Development and Preliminary Evaluation of a CDIO-Based Electrocardiogram Interpretation Training Program for Clinical Nurses: A Mixed-Methods Study
Abstract
Abstract Background: Electrocardiogram (ECG) interpretation and monitoring are essential clinical competencies for nurses, yet conventional training approaches predominantly emphasize theoretical knowledge transmission, with limited systematic integration of ECG interpretation, monitoring operations, and clinical application. The Conceive-Design-Implement-Operate (CDIO) engineering education framework offers a task-driven, cyclical approach that may address these gaps, but its application to in-service clinical nurse training remains underexplored.
Methods:: A multi-stage mixed-methods design incorporating action research methodology, a single-group pre-post quantitative evaluation, and descriptive qualitative research was employed. The study was conducted across eight clinical areas in a Class III Grade A hospital in Jiangsu Province, China, from May to October 2025. A total of 267 clinical nurses completed the training needs assessment. The training program was developed iteratively through four CDIO stages informed by needs assessment data and action research cycles. Training content encompassed four modules: ECG fundamentals, common arrhythmia interpretation, critical arrhythmia identification, and standardized monitoring operations with alarm management. Seventy-seven nurses voluntarily enrolled in and completed all training activities and evaluations. Evaluation followed the Kirkpatrick four-level model (reaction, learning, behavior, and results), supplemented by…
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