The skill of nursing students trained in the evaluation of electrocardiographic trace: a comparison with emergency nurses

The skill of nursing students trained in the evaluation of electrocardiographic trace: a comparison with emergency nurses



nurse, education, simulation, knowledge, ECG interpretation, emergency department


Background and aim of the work: Cardiovascular diseases represent the main cause of death in Italy. Early recognition of pathological electrocardiographic (ECG) trace is an important skill for nurses. The theoretical knowledge and the practical skills on the recognition of pathological ECG trace of trained nursing students were compared with those of emergency nurses.

Methods: The study involved 35 nursing students and 41 nurses from the emergency room, emergency medicine and ambulance service. Students were previously trained through a theoretical and practical ECG course. The data were collected using  two questionnaires aimed at evaluating in the two groups the ability to recognize electrocardiographic signs. The tools were uploaded to an online platform and remotely administered.

Results: Both the students and the nurses showed a satisfactory theoretical knowledge of the ECG trace, with a statistically significant difference in favor of the nurses. Regarding practical skills, both groups showed difficulty in recognizing pathological electrocardiographic signs, particularly blockages and acute coronary syndromes.

Conclusions: Nursing students' knowledge of ECG did not differ much from that of nurses. Training through simulation probably played a key role in improving the skill of ECG evaluation among students. More theoretical and practical courses on ECG should be recommended in Nursing Programme.

Keywords: nurse, education, simulation, knowledge, ECG interpretation, emergency department

Author Biography

Ivan Rubbi, School of Nursing, University of Bologna, Bologna, Italy

Coordinatore Didattico - Docente


ISS. 2020. Malattie cardiovascolari in Italia. (Accessed on July 30, 2021).

Fanaroff AC, Rymer JA, Goldstein SA, Simel DL, Newby LK. Does this patient with chest pain have acute coronary syndrome?: The rational clinical examination systematic review. JAMA 2015; 314: 1955-65. doi: 10.1001/jama.2015.12735.

Hayashi M, Shimizu W, Albert CM. The spectrum of epidemiology underlying sudden cardiac death. Circ Res 2015; 116: 1887-906. doi: 10.1161/CIRCRESAHA.116.304521.

Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-Hospital Cardiac Arrest: A Review. JAMA 2019; 321: 1200-10. doi: 10.1001/jama.2019.1696.

Barstow C. Acute Coronary Syndrome: Presentation and Diagnostic Evaluation. FP Essent 2020; 490: 11-9.

Barstow C, Rice M, McDivitt JD. Acute Coronary Syndrome: Diagnostic Evaluation. Am Fam Physician 2017; 95: 170-7.

Atwood D, Wadlunci DL. ECG Interpretation Using the CRISP Method: A Guide for Nurses. AORN J 2015; 102: 396-405. doi: 10.1016/j.aorn.2015.08.004.

Funk M, Fennie KP, Stephens KE, et al. Association of Implementation of Practice Standards for Electrocardiographic Monitoring with Nurses’ Knowledge, Quality of Care, and Patient Outcomes Findings From the Practical Use of the Latest Standards of Electrocardiography (PULSE) Trial. Circ Cardiovasc Qual Outcomes 2017; 10: e003132. doi: 10.1161/CIRCOUTCOMES.116.003132.

Nickerson J, Taub ES, Shah K. A checklist manifesto: Can a checklist of common diagnoses improve accuracy in ECG interpretation? Am J Emerg Med 2020; 38: 18-22. doi: 10.1016/j.ajem.2019.03.048.

Deal J. Did you see what you saw? How to interpret cardiac monitor patterns. Bedside Nurse 1970; 3: 21-7.

Hubner PJ. Nursing guide to cardiac monitoring. 1. Introduction monitors and electrodes. Nurs Mirror Midwives J 1970; 131: 13-5.

Hubner PJ. Nursing guide to cardiac monitoring. 2. The normal ECG trace. Nurs Mirror Midwives J 1970; 131: 9-11.

Powell C. Cardiograms for nurses. 3. Ventricular abnormal rhythms. Nurs Times 1970; 66: 1229-31.

Takashina T. [Simple interpretation of the electrocardiogram. 4. Abnormal rhythms. 1. Intervals between the P wave and PR]. Kangogaku Zasshi 1976; 40: 409-12.

Lehmann HU. [Cardiac arrhythmias. Types and drug therapy (author's transl)]. MMW Munch Med Wochenschr 1981; 123: 680-86.

Van Riper S, Luciano A. Basic cardiac arrhythmias: a review for postanesthesia care unit nurses. J Post Anesth Nurs 1994; 9: 2-13.

Scrima DA. Foundations of arrhythmia interpretation. Medsurg Nurs 1997; 6: 193-202.

Drew BJ, Dracup K, Childers R, et al. Finding ECG Readers in Clinical Practice: Is It Time to Change the Paradigm? J Am Coll of Cardiol 2014; 64: 528. doi: 10.1016/j.jacc.2014.01.086.

Zègre-Hemsey JK, Lee Garvey J, Carey MG. Cardiac Monitoring in the Emergency Department. Crit Care Nurs Clin North Am 2016; 28: 331-45. doi: 10.1016/j.cnc.2016.04.009.

Drew BJ, Califf RM, Funk M, et al. Practice standards for electrocardiographic monitoring in hospital settings: an American Heart Association scientific statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation 2004; 110: 2721-46. doi: 10.1161/01.CIR.0000145144.56673.59.

Drew BJ, Funk M. Practice standards for ECG monitoring in hospital settings: Executive summary and guide for implementation. Crit Care Nurs Clin North Am 2006; 18: 157-68. doi: 10.1016/j.ccell.2006.01.007.

Hernández-Padilla JM, Granero-Molina J, Márquez-Hernández VV, Suthers F, López-Entrambasaguas OM, Fernández-Sola C. Design and validation of a three-instrument toolkit for the assessment of competence in electrocardiogram rhythm recognition. Eur J Cardiovasc Nurs 2017; 16: 425-34. doi: 10.1177/1474515116687444.

Lancia L, Pisegna Cerone M, Vittorini P, Romano S, Penco M. A comparison between EASI system 12-lead ECGs and standard 12-lead ECGs for improved clinical nursing practice. J Clin Nurs 2008; 17: 370-77. doi: 10.1111/j.1365-2702.2007.01935.x.

Docherty B. 12-Lead ECG interpretation and chest pain management: 1. Br J Nurs 2003; 12: 1248-55. doi: 10.12968/bjon.2003.12.21.11882.

Rubbi I, Ferri P, Andreina G, Cremonini V. [Learning in clinical simulation: observational study on satisfaction perceived by students of nursing] [Article in Italian]. Prof Inferm 2016; 69: 84-94. doi: 10.7429/pi.2016.692084.

Lapucci G, Bondi B, Rubbi I, et al. A randomized comparison trial of two and four-step approaches to teaching Cardio-Pulmonary Reanimation. Acta Biomed 2018; 89(4-S): 37-44. doi: 10.23750/abm.v89i4-S.7129.

Rubbi I, Lapucci G, Bondi B, et al. Effectiveness of a video lesson for the correct use in an emergency of the automated external defibrillator (AED). Acta Biomed 2020; 91: 71-8. doi: 10.23750/abm.v91i6-S.9589.

Rajaganeshan R, Ludlam CL, Francis DP, Parasramka SV, Sutton R. Accuracy in ECG lead placement among technicians, nurses, general physicians and cardiologists. Int J Clin Pract 2008; 62: 65-70. doi: 10.1111/j.1742-1241.2007.01390..x.

DiLibero J, DeSanto-Madyea S, O'Dongohue S. Improving accuracy of cardiac electrode placement: outcomes of clinical nurse specialist practice. Clin Nurse Spec 2016; 30: 45-50. doi: 10.1097/NUR.0000000000000172.

Gye Jeong Y, Jeongha Y, Hyun Sook K. Development and Effects of Supplementary Textbook about EKG for Nursing Students. J Korean Acad Fundam Nurs 2020; 27: 268-76. doi:

Al-Husaunawy AA. Evaluation of Nurses Knowledge and Practice of Electrocardiogram Toward Adolescent Patient. IOSR Journal of Nursing and Health Science 2015; 4: 10-6. doi: 10.9790/1959-04421016.

Jang KS, Hwang SY, Park SJ, Kim YM, Kim MJ. Effects of a Web-based teaching method on undergraduate nursing students’ learning of electrocardiography. J Nurs Educ 2005; 44: 35-9.

doi: 10.3928/01484834-20050101-07.

Zhang H, Hsu LL. The effectiveness of an education program on nurses’ knowledge of electrocardiogram interpretation. Int Emerg Nurs 2013; 21: 247-51. doi: 10.1016/j.ienj.2012.11.001.

Sharman J. Clinical skills: cardiac rhythm recognition and monitoring. Br J Nurs 2007; 16: 306-11. doi: 10.12968/bjon.2007.16.5.23012.

McGrath A, Sampson M. Electrocardiograms: a guide to rhythm recognition for emergency nurses. Emerg Nurse 2018; 26: 21-9. doi: 10.7748/en.2018.e1767.

National Association of Emergency Medical Technicians (NAEMT). AMLS Advanced Medical Life Support. Elsevier Srl, 2012.

Tahboub OYH, Dal Yılmaz Ü. Nurses’ knowledge and practices of electrocardiogram interpretation. Int Cardiovasc Res J 2019; 13: 80-4.

Coll-Badell M, Jiménez-Herrera MF, Llaurado-Serra M. Emergency Nurse Competence in Electrocardiographic Interpretation in Spain: A Cross Sectional Study. J Emerg Nurs 2017; 43: 560-70. doi: 10.1016/j.jen.2017.06.001.

Hand H. Common cardiac arrhythmias. Nurs Stand 2002; 16: 43-52. doi: 10.7748/ns2002.

Hutchisson B, Cossey S, Wheeler RM. Basic electrocardiogram interpretation for perioperative nurses. AORN J 2003; 78: 572-81, 585-90, quiz 591-94. doi: 10.1016/s0001-2092(06)60665-0.

Smith JN, Negrelli JM, Manek MB, Hawes EM, Viera AJ. Diagnosis and Management of Acute Coronary Syndrome: An Evidence-Based Update. J Am Board Fam Med 2015; 28: 283-93. doi: 10.3122/jabfm.2015.02.140189.

Werner K, Kander K, Axelsson C. Electrocardiogram interpretation skills among ambulance nurses. Eur J Cardiovasc Nurs 2016; 15: 262-8. doi: 10.1177/1474515114566158.

Blakeman JR, Sarsfield K, Booker KJ. Nurses' Practices and Lead Selection in Monitoring for Myocardial Ischemia: An Evidence-Based Quality Improvement Project. Dimens Crit Care Nurs 2015; 34: 189-95. doi: 10.1097/DCC.0000000000000118.

Richley D. New training and qualifications in electrocardiography. British Journal of Cardiac Nursing 2013; 8. Doi: 10.12968/bjca.2013.8.1.38.

Cremonini V, Ferri P, Artioli G, Sarli L, Piccioni E, Rubbi I. Nursing students’ experiences of and satisfaction with the clinical learning environment: the role of educational models in the simulation laboratory and in clinical practice. Acta Biomed 2015; 86(S3): 194-204.

Brown DK, Chronister C. The Effect of Simulation Learning on Critical Thinking and Self-confidence When Incorporated Into an Electrocardiogram Nursing Course. Clin Simul Nurs 2009; 5: e45-e52. doi: 10.1016/J.ECNS.2008.11.001Corpus ID: 71630627.

Ravert P. Patient simulator sessions and critical thinking. J Nurs Educ 2008; 47: 557-62. doi: 10.3928/01484834-20081201-06.

Blum CA, Borglund S, Parcells D. High-fidelity nursing simulation: Impact on student self-confidence and clinical competence. Int J Nurs Educ Scholarsh 2010; 7: Article 18. doi: 10.2202/1548-923X.2035.

Alamrani MH, Alammar KA, Alquahtani SS, Salem OA. Comparing the Effects of Simulation-Based and Traditional Teaching Methods on the Critical Thinking Abilities and Self-Confidence of Nursing Students. J Nurs Res 2018; 26: 152-57. doi: 10.1097/jnr.0000000000000231.

Cant RP, Cooper SJ. Use of simulation-based learning in undergraduate nurse education: An umbrella systematic review. Nurse Educ Today 2017; 49: 63-71. doi: 10.1016/j.nedt.2016.11.015.

Magnani D, Di Lorenzo R, Bari A, Pozzi S, Del Giovane C, Ferri P. The undergraduate nursing student evaluation of clinical learning environment: an Italian survey. Prof Inferm 2014; 67(1): 55-61. doi: 10.7429/pi.2014.671055.

Warren JN, Luctkar-Flude M, Godfrey C, Lukewich J. A systematic review of the effectiveness of simulation-based education on satisfaction and learning outcomes in nurse practitioner programs. Nurse Educ Today 2016; 46: 99-108. doi: 10.1016/j.nedt.2016.08.023.

Hegland PA, Aarlie H, Strømme H, Jamtvedt G. Simulation-based training for nurses: Systematic review and meta-analysis. Nurse Educ Today 2017; 54: 6-20. doi: 10.1016/j.nedt.2017.04.004.






Original articles: Health Professions 3/2021

How to Cite

Rubbi I, Carvello M, Bassi V, Triglia C, Di Lorenzo R, Cremonini V, et al. The skill of nursing students trained in the evaluation of electrocardiographic trace: a comparison with emergency nurses. Acta Biomed [Internet]. 2021 Dec. 22 [cited 2024 Jul. 22];92(S2):e2021507. Available from: