Effectiveness of nursing education program on nurses knowledge toward Arrhythmia in Kirkuk's teaching hospitals

Objective: To evaluate the effectiveness of nursing educational program on nurse's knowledge toward arrhythmia in Kirkuk's teaching hospitals. Methodology: A quasi-experimental design was carried out at Azady and Kirkuk teaching hospitals from 17th January, 2011 to 10th of June, 2012. The program and instruments constructed and developed by the researcher to measure the purpose of the study. Purposive sample comprised of (80) nurses was divided into two groups, study group consisted (40) nurses exposed to the nursing educational program and control group consisted (40) nurses were not exposed to the program. The measurement of effectiveness of nursing educational program through the knowledge assessment includes (43) items. Reliability of instrument was determined through the use of test and retest and the instrument validity was determined through a panel of experts. Results: The results of the study showed that the effectiveness of educational program regarding nurses' knowledge toward arrhythmia is a positive and clear . It is also shows that there is good improvement with highly significant differences in study group in overall main domains related to nurse's knowledge. Recommendation: The study recommends that all nurses in the medical department in our country should be involved in the application of educational program which was developed in this study


INTRODUCTION
About 40% of sudden death victims have cardiac arrest as the first manifestation of coronary artery disease.In patients with known coronary heart disease, sudden death is frequently caused by the sudden rupture of an unstable plaque, leading to occlusion of the coronary artery in a vessel previously having only a slight narrowing (1). (2)Emphasized that the nurses have significant diagnostic influence in the areas of cardiac rhythm monitoring and dysrhythmia identification .It is essential that nurses who care patients at risk for cardiac dysrhythmia have a thorough understanding of accurate electrode placement.They must also use current principles when determining the optimal leads to use in monitoring specific types of dysrhythmia. (3)Stated that the coronary care unit (CCU) should be well equipped to deal with the appropriate emergency cases as well as to provide basic and the needed life support equipment such as electro-cardiac record, cardiac monitor, and Holter.Nurses working in CCU should be highly qualified and able to provide an effective care around -the -clock, with ratio of one nurse to one patient.The intention behind this statement is to ensure high quality performance and save as possible patient's life . (4)published a qualitative study of critical care nurses which indicated that the skills necessary to recognize and treat arrhythmias could be -Nurses that should have at least one year of experience or more.
-Nurses who worked in the morning and night shift.
-Nurses who worked in the medical department (CCU, clinical unit, Emergency department, ECG unit) The educational program was designed to provide nurses knowledge related to (Anatomy and physiology of the heart and conduction system.Leads and placement of For the purpose of this study, the number of correct responses of the knowledge questionnaire was used as the measure of the level of knowledge.Each question comprised of (3) alternative for multiple choice.The questions were scored as correct question (1) point and the incorrect question (0) point.
Knowledge tests were used for pre education and after education immediately.The nurses in the control group were given knowledge tests at the same time that be given to the study group.Evaluation of the nurses' knowledge was based on their responses to the questionnaire format items.Scores of the response were categorized according to the following; High high (75-100):4; high low (50-74):3; low high (25-49):2: low low (0-24):1 Nurses in the control group had regular methods and information by the nurses or other staff members who may have verbalized to nurse.They also include brief instructions which are provide by the physician, if the nurses in the control group ask the researcher questions, they are instructed to refer their questions to appropriate member of the health team e.g nurse or physician.

Statistical Analysis
The data of present study were analyzed through the application of two statistical approaches .A descriptive statistical approach that includes Frequency,Percentage, x ∓ S. D.=Arithmetic Mean (x) and Std.Dev.(S.D.),and an Inferential statistical approach that includes Chi-Square test, t.test, Fisher Exact Probability test (F.E.P.T.), Levene's test and ANOVA ,for testing a non-restricted frequency and Wilcoxon Signed Ranks test for testing two category nominal scale variables Results were determined as highly significant at (P<0.01), significant at (P<0.05) and non significant at (P>0.05).Table-1: revealed that the majority 17(42.5%) of nurses in the study group are within the age group (25 -29) while 15(37.7%) of nurses in the control group and 31(77.5%) of nurses in the study group were male and 34(85%) of nurses in the control group ware male.

RESULTS:
According to the educational level,15(37.5%) of nurses in the study and 17(42.5%) of nurses in the control groups are nursing Institute.Statistically, there is no significant difference between study and control groups related to age group ,gender, and educational level when analyzed by chi-square and Student (t-test) .

DISCUSSION:
Arrhythmia is a disturbance in regular heart rate and/or rhythm due to change in electrical conduction or automaticity.Some arrhythmias can be described as minor arrhythmias, which do not usually need treatment, while other major arrhythmias, which should be, treated as soon as possible (5).
This study revealed that there is no significant differences between study and control groups at pre test of items (Heart Anatomy, Leads and Placement of electrodes, Time duration for impulses transition and reading ECG paper, Cardiac rhythm, Ventricular Premature Contractions (VPCs), Atrioventricular Block, Antiarrhythmic Drugs) (table3).
The researcher confirmed that the deficit knowledge of nurses in control group toward arrhythmias might be due to improper perpetration of nursing medical department during this phase of the study ,in addition to unavailability of scientific nursing journal or books in Arabic and emphases of the importance motivation the nurses to important this knowledge in the ECG related to the arrhythmias.
This finding has provided the support and the logical reasoning that the researcher selected the sample of the study by correct methods.The sample has the same criteria and there are no significant differences between them.The researcher selects the study and control groups by using homogeneity as possible. (6)revealed that the researcher must use the homogeneity approach to control intrinsic subject characteristics that could not contaminate the relationship under investigation .
The researcher confirmed that the nursing in the control group are not changed in pre-posttest, they remain stable at all measures.This is agreement with (7) stated that a nurse does not participate in continuing education opportunities, she will not be able to renew her license to practice medicine.
Our study revealed that there is highly significant differences between study categorized as basic, intermediate or advanced.Identification of specific arrhythmias including heart block, aberrant conduction, and tachyarrhythmia's varied across training and experience levels within the test sample.The objective of this study is to evaluate the effectiveness of nursing educational program on nurse's knowledge toward arrhythmia in Kirkuk's teaching hospitals METHODOLOGY A quasi-experimental design was carried out during the period from 17th January 2011 to 1 st June 2012.A Purposive sample comprised of (80) nurses was divided into two groups, study group consisted (40) nurses exposed to the nursing educational program and control group consisted (40) nurses were not exposed to the program.Those who met the criteria for selection were nurses who were working at the teaching hospitals.

Table - 3
-shows that there is no significant differences between study and control groups in all items at pre test except (What direction of current do lead II measure?) of Leads and Placement of electrodes , (Second Degree AV Block Mobitz I (Wenkebach) of Atrioventricular Block shows that there is significant difference related to nurses knowledge when analyzed by Mann-Whitney U .
and control groups at post test in items (Heart Anatomy, Leads and Placement of electrodes, Time duration for impulses transition and reading ECG paper, Cardiac rhythm, Ventricular Premature Contractions (VPCs), Atrioventricular Block ) ( table -4).These differences between the study and control groups in post test indicated nurses must continually educate themselves to keep up date on arising situations in health care.sometimes there is a need for nurses to receive immediate additional training for a particular condition or medical development.Nurses must