Cardiac Rhythm Monitoring: Competency, Accuracy, and Meaningful Use

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.

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.

Cardiac monitoring: Hospital-wide education and staff competence

BACKGROUND

The numbers of patients in acute care hospitals who require cardiac monitoring are increasing. Unpredictable fluctuations in patient flow may result in shortages of telemetry beds for patients who need this level of care.

OBJECTIVE

The aims of this study were to design and implement cardiac monitoring education for all medical-surgical nursing staff in a level I trauma center.

METHODS

This is a descriptive, quantitative performance improvement study. A multidisciplinary implementation plan was developed with biomedical engineering and physical facilities coordinating structural changes and nursing coordinating education and clinical competency. The nursing educational plans included a dysrhythmia course and testing, a clinically based competency, and a statistical analysis of the dysrhythmia test. The impact of this project was evaluated looking at areas transitioned, telemetry beds available, cardiac dysrhythmia education workshops, and dysrhythmia test results.

RESULTS

The implementation of cardiac monitoring was completed over 2 years. Monitored medical-surgical beds increased from 132 to 282 beds. The nursing education expanded hospital-wide to clinical areas requesting standardization of nursing practice.

CONCLUSIONS

In addition to expanding the number of monitored beds and decompression of critical care beds, benefits included increased level of staff competence, standardization of cardiac monitoring practices throughout the facility, and validation of the cardiac dysrhythmia test.