Paper Type

Doctoral Project


Brooks College of Health

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Dr. Carol Ledbetter

Second Advisor

Dr. Kathy Robinson

Third Advisor

Dr. Gerard Hogan


Standards of practice for hospital electrocardiogram monitoring were recommended in 2004 by the American Heart Association; however they are not widely followed. Many nurses monitor in a single lead regardless of diagnosis and are unable to differentiate wide QRS complex tachycardias. The purpose of this project was to evaluate the effectiveness of an interactive web-based education program combined with unit-based collaborative learning activities on both telemetry staff nurses‘ knowledge of dysrhythmias and their monitoring practices for patients at risk for wide QRS complex tachycardias. This interventional, one group before-and-after cohort study design consisted of four components: interactive web-based educational program with a pretest and posttest, unit-based collaborative activities, competency skills validation, and patient audits of electrode placement and lead selection at baseline, six weeks, and 18 weeks. There were 34 nurses who consented to participate, 16 started the program, and nine finished all the components. The pretest scores ranged from 0 – 60% with median of 36.5%. The posttest scores ranged from 47 – 93% with median of 80%. The Wilcoxon Signed Ranks test showed a significant difference between the pretest and posttest scores (p = .008). The patient audit results did not indicate significant differences in proportions of correct electrode placement and correct lead selection between baseline, 6 weeks, and 18 weeks. The program was effective in increasing nurses‘ knowledge about dysrhythmias; however, it was not effective in changing monitoring behavior. More research is needed to see if this type of program is more effective if it involves all the staff on the unit who are responsible for monitoring, and if additional strategies are used, such as unit champions and group rewards.

Included in

Nursing Commons