Academic journal article Nursing Education Perspectives

Technology-Based vs. Traditional Instruction: A Comparison of Two Methods for Teaching the Skill of Performing a 12-Lead ECG

Academic journal article Nursing Education Perspectives

Technology-Based vs. Traditional Instruction: A Comparison of Two Methods for Teaching the Skill of Performing a 12-Lead ECG

Article excerpt

ABSTRACT The purpose of this study was to compare the effectiveness of an interactive, multimedia CD-ROM with traditional methods of teaching the skill of performing a 12-lead ECG. A randomized pre/posttest experimental design was used. Seventy-seven baccalaureate nursing students in a required, senior-level critical-care course at a large midwestern university were recruited for the study.Two teaching methods were compared.The traditional method included a self-study module, a brief lecture and demonstration by an instructor, and hands-on experience using a plastic manikin and a real 12-lead ECG machine in the learning laboratory.The second method covered the same content using an interactive, multimedia CD-ROM embedded with virtual reality and supplemented with a self-study module.There were no significant (p < .05) baseline differences in pretest scores between the two groups and no significant differences by group in cognitive gains, student satisfaction with their learning method, or perception of self-efficacy in performing the skill. Overall results indicated that both groups were satisfied with their instructional method and were similar in their ability to demonstrate the skill correctly on a live, simulated patient.This evaluation study is a beginning step to assess new and potentially more cost-effective teaching methods and their effects on student learning outcomes and behaviors, including the transfer of skill acquisition via a computer simulation to a real patient.

Nursing is a discipline that requires its practitioners to develop basic skills before encountering actual patients. These skills include performing a 12-lead ECG, the most common cardiac examination ordered by physicians (I). In the past, only persons working in the ECG laboratory were allowed to perform this procedure.Today, however, the task has been delegate to a variety of health professionals including RNs, LPNs, and, in some health care settings, even nursing assistants. * Performing a 12-lead ECG is traditionally taught in a laboratory setting and requires a high faculty-to-student ratio to allow for closely monitored practice. Newly hired hospital nurses must also learn or review this skill during their initial orientation. As a result, it is not uncommon for staff development nurses to teach the procedure to groups of employees as many as five times per week.

Repetitive content is ideal material to move from traditional instructional methodology to computer-based virtual reality for first-line instruction. An interactive, multimedia CD-ROM on the 12-lead ECG, using embedded virtual reality, was designed by the author (2,3) based on Chickering and Gamson's principles of best practice in education (4). (See Table 1.) Much research suggests that these seven principles are important individually and are mutually reinforcing for high quality education, good student performance, and high student satisfaction (5,6). The current study used Kirkpatrick's model of evaluation to compare the use of the CD-ROM with the traditional method of learning how to perform this skill (7).

Literature Review Cardiovascular disease is the leading cause of death in the United States. Despite recent advances in resuscitation and cardiac life support, 1.5 million myocardial infarctions result in 520,000 deaths annually (8). A 12-lead electrocardiogram (ECG), usually obtained with a computerized recording device, is the most common diagnostic test for myocardial infarctions and other cardiovascular problems (1). When performing the 12-lead ECG, a small mistake in electrode placement can make a big difference, distorting interpretation and diagnosis. For example, precordial electrodes just 2 cm out of position can significantly distort R waves and ST segments, causing a wrong interpretation and, potentially, leading to a wrong diagnosis or treatment.

Little research has been conducted on teaching strategies related to the 12-lead ECG, although a few studies have assessed the accuracy of health care workers performing the skill. …

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