Obstetrical Nurses and Matters of the Heart: A Successful Collaboration In the Development of a Basic ECG Recognition Course for OB Nursing Practice
Audio File
- Outline the development of an assessment process which accurately reflects staff education needs.
- Identify the elements for a successful multidisciplinary collaboration in the design and implementation of an obstetrics-specific ECG program.
- Describe the benefit and clinical outcomes of an OB and critical care educator collaboration in the delivery of a basic ECG course for OB nurses.
In this program we share a powerful collaboration between perinatal and critical care educators in designing and implementing an obstetric-specific, Electrocardiography (ECG) recognition course. While the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that cesarean delivery patients be provided “a comparable level of care to what they would receive in the main hospital PACU,” neither advanced cardiac life support nor ECG certification for OB nurses is an AWHONN standard when personnel with those skills are readily available. Some literature questions the value of routine ECG monitoring in the OB PACU. Consequently, application of national credentialing and professional organizations’ guidelines is not uniform, and the post-anesthesia expertise of obstetrical nursing staff varies widely.
Our level II and tertiary care facilities routinely provide 3-lead monitoring during and following caesarean delivery. As the acuity and complexity of patients increase, cardiac co-morbidities and dysrhythmia-inducing conditions, while infrequent, necessitate management in high risk labor and delivery. This generates a compelling argument for broadening the obstetrical nurse’s knowledge of cardiac complications.
Proposed change:
A two-day standardized ECG class with a post-test passing score is a requirement across our system however, OB nursing staff found the application of the content in clinical practice and the post-course test very challenging, and expressed concerns about the existing format meeting their learning needs. Discussions with OB nursing staff and a multi-disciplinary team of educators and physicians resulted in a commitment to develop an OB-specific ECG course.
Implementation, outcomes and evaluation:
Assessment of the staff’s learning needs was the first step in this process. Staff was polled on perception and attitude toward the current standardized course and the “ideal” learning experience. Responses revealed the course content was “confusing,” “difficult to relate to clinical practice,” “too specific to the medical-surgical population,” and the emphasis on analysis and treatment of uncommon dysrhythmias was “information overload.” As dysrhythmia is of low incidence in OB populations, there was concern that the depth and breadth of instruction diluted the issues of greatest importance in recognizing abnormal cardiac events. Based on this feedback, OB and critical care educators utilized their expertise in curriculum revision.
Implications for nursing practice:
Program modification focused on recognition and immediate response to critical rhythms, employing relevant obstetric scenarios, simulation and a post-test. The course evaluations were overwhelmingly positive. Shortly following its completion, a participating nurse identified and intervened when a patient presented with a significant dysrhythmia; evidencing clinical application of the revised obstetrical ECG recognition course.
Keywords:
Collaboration, ECG, multi-disciplinary, learning needs
