Introduction
Understanding the basic information on the electrocardiogram is essential to nursing students. The electrocardiogram is an essential investigation that can provide a speedy diagnosis of the condition of the heart in an emergency. Several conditions of the heart can be diagnosed using this tool. The nurse who sees the patients in the emergency room must understand the value of the ECG in a life-saving situation. She may have to do it as the first step in patients who arrive with chest pain or after an accident. The ECG is a transthoracic interpretation of the electrical activity of the heart and is recorded externally by using skin electrodes. An electrocardiograph is a device used to perform this non-invasive procedure. The electrical impulses begin in the sino-atrial node and travel through the heart. The heart muscles contract and causes systole. The relaxation produces the diastole of the heart. Electrodes on the different parts of the heart measure the activity in the different parts. The display on the ECG shows the voltage difference between pairs of electrodes and the corresponding muscle activity. Abnormal rhythms of the heart can be measured and diagnosed (Braunwald, 1997). Abnormal rhythms can be demonstrated when the conducting tissue gets damaged due to electrolyte changes (Clinical value, 2004). The standard 12-lead ECG used all over the world was introduced in 1942 (Electrocardiogram, WebMD).
Aim of Teaching the recording of ECG in the clinical setting
Clinical education has models which help improve the clinical education experience immensely. “Overall planning, structuring of sessions, integration and logical progression of the clinical practicum” are aspects to be improved in clinical education (Rose and Best, 2005). The ultimate aim is to improve patient care. This teaching class aims to enable the learners to understand the different aspects of the ECG; the reasons for using it, the emergencies which require ECG for diagnosis, how the ECG is taken in an emergency and what readings are generally considered normal and abnormal. A smoothly run clinical education experience is least stressful for both the participants, the educator, and the student, and yet the maximum productivity must be realized. Competence in the field allows educators to contribute positively to the teaching standards of practice in a particular discipline.
Models of learning
Here the traditional method will be used for procedural instruction. The constructivist theory will be adopted for the rest of the clinical education. Students who are being trained to serve patients acquire their experiences in the ward. Organizing their knowledge base, developing their skills for clinical reasoning, improving their diagnostic skills, and helping them to apply clinically their sound knowledge form part of the teaching curriculum (Clinical education, Griffith University). The students need to learn the theoretical aspects, develop their reasoning and use their skills in a dynamic classroom.
Constructivism
Constructivism is a “philosophical viewpoint on how the mind forms and modifies its understanding of reality”(Constructivism, UmassAmherst). Jean Piaget was the first person to introduce constructivism in the modern era and he believed that” the mind organizes the world by organizing itself” (1937). Other philosophers considered that knowledge is not a representation of facts but an association of theories, relationships, and rules (Foerster, 1981; Glaersfeld, 1984). Locke, Dewey, and Kant also believed in the constructivist theory (Young and Patterson, 2007). In constructivism, knowledge is not transmitted from teacher to student; it is constructed by the student himself or is student-centered. His prior experience or knowledge influences his present learning. Effortful activity with a purpose is necessary for the process of learning(Constructivism, UmassAmherst).
The traditional method and constructivism model have been selected for teaching the subject of electrocardiography to Second Year Nursing students. In constructivism the students gain and process information, simultaneously constructing meaning from the experience (Constructivism, Pearson Education, Inc.). The teacher creates the environment. The students give shape to what they have learned from their active involvement and their critical skills. They are not passive listeners as in the traditional model of learning where the teacher teaches and the student listens. The principle behind this is that knowledge obtained from data acquired by learners is more flexible and transferable than that obtained by experts. The teacher first gauges the basic knowledge that the students have. He then helps the students build on that with further knowledge, skills, and competencies so that he slips into the role of a professional easily (Demarco, Hayward, & Lynch, 2002). The possibility of a shift in nursing from nurse-centered to client-centered nursing practice is demonstrated by the constructivist theory; the student would use the experience he had from teaching classes (Engebretson & Littleton, 2001).
Teacher objectives
The student would be able to identify the reasons and significance of taking an ECG in the emergency room, describe the importance of doing it as much as any life-saving measure and demonstrate how an ECG is recorded, and explain the significance of letting the emergency doctor know immediately.
Teacher Strategies and rationales
Utilizing the five principles of constructivism, the teacher would create sessions that help the student come through with his ideas (Brooks and Brooks, 1993). Students would be assisted in boldly sharing their ideas during and after each session of their learning. They would be free to change their concepts whenever necessary. Key concepts of the subject would be always remembered and the students would be assessed frequently to observe that they are not missing the essential ones. The teacher ensures that the interpretations of the student are asked for and valued. The plan that the teacher decided on could be changed at any moment to suit the intelligence and cognitive styles of the students. Whatever the student provides as feedback should not be considered in a biased manner and the teacher should not be judgemental or allow others to be so (Brooks and Brooks, 1993).
The teacher finds ways to promote student autonomy and creativity in class (Health, Pearson Education Inc.). They are expected to come prepared for class as the timetable is the notice board. In the first session, the procedural information would be imparted traditionally. The students would also share the information gathered from their readings and what each of them thought about the subject and what more they would like to know about it (Health, Pearson Education Inc.). Engaging the students to frame their questions and layout the basic information which they have gathered, they would be helped to evolve an aim from their ideas about what else they would like to know. The learning objective then should become obvious.
They would be shown an ECG and the students would be expected to explore it and ask questions and how it is related to a patient. The significance and importance of taking an ECG early for diagnosis in an emergency will probably be surmised by the students themselves. When other examples of ECGs are shown, they would ask more questions about the differences. The interesting comments and observations would help the teacher provide her suggestions and knowledge about the subject. Occasionally resorting to open-ended questions, the interest of the students may be stimulated for more information (Health, Pearson Education Inc.). Clarification may have to be given; their original responses may be clarified along the way. Providing opportunities for them to correct wrong assumptions will be the teacher’s job but guiding them to correct themselves would be better than openly telling them in the first place. Ensuring that sufficient time is allowed after a question for the answer to be made, they would be given ample chance to answer in their own words. Their natural curiosity is to be used as a means of furthering their knowledge (Health, Pearson Education Inc.).
The third session would be a training class in the ECG room to see how an ECG is being taken. They would be given sufficient opportunities to take the ECG themselves. They are guided by the teacher and Technician on duty.
The minimum requirements for effective teaching include the environment, the dialogue, and the closure. The learning environment requires lighting, seating arrangement, and audiovisual aids adequate for training. The dialogue must be offered in a formal, clear, and logical manner so that the students do not miss any part of it. The lessons must end with sufficient time for discussion and clearing doubts. The teaching must end with the educators being in a position to submit a summary (McTaggart, 1997). The teacher must also be able to have applied proper teaching and learning principles in the three areas of cognitive, affective, and psychomotor (Roberta, 2001).
Learner outcome
The student must be able to record an ECG and know about its significance in an emergency.
Student Evaluation
The written examinations and practical evaluations would determine the level of learning the student has acquired.
Teacher self-assessment
By viewing the examination papers, the teacher understands how much her students have learned from her. This should be able to tell her whether her methods were right and whether she needs to change them for later batches of students. She can ask and clarify which parts failed in the process (Bradshaw, M., & Lowenstein, 2006).
References
Bradshaw, M., & Lowenstein, A. (2006). Innovative Teaching Strategies in Nursing and Related Health Profession. London: Jones and Bartlett Publishers.
Braunwald E. (Editor), Heart Disease: A Textbook of Cardiovascular Medicine, Fifth Edition, p.108, Philadelphia, W.B. Saunders Co., 1997. ISBN 0-7216-5666-8.
Brooks, M.G. and Brooks, J.G. (1993), In Search of Understanding, The Case for the Constructivist Classroom”, New York: SUNY.
Cobb, T. (1999). “Applying constructivism: A test for the learner as scientist. Educational Technology Research & Development, 47 (3),15-31.
Constructivism, Scientific Research and Reasoning institute, UMassAmherst, University of Massachusetts, Amherst.
Demarco, R., Hayward, L., & Lynch, M. (2002). Nursing Experiences with the Strategic Approaches to Case-Based Instructions: Areplication and Comparison Study between two Disciplines. Journal of Nursing Education, 41, 165-174.
Engebretson, J.C. and Littleton, L.Y. (2001). “Cultural negotiation: A constructivist-based model for Nrsing Practice” Nursing Outlook, Volume 49, Issue 5, Pages 223-230.
Foerster, H. von (1981) Observing systems. Seaside, California: Intersystems Publications.
Glasersfeld, E. von (1984) An introduction to radical constructivism, in P. Watzlawick (ed.) The invented reality. New York: Norton. German original, 1981.
Health, “Clinical Education”. Web.
Health: “Constructivism: A model of Learning”.
McTaggart, R. (1997). Participatiry Action Research. New York:Sunny Press.
Piaget, J. (1971) The construction of reality in the child; New York: Basic Books. French original, 1937.
Rose, M. and Best, D., (2005). “Transforming practice through clinical education, professional supervision, and mentoring”. Elsevier Health Sciences.
“The clinical value of the ECG in noncardiac conditions” Chest 2004; 125(4): p. 1561-76. PMID 15078775.
Young, L & Paterson, B. (2007). Teaching Nursing: Developing a Student-Centered Learning Environment. Philadelphia: Lippincott, Williams & Wilkins.