Arrhythmia knowledge: a qualitative study

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.

Final-year nursing students' foundational knowledge and self-assessed confidence in interpreting cardiac arrhythmias: A cross-sectional study

BACKGROUND

Graduating nurses should possess knowledge and understanding of cardiac arrhythmia interpretation, so they can assess abnormal and life-threatening arrhythmias. However, literature around nursing students' foundational knowledge in cardiac arrhythmia interpretation remains scarce.

OBJECTIVES

To examine final-year nursing students' foundational knowledge and self-assessed confidence in interpreting cardiac arrhythmias.

DESIGN

Cross-sectional study design.

SETTINGS

Two Australian universities (one regional and the other large metropolitan).

PARTICIPANTS

Nursing students in the final year of a program of study leading to initial registration as a registered nurse.

METHODS

An online survey was adopted to examine final-year nursing students' foundational knowledge and their self-assessed confidence when interpreting cardiac rhythms.

RESULTS

A total of 114 participants completed surveys, representing a response rate of 22%. More than 70% of the participants were able to interpret asystole, sinus rhythm, and sinus bradycardia. Over 50% correctly identified ventricular tachycardia, atrial flutter, sinus tachycardia, atrial fibrillation, and ventricular fibrillation. Under 15% of the participants were able to interpret junctional rhythm, paced rhythm, and unifocal/multifocal premature ventricular contractions. Self-assessed confidence levels were generally lower than the accuracy rates of arrhythmia interpretation. Although many participants acknowledged that learning arrhythmia interpretation was difficult and challenging, most of them had positive perceptions and wanted to learn more.

CONCLUSION

Nursing curricula need to be supported and strategies need to be implemented to standardise educational electrocardiogram interpretation programs, which are critical to improving final-year nursing students' foundational knowledge and confidence in interpreting cardiac arrhythmias and enhancing patient safety.

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.].

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

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.

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.

Improving Nurses’ Knowledge of Continuous ST-Segment Monitoring

Background:

Continuous ST-segment monitoring can result in detection of myocardial ischemia, but in clinical practice, continuous ST-segment monitoring is conducted incorrectly and underused by many registered nurses (RNs). Many RNs are unable to correctly institute ST-segment monitoring guidelines because of a lack of education.

Purpose:

To evaluate whether an educational intervention, provided to 32 RNs, increases knowledge and correct clinical decision making (CDM) for the use of continuous ST-segment monitoring.

Methods:

At a single institution, an ST-segment monitoring class was provided to RNs in 2 cardiovascular units. Knowledge and correct CDM instruments were used for a baseline pretest and subsequent posttest after ST-segment monitoring education.

Results:

Statistical significance between pretest and posttest scores for knowledge and correct CDM practice was noted with dependent t tests (P = .0001).

Conclusions:

Many RNs responsible for electrocardiographic monitoring are not aware of evidence-based ST-segment monitoring practice guidelines and cannot properly place precordial leads needed for ST-segment monitoring. Knowledge and correct CDM with ST-segment monitoring can be improved with focused education.