https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article Teacher’s Practice Regarding Cardiopulmonary Resuscitation at Basic Schools in Erbil City ABSTRACT Background and objectives: Every day, either by accident or illness, there are numerous situations in which the safety of individuals, families or communities is endangered. >2000 children worldwide die every day as a result of unintentional injuries. The majori- ty of risks influencing a cardiac arrest in a school are related to physical activity, such as participating in sports or having an airway obstruction or trauma event. In the United States and Europe, one million people experience cardiac arrests annually. The aim of this study was to assess the basic school teachers’ practices regarding cardiopulmonary resuscitation at basic schools in Erbil City. Methods: A cross suctional study was carried out. To assess the practices of basic school teachers regarding cardiopulmonary resuscitation. The study was conducted from Janu- ary 20,2021 to May 15, 2022. This study was conducted in basic schools in Erbil city ac- cording to six municipalities. The sample size was 470 teachers. The observational check list technique was used to assess cardiopulmonary resuscitation performance. Results: The majority of them were female (74%), more than half of them have a diplo- ma (52.3%), the majority of age group were between 37-48 years old which represents 51%, the mean age was (43.85±8.27), most of the teachers were married (86.4%), the majority of them did not a training course (86.4%). Several teachers use tradition at me- dia (9.6%) and social media (44.7). A lot of barriers were faced teachers to prevent par- ticipation in training courses were not found in professional training course The majority of the schoolteachers had poor levels of practice (51.1%) regarding the performance of cardiopulmonary resuscitation. Conclusion: The majority of schoolteachers had poor levels of practice regarding cardio- pulmonary resuscitation. There was a significant association between the performance of CPR and some socio-demographic variables like age group, gender, years of experi- ence, and desire to attend CPR training course. Keywords: Cardiopulmonary Resuscitation; Practices; Basic School Teacher. Jawdat Mamand Akhagbaker; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. (Correspondence: jawdat.baker@hmu.edu.krd) Kareem Fattah Aziz; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq. 31 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Received: 17/09/2022 Accepted: 06/11/2022 Published: 30/05/2024 mailto:jawdat.baker@hmu.edu.krd https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article Every day, either by accident or illness, there are numerous situations in which the safety of individuals, families or communi- ties is endangered. >2000 children world- wide die every day as a result of uninten- tional injuries [5]. To date, an estimated 17.5 million people have died each year from cardiovascular diseases (CVD) such as stroke and heart attack, known to be the world's leading cause of death [4]. Cardiac arrests in schools are linked to physical ac- tivity, sports, aerobic fitness participation, or other trauma- or airway-related occlud- ed. Although there are about one million cardiac arrests annually in the United States and Europe, cardiac arrest is still a clinical illness with a dismal prognosis [1]. Basic life support (BLS): is defined as “maintaining airway patency and sup- porting breathing and circulations without the use of equipment other than a protec- tive device” [2]. Basic life support (BLS) is a set of emergency procedures applied to a patient, it comprises a number of tech- niques, like cardiopulmonary resuscitation (CPR to sustain patient’s life until the hos- pital facility arrives or the person reaches the hospital [3] The American Academy of Pediatrics and the American Heart Associa- tion (AHA) have issued guidelines that stress the need for school teachers to be knowledgeable about emergency response measures to address life-threating emer- gency. Thus, in this regard, the training of school teachers will facilitate the learning process for students [4]. Considering that school instructors have the time to demon- strate BLS to pupils and should be certified in CPR, the European Resuscitation Council recommended that CPR be included in the school curriculum [1]. The study is im- portant because it illustrate practices of cardiopulmonary resuscitation among teachers in basic school. It motivates teachers, how to take care of the school, to make good scientific intervention, the lives of students in cases of cardiac arrest. The study contributes to the awareness of emergency in the school among the school teachers and staff of school administration to decrease emergency problems by in- creasing suitable intervention for the pur- pose of saving lives students and staff in school. Basic life support is of high im- portance when an individual is at risk. Learning basic life support skills is of great importance in resuscitation, life-saving and is prevention of complications in emergen- cy situations in both the school environ- ment and the community [6]. The aim of this study was to assess teachers, practices regarding cardiopulmonary resuscitation at basic schools in Erbil City. The objectives of the study are to assess the level of teach- ers’ practices in cardiopulmonary resusci- tation and, find out the association be- tween level of performance and socio- demographic variables like age, gender, qualification, marital status, number of children, previous in educational program and source of information. The current cross-sectional study was car- ried out to assess the practices of school teachers regarding cardiopulmonary resus- citation. The study was carried out over a four-month period, from January 20 to May 15, 2021. This study was conducted in basic schools in Erbil city North-Central of Iraq which contents 6 municipality, the sample to six municipality 1 municipality located in the center of the city around a street 60 meters, 2 located from the road- way of Erbil-Mosel to the roadway of Erbil- Shaqlawa, 3 located from the roadway of Erbil-Saqlawa to the roadway of Erbil-Koya, 4 located from the roadway of Eskan to the roadway of Erbil-Mahmur, fifth located from the roadway of Erbil-Koya to the roadway of Eskan street, sixth located 32 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article of education in Erbil city, for each cluster, teachers were selected, in 6 municipality there were 470 teachers for a total sample size of 10445 basic school teachers in Erbil city. Approximately, the samples of teach- ers from each school were enrolled in the study. The number of teachers needed from each school was calculated propor- tionally to the total sample size. The teach- er signed the consent form and then com- pleted the questionnaire using paper and pencil. The samples of teachers from each school are dependent on the total number of teachers in schools. According to the formula of teachers (each school) is multi- plied by the sample size (470) and divided by the total of teachers in the whole school (1189). If a teacher did not agree to participate, another one from the same school was randomly replaced. The data collection took place through assessment of cardiopulmonary resuscitation practices using observational checklist technique. After cooperating with the school manager after teachers were accepted to share in the study, assessment tests were used in teachers' rooms in the school to evaluate teachers one by one used. The researcher used an observational checklist for evalua- tion. The data were collected during the morning shift on school duty, from 8:00 AM to 12:00 PM, and during the shift from 1:00PM to 4:00 PM. The period of data col- lection depends on three times in the school. Firstly, some of the teachers partic- ipated when there was no have class for 45 minutes. Secondly, some of the teacher participated in coffee break. Thirdly, some of the teachers participated at the end of class or according to teacher free time. The data was collected for 8–10 minutes for each sample. They were completed, the researcher gathered all the checklist data, the tool was developed by the researchers after reviewing the related literature, for cardiopulmonary resuscitation dependent from the roadway of Erbil-Mahmur to the roadway of Erbil-Mosel. The basic schools were selected randomly utilizing simple random sampling according to six munici- palities as a geographical distribution area in Erbil city, all municipality were included in the study, 5 basic schools in each munici- pality were selected, according to the list of all basic schools affiliated to center for the direct education in Erbil city. A total of 30 different basic schools were chosen out of 242 schools in Erbil city. The sample size estimation is distributed according to the number of teachers in Erbil city based on the proportion of school teachers. 385 teachers were selected from the total num- ber of basic school teachers (10445) for this study. The sample was calculated using Taro Yamane formula and it comprised 385 participants. A sample of 385 teachers was estimated to be enough for this study. However, to improve the representative- ness of the sample, increase the power of the study and accuracy 470 teachers were recruited for this study. The sample size needed to reflect the target p Taro Yamane formula n = N / (1 + Ne^2) n= 10445/ (1+10445* (0.052 )2. n= 10445 / (1+10445*0.0025) n= 10445 / 27.1125 n=385 n= corrected sample size, 385 N = population size, 10445 e = Margin of er- ror (MoE), e = 0.05 based on the research condition, population with a 5% of error at a 95% confidence [7]. A sample is a portion picked from the representative population for the purpose of reaching inferences. All the school teachers who participated in the study were entirely voluntary and their identities were maintained and any feeling of commitment to share in the present study was reduced by satisfying the basic teachers that sharing was optional and that they had the right to drop out at any time they wanted. Probability cluster sampling was carried out, the list of basic schools was obtained from the general directorate 33 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article who teachers disagree to participate and complete the questionnaire. A question- naire of teachers’ socio-demographic char- acteristics and practices consisted of 4 parts. Part 1: Socio-demographic character- istic questions include the following: age, gender, qualification, marital status, num- ber of children, years of experience and previous participation in an educational program about cardiopulmonary resuscita- tion. Part 2: Questions about respondents' experience with educational programs and surveys in have you, attended a previous training course of CPR. Part 3: Questions regarding sources of information which consist of 1. formal learning which includes study in a formal University education or college). 2. Informal learning (seminar, webinar, workshop, training course). 3. so- cial media (Facebook, Instagram. Snap chat. Whats-up. Telegram. YouTube) 4. Tra- ditional media (TV. Program, reading book, magazines, newspaper, listen to the radio) Part 4: Assessment of CPR practices used the observational checklist, and one of these manikins or learning CPR procedure, the personal resuscitation named. Trauma. The serial number of manikins is Tm1172A150213m. This personal training manikin has a CPR mode that shows the depth of chest pressure through a fixed light point on a 1–7-point device. Each light point is equal to 1cm. It is noticed during training that if the chest compression is incorrect, it appears through the light point; and changes color from green to red. If it is correct, the light point will stay in the green color assessment of basic life sup- port practices consists of an observational check list for CPR procedures consisting of 13 steps, checking for safety, checking re- sponsiveness, shouting for help activating emergency response system, calling an emergency number 066122 ,from a mobile phone, moving the child to a firm at sur- face, If the child is face-down, roll him or her face-up, keeping the head, neck and back in a straight line. Airway opened by tilting the head slightly and lifting the chin Checks breathing by listening for breaths, feeling the breaths against the skin and watching the chest movements, checks pulse, performs high-quality compressions, and places hands on the lower half of the sternum 30 compressions at a rate of at least 100 compressions per minute, locat- ed the correct hand position by placing the heel of one hand on the child’s sternum at the center of his or her chest, compressed at least 2 inches (5 cm), completed recoil after each compression, gives 2 breaths with a barrier device, each breath given over 1 second (pinched nose, made a com- plete seal over child’s mouth) visible chest rise with each breath, resumes compres- sions in less than 10 seconds, continued cycles of chest compressions and rescue breaths (30:2), (2 cycles for examination purposes. The observational checklist of CPR consists of 13 steps in the worksheet, it was filled out by the researcher for eval- uation for each step using 6 categorize Lik- ert skills, got zero for not performance, 5 for excellent 4 for very good performance, 3 for good performance, 2 for moderate performance, and 1 for poor performance. The system scores, forever. CPR evaluation practice starts from 0 minimum to 65 max- imum and is categorized into 6 levels, which consist of excellent performance (53 -65), very good performance (40-52), good performance (27-39), moderate perfor- mance (14-26), poor performance (1-13) and non-performance (0). The initial study was approve by the Ethics committee, Fac- ulty Nursing, Hawler Medical University with registration No 96 on 13 December 2020. Official permission was sought from the .General Directorate of Erbil education Directorate Center Education of Erbil city, then permission was obtained from the manager of the school, following which 34 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article 35 frequent years of experience among teachers were between 15-26 years which reported 54%. The highest sample (86.4%) in the study were married. 65.1% of respondents reported having 1-3 chil- dren, with a mean of 19.09±8.53. Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. consent was taken orally from each school teacher .They signed the written informed consent attached to the study question- naire after explaining the purpose of the participants were assured that all infor- mation was confidential and their partici- pation in the study was voluntary without any costs and they had the right to refuse to participate in the study. The data was collected and entered into the personal computer. Statistical analysis was done using the statistical package for Social Sci- ence (SPSS/version 26) Analysis including frequencies and percentages. They were used to describe the items and the stud variables. A chi-squire test was used to find out the association between socio- demographic variables like age, sex, quali- fication, years of experience, and source f information. All statistical test had a sig- nificance P -value ≤ 0.05 with a 5% confi- dence level. During the data collection, a total of 500 questionnaires were distributed among school teachers. Finally, 30 questionnaires by the teachers were not completed, re- lated to school issues. In the end, only 470 questionnaires were completed and re- turned; it was considered in the study that the response rate in the current study is 94%. Table 1: It was reported that the ma- jority of teachers lived in municipality 6, which represented 20.2% while the low- est in musicality 4, which represented 12.6%. The highest age groups among participants were between 37-48 years which represented 53%. The mean age was 43.85±8.283. The majority of the samples were female (74%). 52.3% of par- ticipants in the study graduated from an institute while 47.7 % graduated from a college. The majority of class subjects were teaching language (42.1%), while the lowest were exercise (3.4%). The most RESULTS Table 1: Socio-demographic date of participants Socio-demographic characteristic F (%) Municipality Municipality 1 76 (16.2) Municipality 2 75 (16) Municipality 3 83 (17.7) Municipality 4 59 (12,6) Municipality 5 82 (17.4) Municipality 6 95 (20.2) Age group years 25-36 85 (18.1) 37-48 249 (53) 49-60 136 (28.9) Mean and standard deviation Gender Male 122 (26) Female 348 (74) Education College 224 (47.7) Institute 246 (52.3) Class Subject Science 97 (20.6) Language ( Kurdish, Arabic and English) 198 (42.1) Math 68 (14.5) Sociality 68 (14.5) Exercise 16 (3.4) Art 23 (4.9) Years of experience 3-14 130 (27.7) 15-26 254 (54) 27-38 86 (18.3) Mean and standard deviation Marital Status Married 406 (86.4) Single 56 (11.9) Divorced 5 (1.1) Widowed 3 (0.6) Number of child 1-3 252 (65.1) 4-6 125 (32.3) 7-9 10 (2.6) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article represented 76.6%. 86.8% of school teachers do not have the opportunity to attend any a previous training courses. by formal learning (62.6%) and social me- dia (44.7), while the minority comes from formal learning (13.4 %). 36 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2 shows that the majority of study samples have a desire to participate in a basic life support training courses which Table 3 demonstrated that the majority of sources of information among teachers come from traditional media (79.6%),followed Table 2: Basic life support training course F % Do you have a desire to participate in basic life support (BLS) training course No 110 (23.4) Yes 360 (76.6) Do you have attended a previous course of basic life support? No 408 (86.8) Yes 62 (13.2) How many course Not participation 387 (82.3) one course 36 (7.7) two course 22 (4.7) three course 25 (5.3) Type of training course Not participation 387 (82.3) theory course 29 (6.2) practices course 15 (3.2) both theory and practices 39 (8.3) Table 3: Source of information No. Source of information Yes F (%) 1 Formal learning (study in formal University education ) 63 (13.4) 2 In formal learning (seminar, webinar, workshop, training course) 294 (62.6) 3 Social media (Facebook, Insata-gram, Snap-chat, whats-up, tell-gram, You-Tub) 210 (44.7) 4 Traditional media (TV-program , reading book, magazine, newspaper and lis- ten to the radio) 374 (79.6) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article of them had good performance and none of the teachers had very good or excellent performance. using the same data in table4 socio-demographic variables like age group, gender, years of experience, and desire to attended CPR training course. Table 4 illustrates that the highest per- centage of study samples had poor prac- tice performance in CPR, 51.1%, only 0.4 % Figu1 demonstrates levels of performance Table 5 shows that the assessment of CPR procedure was done in 13 steps, most of the school teachers had poor perfor- mance. Table 6 indicated that there was a significant association between the perfor- mance of CPR and some 37 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Figure 1:Over all CPR performance Table 4: Over all CPR performance Levels of Cardiopulmonary Resuscitation Performance F (%) Excellent Performance 0 (0) Very Good Performance 0 (0) Good Performance 2 (0.4) Moderate Performance 38 (8.1) Poor Performance 240 (51.1) Non Performance 190 (40.4) Total 470 (100) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article 38 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 5: Assessment of practices of CPR Cardiopulmonary Resuscita- tion steps Not per- formance Poor perfor- mance Moder- ate per- formanc e Good perfor- mance Very good per- formance Excellent perfor- mance F (%) F (%) F (%) F (%) F (%) F (%) 1. Check for safety 376 (80) 80 (17) 2 (0.4) 1 (0.2) 2 (0.4) 9 (1.9) 2.Checks Responsiveness 404 (86) 64 (13.6) 1 (0.2) 1 (0.2) 0 (0) 0 (0) 3.Shouts for help Activates emergency called an emer- gency number 066122 398 (84.7) 67 (14.3) 2 (0.4) 3 (0.6) 0 (0) 0 (0) 4.Moved the child to the firm flat surface. keeping the head, neck and back in a straight line 369 (78.5) 86 (18.3) 8 (1.7) 5 (1.1) 1 (0.2) 1 (0.2) 5. Opened the airway by tilting head slightly and lifting chin. 317 (67.4) 118 (25.1) 16 (3.4) 15 (3.2) 3 (0.6) 1 (0.2) 6. check for pulse 1 (0.2) 156 (33.2) 21 (4.5) 14 (3) 3 0 (0) 7.Hand placement on lower half of sternum 244 (51.9) 174 (37) 27 (5.7) 22 (4.7) 3 (0.6) 0 (0) compressions a rate of at least 100 compressions per minute. 225 (47.9) 200 (42.6) 30 (6.4) 13 (2.8) 2 (0.4) 0 (0) 9. Located the correct hand position by placing the heel of one hand on the child’s sternum at the center of his or her chest, compresses at least 2 inches (5 cm) depth 234 (49.8) 203 (43.2) 19 (4) 11 (2.3) 3 (0.6) 0 (0) 10.Complete chest recoil after each compression 252 (53.6) 192 (40.9) 16 (3.4) 9 (1.9) 1 (0.2) 0 (0) 11.Gives 2 breaths with a barrier device Each breath given over 1 second(pinched nose, made a complete seal over child’s mouth) 245 (52.1) 209 (44.5) 11 (2.3) 5 (1.1) 0 (0) 0 (0) 12. Visible chest rise with each breath 252 (53.6) 205 (43.6) 12 (2.6) 1 (0.2) 0 (0) 0 (0) 13. Continued cycles of chest compressions and rescue breaths (30:2). (2 cycles for examination purposes 270 (57.4) 192 (40.9) 8 (1.7) 0 (0) 0 (0) 0 (0) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article 39 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 6: Relationship between Overall and Socio-Demographic Characteristics practices of CPR Socio-demographic variables Good Mod- erate Poor Non Chi- square P Value F F F F 109.627 0.001 Municipality 1 0 6 54 16 2 1 16 27 31 3 1 11 45 26 4 0 3 37 19 5 0 1 15 66 6 0 1 62 32 Age Group 25-36 0 10 43 32 13.18 0.04 37-48 0 22 135 92 49-60 2 6 62 66 Gender Male 2 20 61 39 22.725 0.001 Female 0 18 179 151 Education College 2 24 114 84 6.764 0.08 Institute 0 14 126 106 Class Subject Science 0 6 51 40 7.899 0.928 Language 2 22 99 75 Math 0 3 35 30 Sociality 0 4 36 28 Exercise 0 1 8 7 Art 0 2 11 10 Years of experi- ence 3-14 years 0 15 72 43 16.581 0.011 15-26 years 0 18 131 105 27-38 years 2 5 37 42 Marital Status Married 2 36 202 166 8.323 0.502 Single 0 2 32 22 Divorced 0 0 5 0 Widowed 0 0 1 2 Number of chil- dren No Children 1 5 41 36 3.977 0.913 1-3 child 0 21 130 101 4-6 child 1 11 63 50 7-9 child 0 1 6 3 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article 40 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Continue of Table 6: Relationship between Overall and Socio-Demographic Characteristics practices of CPR Socio-demographic variables Good Mod- erate Poor Non Chi- square P- Value F F F F Do you have a desire to partic- ipate in train- ing course No 0 2 53 55 11.077 0.011 Yes 2 36 187 135 Do you have attended a pre- vious training course No 2 33 199 153 1.443 0.695 Yes 0 5 41 37 how many course 0 2 33 199 153 6.595 0.679 One course 0 2 21 13 Two course 0 3 8 11 Three course 0 0 12 13 Type of training course 0 2 33 198 154 9.908 0.358 Theory course 0 5 15 9 Practices course 0 0 8 7 Theory and practices 0 0 19 20 Formal Learning No 2 32 208 165 0.507 0.917 Yes 0 6 32 25 Tradition Media No 1 16 126 106 3.421 0.754 Yes 1 16 91 65 social media No 1 22 124 113 2.747 0.432 Yes 1 16 116 77 Informal Learning No 0 10 88 78 4.324 0.229 Yes 2 28 152 112 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article course (70%) [10]. The finding of the pre- sent study was consistent with the study done in Turkey Anatolia province that shows more than half of school teachers were female; most of them were mar- ried and had children while there was inconsistency with participation in a pre- vious training course in which the major- ity of study samples participated [11]. The difference could be due to the man- datory requirement among school teach- ers to participate in training courses. This rule effected improved teachers’ knowledge and practice regarding basic life support. The result of the current study is in agreement with the study done in Malaysia regarding sources of information that come from social media and TV. Program while disagreeing with participating in the training course, more than half of school teachers in Malaysia shared in the training course regarding basic life support [12]. The result of the present study is in agreement with the study done by Alhejaili AS et al, in Saudi Arabia, which shows that in the majority age group (41-50), most of the school teachers have the desire to participate in a training course [13]. Also, our result strongly agrees with the study done in Saudi Arabia-Hail city by Alshammari KO, (2021) which demonstrates that the mean age is 39±7.8 the majority of teachers were married, more than half of them have not participated in training course, the majority of samples have a desire to participate in training course (87%), and most teachers use social me- dia as sources of information [4]. The average of teachers who received basic life support training sessions in the pre- sent study was found to be very low be- cause most of the teachers had not attended any training course. This find- ing is consistent with studies that shows that lowest percentage of teachers 41 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. The performance of CPR among school teachers in the current research study was found to be inadequate, and this find- ing was investigated in another country from a neighboring country. Basic life sup- port practices among teachers are weak and inadequate the public administration of education makes compulsory participa- tion in basic life support training courses among school teachers, this can be e im- proved and promoted by opening manda- tory training courses or teachers annually. All the factors contributing the low level of performance in cardiopulmonary resus- citation are related to a lack of training courses or educational programs in a school, no present instructors or guide posters and postcards for basic emergen- cy first aid, and no films on health-applied TV programs in order to show how to pro- vide basic life support and immediate care for sudden cardiac arrest. It is an out- standing role of teachers when dealing with injuries and accidents that happened in the school. After dealing with them us- ing appropriate first aid techniques, the morbidity and death rate of these acci- dents decreased. Community health nurs- es or other health care providers are not present in schools for the purpose of per- forming immediate emergency health care services. In the present, study out of 470 school teachers, 26 % were males and 47.7% graduated from college; most of them had not attended a previous training course in school. This finding is in agree- ment with the study done in South India (2015) shows the majority of school teachers do not know how to perform CPR. Out of 146 participants, only 8 teach- ers can perform CPR correctly. The pre- sent result is similar with a mean age (39.3±10). Most of the teachers were fe- male (82%) and the majority of school teachers do not attend a previous training DISCUSSION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article sometimes lead you to situations that are dependent on teachers' personalities or school situations; on the other hand, the responsibility is related to the gen- eral directorate of education. All those factor cause school teachers to have poor knowledge and practices regarding basic life support. Most teacher do not attend any training courses in the school, and the educational program content in the school curriculum does not present any subject of basic first aid. A lack of training in teachers may also contribute to the curriculum of higher education (university degrees) that does not con- tain basic support, even in the colleges of science and physical activity. For this reason, our school teachers have poor skills. Most teachers agree that training Most teachers agree that basic life sup- port should be mandatory teachers in school. Some of responders fear causing harm to victims and fear transferring communicable diseases like Corona virus during mouth-to-mouth breathing [3]. The majority of the present investigation reported that the levels of practices among school teachers were very low. This finding is compatible with a study done in Palestine, Hebron city by Ghraib FA, et al. in 2017 that showed a low level of practices toward basic life support [18] . The current study findings regard- ing basic life support practices were simi- lar to those of the study done in South Delhi by Jacob OM et al, (2018) that showed a low score percentage in CPR (15%), and choking (10%) [20] because the majority of school teachers had not attended training courses. A similar out- come was investigated in Egypt by Abu- Elenen NRM, which showed that the ma- jority of basic life support poor perfor- mance [21] Our finding, regarding CPR practices is in agreement with a study done in Iraq- Baghdad (2016) that shows 42 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. having attended training courses in the school, 40% in Greece [14], % 30% in Sau- di Arabia [13]. 50% in Spain [15], 8.9% in South Africa [16] 3 % in Ethiopia [17], 42% in Palestine [18], 24.2 % in Indonesia [19]. In the current finding, there was no sig- nificant difference between teachers who attend training courses with those attend training courses. This result is in is agree- ment with the study in Greece that found that those teachers had a higher level of knowledge than their non-trained coun- terparts [14]. Variety among countries regarding rules and regulations could be one of the factors the affects the differ- ence between the two results of the study. The educational program regarding basic life support does not involve a school curriculum, and is not mandatory, among school teachers in our country when compared to other countries. Re- garding sources of information, the pre- sent study found that most teachers got information from formal learning like seminars, webinars, workshops and train- ing courses. In addition, the next source comes from social media. This finding is in disagreement with a study done in Saudi Arabia by. Sara A. alzherei, et al20. Most school teachers, sources of information come from social media while the lowest come from informal learning. The present studies demonstrate the signaled low scores in overall levels of CPR among school teachers because most of them do not participate in any educational pro- gram or training course and do not have the opportunity to participate in work- shops and seminars. In addition, no extra supports are present to improve the knowledge and skill of teachers regarding basic life support in school. The school teachers faced many barriers in their lives that did not allow them to participate in educational programs or training courses regarding basic life support. These issues https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.04 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article [4] Alshammari KO. Assessment of knowledge, attitude, and practice about first aid among male school teachers in Hail city. Journal of Family Medicine and Primary Care. 2021 Jan;10(1):138 https:// www.ncbi.nlm.nih.gov/pmc/articles/ PMC6436304/ [5] Míguez-Navarro C. The Knowledge of and attitudes toward first aid and cardiopul- monary resuscitation among parents. Journal of pediatric nursing. 2018. 42, pp.e91-e96. https:// www.pediatricnursing.org/article/S0882- 5963(17)30362-7/fulltext\ [6] Charalambous C. Investigation of the Teacher's Knowledge and Attitude to- wards Providing First Aid in the School Environment. International Journal of Car- ing Sciences. 2021 May 1;14(2):1468-72. https://www.researchgate.net/profile/ Dimos-Mastrogiannis/ publica- tion/357535074_Investigation_of_the_Te acher's_Knowledge_and_Attitude_toward s_Providing_First_Aid_in_the_School_Env ironment/ links/61d2fea0e669ee0f5c8368a1/ Investigation-of-the-Teachers-Knowledge- and-Attitude-towards-Providing-First-Aid- in-the-School-Environment.pdf [7] Kayumba JD. Effectiveness of video teach- ing on basic life support knowledge, atti- tude among non-health professional stu- dents at the University of Rwanda (Doctoral dissertation, University of Rwan- da). http://dr.ur.ac.rw/bitstream/ handle/123456789/999/KAYUMBA% 20Jean%20de%20Dieu.pdf?sequence=1 [8] American Heart Association (2016) Basic Life Support provide manual, ISBN 978-1- 61669-407-4 Printed in the United States of America available at file:///C:/Users/ HC/Downloads/(1)%20American% 20Heart%20Association%20-%20BLS% 20Provider%20Manual%20(2016).pdf [9] Merchant RM. Adult Basic and Advanced Life Support, Pediatric Basic and Ad- vanced Life Support, Neonatal Life Sup- port, Resuscitation Education Science, and Systems of Care Writing Groups. Part 1: executive summary: 2020 American Heart Association guidelines for cardiopulmo- nary resuscitation and emergency cardio- vascular care. Circulation. 2020 Oct 20;142(16_Suppl_2):S337-57. 43 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. most school teachers have very weak CPR practices[22]. The majority of school teachers in basic school have poor performance about CPR, the majority of them have not attended previous training course. 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