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

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

This is an author accepted manuscript version of an article; made available in this repository in accordance with the publisher's self-archiving policy. The published version appears in European Journal of Cardiovascular Nursing at SAGE Journals (http://online.sagepub.com): http://journals.sagepub.com/doi/full/10.1177/1474515116687444