Application effect of Miller’s pyramid teaching method based on HeartCode BLS in basic life support training for nursing students

BACKGROUND: 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's pyramid-based HeartCode BLS teaching model compared with traditional instruction in undergraduate nursing students. METHODS: In this randomized controlled trial, 229 eligible nursing students were enrolled and assigned to a control group (n = 115) or an observation group (n = 114). The observation group received a HeartCode BLS teaching model structured according to Miller's 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 t-tests, Mann-Whitney U tests, and repeated-measures ANOVA, as appropriate. FINDINGS: 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 ± 9.94 vs. 68.81 ± 9.33), CPR skills (85.92 ± 8.67 vs. 79.80 ± 7.56), and defibrillation skills (85.48 ± 8.63 vs. 78.86 ± 5.77; all p < 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 p < 0.001). A greater proportion of students in the observation group maintained total compression interruption times below 30 s (57.0% vs. 25.2%; p < 0.001). Learner satisfaction was consistently higher across all domains (all p < 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 p < 0.001). INTERPRETATION: A Miller's 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.