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The aim of this study is to develop, implement, and evaluate the effects of a virtual ECG rhythm intervention on the interpretation and competence of cardiology nurses in Finnish university hospitals. The virtual ECG rhythm intervention consists of a virtual animation component and a virtual simulation component, both incorporating cardiological patient cases with corresponding ECG rhythms. The virtual animation includes educational content on a total of 31 different ECG rhythms, as well as a virtual simulation containing 6-8 different cardiological patient cases with ECG rhythms (covering 11 distinct rhythms).
The study employs a quasi-experimental design. Cardiology nurses are divided into two groups based on hospital: an intervention group and a control group.
In this study, data will first be collected for the virtual animation component during 2026-2027, followed by data collection for the virtual simulation component during 2027-2028. A baseline measurement of ECG interpretation and competence will be conducted for both groups (n = 508) using an online survey (LimeSurvey) prior to the intervention.
The same measurement schedule will be applied to the virtual simulation component during the 2027-2028 data collection period.
In this study, three (3) reminder letters will be sent at weekly intervals to encourage participation in the study, its surveys, and the virtual interventions. These reminder messages will be distributed via email by unit managers or equivalent personnel in each hospital to the participants.
The virtual intervention will be delivered online via a web service (GitHub) link. Research data on ECG interpretation and competence will be collected using an ECG interpretation measurement instrument administered through an electronic survey (LimeSurvey).
The ECG interpretation instrument was previously developed by the researcher and includes ECG recordings from real patient cases, for which prior permission has been obtained in accordance with the practices of a cardiac care unit in a central hospital. The instrument has been partially updated in terms of ECG rhythms, with additional new ECG recordings included. Permission for the new ECG recordings was obtained in April 2023 from a Finnish wellbeing services county. The instrument also includes ECG recordings from a simulation monitor display.
The ECG interpretation instrument begins with 14 background questions. It includes five questions assessing ECG competence and currently contains 31 ECG interpretation questions, compared to the previous 21 items. Additionally, the end of the instrument includes seven questions assessing the experiences of participants in the intervention group regarding the virtual intervention.
These implementation methods aim to control for the potential influence of external variables, as the intervention and survey are identical for all participants. This consistency could not be guaranteed if the virtual ECG interpretation intervention were delivered, for example, as a traditional theory-based lecture.
The results of the study will be analyzed using statistical methods. The findings can be utilized, for example, in the development of ECG rhythm interpretation and competence training programs for cardiology nurses.
During the 2026-2027 data collection phase, participants in the intervention group (n = 254) will use the virtual ECG rhythm animation intervention for one month. The experiences of cardiology nurses regarding the virtual ECG rhythm intervention will be collected during the intervention through open-ended questions.
A second measurement of ECG interpretation and competence will be conducted immediately after the intervention (one month after the baseline) for both groups: the intervention group (n = 254) and the control group (n = 254). A third measurement will be conducted three months after the intervention, again for both groups.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Active Comparator | Data will first be collected for the virtual animation component during 2026-2027, followed by data collection for the virtual simulation component during 2027-2028. A baseline measurement of ECG interpretation and competence will be conducted for both groups (n = 508) using an online survey (LimeSurvey) prior to the intervention. During the 2026-2027 data collection phase, participants in the intervention group (n = 254) will use the virtual ECG rhythm animation intervention for one month. The experiences of cardiology nurses regarding the virtual ECG rhythm intervention will be collected during the intervention through open-ended questions. A second measurement of ECG interpretation and competence will be conducted immediately after the intervention (one month after the baseline) for both groups. A third measurement will be conducted three months after the intervention, again for both groups. The same measurement schedule will be applied to the virtual simulation component. |
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| Control group | No Intervention | A baseline measurement of ECG interpretation and competence will be conducted for both groups (n = 508) using an online survey (LimeSurvey). A second measurement of ECG interpretation and competence will be conducted immediately after the intervention (one month after the baseline) for both groups. And final, third measurement will be conducted three months after the intervention, again for both groups. The respondents in the control group will continue with standard practice while intervention, meaning that they will not receive any educational material related to ECG interpretation and competence. Instead, learning ECG rhythms will rely on their usual learning processes, such as workplace-based learning. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Virtual intervention for ECG rhythms | Other | In this study, data will first be collected for the virtual animation component during 2026-2027, followed by data collection for the virtual simulation component during 2027-2028. A baseline measurement of ECG interpretation and competence will be conducted for both groups (n = 508) using an online survey (LimeSurvey) prior to the intervention. During the 2026-2027 data collection phase, participants in the intervention group (n = 254) will use the virtual ECG rhythm animation intervention for one month. The experiences of cardiology nurses regarding the virtual ECG rhythm intervention will be collected during the intervention through open-ended questions. A second measurement of ECG interpretation and competence will be conducted immediately after the intervention (one month after the baseline) for both groups: the intervention group (n = 254) and the control group (n = 254). A third measurement will be conducted three months after the intervention, again for both groups. |
| Measure | Description | Time Frame |
|---|---|---|
| ECG Interpretation skills | Questionnaire (ECG interpretation Scale) is used to assess ECG interpretation skills and expertise | from the start of the intervention until its completion, for a period of three months |
| ECG Interpretation Scale | The ECG interpretation instrument begins with 14 background questions. It includes five questions assessing ECG competence and currently contains 31 ECG interpretation questions. Answers on the ECG interpretation section are scored such that a correct answer earns one point and an incorrect answer earns zero points. The maximum score on the questionnaire is 31, indicating a very high level of proficiency in ECG interpretation. | From participation to the end of the intervention (3 months) |
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Inclusion Criteria:
Exclusion Criteria:
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This study does not collect patient-specific data.
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