Female anatomical manikins in basic life support training: A mixed methods study.

Background: Gender inequalities in care of women with cardiopulmonary arrest may be due to lack of training with manikins representing the female thorax. Incorporating this feature in basic life support (BLS) training would support a more equitable and effective response.

Aim: To evaluate the impact of using female torso mannikins in BLS training for nursing students.

Design: Mixed-method study with a sequential explanatory design.

Method: Eighty undergraduate nursing students from a university in northern Spain participated. A quasi-experimental single-group design evaluated a BLS training program. The intervention included training and retraining using simulation with male and female torso manikins. Technical performance, physiological variables and emotional responses were assessed. A qualitative descriptive study was conducted through focus groups to explore students' experiences and perceptions.

Outcomes: The use of torsos with breasts led to poorer technical performance (initiation time: 14 vs. 9 s; hand placement: 57.5 % vs. 97.5 %; correct use of the automated external defibrillator (AED): 31.3 % vs. 98.8 %; electrode placement: 55 vs. 45.4 s; p < 0.001) and greater physiological activation (heart rate: 90 vs. 76 bpm; perceived stress: 5.0 vs. 3.0; p < 0.001). Retraining with the female torso improved AED use (56.3 % vs. 31.3 %) and compression time (11 vs. 14 s); however, differences with the male torso persisted. Technical and emotional barriers-such as hesitation and uncertainty-aligned with perceptions in focus groups, reinforcing the emotional impact in qualitative phase.

Conclusions: The incorporation of female torsos revealed performance limitations affecting emergency care. Findings support the need for gender-sensitive training in life-saving interventions.