Design and validation of a three-instrument toolkit for the assessment of competence in electrocardiogram rhythm recognition

Background: Rapid and accurate interpretation of cardiac arrhythmias by nurses has been linked with safe practice and positive patient outcomes. Although training in electrocardiogram (ECG) rhythm recognition is part of most undergraduate nursing programmes, research continues to suggest that nurses and nursing students lack competence in recognising cardiac rhythms. In order to promote patient safety, nursing educators must develop valid and reliable assessment tools that allow the rigorous assessment of this competence before nursing students are allowed to practise without supervision. Aim: To develop and psychometrically evaluate a toolkit to holistically assess competence in ECG rhythm recognition. Methods: Following a convenience sampling technique, 293 nursing students from a nursing faculty in a Spanish university were recruited for the study. The following three instruments were developed and psychometrically tested: a knowledge assessment tool (ECG-KAT), a skills assessment tool (ECG-SAT) and a self-efficacy assessment tool (ECG-SES). Reliability and validity (content, criterion and construct) of these tools were meticulously examined. Results: A high Cronbach’s alpha coefficient demonstrated the excellent reliability of the instruments (ECG-KAT=0.89; ECG-SAT=0.93; ECG-SES=0.98). An excellent context validity index (S-CVI/Ave>0.94) and very good criterion validity were evidenced for all the tools. Regarding construct validity, principal component analysis revealed that all items comprising the instruments contributed to measure knowledge, skills or self-efficacy in ECG rhythm recognition. Moreover, known-groups analysis showed the tools’ ability to detect expected differences in competence between groups with different training experiences. Conclusion: The three-instrument toolkit developed showed excellent psychometric properties for measuring competence in ECG rhythm recognition

Impact of multimodal interventions on medication nonadherence among elderly hypertensives: a randomized controlled study

Melita Sheilini,1 H Manjunatha Hande,2 Mukhyaprana M Prabhu,2 Mamatha Shivananda Pai,3 Anice George41Department of Medical Surgical Nursing, Manipal College of Nursing Manipal, MAHE, Manipal, Udupi District, Karnataka, India; 2Department of Medicine, Kasturba Hospital, MAHE, Manipal, Udupi District, Karnataka, India; 3Department of Child Health Nursing, Manipal College of Nursing Manipal, MAHE, Manipal, Udupi District, Karnataka, India; 4Department of Child Health Nursing, Manipal College of Nursing Manipal, Manipal MAHE, Manipal, Udupi District, Karnataka, IndiaPurpose: The study was conducted to investigate the effects of multimodal interventions on medication nonadherence, quality of life (QoL), hypertension (HTN), self-efficacy, and clinical outcome in terms of blood pressure (BP) among elderly people with HTN.Methods: An experimental design using a randomized controlled trial was adopted (N=80+80). The experimental group received multimodal interventions and the control group received routine care. Both groups were followed up at baseline and at 3 and 6 months. The data collection tools of demographic and clinical proforma, structured knowledge questionnaire on HTN (r=0.84), Revised Medication Adherence Self-Efficacy Scale (r=0.94), Morisky Medication Adherence Scale (r=0.83), World Health Organization Quality of Life-BREF scale (r=0.87), and digital BP apparatus were used. Necessary administrative permission was obtained for the study.Results: The study results proved that nurse-led multimodal interventions led to an improvement in medication adherence [F(1.75,214.30)=774.18, p<0.001], knowledge on HTN [F(2,244)=43.83, p<0.001], and self-efficacy [F(1,122)=3.99, p=0.04] of elderly people on antihypertensives over a period of 6 months. Overall QoL did not exhibit any statistically significant improvement, and no statistically significant reductions in the systolic BP (SBP) and diastolic BP (DBP) scores were obtained (p>0.05) in the experimental group over a period of 6 months. However, the clinical significance of multimodal interventions for improvements in medication adherence, QoL, knowledge on HTN, and self-efficacy was more favorable compared with the reduction in SBP and DBP scores.Conclusion: Nurses play a crucial role in improving medication adherence among elderly people with HTN.Trial details: Ethical clearance was obtained (IEC no. KH IEC 253/2012) from the Institutional Ethical Committee of Manipal University, Manipal, and the study was conducted in accordance with the Declaration of Helsinki. The study is registered under Clinical Trials Registry of India (CTRI/2017/04/008405). Informed consent was obtained from participants, and the confidentiality of information was assured.Keywords: hypertension, elderly, medication adherence, knowledge, self-efficacy, quality of lif