The effectiveness of an education program on nurses’ knowledge of electrocardiogram interpretation

Practice and confidence in electrocardiogram interpretation among ICU nurses: A cross-sectional study

OBJECTIVES

This study aimed to determine practice and confidence in electrocardiogram (ECG) interpretation among intensive care unit (ICU) nurses in Fujian Province, China, and identify predictors of ECG interpretation practice.

RESEARCH METHODOLOGY/DESIGN

A quantitative cross-sectional study was conducted between October 2021 and December 2021 among 357 respondents.

SETTING

Conducted online at twenty-one hospitals in all nine cities of Fujian Province.

MAIN OUTCOME MEASURES

Purposive and convenient sampling techniques were employed in selecting hospitals and respondents, respectively. A validated and pre-tested Chinese version of the questionnaire was used in data collection. We conducted binary logistic regression to identify the predictors of ICU nurses' ECG interpretation practice, and linear regression to analyze the relationship between ECG interpretation practice and confidence. We considered statistically significant a p-value < 0.05.

RESULTS

The practice mean score of the respondents was 5.54 (SD = 2.26) out of 10 points, and only 2.2 % of nurses correctly interpreted all the patient ECG strips. Few ICU nurses (25.5 %) had good ECG interpretation practice, with a confidence mean score of 2.02 (SD = 0.99) out of 4 points in their overall ability to interpret patient ECG strips. Currently working unit in comparison to cardiac ICU (emergency ICU: AOR = 5.71, 95 % CI: 1.84-17.75); previous ECG training (AOR = 2.02, 95 % CI: 1.10-3.70); source of ECG training (university/school) (AOR = 2.02, 95 % CI: 1.12-3.65); and ECG knowledge (AOR = 16.18, 95 % CI: 7.43-35.25) were significantly associated with the ECG interpretation practice.

CONCLUSIONS

ICU nurses' ECG interpretation practice in the current study was relatively poor. An ECG education program is recommended to impart ICU nurses with basic ECG knowledge for enhancing good ECG interpretation practice and confidence in nursing care provision.

IMPLICATIONS FOR CLINICAL PRACTICE

Good ECG interpretation skills are paramount among ICU nurses for better patient outcomes. ECG knowledge among ICU nurses is an important predictor of effective ECG monitoring for cardiac arrhythmias. Therefore, frequent, continuouszgood practice and boost confidence in the provision of quality nursing care.

Registered nurses' knowledge and interpretation of ECG rhythms: A cross-sectional study

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.

Electrocardiogram (EKG) knowledge and interpretation proficiency among healthcare professionals in Pakistan: a prospective cross-sectional study

Background

Electrocardiogram (EKG) is a commonly used diagnostic tool for the evaluation of the electrical activity of the heart. The purpose of this study was to assess the knowledge and interpretation proficiency of EKG among healthcare professionals (HCPs) in Pakistan.

Methods

This prospective cross-sectional study was conducted among HCPs working in different healthcare settings. A structured questionnaire was used to assess the participants' theoretical knowledge and ability to interpret EKG findings. The data were analyzed using descriptive statistics and χ2 tests. The study indicates that EKG knowledge and interpretation proficiency among HCPs in Pakistan is unsatisfactory. The inadequacy of training periods of EKG training sessions and insufficient participation of HCPs in offered training opportunities put forward the need for the formation and introduction of better structured and efficient EKG training programmes.

Results

A total of 511 HCPs participated in the study, 28% of whom reportedly had received formal training for EKG interpretation. About 80% of the participants correctly identified theoretical questions pertaining to EKG, while 58% of the participants were able to accurately interpret EKG findings, and most HCPs (69.9%) read fewer than ten EKGs per week.

Conclusion

This study demonstrates a lack of expertise and a poor understanding of EKG in HCPs of Pakistan. The low level of EKG knowledge and interpretation proficiency among HCPs may lead to diagnostic errors and poor patient outcomes. Therefore, efforts should be made to improve EKG education and training among HCPs in Pakistan.

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

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.

Advancing arrhythmia education through the CDIO approach: a new paradigm in nursing student training

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.

EDUCATE: An international, randomized controlled trial for teaching electrocardiography

INTRODUCTION

Despite the critical role of electrocardiograms (ECGs) in patient care, evident gaps exist in ECG interpretation competency among healthcare professionals across various medical disciplines and training levels. Currently, no practical, evidence-based, and easily accessible ECG learning solution is available for healthcare professionals. The aim of this study was to assess the effectiveness of web-based, learner-directed interventions in improving ECG interpretation skills in a diverse group of healthcare professionals.

METHODS

In an international, prospective, randomized controlled trial, 1206 healthcare professionals from various disciplines and training levels were enrolled. They underwent a pre-intervention test featuring 30 12-lead ECGs with common urgent and non-urgent findings. Participants were randomly assigned to four groups: (i) practice ECG interpretation question bank (question bank), (ii) lecture-based learning resource (lectures), (iii) hybrid question- and lecture-based learning resource (hybrid), or (iv) no ECG learning resources (control). After four months, a post-intervention test was administered. The primary outcome was the overall change in ECG interpretation performance, with secondary outcomes including changes in interpretation time, self-reported confidence, and accuracy for specific ECG findings. Both unadjusted and adjusted scores were used for performance assessment.

RESULTS

Among 1206 participants, 863 (72 %) completed the trial. Following the intervention, the question bank, lectures, and hybrid intervention groups each exhibited significant improvements, with average unadjusted score increases of 11.4 % (95 % CI, 9.1 to 13.7; P<0.01), 9.8 % (95 % CI, 7.8 to 11.9; P<0.01), and 11.0 % (95 % CI, 9.2 to 12.9; P<0.01), respectively. In contrast, the control group demonstrated a non-significant improvement of 0.8 % (95 % CI, -1.2 to 2.8; P=0.54). While no differences were observed among intervention groups, all outperformed the control group significantly (P<0.01). Intervention groups also excelled in adjusted scores, confidence, and proficiency for specific ECG findings.

CONCLUSION

Web-based, self-directed interventions markedly enhanced ECG interpretation skills across a diverse range of healthcare professionals, providing an accessible and evidence-based solution.

ICU nurses' knowledge and attitude towards electrocardiogram interpretation in Fujian province, China: a cross-sectional study

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.

Effect of a blended learning design in an undergraduate nursing electrocardiogram course: A quasi-experimental study

AIM

The study aimed to explore learning achievement and students' satisfaction with a blended learning (BL) electrocardiogram (ECG) education programme in undergraduate nursing education.

DESIGN

This was a quasi-experimental post-test design.

METHODS

The study was conducted during semester one of the academic year 2020/2021. Participants were divided into two groups: the BL group and face-to-face (FTF) group. The BL group received the newly designed BL programme. The FTF group received the traditional learning methods. Post-test measures of the study variables such as knowledge, study time and satisfaction were conducted. Chi-square (χ² ) test was used to evaluate categorical variables. The Mann-Whitney test was used to analyse continuous variables.

RESULTS

Participants in BL group had significantly higher scores in ECG interpretation and total score. No significant differences in foundational knowledge between the two groups were found. Study time was significantly longer in the BL group. Regarding satisfaction, significant differences were found in structure rationality and promotion of self-learning.

Electrocardiogram interpretation during nurse triage improves the performance of the triage system in patients with cardiovascular symptoms - A prospective observational study

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.

The triage Nurse's ability in electrocardiogram interpretation in real clinical practice

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.

Competency in ECG Interpretation and Arrhythmias Management among Critical Care Nurses in Saudi Arabia: A Cross Sectional Study

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.

Effect of Digital Learning With an Interactive eBook on Electrocardiogram Interpretation Among Clinical Nurses: A Repeated-Measures Analysis

In digital learning, the use of an interactive eBook is perceived as helpful for students. However, the effect of interactive eBooks on learning among clinical nurses has not been explored yet. This study used an interactive electrocardiogram eBook to explore the effect of digital learning on the promotion of electrocardiogram interpretation competence, confidence, knowledge retention, and learning satisfaction among clinical nurses. A single-group quasi-experimental study with three repeated measures was conducted. A total of 80 nurses from the emergency room, critical units, and medical-surgical units completed the measures. The results showed that digital learning is an effective method that significantly improved nurses' electrocardiogram competence, learning retention, confidence, and learning satisfaction. Most nurses were satisfied with the convenience and content design of this eBook. Few nurses reported drawbacks regarding loading speed and individual learning habits. It is recommended that more preset learning exercise questions should be created for trial and error so that nurses can have repeated practice for self-assessment. Specific feedback mechanisms should be established to promote motivation for digital self-learning.

Nurses' competency in electrocardiogram interpretation in acute care settings: A systematic review

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.

Effects of peer learning on nursing students' learning outcomes in electrocardiogram education

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.

The effectiveness of short text messages on nurses' arrhythmia interpretation skills

BACKGROUND

Intensive care nurses play an important role in the management of critically ill patients including identification of cardiac arrhythmias. Interventions to improve arrhythmia identification can be expensive, time-consuming, and are not always successful.

AIMS

This study aimed to explore the effectiveness of using short message service (SMS) messaging to improve intensive care nurses' cardiac arrhythmia interpretation skills.

DESIGN

This study was a prospective, two-group, assessor-blinded, randomized controlled trial with a pretest-posttest experimental design.

METHODS

The study was conducted from February 2020 to February 2021 for the intervention as well as the control group, in a teaching hospital in northwest Turkey. The intervention group was sent the one-way SMS messages on cardiac arrhythmias via WhatsApp during an 8-week period, whereas the control group did not receive any intervention. The Cardiac arrhythmias assessment questionnaire (CAAQ) was used to measure outcomes. The data were analysed using ANCOVA and an independent t-test.

RESULTS

A total of 66 intensive care nurses were randomly assigned to either the intervention or the control group. The ANCOVA analysis indicated that ICU nurses who received SMS messages about cardiac arrhythmias two times a week had significantly increased CAAQ scores (P < 0.001) with a large effect size (partial eta-squared = 0.588).

CONCLUSION

This study concluded that using SMS messages as a training tool has a positive influence on cardiac arrhythmias interpretation skills among ICU nurses.

RELEVANCE TO CLINICAL PRACTICE

Using SMS messages could be an alternative, effective, and innovative approach to improve nurses' clinical practice skills.

Effects of an Electrocardiography Training Program: Team-Based Learning for Early-Stage Intensive Care Unit Nurses

BACKGROUND

Team-based learning (TBL) can be one way of improving professional and practical skills for nurses. This study explored the effectiveness of an electrocardiography training program using TBL for early-stage nurses in intensive care units.

METHOD

This study used a pretest-posttest nonequivalent control group. A total of 65 participants were enrolled in the study (36 in the experimental group and 29 in the control group). Participants in the experimental group were trained with TBL, and participants in the control group had lecture-based learning on electrocardiography education.

RESULTS

There was no statistically significant difference between the team-based and lecture-based learning groups after the training in participants' knowledge of electrocardiography and reading ability of bedside (lead II rhythm) electrocardiography monitoring (p > .05). However, there was a statistically significant difference between the two groups in the reading ability of the 12-lead electrocardiography (p < .001).

CONCLUSION

TBL was more effective in improving nurses' reading ability of the 12-lead electrocardiography. [J Contin Educ Nurs. 2020;51(4):174-180.].

Electrocardiogram interpretation competency among emergency nurses and emergency medical service (EMS) personnel: A cross-sectional and comparative descriptive study

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.

Capability of emergency nurses for electrocardiogram interpretation

INTRODUCTION

Electrocardiogram is the first-line diagnostic imaging modality for evaluating patients with chest pain. The present study aimed to determine the capability of emergency nurses for electrocardiogram interpretation by using a more appropriate questioning method.

METHODS

This was a cross-sectional descriptive survey. A convenience sample of 96 emergency nurses was obtained from two emergency departments in Hong Kong. The electrocardiogram-interpretation capability of the emergency nurses was determined using a self-developed well-designed questionnaire comprising 10 questions on electrocardiogram interpretation. Each question carried one point, such that the maximum score was 10 points. The higher the score, the more capable was the emergency nurse at electrocardiogram interpretation.

RESULTS

The mean score achieved by the participants was 7.7 ± 1.8. Only 12.5% of the participants were able to answer all questions correctly. A considerable proportion of the participants were unable to recognize first-degree heart block (74.0%), second-degree heart block type I (52.1%), or third-degree heart block (39.6%). Gender, electrocardiogram training, nursing experience, and emergency department experience had significant associations with mean score.

CONCLUSIONS

The electrocardiogram-interpretation capability of the emergency nurses was fair. Better training should be implemented to help emergency nurses recognize potentially fatal heart blocks, enabling prompt and appropriate patient treatment.

Effectiveness of the CRISP Method on the Primary Cardiac Arrhythmia Interpretation Accuracy of Nurses

BACKGROUND

Accurate electrocardiogram (ECG) interpretation is key to quickly providing attention to patients, and the first health staff who evaluate ECGs are nurses.

METHOD

This was a prospective study with a pre-posttest design. The study test included 15 ECGs related to primary cardiac arrhythmias. After pretest nurses were instructed on arrhythmia interpretation using the Cardiac Rhythm Identification for Simple People (CRISP) method, posttests were completed.

RESULTS

There was a significant difference between the pretest scores of nurses who had postgraduate education on ECG interpretation and who did not (p = .002). Median test score increased from 3 (interquartile range [IQR] = 2-5) to 7 (IQR = 5-9) (p < .001). Participants mostly missed questions about heart blocks and were most successful with questions about fatal arrhythmias after education.

CONCLUSION

The CRISP method is an effective, simple, and easy method for accurate ECG interpretation by nurses. The posttest scores of the participants, especially accurate interpretation of fatal arrhythmias, increased significantly after training. [J Contin Educ Nurs. 2020;51(12):574-580.].

Conditions-Based Learning Theory as a Framework for Comparative-Effectiveness Reviews: A Worked Example

Phenomenon: An evidence-informed era of medical education encourages the generation and use of comparative-effectiveness reviews, yet the reviews often conclude, curiously, that all instructional approaches are equally effective. Approach: We used a conditions-based learning theory to structure a review of the comparative-effectiveness literature on electrocardiogram instruction. We searched MEDLINE, EMBASE (Ovid), ERIC (Ovid), PsycINFO (Ovid), and CINAHL (EBSCO) from inception to June 2016. We selected prospective studies that examined the effect of instructional interventions on participants' knowledge and skill with electrocardiogram interpretation. Two reviewers extracted information on the quality of the studies, the effect of instruction on the acquisition of knowledge and skill, and instructional quality. Instructional quality is an index of the extent to which instruction incorporates 4 practices of Gagne's conditions-based learning theory: presenting information, eliciting performance, providing feedback, and assessing learning. Findings: Twenty-five studies (3,286 participants) evaluating 47 instructional interventions were synthesized. The methodological quality of most studies was moderate. Instructional quality varied: All interventions presented information and assessed learning, but fewer than half elicited performances or provided feedback. Instructional interventions that incorporated all 4 components improved trainees' abilities considerably more than those that incorporated 3 or fewer; respectively, standardized mean difference (SMD) = 2.80, 95% confidence interval (CI) [2.05, 3.55], versus SMD = 1.44, 95% CI [1.18, 1.69]. Studies that compared "innovative" to "traditional" types of instruction did not yield a significant pooled effect: SMD = 0.18, 95% CI [-0.09, 0.45]. Insights: The use of a conditions-based learning theory to organize the comparative-effectiveness literature reveals differences in the instructional impact of different instructional approaches. It overturns the unlikely, but common, conclusion that all approaches are equally effective.

Electrocardiograms: a guide to rhythm recognition for emergency nurses

Electrocardiogram (ECG) is one of the most commonly performed investigations in emergency departments (EDs), and is an extremely useful adjunct that guides diagnosis, prognosis and treatment. In most cases nurses are the first healthcare professional to assess patients and record an ECG, yet anecdotal evidence suggests that few emergency nurses review, interpret and act on ECG findings. Research suggests this may be due to lack of confidence in, or knowledge about, interpretation of results, often because of inadequate training. This article aims to help emergency nurses understand and interpret the cardiac rhythms commonly encountered on ECGs in EDs, to enable them to support earlier diagnosis and treatment. It describes a simple, five-step method for evaluating the main components of cardiac rhythm.

Educational Software Applied in Teaching Electrocardiogram: A Systematic Review

Background

The electrocardiogram (ECG) is the most used diagnostic tool in medicine; in this sense, it is essential that medical undergraduates learn how to interpret it correctly while they are still on training. Naturally, they go through classic learning (e.g., lectures and speeches). However, they are not often efficiently trained in analyzing ECG results. In this regard, methodologies such as other educational support tools in medical practice, such as educational software, should be considered a valuable approach for medical training purposes.

Methods

We performed a literature review in six electronic databases, considering studies published before April 2017. The resulting set comprises 2,467 studies. From this collection, 12 studies have been selected, initially, whereby we carried out a snowballing process to identify other relevant studies through the reference lists of these studies, resulting in five relevant studies, making up a total of 17 articles that passed all stages and criteria.

Results

The results show that 52.9% of software types were tutorial and 58.8% were designed to be run locally on a computer. The subjects were discussed together with a greater focus on the teaching of electrophysiology and/or cardiac physiology, identifying patterns of ECG and/or arrhythmias.

Conclusions

We found positive results with the introduction of educational software for ECG teaching. However, there is a clear need for using higher quality research methodologies and the inclusion of appropriate controls, in order to obtain more precise conclusions about how beneficial the inclusion of such tools can be for the practices of ECG interpretation.

Emergency Nurse Competence in Electrocardiographic Interpretation in Spain: A Cross-Sectional Study

INTRODUCTION

Electrocardiographic interpretation skills are key to provide a fast attention to patients with thoracic pain. The aim of the study was to determine the current level of competence in electrocardiographic interpretation of nurses in emergency departments.

METHODS

Cross-sectional, multicenter study via an ad hoc questionnaire. Subjects were nurses from three Spanish emergency departments with at least a year experience in this area. A two-part questionnaire was created consisting of a professional profile, and 12 questions (2 theoretical questions and 10 questions on practical cases with electrocardiographic register [readout]). A pilot test was carried out to evaluate the validity of the questionnaire, the content validity index. The reliability of the questionnaire was also tested on a subsample through intraclass correlation coefficient with a value of 0.869 (CI 95% 0.712-0.941). Descriptive and bivariate analyses were conducted using an independent t-test or one-way ANOVA as appropriate. A statistical significance of P < .05 was assumed.

RESULTS

Fifty-seven usable questionnaires were obtained (47.2% response rate). Women comprised 84.2% of the sample and the mean age of the sample was 40.5 (SD = 9.3) years. Slightly more than 91% had taken electrocardiographic interpretation training courses, the main modality for which was face-to-face (84.2%). The average score on our questionnaire was 8.6 (SD=1.1) points. No significant differences between nursing experience and hospitals were observed. Nurses who had received training within the previous five years scored significantly higher than those who had not (P = .031).

DISCUSSION

The electrocardiographic knowledge of emergency nurses is high. Level of knowledge was not influenced by experience or hospital but was influenced by training when provided in the previous 5 years. Therefore, refreshing courses should be taken at least every 5 years. Contribution to Emergency Nursing Practice.

What We Do and Do Not Know about Teaching Medical Image Interpretation

Educators in medical image interpretation have difficulty finding scientific evidence as to how they should design their instruction. We review and comment on 81 papers that investigated instructional design in medical image interpretation. We distinguish between studies that evaluated complete offline courses and curricula, studies that evaluated e-learning modules, and studies that evaluated specific educational interventions. Twenty-three percent of all studies evaluated the implementation of complete courses or curricula, and 44% of the studies evaluated the implementation of e-learning modules. We argue that these studies have encouraging results but provide little information for educators: too many differences exist between conditions to unambiguously attribute the learning effects to specific instructional techniques. Moreover, concepts are not uniformly defined and methodological weaknesses further limit the usefulness of evidence provided by these studies. Thirty-two percent of the studies evaluated a specific interventional technique. We discuss three theoretical frameworks that informed these studies: diagnostic reasoning, cognitive schemas and study strategies. Research on diagnostic reasoning suggests teaching students to start with non-analytic reasoning and subsequently applying analytic reasoning, but little is known on how to train non-analytic reasoning. Research on cognitive schemas investigated activities that help the development of appropriate cognitive schemas. Finally, research on study strategies supports the effectiveness of practice testing, but more study strategies could be applicable to learning medical image interpretation. Our commentary highlights the value of evaluating specific instructional techniques, but further evidence is required to optimally inform educators in medical image interpretation.

Screening for Atrial Fibrillation--A Cross-Sectional Survey of Healthcare Professionals in Primary Care

Introduction

Screening for atrial fibrillation (AF) in primary care has been recommended; however, the views of healthcare professionals (HCPs) are not known. This study aimed to determine the opinions of HCP about the feasibility of implementing screening within a primary care setting.

Methods

A cross-sectional mixed methods census survey of 418 HCPs from 59 inner-city practices (Nottingham, UK) was conducted between October-December 2014. Postal and web-surveys ascertained data on existing methods, knowledge, skills, attitudes, barriers and facilitators to AF screening using Likert scale and open-ended questions. Responses, categorized according to HCP group, were summarized using proportions, adjusting for clustering by practice, with 95% C.Is and free-text responses using thematic analysis.

Results

At least one General Practitioner (GP) responded from 48 (81%) practices. There were 212/418 (51%) respondents; 118/229 GPs, 67/129 nurses [50 practice nurses; 17 Nurse Practitioners (NPs)], 27/60 healthcare assistants (HCAs). 39/48 (81%) practices had an ECG machine and diagnosed AF in-house. Non-GP HCPs reported having less knowledge about ECG interpretation, diagnosing and treating AF than GPs. A greater proportion of non-GP HCPs reported they would benefit from ECG training specifically for AF diagnosis than GPs [proportion (95% CI) GPs: 11.9% (6.8–20.0); HCAs: 37.0% (21.7–55.5); nurses: 44.0% (30.0–59.0); NPs 41.2% (21.9–63.7)]. Barriers included time, workload and capacity to undertake screening activities, although training to diagnose and manage AF was a required facilitator.

Conclusion

Inner-city general practices were found to have adequate access to resources for AF screening. There is enthusiasm by non-GP HCPs to up-skill in the diagnosis and management of AF and they may have a role in future AF screening. However, organisational barriers, such as lack of time, staff and capacity, should be overcome for AF screening to be feasibly implemented within primary care.

Effects of web-based electrocardiography simulation on strategies and learning styles

OBJECTIVETo identify the association between the use of web simulation electrocardiography and the learning approaches, strategies and styles of nursing degree students.METHODA descriptive and correlational design with a one-group pretest-posttest measurement was used. The study sample included 246 students in a Basic and Advanced Cardiac Life Support nursing class of nursing degree.RESULTSNo significant differences between genders were found in any dimension of learning styles and approaches to learning. After the introduction of web simulation electrocardiography, significant differences were found in some item scores of learning styles: theorist (p < 0.040), pragmatic (p < 0.010) and approaches to learning.CONCLUSIONThe use of a web electrocardiogram (ECG) simulation is associated with the development of active and reflexive learning styles, improving motivation and a deep approach in nursing students.