Current literature reveals that although nursing students must correctly interpret electrocardiogram (ECG) rhythms in order to provide safe, competent care, they often have difficulty grasping ECG identification. With few opportunities for practice, nursing students may not be comfortable applying theoretical knowledge from classroom lectures during the clinical experience (Celikkan, Senuzun, Sari, & Sahin, 2013). The lack of clinical experience may result in difficulty in identifying ECG rhythms and directly affect patient care.
According to Hoyert and Xu's (2012) National Vital Statistics Report, the number one cause of death in the United States for 2011 was heart disease. Heart disease can result in dysrhythmias that are visible on an ECG. However, correctly interpreting the information on an ECG takes a significant amount of practice. As nurses must act under pressure to detect life-threatening dysrhythmias (Akgun et al., 2014; Zhou et al., 2011), skilled ECG interpretation is vital in nursing education.
Innovative technologies, such as three-dimensional applications (3D apps), provide immediate interactive content via mobile devices and practice opportunities for learning ECG interpretation. To date, this research study is the first to look at the effectiveness of 3D app technology on nursing knowledge of ECG interpretation as evidenced by examination performance.
TECHNOLOGY IN NURSING EDUCATION
The National League for Nursing (2016) research priorities for nursing education point out the necessity for nurse educators to identify and evaluate effective emerging technologies that teach decision-making skills to nursing students. Kucirkova, Messer, Sheehy, and Panadero (2014) note that little empirical research has been done to review the educational value of apps or the impact of apps. Apps that are 3D engage students in active learning, allowing the opportunity to spin true-to-life pictures as well as assisting in visualizing content (Steinbach, 2011).
3D app technology increases student engagement by including richer experiences through high-definition audio and video, quality multimedia option, interactivity, access to web content, and 3D graphics (Gutierrez, Abud, Vera, & Sanchez, 2013; Montserrat, Belen, Rodriguez, Jorge, & Rodriguez, 2013). The technology can offer interactivity for learning ECG content and provide plentiful practice opportunities on mobile devices within current classroom pedagogies.
METHOD
This research study used a quasiexperimental research design with one experimental group and one control group. The 3D app functioned as the independent variable; the dependent variable was the nursing student's level of knowledge as evidenced by examination performance. The study was granted approval from the institutional review board at the university where the researcher was enrolled in a doctoral program; reciprocal approval was also granted from the institutional review board at the university where the study took place.
The sample consisted of 50 undergraduate nursing students enrolled in a critical care course at a private university in the southeast. Participants were asked to complete a computerized 10-item pretest prior to the presentation of the ECG traditional lecture content, which was provided to all students. An outline that aligned classroom lecture objectives for ECG content was used in both learning experiences in order to ensure that the same objectives were taught by both teaching methods. The researcher used Gagne, Briggs, and Wagner's (1992) nine events of instruction as the framework to guide the instructional sequence to provide consistent structure for both teaching strategies in both learning environments. Of the 25 participants randomized to the control group. 22 completed the posttest following the ECG traditional lecture intervention.
For the experimental group's 3D app learning session, the investigator provided iPads with the 3D app downloaded and ready for use. The first 10 minutes of the session included an orientation that demonstrated the interactive components of the app (animations, videos, sound, and content). All 25 participants randomized to the experimental group completed the posttest the day following their 3D app learning session intervention. The control group was offered a 3D app learning session at a later time so that both groups completed the 3D content prior to the scheduled course examination.
FINDINGS
The sample consisted of 50 traditional and nontraditional undergraduate nursing students. Most (n = 47, 94 percent) were women; the majority (n = 44, 88 percent) were Caucasian, with three African American and three Hispanic American students. The majority (n = 35, 70 percent) were between the ages of 19 and 24; 11 students (22 percent) were 25 to 31 years of age, and three (6 percent) were ages 32 to 40. Asked about marital status, 42 students (84 percent) indicated that they were single. Students enrolled in the critical care course followed four different university tracks: 11 traditional undergraduate, 18 transfer students following traditional track, 11 second-degree students following traditional track, and 10 accelerated students.
Data were entered into SPSS for statistical analyses. At the .05 level of significance, an independent t-test indicated no statistically significant difference between posttest scores for the control group and the experimental group, t(45) = -0.17, p = .248, d = -0.35, 95% CI (-1.26, 0.34). The 3D app technology did not have any significant effect (p = .248) on nursing students' level of ECG knowledge as evidenced by exam performance.
Paired (dependent) t-tests of the pretest were conducted with the posttest control and posttest experimental groups in order to compare the means for the same groups of participants at two different points in time. There was no statistically significant difference between the pretest and posttest scores, but the mean of the posttest scores increased for both groups: control (pretest, M = 4.90, SD = 1.66; posttest, M = 7.45, SD = 1.22) and experimental (pretest, M = 5.52, SD = 1.44; posttest, M = 7.92, SD = 1.47).
DISCUSSION AND LIMITATIONS
In this study, the means of the experimental and control groups' posttest scores increased from the pretest, which may indicate to nurse educators that students are learning from both teaching methods. The small convenience sample was a limitation of this study. In addition, a time lapse and learning effect could have existed, since the 3D app learning session took place the day following the traditional lecture.
This study is the first to report a positive or negative effect on student examination scores using 3D app technology for ECG interpretation by nursing students. The results suggest that nurse educators should consider the use of this technology for this purpose. The importance of the ability to identify normal versus abnormal or life-threatening ECG rhythms cannot be overstated. Because of the seriousness of patient outcomes (saving patients' lives) that can be altered by correctly (or incorrectly) interpreting ECG rhythms, additional teaching strategies should be considered.
On the basis of the findings from this study, further research is recommended. First, replication with a larger sample size and multiple sites would result in a more diverse sample and would increase generalizability. Second, replication with an extended design should be completed longitudinally in order to achieve cumulative data for analysis. Third, retesting the 10-item test needs to be done multiple times in order to accumulate data on each test item. Finally, a qualitative study examining students' perceptions of learning using 3D app technology and their learning experience on a mobile device should be completed.
CONCLUSION
Although this study's findings did not show a statistical difference in learning from 3D app technology for ECG knowledge, the findings do provide a starting point for future research utilizing 3D app technology in nursing. More research is warranted in order to validate 3D technology as an evidence-based teaching methodology for nursing. The benefits of the interactivity of 3D app technology and how this technology enables alternative teaching methods, compared to traditional lecture, is important for nursing students learning ECG interpretation.
REFERENCES