Jurnal Keperawatan Indonesia, 2025, 28 . , 95Ae106 DOI: 10. 7454/jki. Received April 2024. Accepted April 2025 A JKI 2025 pISSN 1410-4490. eISSN 2354-9203 Determinants Influencing the Readiness of Non-Medical Hospital Personnel to Perform Basic Life Support Elin Hidayat1*. Suaib1. I Made Rio Dwijayanto1. Nur Aviva Pemasi1. Ilne Ai Purana Adel2 Professional Nurse Education Program. Faculty of Health. Universitas Widya Nusantara. Palu 94148. Indonesia Psychology Master Program. Faculty of Psychology Education. Universitas Negeri Malang. Malang 65145. Indonesia *E-mail: elin. hidayat50@gmail. Abstract All healthcare personnel, including both medical and non-medical staff within hospitals, are expected to possess the capability to administer Basic Life Support (BLS) in order to provide immediate assistance during emergencies. However, many non-medical hospital staff remain unprepared to perform BLS due to a lack of knowledge, willingness, and This study aims to identify the factors affecting the preparedness of non-medical hospital staff in carrying out BLS at Undata Hospital, a healthcare facility in Central Sulawesi. This research employed quantitative design with a cross-sectional approach. The sample comprised 103 non-medical respondents selected through total sampling. Data were collected through structured interviews and self-administered questionnaires. The variables measured in this study include behavioral beliefs, normative beliefs, control beliefs, intention, and BLS readiness. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The results indicated that behavioral beliefs significantly influenced intention . = 0. , while normative beliefs did not . = 0. Control beliefs showed no significant influence on intention . = 0. , whereas intention had a significant effect on BLS readiness . = 0. The study concludes that behavioral beliefs influence intention, which in turn significantly affects BLS readiness. Keywords: basic life support, behavioral beliefs, control beliefs, intention, normative beliefs, non-medical personnel Abstrak Determinan yang Memengaruhi Kesiapan Tenaga Nonmedis dalam Melaksanakan Bantuan Hidup Dasar di Lingkungan Rumah Sakit. Seluruh petugas rumah sakit, baik medis maupun nonmedis, diharapkan memiliki kemampuan untuk melakukan Bantuan Hidup Dasar (BHD) guna memberikan pertolongan segera kepada pasien dalam situasi gawat Permasalahan yang terjadi saat ini adalah masih banyak tenaga nonmedis di rumah sakit yang belum siap melaksanakan BHD dalam kondisi darurat karena keterbatasan pengetahuan, kurangnya kemauan, serta rendahnya rasa percaya diri. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang memengaruhi kesiapan petugas nonmedis rumah sakit dalam pelaksanaan BHD di Rumah Sakit Undata. Provinsi Sulawesi Tengah. Penelitian ini merupakan studi kuantitatif dengan desain potong lintang. Sampel terdiri atas 103 responden nonmedis yang dipilih menggunakan teknik total sampling. Pengumpulan data dilakukan melalui wawancara terstruktur dan pengisian kuesioner berupa daftar pertanyaan yang dijawab langsung oleh responden. Determinan yang diukur meliputi behavioral beliefs, normative beliefs, control beliefs, intention, dan kesiapan melakukan BHD. Analisis data menggunakan Partial Least Squares Structural Equation Modeling (PLS-SEM). Hasil penelitian menunjukkan bahwa behavioral beliefs berpengaruh signifikan terhadap intention . = 0,. , normative beliefs tidak berpengaruh signifikan terhadap intention . = 0,. , control beliefs berpengaruh signifikan terhadap intention . = 0,. , dan intention berpengaruh signifikan terhadap kesiapan melakukan BHD . = 0,. Disimpulkan bahwa faktor-faktor yang memengaruhi intention adalah behavioral beliefs dan control beliefs, sedangkan intention memengaruhi kesiapan petugas nonmedis dalam melakukan BHD. Kata Kunci: bantuan hidup dasar, keyakinan kontrol, keyakinan normatif, keyakinan perilaku, niat, petugas nonmedis sessed by all healthcare facility workers, including both medical and non-medical personnel. This is essential given that emergency situa- Introduction Basic Life Support (BLS) should be a skill pos95 Hidayat, et al. Determinants Influencing the Readiness of Non-Medical Hospital Personnel to Perform Basic Life Support JKI. Vol. 28 No. July, 95Ae106 tions can occur unpredictably and in any location (Olasveengen et al. , 2. The preparedness of non-medical personnel to perform BLS remains a critical concern that may contribute to increased mortality from sudden cardiac arrest (Alsabri et al. , 2. Numerous cases have shown that victims often do not receive timely and effective initial assistance due to a lack of skill and confidence among non-medical staff (Amoako-Mensah et al. , 2. currence of cases involving cardiac arrest patients necessitates emergency services to spend considerable time on the initial management of first aid at the scene (Maulidah, 2. Of these, around 350,000 adults experience out-of-hospital cardiac arrest. However, fewer than 40% receive cardiopulmonary resuscitation (CPR) from bystanders, and less than 12% are defibrillated with an Automated External Defibrillators (AED) before emergency medical services arrive (Albargi, 2. Key contributing factors include the lack of continuous training, limited exposure to reallife simulations, and the absence of mandatory BLS competency policies within healthcare institutions. Additionally, fear of making mistakes and the lack of adequate supporting facilities further inhibit non-medical personnel from responding effectively to emergencies. Without immediate intervention, these issues may lead to a rise in preventable deaths that could other-wise be mitigated through timely and effective BLS (Mekonnen & Muhye, 2. Based on the 2018 Basic Health Research (Riset Kesehatan Dasar [Riskesda. ), the national prevalence of heart disease in Indonesia stood 5%, with the highest rates found in North Kalimantan . 2%). Yogyakarta . 0%), and Gorontalo . 0%). In addition, eight other provinces exceeded the national average, including Aceh . 6%). West Sumatra . 6%). DKI Jakarta . 9%). West Java . 6%). Central Java . 6%). East Kalimantan . 9%). North Sulawesi . 8%), and Central Sulawesi . (Adisasmito et al. , 2. Preliminary observations and interviews with non-medical personnel at Undata Hospital in Palu revealed a low level of preparedness in administering BLS during emergency situations. This is particularly alarming given that the hospital recorded 140 cases of cardiac arrest in 2023, none of which resulted in successful resuscitation. Furthermore, several cardiac arrest incidents that occurred outside care units went undocumented, with patients failing to receive timely BLS due to delays in its administration. As the primary referral hospital in Central Sulawesi. Undata Hospital plays a crucial role in emergency care. Therefore, delays in initial BLSAiespecially by non-medical personnel, who are often the first respondersAican significantly impact patient survival outcomes. Interviews conducted at the research site revealed that non-medical personnel were inadequately prepared to perform BLS, primarily due to limited knowledge and lack of training, as well as fear of failure. The absence of training, skills, and clear intentionAicoupled with misconceptions about BLSAicontributes to reduced lifesaving potential for cardiac arrest patients (Nyirenda et al. , 2. Many non-medical staff members are hesitant to perform BLS due to insufficient knowledge, fear, and limited access to necessary facilities (Qian et al. , 2. A lack of training and understanding of BLS procedures often leads to uncertainty in performing them correctly. Additionally, fear of worsening the victimAos condition or facing legal repercussions deters many from taking action (Mekonnen & Muhye, 2. Low confidence in managing emergencies further affects their readiness to respond. Limited access to essential equipmentAisuch as AEDs in public areasAialso discourages non-medical According to the World Health Organization (WHO), cardiac arrest is among the medical emergencies with the highest mortality rates (Nowbar et al. , 2. In Indonesia, the annual incidence of emergency department visits is approximately 10,000 cases. The significant oc96 Hidayat, et al. Determinants Influencing the Readiness of Non-Medical Hospital Personnel to Perform Basic Life Support JKI. Vol. 28 No. July, 95Ae106 personnel from providing first aid. Previous studies have shown that BLS training can significantly enhance non-medical personnelAos preparedness and confidence. Other influential factors include education level, prior emergency experience, and the existence of legal protections for bystanders (Alsayali et al. , 2. for behavioral beliefs . nowledge and attitude. (Jarrah et al. , 2. , normative beliefs . eliefs and motivatio. (Assarroudi et al. , 2. , control beliefs . erception and trainin. (Wahyuningsih, 2. , intention to perform BLS (Setioputro et al. , 2. , and readiness to perform BLS (Kose et al. , 2. Thus, it is crucial for personnel to master BLS skills and respond swiftly to cardiac arrest incidents (Husen & Rahman, 2. This is supported by Riggs et al. , who found that staff readinessAiparticularly in hospitalsAito provide BLS is influenced by prior training, experience, willingness to assist, and a personal drive to develop these capabilities. Based on these findings, this study aims to investigate the factors influencing the readiness of hospital personnelAiparticularly non-medical staffAiin performing BLS. Validity testing was conducted using factor analysis, with a cut-off loading factor of Ou 0. for construct validity. Items below this threshold were deemed invalid and excluded. Reliability testing was carried out using CronbachAos Alpha, with a cut-off value of Ou 0. 70, indicating acceptable internal consistency. The validity and reliability results are presented in Table 4 and Table 6. Data were analyzed using inferential Structural Equation Modeling (SEM) with the licensed SmartPLS 4 application. The independent variables included behavioral beliefs . nowledge and attitud. , normative beliefs . eliefs and motivatio. , control beliefs . erception and trainin. , and intention. The dependent variable was the readiness to perform BLS. Methods This quantitative research used a cross-sectional design and was conducted at Undata Hospital in Central Sulawesi Province. The research was carried out over the course of one month and received ethical approval from the Faculty of Medicine Ethics Committee at Tadulako University, under approval number 6559/ UN. 30/KL/2023. The population comprised all non-medical personnel working at Undata Hospital, totaling 103 individuals. The inclusion criteria were: non-medical personnel aged 18 years or older, willingness to participate and provide informed consent, no prior BLS training, and a minimum of six months of work experience. The study employed a total sampling . aturated samplin. technique, meaning all eligible non-medical staff . = . were included in the sample. Results Behavioral beliefs consist of two indicators: knowledge and attitude. As shown in Table 1, 3% of respondents demonstrated high knowledge, while 68. 7% had moderate knowledge, and none were categorized as having low knowledge. In terms of attitude, only 7. 8% of respondents exhibited a high attitude, 23. 5% showed a moderate attitude, and the majorityAi68. 7%Ai displayed a low attitude (Table . The normative belief variable includes the indicators of belief and motivation. Both indicators share the same distribution: 61 . 8%) of respondents held positive beliefs and were positively motivated, while 61 . 2%) held negative beliefs and showed low motivation, respectively. The instrument used was a modified version of an existing questionnaire designed to measure the readiness of non-medical personnel in performing BLS. The modifications ensured relevance to the study context and the hospital environment. The instrument included indicators Control beliefs are represented by perception and Regarding perception, 72. 5% of respon97 Hidayat, et al. Determinants Influencing the Readiness of Non-Medical Hospital Personnel to Perform Basic Life Support JKI. Vol. 28 No. July, 95Ae106 Table 1. Descriptive Analysis Variable Behavioral Beliefs Indicators Knowledge Attitude Normative Beliefs Confidence Motivation Control Beliefs Perception Training Intention BLS Readiness Intention BLS Readiness Category High Moderate Low High Moderate Low Positive Negative Positive Negative Positive Negative Positive Negative High Low Ready Not ready Figure 1. Outer Model Constructs of Factors Influencing the Readiness of Hospital Staff in Implementing BLS at Undata Hospital. Central Sulawesi Province dents had a positive perception, while 27. 5% had a negative perception. In terms of training, 8% reported a positive training experience, 1% indicated a negative training experience. The intention to perform BLS was categorized as either high or low. A total of 54 respondents . 9%) demonstrated high intention, while 49 respondents . 1%) were categorized as having low intention. Finally. BLS readiness was Hidayat, et al. Determinants Influencing the Readiness of Non-Medical Hospital Personnel to Perform Basic Life Support JKI. Vol. 28 No. July, 95Ae106 grouped into two categories: ready and not ready. Of the total respondents, 66. 6% were considered ready to perform BLS, while 33. 3% were not ready. The reduction results also highlight the most influential indicators for each variable. For the behavioral beliefs variable, the attitude indicator makes the strongest contribution. Within the normative beliefs construct, both belief and motivation indicators hold the greatest significance. The most influential indicator in the control beliefs variable is training, while for the intention variable, the intention indicator itself contributes the most. Outer Model Evaluation. The outer model evaluation serves to assess the validity and reliability of constructs, particularly focusing on construct validity and construct reliability. The structure of the outer model is illustrated in Figure 1. Discriminant Validity Test. Discriminant validity was assessed using the cross-loading values. This evaluation involved comparing the cross-loading of each indicator on its corresponding construct with its correlations to other An indicator is considered valid if its loading on the intended construct is higher than its loadings on other constructs. The results of the cross-loading analysis are presented in Table 4. Convergent Validity Test. The convergent validity of each construct is evaluated using loading factor values. An indicator is considered to meet convergent validity if its loading factor The initial test results are presented in Table 2. Based on the data in Table 2, most indicators achieved the required loading factor threshold of > 0. However, the knowledge and perception indicators recorded loading factors below As a result, these two indicators were deemed insignificant in measuring the personal factor variables and were therefore excluded from the model. As shown in Table 4, the loading values . n bol. of each indicator are higher on their respective constructs than on others. Therefore, it can be concluded that the indicators demonstrate adequate discriminant validity, effecttively distinguishing between different latent variables. Following the removal of invalid indicators, the recalculated loading factors in Table 3 confirm that all remaining indicators have values above 5, indicating acceptable convergent validity. Thus, each retained indicator is valid in representing its respective construct. Construct Reliability. Construct reliability was assessed using CronbachAos alpha and Composite Reliability (CR) values. A construct is considered reliable if the CronbachAos alpha exceeds Table 2. Convergent Validity Test of Factors Affecting the Readiness of Hospital Staff in Carrying Out BLS at Undata Hospital. Central Sulawesi Variable Behavioral Beliefs Indicator Knowledge Attitude Loading Factor Cut off Explanation Invalid Valid Normative Beliefs Confidence Motivation Valid Valid Control Beliefs Perception Training Invalid Valid Intention BLS Readiness Intention BLS Readiness Valid Valid Hidayat, et al. Determinants Influencing the Readiness of Non-Medical Hospital Personnel to Perform Basic Life Support JKI. Vol. 28 No. July, 95Ae106 Table 3. Convergent Validity Test After Indicator Reduction for Factors Influencing the Readiness of Hospital Staff in Performing BLS at Undata Hospital. Central Sulawesi Variable Behavioral Beliefs Normative Beliefs Indicator Attitude Confidence Motivation Training Intention BLS Readiness Control Beliefs Intention BLS Readiness Loading Factor Cut off Explanation Valid Valid Valid Valid Valid Valid Table 4. Cross-Loading Values in the Discriminant Validity Test of Factors Influencing Hospital Staff Readiness to Perform BLS at Undata Hospital. Central Sulawesi Indicator Attitude Confidence Motivation Training Intention Behavioral Belief Normative Belief Control Belief Intention BLS Readiness Table 5. Construct Reliability Test of Factors Influencing Hospital Staff Readiness to Perform BLS at Undata Hospital. Central Sulawesi Variable Behavioral Beliefs Normative Beliefs Control Beliefs Intention BLS Readiness Cronbach Alpha 6 and the Composite Reliability exceeds 0. The calculation results are presented in Table 5. Composite Reliability P-value is less than 0. If these conditions are met, it can be concluded that there is a significant effect of the exogenous variables on the endogenous variables. The test results are presented in Figure 2 and Table 6. As shown in Table 5, all variables exhibit CronbachAos alpha values above 0. 6 and Composite Reliability values above 0. These results indicate strong internal consistency among the indicators, confirming that each construct is measured reliably. Therefore, the instrument used in this study is considered dependable for assessing the intended variables. Based on the results in Table 6, the findings are as follows: The Relationship between Behavioral Beliefs and Intention. The relationship between the behavioral beliefs factor . nowledge and attitude. and intention to perform BLS was tested. The T statistic value is 2. 058, and the P-value is Since the P-value is less than 0. 05, it can be concluded that there is a significant relationship between behavioral beliefs and intention. Therefore. Hypothesis 1 is supported. Hypothesis Testing (Inner Mode. The purpose of this test is to evaluate whether exogenous variables have a significant effect on endogenous variables. A relationship is considered significant if the T statistic value is greater than or equal to the T-table value . or if the Hidayat, et al. Determinants Influencing the Readiness of Non-Medical Hospital Personnel to Perform Basic Life Support JKI. Vol. 28 No. July, 95Ae106 Figure 2. Inner Model Constructs of Factors Influencing the Readiness of Hospital Staff in Implementing BLS at Undata Hospital. Central Sulawesi Table 6. Hypothesis Testing Results for Factors Influencing the Readiness of Hospital Staff in Performing BLS at Undata Hospital. Central Sulawesi Relationship Behavioral Ie Beliefs Ie Intention Control Beliefs Ie Intention Intention Ie BLS Readiness Normative Beliefs Ie Intention Original Sample . T Statistics (IO/STDEVI) The Relationship between Normative Beliefs and Intention. The relationship between normative beliefs . eliefs and motivatio. and intention to perform BLS was tested. The T statistic value is 1. 523, and the P-value is 0. Since the P-value is greater than 0. 05, it can be concluded that there is no significant relationship between normative beliefs and intention. Therefore. Hypothesis 2 is not supported. P Values Explanation Significant Not Significant Significant Not Significant thesis 3 is not supported. The Relationship between Intention and BLS Readiness. The relationship between intention to perform BLS and BLS readiness was tested. The T statistic value is 1. 996, and the P-value is Since the P-value is less than 0. 05, it can be concluded that there is a significant effect of intention on BLS readiness. Therefore. Hypothesis 4 is supported. The Relationship between Control Beliefs and Intention. The relationship between control beliefs . erception and trainin. and intention to perform BLS was tested. The T statistic value 727, and the P-value is 0. Since the Pvalue is greater than 0. 05, it can be concluded that there is no significant relationship between control beliefs and intention. Therefore. Hypo- Discussion The Effect of Behavioral Beliefs on Intention. Based on the analysis, it is evident that behavioral beliefs have a significant influence on Behavioral beliefs are indicated by knowledge and attitudes, while intention is ref101 Hidayat, et al. Determinants Influencing the Readiness of Non-Medical Hospital Personnel to Perform Basic Life Support JKI. Vol. 28 No. July, 95Ae106 lected through various intention indicators, most of which fall into the high category. Behavioral beliefsAiparticularly attitudesAiplay a role in shaping intention, as they are rooted in how individuals view and respond to certain behaviors. If someone holds a favorable attitude toward a behavior, a strong intention to perform that behavior is likely to follow (Badi'ah et al. , 2. The implication of this non-significant result is that external social pressureAisuch as encouragement from othersAiis not enough to foster BLS-related intention among non-medical staff. Interventions should not rely solely on social influence but also aim to build internal factors such as confidence, knowledge, and practical skills (Amin & Haswita, 2. An individual with a positive attitude toward a behavior is also likely to express the intention to engage in that behavior. In this context, improving attitudes toward BLS is expected to foster more positive intentions. Attitudes shape perceptions of specific situations or actions. positive attitude leads to more optimistic perceptions, which in turn strengthen intention (Ching & Chan, 2. The Effect of Control Beliefs on Intention. The analysis shows that control beliefs also do not significantly influence the intention to perform BLS. Control beliefs in this study is represented by perception and training. These beliefs affect whether an individual feels capable of performing a behavior, depending on how they perceive the resources or barriers involved (Tversky, 2. This finding aligns with the study by Ulfah . , which found that attitude plays a major role in determining intention: the more positive the attitude, the stronger the intention, and vice If individuals perceive that a behavior is easy to perform or that support is available, their intention to act increases. Conversely, if they believe the task is difficult or someone else is more qualified, the intention may not develop (SynchezCayizares et al. , 2. In this study, the lack of significant influence may be due to respondents having inaccurate perceptions or an over-reliance on medical professionals. If they assume help will arrive quickly, they may not feel the need to act themselves. The Influence of Normative Beliefs on Intention. The analysis indicates that normative beliefs do not have a significant effect on intention. Normative beliefs are indicated by beliefs and motivation, which represent an individual's perception of expectations from influential people in their life . , such as family or peers. While these beliefs and motivations can influence intention, the data in this study suggest that they were insufficient to do so in this context. This suggests that improving perception or offering training alone may not be enough. Future programs should also emphasize personal responsibility and build a sense of urgency. Simulation-based training or empowerment initiatives may strengthen self-efficacy and intention more effectively. According to Zebua . , normative beliefs contribute to intention when strong motivations and self-belief are present. However, the assumption in this study is that belief and motivation alone are not enough to drive intentionAi particularly in the case of non-medical staff, who do not receive regular BLS training like medical personnel. A lack of routine practice and confidence, even in the presence of social motivation, may inhibit the intention to act in The Effect of Intention on Officer Readiness to Perform BLS. The analysis confirms that intention significantly influences staff readiness to perform BLS. The intention variable is composed of several indicators reflecting commitment to perform BLS-related actions. Intention is a mental state that embodies a commitment to execute a behavioral action in the Hidayat, et al. Determinants Influencing the Readiness of Non-Medical Hospital Personnel to Perform Basic Life Support JKI. Vol. 28 No. July, 95Ae106 present or future. It signifies a mental state that originates from the planning phase and extends to behavior (Scanlan & Still, 2. Further, intention is closely linked to behavior, as it is the intention that motivates individuals to engage in Without a strong intention, individuals may struggle to exhibit positive behavior (Arifin et al. , 2. Positive behavioral outcomes typically stem from strong intentions. As such, the more positive the intention, the more positive the resulting behavior. Intention has a significant influence on behavior in con-ducting BLS because the intention that arises from within a person will identify how strong the individual is in trying to behave (Santi & Indarjo, 2. intention to engage in life-saving actions. Recognition or rewards for active participation may further support this goal. Fourth, regular evaluations should be conducted to monitor staff readiness and ensure the effectiveness of training programs, thereby helping organizations maintain a reliable and responsive emergency Conclusion Strong behavioral beliefs, such as knowledge and positive attitudes, can foster the intention of non-medical staff to enhance their readiness to perform BLS. Normative beliefsAinamely belief and motivationAiplay a vital role as well. When individuals possess strong internal motivation and belief, their intention to act becomes Ideally, these positive motivations and beliefs emerge from within and lead to a corresponding positive intention. Control beliefs, including perception and training, also influence the formation of intention. It is assumed that staff with a strong intention to perform BLS are more likely to follow through. Conversely, if the intention is weak or absent, the behavior is unlikely to occur. This finding supports the idea that intention is a key predictor of BLS readinessAiconsistent with Gieure et al. , who emphasize that good behavior is always preceded by strong intention. An individual's perception can either strengthen or weaken their intention, depending on whether the behavior is perceived as beneficial. the behavior is seen as advantageous, the intention to act will likely increase. Conversely, if the behavior is perceived as irrelevant or unhelpful, intention may weaken. Strong intention ultimately drives readiness and behavior. When non-medical staff have clear and positive intentions, they are more likely to perform BLS This intention guides their actions, and positive behavior tends to follow. Therefore, fostering intention through enhanced knowledge, attitudes, perception, and motivation is essential for improving readiness and response in emergency situations. Limitations. Several factors may influence the readiness of non-medical responders that are not directly measurable or were not identified during the study. Variations in experience and educational background among non-medical responders can significantly impact their preparedness to perform BLS, and this study may not have fully captured the effects of these The findings of this study also carry implications for healthcare services. First, continuous BLS training should be implemented for nonmedical staff, with a focus on enhancing their behavioral and control beliefs to improve their preparedness in emergency situations. Second, empowering non-medical staff through practical simulations and confidence-building measures can significantly enhance their readiness to perform BLS, helping them feel more competent when faced with emergencies. Third, fostering an organizational culture that promotes BLS readiness can increase non-medical staff's Acknowledgements We extend our sincere gratitude to all respondents who participated in this study. We also thank Undata Hospital. Central Sulawesi, for their support and willingness to facilitate the research process. Hidayat, et al. Determinants Influencing the Readiness of Non-Medical Hospital Personnel to Perform Basic Life Support JKI. Vol. 28 No. July, 95Ae106 Arifin. Hakim. , & Sitorus. 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