Identifying clinical error patterns in nursing students' CPR performance: a mixed-methods OSCE study

Basic Life Support (BLS) competency is critical for healthcare professionals, yet persistent performance gaps exist in training settings. This study aimed to identify error patterns in nursing students' cardiopulmonary resuscitation (CPR) performance during Objective Structured Clinical Examinations (OSCEs) and, through stakeholder insights, identify perceived challenges and suggest remediation strategies to improve learning outcomes.

A sequential explanatory mixed-methods study was conducted (2021-2024) with 250 eighth-semester nursing students. The quantitative phase analyzed OSCE performance using: 1) a validated 20-item BLS knowledge test, 2) a 17-item skills checklist, and 3) Laerdal QCPR® mannequin metrics. The qualitative phase included interviews with 25 stakeholders (students, instructors, examiners). Data were analyzed using descriptive/inferential statistics (SPSS v25) and thematic analysis (MAXQDA 2022).

Significant deficiencies were identified: 68 % failed to achieve guideline-compliant compression depth (mean: 40-50 mm vs. recommended 50-60 mm), 45 % demonstrated incorrect rates, and only 18 % properly applied AED pads. Qualitative analysis revealed stress (89 % prevalence) and inadequate feedback (75 %) as key performance barriers. Gender disparities emerged, with female students delivering 40 % shallower compressions (p < 0.05).

This study reveals persistent gaps in nursing students' ability to translate BLS knowledge into competent CPR performance during OSCEs. Deficiencies in compression quality, AED use, and decision-making highlight limitations of current training models. Integrating high-fidelity simulation, real-time feedback, and stress-mitigation strategies may strengthen skill acquisition. Further multicenter research is needed to establish evidence-based approaches that ensure graduates are prepared to deliver high-quality resuscitative care.Clinical trial number: not applicable.