RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address (in block letters)

SEENIA K. JOSE,K.PANDYARAJAH BALLAL NURSING INSTITUTE, COLLEGE OF NURSINGSOMESHWAR ROAD, ULLALMANGALORE-575 020.

2. Name of the Institution K.PANDYARAJAH BALLAL NURSING INSTITUTE, COLLEGE OF NURSINGSOMESHWAR ROAD,ULLALMANGALORE

3. Course of Study and SubjectM.Sc. NURSINGMEDICAL SURGICAL NURSING

4. Date of Admission to the course 15.06.09

5. Title of the study

“A STUDY TO EVALUATE THE EFFECTIVENESS OF ASSISTED SELF-DIRECTED LEARNING ON ECG INTERPRETATION AMONG THE NURSING STUDENTS IN SELECTED COLLEGES OF NURSING AT MANGALORE.”

6. Brief resume of intended work

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Introduction

Electrocardiography is the most commonly used diagnostic test in cardiology. If properly

interpreted, it contributes significantly to the diagnosis and management of patients with cardiac

disorders. Importantly, it is essential to the diagnosis of cardiac arrhythmias and the acute

myocardial ischemic syndromes. These two conditions account for the majority of cardiac

catastrophes. It is appropriately used as a screening test in many circumstances.1 Basic knowledge

of the ECG is usually the most difficult to assimilate, as it implies learning the basis of

interpretation. With technological advances, changes in provision of healthcare services and

increasing pressure on critical care services, ward patients' severity of illness is ever increasing. As

such, nurses need to develop their skills and knowledge to care for their client group. Competency

in cardiac rhythm monitoring is beneficial to identify changes in cardiac status, assess response to

treatment, diagnosis and post-surgical monitoring.2 Every nursing student, nurse or even resident

doctor must be aware of the importance of correlating clinical findings after a complete

examination with the ECG finding. A good basic ECG interpretation may rely on the ability to

combine clinical skills with basic ECG interpretation.

6.1 The need for the study

Understanding and interpreting a standard 12-lead ECG can prove to be a quite difficult

task, especially for nursing students and practicing nurses at their first contact with clinical cases

requiring an accurate interpretation of an ECG. Interpretive exercises are identified as one of the

best methods to measure complex achievements by many educationist3. The students admitted to

third year B. Sc. Nursing programme have to study Advanced Medical-Surgical Nursing in their

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curriculum, which highlights the need to have an in-depth understanding of the various diagnostic

tests. This study will help the students to obtain an understanding of the interpretation of ECG

changes of selected cardiac conditions, which will in turn help them to fulfil the needs of a

practicing nurse in the future. The graduate nurses has a large area of scope in nursing practice by

taking up the roles such as case manager, nurse practitioners, nurse managers etc. The

performance of these upcoming roles necessitates the need for learning the interpretation of ECG

changes.

A comparative study was conducted to investigate nursing students' responses to a basic

electrocardiography by a computer assisted learning (CAL) programme and a lecture on the same

topic. There were no significant differences between the CAL and lecture groups on cognitive

outcomes (measured by a 20 item test on electrocardiogram knowledge) or transfer of learning

outcomes (measured in the clinical setting by the students' ability to identify and interpret six

electrocardiogram tracings). However, CAL students displayed more positive affective responses.

They also took between 10 and 32 minutes to complete the programme while all lecture students

took a mandatory 50 minutes or more4.

A comparative study was conducted to assess the long term results of the pedagogic

approach (self instructional module). Fifth year medical students were assigned to receive self

instruction modules or expositive lectures on electrocardiography. The knowledge and opinions of

these two groups were evaluated two years later. Knowledge assessment was significantly better

among students receiving self instruction modules The self instruction method and traditional

lectures were qualified as very useful by 86.8 and 38.9% of students respectively. It is concluded

that self instruction methods have good long term results, when applied to medical students5.

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From the above descriptions and personal experiences while working as a staff nurse in

cardiology department, the researcher felt a need to conduct a study to determine the effectiveness

of self instructional module on ECG interpretation of selected cardiac conditions for 3rd year B. Sc.

Nursing students with the main objective of improving their knowledge.

6.2 Review of Literature

A study conducted in 2004 to examine the effect of web based teaching method on

undergraduate nursing student’s of electrocardiography.. The study used a pre-test post-test

experimental design. A total of 105 senior nursing students were recruited at a university in Korea.

In that 54 students were assigned to an experimental group & 57 were assigned to a control group.

Knowledge about ECG among students in the control group was significantly lower than that of

students in study group (p<0.01) conversely the ability to interpret ECG recording was

significantly higher among students in the web based group (p<0.05). No significant difference

found between the two groups in level of motivation or satisfaction with learning. The self directed

web based ECG learning programme appears to be effective in helping nursing students to

interpret ECG recording.6

An exploratory study was conducted to determine, whether the ward nurses have basic

knowledge regarding 12 lead ECG recording and their interpretation ability in ECG changes

among nurses in general ward areas. The nurses were instructed to complete a 14 item

questionnaire on basic 12 lead ECG knowledge. The results of completed questionnaire by staff

nurses revealed that overall knowledge was insufficient. The mean score for correct answer was

42% those who had attended education session scored 55%. In that 79% of all nurses surveyed to

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perform ECG on their wards. The reason given for performing the majority of ECGs were chest

pain and pre-operatively. Other reasons included pulmonary embolism, irregular pulse, post

cardiac catheter and angioplasty. In that 39% of ECGs were reviewed immediately 35% in 1-2

hour, 4% in 3-4 hrs, 9% at > 4 hrs, and 13% never.7

An evaluatory study was conducted to assess the effectiveness of a competency programme

on ECG interpretation and monitoring & also to find out the competency of staff nurses working in

critical care areas and to determine the factors influencing their competency as expressed by them.

A teaching guide on ECG monitoring and interpretation was prepared and distributed among the

participants. Descriptive and inferential statistics were used to analyze the data. The significant

findings of the study were: majority 29 (96.66%) of were having general nursing and midwifery

degree. Most 6 (20%) were from paediatric ICU and most of the staff nurses were having >7 years

of experience in critical care area. Statistical analysis shows that there was a significant increase in

competency scores (t29 = 8.11, p<0.05). Area-wise competency analysis shows that there was a

significant increase in knowledge (t29=9.35 p<0.05) and skill (t29=4.78, p<0.05) scores but there

were very minimal increase in attitude scores.8

A comparative study was conducted to determine the knowledge retention after completion

of either a competency based written self instructional module or a competency based didactic

lecture module among registered nurses. The 67 subjects were given pre-test and the same content

material using the two types of presentations and the post-test. Results indicated that no significant

difference among post-test scores of the treatment group and the control group. Knowledge

retention essentially was the same, regardless of the antecedent teaching methodology. The

advantage of one teaching method versus another may be in the flexibility afforded by the staff

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educator. After desired outcomes are identified, a teaching method can be determined based on the

staff educator’s requirements, the resource available & the learner’s need9.

An experimental study was conducted to compare the effectiveness of assisted self-directed

learning (ASD) and traditional lecture method (TLM) in acquiring competency for

electrocardiogram interpretation, within a conceptual framework of developmental and adult

learning theory. After two teaching units were designed and an EKG post-test was constructed (r

=0.75) from actual patient records, registered nurse volunteers (N=19) were randomly assigned to

groups for simultaneous instruction. Because of the small sample size, statistical procedures were

used to determine the effectiveness of randomization and to justify statistical procedures. EKG

post-test scores for the experimental group (ASD, M=81) and the control group (TLM, M=71)

were significantly different. ASD had higher mean score and is more cost and time efficient.10

An evaluatory study was conducted to find out the effectiveness of computer-based tutorial

and a post-test on ECG interpretation for training residents and determining competency :forty

residents, six cardiology fellows, and four experienced physicians participated. The tutorial

emphasized recognition and understanding of abnormal ECG features. Active learning was

promoted by asking questions prior to the discussion of ECGs. Interactivity was facilitated by

providing rapid and in-depth rationale for correct answers. Post-test grades revealed that the

tutorial, contributed to marked improvement in feature recognition. Competency testing

distinguished between residents with outstanding grades and those who needed remediation. The

strategy for critical evaluation of our computer programme could be applied to any computer-

based educational programme, regardless of the topic.11

6.3 Statement of the problem

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“A study to evaluate the effectiveness of assisted self-directed learning on ECG

interpretation among the nursing students in selected colleges of Nursing at Mangalore”

6.4 Objectives of the study

1. To determine the pre-intervention ability of the nursing students on ECG interpretation of

selected cardiac conditions in terms of pre-test score.

2. To evaluate the effectiveness of assisted self directed learning in terms of gain in level of

knowledge.

3. To evaluate the usefulness of assisted self-directed learning using an opinionnaire.

6.5 Operational definitions

1. Effectiveness: In this study, effectiveness refers to the usefulness of the assisted self-

directed learning in terms of improvement on the interpretative ability of the students as

measured by increased post-test score in ECG interpretation questionnaire of selected

cardiac conditions.

2. Assisted self-directed learning (ASD): In this study assisted self directed learning

includes a teaching session followed by provision of instructional material on ECG

interpretation along with a workbook containing interpretive exercises on selected cardiac

conditions.

3. Electrocardiogram (ECG): In this study ECG refers that a graphic recording that shows

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electrical activity generated by the heart muscle, it is seen as different wave patterns

consists of P, Q, R, S & T waves in a graph paper.

4. Interpretation: In this study interpretation refers to identification of the normal and

abnormal wave patterns in the ECG and recognition of the cardiac conditions particular to

that ECG change.

5. Nursing students: In this study Nursing students refers that, 3rd year students of basic B.

Sc. nursing programme in a selected college of nursing at Mangalore.

6.6 Assumptions

1. The student population involved in this study will have basic knowledge on anatomy &

physiology of the human heart.

2. The students involved in the study will have basic knowledge about Electrocardiogram.

3. Assisted self-directed learning is an accepted teaching strategy.

4. Interpretative exercises measure complex achievements.

6.7 Delimitations

Present study is delimited to the third year Basic B. Sc. nursing students in selected college

of nursing at Mangalore.

6.8 Hypotheses

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The following hypothesis will be tested at 0.05 level of significance:

H1: There will be significant improvement in the interpretative ability of the students who have

undergone assisted self-directed learning on ECG interpretation in selected cardiac

conditions.

7. Material and Methods

Source of Data

Data will be collected from third year B. Sc. nursing students of selected college of nursing

In Mangalore.

7.1.1 Research design

The research design for the study will be pre-experimental with one group pre-test post-test

design.

O1 X O2

O1 - Pre test

X – Assisted self-directed learning

O2 - Post test

7.1.2 Setting

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This study will be conducted in selected College of Nursing in Mangalore.

7.1.3 Population

The population selected for the study would comprise of third year B. Sc. nursing students

of selected college of nursing in Mangalore.

7.2 Methods of Data collection

7.2.1 Sampling procedure

Through purposive sampling 60 students of third year of basic B. Sc. nursing programme

would be selected from a college of nursing.

7.2.2 Sample size

A sample size of sixty third year B. Sc. nursing students would be selected.

7.2.3 Inclusion criteria for sampling

Students who are admitted to third year B. Sc. nursing course in selected college of

Nursing in Mangalore.

Students those who are present on the day of conducting the study.

The third year B. Sc. nursing students who are willing to participate in the study.

7.2.4 Exclusion criteria for sampling

Students who had attended any competency programme in ECG interpretation.

7.2.5 Instruments intended to be used

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Demographic Proforma

Structured knowledge questionnaire on selected ECG changes

Interpretive questionnaire on ECG interpretation on selected cardiac conditions.

Opinionnaire.

7.2.6 Data collection method

The researcher will get the permission from authorities of selected college of nursing. The

purpose of the study will be explained to the nursing students, and informed consent will be

obtained from them. Through purposive sampling 50 students of third year of basic B. Sc. nursing

programme would be selected from a college of nursing. Data will be collected using a structured

knowledge questionnaire and interpretative questionnaire. Education session will be conducted

and self-instructional material along with workbook containing interpretative exercises on

interpretation of ECG of selected cardiac conditions will be given to the participants. After seven

days, its effectiveness would be evaluated by giving a post-test using the same questionnaire.

7.2.7 Data analysis plan

Demographic proforma and opinionnaire analysis are described in terms of frequency and

percentage.

Paired ‘t’ test for the effectiveness of self instructional module on ECG variations of

selected cardiac conditions.

7.3 Does the study require any investigation or interventions to be conducted on

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patients or other animals? If so please describe briefly.

No, the study does not require any investigation on patients or other animals.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

The proposal has been accepted and recommended by the institutional ethical committee.

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References

1. Myerburg JR, Chaitman RB. Task force 2 training in electrocardiography, ambulatory

electrocardiography. Journal of American College of Cardiology 2008;51(3).

2. Sharman J. Clinical skills: cardiac rhythm recognition and monitoring. British Journal of

Nursing 2007 Mar;16(5):306-11.

3. Krishnendhu AK. Effectiveness of interpretive exercises in improving the interpretative

ability of basic B. Sc. nursing students on selected radio diagnostic images, in a selected

college of nursing. Unpublished M. Sc. Nursing dissertation submitted to Manipal

University; 2009.

4. Koch B, Guice R. Teaching electrocardiography :computer assisted learning Vs lecture

method. Australian Journal Of Advanced Nursing 1999 Jun-Aug;6(4):33-9.

5. Fasce E,Ibanez P.Long term results of an independent study program of eletrocardiography

applied to medical students. (online) .Available from pubmed.1994 Feb;122(2):133-40.

6. Janq KS, Hwanq SY, Park SJ. Effects of a web based teaching method on undergraduate

nursing student’s learning of electrocardiography. Journal of Nursing Education 2005

Jan;44(1):35-9.

7. Amos L. Testing nursing knowledge on performing 12 lead ECGs. [online]. Available

from: URL:http://www.ciap.health.nsw.gov.au/hospolic/stvincents1990/.html

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8. Sheillini M. Effectiveness Of a competency programme on ECG monitoring and

interpretation for staff nurses working in critical care areas and to determine the factors

influencing their competency as expressed by them in a selected hospital of Karnataka.

Unpublished M. Sc. Nursing dissertation submitted to Manipal University; 2008.

9. Schlomer RS, Anderson MA. Teaching strategies and knowledge retention. Journal of

Nurse Staff Development 1997 Sep-Oct;13(5):249-53.

10. Lamb MJ, Henderson MC. Comparison of two methods for teaching advanced arrhythmias

to nurse. Journal of Continuing Education 1999 Sep-Oct;24(5):221-6

11. Burke JF, Gnall E. Critical analysis of a computer assisted tutorial on ECG interpretation

and its ability to determine competency. American Journal of Nursing 2008:30(2);E41-8.

12. Salerno MS, Alguire PC. Competency in interpretation of 12 lead electrocardiograms.

(online).Available from http://www.Annals.org/content/138/9/751.full

13. Scrima DA. Foundation of arrhythmia interpretation. Medical Surgical Nursing 1997

Aug;6(4):193-202.

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9. Signature of the candidate

10.Remarks of the guide

Interpretation of ECG needs lots of understanding and

continuous practice, learning on their own pace gives

them control over their subject matter.

11. Name and designation of (in block letters)

11.1 Guide

MRS. KANUMILLI VISALAKSHI,

ASSOCIATE PROFESSOR,

K.P.B.N.I., ULLAL,

MANGALORE.

11.2 Signature

11.3 Co-guide(if any)MISS. KAINI CECILIA,

LECTURER,

K.P.B.N.I., ULLAL,

MANGALORE.

11.4 Signature

12. 12.1 Head of the departmentMRS. KANUMILLI VISALAKSHI,

ASSOCIATE PROFESSOR,

MEDICAL SURGICAL NURSING,

K.P.B.N.I., ULLAL,

MANGALORE

12.2 Signature

13. 13.1 Remarks of the Chairman and Principal

13.2 Signature

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