1
|
Ng J, Christensen M. Registered nurses' knowledge and interpretation of ECG rhythms: A cross-sectional study. Nurs Crit Care 2024; 29:1032-1039. [PMID: 38156358 DOI: 10.1111/nicc.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Electrocardiographic (ECG) monitoring and recording are seen as the most commonly used non-invasive diagnostic tool to identify cardiac arrhythmia and myocardial damage in the clinical setting. There is an expectation that critical care nurses are ideally trained to interpret abnormalities and morphology in the ECG more proficiently than nurses from general ward areas. However, the ability to interpret and recognise ECG abnormalities is dependent on which critical care area nurses are currently working in and their level of experience. AIM The aim of this study was to investigate registered nurses' knowledge in being able to identify and interpret select electrocardiographic rhythms. STUDY DESIGN This was a cross-sectional study that evaluated registered nurses' knowledge of electrocardiogram rhythm identification and interpretation. A convenience sample of 105 registered nurses currently enrolled in a 2-year Master's programme leading to critical care specialism and advanced practice nurse award were recruited. A 20-item multiple choice questionnaire that provided examples of electrocardiogram rhythm (n=14) abnormalities and rhythm abnormalities caused by electrolyte disturbances (n=6) RESULTS: The study included registered nurses from critical care and general ward areas. The overall results were poor with only 55% of questions answered correctly. Coronary care nurses scored the highest in identifying ECG rhythms (12/20 ± 1.58; p < .001). When ECG abnormalities associated with electrolyte imbalances were analysed, both groups were unable to identify the effects of hypokalaemia and hypomagnesaemia effectively (p = .748). Length of time as a registered nurse (r = -0.304, p = .002) and length of time in current work environment were weakly correlated (r = -0.328, p = .001). Having a critical care background showed a positive relationship with nursing knowledge of ECG rhythm identification (r = 0.614, p < .001). CONCLUSION The results of this study demonstrate that nurses have a poor knowledge of ECG rhythm identification and interpretation, a consistent finding from other work. A possible solution is a revamp of education and training associated with ECG recognition and morphology. RELEVANCE TO CLINICAL PRACTICE Monitoring and assessing ECG morphology provide important details about cardio-electroconductive stability, especially with fluctuations in serum electrolyte levels seen in critical illness or trauma. For this, critical nurses must improve their proficiency through education/training or internal quality improvement activities in detecting abnormalities associated with ECG changes beyond those most easily recognizable rhythms such as atrial fibrillation or ventricular tachycardia.
Collapse
Affiliation(s)
- Jessie Ng
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Martin Christensen
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| |
Collapse
|
2
|
Chamiso TM, Lemessa Jinfessa F, Jibril M. Knowledge, practice, and factors associated with electrocardiography interpretation among nurses working in adult emergency and critical care units at selected governmental hospitals in Addis Ababa, Ethiopia, 2023: a cross-sectional study. BMC Nurs 2024; 23:557. [PMID: 39135036 PMCID: PMC11321218 DOI: 10.1186/s12912-024-02201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 07/25/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Electrocardiography (ECG) is a noninvasive diagnostic method used to examine electrical and muscular cardiac activity. It is usually the first-line diagnostic tool for patients with chest pain. Late recognition of electrocardiography abnormalities can cause in-hospital cardiac arrest, further complicate care, increase the cost of health care, and prolong admission. Hence, the objective of this study was to determine the knowledge, practice, and associated factors of nurses regarding the interpretation of electrocardiography. METHODS A cross-sectional study was carried out on 334 nurses working at randomly selected public hospitals from March 06, 2023, to April 05, 2023. Since our study populations were less than the calculated sample size, all nurses who fulfilled the inclusion criteria were included. The collected data were coded and cleaned using EpiData version 4.2 and analysed using Statistical Package for the Social Sciences (SPSS) version 25. Both bivariate and multivariate logistic regression was run to find an association between dependent and independent variables. Odds ratios (ORs) with 95% confidence levels were used to measure the strength of associations. RESULTS A total of 334 nurses responded to the survey, yielding a 93% response rate. Only 15.4% and 9% of them had satisfactory knowledge and good practice, respectively. Nurses who had 2-4 years of experience in the current unit were 3.13 times more likely (AOR = 3.13 (1.23, 7.92) to have sufficient knowledge. Nurses working in cardiac care units were 3.45 times more likely to have good practices than those working in intensive care units (AOR = 3.45 (1.02, 13.73)). CONCLUSION The study revealed that educational qualifications, in-service training, and current working units were significantly associated with nurses' knowledge and practice of electrocardiography interpretation. The concerned body must provide continuous on-the-job training related to ECG interpretation to all nurses working in adult emergency and critical care unit.
Collapse
Affiliation(s)
- Tekalign Markos Chamiso
- Department of Cardiovascular Nursing, School of Nursing St, Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Feyissa Lemessa Jinfessa
- Dean at School of Nursing, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Medina Jibril
- Department of Cardiovascular Nursing, School of Nursing St, Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
3
|
Chen Y, Wen H, Huang Z, Zhang R, Peng L. Advancing arrhythmia education through the CDIO approach: a new paradigm in nursing student training. BMC Nurs 2024; 23:427. [PMID: 38918825 PMCID: PMC11197327 DOI: 10.1186/s12912-024-02118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/20/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The accurate diagnosis and effective management of arrhythmias are crucial, with nurses playing a key role in the early detection and treatment, significantly impacting patient outcomes. Improving education on arrhythmias among nurses, especially in critical care and perioperative settings, can enhance patient safety and the quality of care. METHODS A total of 116 trainee nurses were randomly divided into two groups: one utilizing the conceive-design-implement-operate (CDIO) model and the other employing a traditional lecture-based learning (LBL) method, to undergo arrhythmia training. The studyassessed the effects of the two teaching methods and investigated the students' attitudes toward these educational practices, with all participants completing pre- and post-course tests. RESULTS The CDIO model significantly enhances nursing students' arrhythmia proficiency, yielding higher test scores and sustained improvement after 24-week compared to the traditional LBL method, alongside markedly better self-learning enthusiasm, understanding, satisfaction with the teaching approach and effectiveness, and interest in learning arrhythmia. The CDIO model in nursing arrhythmia courses boosts theoretical knowledge and application, showing potential in clinical skill enhancement. CONCLUSIONS Our study introduces the CDIO model in nursing arrhythmia courses, with improvement in knowledge and skills, and promise for broader application.
Collapse
Affiliation(s)
- Yu Chen
- Department of Cardiology, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Heling Wen
- Department of Cardiology, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Zheng Huang
- Department of Surgery, The Affiliated Tumor Hospital of Chengdu Medical College, Chengdu, 610021, China
| | - Rui Zhang
- Department of Surgery, The Affiliated Tumor Hospital of Chengdu Medical College, Chengdu, 610021, China.
| | - Lei Peng
- Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| |
Collapse
|
4
|
Belay YH, Gezahegn D, Melaku B, Adal O. Nurses' competency on electrocardiography interpretation in adult emergency room: Addis Ababa, Ethiopia, 2021. Multicenter cross-sectional study. Int Emerg Nurs 2024; 74:101453. [PMID: 38678683 DOI: 10.1016/j.ienj.2024.101453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/26/2024] [Accepted: 04/06/2024] [Indexed: 05/01/2024]
Abstract
AIM This study aimed to assess the proficiency of nurses in interpreting electrocardiogram within the adult emergency units of Addis Ababa, Ethiopia, during the year 2021. METHODS This institutional-based descriptive, cross-sectional study involved 175 nurses from five randomly selected hospitals' adult emergency units. Semi-structured, self-administered questionnaires were used for data collection. Data were entered into Epi-Data and analyzed using SPSS version 26. Fisher's exact test identified statistical significance between dependent and independent variables at a p-value < 0.05. RESULTS Out of 203 respondents, 175 participated actively, yielding a response rate of 86.2%. Among these nurses, 159 (90.9%) were deemed not competent (scoring < 65%), with a mean score of 6.82 ± 3.65 SD. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was included in this study. CONCLUSION The overall competency level in electrocardiogram interpretation among nurses is significantly poor. This indicates that most nurses in the emergency units are unable to accurately interpret ECG monitoring, potentially leading to the failure to recognize signs of arrhythmias, electrolyte disturbances, and other cardiac abnormalities. Consequently, this may result in inappropriate patient care and increased mortality rates. Education and training were identified as key factors in enhancing their competency.
Collapse
Affiliation(s)
- Yegremew Haimanot Belay
- Department of Emergency Medicine & Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Demmelash Gezahegn
- Department of Emergency Medicine & Critical Care, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birhanu Melaku
- Department of Emergency Medicine & Critical Care, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ousman Adal
- Department of Emergency Medicine & Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| |
Collapse
|
5
|
Obied RNA, Salameh B, Ayed A, Harazni L, Fashafsheh I, Zaben K. Assessing the Level of Electrocardiographic Interpretation Competency among Emergency Nurses in Palestine. SAGE Open Nurs 2024; 10:23779608241244677. [PMID: 38601011 PMCID: PMC11005491 DOI: 10.1177/23779608241244677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/11/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The use of electrocardiograms (ECGs) is widespread among emergency room (ER) nurses for diagnosis and triage, making it crucial for them to have the appropriate level of competency in interpreting ECGs. This can lead to better healthcare and patient outcomes. Objectives This study aims to assess the competency level of emergency nurses in Palestine in interpreting normal ECG and certain cardiac arrhythmias, and to explore the association between socio-demographic characteristics and their ECG interpretation competency. Methods The study used a cross-sectional descriptive design, and 196 ER nurses were conveniently recruited to fill out a self-administered questionnaire based on previous literature. The data collected were analyzed using SPSS with strict adherence to ethical considerations. Results The results showed that 70.9% of the nurses were males, 65.3% held a bachelor's degree in nursing, 46.9% had 1-5 years of experience, and 60.7% had received previous courses on ECG interpretation. The mean competency level of the ER nurses was satisfactory at 60.714%, but 38.8% had a poor level of competency. This was significantly higher among nurses with higher educational levels (p-value < 0.001), those who had taken previous ECG courses (p-value = 0.045) and life support (p-value < 0.05), and those who were exposed to more ECG interpretations per day (p-value = 0.001). Conclusion There is a need to focus more on ECG competency levels in Palestinian literature and compare them between different departments. It is also essential to evaluate nurses' needs for continuous education.
Collapse
Affiliation(s)
| | - Basma Salameh
- Faculty of Nursing, Arab American University-Palestine, Jenin, Palestine
| | - Ahmad Ayed
- Faculty of Nursing, Arab American University-Palestine, Jenin, Palestine
| | - Lobna Harazni
- Faculty of Nursing, Arab American University-Palestine, Jenin, Palestine
| | - Imad Fashafsheh
- Faculty of Nursing, Arab American University-Palestine, Jenin, Palestine
| | - Kefah Zaben
- Department of Nursing, Alquds University, Jerusalem, Palestine
| |
Collapse
|
6
|
Buluba SE, He J, Li H. ICU nurses' knowledge and attitude towards electrocardiogram interpretation in Fujian province, China: a cross-sectional study. Front Med (Lausanne) 2023; 10:1260312. [PMID: 37840997 PMCID: PMC10568621 DOI: 10.3389/fmed.2023.1260312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction The series of electrocardiograms (ECGs) can help track cardiac abnormalities in patients' conditions and make an earlier clinical decision. It is crucial for nurses working in critical care environments to acquire ECG knowledge for effective ECG monitoring and act accordingly in case of a change in patient condition. This study aimed at investigating intensive care unit (ICU) nurses' knowledge and attitude towards ECG interpretation in Fujian province, China. The study also analyzed the relationship between participants' demographic characteristics and level of ECG knowledge. Methods This study was done online at twenty-one hospitals in Fujian province using a quantitative cross-sectional design involving 357 registered nurses working in the ICU between October and December 2021. The selection of hospitals and potential participants involved purposive and convenient sampling methods, respectively. Binary logistic regression was carried out to determine factors that predict ICU nurses' knowledge of ECG interpretation, and a p-value <0.05 was deemed statistically significant. Results The majority of nurses (70.9%) demonstrated a low level of ECG knowledge. The mean score for ECG knowledge was 5.95 (SD = 2.14), with only 0.8% of ICU nurses answering all questions correctly. The majority portrayed positive attitude towards ECG interpretation; however, more than half (61.6%) believed that nurses should rely on a doctor's opinion about ECG interpretation. Previous ECG training (AOR = 3.98, 95% CI: 2.12-7.45); frequency of ECG interpretation in comparison with no frequency of ECG interpretation (1-3 times per day: AOR = 15.55, 95% CI: 6.33-38.18; 1-3 times per week: AOR = 18.10, 95% CI: 6.38-51.34); and current working unit in comparison to those working in cardiac ICU (general ICU: AOR = 0.45, 95% CI: 0.21-0.94; medical ICU; AOR = 0.28, 95% CI: 0.12-0.67; and surgical ICU; AOR = 0.05, 95% CI: 0.01-0.43) remained statistically significant after adjusting for confounders. Conclusion The present study revealed a low level of knowledge about ECG interpretation among ICU nurses. Although the participants demonstrated positive attitudes toward ECG interpretation, the negative attitude still existed. Nurses should acknowledge ECG interpretation as part of their duties and responsibilities in nursing care instead of merely relying on doctors' opinions.
Collapse
Affiliation(s)
- Salome E. Buluba
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Jinyi He
- Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
- School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Hong Li
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| |
Collapse
|
7
|
Zaboli A, Ausserhofer D, Sibilio S, Toccolini E, Paulmichl R, Giudiceandrea A, Bonora A, Pfeifer N, Turcato G. Electrocardiogram interpretation during nurse triage improves the performance of the triage system in patients with cardiovascular symptoms - A prospective observational study. Int Emerg Nurs 2023; 68:101273. [PMID: 36924577 DOI: 10.1016/j.ienj.2023.101273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/13/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND An immediate ECG on arrival of a patient with cardiovascular symptoms in the ED may anticipate the need for life-saving intervention. The aim was to evaluate whether ECG interpretation during nurse triage can improve triage system performance in patients with cardiovascular symptoms. METHODS All patients who required an assessment for cardiovascular symptoms were considered for this observational study. During triage assessment, the nurses assessed the patient's level of urgency applying the MTS, then again after this evaluation (confirming or modifying the level of urgency based on personal clinical experience) and after interpretation of the patient's ECG. The main study outcome was the diagnosis of an acute cardiovascular event. RESULTS Of the 1211 patients in the study, 10.5% presented the main study outcome. ECG interpretation in triage exhibited a nurse-physician agreement of 92.9% (p<0.001). increased patient priority in 7.5% of cases and reduced it in 39.6%. The discriminatory ability of the triage system had an area under the ROC of 0.712and 0.845 after ECG interpretation. ECG interpretation improved the baseline assessment of priority, with an NRI of 60.1% (p<0.001). CONCLUSIONS ECG interpretation in triage can be a simple and safe tool that improves the assessment of patient priority.
Collapse
Affiliation(s)
- Arian Zaboli
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy.
| | - Dietmar Ausserhofer
- College of Health Care Professions Claudiana, Bolzano-Bozen, Italy; Institute of Nursing Science, Department of Public Health, University of Basel, Switzerland
| | - Serena Sibilio
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Elia Toccolini
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Rupert Paulmichl
- Department of Cardiology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | | | - Antonio Bonora
- Emergency Department, University of Verona, Verona, Italy
| | - Norbert Pfeifer
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Gianni Turcato
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| |
Collapse
|
8
|
Sibilio S, Zaboli A, Magnarelli G, Canelles MF, Rella E, Pfeifer N, Brigo F, Turcato G. Can triage nurses accurately interpret the electrocardiogram in the emergency department to predict acute cardiovascular events? A prospective observational study. J Adv Nurs 2023. [PMID: 36811169 DOI: 10.1111/jan.15616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/16/2023] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
AIMS The prompt recording of the electrocardiogram (ECG) and its correct interpretation is crucial to the management of patients who present to the emergency department (ED) with cardiovascular symptoms. Since triage nurses represent the first healthcare professionals evaluating the patient, improving their ability in interpreting the ECG could have a positive impact on clinical management. This real-world study investigates whether triage nurses can accurately interpret the ECG in patients presenting with cardiovascular symptoms. DESIGN Prospective, single-centre observational study conducted in a general ED of General Hospital of Merano in Italy. METHODS For all patients included, the triage nurses and the emergency physicians were asked to independently interpret and classify the ECGs answering to dichotomous questions. We correlated the interpretation of the ECG made by the triage nurses with the occurrence of acute cardiovascular events. The inter-rater agreement in ECG interpretation between physicians and triage nurses was evaluated with Cohen's kappa analysis. RESULTS Four hundred and ninety-one patients were included. The inter-rater agreement between triage nurses and physicians in classifying an ECG as abnormal was good. Patients who developed an acute cardiovascular event were 10.6% (52/491), and in 84.6% (44/52) of them, the nurse accurately classified the ECG as abnormal, with a sensitivity of 84.6% and a specificity of 43.5%. CONCLUSION Triage nurses have a moderate ability in identifying alterations in specific components of the ECG but a good ability in identifying patterns indicative of time-dependent conditions correlated with major acute cardiovascular events. IMPACT FOR NURSING Triage nurses can accurately interpret the ECG in the ED to identify patients at high risk of acute cardiovascular events. REPORTING METHOD The study was reported according to the STROBE guidelines. NO PATIENT OR PUBLIC CONTRIBUTION The study did not involve any patients during its conduction.
Collapse
Affiliation(s)
- Serena Sibilio
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano, Italy
| | - Arian Zaboli
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano, Italy
| | | | | | - Eleonora Rella
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano, Italy
| | - Norbert Pfeifer
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy
| | - Gianni Turcato
- Intermediate Care Unit, Department of Internal Medicine, Hospital Alto Vicentino, Santorso, Italy
| |
Collapse
|
9
|
Zaboli A, Sibilio S, Brigo F, Magnarelli G, Fanni Canelles M, Paulmichl R, Pfeifer N, Turcato G. The triage Nurse's ability in electrocardiogram interpretation in real clinical practice. J Clin Nurs 2023. [PMID: 36658683 DOI: 10.1111/jocn.16624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/28/2022] [Accepted: 12/31/2022] [Indexed: 01/21/2023]
Abstract
AIMS AND OBJECTIVE The study aimed to assess the triage nurse's skill in the recognition of abnormal electrocardiogram during actual clinical practice and to identify nurse- and patient-related factors associated with errors in electrocardiogram interpretation. BACKGROUND The nurse's ability to interpret the electrocardiogram has only been evaluated in simulation settings and has reported conflicting results. DESIGN A prospective single-centre observational study. METHODS During the evaluation of a patient with a cardiovascular symptom, the triage nurses were asked to define whether the 12-lead electrocardiogram performed during the triage evaluation was pathological or non-pathological for the presenting symptom. Patient characteristics and some nurse-related variables were recorded. Inter-rater agreement between the physician and nurse in the electrocardiogram interpretation was considered the primary outcome, while the association of a major acute cardiovascular event related to patient access in the Emergency Department was the secondary outcome. We have followed the STROBE checklist for the preparation of this manuscript. RESULTS Twenty nurses agreed to participate to the study and collect data. Of the 644 patients enrolled, 21.6% (139/644) reported a pathological electrocardiogram according to the ED Physician. The concordance between nurse and physician was modest with Cohen's Kappa of 0.666. An error in the electrocardiogram interpretation was present in 11% of the patients. Nurses who performed an electrocardiogram course within 1 year and studied electrocardiogram interpretation autonomously presented a lower error rate, while older patients and patients with more previous cardiovascular disease were found to be more associated with an error in electrocardiogram interpretation. CONCLUSIONS The study demonstrates that triage nurses have a fair ability to interpret the electrocardiogram. RELEVANCE TO CLINICAL PRACTICE Specific educational programmes for electrocardiogram interpretation could improve the skill of electrocardiogram interpretation by the nurse and enable this instrument to become an indispensable tool in triage assessment.
Collapse
Affiliation(s)
- Arian Zaboli
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Serena Sibilio
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | | | | | - Rupert Paulmichl
- Department of Cardiology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Norbert Pfeifer
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino, Santorso, Italy
| |
Collapse
|
10
|
Rakab A, Swed S, Alibrahim H, Bohsas H, Abouainain Y, Abbas KS, Khair Eldien Jabban Y, Sawaf B, Rageh B, Alkhawaldeh M, Al-Fayyadh I, Rakab MS, Fathey S, Hafez W, Gerbil A, El-Shafei EHH. Assessment of the competence in electrocardiographic interpretation among Arabic resident doctors at the emergency medicine and internal medicine departments: A multi-center online cross-sectional study. Front Med (Lausanne) 2023; 10:1140806. [PMID: 37168264 PMCID: PMC10165895 DOI: 10.3389/fmed.2023.1140806] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/24/2023] [Indexed: 05/13/2023] Open
Abstract
Background This study aims to assess the electrocardiographic interpretation abilities of resident doctors at internal medicine and emergency medicine departments in eight Arabic countries. Methods An online cross-sectional study was conducted between October 7, 2022 and October 21, 2022 in eight Arabic countries. The questionnaire consisted of two main sections: the first section included sociodemographic information, while the second section contained 12 clinical case questions of the most severe cardiac abnormalities with their electrocardiography (ECG) recordings. Results Out of 2,509 responses, 630 were eligible for the data analysis. More than half of the participants were males (52.4%). Internal medicine residents were (n = 530, 84.1%), whereas emergency medicine residents were (n = 100, 15.9%). Almost participants were in their first or second years of residency (79.8%). Only 36.2% of the inquired resident doctors had attended an ECG course. Most participants, 85.6%, recognized the ECG wave order correctly, and 50.5% of the participants scored above 7.5/10 on the ECG interpretation scale. The proportions of participants who were properly diagnosed with atrial fibrillation, third-degree heart block, and atrial tachycardia were 71.1, 76.7, and 56.6%, respectively. No statistically significant difference was defined between the internal and emergency medicine residents regarding their knowledge of ECG interpretation (p value = 0.42). However, there was a significant correlation between ECG interpretation and medical residency year (p value < 0.001); the fourth-year resident doctors had the highest scores (mean = 9.24, SD = 1.6). As well, participants in the third and second years of postgraduate medical residency have a probability of adequate knowledge of ECG interpretation more than participants in the first year of residency (OR = 2.1, p value = 0.001) and (OR = 1.88, p value = 0.002), respectively. Conclusion According to our research findings, resident doctors in departments of internal medicine and emergency medicine in Arabic nations have adequate ECG interpretation abilities; nevertheless, additional development is required to avoid misconceptions about critical cardiac conditions.
Collapse
Affiliation(s)
- Amine Rakab
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- *Correspondence: Amine Rakab,
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | | | | | | | | | | | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Bushra Rageh
- Faculty of Medicine, Sanaa University, Sanaa, Yemen
| | | | | | | | | | - Wael Hafez
- NMC Royal Hospital, Abu Dhabi, United Arab Emirates
- Medical Research Division, Department of Internal Medicine, The National Research Center, Cairo, Egypt
| | - Amr Gerbil
- NMC Royal Hospital, Abu Dhabi, United Arab Emirates
| | | |
Collapse
|
11
|
Competency in ECG Interpretation and Arrhythmias Management among Critical Care Nurses in Saudi Arabia: A Cross Sectional Study. Healthcare (Basel) 2022; 10:healthcare10122576. [PMID: 36554100 PMCID: PMC9777912 DOI: 10.3390/healthcare10122576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Electrographic interpretation skills are important for healthcare practitioners caring for patients in need of cardiac assessment. Competency in ECG interpretation skills is critical to determine any abnormalities and initiate the appropriate care required. The purpose of the study was to determine the level of competence in electrocardiographic interpretation and knowledge in arrhythmia management of nurses in critical care settings. Methods: A descriptive cross-sectional design was used. A convenience sample of 255 critical care nurses from 4 hospitals in the Al-Madinah Region in Saudi Arabia was used. A questionnaire was designed containing a participant’s characteristics and 10 questions with electrocardiographic strips. A pilot test was carried out to evaluate the validity and reliability of the questionnaire. Descriptive and bivariate analyses were conducted using an independent t-test, one-way ANOVA, or bi-variate correlation tests, as appropriate. A statistical significance of p < 0.05 was assumed. Results: Females comprised 87.5% of the sample, and the mean age of the sample was 32.1 (SD = 5.37) years. The majority of the participants (94.9%) had taken electrocardiographic interpretation training courses. The mean total score of correct answers of all 10 ECG strips was 6.45 (±2.54) for ECG interpretation and 4.76 (±2.52) for arrhythmia management. No significant differences were observed between ECG competency level and nursing experience or previous training. Nurses working in the ICU and CCU scored significantly higher than those working in ED. Conclusions: The electrocardiographic knowledge in ECG interpretation and arrhythmia management of critical care nurses is low. Therefore, improving critical care nurses’ knowledge of ECGs, identification, and management of cardiac arrhythmias is essential.
Collapse
|
12
|
Bdair IA. Electrocardiogram interpretation competency among undergraduate nursing students: A quasi-experimental study. Nurs Forum 2022; 57:1273-1280. [PMID: 35997263 DOI: 10.1111/nuf.12790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/25/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac diseases are highly prevalent. Electrocardiogram (ECG) is a noninvasive, rapid, safe, and low-cost procedure that is commonly used by nurses in clinical settings to diagnose a variety of cardiac arrhythmia. However, there is a limited number of studies that have assessed nursing students' competencies in electrocardiogram interpretation in Saudi Arabia. This study aimed to assess the electrocardiogram interpretation competency among undergraduate nursing students and to evaluate the effectiveness of the electrocardiogram interpretation educational program. METHODS A quasi-experimental pre-post-test design was conducted. A pre-post-test self-administered standardized questionnaire was completed by a convenient sample of 79 nursing students who enrolled in an educational program. Data were analyzed using descriptive and inferential statistics with p < .05 was assumed. The study hypothesized that ECG competency scores of nursing students who are enrolled in an educational program will be higher in post-test than their pre-test scores. RESULTS The vast majority of students (96.2%) expressed their interest to enroll in more ECG training sessions. The study results showed that students' mean ECG interpretation competency was 4.16 (1.88) and 7.43 (2.38) in pre- and post-tests, respectively, with a statistical significance of p < .001. CONCLUSION Overall performance of nursing students was limited. Study results confirm the primary hypothesis that the educational program was effective in improving students' ECG interpretation competencies. More ECG contents and programs should be integrated into nursing curricula and more follow-up studies are recommended. This study highlighted the significance of equipping nursing students with ECG interpretation competencies through education and training to ensure safe practice.
Collapse
Affiliation(s)
- Izzeddin A Bdair
- Department of Nursing, Al-Ghad International Colleges for Applied Medical Sciences, Riyadh, KSA
| |
Collapse
|
13
|
Amini K, Mirzaei A, Hosseini M, Zandian H, Azizpour I, Haghi Y. Assessment of electrocardiogram interpretation competency among healthcare professionals and students of Ardabil University of Medical Sciences: a multidisciplinary study. BMC MEDICAL EDUCATION 2022; 22:448. [PMID: 35681191 PMCID: PMC9179219 DOI: 10.1186/s12909-022-03518-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/03/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND Electrocardiogram (ECG) interpretation is a core clinical skill that helps to rapid diagnosis of potentially life-threatening diseases. Misinterpretation of the electrocardiogram can lead to inappropriate clinical decisions with adverse outcomes. The main aim of this survey was to assess the competency of electrocardiogram interpretation and related factors among healthcare professionals and students of Ardabil University of Medical Sciences. METHODS This descriptive cross-sectional study included 323 staff and students of Ardabil University of Medical Sciences in northwestern Iran. Data were collected randomly from November to January 1400 using the Badell-Coll ECG Interpretation Competency Questionnaire and analyzed using SPSS V.14. Statistical analysis included descriptive statistics, independent t-test, ANOVA, Pearson correlation coefficient and multiple linear regression. RESULTS The results showed that the mean and standard deviation of electrocardiogram interpretation competency of health professional staff and students was 5.13 ± 2.25 (maximum score = 10). The large number of participants wasn't able to identify normal sinus rhythm (n = 251, 77.3%), acute myocardial infarction (n = 206, 63.8%) and pathological Q waves (n = 201, 62.2%). The results of multiple linear regression showed that the variables of education level, self-assessment of electrocardiogram interpretation competence, work experience, and type of hospital were able to predict the competence of ECG interpretation in participants. CONCLUSIONS Our findings showed that the participants' level of electrocardiogram interpretation competency was low. Hence, regular, standard training and education are recommended. Also, managers and educators of the health system should consider the role of positive self-assessment and exposure to ECG interpretation in improving the competence of staff and students to interpret ECG.
Collapse
Affiliation(s)
- Keyvan Amini
- Department of Internal Medicine, School of Medicine. Fatemi Hospital, Ardabil University of Medical, Ardebil, Iran
| | - Alireza Mirzaei
- Students Research Committee, Department of Emergency Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mirtohid Hosseini
- Department of Critical Care Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Guilan, Iran
| | - Hamed Zandian
- Social Determinants of Health Research Center , Ardabil University of Medical Sciences, Ardabil, Iran
| | - Islam Azizpour
- Students Research Committee, Department of Emergency Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Yagoob Haghi
- Faculty of Medicine & Paramedical, Ardabil University of Medical Sciences, Ardabil, Iran
| |
Collapse
|
14
|
Chen Y, Kunst E, Nasrawi D, Massey D, Johnston ANB, Keller K, Fengzhi Lin F. Nurses' competency in electrocardiogram interpretation in acute care settings: A systematic review. J Adv Nurs 2022; 78:1245-1266. [PMID: 34989423 DOI: 10.1111/jan.15147] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/03/2021] [Accepted: 12/18/2021] [Indexed: 12/22/2022]
Abstract
AIMS Identify and synthesize evidence of nurses' competency in electrocardiogram interpretation in acute care settings. DESIGN Systematic mixed studies review. DATA SOURCES Cumulative Index to Nursing and Allied Health Literature, Medline, Scopus and Cochrane were searched in April 2021. REVIEW METHODS Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. A data-based convergent synthesis design using qualitative content analysis was adopted. Quality appraisal was undertaken using validated tools appropriate to study designs of the included papers. RESULTS Forty-three papers were included in this review. Skills and attitudes were not commonly assessed, as most studies referred to 'competency' in the context of nurses' knowledge in electrocardiogram interpretation. Nurses' knowledge levels in this important nursing role varied notably, which could be partly due to a range of assessment tools being used. Several factors were found to influence nurses' competency in electrocardiogram interpretation across the included studies from individual, professional and organizational perspectives. CONCLUSION The definition of 'competency' was inconsistent, and nurses' competency in electrocardiogram interpretation varied from low to high. Nurses identified a lack of regular training and insufficient exposure in electrocardiogram interpretation. Hence, regular, standard training and education are recommended. Also, more research is needed to develop a standardized and comprehensive electrocardiogram interpretation tool, thereby allowing educators to safely assess nurses' competency. IMPACT This review addressed questions related to nurses' competency in electrocardiogram interpretation. The findings highlight varying competency levels and assessment methods. Nurses reported a lack of knowledge and confidence in interpreting electrocardiograms. There is an urgent need to explore opportunities to promote and maintain nurses' competency in electrocardiogram interpretation.
Collapse
Affiliation(s)
- Yingyan Chen
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Elicia Kunst
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Dima Nasrawi
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Debbie Massey
- School of Health and Human Sciences, Gold Coast Campus, Southern Cross University, Bilinga, Queensland, Australia
| | - Amy N B Johnston
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.,Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Kathryn Keller
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, United States
| | - Frances Fengzhi Lin
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.,Sunshine Coast Health Institute, Birtinya, Queensland, Australia
| |
Collapse
|
15
|
Ko Y, Issenberg SB, Roh YS. Effects of peer learning on nursing students' learning outcomes in electrocardiogram education. NURSE EDUCATION TODAY 2022; 108:105182. [PMID: 34741917 DOI: 10.1016/j.nedt.2021.105182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Nurses should have the ability to interpret electrocardiograms (ECGs) quickly and accurately, but their ECG interpretation skills may be suboptimal. The best evidence for effective teaching methods is lacking. OBJECTIVES This study aimed to compare the effects of peer and self-directed individual learning methods on nursing students' learning flow, interpretation skills, and self-confidence in web-based ECG education. DESIGN This study employed a nonequivalent control group with a pretest-posttest design. SETTINGS This study was conducted at two colleges of nursing in the Republic of Korea. PARTICIPANTS Nursing students were conveniently assigned to either a peer learning group (n = 45) or a self-directed individual learning group (n = 51). METHODS A self-administered questionnaire was used to measure the nursing students' learning flow and self-confidence in ECG rhythm interpretation. ECG interpretation skills were measured using a web-based interpretation skills test. Data were analyzed using a paired t-test and a two-sample t-test. RESULTS Nursing students in both groups showed improved learning flow, interpretation skills, and self-confidence after ECG education compared with before learning. However, there were no significant pretest-posttest differences in learning flow, interpretation skills, or self-confidence between the two groups. CONCLUSIONS Peer learning was as effective as self-directed individual learning in improving nursing students' learning flow, interpretations skills, and self-confidence in web-based education. Nurse educators should educate nursing students to have optimal ECG interpretation abilities, and web-based peer or individual learning are effective education methods.
Collapse
Affiliation(s)
- Youngmin Ko
- Graduate School of Nursing and Health Professions, Chung-Ang University, Seoul, Republic of Korea
| | | | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-gu, Seoul 06974, Republic of Korea.
| |
Collapse
|
16
|
Rahimpour M, Shahbazi S, Ghafourifard M, Gilani N, Breen C. Electrocardiogram interpretation competency among emergency nurses and emergency medical service (EMS) personnel: A cross-sectional and comparative descriptive study. Nurs Open 2021; 8:1712-1719. [PMID: 33611852 PMCID: PMC8186699 DOI: 10.1002/nop2.809] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/24/2020] [Accepted: 01/31/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS The aim of this research study was to compare electrocardiogram (ECG) interpretation competency among emergency nurses and EMS personnel. DESIGN A cross-sectional comparative descriptive study design was used. METHODS This study recruited 170 participants (105 emergency nurses and 65 EMS personnel) in northwest of Iran. Data were collected during 2018 using ECG, an interpretation competency questionnaire and analysed using SPSS V.24 through independent t test, linear regression, Pearson and Spearman correlation coefficient. A statistical significance of p < .05 was assumed. RESULTS The study results showed a mean score of 6.65 ± 2.16 out of 10 for emergency nurses' and 4.87 ± 1.81 for EMS personnel ECG interpretation competency (p < .05). CONCLUSIONS Hospital emergency nurses were more qualified to interpret the ECG than the pre-hospital emergency medical personnel (p = .792 and β (SE)) = 0.22 (0.84). Active involvement in ECG interpretation and standard continued education are needed to develop and improve the emergency nurses and EMS personnel ECG interpretation competency.
Collapse
Affiliation(s)
- Maryam Rahimpour
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Shahbazi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery and Clinical Research Development Unit, Sina Educational, Research and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mansour Ghafourifard
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Cathal Breen
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Ulster, UK
| |
Collapse
|