021; Tuzer, et al., 2020). Furthermore, examining the relationship between knowledge and skills can offer valuable insights into how educational interventions influence overall clinical competence.

In the Palestinian context, limited local evidence exists regarding the effectiveness of structured BLS training among undergraduate nursing students. Given the constraints faced by the healthcare system, including workforce shortages, resource limitations, and ongoing political instability, strengthening the emergency preparedness of future nurses is both an educational and public health priority. University, as a leading institution in nursing education, provides an important setting to evaluate the impact of BLS training on students’ readiness to manage cardiac emergencies.

Review of Literature

Basic Life Support (BLS) competence among nursing students has received increasing scholarly attention due to its direct association with patient survival during cardiac arrest. International literature consistently reports that nursing students enter clinical training with insufficient preparedness to perform cardiopulmonary resuscitation (CPR), particularly with respect to psychomotor skills and adherence to guideline-based performance standards. A multicountry observational study by Bylow et al. (2021) across European nursing programs demonstrated that fewer than half of undergraduate nursing students could correctly perform chest compression depth and rate according to international recommendations, despite prior theoretical exposure. These findings suggest that didactic instruction alone is insufficient to ensure clinical readiness.

Similarly, a longitudinal cohort study conducted in South Korea by Lee and Kim (2020) revealed that although nursing students exhibited moderate CPR knowledge, skill decay occurred rapidly within three months of initial instruction in the absence of structured reinforcement. This pattern of early skill attrition highlights the vulnerability of CPR competence when training is sporadic or inadequately reinforced within nursing curricula.

A substantial body of intervention-based research supports the effectiveness of structured BLS training in improving CPR knowledge and performance among nursing students. Simulation-based education, in particular, has emerged as a highly effective pedagogical strategy. In a randomized controlled trial conducted in Spain, López-Campos et al. (2021) found that nursing students who received high-fidelity simulation training demonstrated significantly higher post-training CPR accuracy and retention at six weeks compared to those trained using traditional lecture-based methods.

Blended learning approaches have also shown promising results. A quasi-experimental study in Malaysia by Rahman et al. (2022) reported significant improvements in both cognitive and psychomotor CPR outcomes following a hybrid BLS program combining online modules with supervised hands-on practice. Importantly, students reported higher confidence and perceived readiness to intervene in real emergency situations, reinforcing the role of educational design in shaping clinical self-efficacy.

Evidence from low- and middle-income countries further supports these findings. In Ethiopia, Tsegaye et al. (2023) demonstrated that a short, competency-based BLS workshop significantly improved nursing students’ CPR performance, regardless of prior exposure. This suggests that well-designed training can overcome baseline educational disparities and resource limitations. The relationship between theoretical knowledge and practical CPR skills remains a critical focus in nursing education research. While knowledge is a necessary foundation, it does not consistently predict effective performance under pressure. A cross-lagged analysis by Park et al. (2020) among nursing undergraduates in Japan showed that gains in knowledge did not automatically translate into skill proficiency unless accompanied by repetitive, supervised practice. This finding underscores the importance of integrated educational models that deliberately bridge cognitive learning with psychomotor execution.

Conversely, a Canadian mixed-methods study by Oermann et al. (2021) found that students who achieved higher post-training knowledge scores were more likely to adhere to CPR sequence accuracy during simulation scenarios, indicating that knowledge may enhance performance when embedded within structured training environments. These nuanced findings suggest that the knowledge–skill relationship is conditional rather than linear and depends heavily on instructional design and assessment strategies.

The role of socio-demographic variables in CPR competence has produced inconsistent findings across studies. Several investigations report no significant associations between CPR knowledge or skills and variables such as age, gender, or academic year. For instance, a multicenter study in Australia by Smith et al. (2020) found that CPR performance among nursing students was primarily influenced by training exposure rather than demographic characteristics. In contrast, limited evidence suggests that prior clinical exposure may exert a modest influence on performance. A study conducted in China by Zhang et al. (2021) reported that senior nursing students demonstrated slightly higher CPR skill scores than juniors; however, the difference was not clinically significant after controlling for recent training participation. These findings reinforce the view that demographic characteristics alone are weak predictors of CPR competence compared to structured educational interventions.

Within the Middle Eastern context, research on BLS training among nursing students remains limited but growing. A Saudi Arabian interventional study by Al-Enizi et al. (2022) demonstrated significant improvements in CPR knowledge and hands-on performance following a standardized BLS course aligned with international guidelines. Importantly, the authors emphasized the need for mandatory curriculum integration rather than optional workshops. In Jordan, Abu-Al-Rub et al. (2020) reported that nursing students expressed strong motivation to learn CPR but lacked confidence prior to formal training. Post-intervention assessments revealed substantial improvements, supporting the relevance of structured BLS education in Arab healthcare education systems. However, Palestinian-specific intervention studies remain scarce, highlighting a critical gap in the regional literature.

Collectively, the reviewed literature demonstrates that nursing students worldwide often exhibit inadequate baseline CPR knowledge and skills, which can be significantly improved through structured, evidence-based BLS training programs. Simulation-based and blended learning approaches appear particularly effective in enhancing both performance and confidence. While socio-demographic variables show inconsistent associations with CPR competence, training exposure consistently emerges as the strongest determinant of improved outcomes.

Despite robust international evidence, there remains a notable lack of intervention-based studies evaluating BLS training effectiveness among nursing students in Palestinian universities. Moreover, few studies simultaneously examine knowledge, skills, and their interrelationship using standardized assessment tools within resource-constrained settings. Addressing this gap is essential to inform curriculum development, strengthen emergency preparedness, and enhance patient safety in the Palestinian healthcare system.

Aim of the Study

The aim of this study was to examine changes in cardiopulmonary resuscitation (CPR) knowledge and practical skills among undergraduate nursing students before and after participation in a structured Basic Life Support (BLS) training program. Additionally, the study sought to explore the relationship between knowledge and skill performance and to assess the influence of selected socio-demographic characteristics on these outcomes.

Hypothesis

H1: There is a statistically significant difference in CPR knowledge scores among nursing students before and after participation in the BLS training program.

H2: There is a statistically significant difference in CPR practical skill scores among nursing students before and after participation in the BLS training program.

Methods

Study Design

This study employed a quasi-experimental one-group pretest–posttest design to evaluate changes in cardiopulmonary resuscitation (CPR) knowledge and practical skills among undergraduate nursing students following participation in a structured Basic Life Support (BLS) training program. This design is appropriate for assessing educational interventions when randomization or the inclusion of a control group is not feasible, particularly in academic settings where all students are expected to receive standardized training. However, this design does not control for potential confounding factors such as testing effects, maturation, or the Hawthorne effect. Therefore, findings should be interpreted as reflecting associations over time rather than causal effects of the intervention. The study was reported in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) statement.

Study Setting

The study was conducted at the College of Nursing of a public university in Palestine during the 2024–2025 academic year. The educational intervention was implemented within the institutional learning environment, with the theoretical component delivered in designated university classrooms equipped for multimedia instruction. The practical component and skills assessment were conducted in the nursing skills laboratory, which is equipped with adult CPR mannequins and simulation resources aligned with Basic Life Support training requirements. This setting provided a controlled and standardized environment for both instruction and evaluation of psychomotor performance.

Study Population and Sampling

The target population comprised all third-year undergraduate nursing students enrolled in the Bachelor of Science in Nursing program during the study period (N = 134). Third-year students were selected because they had completed foundational theoretical courses and had begun clinical exposure, making them suitable candidates for evaluating emergency care competencies such as CPR. A convenience sampling approach was adopted due to logistical constraints related to training capacity, instructor availability, and laboratory resources. A total of 60 students were invited to participate, of whom 56 completed both the pre-intervention and post-intervention assessments and were included in the final analysis. Four students were excluded due to incomplete post-intervention data. Although convenience sampling may limit generalizability, it is commonly used in educational intervention studies where participation is dependent on course scheduling and resource availability.

Sample Size Determination

Sample size estimation was conducted using G*Power software (version 3.1) for a paired-sample t-test. Assuming a medium effect size (d = 0.50), a significance level of 0.05, and a statistical power of 0.80, the minimum required sample size was calculated as 54 participants. To account for potential attrition, 60 students were initially recruited.

Eligibility Criteria

Participants were eligible if they were third-year undergraduate nursing students who had completed prerequisite courses in anatomy and physiology and had not previously received formal or certified BLS or CPR training. Students who had prior certification, were absent during either assessment phase, or submitted incomplete data were excluded from the study.

Intervention: Basic Life Support Training Program

The educational intervention consisted of a structured BLS training program developed in accordance with the 2020 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care (Panchal et al., 2020). The training was delivered by two certified BLS instructors with expertise in emergency and critical care nursing. The program was conducted over four hours and comprised two integrated components. The first component involved a two-hour theoretical session delivered using interactive lectures supported by audiovisual materials. This session addressed recognition of cardiac arrest, activation of emergency response systems, and the standardized sequence of adult BLS procedures. Emphasis was placed on the principles of high-quality CPR, including compression depth, compression rate, chest recoil, and ventilation techniques. The second component consisted of a two-hour supervised practical session conducted in the skills laboratory. Students practiced CPR procedures using adult mannequins in small groups to ensure individualized feedback. Each participant performed the full CPR sequence under instructor supervision, with immediate corrective feedback provided to enhance procedural accuracy and adherence to guideline-based standards.

Data Collection Instruments

Data were collected using a structured assessment instrument comprising three components: demographic characteristics, CPR knowledge, and CPR practical skills. The knowledge assessment tool was developed based on the American Heart Association, 2020 BLS guidelines and relevant literature. Item development involved identifying key domains (recognition of cardiac arrest, CPR sequence, compression technique, ventilation, and emergency response activation), followed by drafting and refinement of items based on expert feedback. Each correct response was assigned one point, and total scores were converted to percentage values.

Practical CPR skills were assessed using a standardized observational checklist aligned with guideline-based performance criteria. The checklist included key procedural elements such as scene safety assessment, responsiveness check, compression depth and rate, ventilation technique, adherence to sequence, and overall performance accuracy. Each item was scored as correctly performed or incorrectly performed, and total scores were expressed as percentages.

The scoring system applied equal weighting across items for operational consistency in scoring and analysis. However, it is acknowledged that this approach does not reflect the varying clinical importance of different CPR components, and therefore represents a methodological simplification. Scores were categorized into three levels (<50%, 50–75%, >75%) to facilitate descriptive interpretation. These thresholds were adopted from prior educational literature; however, they should be considered pragmatic and non-validated categories, and do not represent established competency standards or clinically validated cut-off points.

Validity and Reliability

Content validity of the instrument was established through evaluation by a panel of five experts in emergency nursing, critical care, and nursing education. Experts assessed each item for relevance, clarity, and representativeness using a four-point scale. The scale-level content validity index (S-CVI/Ave) was 0.92, indicating excellent agreement. Internal consistency reliability of the knowledge questionnaire was assessed using Cronbach’s alpha (α = 0.84). For the practical skills checklist, inter-rater reliability was assessed using Cohen’s kappa coefficient (κ = 0.87), indicating strong agreement.

Construct validity remains limited. Although the instrument was aligned with established international BLS guidelines, such alignment supports content relevance rather than full construct validation. Furthermore, the ability of the instrument to detect pre–post changes reflects sensitivity to change rather than evidence of construct validity. The absence of formal procedures such as factor analysis or domain validation should be considered when interpreting the findings.

Data Collection Procedure

Data collection was conducted in three sequential phases. In the pre-intervention phase, participants completed the knowledge questionnaire and underwent baseline skills assessment using the observational checklist. In the intervention phase, participants attended the structured BLS training program. In the post-intervention phase, participants were reassessed immediately after training using the same instruments to evaluate changes in knowledge and skills.

Statistical Analysis

Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 24. Descriptive statistics were used to summarize participants’ characteristics and outcome variables. Continuous variables, including age and CPR scores, were presented as means and standard deviations, while categorical variables were presented as frequencies and percentages. Paired-sample t-tests were used to compare pre- and post-intervention scores. Pearson correlation analysis was conducted to examine the relationship between knowledge and skills. A significance level of p < 0.05 was adopted.

Ethical Considerations

Ethical approval was obtained from the Institutional Review Board of the participating university, participation was voluntary, and written informed consent was obtained from all participants. Confidentiality and anonymity were ensured, and all procedures were conducted in accordance with ethical standards for research involving human participants.

Results

Participants’ Socio-Demographic Characteristics

A total of 56 third-year undergraduate nursing students completed both the pre- and post-intervention assessments. The mean age of participants was 20.89 ± 0.87 years. The majority were female (85.7%), while males constituted 14.3% of the sample. Detailed socio-demographic characteristics are presented in Table 1.

Table 1.

Socio-Demographic Characteristics of Nursing Students (N = 56)

Variables	Category	n	%
Age (years)	Mean ± SD	20.89 ± 0.87	—
Gender	Male	8	14.3
	Female	48	85.7

Baseline CPR Knowledge and Skill Levels Before Training

At baseline, most participants scored within the lower ranges of the study classification system for both CPR knowledge and practical skills. Specifically, 66.1% of students fell within the lowest category for knowledge scores, and 89.3% fell within the lowest category for practical skills. No participants were classified in the highest category at baseline. These distributions are presented in Table 2. It should be noted that these categories (<50%, 50–75%, >75%) were used for descriptive purposes and do not represent validated clinical competency thresholds.

Table 2.

Distribution of CPR Knowledge and Skill Score Categories Before BLS Training (N = 56)

Outcome variable	Level	n	%
CPR Knowledge	<50%	37	66.1
	50–75%	19	33.9
	>75%	0	0.0
CPR Skills	<50%	50	89.3
	50–75%	6	10.7
	>75%	0	0.0

Comparison of Pre- and Post-training CPR Knowledge and Skills

Following participation in the BLS training program, increases in both CPR knowledge and practical skill scores were observed. The mean knowledge score increased from 42.18 ± 3.01 at baseline to 87.64 ± 3.22 post-training. Similarly, the mean skill score increased from 35.12 ± 4.26 to 88.21 ± 3.67. Paired-sample t-tests indicated that these differences were statistically significant (p < .001). These findings reflect within-group changes over time; however, due to the one-group pretest–posttest design and absence of a control group, they should be interpreted as associations rather than causal effects in Table 3.

Table 3.

Comparison of Pre- and Post-training CPR Knowledge and Skill Scores (N = 56)

Outcome	Pre-training mean ± SD	Post-training mean ± SD	Mean difference	t-value	p-value
CPR Knowledge	42.18 ± 3.01	87.64 ± 3.22	45.46	62.31	< .001
CPR Skills	35.12 ± 4.26	88.21 ± 3.67	53.09	58.74	< .001

Association Between Socio-Demographic Variables and Baseline CPR Scores

The association between selected socio-demographic variables (age and gender) and baseline CPR knowledge and skill score categories was examined. No statistically significant associations were identified between gender and knowledge scores (χ² = 0.47, p = .493) or skill scores (χ² = 0.01, p = .912). Similarly, independent-sample t-tests indicated no significant differences in mean age across different knowledge or skill categories (p > .05). These findings are presented in Table 4.

Table 4.

Association Between Socio-Demographic Variables and Baseline CPR Knowledge and Skill Categories (N = 56)

Variable	Category	Knowledge level n (%)	p-value	Skill level n (%)	p-value
Gender	Male	<50%: 6 (75.0)		<50%: 7 (87.5)
	Male	50–75%: 2 (25.0)	.493	50–75%: 1 (12.5)	.912
	Female	<50%: 31 (64.6)		<50%: 43 (89.6)
	Female	50–75%: 17 (35.4)		50–75%: 5 (10.4)

Discussion

The present study examined changes in cardiopulmonary resuscitation (CPR) knowledge and practical skills among undergraduate nursing students following participation in a structured Basic Life Support (BLS) training program. The findings indicated statistically significant increases in both cognitive and psychomotor scores between pre- and post-assessment. These results suggest that participation in the training was associated with improved performance on the study measures; however, they should be interpreted with caution given the methodological characteristics of the study design.

A key finding was that most participants scored within the lower ranges of the study’s classification system at baseline, particularly in practical skills. This observation is consistent with existing literature indicating that nursing students often demonstrate limited preparedness in CPR prior to formal training. For example, Bylow et al. (2021) reported that a substantial proportion of nursing students were unable to meet recommended compression standards despite prior theoretical exposure. Similarly, Zhang et al. (2021) found that CPR performance among nursing students was generally suboptimal in the absence of structured, supervised training. In the present study, these baseline findings should be interpreted as reflecting performance within the defined scoring framework rather than definitive evidence of clinical incompetence, particularly given that the classification thresholds used were not based on validated competency standards.

Following the training program, both knowledge and skill scores increased substantially. These findings align with previous studies reporting improvements in CPR-related outcomes after structured educational interventions. For instance, Rahman et al. (2022) demonstrated that nursing students showed higher post-training knowledge and skills following a blended BLS program, while Tsegaye et al. (2023) reported significant gains in CPR performance after a short, competency-based training intervention. However, it is important to emphasize that such improvements in the present study represent within-group changes over time, and cannot be attributed solely to the intervention due to the absence of a control group and lack of control for potential confounding factors.

The observed increases in practical skills may be related to the structured, hands-on nature of the training, which incorporated supervised practice and immediate feedback. Educational research suggests that simulation-based learning and deliberate practice play an important role in enhancing psychomotor competence. For example, Oermann et al. (2021) found that repeated practice significantly improved CPR performance among nursing students. Nevertheless, in the current study, the magnitude of observed changes should be interpreted cautiously, as large differences in pre–post designs may be influenced by testing effects, increased familiarity with assessment procedures, and participant awareness of being observed (Hawthorne effect), rather than reflecting sustained or generalizable skill acquisition.

An additional finding was the parallel increase in knowledge and skills following the training. This observation is consistent with studies suggesting a relationship between cognitive understanding and psychomotor performance in CPR education. Park et al. (2020) reported that repeated training enhanced both knowledge retention and skill accuracy, while Oermann et al. (2021) highlighted that higher knowledge scores were associated with better adherence to procedural steps. However, the present study did not establish a causal relationship between knowledge and skills, and the observed association should be interpreted as indicative of concurrent improvement rather than directional influence.

Importantly, the interpretation of findings must consider the measurement characteristics of the study instrument. Although the tool demonstrated acceptable content validity and reliability, evidence for construct validity remains limited. Alignment with established guidelines supports content relevance but does not confirm that the instrument fully captures the multidimensional construct of CPR competence. Furthermore, the scoring system applied equal weighting to all items, which may not reflect the varying clinical importance of different CPR components. As such, the results should be interpreted as reflecting performance on the study instrument rather than definitive measures of real-world clinical competence.

The study also found no statistically significant association between socio-demographic variables and baseline CPR scores. This finding is consistent with prior research suggesting that demographic characteristics are less influential than training exposure in determining CPR performance. For instance, Smith et al. (2020) reported that CPR competence among nursing students was primarily associated with training experience rather than age or gender. These findings further support the importance of structured educational opportunities in shaping CPR-related performance.

Several methodological limitations should be acknowledged when interpreting the findings. First, the one-group pretest–posttest design limits the ability to draw causal inferences, as changes may be influenced by testing effects, maturation, or the Hawthorne effect. Second, the use of convenience sampling from a single institution restricts the generalizability of the results. Third, post-intervention assessment was conducted immediately after training, which may reflect short-term knowledge acquisition and performance rather than long-term retention. Fourth, the categorization of scores into predefined ranges was not based on validated competency thresholds, which may influence interpretation of performance levels. Finally, the absence of comprehensive construct validation procedures limits confidence in the extent to which the instrument fully captures CPR competence.

Implications for Practice

Structured Basic Life Support training was associated with improved CPR knowledge and practical skills among nursing students. Integrating mandatory BLS training into undergraduate nursing curricula may enhance emergency preparedness and clinical readiness. Combining theory with supervised hands-on simulation and regular refresher sessions may strengthen skill retention. In resource-limited settings such as Palestine, early CPR competency development could support patient safety and rapid emergency response. However, further controlled studies are needed to confirm long-term effectiveness.

Strengths and Limitations

This study demonstrated several strengths, including the use of a structured pretest–posttest design, allowing direct assessment of changes in CPR knowledge and skills within the same participants. The inclusion of both cognitive and psychomotor domains provided a comprehensive evaluation, while standardized training based on international guidelines enhanced consistency.

However, limitations include the absence of a control group, restricting causal inference, and potential influences such as testing and Hawthorne effects. Convenience sampling and a single-site setting limit generalizability. Immediate post-testing reflects short-term outcomes only. Additionally, limited construct validity, equal item weighting, and non-validated score categories may affect interpretation of performance.

Conclusion

This study found that CPR knowledge and practical skill scores among undergraduate nursing students increased following participation in a structured Basic Life Support training program. These findings suggest that structured training may be associated with short-term improvements in both cognitive and psychomotor performance.

However, due to the quasi-experimental one-group design, the absence of a control group, and limitations related to measurement and immediate post-intervention assessment, the findings should not be interpreted as evidence of causal effectiveness or long-term competence. Rather, they indicate observable changes within the study context that warrant further investigation. Future research employing controlled, longitudinal, and multi-center designs is needed to better understand the impact of BLS training on sustained CPR competence and its potential implications for clinical practice and patient outcomes.

Supplementary File 1: TREND Checklist.

Supplemental Material

Supplementary material - Association of Basic Life Support Training on Cardiopulmonary Resuscitation Knowledge and Skills among Nursing Students in Palestine

Supplementary material for Association of Basic Life Support Training on Cardiopulmonary Resuscitation Knowledge and Skills among Nursing Students in Palestine by Khalaf Awad, Mohammad Qtait, Nesreen Alqaissi, Amira Abuawad, Alaa Amro, Baraa Rjoub, Mohammad Amro, and Izzaldeen Dodeen in Sage Open Nursing.

Footnotes

Acknowledgements

The authors sincerely thank all participants who contributed to this study, as well as the healthcare personnel who facilitated data collection.

ORCID iDs

Mohammad Qtait

Nesreen Alqaissi

Ethical Considerations

Ethical approval for this study was obtained from the Institutional Review Board of (IRB No. 0239/2025).

Consent to Participate

Participation was voluntary, and written informed consent was obtained from all participants prior to data collection. Confidentiality and anonymity of participants were maintained throughout the study. All procedures were conducted in accordance with internationally accepted ethical standards for research involving human participants.

Author Contributions

All authors made substantial contributions to the conception and design of the study. Data collection, analysis, and interpretation were conducted collaboratively. All authors contributed to drafting and critically revising the manuscript, approved the final version for submission, and agree to be accountable for all aspects of the work.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.*

Supplemental Material

Supplemental material for this article is available online.

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