Journal of Modern Medical

Introduction
Cardiopulmonary arrest is one of the most common causes of death that occurs at any time and place. In the United States, about 5 million people suffer from cardiovascular diseases every year. In Iran, 80% of deaths occur due to cardiovascular diseases. Currently, coronary artery diseases are the first cause of death in people over 35 years old in Iran. About 70% of cardiac arrests happen at home or places outside the hospital without access to experienced people. Many factors can affect the rate of death caused by cardiac arrest, one of the most important of which is correct and timely cardiopulmonary resuscitation. Most people who suffer cardiac arrest have an underlying cause for cardiovascular disease that can be reversed with timely resuscitation. According to the American Heart Association, rapid initiation of cardiopulmonary resuscitation and defibrillation within 4-6 minutes of a patient’s cardiac arrest, along with rapid initiation of advanced life support, increases survival and long-term outcomes by more than 50% in patients with cardiac arrest. If the family members have the ability of cardiopulmonary resuscitation, they can prevent brain death in the golden time. This study was conducted with the aim of determining the effect of virtual cardiopulmonary resuscitation training on the self-efficacy of family caregivers of patients with cardiovascular diseases.

Methods
This is a randomized controlled field trial study that was conducted on 60 patients with cardiovascular diseases referred to the heart clinic of Razi Hospital in Birjand, Iran in 2021. They were selected by a simple random sampling method and were randomly divided into two groups of training (n=30) and control(n=30). They completed a demographic form and the Basic Resuscitation Skills Self-Efficacy Scale (BRS-SES) developed by Hernández-Padilla et al. [24]. Collected data were entered into SPSS Sofware, version 20 statistical software for analysis. Frequency and percentage were used to report qualitative variables, and mean and standard deviation were used for quantitative variables. Using the Kolmogorov-Smirnov test, the normal distribution of the data was examined. Due to the normality of the data, independent t-test, paired t-test, and chi-square test were used for data analysis. The significance level was set at 0.05.

Results
Based on the descriptive results, 16.7% and 26.7% of caregivers in the training and control groups were over 45 years old, respectively. Based on the chi-square test results, there was no statistically significant difference between the two groups in terms of gender and other demographic variables (P>0.05). Before the intervention, there was no statistically significant difference in the BRS-SES score between the control group (3.09±0.64) and training groups (2.97±0.82) (P=0.53). However, after the intervention, a statistically significant difference was observed between the training group (4.15±0.49) and the control group (3.12±0.58) (P<0.001). In the within-group comparison, a significant difference was observed in the BRS-SES score before (2.97±0.82) and after (4.15±0.49) the intervention in the training group (P<0.001). In the control group, there was no significant difference in the BRS-SES score before (3.09±0.64) and after the intervention (3.12±0.58) (P=0.22). The result of the independent t-test showed that the mean changes in the self-efficacy score before and after the intervention in the training group (1.18±0.54) were significantly higher than in the control group (0.11±0.03) (P<0.001).

Conclusion
Virtual cardiopulmonary resuscitation training has a significant effect on increasing the self-efficacy of family caregivers of patients with cardiovascular diseases. Virtual education can be effective due to lower costs and higher efficiency. Therefore, it is recommended that the planners should consider the impact of this type of education in their policies for cardiovascular diseases.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Birjand University of Medical Sciences (Code: IR.BUMS.REC.1400.26)

Funding
This study was extracted from the masters’ thesis of Hossein Keshtgar registered by Birjand University of Medical Sciences. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Authors' contributions
Investigation: Hossein Keshtgar;  Data collection and data analysis: Behnam Khodadoust; Methodology, design, initial draft preparation, and approval of final draft: All authors.

Conflicts of interest
The authors declared no conflict of interest.


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