title: Design and validation of a three-instrument toolkit for the assessment of competence in electrocardiogram rhythm recognition.
abstract: Rapid and accurate interpretation of cardiac arrhythmias by nurses has been linked with safe practice and positive patient outcomes. Although training in electrocardiogram rhythm recognition is part of most undergraduate nursing programmes, research continues to suggest that nurses and nursing students lack competence in recognising cardiac rhythms. In order to promote patient safety, nursing educators must develop valid and reliable assessment tools that allow the rigorous assessment of this competence before nursing students are allowed to practise without supervision.
  
  
  
  The aim of this study was to develop and psychometrically evaluate a toolkit to holistically assess competence in electrocardiogram rhythm recognition.
  
  
  
  Following a convenience sampling technique, 293 nursing students from a nursing faculty in a Spanish university were recruited for the study. The following three instruments were developed and psychometrically tested: an electrocardiogram knowledge assessment tool (ECG-KAT), an electrocardiogram skills assessment tool (ECG-SAT) and an electrocardiogram self-efficacy assessment tool (ECG-SES). Reliability and validity (content, criterion and construct) of these tools were meticulously examined.
  
  
  
  A high Cronbach's alpha coefficient demonstrated the excellent reliability of the instruments (ECG-KAT=0.89; ECG-SAT=0.93; ECG-SES=0.98). An excellent context validity index (scales' average content validity index>0.94) and very good criterion validity were evidenced for all the tools. Regarding construct validity, principal component analysis revealed that all items comprising the instruments contributed to measure knowledge, skills or self-efficacy in electrocardiogram rhythm recognition. Moreover, known-groups analysis showed the tools' ability to detect expected differences in competence between groups with different training experiences.
  
  
  
  The three-instrument toolkit developed showed excellent psychometric properties for measuring competence in electrocardiogram rhythm recognition.
authors.affiliation: 1 Adult, Child and Midwifery Department, Middlesex University, UK.
authors.forename: José M
authors.initials: JM
authors.lastname: Hernández-Padilla
authors.affiliation: 2 Nursing, Physiotherapy and Medicine Department, University of Almeria, Spain.|3 Faculty of Health Sciences, Universidad Autónoma de Chile, Chile.
authors.forename: José
authors.initials: J
authors.lastname: Granero-Molina
authors.affiliation: 2 Nursing, Physiotherapy and Medicine Department, University of Almeria, Spain.
authors.forename: Verónica V
authors.initials: VV
authors.lastname: Márquez-Hernández
authors.affiliation: 1 Adult, Child and Midwifery Department, Middlesex University, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Suthers
authors.affiliation: 4 Department of Health Sciences, University of Jaén, Spain.
authors.forename: Olga M
authors.initials: OM
authors.lastname: López-Entrambasaguas
authors.affiliation: 2 Nursing, Physiotherapy and Medicine Department, University of Almeria, Spain.|3 Faculty of Health Sciences, Universidad Autónoma de Chile, Chile.
authors.forename: Cayetano
authors.initials: C
authors.lastname: Fernández-Sola
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement / Q000592:standards*; D004562:Electrocardiography / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D013030:Spain; D011795:Surveys and Questionnaires; D063189:Symptom Assessment / Q000592:standards*
keywords: Competence assessment; cardiac arrhythmias; knowledge; nursing students; self-efficacy; skills