Achieving competence and confidence in paediatric BLS : a non-inferiority study comparing generic and specific bls training

Abstract

Background: Standard Basic Life Support (BLS) training forms the foundation of emergency preparedness among nursing students. While standard BLS primarily focuses on adult resuscitation, paediatric adaptations are often given limited attention. Paediatric Basic Life Support (PBLS) training needs to be specifically tailored to meet the physiological and anatomical differences of children and infants. Despite this, limited evidence exists comparing PBLS and standard BLS training in terms of confidence, perceived competence and actual competence. Aim: To determine whether standard (generic) BLS training produces comparable levels of confidence and competence in performing child and infant BLS to those achieved through paediatric (specific) BLS training. Design and Methods: A quantitative randomised controlled non-inferiority trial was conducted among second-year undergraduate nursing students at the University of Malta. Participants were randomly allocated to either the Intervention group (Standard BLS) or the Control group (PBLS). Data were collected using a validated questionnaire measuring confidence and perceived competence, and a structured skills checklist assessing actual competence. Statistical analysis included t-tests, Mann–Whitney U tests, and effect size calculations using SPSS version 29. Participants: Sixty one second-year nursing students were recruited, with 29 participants in the intervention and 32 in the control group. Both groups were comparable in terms of demographic characteristics and previous training experience. Results: Findings demonstrated significantly higher levels of confidence, perceived competence, and actual competence in the PBLS group compared with the standard BLS group across all domains, including identification of arrest, ventilation, chest compressions, and AED use. Effect sizes indicated strong practical significance, confirming the robustness of results. Conclusion: Standard BLS training did not meet the non-inferiority criteria for any outcome measure, indicating that it is inferior to paediatric-specific instruction in preparing nursing students for paediatric resuscitation. PBLS training consistently produced higher confidence, perceived competence, and actual competence scores, demonstrating clear superiority across all domains. These findings show that paediatric-focused training not only achieves but exceeds the learning outcomes of generic BLS, enhancing both technical performance and self-assurance. The results strongly support the integration of dedicated PBLS training within undergraduate nursing programmes to ensure nurses are adequately prepared for both adult and paediatric cardiac emergencies.