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 NURSING SOMESHWAR ROAD, ULLAL MANGALORE-575 020.

2.

Name of the Institution

K.PANDYARAJAH BALLAL NURSING INSTITUTE, COLLEGE OF NURSING SOMESHWAR ROAD,ULLAL MANGALORE M.Sc. NURSING MEDICAL SURGICAL NURSING 15.06.09

3.

Course of Study and Subject

4.

Date of Admission to the course

5.

Title of the study

A STUDY TO EVALUATE THE EFFECTIVENESS OF ASSISTED SELFDIRECTED 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 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
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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.

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.
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6.2

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

undergraduate nursing students 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

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
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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

educator. After desired outcomes are identified, a teaching method can be determined based on the staff educators requirements, the resource available & the learners 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
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used to determine the effectiveness of randomization and to justify statistical procedures. EKG posttest 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

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
1.

Operational definitions
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 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
1.

Assumptions
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.
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3. 4.

Assisted self-directed learning is an accepted teaching strategy. 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
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

7.1 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
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O2

O1 - Pre test X Assisted self-directed learning O2 - Post test

7.1.2 Setting
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.
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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

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 selfinstructional 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
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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 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 students 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. 10. 11.

Signature of the candidate Interpretation of ECG needs lots of understanding and Remarks of the guide continuous practice, learning on their own pace gives them control over their subject matter. Name and designation of (in block letters) MRS. KANUMILLI VISALAKSHI, 11.1 Guide ASSOCIATE PROFESSOR, K.P.B.N.I., ULLAL, MANGALORE. 11.2 Signature MISS. KAINI CECILIA, 11.3 Co-guide(if any) LECTURER, K.P.B.N.I., ULLAL, MANGALORE. 11.4 Signature MRS. KANUMILLI VISALAKSHI,

12.

12.1 Head of the department

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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