Structured Plus/Delta Debriefing with Graphical Feedback Versus Conversational Debriefing and Chest Compression Quality in Simulated Cardiopulmonary Resuscitation Among Nursing Students: A Quasi-Experimental Study

Abstract

Background/Objectives: Chest compression quality is a key determinant of survival after cardiac arrest. Debriefing is an essential educational tool in cardiopulmonary resuscitation training; however, limited evidence exists regarding the comparative effectiveness of specific debriefing approaches incorporating objective feedback. The objective of this study was to evaluate whether a structured Plus/Delta debriefing approach incorporating graphical performance feedback was associated with greater improvements in chest compression quality parameters than unstructured conversational debriefing in nursing students. Methods: A pre-post quasi-experimental study with a control group was conducted in nursing students. Participants were assigned to experimental or control groups at the academic subgroup level. The experimental group received a structured Plus/Delta debriefing approach incorporating graphical performance feedback, whereas the control group received conversational debriefing. Performance outcomes were assessed before and after the intervention. The primary outcome was the time spent with compression rate, compression depth, and residual leaning simultaneously within their recommended ranges, expressed in seconds. Data were primarily analyzed using linear mixed-effects models to account for repeated measures and clustering. Sensitivity analyses using ANCOVA models adjusted for baseline values and age were performed to assess the robustness of the findings. Results: A total of 112 participants were included (n = 56 per group), with no baseline differences between groups. Improvements were observed in both groups, although they were larger in the experimental group. Mixed-effects models showed significant group × time interactions, with the experimental group showing greater improvements in the primary outcome (? = 91.40 s, 95% CI 82.51-100.28; p < 0.001). Significant group × time interactions were also observed for the secondary compression-quality outcomes. The percentage of total test duration during which all three parameters were simultaneously within the recommended ranges increased in both groups and showed a greater improvement in the experimental group. A complementary analysis using a fixed 120 s observation period showed a greater proportion of time with all three parameters simultaneously within the recommended ranges in the experimental group (50.7% ± 24.8% vs. 42.8% ± 11.0%; p = 0.042). ANCOVA sensitivity analyses adjusted for baseline values and age yielded results consistent with the primary analysis. Conclusions: A structured Plus/Delta debriefing approach incorporating graphical performance feedback was associated with greater improvements in the consistency of guideline-compliant chest compression performance than unstructured conversational debriefing in undergraduate nursing students during simulated CPR training. However, given the quasi-experimental design, group-level allocation, potential practice effects, residual confounding, and the inability to isolate the independent contributions of structured debriefing and graphical feedback, causal inference should be made with caution. Randomized controlled studies are needed to confirm these findings, evaluate their long-term effects, and determine whether similar findings are observed in other populations and settings.