A systematic approach to pacemaker assessment

Arrhythmia knowledge: a qualitative study

OBJECTIVE

The objective is to identify and describe critical care nurses' perception of arrhythmia knowledge. In addition, this study is the first step in developing levels of arrhythmia competency.

DESIGN

A qualitative research design was used. Focus group technique using a semistructured group session, with a moderator, was used to gather data. Data were analyzed by the constant comparative method.

SUBJECTS

The subjects were critical care nurses who work in acute care settings where they read electrocardiographic data and make treatment decisions.

PROCEDURES

Five focus groups were conducted over a period of 12 months. Group size ranged from four to eight participants. Participants were asked to describe their perceptions of arrhythmia knowledge and to assign a rating score related to the level of knowledge needed to identify specific arrhythmias.

RESULTS

Basic, intermediate, and advanced levels of arrhythmia knowledge were identified. This study revealed a deficit in nurses' ability to recognize and identify specific arrhythmias including heart block, aberrant conduction, and tachyarrhythmias. Understanding of lead placement concepts varied greatly among participants.

CONCLUSIONS

The insight and perspective of critical care nurses related to the level of arrhythmia knowledge are needed for the development of competency measures and evidence-based teaching strategies.

Update on implantable pacemakers

There are currently more than 3 million patients worldwide with implanted pacemakers, and indications for implants are expanding. Pacemakers today are smaller (23-30 g) and fashioned in a more physiologic shape so as to be less obtrusive. They are replete with sophisticated diagnostic and programming features that make troubleshooting of complicated arrhythmias easier. Advanced nurse clinicians need to have a basic understanding of pacemaker function, indications for implantation, an awareness of potential complications, and facility with basic troubleshooting. The purpose of this article is to describe the features of the pacemakers available today and approaches to troubleshooting these devices.