working in sdm hospital dharawad”

i

“A COMPARATIVE STUDY TO EVALUATE THE EFFECTIVENESS OF

VIDEO ASSISTED TEACHING (VAT) AND POWER-POINT

PRESENTATION (PPT) ON KNOWLEDGE REGARDING RECORDING

AND INTERPRETATION OF 12 LEAD ECG AMONG STAFF NURSES

WORKING IN SDM HOSPITAL DHARAWAD”

By

MR. SHIVAPPA I. BANNUR.

DISSERTATIONSUBMITTED TO THE

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,KARNATAKA, INDIA

In partial fulfillment of the requirement

For the degree of

MASTER OF SCIENCE

IN

MEDICAL SURGICAL NURSING

Under the guidance of

MR.ANANDA KUDARIM.Sc.[N]

ASSOCIATE PROFESSOR &HOD.

Medical – Surgical Nursing

SDM Institute of Nursing SciencesDharwad-58009, Karnataka

2018

IX

LIST OF ABBREVIATIONS

ABBREVIATION EXPANSIONS

Df Degree of freedom

ECG Electrocardiogram

PPT PowerPoint presentation

SD Standard Deviation

SDM Sri Dharmasthala Manjunatheshwara

SE Standard Error

VAT Video assisted teaching

X

LIST OF TABLES

SL .NO TABLES PAGE. NO.

1 Distribution of respondents by pre-test level of

knowledge

42

2 Comparison of pre-test and post-test knowledge scores

of VAT Group by paired‘t’ test

43

3 Comparison of pre-test and post-test knowledge scores

of PPT Group by paired‘t’ test

44

4 Comparison of PPT & VAT Groups with post-test

knowledge scores of both groups by un-paired ‘t’ test

45

xi

LIST OF FIGURES

SL.NO FIGURES PAGE. NO

1 Conceptual framework

16

2 Schematic presentation of study design

38

3 Pie diagram showing distribution of respondents

by pre-test levels of knowledge score.

43

4 Cylinder diagram showing Comparison of pre-test

and post-test knowledge scores of PPT Group by

paired‘t’ test

44

5 Cylinder diagram showing Comparison of pre-test

and post-test knowledge scores of PPT Group by

paired‘t’ test.

45

6 Bar diagram showing Comparison of PPT & VAT

Groups with post-test knowledge scores.

46

xiii

STRUCTURED ABSTRACT

“A comparative study to evaluate the effectiveness of video assisted

teaching(VAT) and power-point presentation(PPT) on knowledge regarding

recording and interpretation of 12 lead ECG among staff nurses working in

SDM hospital Dharwad”

An electrocardiogram is a graphical representation of electrical activity of the heart

and it is an important part of the initial evaluation of a patient who is suspected to

have a heart related problems. There are 12 electrodes that are applied to the patient's

chest, arms and legs. Interpretation of ECG allows correlating the specific ECG

findings with the pathophysiology and clinical status of the patient.

Objectives of the study were to:

assess the existing level of knowledge of staff nurses regarding recording and

interpretation of 12 lead ECG.

evaluate the effectiveness of video assisted teaching and PPT presentation on

knowledge regarding recording and interpretation of 12 lead ECG.

compare the effectiveness of video assisted teaching and PPT presentation.

Methodology:

The Randomized Factorial research design was adopted for the present study. The

total of 40 staff nurse were selected by simple random sampling technique. Structured

knowledge questionnaire was used to collect the data and it was analyzed by

appropriate statistical methods

xiv

Results:

The result depicted that in post-test mean score of PPT was ±28.05 and SD ±2.96

whereas mean post-test score of VAT was ±24.25 and SD ±2.69. The calculated ‘t’

value was ±4.68 which was higher than the table value 2.02, which was highly

significant at p ≤0.05 level. Hence the research hypothesis was accepted.

Interpretation and Conclusion

Based on the research findings PPT presentation was effective comparing to Video

assisted teaching on knowledge of staff nurses regarding recording and interpretation

of 12-lead ECG.

Key words: Electrocardiogram, Knowledge, Staff nurse, Interpretation,

Effectiveness, PowerPoint, electrode.

Chapter-I Introduction

Page 1

CHAPTER-I




SDM hospital Dharawad”

INTRODUCTION

“Teaching is only demonstrating that it is possible. Learning is making

it possible yourself. ”

-Paulo Coelho.

Cardiovascular diseases are the world leading killer disease. The factors that make the

occurrence of cardiovascular diseases are more probable. The major risk factors

include overweight, central obesity, high BP, dyslipidemia, diabetes and unhealthy

dietary patterns. The WHO estimates that 60% of the world’s cardiac patients will be

Indian by 2010.Electrocardiography (ECG) is the most common diagnostic evaluation

for many cardiovascular disorders and also helps to make early diagnosis.1

An electrocardiogram is a graphical representation of electrical activity of the

heart and it is an important part of the initial evaluation of a patient who is suspected

to have a heart related problems. It may be taken at rest or during exercises. The ECG

can provide important information about the patient's heart rhythm, a previous heart

attack, increased thickness of heart muscle, and signs of decreased oxygen delivery to

the heart, and problems with conduction of the electrical current from one portion of

the heart to another. There are 12 electrodes that are applied to the patient's chest,

arms and legs. The wires are used to connect the patient to the electrocardiogram


Page 2

machine or galvanometer. The electrical activity generated by the patient's heart is

processed by the ECG machine and then printed on a special graph paper. This is then

interpreted by the physician or expert2.

The ECG has evolved over the years. To fully understand how an ECG reveals

useful information about the condition of the heart requires a basic understanding of

Anatomy and Physiology of heart. Without the benefit of an ECG it may be

impossible to tell whether these symptoms are explained by an illness, injury or

condition known to not affect heart an ECG will generally be done3.

Interpretation of ECG allows diagnosis of a wide range of heart

conditions. These conditions are varying from minor to life threatening. ECG

terminology and diagnostic criteria and interpretation often vary from book to book

and from one teacher to another. Finally, it is important to recognize that the mastery

of ECG interpretation, one of the most useful clinical tools in medicine, can only

occur if one acquires considerable experience in reading ECG’s and correlating the

specific ECG findings with the pathophysiology and clinical status of the patient.

ECG can act as a diagnostic procedure for all clinical findings4.

The Video assisted teaching programme is easy to access anytime with video

lectures. Individuals can learn anywhere from their mobile devices, laptops, tablets or

smart phones. And can learn whenever individual’s wants and easy to delivers

information, also it gives opportunities for self-studying and gives chances for self-

testing. Video assisted teaching is an effective means of promoting knowledge among

individuals5.


Page 3

PowerPoint Presentation is one of the most helping factors behind success of

every teaching. There are various uses of power point presentations, some of them are

integrated. The most popular uses of power point presentations in modern days are

learning, training employers of an organization, continuing education, staff

development and in-service education programs.

Power point presentation combines audio and visual both aspects, making it easier to

understand for audience. Even the normal teaching or training becomes interactive by

just using presentations in lectures6.

Among health care providers Nurses play a vital role in identification and

management of cardiac abnormalities so the nurse should have knowledge regarding

ECG and its interpretation which is essential for identifying potential life threatening

situations and ensuring appropriate and timely interventions which will promote to

optimal patient outcomes leading to improvement in the quality nursing care and also

in the prevention, diagnosis, and treatment of heart diseases, heart attacks, and other

cardiovascular health issues.

NEED FOR THE STUDY

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.It is appropriately used as a screening test in many

circumstances.7

ECGs are often performed when a patient complains of light headedness, palpitations,

or syncope (passing out) since abnormal heart rate and rhythms may affect the heart's

ability to pump blood and provide the body with oxygen. Interpreting an ECG

requires a fair amount of education and experience. The ECG is just one test to assess


Page 4

the heart. The ECG assessment includes the determination of the rate, assessment of

the rhythm, evaluation of the electrical conduction patterns of the Heart8.

ECG monitoring is one of the most valuable diagnostic tools in modern

medicine. The goal of ECG monitoring in hospital setting have expanded from simple

heart rate and basic rhythm interpretation to diagnosis of complex cardiac arrhythmias

myocardial ischemia and prolonged QT interval and many more9.

Good patient care dictates that nurses have a basic knowledge of ECG

recording and interpretation. Even with technological advances providing electronic

ECG interpretation, nurses maintain a responsibility for understanding the

significance of changes in the patient's condition and responding appropriately.

Knowledge of ECGs contributes to the nurse's confidence in recognizing and

managing effectively the contingencies of patient care10

.

Video assisted teaching is a method of teaching that engages viewers from multiple

senses – sight and sound – and can generate excitement about a subject or concept.

Students will enjoy the effectively. Designed video can grab a student’s attention,

spark curiosity, and provide value to the course content. Stimulate a focused

discussion guided by the instructor. Video is clearly an instructional medium that is

compelling and generates a much greater amount of interest and enjoyment than the

more traditional printed material. Video stimulates and engages students creating

interest and maintaining that interest for longer periods of time, and it provides an

innovative and effective means for educators to address and deliver the required

curriculum content11

.

PowerPoint, when used effectively, can really enhance teacher presentations and the

overall comprehension of students. It is a program that allows teachers to present their


Page 5

lessons in a more dynamic way than simply lecturing and writing on the blackboard.

PowerPoint has become very popular because it's easy to learn and widely available.

It provides the ability to equip individual’s presentations with different types of media

- including images, sounds, animations, and much more. This enhances the students'

abilities to retain what they're being taught, especially those who are visual learners.

Teachers can focus on the class and interacting with the students instead of writing on

a board, because the text and the entire presentation is already there in the form of a

PowerPoint file12

.

Nurses must incorporate scientific knowledge and technical advances into their

practice to assist the patients in remaining well and functioning at the maximum level.

Especially in critical care units of hospitals, with the advancing science and

technology on par with doctors, the nurses should upgrade their knowledge regarding

the recording and interpretation of 12 lead ECG. They must be able to identify how to

record and Interpret the 12 lead ECG13

.

Understanding and interpreting a standard 12-lead ECG can prove to be a

quite difficult task, especially for nursing students and practicing nurses at their first

contact with clinical cases requiring an accurate interpretation of an ECG14

.

A study was conducted in Tamilnadu, to evaluate the effectiveness of Video

Assisted Teaching Programme on Knowledge regarding Identification and

Management of selected Cardiac Arrhythmias among Staff Nurses. 30 nurses were

selected by simple random sampling technique and were divided into 2 groups

Experimental and control group. Structured tool-for identification and management of

cardiac arrhythmias was used for assessing level of knowledge. The findings revealed

that there was no significant association between post-test scores of nurses in


Page 6

experimental group and their selected demographic variables. Study concluded that

the video assisted teaching program was most effective on knowledge regarding

identification and management of selected cardiac arrhythmias among nurses15

.

Nurses being a member of the health team should be able to record and

interpret ECG findings up to her extent of practice needed in clinical settings.

Interpretation of ECG is the conclusion of identifying normal and abnormal findings

among cardiovascular diseases with the help of measurements, rhythm analysis,

conduction analysis, wave form description16

.

It is important that staff nurses are able to identify the location of cardiac

muscle ischemia, injury and infarction and the E.C.G. Knowing the site of infarction

is essential in anticipating clinical manifestations and therefore has implication for the

patient’s plan of care. Hence the investigator strongly feels that there is a need for

conducting a video assisted teaching and power point presentation to enhance nurses

knowledge regarding recording and interpretation of ECG as it helps them to identify

and manage the cardiac disease early.

Chapter-II Objectives

Page 7

CHAPTER-II

OBJECTIVES

This chapter deals with the statement of the problem, objectives of the study,

operational definitions, and hypothesis of the study, assumptions, delimitation and

conceptual framework.

STATEMENT OF THE PROBLEM:





OBJECTIVES OF THE STUDY:

Objectives of the study are to,



evaluate the effectiveness of video assisted teaching on knowledge regarding

recording and interpretation of 12 lead ECG.

evaluate the effectiveness of PPT on knowledge regarding recording and



OPERATIONAL DEFINITIONS:

EFFECTIVENESS: It refers to the desired changes in knowledge of staff

nurses on recording and interpretation of 12 leads ECG through video


Page 8

assisted teaching (VAT) and PowerPoint presentation (PPT) which will be

measured in terms of significant gain in knowledge in the post test scores.

EVALUATION: In this study, it refers to the extent to which video assisted

teaching and PPT presentation will attain the desired gain in knowledge of

staff nurses on recording and interpretation of 12 lead ECG scores as

measured by structured knowledge questionnaires’.

Video assisted teaching: It refers to method of teaching that engages viewers

from multiple senses, sight, sound that can generate excitement about subject

which involves description regarding ECG, Types, procedure of taking ECG

and its interpretation.

PPT presentation: It refers to planned and well organized teaching, by use

of power point templates slides which contain description regarding ECG,

Types, procedure of taking ECG and its interpretation

KNOWLEDGE: it refers to the correct response of the staff nurses to the

structured knowledge questionnaires on recording and interpretation of 12

lead ECGwhich includes,

Remembering: terms, basic concepts.

Comprehending: understanding of faith and ideas by organizing,

comparing, translating, interpreting ect.

Applying: which includes using acquired knowledge, solving

problem in a new situation by acquired knowledge, facts, and

techniques.

Analyzing: it includes examining and breaking information into

component parts and making inference and find evidence to support

generalization.


Page 9

Synthesizing: which includes production of unique communication,

proposed set of operation, derivation of a set of a abstracts relations.

Recording and interpretation of 12 lead ECG: It refers to the procedure of

12-lead ECG for obtaining a strip of ECG graph paper and interpreting it in a

systematic manner. It is seen as different wave patterns, segments, intervals,

etc. and understanding normal ECG and some of the abnormal conditions like

Sinus Bradycardia and Sinus Tachycardia.

STAFF NURSES: It refers to the person/individual working in a hospital

setting after completion of his/her diploma/degree in nursing and has

registered in state nursing council.

HYPOTHESES:

Hypotheses will be tested at 0.05 level of significance

H1: There will be a significant difference between pretest and posttest mean

scores after video assisted teaching among staff nurses on recording and



scores after PPT presentation among staff nurses on recording and


H3: There will be a significant difference between mean posttest of VAT and

mean posttest of PPT knowledge scores of staff nurses on recording and



Page 10

ASSUMPTIONS:

The assumptions of the study are,

The staff nurses are having certain knowledge regarding recording and


Knowledge of staff nurses on recording and interpretation of 12 lead ECG

will increase aftervideo assisted teaching and power point presentation

teaching programme.

DELIMITATIONS:

The study is delimited to the,

staff nurses who were working in SDM Hospital Dharwad.

prescribed data collection period was limited to 4-6weeks

CONCEPTUAL FRAMEWORK

A conceptual framework is an abstract, logical structure meaning such as a portion

of theory or model which guides the development of the study and enables the

researcher to link the findings to nursing’s body of knowledge . It is an overall

underpinning of a study. Conceptual framework considered as road map for the

researcher. It represents ideas or notions that have been put together in a unique way

to describe areas of concern. Conceptual model assist individuals in organizing their

thinking in order to select a focus of study and interpreting the findings.

The proposed study concentrated on effectiveness of Video assisted teaching (VAT)

and PowerPoint presentation (PPT) on knowledge regarding recording and

interpretation of 12-lead ECG; hence conceptual framework developed for the

present study is based on modified Gagne’s 9 Events of Instruction Model. Robert


Page 11

Gagne was born in 1916 in New Andover, Massachussetts. He graduated from Yale

University with his A.B. and graduated with his PhD. in Psychology from Brown

University in 1940. Gagne worked in the Air Force as a research director of the

perceptual and motor skills laboratory. While conducting his research there, he

began to form his ideas that made up his theory of Conditions of Learning. Gagne

published many books and articles relating to his learning theory. He also worked at

Florida State University as a Professor in the Department of Educational Research.

Gagne's instructional theory has been a prominent force in the area of instructional

design and his influence will be felt for years to come.

Gagne’s9Events ofInstruction

1. Gain attention of learners (reception)

2. Inform learners of learning objectives (expectancy)

3. Stimulate recall of prior learning (retrieval)

4. Present content (stimulus); break it down into components to avoid

information overload (selective perception)

5. Provide "learning guidance" (semantic encoding)

6. Elicit performance (practice/ responding)

7. Provide feedback to learners (reinforcement)

8. Assess their performance (retrieval of information)

9. Enhance knowledge retention and transfer to real-life, authentic work

(generalization)


Page 12

1. Gain attention of learners (reception)

This is accomplished by having the learners and their managers discuss

what they need to learn and be able to perform when they finish the

training.

Welcomed Participants and grabbed attention through thought provoking

questions on 12lead ECG

2. Inform learners of learning objectives (expectancy)

This allows the learners to organize their thoughts on what they will

learn and perform. Include learning objectives in lecture slides, the syllabus,

and in instructions for activities, projects, papers, and so on.

.In present study learning objectives are communicated to the

participants/subjects and convey to staff nurses about need to acquire

knowledge and importance of having knowledge on 12-lead ECG and its

application in clinical area.

3. Stimulate recall of prior learning (retrieval)

Allow students to build on previous knowledge or skills. Recall events from

previous lecture, integrate results of activities into the current topic, and/or relate

previous information to the current topic. Give surveys eliciting opinions,

attitudes, or perceptions of previous materials. Moderate discussions about the

poll results.

In present study instruct the staff nurses to recall and remember

previous lecturer and bridge the results of activities into the present research

topic that is recording and interpretation of 12-lead ECG.


Page 13

4. Present thecontent: ( Stimulus)

Utilize a variety of methods including lecture, readings, activities, projects,

multimedia, and others. Present or post content via a learning management

system to allow students to access the materials outside of course meeting

times. In face to face courses, integrate the use of clickers to keep student

attention during content presentation.

In present study, the teaching will be delivered by using Video

Assisted Teaching and Power Point presentation to subjects which includes

Anatomy and Physiology of Heart, Conduction system of the heart,

Definition, principles, clinical uses, components of ECG,

electrocardiographic leads and their placements and about interpretation of

sinus Bradycardia and Tachycardia.

5. Provide "learning guidance" (semantic encoding)

Provide students with instructions on how to learn, such as guided

activities. With learning guidance, the rate of learning increases because

students are less likely to lose time or become frustrated by basing performance

on incorrect facts or poorly understood concepts.

Provide staff nurses with instruction and guidelines on how to learn 12-lead

ECG including knowing anatomy and physiology of heart, conduction system

of the heart, placement of chest and limb leads and how to interpret 12-lead

ECG.


Page 14

6. Elicit performance (practice/ responding)

Allow students to apply knowledge learned in group or individual projects and

activities, written assignments, lab practical, and so on.

In present study after educational programme encouraged the staff nurses to

apply their learned knowledge in clinical area.

7. Provide feedback to learners (reinforcement)

Allow students to receive feedback on individualized tasks, thereby correcting

isolated problems rather than having little idea of where problems and

inconsistencies in learning are occurring.

In present study researcher instructed and provided feed back with

subjects on one to one bases and observed, where to improve, how to

improve, what the difficulties of subjects are, how to solve the problems and

how to improve their knowledge regarding recording and interpretation of

12lead ECG.

8. Assess their performance (retrieval of information)

Allow students to see content areas that they have not mastered. Utilize a variety

of assessment methods including exams/quizzes, written assignments, projects,

and so on. Utilize rubrics when grading activities that are not standard exam and

quiz questions.

In present study post-test was conducted by using structured knowledge

questionnaire on 7th day of intervention to assess their knowledge regarding

recording and interpretation of 12lead ECG gained through educational

programme.


Page 15

9. Enhance retentionandtransfertothejob:( G e n e r a l i z a t i o n )

Allow students to apply information to personal contexts. This increases

retention by personalizing information. Provide opportunities for

students to relate course work to their personal experiences when

designing essays and projects.

In present study provide chance for the staff nurses to use

their gained knowledge in clinical area to increase their performance

and productivity.


Page 16Fig-1 MODIFIED GAGNE’S 9 EVENTS OF INSTRUCTION MODEL





Chapter-III Review of literature

Page 17

CHAPTER-III

REVIEW OF LITERATURE

Review of literature is the key step in the process. It refers to an extensive, exhaustive

and systemic examination of publications relevant to the research project. It involves

the systemic identification, location, and summary of the written materials that

contain information on research problem. A literature review helps to lay foundation

for a study and can also inspire new research ideas. It provides basis for future

investigations and justifies the replication. Thus the literature review sometimes

precedes the delineation of the research problem.

In this chapter, the investigator presented the review of literature under the

following headings.

1. Literature related to knowledge on 12-lead ECG.

2. Literature related to recording and interpretation on 12-lead ECG.

3. Literature related to effectiveness of teaching programme on knowledge and

practice on ECG.

Literature related to knowledge on 12-lead ECG.

A cross-sectional study was conducted in university of Thiqre Al Nasiriyah – IRAK

on evaluation of nurses’ knowledge and practice of electrocardiogram toward Adolescent

Patient. A random sampling technique was used to select 102 nurses who are working in

CCU, ICU, and Emergency Unit. Tool used for data collection was self-administered

questionnaire related to demographic characteristics of the nurses, and observational checklist

for nurses' practice regarding ECG implementation. The findings of the study indicates that

the electrocardiogram toward adolescent patient affect the knowledge and practices domains.

The study showed that the percentage of successful knowledge about electrocardiogram is


Page 18

74.5 %, while the proportion of failures 25.5% there is no significant association of

knowledge and Practices with demographic data. The study concluded that intensive training

courses for staff nurses were necessary under the supervision of qualified well trained staff to

improve the knowledge of ECG17

.

A qualitative research study was conducted in florida to assess the

perception of arrhythmia knowledge of critical care nurses, purposeful samplng

technique was used to create group, five focus groups were conducted over the period

of 12 months, group size ranged from 4 to 8 participants . Semi structured group

session, was used to gather data and participants were asked to describe their

perception of arrhythmia knowledge and to assign a rating score related to the

knowledge need to identify specific arrhythmias the data from these focus groups

revealed a deficit in nurses ability to recognize and identify specific arrhythmias .

there was a significant lack of ability to recognize and differenciate heart blocks and

tachy arrhythmias in addition lead placements concepts were not fully understood.

The study concluded that insight and perspective of critical care nurses related to level

of arrhythmias knowledge was needed for development of competence measures and

evidenced based teaching stratergies18

.

A study was conducted to assess the nurse’s knowledge and practice related

to ECG monitoring in America from September 2008 to June 2009. Sample size

consisted of 1739 nurses working on adult cardiac units in 17 hospitals. Data was

collected through online demographic form and a 20-item knowledge test that covered

essentials of ECG monitoring and arrhythmia, ischemia, and QT-interval monitoring.

The result shows that 89% female are 72% white are with a mean age of 38 (SD, 11)

years; 74% had a bachelor’s degree or higher. The mean test score was 48 (SD, 12;

range, 6 - 90). Of the 4 subsections, nurses had the highest mean score (52; SD, 16)


Page 19

on the essentials of ECG monitoring and had the lowest mean score (36; SD, 23) on

ischemia monitoring. The study concluded that, nurses' knowledge about ECG

monitoring has to be improved19

.

A cross sectional research study was conducted in Narayana College of

nursing, Nellore to Assess the knowledge of final year B.Sc.(N) students regarding

electrocardiogram. Thirty subjects were selected by Non Probability Convenience

Sampling Technique. Semi structured Questionnaire was used for collecting the data.

The results revealed that 15 (50%) nursing students have inadequate knowledge,

6(20%) nursing students have moderately adequate knowledge and only 9 (30%)

nursing students have adequate knowledge regarding ECG. The study concluded that

majority of nursing students had inadequate knowledge and source of information

given showed significant association with level of knowledg20

.

Literature related to recording and interpretation on 12-lead ECG.

A study was conducted in college of nursing, Chonbuk national university

Seoul, South Korea to assess cardiac status of patients in intensive care units. The

participants in this survey research were 156 nurses from 25 intensive care units

distributed in five hospitals with more than 1,000 beds each in Seoul, South Korea.

They were selected by convenient sampling technique. Knowledge of staff nurses

were assessed by using knowledge questionnaire which explored knowledge and

nursing practices regarding bedside ECG monitoring Participants showed limited and

incorrect knowledge and nursing practices. Only 4 (2.6%) participants correctly

answered to all electrode placement sites of RA, LA, LL, and V1. Lead II was the

most frequently monitored unit regardless of the main purpose of ECG monitoring;

the study concluded that Educators and clinicians alike need to make an effort to


Page 20

ensure that a safe level of knowledge and practices for the monitoring is maintained in

order to make sure that patient outcomes are not compromised21

.

The study was conducted in western Sweden to describe ambulance nurses’

practical electrocardiogram (ECG) interpretation skills and to measure the correlation

between these skills and factors that may impact on the level of knowledge. A

convenience sampling method was used to select the samples among ambulance

nurses in three different districts. Tool used for the study was prospective quantitative

survey with knowledge questionnaires. The data were collected and analyzed by using

Mann–Whitney U test, Kruskal–Wallis test and Spearman’s rank correlation. The

results showed that on average, the respondents had 54% correct answers on the test

and identified 46% of the ECGs indicating acute myocardial infarction. The median

total score was 9 of 16 (interquartile range 7–11) and 1 of 3 (IQR 1–2) in infarction

points. No correlation between ECG interpretation skill and factors such as education

and professional experience was found, except that coronary care unit experience was

associated with better results on the ECG test. This study concluded that Ambulance

nurses had deficiencies in their ECG interpretation skills. The study showed that

neither education, extensive experience in ambulance service, contributed to an

improved result. The only factor of importance for higher ECG interpretation

knowledge was prior experience of working in a coronary care unit22

.

A study was under taken in Trivandrum to assess the knowledge regarding

interpretation of life threatening arrhythmias and its emergency management among

cardiac nurses. Forty five cardiac nurses were purposely selected from CMICU,

CSICU, and CHICU. Structured knowledge questionnaire consisting of 14 questions

regarding ECG interpretation and its emergency management were used for data

collection. Based on the findings of the study 88.88% of cardiac nurses had above


Page 21

average level of knowledge about arrhythmia interpretation and its emergency

man1agement23

.

A comparative study was conducted to compare the six-stage method (SSM)

for instructing primary cardiac arrhythmias interpretation to students without basic

electrocardiogram (ECG) knowledge with a descriptive teaching method in a single

educational intervention for which 134 students were divided into 2 groups group A

for instructional session, and group B for descriptive teaching method. Overall results

showed that the SSM was equally effective with the descriptive teaching method.

Finally study concluded that the SSM effectively develops staff competency for

interpreting common cardiac arrhythmias in students without ECG knowledge24

.

Literature related to effectiveness of teaching programme on knowledge

and practice on ECG.

A Pre-experimental study was conducted in Manipal college of nursing, Manipal

university on effectiveness of educational intervention on ECG monitoring and

interpretation among nursing students. Samples for the study were 40 M.Sc.

nursing 1st year students who were selected by using convenient sampling

technique. The data collection instruments were demographic Performa,

Structured knowledge questionnaire on ECG monitoring and interpretation and

tool to assess skill in ECG interpretation. The teaching was done on the same day

after pretest. The post test was conducted one month after the intervention. The

result showed that there was no one with the poor knowledge prior to the

intervention but still some improvement was seen in the knowledge after

intervention but there was significant improvement in the skill of interpreting

ECG after the intervention among nursing students. It proves that the teaching

program conducted in this study worked as reinforcement for the students as the


Page 22

basics of ECG. The study concluded that electrocardiographic monitoring is a

cornerstone of the intensive care units. The quick response of the nurses to life

threatening arrhythmias plays a central role in the prevention of sudden death in

the hospital25

.

A quasi-experimental study was conducted in university of Pittsburgh,

Pennsylvania to compare traditional instruction vs. asynchronous online video lecture

on knowledge skill and attitude of 12 leads ECG among nurses’ anesthesia students.

In the study Knowledge, analytical skill, satisfaction and attitude were measured

using 3 instruments developed by the investigator. Knowledge was measured using

pretest/posttest examination items and a 12 lead EKG analytical skill examination

(ASE) was used to evaluate the ability to recognize abnormalities and interpret the

findings. Satisfaction was measured using items adapted from the University of

Pittsburgh Office of Measurement and Evaluation (OMET) course surveys. Attitude

about factors associated with online instruction was measured using a 5-point Likert

scale instrument. A 25 point pretest containing 21 short answer and 4 multiple choice

questions was administered. The same test was administered as a posttest at the

conclusion of the class to quantify the amount learned and compare the effectiveness

of the two educational methods. The study concluded that student’s attitudes

concerning online instruction improved after exposure to the online method of

teaching. These findings indicate that similar online activities can be successfully

incorporated into a Nurse Anesthesia curriculum while maintaining learning outcomes

and satisfaction26

.

A quasi-experimental study was conducted in emergency center, Zhongnan

hospital, Wuhan university, Wuhan, China to assess the effectiveness of an education

program on nurses’ knowledge of electrocardiogram interpretation. Fifty-two nurses,


Page 23

including 23 nurses working in an emergency department, 12 nurses working in a

cardiology department and 17 nurses working in an intensive care unit (ICU) were

recruited for the study. Two learning methods were used: a lecture-based education

program and a self-learning handbook. The effectiveness of the methods was

evaluated using a questionnaire containing five domains. Researchers conducted a

pretest and three post-test scores to determine the change in knowledge level in ECG

interpretation. The 52 participants began by filling out the demographic data

questionnaire. The participating nurses were instructed in the correct form to answer

the questions, and then they received the pretest on ECG knowledge. Immediately

after the pretest, the nurses attended the lecture based training program. Two weeks

after the lectures, the participants received the first post-test. Data analysis showed

that before training, nurses who worked in the cardiology department scored higher in

basic ECG knowledge than those in the emergency department and ICU test scores of

nurses who had worked for 2–10 years were higher than else. The post-test total and

domain scores at 2 weeks, and 4 months after the lecture-based learning and 1 month

after a self-learning ECG handbook was presented were higher than the pretest scores.

Study concluded that prior to training; ECG knowledge differed with respect to the

nurses’ different demographic characteristics. The lecture-based education program

and self-learning handbook material were effective in improving the nurses’ ECG

knowledge27

.

A quasi-experimental study was conducted in , college of nursing,

university of Baghdad, to evaluate effectiveness of nursing education program and

Practice toward Arrhythmia among nurses. Total of 80 staff nurses who were selected

through purposive sampling technique and were divided into 2 groups, 40 nurses

exposed to the nursing educational program and control group consisted of 40 nurses


Page 24

were not exposed to the program. Tool used was observational checklist which

included 25 items concerning ECG. The results of the study showed that the

effectiveness of educational program regarding nurses' practice toward arrhythmia

was positive and clear. It also showed that there is good improvement with highly

significant differences in study group in overall main domains related to nurses'

practice. The study concluded that majority of nurses’ had un satisfactory knowledge

and practice toward Arrhythmia before implementation of educational program and

after applying it, there was improvement in knoweldge28

.

A prospective study was conducted in George Washington university, to

evaluate the impact of an online asynchronous training module on the ability of

medical students and emergency medicine (EM) residents to detect ECG

abnormalities of acute myocardial infarction (AMI). Samples for the study were148

students and 35 EM residents .Tool used was online ECG training and testing

module on AMI, with emphasis on recognizing ST elevation myocardial infarction

(MI) and early activation of cardiac catheterization resources. Participants were

given a baseline set of ECGs for interpretation. This was followed by a brief

interactive online training module on recording and interpretation of 12 lead ECGs

as well as a recording and interpretation of 12 lead ECGs representing an acute MI.

Participants then underwent a post-test with a set of ECGs in which they had to

interpret and decide appropriate intervention including catheterization lab activation.

Results of the study showed significant improvements in recognizing ECG

abnormalities after taking the asynchronous online training module. the study

concluded that online interactive module of training improved the ability of medical

students and EM residents to correctly recognize the ECG evidence of an acute MI29

.


Page 25

A Pre – experimental study was conducted in Nursing College at Indore to

assess the effectiveness of structured teaching programme (STP) on knowledge on

‘electrocardiogram’ among nursing students. Total 30 samples were selected by Non

probability purposive sampling technique. Knowledge of staff nurses were assessed

by using knowledge questionnaires, the study showed that mean and standard

deviation in pretest assessment score was 7.93, (SD=3.12) and in posttest assessment

mean score was 23.8 (SD=3.08). The study concluded that the STP was effective and

helpful to raise the knowledge in the association between socio demographic

variables and pretest knowledge of 2nd year B.Sc Nursing students30

.

A quasi experimental study was conducted in 2004 to examine the effect of web

based teaching method among undergraduate nursing students on

electrocardiography. The study used a pre-test post-test experimental design. A total

of 105 senior nursing students were recruited at a university in Korea. In that 54

students were assigned to an experimental group & 51 were assigned to a control

group. Knowledge about ECG among students in the control group was significantly

lower than that of students in study group (p<0.01) conversely the ability to interpret

ECG recording was significantly higher among students in the web based group

(p<0.05). No significant difference found between the two groups in level of

motivation or satisfaction with learning. The self-directed web based ECG learning

programme appears to be effective in helping nursing students to interpret ECG

recordings31

.

A study was undertaken in University of Baghdad to evaluate the effectiveness of an

educational programme on the practices of the nursing staff concerning the

electrocardiographic procedural errors. Through random sampling 60 nurses were


Page 26

selected and divided into two groups, 30 in experimental and 30 in control group.

Tool used for the study was observational checklist including 30 items concerning

nurses' practice in preparation of ECG machine, location of limb leads and pericardial

electrodes placement and nursing intervention. Results of the study indicated that

there were highly significant differences between pre and post tests in the study group

,The study concluded that the educational program regarding nurses' practice

concerning the electrocardiographic procedural errors was positive and clear thus the

nursing staff can be encouraged and motivated to participate in the special training

programs and conference with leading ECG specialists who have long experience in

teaching ECG procedure to fulfill the nurses needs concerning defects and limitation

in their practices32

.

A pre experimental study was conducted in college of nursing Indore to determine

effectiveness of structured teaching programme on knowledge and interpretation of

ECG among staff nurses. Through purposive sampling technique 45 subjects, working

in open heart unit, step down ICU, and ICU were selected. Tool used for the study

was knowledge questionnaire which included items on knowledge and interpretation

of ECG ,pre test was taken to assess the pre interventional knowledge of the staff

nurses followed by educational programme on knowledge and interpretation of ECG,

and after 7 days post test was taken The findings showed that mean of post-test score

(12.8) was higher than pretest score (7.2) which indicated the effectiveness of

structured teaching programme in increasing the knowledge of staff nurses regarding

ECG33

.

A quantitative study was under taken in Govt. Medical College and Hospital,

Vandanam, Alappuzha on Effect of Planned Teaching Programme On

cardiotocography among Midwives. One group pre-test post-test design was used.


Page 27

Through convenient sampling 60 Midwives working in maternity areas of selected

hospital, were selected has samples for the study. The tools used were Self-

administered structured questionnaire to assess the socio demographic data and level

of knowledge of Midwives regarding cardiotocography. Level of pre-test knowledge

of midwives was assessed and Planned Teaching Programme on Cardiotocography

was administered on the same day of pre-test. After seven days of Planned Teaching

Programme Post test was conducted by using same questionnaire. Results of the study

revealed that mean improvement in knowledge 9.35 %.The result showed that the

Planned Teaching Programme was effective in improving level of knowledge

regarding Cardiotocography among Midwives .study concluded that Midwives had no

adequate knowledge on cardiotocography and the planned teaching programme was

effective in improving the level of knowledge regarding cardiotocography among

Midwives34

.

A study was done in University of Massachusetts – Amherst to Evaluate an

Educational Program for Improving the Accuracy of ECG Interpretation in Athletes

by Primary Care Clinicians. The goal for this project was to increase ECG

interpretation accuracy among primary care providers, including physicians and

nurse practitioners. A total of 13 care providers participated in the study and were

asked to assess 40 ECG strip and classify them as clear to compete or refer to further

workup. Then the participants completed a six-hour online education course related

to interpretation of ECG in athletes. After completion of the education program the

providers were asked to reinterpret the ECG as before and improvements in

interpretation and reduction of false positives were seen results showed a significant

decrease of false positive rates from 21% to 13% after Educational Program. Study


Page 28

concluded that education intervention was effective in increasing the accuracy of

ECG interpretation by primary care providers35

.

A quasi-experimental study was conducted in Iran to evaluate the

effectiveness of educational software method of arrhythmias stimulator on the level of

knowledge of electrocardiograms interpretation on nurses. A total 73 ICU and CCU

nurses were selected randomly and divided into 2 groups for the study. Data was

gathered by questionnaire which consisted of 15 theoretical questions and 25

arrhythmia strips in the form of pretest-posttest design. Results of the study showed

that The mean and standard deviation of the nurses’ before and after scores, the group

that used educational software of arrhythmia simulator method was 17.21 before

intervention and 22.15 after intervention respectively. Study Concluded that use of

educational software of arrhythmias simulator causes more improvement of the

knowledge of nurses in arrhythmias interpretation field36

.

A pre-experimental study was conducted in Navi Mumbai, Maharashtra to

assess the effectiveness of VAT on the Knowledge regarding selected aspects of

cardiac monitoring among the Staff Nurses. In the study a video on ECG was

developed to check the effectiveness of the video among the staff nurses of ICU with

respect to their level of knowledge in interpreting an ECG. Purposive sampling

technique was used to select the 50 staff nurses. Semi structured questionnaire was

used to collect the data. Result of the study showed that in pre test 38 staff nurses had

inadequate knowledge and 12 staff nurses had moderately adequate knowledge

however in the post test it is seen that only 7 staff nurses had inadequate knowledge.

Study result revealed that the mean post test score of knowledge was significantly

higher than the mean pre test knowledge score. Study concluded that video assisted


Page 29

tool created on selected aspect of cardiac monitoring (ECG) was a sound tool and it

helped the nurses to gain knowledge and put that into practice37

.

A correlational study was conducted in Spain to identify the association

between the use of web simulation electrocardiography and the learning approaches,

strategies and styles of nursing degree students.. The study sample included 246

students, Evaluation of Learning and Study Processes Questionnaire was used to

collect the data. A 3-hour educational intervention using the SS-ECG simulator was

conducted with groups of 15 students in two in-person stages.. Result of the study

showed after the introduction of web simulation electrocardiography, significant

differences were found in item scores of learning style. Study Concluded That use of

a web electrocardiogram (ECG) simulation is associated with the development of

active and reflexive learning styles, improving motivation and a deep approach in

nursing students38

.

Chapter-IV Methodology

Page 30

CHAPTER - IV

RESEARCH METHODOLOGY

Research methodology is a systematic way to solve a problem. It is a science of

studying how research is to be carried out. Essentially, the procedures by which

researchers go about their work of describing, explaining and predicting phenomena.

The chapter deals with the description of the research methodology adopted by

the investigator. The steps followed in the present study include Research approach,

Research design, research setting, population, sample and sample technique,

development and description of the tool, data collection procedure, pilot study, and

plan for data analysis.

RESEARCH APPROACH

Research approach is plan and procedure that consist of steps of broad

assumptions to detailed method of data collection, analysis and interpretation.

The research approach used for the present study was quantitative evaluative research

approach.

RESEARCH DESIGN

A research design is a blue print for conducting a study, the purpose of the design is to

maximize the control over factors that can interfere with the validity of findings. It is

an overall plan used by the investigator to obtain valid answers to research.

Quasi experimental with two group pre and posttest design was adopted for the

present study to evaluate the effectiveness of VAT and PPT presentation on

knowledge regarding recording and interpretation of 12-lead ECG


Page 31

Group

Staff nurses working in Group I O1 Xv O2

selected hospital Dharwad Group II O1 XpO2

KEY:

O1 - Pre-test by structured knowledge questionnaire

Xv - Intervention (video assisted teaching on interpretation and recording of 12 lead

ECG)

Xp - Intervention (PPT presentation on interpretation and recording of 12 lead ECG)

O2 - Posttest by same structured knowledge questionnaire.

VARIABLES UNDER STUDY

In quantitative studies concepts are usually referred to as variables which may be

qualities, properties, or characteristics of person, things or situations that can change

or vary.

The variables for the present study are

Independent variable: Video assisted teaching and power point presentation

Dependent variable: Knowledge of staff nurses on recording and


RESEARCH SETTING

The research setting refers to the area or physical location where study has been

conducted. The present study was conducted in SDM Tertiary Care Hospital

Dharwad.


Page 32

POPULATION

Population refers to well-defined collection of individuals or objects known to have

similar characteristics. In other words population is a set of people or entities to which

the results of research can be generalized.

In the proposed study population consisted of staff nurses working in hospital.

SAMPLING TECHNIQUE

Sampling is a process of selecting a portion of the population to represent the entire

population.

In the undertaken study simple random sampling technique was adopted. All together

40 Staff nurses were selected to include in the study by applying the below mentioned

sampling criteria.

Sampling criteria

The criteria for selection of the samples in the study involves

Inclusion criteria

Inclusion criteria are a set of predefined characteristics used to identify subjects who

are included in a research study.

In the present study the inclusion criteria are

The staff nurses who were,

working in SDM Hospital Dharwad.

willing to participate in the study.

working in Medical and Surgical wards and all Critical care areas.


Page 33

Exclusion criteria

Exclusion criteria are those characteristics that disqualify prospective subjects from

inclusion in the study.

In the present study the Exclusion criteria are

The staff nurses who were,

working in night shifts.

not available at the time of data collection.

SAMPLE SIZE

Sample size was a total of 40 staff nurses working in SDM hospital Dharwad

by applying inclusion and exclusion criteria from Medical, Surgical and all

critical care areas.

TOOLS USED FOR THE DATA COLLECTION

The most important aspect of any investigation is the collection of appropriate

information which provides necessary data to answer the question raised in the study.

The tool used for the study should be a vehicle that would provide data for drawing

conclusions pertaining to the study.

DEVELOPMENT OF THE TOOL

The tool was developed by the investigator based on

Research problem

Extensive review of related literature

Discussion and Suggestions from the guide and experts

Past clinical experiences

Preparation of blue prints


Page 34

DESCRIPTION OF THE TOOL

In the undertaken study structured knowledge questionnaire are

thought to be appropriate for the assessment of the knowledge of staff nurses

regarding recording and interpretation of 12-lead ECG

Prepared tool had been divided into three sections:

Section-1 – Consisted of 9 items were used to collect basic knowledge on

anatomy and physiology of heart.

Section-2 - Consisted of 9 items which included questions on recording of

electrocardiogram (ECG).

Section-3 – Consisted of 21 questions on interpretation of electrocardiogram

(ECG)

Scoring and interpretation

Total items were 39 each right answers carried ‘1’ marks and wrong answers carried

‘0’ marks

0-13= Poor knowledge

14-26= Average knowledge

27-39= Good knowledge

TESTING OF THE TOOL

Content validity of the tool

Content validity refers to the degree to which an instrument measure what it is

supposed to measure.

In order to obtain content validity, the prepared instrument along with problem

statement, operational definitions and blue print were submitted to seven experts from


Page 35

the field of medical surgical nursing and one expert from Medicine department. The

experts gave their valuable suggestions. As per the suggestions of the experts, more

interpretation of 12-lead ECG questionnaires were included before conducting pilot

study.

PILOT STUDY

Pilot study is a small preliminary investigation of the same general

characteristics of the main study. The main aim of the pilot study was to Find out the

feasibility and practicability of the study, Refine the instrument, and determine the

method of data analysis and to identify the Problems related to the study. The pilot

study was conducted at SDMCMS & Hospital (Super specialty hospital) Dharwad,

from 15/12/2017 to 22/12/2017. Formal permission was obtained from the authorities

and purpose of the study was explained to the subjects and confidentiality was

assured. 10 samples were selected from SDMCMS & Hospital (Super specialty

hospital)by using simple random sampling technique. Written consent was obtained

from subjects to participate in the study .Pretest was administered to the samples and

on the next day PowerPoint presentation and Video assisted teaching on knowledge

regarding recording and interpretation of 12-lead ECG was administered to the

participants followed by posttest on the seventh day. The analysis of the pilot study

data revealed that tool developed for the study was appropriate. No any problem was

encountered during the process of pilot study; it was revealed that the final study was

feasible, practicable and reliable.


Page 36

RELIABILITY OF THE TOOL

Reliability of the research instrument is defined as the extent to which the instrument

yield the same result in repeated measures. It is then concerned with consistency,

accuracy, precision, stability, equivalence and homogeneity. The reliability of the tool

was established by test-retest method. The reliability of the tool was r = 0.97 and

developed tool was found to be reliable and feasible to conduct main study.

PROCEDURE FOR DATA COLLECTION

Details of the data collection are as follows

Formal permission was obtained from the authorities and purpose of the study was

explained to the subjects and confidentiality was assured.

Written consent was obtained from the subjects to participate in the study.

Subjects were selected by simple random sampling technique.

On the first day pre-test was administered for the both the groups (PowerPoint

Presentation and Video assisted Teaching groups).

On the next day PowerPoint Presentation and Video assisted Teaching was

administered to both the groups for 2 hours.

Posttest was conducted on the seventh day of intervention using the same tool as

the pretest.


Page 37

Data analysis method

The plan of data analysis was worked out with the experts in the field of

statistics and Nursing. The obtained data was analyzed in terms of objectives of the

study by using descriptive and inferential statistics.

The plan of analysis was as followed

1. Data was organized in master sheet.

2. Tabulation of data in terms of frequency, percentage, mean and standard

deviation.

3. Paired ‘t’ test was used to compare the pre-test and post-test data within the

group.

4. Unpaired ‘t’ test was used to find out the effectiveness of the Video assisted

teaching and PowerPoint presentation.


Page 38

Research approach Quantitative Evaluative approach

Research Design Randomized factorial research design

Study setting SDMCMS & Hospital Dharwad

Sample

Sample technique

Staff nurses working in Hospital

40 preoperative patients admitted in

surgical wards of the SDM Hospital

(20 in PPT, 20 in VAT group)

Simple random sampling technique

Tool for data collection Structured knowledge

questionnaires

Pre-test Intervention

(VAT &

PPT)

Post-test

Descriptive and inferential

statistics

Figure 3: Schematic representation of study design/ Research process

Population

Findings and conclusion


Page 39

Summary

This chapter dealt with the research approach, variables, setting of the study, research

population, sample and sample techniques discussed in detail the data collection tool

and techniques. It also included a note on content validity and reliability. This chapter

provided the directions to conduct main study through the findings of pilot study.

Chapter-V Results and Analysis

Page 40

CHAPTER V

RESULT AND ANALYSIS

Analysis is defined as a method of organizing data in such a way that the

research question can be answered. It is a method of rendering qualitative

information, meaning and intelligible. The purpose of the analysis is to reduce data to

intengible and interpretable form so that the relation of research problem can be

studied and tested.

This chapter deals with the organization and analysis of the data and its

interpretation. The data collected was analyzed as per the objectives of the study,

using descriptive and inferential statistics.

Objectives of the study were to:








HYPOTHESES: Hypothesis tested at 0.05 level of significant


scores after video assisted teaching among staff nurses on recording and



Page 41


scores after PPT presentation among staff nurses on recording and


H3: There will be a significant difference between mean posttest of VAT and

mean posttest of PPT knowledge scores of staff nurses on recording and


Organization of the findings:

The data was organized and presented under the following section;

Section 1: Assessment of the existing level of knowledge of staff nurses regarding

recording and interpretation of 12-lead ECG.

Section 2: Dealt with the effectiveness of Video assisted teaching(VAT) on

knowledge regarding recording and interpretation of 12-lead ECG.

Section 3:Dealt with the effectiveness of PowerPoint presentation (PPT) on

knowledge regarding recording and interpretation of 12-lead ECG

Section 4: comparison between effectiveness ofVideo assisted teaching (VAT) and

PowerPoint presentation (PPT).


Page 42

Section 1: Assessment of the existing level of knowledge of staff nurses regarding


TABLE - 1

Distribution of respondents on existing level of knowledge

[n=40]

Level of knowledge No of respondents % of respondents

Poor knowledge 10 25%

Average knowledge 29 72.5%

Good knowledge 1 2.5%

Total 40 100.00

Table: 1& figure: 3 reveal the classification of staff nurses on existing level of

knowledge. Among 40 staff nurses 25% (10) of them had poor level of knowledge,

72.5% (29) had average level of knowledge and 2.5% (1) of them had good

knowledge.


Page 43

Figure 3: Pie diagram showing distribution of respondents by pre-test levels of

knowledge score.

Section 2: Dealt with the effectiveness of Video assisted teaching (VAT) on


TABLE - 2

Comparison of pre and post-test knowledge scores of VAT by paired‘t’ test

[n=20]

Group Knowledge Mean Mean difference SD Df ‘t’ value ‘p’ value

VAT Pre-test 14.75 9.5 3.52 19 -11.38 0.0001

Post-test 24.25 2.69 19

*

Table: 2 & figure: 4 Indicates the difference of pre-test and post-test knowledge

scores of VAT Group of staff nurses regarding recording and interpretation of 12-lead

ECG. Pre-test mean score was ±14.75 and SD ±3.52 whereas the mean post-test score

was ±24.25 and SD ±2.69. The calculated‘t’ value was ±11.38 which was higher than

the table value 2.09, i.e which is significant at p ≤0.05 level. Hence theresearch

hypothesis was accepted and null hypothesis was rejected.

25%

72.50%

2.50%

POOR

AVERAGE

GOOD


Page 44

Figure 4: Cylinder diagram showing Comparison of pre-test and post-test

knowledge scores of PPT Group by paired‘t’ test

Section 3: Dealt with the effectiveness of PowerPoint presentation (PPT) on


TABLE - 3

Comparison of pre and post-test knowledge scores of PPT by paired‘t’ test

[n=20]

Group Knowledge Mean Mean difference SD Df ‘t’ value ‘p’ value

PPT Pre-test 17.7 10.35 4.44 19 -8.84 0.0001

Post-test 28.05 2.96 19

*

Table: 3& figure:5 Reveal the difference of pre-test and post-test knowledge scores of

PPT Group of staff nurses regarding recording and interpretation of 12-lead ECG.

Pre-test mean score was ±17.7 and SD ±4.44 whereas the mean post-test score was

±28.05 and SD ±2.96. The calculated‘t’ value was ±8.84 which was higher than the

0

5

10

15

20

25

PRETEST POSTETST

14.75

24.25

Mea

n v

alu

e

pretest

postetst


Page 45

table value 2.09, i.e. which is significant at p ≤0.05 level. Hence the research


Figure 5: Cylinder diagram showing Comparison of pre-test and post-test

knowledge scores of PPT Group by paired‘t’ test.

Section-4: Comparison between effectiveness of Video assisted teaching (VAT) and

PowerPoint presentation (PPT).

TABLE - 4

Comparison of PPT & VAT Groups with post-test knowledge scores of by un-

paired ‘t’ test

[n=40]

Group Knowledge Mean SD SE Df ‘t’ value ‘p’ value

PPT Post-test 28.05 2.96 0.88 38 4.68 0.0001

VAT Post-test 24.25 2.69

Table:4& figure:6 indicates the difference of post-test of PPT and post-test of VAT

knowledge scores of staff nurses regarding recording and interpretation of 12-lead

ECG. In post-test mean score PPT was ±28.05 and SD ±2.96 whereas the mean post-

0

5

10

15

20

25

30

PRETEST POSTTEST

17.7

28.05 M

ean

va

lues

PRETEST

POSTTEST


Page 46

test score in VAT was ±24.25 and SD ±2.69. The calculated ‘t’ value was ±4.68

which was higher than the table value 2.02, i.e which was highly significant at p

≤0.05 level. Hence the research hypothesis was accepted and null hypothesis was

rejected .This shows that PPT presentation was effective comparing to Video assisted

teaching on knowledge of staff nurses regarding recording and interpretation of 12-

lead ECG.

Figure 6: Bar diagram showing Comparison of PPT & VAT Groups with post-

test knowledge scores.

Summary

This chapter dealt with the analysis and interpretation of data using descriptive

statistics, frequency, percentage, and graphs. Further statistical significance of the

effectiveness of PPT and VAT was computed by paired and Unpaired ‘t’ test and

drawn the result.

22

23

24

25

26

27

28

29

28.05

24.25

Mea

n v

alu

es

PPT post-test VAT post-test

Chapter-VI Discussion

Page 47

CHAPTER - VI

DISCUSSION

This chapter discusses major findings of the study with reference to the objectives and

hypothesis and findings of the similar studies.

The aim of the study was to evaluate the effectiveness of Video assisted

teaching (VAT) and PowerPoint presentation (PPT) on knowledge regarding


The objectives of the study were to:








HYPOTHESES: Hypothesis are tested at 0.05 level of significance.

H1: There is a significant difference between pretest and posttest mean scores after

video assisted teaching among staff nurses on recording and interpretation of 12 lead

ECG.


PPT presentation among staff nurses on recording and interpretation of 12 lead ECG.


Page 48

H3: There will be a significant difference between mean posttest of VAT and mean

posttest of PPT knowledge scores of staff nurses on recording and interpretation of 12

lead ECG.

MAJOR FINDINGS OF THE STUDY

To achieve the objective of the study, forty subjects were selected by applying Simple

random sampling technique.

Findings related to the objectives and hypotheses

Objective 1: Toassess the existing level of knowledge of staff nurses regarding


This study findings on existing level of knowledge of staff nurses regarding recording

and interpretation of 12-lead ECG. Among 40 staff nurses 25% (10) of them had poor

level of knowledge, 72.5% (29) had average level of knowledge and 2.5% (1) of them

had good knowledge.

This result is supported by underlining study.

A study was conducted in Trivandrum to assess the knowledge regarding

interpretation of life threatening arrhythmias and its emergency management among

cardiac nurses. Forty five cardiac nurses were purposely selected from CMICU,

CSICU, and CHICU. Structured knowledge questionnaire was consisting of 14

questions regarding ECG interpretation and its emergency management was used for

data collection. The study concluded that 88.88% of cardiac nurses had above average

level of knowledge about arrhythmia interpretation and its emergency management8.


Page 49

Objective 2: To evaluate the effectiveness of video assisted teaching on

knowledge regarding recording and interpretation of 12 lead ECG.

H1: There is a significant difference between pretest and posttest mean scores

after video assisted teaching (VAT) among staff nurses on recordingand


Pre-test and post-test knowledge score of VAT group of staff nurse regarding

recording and interpretation of 12-lead ECG. Pre-test mean score ±14.75 and SD

±3.52 whereas the mean post-test score was ±24.25 and SD ±2.69. The calculated ‘t’

value was ±11.38 which was higher than the table value 2.09, i.e. which is significant

at p ≤0.05 level. Hence the research hypothesis was accepted and null hypothesis was

rejected.

This result is supported by underlining study:

A true experimental study was done in Kumarapalyam Tamil Nadu to assess

the effectiveness of video therapy on level of knowledge regarding identification and

management of cardiac arrhythmias. Thirty nurses who are working in selected

hospitals were selected through simple random sampling technique. Structured tool

was used to assess the level of knowledge, identification and management of cardiac

arrhythmias. Tool had 2 sections on Identification of selected cardiac arrhythmias

comprising of 20 questions and Management of selected cardiac arrhythmias

comprising of 20 questions. Results of the study showed that experimental group; the

pretest mean score was 16 ± 5.8 whereas in post test 29 ± 5.4 and the difference in

mean percentage was 20% showing that level of knowledge in post test was higher

than the level of knowledge in pretest. The study concluded that critical tool prepared


Page 50

by the researcher would aid for continuous development of a relevant body of

knowledge for the body of nursing profession6.

Objective 3: To evaluate the effectiveness of PPT on knowledge regarding recording

and interpretation of 12 lead ECG.

H2: There is a significant difference between pretest and posttest mean scores in

PPT presentation among staff nurses on recording and interpretation of 12 lead

ECG.

Pre-test and post-test knowledge scores of PPT group of staff nurse regarding

recording and interpretation of 12-lead ECG. In pre-test mean score was ±17.7 and

SD ±4.44 whereas the mean post-test score was ±28.05 and SD ±2.96. The

calculated‘t’ value was ±8.84 which was higher than the table value 2.09, i.e. which is

significant at p ≤0.05 level. Hence the research hypothesis was accepted and null

hypothesis was rejected.

This result is supported by the underlining study.

A pre experimental study was conducted in college of nursing Indore to

determine effectiveness of structured teaching programme on knowledge and

interpretation of ECG among staff nurses. Through purposive sampling technique 45

subjects, working in open heart unit, step down ICU, and ICU were selected. Tool

used for the study was knowledge questionnaire which was included items on

knowledge and interpretation of ECG,pre test was taken to assess the pre

interventional knowledge of the staff nurses followed by educational programme on

knowledge and interpretation of ECG. And after 7 days post test was taken The

findings showed that mean of post-test score (12.8) was higher than pretest score (7.2)


Page 51

which indicated the effectiveness of structured teaching programme in increasing the

knowledge of staff nurses regarding ECG5.

Objective 4: To compare the effectiveness of video assisted teaching and PPT

presentation.

H3: There will be a significant difference between mean posttest of VAT

and mean posttest of PPT knowledge scores of staff nurses on recording

and interpretation of 12 lead ECG.

Post-test in PPT and VAT knowledge score of staff nurses regarding recording and

interpretation of 12-lead ECG. The study findings on post-test mean score PPT was

±28.05 and SD ±2.96 whereas the mean post-test score in VAT was ±24.25 and SD

±2.69. The calculated‘t’ value was ±4.68 which was higher than the table value 2.02,

i.e which was highly significant at p ≤0.05 level. Hence the research hypothesis was

accepted and null hypothesis was rejected. This shows that PPT presentation was

effective comparing to Video assisted teaching on enhancement of knowledge of staff

nurses regarding recording and interpretation of 12-lead ECG.

This result is supported by the underlining study.

A quasi-experimental study was undertaken to evaluate the effectiveness of a

continuing education program on nurses' knowledge of electrocardiogram

interpretation. Fifty-two nurses, including 23 nurses working in an emergency

department, 12 nurses working in a cardiology department and 17 nurses working in

an intensive care unit (ICU) were recruited for the study. A lecture-based education

program and a self-learning handbook method were used. The effectiveness of the

methods was evaluated using a questionnaire containing questions in five domains.


Page 52

On program on nurses' knowledge of interpretation of 12-lead electrocardiograms.

Results of the study showed that nurses who worked in the cardiology department

scored higher in basic ECG knowledge than those in the emergency department and

ICU, and the second domain used was self-learning handbook which showed a

significant increase in post test scores at 2 weeks, and 4 months’ time interval. Study

concluded that lecture-based education program and self-learning handbook material

were effective in improving the nurses' ECG knowledge7.

Summary:

This chapter dealt with the discussion of the major findings of the study based on the

objectives and hypothesis of the study. The supporting previous studies were included

in the chapter to enlighten the findings.

Chapter-VII Conclusion

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CHAPTER-VII

CONCLUSION

The ECG is an important diagnostic tool used for the diagnosis and treatment of

various cardiac and other related diseases so the nurse should have adequate

knowledge regarding ECG and its interpretation which is essential for identifying

potential life threatening situations and ensuring appropriate treatment to save the life

of the patient.

This chapter dealt with the important part of the findings of the study and their

implications on different aspects on nursing such as nursing practice, nursing

education, nursing administration and nursing research. It also examines the limitation

of the study and suggests recommendation for further research.

STATEMENT OF THE PROBLEM:




SDM hospital Dharwad”

Based on the findings of the study following conclusions were drawn

The result of the study showed that, among 40 staff nurses 25% (10) of them

had poor level of knowledge, 72.5% (29) had average level of knowledge and

2.5% (1) of them had good knowledge. Pre-test mean score in PPT was

±28.05 and SD was ±2.96 whereas the mean post-test score in VAT was


Page 54

±24.25 and SD was ±2.69. The obtained or calculated‘t’ value was ±4.68

which was higher than the table value 2.02, i.e which is highly significant at p

≤0.05 level. Hence the null hypothesis was rejected and research hypothesis

was accepted. This shows that PPT presentation was effective comparing to

Video assisted teaching on knowledge of staff nurses regarding recording and

interpretation of 12-lead ECG.

This study findings on existing level of knowledgeof staff nurses regarding

recording and interpretation of 12-lead ECG. Among 40 staff nurses 25%

(10) of them had poor level of knowledge, 72.5% (29) had average level of

knowledge and 2.5% (1) of them had good knowledge.

Pre-test and post-test knowledge score of VAT group of staff nurse regarding

recording and interpretation of 12-lead ECG. Pre-test mean score was ±14.75

and SD ±3.52 whereas the mean post-test score was ±24.25 and SD ±2.69.

The calculated ‘t’ value was ±11.38 which was higher than the table value

2.09, i.e. which is significant at p ≤0.05 level. Hence the research hypothesis

was accepted and null hypothesis was rejected.

Pre-test and post-test knowledge scores of PPT group of staff nurse regarding

recording and interpretation of 12-lead ECG. In pre-test mean score was

±17.7 and SD ±4.44 whereas the mean post-test score was ±28.05 and SD

±2.96. The calculated ‘t’ value was ±8.84 which was higher than the table

value 2.09, i.e. which is significant at p ≤0.05 level. Hence the research



Page 55

IMPLICATIONS OF THE STUDY

The findings of the present study have implications in the area of nursing education,

nursing practices, nursing administration and nursing research.

Nursing Education

The educational background of nursing personnel equip his/her with the knowledge

necessary to function as a health educator. Findings of the study can be used by the

nurse educator to highlight the importance of the teaching programme by using PPT

and VAT regarding recording and interpretation of 12-lead ECG among staff nurses.

This method can be used to teach the student nurses and staff nurses to enhance the

knowledge regarding ECG. The nurse educator should periodically organize special

training programme for students and staff nurses regarding ECG to build up their

knowledge and bring up productivity.

Nursing Practice

Nurses are key personnel of health team who plays vital role in the health promotion

and maintenance. Nursing is a practice of profession so the investigator generally

integrates findings into practice.

The health teaching in health care area is one of the important aspect in the health

care delivery system. In-service education improves the staff nurse knowledge and

practice on recording and interpretation of 12-lead ECG.

The result of the study is useful in planning the health care action in different

setting.

The findings of this study helps to plan , develop and utilize various methods of

teaching, learning and practicing 12-lead ECG interpretation.


Page 56

Nursing Administration

Staff development programme in any organization is the primary responsibility of the

nurse administrator. In the era of development of advance technology, demand for

quality and competent care, improved awareness in dignity of life all poses challenges

to nurse administrator to demonstrate their efficacy in providing information

regarding recording and interpretation of 12-lead ECG.

Nurse administrator can organize and conduct seminar to make students and

staff nurses aware about recording and interpretation of 12-lead ECG.

CNE for the staff nurses regarding ECG, in order to update and enhance

knowledge.

It also helps the nurse administrator to plan for man power ,money, material

method and time to conduct successful education programme regarding 12-

lead ECG.

Nursing Research

Emphases on nursing research or clinical studies are needed to improve the quality of

the nursing care. Dissemination of findings through conference and professional

journals will make application of research findings to be effective.

This study serves as a valuable reference material for future investigators.

Research should focus on improving level of knowledge regarding recording

and interpretation of 12-lead ECG. The nurse researcher can include

evidenced based practice in nursing field.


Page 57

Limitations

The findings of the study could not be generalized because of time constrains

and small numbers of subjects and knowledge of staff nurses is different in

different demographic variables.

The study findings are limited only staff nurses working in single setting

which cannot be generalized.

The tool used for the data collection was not standardized. It was designed by

the investigator himself for the purpose of present study based on the

objectives of the study which was validated by experts.

Recommendations:

Based on the findings of the present study and keeping in mind the limitations of the

study, the following suggestions are offered to conduct studies on

The similar study can be conducted in larger samples.

A similar study can be undertaken by utilizing other domains like practice

and comparative study.

A similar study can be conducted by different teaching methods.

Similar study can be conducted in different settings to find out the significant

difference.

The same can be conducted with an experimental research approach having a

control group.

Summary

This chapter dealt with the implications of the study in nursing practice, nursing

education, nursing administration and nursing research also recommendations of the

study.

Chapter-VIII Summary

Page 58

CHAPTER - VIII

SUMMARY

This chapter presents a brief summary of the research study. The primary aim of the

study was to evaluate the effectiveness of video assisted teaching (VAT) and

power-point presentation (PPT) on knowledge regarding recording and

interpretation of 12 lead ECG among staff nurses working in SDM hospital

Dharwad”.

The study was accomplishing the following objectives








The study also attempted to test the following hypotheses which are tested at 0.05

level of significance.


video assisted teaching among staff nurses on recording and interpretation of 12 lead

ECG.


PPT presentation among staff nurses on recording and interpretation of 12 lead ECG.


Page 59

H3: There will be a significant difference between mean posttest of VAT and mean

posttest of PPT knowledge scores of staff nurses on recording and interpretation of 12

lead ECG.

A review of literature enables the researcher to develop the methodology for

the study and to plan for the data analysis in the most effective and efficient way.

The conceptual framework selected for the study was based on modified Gagne’s 9

events of instructional model.

The variables for the present study are as follows

Independent variable: Video assisted teaching and power point presentation

Dependent variable: Knowledge of staff nurses on recording and interpretation of 12

lead ECG.

The tool used for the study was structured knowledge questionnaire on 12-lead

ECG.

Level of knowledge was assessed in 3 levels good, average, poor level of

knowledge.

The tool and teaching material was validated by experts and their suggestions

were incorporated.

The Pilot study was conducted on 10 samples from 15/12/2017 to 22/12/2017.

The reliability of the tool was assessed by Test Retest method and was found to be

reliable.

The main study was conducted among 40 staff nurses working in SDMCMS &

hospital, Dharwad, within a time period of one month.


Page 60

The collected data were analyzed and interpreted by using descriptive and

inferential statistical method.

The study summarizes with following findings

The result of the study shows that in pre-test among 40 staff nurses 25% (10) of them

had poor level of knowledge, 72.5% (29) had average level of knowledge and 2.5%

(1) of them had good knowledge.

In pre-test mean score of PPT was ±17.7 and SD ±4.44 whereas the mean

post-test score was ±28.05 and SD ±2.96. The calculated‘t’ value was ±8.84 which

was higher than the table value 2.09, i.e. which is significant at p ≤0.05 level. Hence

the research hypothesis was accepted and null hypothesis is rejected.

In pre-test mean score of VAT was ±14.75 and SD ±3.52 whereas the mean

post-test score was ±24.25 and SD ±2.69. The calculated‘t’ value was ±11.38 which

was higher than the table value 2.09, i.e. which is significant at p ≤0.05 level. Hence

the null hypothesis is rejected and research hypothesis is accepted.

In post-test mean score of PPT was ±28.05 and SD ±2.96 whereas the mean

post-test score of VAT was ±24.25 and SD ±2.69. The calculated ‘t’ value was ±4.68

which was higher than the table value 2.02, i.e which is highly significant at p ≤0.05

level. Hence the null hypothesis is rejected and research hypothesis is accepted. This

shows that PPT presentation was effective comparing to Video assisted teaching on

knowledge of staff nurses regarding recording and interpretation of 12-lead ECG.


Page 61

Interpretation

There is a substantial increase in the level of knowledge among staff nurses regarding

recording and interpretation of 12 lead ECG. Hence PPT was effective than Video

assisted teaching in increasing the level of knowledge regarding recording and

interpretation of 12 lead ECG among staff nurses working in SDM hospital

Dharwad”.

Chapter-IX References

Page 62

CHAPTER-IX

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Consent form

Page 68

CONSENT FORM FOR STAFF NURSE

Dear respondent,

I am the MSc nursing student of SDM Institute of nursing sciences,

Dharwad. In partial fulfillment of the course requirement, I have to undertake a

research project to RGUHS Bangalore. The title of our project is;

Topic: “A comparative study to evaluate the effectiveness of video assisted




The purpose of this study is to evaluate the effectiveness of video assisted

teaching (VAT) and power-point presentation (PPT) on knowledge related to


You are requested to participate in this study which will take about 45 minutes

for you to complete. Your kind co-operation is highly esteemed and your honest

responses are valuable.

I assure you that the information given by you will be kept strictly confidential

and used only for the study purpose. If you are willing to participate in this study

please sign the consent form given below.

Place: Yours sincerely

Date: Mr. Shivappa I Bannur

M.Sc.Nursing student.

Consent form

Page 69

I HERE BY VOLUNTEER AND CONSENT TO PARTICIPATE IN THIS

STUDY. IT HAS READ THE CONSENT OR IT HAS BEEN READ TO MY OWN

LANGUAGE. THE STUDY HAS BEEN FULLY EXPLAINED TO ME AND I

HAVE BEEN TOLD BY THE INVESTIGATOR TO CONTACT HIM

PERSONALLY FOR THE CLARIFICATION THE DOUBTS/QUESTIONS

OR WITHDRAW MY SELF FROM THE STUDY AT ANY TIME.

Participants name

and address

Participants

signature

Researcher name

Researcher signature

Date

Date

I have been informed of the purpose of the study and voluntarily give my consent to

participate in the study

Place: Signature of the Respondents

Date: Name:

ETHICAL COMMITTEE CLEARANCE PERMISSION LETTER

PROFORMA PROTOTYPE

DESCRIPTION OF THE TOOL

Part – I :Anatomy and physiology related to heart

Part - II :Recording of Electrocardiogram (ECG)

Part- III :Interpretation of Electrocardiogram (ECG)

PART- I. ANATOMY AND PHYSIOLOGY RELATED TO HEART

1. Heart is located in

a) Between the lungs, in the middle compartment of the chest ( )

b) Right side of the chest cavity ( )

c) Left side of the chest cavity ( )

d) Mediastinal cavity between upper compartment of the chest ( )

2. Inner layer of the heart is named as

a) Endocardium ( )

b) Myocardium ( )

c) Epicardium ( )

d) Pericardium ( )

3. Adult human heart weights about

a) 150-250grams ( )

b) 250-350grams ( )

c) 350-450grams ( )

d) 450-550grams ( )

4. An average stroke volume is about

a) 30 ml ( )

b) 50 ml ( )

c) 70 ml ( )

d) 90 ml ( )

5. An average cardiac output in human being is

a) 2-3 liters of blood per minute ( )

b) 3-4 liters of blood per minute ( )

c) 4-5 liters of blood per minute ( )

d) 5-6 liters of blood per minute ( )

6. Normal heart rate of human individual is

a) 30-60b/min ( )

b) 60-100b/min ( )

c) 100-120b/min ( )

d) 120-150b/min ( )

7. The electrical conduction system of the heart initiates from

a) SA node ( )

b) AV node ( )

c) Bundle of His ( )

d) Purkinje fibers ( )

8. Natural pace maker of the heart is

a) SA Node ( )

b) AV node ( )

c) Bundle of His ( )

d) Purkinje Fibres ( )

9. The anatomic space between two ribs is named as

a) Pleural space ( )

b) Intercostal space ( )

c) Inter nodal space ( )

d) Sub-costal space ( )

PART-II. RECORDING OF ELECTROCARDIOGRAM (ECG)

10. Unipolar Precordial leads are

a) 3 ( )

b) 6 ( )

c) 9 ( )

d) 12 ( )

11. An ECG is a graphical record of

a) Sensory‟s activity ( )

b) Kidney‟s activity ( )

c) The heart's activity ( )

d) Brain‟s activity ( )

12. ECG detects and records the

a) Electrical impulses of the heart ( )

b) Electrical activity of the heart ( )

c) Stimulation of impulses to the heart ( )

d) Stimulation of impulses to the heart muscles ( )

13. Out of 12-lead ECG, a total number of limb leads are

a) 3 ( )

b) 4 ( )

c) 5 ( )

d) 6 ( )

14. V1 electrode is placed at

a) 4th intercostal space to the right of the sternum ( )

b) 4th

intercostal space to the left of the sternum ( )

c) Horizontally even with V4 and V5 in the mid axillary line ( )

d) Between leads V2 and V4 ( )

15. Bipolar limb leads are

a) Measure the difference of electric potential between 2 limbs ( )

b) Include a aVL and aVR and aVF ( )

c) Are represented by the letter V ( )

d) Are not sufficient to calculate the electrical axis of ventricular depolarization (

)

16. Following electrode acts as a grounding lead

a) Arm electrode ( )

b) Leg electrode ( )

c) Chest electrode ( )

d) Galvanometer electrode ( )

17. Einthoven's triangle in ECG used to

a) Identify Lead Misplacements ( )

b) Identify myocardial infarction ( )

c) Identify cardiac arrhythmias ( )

d) Identify abnormalities ( )

18. Einthoven's triangle is formed by

a) Two legs and the one shoulder ( )

b) Two shoulders and one the pubis ( )

c) Two shoulders and one legs ( )

d) Two legs and Two shoulders ( )

PART- III INTERPRETATION OF ELECTROCARDIOGRAM(ECG)

19. “P” wave is initiated at

a) AV node ( )

b) SA node ( )

c) Purkinje fibers ( )

d) Bundle of His ( )

20. „P‟ wave represents

a) Atrial repolarization ( )

b) Ventricular depolarization ( )

c) Atrial depolarization ( )

d) Ventricular repolarization ( )

21. The spread of electrical activity through the ventricular myocardium produces

a) QRS complex ( )

b) ST segment ( )

c) QT interval ( )

d) PR interval ( )

22. QRS complex lies in

a) Isometric contraction phase ( )

b) Isometric relaxation phase ( )

c) Maximum filling phase ( )

d) Maximum ejection phase ( )

23. „PR‟ interval in ECG denotes

a) Atrial depolarization ( )

b) Ventricular repolarization ( )

c) Atrial repolarization ( )

d) Atrio-Ventricular repolarization ( )

24. QT interval represents the

a) Ventricular repolarization ( )

b) Atrial depolarization ( )

c) Ventricular depolarization and repolarization ( )

d) Atrial depolarization and repolarization ( )

25. „ST‟ segment in ECG connects

a) P wave ( )

b) QRS complex and T wave ( )

c) Q wave ( )

d) U wave ( )

26. „J‟ point in normal ECG is

a) The junction between Termination of the QRS complex and the beginning of

the ST segment ( )

b) the junction between beginning of the P wave and Termination of the

QRS complex ( )

c) the junction between Beginning of QRS complex and termination of ST

segment ( )

d) the Junction between PR interval ( )

27. The longest wave in ECG is

a) P wave ( )

b) T wave ( )

c) Q wave ( )

d) R wave ( )

28. Latter phase of ventricular repolarization is represented by

a) S-wave ( )

b) T-wave ( )

c) ST segment ( )

d) PR interval ( )

29. The „T‟ Wave on an ECG represents

a) Ventricular depolarization ( )

b) Ventricular repolarization ( )

c) Atrial Depolarization ( )

d) Atrial Repolarization ( )

30. The „U‟ wave on an ECG represents

a) Ventricular depolarization ( )

b) Papillary muscle repolarization. ( )

c) Atrial depolarization. ( )

d) Ventricular repolarization ( )

31. The height of ECG wave is called as

a) Diameter ( )

b) Square ( )

c) Axis ( )

d) amplitude ( )

32. One small square in normal ECG graph represents

a) 0.02 seconds ( )

b) 0.04 seconds ( )

c) 0.06 seconds ( )

d) 0.08 seconds ( )

33. One large square in normal ECG graph represents

a) 0.20 seconds ( )

b) 0.02 seconds ( )

c) 0.4 seconds ( )

d) 2 seconds ( )

34. The normal speed of ECG paper per second is

a) 15mm/s

( )

b) 20mm/s

( )

c) 25mm/s

( )

d) 30mm/s

( )

35. The average normal electrical axis of the heart is

a) 60o

( )

b) 0o

( )

c) -30o

( )

d) 900

( )

36. Artifacts are caused by

a) Improper electricity supply ( )

b) Patient‟s movements ( )

c) Improper position ( )

d) Adequate contact with electrode and skin surface ( )

37. Each R-R interval consist of

a) 3 small squares ( )

b) 6 small squares ( )

c) 9 small squares ( )

d) 12 small squares ( )

38. In Bradycardia duration of P-R interval is between

a) 0.12 and 0.20 sec ( )

b) 0.09 and 0.16 sec ( )

c) 0.06 and 0.12 sec ( )

d) 0.03 and 0.08 sec ( )

39. In Tachycardia QT interval will be

a) Small with increasing heart rate ( )

b) Normal with increasing heart rate ( )

c) Larger with increasing heart rate ( )

d) Merge with T wave at very fast rate ( )

SCORING KEY FOR STRUCTURED KNOWLEDGE QUESTIONNAIRE

Question

No

Answers Question

No

Answers Question

No

Answers

1

2

3

4

5

6

7

8

9

10

11

12

13

a

a

b

c

d

b

a

a

b

a

c

b

a

14

15

16

17

18

19

20

21

22

23

24

25

26

A

a

b

a

b

b

a

a

a

a

c

b

a

27

28

29

30

31

32

33

34

35

36

37

38

39

d

b

b

b

d

b

d

c

d

b

d

a

a

Scoring and interpretation

Total items are 39 each right answers carries „1‟ marks and wrong answers carries „0‟

marks

0-13= Poor knowledge

14-26= Average knowledge

27-39= Good knowledge

ANNEXURES

Page 87

ANNEXURE- I

ETHICAL COMMITTEE CLEARANCE PERMISSION LETTER

ANNEXURES

Page 88

ANNEXURES-II

PERMISSION FOR CONDUCTING PILOT STUDY

ANNEXURES

Page 89

ANNEXURE-III

PERMISSION LETTER FOR CONDUCTING MAIN STUDY

ANNEXURES

Page 90

ANNEXURE - IV

LETTER REQUESTING OPINION AND SUGGESTION FROM EXPERT

From,

Mr. Shivappa I Bannur

M.Sc. Nursing IInd

Year,

SDM Institute of Nursing Sciences,

Dharwad -09.

To,

Respected Sir/Madam,

Subject: Request for expert opinion and suggestions to establish content validity

of the research tool.

I, Mr. Shivappa I Bannur M.Sc. Nursing [Medical-Surgical Nursing Specialty] student of SDM

Institute of Nursing Sciences, Dharwad has selected the topic titled ―A comparative study to

evaluate the effectiveness of video assisted teaching (VAT) and power-point

presentation (PPT) on knowledge regarding recording and interpretation of 12 lead

ECG among staff nurses working in SDM hospital Dharawad” for the dissertation to

be submitted to Rajiv Gandhi University of Health Sciences, Bangalore as a partial fulfillment

of Master of Science of Nursing Programme.

ANNEXURES

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May I request you to go through the items and give your valuable

suggestions and opinions to develop the content validity of the tool kindly suggest

modifications, additions, if any, in the remark column.

I also request you to certify regarding your validation in the enclosed

format. I will be grateful to your honorable work. Anticipating a favorable response at

the earliest.

Here with I have enclosed:

1) Statement of the problem, Objectives of the study, Operational definitions,

Hypothesis.

2) Structured knowledge questionnaire’s

3) Evaluative criteria checklist.

4) Content validity certificate.

5) Lesson plan

Thankingyou,

Yours sincerely,

[Mr. ShivappaBannur]

Date:

Place:

ANNEXURES

Page 92

ANNEXURE – V

EVALUATION CRITERIA CHECKLIST FOR VALIDATION OF TOOL

Instructions:

Please review the items in the tool and give your suggestions regarding accuracy,

relevance and appropriateness of the content. Kindly place a tick mark (√) in the

appropriate column. If there are any suggestions or comments please mention in the

remark column.

SECTION 1: STRUCTURED KNOWLEDGE QUESTIONNAIRE ON

NORMAL ELECTROCARDIOGRAM

Sl.No Relevant Need modification Not relevant Remarks

1

2

3

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

ANNEXURES

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29

30

31

32

33

34

35

36

37

38

39

39

ANNEXURES

Page 94

ANNEXURE - VI

CONTENT VALIDATION CERTIFICATE

This is to certify that the tool describing the demographic data and knowledge

questionnaires prepared by Mr. Shivappa. Bannur final year student of the masters in

nursing programme at Sri Dharmasthala Manjunatheshwara Institute of Nursing

Sciences, Dharwad, to be used in his study titled “A comparative study to

evaluate the effectiveness of video assisted teaching(VAT) and power-point

presentation(PPT) on knowledge regarding recording and interpretation of 12

lead ECG among staff nurses working in SDM hospital Dharwad”

My comments on the following:

Tool :

Adequate of tool to measure objectives:

Organization of the tool :

Feasibility of the tool :

Place: Signature & Seal of Expert

Date: Designation & Address

ANNEXURES

Page 95

LESSON PLAN

Name of the Teacher : Mr. Shivappa I. Bannur

Topic : Recording and Interpretation of 12 lead

Method of teaching : Lecture cum discussion

Group : Staff Nurse

A.V aids : PPT and Video presentation

Date :

Time :

Venue : SDM Hospital, Dharawad

General objectives : After the completion of the topic subjects are able to learn Recording and Interpretation of ECG.

ANNEXURES

Page 96

Sl.

No

TIME SPECIFIC

OBJECTIVES

CONTENTS TEACHER

ACTIVITIES

STAFF

NURSE

ACTIVIT

IY

A.V

AIDS

EVALUATI

ON

1

3min

Introduces the

topic

INTROCTION

ANATOMY AND PHYSIOLOGY OF HEART

The heart is a muscular organ in humans and other

animals, which pumps blood through the blood

vessels of the circulatory system. Blood provides

the body with oxygen and nutrients, as well as

assists in the removal of metabolic wastes. In

humans, the heart is located between the lungs, in

the middle compartment of the chest.

The shape of the heart is similar to a pinecone,

rather broad at the superior surface and tapering to

Gives

Introduction

Listens

carefully

PPT/Vide

o

Presentati

on

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the apex. A typical heart is approximately the size

of your fist: 12 cm (5 in) in length, 8 cm (3.5 in)

wide, and 6 cm (2.5 in) in thickness. The weight of

a heart is approximately 250–300 grams. The heart

wall is made up of three layers: the inner

endocardium, middle myocardium and outer

epicardium. These are surrounded by a double-

membraned sac called the pericardium.

The cardiac cycle refers to a complete heartbeat

which includes systole and diastole and the

intervening pause. The cycle begins with

contraction of the atria and ends with relaxation of

the ventricles. Systole refers to contraction of the

atria or ventricles of the heart. Diastole is when the

atria or ventricles relax and fill with blood. Cardiac

output (CO) is a measurement of the amount of

blood pumped by each ventricle (stroke volume) in

one minute. This is calculated by multiplying the

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Page 98

stroke volume (SV) by the beats per minute of the

heart rate (HR). So that: CO = SV x HR. The

average cardiac output, using an average stroke

volume of about 70mL with a normal range of 5–

6L/min.

The normal rhythmical heartbeat, called sinus

rhythm, is established by the Sino atrial node, the

heart's pacemaker. Here an electrical signal is

created that travels through the heart, causing the

heart muscle to contract. Normal heart rate of the

human individual is 60-100b/min

.

ANNEXURES

Page 99

2

5min

Explains the

Conduction

system of the

Heart

CONDUCTION SYSTEM OF THE HEART

The electrical conduction system of the heart

transmits signals generated usually by the

sinoatrial node to cause contraction of the heart

muscle. The pacemaking signal generated in the

sinoatrial node travels through the right atrium to

the atrioventricular node, along the Bundle of His

and through bundle branches to cause contraction

of the heart muscle. This signal stimulates

contraction first of the right and left atrium, and

then the right and left ventricles.The conduction

system consists of specialized heart muscle cells,

and is situated within the myocardium. There is a

skeleton of fibrous tissue that surrounds the

conduction system which can be seen on an ECG.

The conduction system of the heart

consist of following structures

Teacher

Explains the

Conduction

system of the

Heart

Listens

carefully

PPT/Vide

o

Presentati

on

ANNEXURES

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SA node:

SA node is located in the right atrial wall, near the

opening of superior venacava. It is the normal

pacemaker of the heart.The electrical impulses are

generated in SA node and SA node also called the

sinus node. It is inverted by the parasympathetic

fibres from the right vagus and sympathetic fibres

via the stellate ganglion.

AV node:It is situated just below beneath the

endocardium on the right side of the interatrial

septum, near the tricuspid valve. It is the only

pathway of the spread of impulses from atria to the

ventricles. It is inverted by the left vagus and left

stellate ganglion.

Intermodal tracts: They connect the SA node

with AV node and with left atrium. They are

composed of 3 bundles or tracts.

1) The anterior bundle of Bachman

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Page 101

2) The middle intermodal tract of

Wenckebach

3) The posterior bundle of thorel.

AV Bundle (Atrioventricular Bundle)

AV bundle or bundle of His is the continuation of

the AV node and is located beneath the

endocardium on the right side of the

intraventricular septum. It divides into right and

left branches. Throughout their course, they gave

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Page 102

3

4min

Explains about

History of ECG

off branches of the ventricular muscle, forming a

network.

Purkinje Fibres: Purkinje fibres arise from both

bundle branches of the bundle of His They branch

extensively and form a network on the ventricles.

They possess the highest conduction velocity, due

to which both ventricles contract simultaneously,

so that the contraction becomes effective.

ELECTROCARDIOGRAM (ECG)

History

In 1937, Taro Takemi invented the first portable

electrocardiograph machine. Willem Einthoven,

working in Leiden, the Netherlands, used the string

galvanometer which is the first practical

electrocardiograph. He invented in 1901.

Electrocardiography (ECG) is the process of

graphical recording the electrical activity of the

Teacher explains

about History of

ECG

Listens

carefully

PPT/Vide

o

Presentati

on

ANNEXURES

Page 103

heart over a period of time using electrodes placed

on the skin. These electrodes detect the tiny

electrical activity of the heart that arises from the

heart muscle's electrophysiologic pattern of

depolarizing and repolarizing during each

heartbeat. It is a very commonly performed

cardiology test. In a conventional 12-lead ECG,

ten electrodes are placed on the patient's limbs and

on the surface of the chest. The overall magnitude

of the heart's electrical potential is then measured

from twelve different angles ("leads") and is

recorded over a period of time (usually ten

seconds). Out of those a total number of limb leads

are 3. In this way, the overall magnitude and

direction of the heart's electrical depolarization is

captured at each moment throughout the cardiac

cycle. The graph of voltage versus time produced

by this noninvasive medical procedure is referred

ANNEXURES

Page 104

4

3min

Lists the Clinical

uses of ECG

to as an electrocardiogram.

Basic principles of ECG

An ECG is a permanent record of the

electrical impulses generated in the heart

by the depolarization and repolarization

(contraction and relaxation) of the

myocardium.

These impulses are transmitted to the

surface of the body where they are detected

and picked up by the electrode and

measured by Galvanometer.

CLINICAL USES OF ECG

To assess the cardiac functions.

To diagnose the cardiac rhythm disorders.

To diagnose the cardiac diseases.

To detect electrolyte imbalance.

TO evaluate effects of treatments.

Teacher lists the

Clinical uses of

ECG

PPT/Vide

o

Presentati

on

ANNEXURES

Page 105

5

5min

Explains

regarding

Components of

Electrocardiogra

m

COMPONENTS OF

ELECTROCARDIOGRAM

Waves or complex: It is a defection that

can be positive, negative or both e.g.

Waves-P,Q,R,S,T,U,

Complexes-QRS

Segment: A segment is the period of time

between a wave or complex and another

wave or complex; normally, it is a straight

line (isoelectric line) e.g.:- P-Q, S-T, T-P.

Interval : An interval is the period of time

between two points on the ECG that

includes a wave, a complex or both.

ECG Paper: The Electrocardiogram paper is a

graph paper where for every 5 small 1 mm squares

you can find a heavier line forming a larger 5 mm

Teacher explains

Components of

Electrocardiogra

m

Takes

down

notes

Listens

carefully

and Takes

down

notes

PPT/Vide

o

Presentati

on

ANNEXURES

Page 106

square.

The vertical axis measures the amplitude ( Height

of the ECG wave) of the heart’s electrical current.

It is measured in millivolts (mV). By standard, 10

mm in height equals 1 mV. Therefore each 1 mm

square on the vertical axis equals 0.1 mV and each

large square, 0.5 mV.

The horizontal axis measures time. On a standard

EKG the paper speed is 25 mm/s. Therefore, each

1 mm square on the horizontal axis equals 0.04s,

and each large square, 0.20s. The normal electrical

axis of the heart is 900.

ANNEXURES

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ANNEXURES

Page 108

Components of ECG

P WAVE: The P Wave Is the first positive wave

and represents atrial depolarization. It is initiated

at SA node and is best visualized in lead II. It is

smoothly rounded, appears just before the QRS

complex, it represents the time taken by the atria to

empty the blood into the ventricles through the

open A.V valves. Normal, P wave has a duration

of less than 0.11 second and a height of less than

2.5mV.(3small squares width and 3 small squares

height).

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Page 109

Abnormalities: The P wave is

Absent in atrial fibrillation, nodal rhythm,

sinoatrial block and hyperkalemia. P waves

hidden in rapid tachycardias.

Interval in lead I in dextrocardia, incorrect

electrode placement and retrograde atrial

activation.

P-R Interval: In electrocardiography, the PR

interval is the period, measured in milliseconds,

that extends from the beginning of the P wave (the

onset of atrial depolarization) until the beginning

ANNEXURES

Page 110

of the QRS complex (the onset of ventricular

depolarization); it is normally between 120 and

200ms in duration. During the P-R interval, the

filling of the ventricles is completed.

Abnormalities: P-R interval is

Increased in rheumatic fever, IHD,

following drugs(digoxin, quinidine),

Participat

ed in

Discussio

n

ANNEXURES

Page 111

Hypokalemia, First degree AV block.

Variable or cannot be measured in second

or third degree Av block.

QRS Complex: A combination of the Q wave, R

wave and S wave, the ―QRS complex‖ represents

ventricular depolarization. It lies in isometric

contraction phase the normal duration (interval) of

the QRS complex is between 0.08 and 0.10

seconds. The spread of electrical activity through

the ventricular myocardium produces QRS

complex.

ANNEXURES

Page 112

QRS Complex comprises of

Q wave

Normal Q waves, when present, represent

depolarization of the interventricular septum. For

this reason, they are referred to as septal Q waves

and can be appreciated in the lateral leads I, aVL,

V5 and V6.

R Wave: The R wave is the first upward

ANNEXURES

Page 113

deflection after the P wave and represents early

ventricular depolarization which is longest wave in

ECG.

S wave: The S Wave is the first negative

deflection of the QRS complex that follows the R

wave.

T wave: In electrocardiography, the T wave

represents the repolarization (or recovery) of the

ventricles and latter phase of ventricular

repolarization. The interval from the beginning of

the QRS complex to the apex of the T wave is

referred to as the absolute refractory period.

ANNEXURES

Page 114

Abnormalities

Flat T wave indicates myocardial ischemia;

inverted T wave indicate myocardial

infarction; usually tall T wave indicate

elevated serum potassium.

U wave: The 'U' wave is a wave on an

electrocardiogram (ECG). It is the successor of the

'T' wave and may not always be observed as a

result of its small size. 'U' waves are thought to

represent repolarization of the Purkinje fibers or

ANNEXURES

Page 115

papillary muscles.

Abnormalities of QRS complex

QRS complex is more than 0.11 sec in width and

often with a bizarre appearance indicate the

depolarization is proceeding in abnormal sequence

and direction. Widened QRS complex is indicative

of bundle branch block.

ST Segment : the ST segment connects the QRS

complex and the T wave and has a duration of

0.005 to 0.150 sec (5 to 150 ms).It starts at the J

point (junction between the QRS complex and ST

ANNEXURES

Page 116

segment) and ends at the beginning of the T wave.

However, since it is usually difficult to determine

exactly where the ST segment ends and the T wave

begins, the relationship between the ST segment

and T wave should be examined together. The

typical ST segment duration is usually around 0.08

sec (80 ms). It should be essentially level with the

PR and TP segment.

The ST segment represents the isoelectric period

when the ventricles are in between depolarization

and repolarization.

ANNEXURES

Page 117

Abnormalities

If the ST segment is more than 1mm above

or below the base line, it indicates possible

myocardial ischemia or infarction.

QRS Interval: The normal duration (interval) of

the QRS complex is between 0.08 and 0.10

seconds — that is, 80 and 100 milliseconds. When

the duration is between 0.10 and 0.12 seconds, it is

intermediate or slightly prolonged. QRS duration

of greater than 0.12 seconds is considered

abnormal.

QT Interval: The QT interval is a measure of the

time between the start of the Q wave and the end

of the T wave in the heart's electrical cycle. The

QT interval represents electrical depolarization and

repolarization of the ventricles.

PR Segment: The PR segment is the flat, usually

isoelectric segment between the end of the P wave

PPT/Vide

ANNEXURES

Page 118

6

10min

Explains

regarding

Electrocardiogra

phic leads and

their placements

and the start of the QRS complex. PR segment

abnormalities occur in two main conditions:

Pericarditis. Atrial ischemia.

J Point: The J point of the ECG is the junction

between termination of the QRS complex and the

beginning of the ST segment. J point elevation can

be seen in early repolarization.

ELECTROCARDIOGRAPHIC LEADS

The standard 12-lead electrocardiogram is a

representation of the heart's electrical activity

recorded from electrodes on the body surface. This

section describes the basic components of the ECG

Teacher explains

Electrocardiogra

phic leads and

their placements

o

Presentati

on

ANNEXURES

Page 119

and the lead system used to record the ECG

tracings. The commonly used 12-lead

electrocardiogram consists of 3 bipolar limb leads

and 3 augmented unipolar limb leads and 6

unipolar precordial leads. Bipolar limb leads

record the potential differences between two limbs,

as bipolar leads, the output is the potential

difference between the limbs serving as positive

and negative inputs.

Lead I represents the potential difference between

the left arm (positive electrode) and the right arm

(negative electrode),

lead II displays the potential difference between

the left foot (positive electrode) and the right arm

(negative electrode), and

lead III represents the potential difference

between the left foot (positive electrode) and the

left arm (negative electrode). The electrode on the

ANNEXURES

Page 120

right foot that is not included in these leads serves

as a ground connection.

PRECORDIAL LEADS (CHEST LEADS)

It is a unipolar lead having two electrodes, one is

positive or exploring electrode applied on the

surface of the chest wall and other is indifferent

electrode constructed by Wilson central terminal.

Chest lead basically determines electrical activity

of the heart transmitted along the horizontal plane

(Transverse/Antero –posterior plane).

Placement of the ECG Leads – chest leads

There are six standard and three additional chest

leads, the anatomic space between two ribs is

named as intercostal space.

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V1:- 4th

intercostal space to the right of the

sternum

V2:- 4th

intercostal space to the left of the sternum

V3 :- half way between V2 and V4

V4:- Fifth intercostal space in the midclavicular

line

V5:- Fifth intercostal space in the anterior axillary

line

V6:- Fifth intercostal space in the midaxillary line

Hair on the chest wall should be shaved before

placement of electrodes. This improves quality of

registration.

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Page 122

Einthoven's triangle

Einthoven's triangle is an imaginary formation of

three limb leads in a triangle used in

electrocardiography to identify lead

misplacements. Einthoven's triangle formed by the

two shoulders and the pubis. The shape forms an

inverted equilateral triangle with the heart at the

ANNEXURES

Page 123

center that produces zero potential when the

voltages are summed. It is named after Willem

Einthoven, who theorized its existence.

Einthoven used these measuring points, by

immersing the hands and foot in pails of salt water,

as the contacts for his string galvanometer, the first

practical ECG machine.

PPT/Vide

o

Presentati

on

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7

2min

Discuss about

ECG Artifacts

ECG Artifacts

Artifacts mean alterations in the ECG Tracing

caused by the patient’s movements or improper

contact between the electrode and the skin surface.

Causes for Poor ECG Signals

Oily, dirty and scaly skin.

Dirty and encrusted electrodes.

Dried compound in the prejelled electrode

Improper application of Electrodes.

Loose or dislodged electrodes.

Patient’s movements.

Broken cable wire.

Faulty grounding.

Faulty equipment.

Discussed about

ECG artifacts

ANNEXURES

Page 125

8

3min

Explain about

Interpretation of

Bradycardia and

Tachycardia

Interpretation of Bradycardia and Tachycardia

Heart rate variability (HRV) is the measured

changes of the time intervals (in milliseconds)

between successive heart beats called R-R

intervals, or interbeat intervals (IBIs). It is used to

assess the ventricular rate. Each R-R interval is 12

small boxes apart: ventricular rhythm is regular. P-

P intervals are also 12 small boxes: atrial rhythm is

also regular. Generally, when R-R intervals vary

by 3 or more boxes, the rhythm is irregular.

A quicker way to obtain an approximate rate is

1. To go by RR or PP interval. If it is 1 big

box (0.2 secs) then the rate is 60/0.2 = 300 bpm.

The rest of the sequence would be as follows.

1 big box = 300 beats/min (duration = 0.2 sec)

2 big boxes = 150 beats/min (duration = 0.4 sec)

Explained about

Interpretation of

Bradycardia and

Tachycardia.

ANNEXURES

Page 126




2. Count the number of RR intervals between

two Tick marks (6 seconds) in the rhythm strip and

multiply by 10 to get the bpm. This method is

more effective when the rhythm is irregular.

Bradycardia

It is a condition wherein an individual has a slow

heart rate, typically defined as a heart rate of under

60 beats per minute (BPM) in adults. Bradycardia

typically does not cause symptoms until the rate

drops below 50 BPM.

Classification of Bradycardia

Sinus Bradycardia: Atrial bradycardias are divided

into three types.

The first, respiratory sinus arrhythmia, is usually

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Page 127

found in young and healthy adults. Heart rate

increases during inhalation and decreases during

exhalation. This is thought to be caused by

changes in the vagal tone during respiration. If the

decrease during exhalation drops the heart rate

below 60 bpm on each breath, this type of

Bradycardia is usually deemed benign and a sign

of good autonomic tone.

The second, sinus bradycardia, is a sinus rhythm of

less than 60 BPM. It is a common condition found

in both healthy individuals and those considered

well-conditioned athletes.

The third, sick sinus syndrome, covers conditions

that include severe sinus bradycardia, sinoatrial

block, sinus arrest, and bradycardia-tachycardia

syndrome.

ECG characteristics of Bradycardia

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Rate: Less than 60 beats per minute.

Rhythm: Regular.

P waves: Upright, consistent, and normal in

morphology and duration.

P-R Interval: Between 0.12 and 0.20 seconds in

duration.

QRS Complex: Less than 0.12 seconds in width,

and consistent in morphology

Tachycardia

It is also called tachyarrhythmia, is a heart rate that

exceeds the normal resting rate. In general, a

resting heart rate over 100 beats per minute is

accepted as tachycardia in adults.

Classification of Tachycardia

Sinus tachycardia. Often sinus tachycardia

is a normal response to certain situations such as

exercise, anxiety, distress, or fever. Certain

disorders such as thyroid disease, anemia, and low

ANNEXURES

Page 129

blood pressure are also associated with sinus

tachycardia.

Atrial fibrillation (AF). AF is characterized

by chaotic electrical signals, triggering the atria to

quiver rapidly and irregularly. Atrial fibrillation is

often associated with heart disease, an overactive

thyroid, or alcoholism. Frequently, AF causes

blood clot formation inside the heart, which

increases a person’s risk for stroke.

Atrial flutter. This arrhythmia is similar to

atrial fibrillation, except the rhythm is less chaotic.

Supraventricular tachycardia (SVT) or

paroxysmal supraventricular tachycardia (PSVT).

This arrhythmia starts with electrical signals above

the ventricles that travel down an abnormal

electrical pathway or extra pathway. An extra

pathway is the hallmark of Wolff-Parkinson-White

syndrome - the leading cause of SVT in children

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and adolescents.

Ventricular tachycardia (VT). VT is

triggered by an electrical abnormality within the

ventricles. During VT, the ventricles may fill

poorly and inadequately pump blood. Sometimes a

person becomes pulseless during VT - a fatal event

unless immediately corrected.

Ventricular fibrillation (VF). VF is a rapid,

chaotic rhythm, in which the ventricles fail to

pump blood at all. VF is a fatal arrhythmia, unless

immediately converted to a normal rhythm. VF is

usually related to underlying heart disease. Rarely,

a blunt blow to the chest wall of a healthy person

precipitates VF.

ECG characteristics of tachycardia

Rhythm: Regular

Rate : Fast (> 100 bpm)

P Wave: may merge with T wave at very fast rates

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PR Interval: Normal (0.12-0.20 sec)

QRS: Normal (0.06-0.10 sec)

QT interval : shortens with increasing heart rate

ANNEXURES

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ANNEXURE- VII

LIST OF EXPERTS

1. Dr. Jayashankar

Dept of Medicine

SDMCMS & H

Dharwad.

2. Dr. Swami KAlasurmath

Dept of Medicine

SDMCMS & H

Dharwad

3. Prof. S. F. Billali

Principal,

Bapuji college of Nursing,

Davangere.

4. Mrs. Narmada A.

Associate professor,


Davanagere.

5. Mr. Harsha K. M,

Associate professor,


Davanagere.

6. Mr. Sanjay Peerapur

Principal

K.L.E. College of

Nursing

Hubli

7. Mr. Ramesh A. E

Lecturer

Govt college of nursing

Hasan

working in sdm hospital dharawad”

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