Basic Life Support Knowledge and Self Perceived Competence among Registered Nurses in Hazara Region Hospitals, Pakistan: A Cross Sectional Survey

Abstract

Basic life support (BLS) is a foundational emergency competency for registered nurses (RNs) who serve as the primary first responders to in hospital cardiac arrest. However, BLS knowledge deficits among nurses remain a persistent concern, particularly in low and middle income countries. This cross sectional survey assessed BLS knowledge levels, self perceived competence, and associated factors among 385 RNs employed in Hazara region hospitals, Khyber Pakhtunkhwa, Pakistan. Data were collected via a structured Google Forms questionnaire from October to December 2025 (response rate 92.6%). The mean BLS knowledge score was 11.5 ± 3.8 out of 20 (57.5%), and only 37.9% of participants achieved an adequate score (≥75%). Striking gaps were observed on critical items: the initial response to an unresponsive victim was answered correctly by only 23.9% of respondents. Over 42% of RNs rated their BLS competence as high or very high; however, fewer than half of these self confident respondents actually demonstrated adequate knowledge, indicating significant overconfidence. Multivariate logistic regression identified three independent predictors of adequate BLS knowledge: receipt of BLS refresher training within the past two years (AOR = 2.95, 95% CI: 1.72–5.06), assignment to an emergency or critical care unit (AOR = 2.31, 95% CI: 1.38–3.87), and holding a Bachelor of Science in Nursing degree versus a diploma (AOR = 1.83, 95% CI: 1.12–2.99). Gender, age, and years of experience were not significantly associated. These findings reveal an urgent need for institutionalized, regular BLS refresher training programs and reinforcement of emergency skills curricula in nursing education in Pakistan's Hazara region.