{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:18:08Z","timestamp":1783487888079,"version":"3.55.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Basic life support (BLS) competence is a core professional skill for nursing students, yet conventional training often fails to achieve durable gains in knowledge, psychomotor performance, and clinical transfer. This study evaluated the effectiveness of a Miller\u2019s pyramid-based HeartCode BLS teaching model compared with traditional instruction in undergraduate nursing students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this randomized controlled trial, 229 eligible nursing students were enrolled and assigned to a control group (\n                      <jats:italic>n<\/jats:italic>\n                      = 115) or an observation group (\n                      <jats:italic>n<\/jats:italic>\n                      = 114). The observation group received a HeartCode BLS teaching model structured according to Miller\u2019s pyramid, whereas the control group received conventional BLS teaching. Outcomes were assessed using the Kirkpatrick four-level evaluation framework, including post-training theoretical examination scores, 1-week skill performance, CPR quality indicators, 3-month high-fidelity simulation-based comprehensive application ability, and learner satisfaction. Between-group comparisons were conducted using chi-square tests, independent-samples\n                      <jats:italic>t<\/jats:italic>\n                      -tests, Mann\u2013Whitney U tests, and repeated-measures ANOVA, as appropriate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics and pre-training scores were comparable between groups. After training, the observation group achieved significantly higher scores than the control group in theoretical knowledge (74.29 \u00b1 9.94 vs. 68.81 \u00b1 9.33), CPR skills (85.92 \u00b1 8.67 vs. 79.80 \u00b1 7.56), and defibrillation skills (85.48 \u00b1 8.63 vs. 78.86 \u00b1 5.77; all\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). CPR quality indicators, including compression depth, compression rate, chest recoil, and bag-valve-mask ventilation, were also significantly better in the observation group (all\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). A greater proportion of students in the observation group maintained total compression interruption times below 30 s (57.0% vs. 25.2%;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Learner satisfaction was consistently higher across all domains (all\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). At 3 months, the observation group also outperformed the control group in emergency judgment and decision-making, emergency procedure execution, team communication and collaboration, and total simulation score (all\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>A Miller\u2019s Pyramid-based HeartCode BLS teaching model was associated with significantly improved immediate learning outcomes, CPR quality, learner satisfaction, and mid-term integrated clinical performance among nursing students. This theory-informed, feedback-enabled instructional strategy may offer a scalable and effective approach for optimizing BLS education in undergraduate nursing, although multicenter studies with longer follow-up are needed to confirm generalizability and long-term retention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1863479","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T04:49:38Z","timestamp":1783486178000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Application effect of Miller\u2019s pyramid teaching method based on HeartCode BLS in basic life support training for nursing students"],"prefix":"10.3389","volume":"13","author":[{"given":"Wenxian","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Nursing, People\u2019s Hospital of Quzhou, Quzhou","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanyi","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, People\u2019s Hospital of Quzhou, Quzhou","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, People\u2019s Hospital of Quzhou, Quzhou","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, People\u2019s Hospital of Quzhou, Quzhou","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"170","DOI":"10.5152\/TJAR.2018.25986","article-title":"School children save lives.","volume":"46","author":"Kuvaki","year":"2018","journal-title":"Turk J Anaesthesiol Reanim"},{"key":"B2","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1097\/ACM.0000000000000913","article-title":"Amending miller\u2019s pyramid to include professional identity formation.","volume":"91","author":"Cruess","year":"2016","journal-title":"Acad Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"101089","DOI":"10.1016\/j.resplu.2025.101089","article-title":"Identifying clinical error patterns in nursing students\u2019 CPR performance: a mixed-methods OSCE study.","volume":"26","author":"Miri","year":"2025","journal-title":"Resusc Plus"},{"key":"B4","doi-asserted-by":"publisher","first-page":"100951","DOI":"10.1016\/j.ienj.2020.100951","article-title":"The inefficiency of ventilation in basic resuscitation. 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