INTRODUCTION:

Non communicable diseases (NCDs) can refer to chronic diseases which last for long periods of time and progress slowly. Sometimes, NCDs result in rapid deaths such as seen in certain diseases such as autoimmune diseases, heart diseases, stroke, cancers, diabetes, chronic kidney disease, osteoporosis, Alzheimer's disease, cataracts, and others.¹

Electrocardiogram monitoring in hospitals has become more complex since it was first introduced over 40 years ago. Practice standards for ECG monitoring in hospital settings have been established for arrhythmias, ischemia, and corrected QT intervals.²

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.³

Indians develop heart disease about ten years earlier than other population and young Indians often have heart disease as server as older Indians. In west 15% of men and 12% of women who die from heart disease die before reaching 65 years. The median age of first heart attack among Europeans is 59 years and 60 years among Chinese. Among people from Indian subcontinent, it is 50 years fully 10 years earlier.⁴

A recent study which analysed all major world ethnic groups in relation to heart disease found that Indians have the highest risk of coronary heart disease, with rates three to four times higher than Americans, six times more than the Chinese and 20 times more than the Japanese. In North India, 7–10% of people have coronary heart disease while the prevalence is as high as 14% in South India.⁵

Risk assessment with short-term or long-term risk prediction algorithms can help to identify individuals who would benefit most from risk-factor interventions. Evaluation of novel risk factors and screening for subclinical atherosclerosis can also help to identify individuals at highest cardiovascular risk.⁶

As a first line diagnostic tool, health care providers at different levels of training and expertise frequently find it imperative to have the ability to interpret ECGs. ECG monitoring must be meticulously undertaken. Potential consequences of poor technique include misinterpretation of cardiac arrhythmias, mistaken diagnosis, wasted investigations and mismanagement of the patient.⁷

NEED OF THE STUDY:

World Health Organization (WHO) reports that NCDs are responsible for about 70% of worldwide deaths. The risk of heart disease increases as the age advances. There is also a greater risk if there is a close family member who had heart disease at an early age. Prevalence studies report that cardiovascular disease (CVD) diagnosed using history and ECG changes have trebled in both urban and rural adults from early 1960s and current prevalence rates are 10-12 % in urban and 4 to 5 % of rural adults.⁸

A study conducted jointly by the All India Institute of Medical Sciences and Max Hospital shows the incidence of hypertension, obesity and heart disease is increasing at an alarming rate, especially in the young, urban population. According to doctors say, a sedentary lifestyle combined with an increase in the consumption of fatty food and alcohol is to blame cases of obesity, diabetes, and hypertension etc.⁹

Coronary artery Disease is one of the leading disease, which possesses greater risk among Indians. According to World Health Organization - 2002 Coronary artery disease death rates are currently about three times higher than stroke rates and cardiac efficiency is achieved when work and activities of daily livings can be performed at reduced heart rate.¹⁰

Ischemic heart diseases contribute from one-third to one-half of all deaths due to cardiovascular diseases. 3.8 million men and 3.4 million women in the world die every year from ischemic heart diseases, and in Europe about 2 million. Coronary heart disease (CHD) is a major cause of mortality and morbidity all over the world.¹¹

Electrocardiography (ECG) is still regarded as the basic tool in the evaluation of cardiac diseases. It is performed in approximately 2 % of all office visits, and 30- 38 % of these ECGs will be abnormal. ECG may be an important tool in primary care and it can considerably reduce the number of unnecessary referrals.¹²

Nurses being a member of health team should be able to interpret ECG finding up to her extent of practice needed in clinical settings. Interpretation of ECG is the conclusion of identifying normal and abnormal findings among cardio vascular diseases with the help of measurements, rhythm analysis, conduction analysis, wave form description. So that student nurse can able to possess the knowledge in comparing the ECG strip with the previous one.¹³Keeping this in mind the research team has decided to conduct this study to create awareness among 2nd year B.Sc. nursing students regarding ECG interpretation.

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of structured teaching programme (STP) on knowledge regarding electrocardiogram (ECG) interpretation among second year B.Sc. nursing students in a selected college of nursing, Bengaluru.

OBJECTIVES:

1. To assess the level of knowledge regarding ECG interpretation among second year B.Sc. nursing students.

2. To assess the effectiveness of structured teaching programme on level of knowledge regarding ECG interpretation among second year B.Sc. nursing students.

3. To determine the association between pre-test knowledge scores regarding ECG interpretation with selected sample characteristics.

HYPOTHESIS:

· H₁: There will be a statistically significant difference in level of knowledge regarding ECG interpretation before and after administration of structured teaching programme as measured by structured knowledge questionnaire at p<0.05 level.

· H₂: There will be a statically significant association between pre-test knowledge scores regarding ECG interpretation with selected sample characteristics at p<0.05 level.

MATERIALS AND METHODS:

Research approach: Quantitative evaluative approach was adopted for this study.

Research design: Pre experimental, one group pre-test post-test design was adopted.

Setting: For this study St. Philomena’s College of Nursing in Bengaluru, Karnataka was selected.

Population: 2^nd year B.Sc. nursing students

Sampling Technique: Non- probability consecutive sampling.

Sample Size: 60 nursing students.

Description of the tool:

Section I: Socio-demographic profile for nursing students consist of age, gender, previous information obtained regarding ECG, source of information, experience of witnessing ECG monitoring, history of cardiac diseases in the family and previous experience of undergoing electrocardiography.

Section II: Structured knowledge questionnaire. It consists of 40 multiple choice questions.15 questions were regarding facts related to normal ECG and remaining 25 questions were regarding facts related to abnormal ECG. The maximum score was 40. The score interpretation was done as; good knowledge ≥75% (30-40 marks), average knowledge 51-74% (21-29 marks) and poor knowledge ≤50% (≤ 20 marks).

Method of data collection:

Written permission to conduct study was obtained from the Principal of college of nursing. Samples were selected based on the inclusion and exclusion criteria. The data was collected from 10^thJuly to 17^th July 2018. The researchers explained about purpose of the study, confidentiality was assured and written consent was obtained. Structured knowledge questionnaire was administered to assess the pre-test knowledge of students regarding ECG interpretation. Structured teaching programme was administered to the students on the same day and post-test was conducted on the 7^th day, Collected data was coded, tabulated and analysed by descriptive (frequency, percentage, mean, mean difference and standard deviation) and inferential statistics ( z- test and chi-square test).

RESULTS:

Section I: Related to socio- demographic variables of samples.

Table No.1: Distribution of samples according to socio-demographic variables of the 2nd year B.Sc. nursing students (n = 60)

Sample Characteristics	Frequency (f)	Percentage (%)
AGE IN YEARS 17-20 YRS	50	83.3
21-23 YRS	7	11.7
24≥YRS	3	5
GENDER
Male	0	0
Female	60	100
Previous Information Obtained Regarding ECG
Yes	60	100
No	0	0
Source Of Information
Educational programme	1	1.7
Clinical exposure/ classroom teaching	57	95
Electronic Media	0	0
Printed media	2	3.3
Experience of Witnessing ECG Monitoring
Yes	60	100
No	0	0
History of Cardiac Diseases in The Family
Yes	48	80
No	12	20
Previous Experience of Undergoing Electrocardiography
Yes	56	93.3
No	4	6.7

The data represented in the above table shows that out of 60, 2^nd year B.Sc. nursing students; majority 50(83.3%) were in the age group of 17-20 years. With regard to gender, all the 60(100%) samples were females. All the 60 (100%) samples had obtained previous information regarding ECG. With regard to source of information, majority 57(95%) samples had obtained information from clinical exposure/classroom teaching. All 60(100%) samples had experience of witnessing ECG monitoring. 48(80%) samples had history of cardiac diseases in the family. 56(93.3%) samples had previous experience of undergoing electrocardiography.

Section II: Distribution of 2^nd year B.Sc. nursing students according to level of knowledge.

Table No.2: Comparison of pre-test and post-test knowledge scores of 2^nd year B.Sc. nursing students regarding ECG interpretation (n=60)

Knowledge Level	Category	Respondents
		Pre-test knowledge scores		Post-test knowledge scores
		Freq uency (f)	(%)	Freq uency (f)	(%)
Good	≥75%	0	0	9	15
Average	51-74%	4	6.7	26	43.3
Poor	≤50%	56	93.3	25	41.7
Total		60	100	60	100

The data represented in the table-II shows that out of 60 2nd year B.Sc. nursing students; in the pre-test, none had good knowledge, whereas 4 (6.7%) samples had average knowledge and 56(93.3%) of them had poor knowledge. In the post-test, 9(15%) had good knowledge, whereas 26 (43.3%) samples had average knowledge and 25 (41.7%) of them had poor knowledge.

Section III: Effectiveness of structured teaching programme on level of knowledge regarding ECG interpretation among second year B.Sc. nursing students

Table No.3: Mean, Standard Deviation, Mean Difference and Z - Test Scores (n=60)

Know

ledge

Max.

Scores

Mean

S. D.

Mean

Diffe

rence

Z-test

Sig.

Pre- test

15.12

3.82

16.33

10.96

Sig.

Post-test

31.45

10.91

Sig.- Significant; S. D.- Standard Deviation; z (0.05) = 1.96; *Significant at 0.05 level of significance.

The data represented in the above table shows that shows that the mean post- test knowledge (31.45) score was higher than the mean pre-test (15.12). The scores predicted the significant difference (16.33) at p<0.05 level. The calculated “z” value was (10.96) at p <0.05 level of significance, which indicated the significant difference in the level of knowledge before and after the implementation of structured teaching program. Hence it was concluded that there was a significant increase in knowledge of second year B.Sc. nursing students regarding ECG interpretation after the administration of structured teaching programme.

Section IV: Association between the pre-test knowledge scores of 2nd year B.Sc. nursing students regarding ECG interpretation with socio-demographic variables:

Chi square value was calculated to find out the association between the pre-test knowledge scores of the 2nd year B.Sc. nursing students (n=60) with socio - demographic variables. The findings revealed that there was no significant association between the pre-test knowledge scores of 2nd year B.Sc. nursing students regarding ECG interpretation with socio-demographic variables i.e. age - χ2 value of 0.32 (df- 1, chi square value - 3.84 , p>0.05) , source of information - χ2 value of 1.49 (df- 1, chi square value - 3.84 , p>0.05),history of cardiac diseases in the family - χ2 value of 2.19 (df- 1, chi square value - 3.84, p>0.05) and previous experience of undergoing electrocardiography - χ2 value of 2.52 (df- 1, chi square value - 3.84, p>0.05) . Hence, it was concluded that among socio-demographic variables none had association with the knowledge of 2^nd year B.Sc. nursing students.

DISCUSION:

In the pre-test, none had good knowledge, whereas 4 (6.7%) samples had average knowledge and 56(93.3%) of them had poor knowledge. In the post-test, 9(15%) had good knowledge, whereas 26(43.3%) samples had average knowledge and 25(41.7%) of them had poor knowledge. The mean post- test knowledge (31.45) score was higher than the mean pre-test (15.12). The scores predicted the significant difference (16.33) at p<0.05 level. The calculated “z” value was (10.96) at p <0.05 level of significance, which indicated the significant difference in the level of knowledge before and after the implementation of structured teaching program. It was also found that among socio-demographic variables none had association with the knowledge of 2nd year B.Sc. nursing students. Hence it was concluded that structured teaching programme was effective in improving the knowledge of 2nd year B.Sc. nursing students regarding ECG interpretation. As topic is broad and sophisticated recurrent teaching and evaluation must be done to improve the performance of students.

NURSING IMPLICATIONS:

The nursing implications are discussed under nursing practice, nursing education, nursing administration and nursing research.

Nursing practice:

· Nurses should have adequate knowledge regarding ECG interpretation and thereby prevent many fatal complications in all the cardiac disease patients.

· It provides good opportunity to train them to be more knowledgeable and skilful which indirectly reduces the risk of fatalities occurrences.

Nursing education:

Even though ECG interpretation is included in the present curriculum, nurse educators should give more importance towards periodic teaching, interpretation and evaluation.

Nursing administration:

· Nurse administrator can use the findings of the study to establish standard protocol and it can be implemented effectively.

· Extend the role in strengthening and designing the nursing procedure related to ECG monitoring.

· The nurse administrator has a significant role in updating the knowledge and skills of nurses regarding ECG interpretation through in- service programs.

Nursing research:

· Many more studies can be done to assess the knowledge regarding ECG interpretation with different samples and settings.

· An experimental research can be conducted among nurses to assess the knowledge and practice regarding ECG monitoring and interpretation.

CONCLUSION:

From the findings of the study, it was concluded that the structured teaching programme was effective in improving the knowledge of 2nd year B.Sc. nursing students. Periodic updating of knowledge and skill regarding ECG interpretation must be strictly done among nursing students through repeated classes, demonstrations and assessments for maintaining consistency in their performance as the topic is vast and toilsome.

ACKNOWLEDGEMENT:

Our special thanks go to the Principal and Management of St. Philomena’s College of Nursing for permitting us to conduct this study. We are thankful to all the participants of the study.

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

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Received on 04.06.2021 Modified on 10.02.2022

Asian J. Nursing Education and Research. 2022; 12(3):257-261.

DOI: 10.52711/2349-2996.2022.00055