A quasi-experimental comparison of Kolb and Peyton educational approaches on CPR knowledge and performance among nurses

Abstract

Background

Many nurses lack adequate knowledge and skills in CPR. Studies have yielded varying results regarding the effectiveness of Kolb and Peyton education methods on nurses’ performance in CPR.

Aims

The present study aims to compare the effects of education based on Kolb and Peyton methods on nurses’ CPR knowledge and performance.

Methods

In a quasi-experimental study conducted in 2019, 108 nurses from Kashan’s hospitals meeting the inclusion criteria were selected through convenience sampling. Participants were randomly assigned to three groups: Kolb, Peyton, and a control group. Data collection tools included a demographics form and a research-made questionnaire assessing nurses’ knowledge and performance in CPR. Participants completed the questionnaire before the intervention, as well as one- and six-weeks post-intervention. Data analysis was performed using SPSS 19, employing Chi-square and repeated measures ANOVA (p ≤ 0.05).

Results

The three groups were homogeneous in terms of demographics, except for age (p = 0.001) and work experience (p = 0.001). While mean knowledge scores in the Kolb and Peyton groups showed statistically significant increases over time (pre-intervention, one-week post-intervention, and six-weeks post-intervention) (p = 0.001 for Kolb, p = 0.000 for Peyton), there was no statistically significant difference in overall knowledge scores between the three groups at any time point (p = 0.06 at six weeks post-intervention, p = 0.32 at one-week post-intervention, and p = 0.36 pre-intervention). Regarding CPR skills, cardiac massage, (p = 0.001 for Kolb, p = 0.001 for Peyton), breathing (p = 0.01 for Kolb, p = 0.001 for Peyton), and defibrillator skills (p = 0.01 for Kolb, p = 0.01 for Peyton) demonstrated statistically significant improvements in both the Kolb and Peyton groups. Furthermore, comparison of these skills among the three groups revealed that the Peyton method was statistically significantly more effective than the Kolb method (p = 0.001 for cardiac massage, p = 0.01 for breathing, and p = 0.01 for defibrillator skills).

Conclusion

Nurses who received education based on Kolb and Peyton exhibited enhanced knowledge and skills (cardiac massage, breathing, and defibrillator) in CPR. The implementation of these innovative educational methods for CPR training among nurses is recommended.

Introduction

Cardiac arrest (CA) is defined as the termination of the heart’s mechanical activity or the absence of blood circulation [1]. The causes can be cardiac (65%) or pulmonary (15%) in origin [2], making cardiopulmonary arrest a significant contributor to mortality worldwide [1, 3]. In the USA alone, there are approximately 424 thousand out-of-hospital cardiopulmonary arrests (OHPCAs) and 209 thousand in-hospital cardiopulmonary arrests (IHPACs) recorded annually [4]. In Iran, cardiopulmonary arrest (CPA) accounts for 50% of all deaths reported each year [5].

Cardiopulmonary resuscitation (CPR), which involves chest compressions, breathing assistance, and defibrillation, is the primary method for managing CA to restore blood circulation and oxygenation during an event [6]. The success of CPR is heavily reliant on the knowledge and performance of individuals administering it, with nurses often being the first responders to CA patients. Therefore, the inability of nurses to effectively perform resuscitation procedures may result in missed opportunities to save lives [7]. Factors contributing to failed resuscitation efforts include a lack of skilled and well-educated individuals, delays in initiating chest compressions, and improper technique [8].

Despite receiving proper training, studies have shown that the knowledge, skills, and quality of resuscitation efforts by nurses are often subpar [9]. For instance, a study conducted by Adib-Hajbaghery and Azizi-Fini in Kashan in 2013 revealed that 82% of nurses had poor knowledge and 71% exhibited inadequate skills in resuscitation techniques [10]. Similarly, Rajeswaran et al., in 2018 found that only 48% of nurses possessed adequate knowledge, while just 14.5% demonstrated proper CPR performance [11]. Other studies by Tíscar-González et al., [12], and Pettersen et al., [13, 14] also reported unsatisfactory levels of CPR knowledge and performance among nurses. Additionally, a meta-analysis by Greif et al., highlighted that without continuous refresher training, CPR skill retention declines significantly within six months, reinforcing the need for effective training strategies [14]. This highlights the need for improved CPR education to prevent life-threatening errors.

The consequences of inadequate CPR knowledge and skills among nurses extend beyond the risk of patient death to encompass a range of iatrogenic injuries such as bruising, skin irritation, soft tissue damage, oral mucosal injury, rib fractures (60–85%), sternal fractures (15–58%), cardiac tamponade, cardiac rupture, and liver contusions [15, 16]. According to Rudinská et al. in 2016, the overall incidence of resuscitation-related injuries attributable to insufficient knowledge and skills in nurses ranges from 21 to 97% [15]. Salari et al., highlighted that the lack of CPR knowledge and skills among nurses and physicians resulted in a post-resuscitation mortality rate of 90% and a discharge rate of only 7% for CA patients [17].

Given the critical importance of CPR knowledge and skills for nurses, education in this area is imperative. Various methods have been utilized to educate healthcare professionals on CPR, including team-based learning [18], educational workshops [19], moulage-based training [1], conceptual mapping techniques [20], and simulation training [21]. Among these methods, simulation stands out as a powerful tool for enhancing professional skills [7]. Simulation facilitates active participation in learning and enhances problem-solving abilities, critical thinking, clinical reasoning, and self-confidence [7, 21]. The primary goal of simulation is to create a learning environment that closely mirrors real-world scenarios to ensure the transferability of knowledge and skills to actual practice [22].

The Kolb experiential learning cycle, a four-stage process of concrete experience, reflection, conceptualization, and experimentation [23], and the Peyton four-stage approach (demonstration, deconstruction, comprehension, and performance) [24], are two promising simulation-based methods. While both methods emphasize active learning and skill development, they differ in their pedagogical structure. Kolb focuses on a cyclical learning process driven by experience and reflection, while Peyton emphasizes a structured, hierarchical approach to skill acquisition. Research comparing these methods in CPR education remains limited, particularly in nursing education. A study by Varghese and Abraham compared Kolb and Peyton in medical students and found that Peyton was superior for skill acquisition, while Kolb promoted long-term knowledge retention [25]. Additionally, Davitadze et al. examined simulation-based training models, including Peyton and Kolb, and suggested that combining these approaches may yield better learning outcomes [26]. However, conflicting findings in previous studies highlight the need for further investigation.

Previous research on Kolb and Peyton in CPR training has yielded mixed results. Schröder et al., utilized the Peyton four-stage approach for resuscitation education in medical students and demonstrated its effectiveness in improving key aspects of resuscitation techniques such as initiation, depth, and frequency of chest compressions [24]. Muenster et al. also employed the Peyton approach and noted a significant difference in the number of chest compressions performed between groups. However, despite the impact of compression duration on outcomes, no further distinctions were observed in subsequent evaluations [27]. Furthermore, Yamani et al. highlighted the positive influence of Kolb experimental learning on interdisciplinary healthcare team education by enhancing knowledge scores, though it did not directly impact interdisciplinary performance [28].

Given the critical nature of CPR, the implications of unsuccessful resuscitation efforts on patients, and the pivotal role nurses play in CPR outcomes, it is imperative to enhance nurses’ education in this domain. While several studies have explored methods to improve CPR knowledge and skills, the pursuit of more effective educational approaches remains ongoing.

Due to limited research in Iran on Kolb and Peyton methods for CPR education, this study aims to compare the effects of Kolb, Peyton, and a traditional control group on CPR knowledge and performance among nurses in Kashan, Iran. By evaluating these three approaches, we seek to determine which method offers the most effective training for enhancing both theoretical understanding and practical skill acquisition in CPR.

Methods

Study setting

The study was a quasi-experimental design conducted from November to December 2019. The study population comprised nurses employed in educational hospitals affiliated with Kashan University of Medical Science. Participants were selected through convenience sampling, which was chosen due to feasibility constraints and accessibility to a sufficient sample within the given timeframe. However, this approach may limit generalizability compared to probability sampling.

Inclusion and exclusion criteria

Inclusion criteria required a minimum of a bachelor’s degree, at least one year of clinical work experience, prior knowledge of CPR, not currently serving as a resuscitation team nurse, physical capability to perform CPR, and a willingness to participate in the study. The exclusion criterion was missing any education session.

Sample size

The sample size was determined based on a similar study [10], which reported a mean knowledge score of 23.6 and a mean performance score of 36.8 in the routine education group. Assuming equal variances among the three groups, an effect size of 0.75, a type one error rate of 0.05, and a test power of 80%, the G-Power software was used to calculate a required sample size of 36 participants per group. Initially, 150 nurses were selected, with 21 declining to participate and 21 not meeting the inclusion criteria. The remaining 108 candidates were randomly assigned to three groups (Kolb, Peyton, and control) using a computer-generated random number table (Fig. 1). To minimize allocation bias, the sequence was concealed in sealed opaque envelopes, which were opened by an independent researcher not involved in the recruitment or intervention process.

Blinding

Due to the nature of the educational interventions, blinding of participants and instructors was not possible. However, the researcher responsible for data analysis was blinded to the group assignments to minimize potential bias in the interpretation of results.

Fig. 1

Flowchart of participant selection, allocation, and follow-up

Data collection

The data collection tool was a researcher-developed questionnaire assessing nurses’ knowledge and performance in CPR. The tool was designed based on a comprehensive literature review, the USA Cardiac Resuscitation Guide (2015), and other reliable scientific references [29, 30]. The development of the checklist involved a rigorous validation process. First, a pool of items was generated based on the literature review and expert recommendations. This initial pool was then reviewed by 15 experts in emergency medicine, cardiology, medical and nursing education to assess content validity. Based on their feedback, items were revised or removed. The content validity ratio (CVR) and content validity index (CVI) were calculated as 0.85 and 0.89, respectively, indicating strong content validity. To assess reliability, the tool was pilot tested with a small group of nurses (n = 10) not included in the main study. Based on the pilot test results, minor adjustments were made to the wording of some items for clarity. Cronbach’s alpha was then calculated on the pilot test data and found to be 0.73 for the overall tool, with subscale reliabilities ranging from 0.61 to 0.82, demonstrating acceptable internal consistency.

The tool consisted of three sections: demographics, knowledge assessment, and performance assessment.

The demographic section collected information on age, gender, work experience, ward assignment, education level, theoretical and practical background in resuscitation, previous CPR experiences, and participation in resuscitation workshops.

The knowledge assessment tool included 30 items (multiple-choice questions (MCQs)) covering basic and advanced CPR concepts, with a total score range of 0 to 30. Each item in the knowledge section consisted of MCQs, where participants selected the correct answer from multiple options, unlike the initial description of Yes/No items.

The resuscitation performance tool comprised 57 items across four subscales: cardiac massage (n = 21), breathing skills (n = 16), defibrillator use (n = 15), and drug therapy skills (n = 5). Items were answered as Yes (1) or No (0), with a total score range of 0 to 57. Participants completed the self-administered tool before the intervention, one week after, and six weeks after the intervention to evaluate retention.

Reliability

Reliability of both the knowledge and performance assessments was calculated separately. The knowledge assessment tool, based on MCQs, had a Cronbach’s alpha of 0.73 for internal consistency. The performance assessment tool, based on a checklist, had subscale reliabilities ranging from 0.61 to 0.82, indicating acceptable internal consistency.

Intervention

Participants were randomly assigned to three groups, each with 36 members: Kolb, Peyton, and a control group. After completing demographic forms, the first author randomly allocated members of each group into six sub-groups of six members each. Each sub-group received a six-hour educational session on a specific day. The Kolb group attended sessions in the first week, while the Peyton group had sessions in the second week, ensuring that all participants received training under controlled conditions. The education schedule was communicated to sub-groups, assigning specific dates for educational sessions and subsequent questionnaire completion. Participants were reminded of their session the day before, and small incentives (such as educational booklets) were distributed after each session to encourage participation and enhance retention rates. The educational day included one hour of standardized theoretical CPR education using PowerPoint slides and lectures by the first author, ensuring uniform content delivery across groups [Table-1].

Theoretical part

A one-hour theoretical session using PowerPoint slides was conducted for each group. This theoretical instruction included basic and advanced CPR concepts based on the USA Cardiac Resuscitation Guide (2015) [30], ensuring that all participants received the same foundational knowledge before engaging in hands-on practice.

Practical part

After the theoretical session, each group participated in a hands-on practice session tailored to the specific educational model used. The Kolb group’s practical session was conducted in the first week, while the Peyton group’s session took place in the second week. This division allowed for a clear distinction between theoretical and practical training.

Kolb group (Kolb’s experiential learning model)

Following Kolb’s four-stage experiential learning model, participants engaged in three resuscitation scenarios involving different patient conditions. They were instructed to perform resuscitation as a team on a model (concrete experience), share observations and experiences with teammates (reflective observation), conceptualize the process (abstract conceptualization), and perform resuscitation on a model (active experimentation). The author acted as a guide and facilitator, providing answers to questions. Participants adhered to their predetermined time schedules, attending classes and completing the tool one- and six-weeks post-intervention. Participants were encouraged to practice individually on a model during this period to correct errors, with the author available for guidance.

Peyton group (Peyton’s four-step approach)

Following Peyton’s four-step approach, the author demonstrated CPR on a model, guided participants step-by-step through CPR procedures, encouraged questions, and supervised participants as they practiced on a model to demonstrate their skills. This process was repeated to ensure comprehension and retention. Sub-groups met with the author based on their scheduled times to practice CPR on a model, address errors, and ask questions.

Control group

Participants in this group received routine in-service CPR training, consisting of one hour of theoretical instruction via PowerPoint lectures. They also engaged in three simulated scenarios, covering airway management, massage techniques, defibrillator use, and drug therapy, but without structured interactive learning as in the intervention groups.

All participants in the three groups completed questionnaires at baseline, one week, and six weeks post-intervention for follow-up evaluation.

Table 1 Comparison of educational methods among study groups

Data analysis

The collected data were analyzed using SPSS (version 19). Descriptive statistics (mean and standard deviation) were used to summarize data. To compare normally distributed quantitative variables, independent t-tests were performed, while categorical variables were analyzed using Chi-square test. The Chi-square test was specifically chosen to analyze categorical demographic variables such as gender, education level, and prior CPR experience, as these variables were not normally distributed and to assess potential associations between these variables and group membership. To compare knowledge and performance scores at baseline, one week, and six weeks post-intervention, repeated measures ANOVA was applied. Generalized Estimating Equations (GEE) were used to assess the longitudinal effects of the intervention, adjusting for confounding variables. A p-value of < 0.05 was considered statistically significant.

Ethical considerations

The study was approved by the Ethics Committee of Kashan University of Medical Sciences (Ethical code: 1398079IR.KAUMS.MEDNT.REC). Before participation, all nurses provided written informed consent after receiving detailed information about the study’s objectives, procedures, and voluntary nature. Participants were assured that their responses would remain confidential and that they could withdraw at any stage without any consequences. Data confidentiality was maintained by assigning unique codes to participants and storing data in a secure, password-protected system accessible only to the research team.

Results

The three groups were generally homogeneous in terms of demographic variables, with statistically significant differences observed only for age and work experience (p < 0.05) [Table 2]. Specifically, the Kolb and Peyton groups were younger compared to the Control group, and the Kolb and Peyton groups had less work experience than the Control group (p < 0.05).

Table 2 Demographic characteristics of participants in the intervention and control groups

Effects of educational interventions on knowledge and performance

Repeated measures ANOVA revealed statistically significant increases in mean knowledge scores within the Kolb and Peyton groups over time (pre-intervention, one week post-intervention, and six weeks post-intervention) (p < 0.05) [Table-3]. However, no statistically significant difference in knowledge scores was observed between the three groups at any time point (p < 0.05). This suggests that while both interventions improved knowledge within each group, neither was superior to the other, or to the control group’s routine training, in terms of overall knowledge gain. Although no major difference was found between the Kolb and Peyton groups in knowledge scores, minor variations were observed. These small differences could be due to the different teaching methods employed by each model, with Kolb’s model emphasizing experiential learning and reflective observation, and Peyton’s model utilizing a more structured, step-by-step teaching approach.

Regarding CPR performance, statistically significant improvements in cardiac massage, breathing, and defibrillator skills were observed in both the Kolb and Peyton groups (p < 0.05). Additionally, between-group comparisons indicated significant differences in these performance domains one and six weeks post-intervention, with the Peyton method demonstrating the greatest impact, particularly in cardiac massage skills. These minor variations in performance outcomes between the two models are aligned with the research aim to compare their effects on CPR skills. However, no significant improvement in drug therapy skills was observed across the groups (p > 0.05). This finding may be attributed to the limited emphasis on pharmacological aspects in the training sessions, potentially requiring more targeted interventions or practical exposure to enhance these skills.

Table 3 Comparison of mean knowledge and performance score in nurses before, one week and 6 weeks after the intervention in three groups

Regression analysis of knowledge and performance scores

Regression analysis results [Table 4] indicate that the type of educational intervention (Peyton and Kolb), education level, and resuscitation observation significantly influenced nurses’ knowledge scores (p < 0.05). Work experience showed a marginal effect on knowledge scores (p = 0.05), meaning that while work experience appeared to have a slight positive effect on knowledge, it was not strong enough to reach conventional statistical significance. This suggests that other factors, such as the type of intervention, had a more substantial effect.

Regarding performance, type of education, education level, age, and gender significantly influenced cardiac massage, breathing, and defibrillator skills (p < 0.05). Notably, the intervention had no significant effect on drug therapy performance (p > 0.05), reinforcing the need for further specialized training in medication administration during resuscitation.

Table 4 Regression analysis of knowledge and performance scores by educational group and demographic variables

Discussion

The Kolb and Peyton methods significantly increased the total scores of knowledge and performance of nurses in the field of resuscitation, with a more pronounced effect observed in the Peyton group. The study also demonstrated that both the Kolb and Peyton methods improved CPR knowledge among nurses throughout the study. This finding is consistent with Schröder et al., (2007) who noted a low level of CPR knowledge and skills among nurses initially, followed by a significant improvement in the Kolb group [24]. Similarly, Younis et al., (2023) observed significant skill acquisition and improved self-efficacy in pediatric nursing students using the Peyton method for infant CPR [31].

When comparing the three groups after the intervention, there was no significant difference in terms of knowledge scores. One possible explanation for this could be the exposure of the control group to CPR situations, which was beyond the control of the authors, thus serving as a limitation of the present study. Rahimikian et al., (2007) conducted a study on newly graduated midwives’ knowledge of infant CPR and found that knowledge and skills were at a moderate level after education [32]. This finding is similar to our study, where significant increases in knowledge and skill scores were observed. However, the present study included nurses with a six-week follow-up period, whereas Rahimikian et al., studied newly graduated midwives, which might explain the differences in learning outcomes [32].

In this study, participants’ knowledge about resuscitation was assessed in the first and sixth weeks after education using a model. The results indicated an improvement in nurses’ knowledge and awareness over time. This improvement could be attributed to the fact that the assessment itself may have increased participants’ accuracy in performing CPR. Ahmed et al., (2018) found similar results in critical care nursing students, where increased self-confidence and satisfaction in performing CPR were observed over time, reinforcing the benefit of periodic assessments [33].

The results indicated that both education methods led to a significant increase in resuscitation performance in terms of cardiac massage, breathing, and defibrillator use during the first and sixth weeks of the training. When assessing the effects of repetition and interaction, it was observed that the changes in these variables were higher in the two intervention groups compared to the control group. Specifically, the greatest improvement was seen in cardiac massage skills. These findings are supported by Wojewodzka-Zelezniakowicz and Majer [34] and Brennan et al., [35] who demonstrated that practical education and simulation of resuscitation on a model enhanced CPR skill, particularly related to cardiac massage, defibrillator use, and breathing.

The effectiveness of the Kolb method was attributed to its emphasis on experiential learning and feedback, which enhances retention of educational content [23]. Ghanbaryan and Saeidi (2023) demonstrated that the Peyton method’s efficiency in skill acquisition is closely linked to its emphasis on repetition and practice, as demonstrated in their study on pediatric basic life support [36]. Krautter et al. (2011) found that the four-stage Peyton approach resulted in a significant increase in nursing students’ knowledge and skills in nasogastric tube (NGT) placement, with a notably shortened learning period [37]. Giacomino et al. (2020) conducted a systematic review and meta-analysis, concluding that Peyton’s 4-step approach is highly effective for skill acquisition in health professions education, particularly for procedural skills like CPR [38]. Schröder et al., (2007) also applied Peyton’s method to resuscitation education for medical students, finding it effective for teaching basic resuscitation techniques [24]. Muenster et al., also utilized the Peyton four-stage approach for resuscitation education, noting significant differences in the number of compressions between groups. However, no significant differences were observed in terms of compression duration, highlighting the importance of CPR duration in training outcomes [27]. Yamani et al., demonstrated that the Kolb experimental learning cycle was effective for interdisciplinary education of healthcare teams providing care to diabetic patients. While knowledge scores improved after the intervention, performance scores did not show significant changes [28].

The key difference between the Kolb and Peyton methods lies in their instructional strategies. Kolb’s method emphasizes experiential learning through a cyclical process of concrete experience, reflective observation, abstract conceptualization, and active experimentation. In contrast, Peyton’s method focuses on structured, stepwise instruction, which involves demonstration, practice, and feedback. The emphasis on repetition and guided practice in the Peyton method likely explains why it yielded better results in skill acquisition. The structured and repetitive nature of the Peyton approach allows for more focused skill development, which is essential in procedural training such as CPR. Moreover, Peyton’s method ensures that learners practice each step under supervision, reinforcing correct techniques, which may have led to better skill retention and performance consistency, particularly in CPR, where precision is critical [23, 24].

A key finding of this study was the greater improvement in CPR performance observed in the Peyton group compared to the Kolb group. This suggests that the stepwise instructional approach of the Peyton method, which emphasizes guided demonstration and repetitive practice, may be particularly effective for skill acquisition in CPR training. Given that high-quality CPR is essential for patient survival, incorporating the Peyton method into standardized CPR training programs could enhance skill retention and performance consistency among healthcare providers. This is in line with Younis et al., (2023) who found that Peyton’s approach led to improved CPR skills and higher satisfaction in nursing students. The structured, repetitive nature of the Peyton method is particularly beneficial for critical procedural skills like cardiac massage, which showed the most substantial improvement in this study [31]. Future training programs should consider integrating Peyton’s structured approach, particularly for critical procedural skills such as cardiac massage, which showed the most substantial improvement in this study. Additionally, combining elements of both the Kolb and Peyton methods, such as experiential learning with structured repetition, could further optimize CPR education.

Regarding the regression analysis results, this study found that demographic factors such as age, educational level, and years of experience had varying degrees of influence on CPR knowledge and performance. In particular, younger nurses and those with less experience showed more significant improvements in CPR skills, likely due to their greater exposure to the structured nature of the training. Demographic factors such as previous exposure to CPR training also influenced the outcomes, with more experienced nurses showing less improvement due to the ceiling effect. This aligns with the findings of Timsit et al. (2015), who reported that nurses with greater experience demonstrated smaller improvements over time, as they may have already possessed a higher baseline level of knowledge and skill [39].

Contrary to the findings of some previous studies, which suggest that CPR skills tend to decline in nurses over time, this study showed that the intervention had the greatest impact in the sixth week. Timsit et al. (2015) reported that monthly CPR education sessions led to improved skills among nurses, with skill scores peaking in the final month [39]. This suggests that routine repetition of educational courses is crucial for skill retention.

All performance fields showed significant improvement, with the exception of drug therapy skills. This finding is consistent with Shojaie et al., [40], who observed that adherence to drug administration standards during CPR increased post-education, although not significantly compared to the control group. Johnson et al., [41] also found that CPR education improved knowledge and performance in drug therapy during CPR, but discrepancies in results could be attributed to the educational methods employed. The current study focused on Kolb and Peyton’s methods, whereas Johnson’s study employed a specialized curriculum led by emergency team members. The lack of significant improvement in drug therapy skills in our study may be due to the limited number of items assessing this skill, potentially reducing the power to detect a significant change.

The control group, which was in their regular work environment during the study, may have been exposed to CPR procedures, potentially influencing their learning. This factor, however, was beyond the authors’ control and could be considered a limitation of the study.

A significant limitation of this study is the lack of randomization, which plays a crucial role in minimizing bias and may limit the generalizability of the findings. In future studies, it would be beneficial to incorporate randomization or consider statistical methods such as propensity score matching to address this challenge and further validate the results. The control group in this study consisted of nurses with significant experience and advanced education, which may have led to a ceiling effect. This ceiling effect might explain the smaller observed developmental changes over time in the control group. Future research should consider the experience level of participants when evaluating the effectiveness of CPR training programs.

Conclusion

Both Kolb and Peyton education methods improved knowledge and skills in cardiac massage, breathing, and defibrillator use, except for drug therapy skills. The Peyton approach yielded greater improvements. These educational strategies, particularly the Peyton method, can be effectively utilized for CPR training for nurses across various departments.