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Carolina B de S Giusti A, Estevam Cornélio M, Machado de Oliveira E, Giguère JF, Cecília B J Gallani M. Standard practices in cardiac monitoring: training needs of intensive care unit nurses. BMC Nurs 2024; 23:82. [PMID: 38297281 PMCID: PMC10832196 DOI: 10.1186/s12912-024-01742-1] [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: 02/16/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Enforcing practice standards for cardiac monitoring in intensive care units (ICUs) has been shown to reduce misdiagnoses and inappropriate interventions. Continuous professional development (CPD) programs are committed to aligning clinical practices with recommended standards. The crucial initial phase in CPD development involves assessing the training needs of the targeted population. OBJECTIVE To assess the training needs of ICU nurses in cardiac monitoring. The overarching goal was to formulate a focused Continuous Professional Development (CPD) program geared towards implementing standard practices in cardiac monitoring. METHODS This study employed a generic qualitative approach with a descriptive design, utilizing interviews and focus groups from July to September 2018. Involving 16 ICU nurses. Content analysis was employed, encompassing transcription, fluctuant and iterative reading, unitization, categorization, coding, description, and interpretation. RESULTS All nurses recognized cardiac monitoring's importance in the ICU but reported barriers to its effective implementation which were related to factors that could addressed by a CPD as insufficient knowledge and skills. Training needs were identified in both clinical and technical aspects, with recommendations for practical and theoretical activities and e-learning strategies. Barriers related to organizational aspects (equipment and communication within the healthcare team) were also mentioned. CONCLUSION ICU nurses presented clear and specific training needs related to cardiac monitoring as knowledge, skills, and competencies. Other organizational aspects were also reported as barriers. Addressing these learning needs through targeted CPD aligned with organizational initiatives can contribute to enhancing the quality of cardiac monitoring practices in ICUs.
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Grants
- 2881/19 Fundo de Apoio ao Ensino, à Pesquisa e Extensão, Universidade Estadual de Campinas
- 2881/19 Fundo de Apoio ao Ensino, à Pesquisa e Extensão, Universidade Estadual de Campinas
- 2881/19 Fundo de Apoio ao Ensino, à Pesquisa e Extensão, Universidade Estadual de Campinas
- 2881/19 Fundo de Apoio ao Ensino, à Pesquisa e Extensão, Universidade Estadual de Campinas
- 2881/19 Fundo de Apoio ao Ensino, à Pesquisa e Extensão, Universidade Estadual de Campinas
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Ng J, Christensen M. Registered nurses' knowledge and interpretation of ECG rhythms: A cross-sectional study. Nurs Crit Care 2023. [PMID: 38156358 DOI: 10.1111/nicc.13013] [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: 08/02/2023] [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.
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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
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Kashou AH, Noseworthy PA, Beckman TJ, Anavekar NS, Cullen MW, Angstman KB, Sandefur BJ, Shapiro BP, Wiley BW, Kates AM, Huneycutt D, Braisted A, Smith SW, Baranchuk A, Grauer K, O'Brien K, Kaul V, Gambhir HS, Knohl SJ, Albert D, Kligfield PD, Macfarlane PW, Drew BJ, May AM. ECG Interpretation Proficiency of Healthcare Professionals. Curr Probl Cardiol 2023; 48:101924. [PMID: 37394202 DOI: 10.1016/j.cpcardiol.2023.101924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
ECG interpretation is essential in modern medicine, yet achieving and maintaining competency can be challenging for healthcare professionals. Quantifying proficiency gaps can inform educational interventions for addressing these challenges. Medical professionals from diverse disciplines and training levels interpreted 30 12-lead ECGs with common urgent and nonurgent findings. Average accuracy (percentage of correctly identified findings), interpretation time per ECG, and self-reported confidence (rated on a scale of 0 [not confident], 1 [somewhat confident], or 2 [confident]) were evaluated. Among the 1206 participants, there were 72 (6%) primary care physicians (PCPs), 146 (12%) cardiology fellows-in-training (FITs), 353 (29%) resident physicians, 182 (15%) medical students, 84 (7%) advanced practice providers (APPs), 120 (10%) nurses, and 249 (21%) allied health professionals (AHPs). Overall, participants achieved an average overall accuracy of 56.4% ± 17.2%, interpretation time of 142 ± 67 seconds, and confidence of 0.83 ± 0.53. Cardiology FITs demonstrated superior performance across all metrics. PCPs had a higher accuracy compared to nurses and APPs (58.1% vs 46.8% and 50.6%; P < 0.01), but a lower accuracy than resident physicians (58.1% vs 59.7%; P < 0.01). AHPs outperformed nurses and APPs in every metric and showed comparable performance to resident physicians and PCPs. Our findings highlight significant gaps in the ECG interpretation proficiency among healthcare professionals.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Brandon W Wiley
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andrew M Kates
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | | | - Stephen W Smith
- Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota
| | | | - Ken Grauer
- University of Florida, Gainesville, Florida
| | | | - Viren Kaul
- SUNY Upstate Medical University, Syracuse, New York
| | | | | | | | - Paul D Kligfield
- New York-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Peter W Macfarlane
- Electrocardiology Core Lab, New Lister Building, Royal Infirmary, Scotland, UK
| | | | - Adam M May
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Dzikowicz DJ, Carey MG. The Use of Interactive Technology to Improve Student Accuracy on Electrocardiographic Interpretation. Nurs Educ Perspect 2022:00024776-990000000-00086. [PMID: 36729816 DOI: 10.1097/01.nep.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Electrocardiography (ECG) instruction relies heavily on memorization of interpretation rules and lacks opportunities for hands-on practice. Consequently, nursing students struggle with ECG interpretation. In an online undergradute nursing course, we implemented interactive technology to facilitate kinesthetic pedagogy. Accuracy was evaluated at midterm and during final assessments by two experts using a standardized rubric. Students who engaged with interactive technology at both assessments demonstrated consistent accuracy of ECG interpretation; students who did not failed to demonstrate consistent accuracy with ECG interpretation. Incorporating interactive technology to facilitate psychomotor learning may be essential in improving the accuracy of ECG interpretation.
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Affiliation(s)
- Dillon J Dzikowicz
- About the Authors Dillon J Dzikowicz, MS, RN, PCCN, is a registered nurse, University of Rochester Medical Center, and faculty, University of Rochester School of Nursing, Rochester, New York, where he is a PhD candidate. Mary G Carey, PhD, RN, FAHA, FAAN, is an associate professor, University of Rochester School of Nursing. For more information, contact Dillon J Dzikowicz at
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Dzikowicz DJ, Carey MG. Implementing interactive technology to teach electrocardiographic interpretation online. J Prof Nurs 2022; 42:148-155. [DOI: 10.1016/j.profnurs.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 11/15/2022]
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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.
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Affiliation(s)
- Izzeddin A Bdair
- Department of Nursing, Al-Ghad International Colleges for Applied Medical Sciences, Riyadh, KSA
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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.
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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
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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.
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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.
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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.
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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
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Importance Ranking of Electrocardiogram Rhythms: A Primer for Curriculum Development. J Emerg Nurs 2021; 47:313-320. [PMID: 33546884 DOI: 10.1016/j.jen.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/05/2020] [Accepted: 11/15/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Electrocardiogram interpretation is an essential skill for emergency and critical care nurses and physicians. There remains a gap in standardized curricula and evaluation strategies used to achieve and assess competence in electrocardiogram interpretation. The purpose of this study was to develop an importance ranking of the 120 American Heart Association electrocardiogram diagnostic labels with interdisciplinary perspectives to inform curriculum development. METHODS Data for this mixed methods study were collected through focus groups and individual semi-structured interviews. A card sort was used to assign relative importance scores to all 120 American Heart Association electrocardiogram diagnostic labels. Thematic analysis was used for qualitative data on participants' rationale for the rankings. RESULTS The 18 participants included 6 emergency and critical care registered nurses, 5 cardiologists, and 7 emergency medicine physicians. The 5 diagnoses chosen as the most important by all disciplines were ventricular tachycardia, ventricular fibrillation, atrial fibrillation, complete heart block, and normal electrocardiogram. The "top 20" diagnoses by each discipline were also reported. Qualitative thematic content analysis revealed that participants from all 3 disciplines identified skill in electrocardiogram interpretation as clinically imperative and acknowledged the importance of recognizing normal, life threatening, and time-sensitive electrocardiogram rhythms. Additional qualitative themes, identified by individual disciplines, were reported. DISCUSSION This mixed-methods approach provided valuable interdisciplinary perspectives concerning electrocardiogram curriculum case selection and prioritization. Study findings can provide a foundation for emergency and critical care educators to create local ECG educational programs. Further work is recommended to validate the list amongst a larger population of emergency and critical care frontline nurses and physicians.
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Çıkrıkçı Isık G, Şafak T, Tandoğan M, Çevik Y. Effectiveness of the CRISP Method on the Primary Cardiac Arrhythmia Interpretation Accuracy of Nurses. J Contin Educ Nurs 2020; 51:574-580. [PMID: 33232505 DOI: 10.3928/00220124-20201113-08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022]
Abstract
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.].
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Schilinski S, Hellier SD, Cline TW. Evaluation of an Electronically Delivered Learning Module Intended for Continuing Education of Practicing Registered Nurses: A Pretest–Posttest Longitudinal Study. J Contin Educ Nurs 2019; 50:331-336. [DOI: 10.3928/00220124-20190612-09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 02/28/2019] [Indexed: 11/20/2022]
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Interactive Online Module Failed to Improve Sustained Knowledge of the Maryland Medical Orders for Life-Sustaining Treatment Form. Ann Am Thorac Soc 2018; 13:926-32. [PMID: 26967023 DOI: 10.1513/annalsats.201511-738oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Legal documents similar to the Maryland Medical Orders for Life-Sustaining Treatment (MOLST) form requiring physician endorsement are increasingly used by critically ill patients. OBJECTIVES To evaluate whether an interactive, online training module on completion and interpretation of the MOLST form leads to a sustained increase in knowledge among house staff. METHODS Pre/post survey of 329 house staff at Johns Hopkins Hospital who admit and discharge patients between June 2014 and July 2015. House staff were encouraged to complete a voluntary, interactive, online educational module on completing and interpreting MOLST forms. Participants received $25 for accessing the module and $10 for completing each survey. MEASUREMENTS AND MAIN RESULTS The primary outcome was the change in the number of questions answered correctly on the post- versus presurvey comparing house staff who viewed the module for at least 20 minutes with house staff who never viewed or never completed the module. Overall, 329 (69%) house staff completed the knowledge assessment survey both before and after the module was available, and 201 (61%) of these house staff completed the voluntary module. The median score on the presurvey conducted in July and August of 2014 was 14 out of 21 (interquartile range [IQR] 12, 16). The median (IQR) score on the postsurvey conducted in May and June of 2015 was 15 out of 21 (13, 17). The median (IQR) change in score among those who spent at least 20 minutes completing the module was 1 question (-1, 3), and among those who never viewed or never completed the module it was also 1 (IQR -1, 2). The postsurvey was completed a median (IQR) of 59 (52, 62) days after viewing the module. After adjusting for years of postgraduate clinical training, self-reported baseline experience completing MOLST forms, and self-reported responsibility for discharging patients, viewing the module for at least 20 minutes was associated with a nonsignificant increase in score of 0.41 questions (95% confidence interval, -0.25, 1.06; P = 0.23). CONCLUSIONS An interactive, online educational module had no effect on trainee knowledge of completing and interpreting MOLST forms approximately 2 months after completion. Information conveyed via online modules alone may have minimal sustained impact on house staff knowledge.
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Funk M, Fennie KP, Stephens KE, May JL, Winkler CG, Drew BJ. Association of Implementation of Practice Standards for Electrocardiographic Monitoring With Nurses' Knowledge, Quality of Care, and Patient Outcomes: Findings From the Practical Use of the Latest Standards of Electrocardiography (PULSE) Trial. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003132. [PMID: 28174175 DOI: 10.1161/circoutcomes.116.003132] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 12/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although continuous electrocardiographic (ECG) monitoring is ubiquitous in hospitals, monitoring practices are inconsistent. We evaluated implementation of American Heart Association practice standards for ECG monitoring on nurses' knowledge, quality of care, and patient outcomes. METHODS AND RESULTS The PULSE (Practical Use of the Latest Standards of Electrocardiography) Trial was a 6-year multisite randomized clinical trial with crossover that took place in 65 cardiac units in 17 hospitals. We measured outcomes at baseline, time 2 after group 1 hospitals received the intervention, and time 3 after group 2 hospitals received the intervention. Measurement periods were 15 months apart. The 2-part intervention consisted of an online ECG monitoring education program and strategies to implement and sustain change in practice. Nurses' knowledge (N=3013 nurses) was measured by a validated 20-item online test, quality of care related to ECG monitoring (N=4587 patients) by on-site observation, and patient outcomes (mortality, in-hospital myocardial infarction, and not surviving a cardiac arrest; N=95 884 hospital admissions) by review of administrative, laboratory, and medical record data. Nurses' knowledge improved significantly immediately after the intervention in both groups but was not sustained 15 months later. For most measures of quality of care (accurate electrode placement, accurate rhythm interpretation, appropriate monitoring, and ST-segment monitoring when indicated), the intervention was associated with significant improvement, which was sustained 15 months later. Of the 3 patient outcomes, only in-hospital myocardial infarction declined significantly after the intervention and was sustained. CONCLUSIONS Online ECG monitoring education and strategies to change practice can lead to improved nurses' knowledge, quality of care, and patient outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01269736.
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Affiliation(s)
- Marjorie Funk
- From the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.).
| | - Kristopher P Fennie
- From the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.)
| | - Kimberly E Stephens
- From the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.)
| | - Jeanine L May
- From the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.)
| | - Catherine G Winkler
- From the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.)
| | - Barbara J Drew
- From the School of Nursing, Yale University, West Haven, CT (M.F.); Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (K.P.F.); Department of Pharmacology and Molecular Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (K.E.S.); Yale Center for Clinical Investigation, School of Medicine, Yale University, New Haven, CT (J.L.M.); Western Connecticut Medical Group, Danbury (C.G.W.); and Department of Physiological Nursing, School of Nursing, University of California San Francisco (B.J.D.)
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Peer Education Versus Computer-Based Education: Improve Utilization of Library Databases Among Direct Care Nurses. J Nurses Prof Dev 2017; 33:E1-E5. [PMID: 28683041 DOI: 10.1097/nnd.0000000000000371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A quasiexperimental study was conducted to demonstrate which teaching modality, peer education or computer-based education, improves the utilization of the library electronic databases and thereby evidence-based knowledge at the point of care. No significant differences were found between the teaching modalities. However, the study identified the need to explore professional development teaching modalities outside the traditional classroom to support an evidence-based practice healthcare environment.
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