Educational interventions to improve electrocardiogram interpretation competence among nurses: A systematic review.

Review question/objective The objective of this systematic review is to identify the best available research evidence related to the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy in people with chronic respiratory diseases, focusing on measures of adherence and health outcomes. The specific review questions to be addressed are: 1. What is the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy in terms of inhalation regimens and inhalation techniques in people with chronic respiratory diseases? 2. What is the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy on health service utilization and patient outcomes including symptoms, pulmonary function, and quality of life? 3. What is the effectiveness of various designs, in terms of components, modes and intensities, of educational and supportive interventions for improving adherence to inhalation therapy? Inclusion criteria Types of participants This review will consider studies that include adults aged 18 or above, with a clinical diagnosis of chronic respiratory disease and prescribed self-administered inhalation therapy as a long term regular treatment, irrespective of the type of inhaler used. For the purposes of this review, "chronic respiratory diseases" is defined by WHO in 2007 as "the chronic diseases of the airways and other structures of the lung" (p.5). 1 Inhalation therapy is defined as "a treatment in which a substance is administered to the respiratory tract with inspired air". 6 This review will focus on inhalation of drugs. Those studies with prescribed administration of oxygen and water will be excluded. There is no universal standard for how long a treatment is undertaken to be defined as a "long term treatment". Acute episodic drug treatments, such as a course of antibiotics, will be excluded. Types of interventions of interest All educational interventions, with or without supportive programs, designed to improve the chronic respiratory disease sufferers inhalation technique and adherence to their prescribed inhalation therapy will be considered. Those studies that involve comparison of different types of inhalation medications, inhaler devices or inhalation methods to improve the adherence to inhalation therapy will be excluded. For the TRUNCATED AT 350 WORDS

Effectiveness of interventions to reduce exposure to lead through consumer products and drinking water: A systematic review

Direct current shock interventions, including defibrillation and synchronized cardioversion, are critical lifesaving procedures in emergency departments and intensive care units. Nurses play a central role in preparing, monitoring, and in many clinical contexts initiating direct current shock therapy; however, concerns persist regarding variability in nurses’ knowledge and practical skills, which may compromise patient safety. This systematic review aimed to synthesize evidence on nurses’ baseline knowledge and practical skills related to direct current shock management and to examine the effects of educational interventions on these competencies. A systematic review was conducted in accordance with PRISMA guidelines and prospectively registered with PROSPERO. Searches were performed in Web of Science, Scopus, PubMed, ScienceDirect, and the Cochrane Library from 2010 to 15 March 2025. Quantitative and mixed-methods studies assessing nurses’ knowledge and/or skills related to defibrillation or cardioversion were included. Study selection, data extraction, and quality appraisal using the Critical Appraisal Skills Programme (CASP) checklists were undertaken independently by two reviewers. Given variations in study designs, outcome measures, and assessment tools, findings were synthesized narratively. Seven studies met the inclusion criteria, encompassing cross-sectional, quasi-experimental, and randomized controlled designs. Baseline assessments frequently demonstrated low to moderate levels of nurses’ knowledge and skills, particularly in rhythm recognition, energy selection, safety precautions, and post-shock care. Three studies evaluating educational interventions reported short-term improvements in knowledge and/or practical performance. However, follow-up durations were limited, outcome measures varied, and methodological limitations were common. Overall methodological quality ranged from low to high. Available evidence suggests the presence of gaps in nurses’ baseline knowledge and skills related to direct current shock management. Educational and simulation-based interventions were associated with short-term improvements, although the strength of evidence remains limited due to the small number of heterogeneous studies. Further nurse-focused, methodologically robust research with standardized outcome measures and longer follow-up is required. Not applicable. Systematic review was conducted following PRISMA guidelines and prospectively registered with PROSPERO (CRD420251172168).

Digital health professions education on chronic wound management: A systematic review

Simulation can be defined as a person, device or set of conditions made to resemble a real life situation. It is used in many high-risk industries particularly when reality is dangerous, critical events are rare and errors are costly in human and/or financial terms. The use of simulation in the UK is now considered an essential component of education programmes designed for healthcare practitioners. However the use of simulation in undergraduate education has been studied in depth but little is known about its use in postgraduate education. The aim of this systematic review was to establish: where and in which context is simulation an effective educational medium in post qualifying/continuing education; what is the benefit to learners of using simulation in respect of their knowledge, skills and confidence and what are the implications for future research in this area? This review looked for both quantitative and qualitative evidence in the form of primary research.The review focused on post qualification medical, nursing and midwifery staff undertaking educational development programmes utilising simulation. Types of interventions: the intervention explored in this review is simulation in the form of the re-creation of a patient centred scenario / event in a realistic context. The review explicitly excluded simulation designed to specifically to improve motor skills in isolation from context, such as part task trainers. The outcome measures to be explored in this review were: demonstration of the application of knowledge to the simulated clinical situation; demonstrable improvement in knowledge of the environment and equipment; demonstration of risk assessment; safe working practice in relation to the clinical environment; recognition of own limitations and knowing when to call for help; effective communication; team working and leadership skills; evidence from learners in relation to the educational experience; evidence of increased learner confidence following simulated practice; evidence of improved patient outcome being assessed in relation to training SEARCH STRATEGY: The search strategy aimed to find both published and unpublished English language studies from 1998-2009. Databases systematically searched included: Medline, CINAHL, EMBASE, ERIC and the Dissertation Abstracts International Proceedings. Papers were assessed for methodological quality independently by two of the review team. Critical appraisal of methodological quality of papers was undertaken using the Joanna Briggs Institute modules, Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and Qualitative Assessment and Review Instrument (JBI-QARI). Differences in judgment were resolved through discussion between the two reviewers of their differences and through the inclusion of a third reviewer if necessary in order to reach consensus. A fifth member of the team independently reviewed all included and excluded studies as a quality control mechanism. The process of data extraction was undertaken independently by two reviewers using the JBI data extraction tools. A statistical meta-analysis of the data was not possible due to the variation in outcome measures used in the papers. The findings are therefore presented descriptively using the specified outcome measures as a reporting framework. The initial search identified 1522 papers. Thirty eight papers were considered to have met the inclusion criteria and were subsequently critically appraised for methodological quality. Thirty papers were considered to be of appropriate quality for inclusion in the review. These were predominantly experimental pre post test studies but they covered a wide range of healthcare workers and situations. There is considerable evidence that suggests that simulation based educational programmes are consistently effective in improving the performance of doctors, nurses and midwives in educational contexts particularly in teamwork and communication. There is also evidence that practitioners value simulation as a learning and teaching strategy. There is however very little evidence to support the assumption that improvements in performance are translated into "real life" clinical settings and ultimately outcomes for service users. Although the evidence base provided by this review is relatively weak in terms of educational practice it would seem to have high face validity. The evidence has added coherence when seen in the context of educational theory and those planning educational programmes for healthcare practitioners should be cognizant of the potential benefits offered by simulation as part of a blended approach to learning. This review has identified a clear need to establish causative links between simulation based educational programmes and improvements in healthcare practice, by using experimental designs where simulation is compared with other educational interventions.

Global Developmental Delay (GDD) affects cognitive, language, motor, and adaptive functions in children under five years and is often a precursor to long-term neurodevelopmental disorders including intellectual disability and autism spectrum disorder. Early intervention can improve developmental outcomes, yet evidence regarding its effectiveness, especially in low-resource and diverse clinical settings, remains fragmented. To synthesize available evidence on the effectiveness of early intervention programs for children aged 0-6 years with GDD, and to identify intervention types, outcomes, and gaps in current research. A systematic review following PRISMA 2020 guidelines was conducted. PubMed, Web of Science, Scopus, and ClinicalTrials.gov were searched up to October 14, 2025, using predefined search terms. Eligible studies included children aged 0-6 years diagnosed with GDD or nonspecific developmental delay and involved an early intervention program assessing developmental outcomes. Data extraction and quality appraisal were performed using Joanna Briggs Institute (JBI) tools. Narrative synthesis was used due to heterogeneity across studies. Six studies involving a total of 689 participants were included. Interventions varied widely, including multidisciplinary rehabilitation, parent-mediated programs, community-based approaches, and combined medical-therapeutic methods. All studies reported improvements in at least one developmental domain (motor, language, cognitive, or social), with greater gains observed when interventions were initiated early (6 months) and sustained over longer durations. Parent-mediated and community-based models were feasible and effective in low-resource settings. However, no randomized controlled trials were identified, and most studies showed moderate to high risk of bias. Certainty of evidence was rated low to very low using GRADE. Early intervention programs demonstrate consistent benefits for children with GDD across settings, particularly when initiated early and involving caregivers. However, the current evidence base is limited by methodological weaknesses and lack of standardized outcome measures. High-quality randomized trials and long-term follow-up studies are urgently needed to inform best practices and policy implementation.

BackgroundEye-tracking technology provides an objective method for analyzing visual behavior during diagnostic tasks such as electrocardiogram (ECG) interpretation. As a high-stakes and visually complex clinical skill, ECG interpretation benefits from technologies that differentiate experts from novices via gaze patterns. We systematically reviewed eye-tracking in ECG research to examine links between gaze metrics and diagnostic performance and to appraise educational applications.MethodsFollowing PRISMA (PROSPERO CRD420251052940), we searched PubMed, Embase, Web of Science, Scopus, ERIC, IEEE Xplore, and PubPsych databases to September 2025. Eligible studies used eye-tracking during ECG interpretation and reported visual behavior or diagnostic outcomes. Two independent reviewers performed the study selection, data extraction, and quality assessment using the Jadad and Newcastle–Ottawa scales. Given heterogeneity, we conducted a narrative synthesis.ResultsNineteen studies (573 participants) were included, mainly involving students or early-career clinicians. Common metrics included fixation duration, counts, time to first fixation, and scan-path efficiency. Experts showed faster, more targeted fixation on critical leads (V1, V2, and II), shorter interpretation times, and higher accuracy. Novices exhibited scattered visual behavior and delayed attention to diagnostically relevant regions. Eye movement data were informative of underlying cognitive processes, including the selection, organization, and integration of ECG features. Additional factors, such as presentation format, individual experience, metacognitive strategies, and emotional responses, may moderate gaze behavior, although these were underexplored. Educational interventions leveraging expert gaze modeling or structured checklists showed mixed but promising outcomes.ConclusionsEye-tracking differentiates expertise in ECG interpretation and may inform diagnostic reasoning, but prospective validation is needed. Gaze metrics are candidate indicators of performance and a foundation for feedback-based educational tools. Standardized protocols, larger multi-site studies, and inclusion of diverse learners are required to realize the potential of eye-tracking in ECG training and assessment.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1186/s40001-025-03635-8.

BackgroundWhile undergraduate medical education curricula typically integrate electrocardiogram (ECG) interpretation during the preclinical phase, the skill can be challenging, and students may lack confidence to interpret ECGs in clinical practice. The purpose of this online curriculum was to provide a supplemental course which provides a practical, systematic approach to ECG reading and increases student confidence in recognizing basic patterns of pathology.MethodsWe used a proprietary online learning content-management system to create a course for 4th-year medical students at a US-based MD program. The course consisted of 12 video modules which reviewed basic ECG interpretation and then provided practice ECG tracings for the students to interpret. Weekly online video calls with faculty were held to address any questions and to emphasize key concepts presented in that week’s material. The students completed a pre- and post-course assessment on ECG pathology and reported their self-confidence in ECG interpretation skills.ResultsThe median score for the pre-test was 76.5/100 with a median self-confidence score of 3/10. After completion of the course, the students’ post-test median score increased to 87.5 (p < 0.0001) with a median self-confidence score of 7.5 (p < 0.0001). As a result of this course, the students showed a significant improvement in grades and self-confidence.DiscussionAn online course consisting of practice ECGs and limited direct faculty interaction helped the students improve ECG interpretation accuracy and self-confidence.

Aim: To evaluate the effectiveness of family-centred educational interventions on the anxiety, pain and behaviours of children and adolescents (three to 19 years old) and their parents’ anxiety during the perioperative journey. Design: Systematic review of effectiveness and meta-analysis. Data sources were systematically searched from January 2007 to April 2021 for available articles in English, Spanish and Portuguese. Review methods: This review followed the methodology for systematic reviews of effectiveness from Joanna Briggs Institute (JBI). Included studies were critically appraised using JBI critical appraisal checklists for Randomised Controlled Trials and JBI Critical Appraisal Checklist for Quasi-Experimental Studies. Data was synthesised through meta-analysis, using a random-effects model, and narrative synthesis. Two independent reviewers performed the selection process, critical analysis, and data extraction. Results: Twenty-eight studies (26 randomised controlled trials (RCTs) and two quasi-randomised controlled trials) were included with a total of 2516 families. In a meta-analysis of ten RCTs with 761 participants, pre‑operative anxiety management was more effective in children and adolescents who received educational interventions (SMD = -1.02; SE = 0.36; 95% CI [-1.73; -0.32]). At the induction of anaesthesia, children and adolescents were significantly less anxious (SMD = -1.54; SE = 0.62; 95% CI [-2.72; -0.36]) and demonstrated better compliance than controls (SMD = -1.40; SE = 0.67; 95% CI [-2.72; -0.09]). Post‑operative pain (SMD = -0.43; SE = 0.33; 95% CI [-1.05; 0.19]) and pre‑operative parental anxiety (SMD = -0.94; SE = 1.00; 95% CI [-2.87; 0.99]) were reduced in favour of the educational interventions. Conclusion: Family-centred educational interventions probably lead to a considerable reduction of paediatric and parental anxiety and improve paediatric behaviours at induction of anaesthesia. The evidence is very uncertain regarding the effectiveness of these interventions on post‑operative paediatric maladaptive behaviours and pain intensity or parental anxiety levels at the induction of anaesthesia.

Identify and synthesize evidence of nurses' competency in electrocardiogram interpretation in acute care settings. Systematic mixed studies review. Cumulative Index to Nursing and Allied Health Literature, Medline, Scopus and Cochrane were searched in April 2021. Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. A data-based convergent synthesis design using qualitative content analysis was adopted. Quality appraisal was undertaken using validated tools appropriate to study designs of the included papers. Forty-three papers were included in this review. Skills and attitudes were not commonly assessed, as most studies referred to 'competency' in the context of nurses' knowledge in electrocardiogram interpretation. Nurses' knowledge levels in this important nursing role varied notably, which could be partly due to a range of assessment tools being used. Several factors were found to influence nurses' competency in electrocardiogram interpretation across the included studies from individual, professional and organizational perspectives. The definition of 'competency' was inconsistent, and nurses' competency in electrocardiogram interpretation varied from low to high. Nurses identified a lack of regular training and insufficient exposure in electrocardiogram interpretation. Hence, regular, standard training and education are recommended. Also, more research is needed to develop a standardized and comprehensive electrocardiogram interpretation tool, thereby allowing educators to safely assess nurses' competency. This review addressed questions related to nurses' competency in electrocardiogram interpretation. The findings highlight varying competency levels and assessment methods. Nurses reported a lack of knowledge and confidence in interpreting electrocardiograms. There is an urgent need to explore opportunities to promote and maintain nurses' competency in electrocardiogram interpretation.

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Clinical competence in electrocardiography. A statement for physicians from the ACP/ACC/AHA Task Force on Clinical Privileges in Cardiology.

BackgroundHaving psychologically safe teams can improve learning, creativity and performance within organisations. Within a healthcare context, psychological safety supports patient safety by enabling engagement in quality improvement and encouraging staff to speak up about errors. Despite the low levels of psychological safety in healthcare teams and the important role it plays in supporting patient safety, there is a dearth of research on interventions that can be used to improve psychological safety or its related constructs. This review synthesises the content, theoretical underpinnings and outcomes of interventions which have targeted psychological safety, speaking up, and voice behaviour within a healthcare setting. It aims to identify successful interventions and inform the development of more effective interventions.MethodsA key word search strategy was developed and used to search electronic databases (PsycINFO, ABI/Inform, Academic search complete and PubMed) and grey literature databases (OpenGrey, OCLC WorldCat, Espace). Covidence, an online specialised systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers.ResultsFourteen interventions were reviewed. These interventions fell into five categories. Educational interventions used simulation, video presentations, case studies and workshops while interventions which did not include an educational component used holistic facilitation, forum play and action research meetings. Mixed results were found for the efficacy or effectiveness of these interventions. While some interventions showed improvement in outcomes related to psychological safety, speaking up and voice, this was not consistently demonstrated across interventions. Included interventions’ ability to demonstrate improvements in these outcomes were limited by a lack of objective outcome measures and the ability of educational interventions alone to change deeply rooted speaking up behaviours.ConclusionTo improve our understanding of the efficacy or effectiveness of interventions targeting psychological safety, speaking up and voice behaviour, longitudinal and multifaceted interventions are needed. In order to understand whether these interventions are successful, more objective measures should be developed. It is recommended that future research involves end users in the design phase of interventions, target both group and organisational levels, ensure visible leader support and work across and within interdisciplinary teams.Prospero registration numberCRD42018100659.

Strengthening clinical competence among primary health care (PHC) professionals is essential as they directly influence the quality of care provided to healthcare users. Clinical competence is a multidimensional construct that integrates knowledge, skills, attitudes, and professional judgment. Despite the recognized importance of education for professional competencies, evidence remains limited regarding the effects of educational interventions on clinical competence among PHC, including how these effects are measured and which clinical competencies are developed through such interventions. This scoping review aimed to map educational interventions targeting PHC professionals and to examine how clinical competence has been assessed within these initiatives. This scoping review followed PRISMA-ScR guidelines. A comprehensive search was conducted in March 2025 in the databases PubMed, LILACS, PsycINFO, Embase, CINAHL, and Scopus, followed by an exploratory search on Google and the websites of recognized public health institutions to identify additional information, such as training programs and reports. Two independent reviewers evaluated the eligible sources and extracted information on the educational interventions using a standardized form developed by the authors. After screening 3,839 records, 91 information sources were included, of which 30 were peer-reviewed studies reporting evaluated outcomes. Most interventions addressed non-communicable chronic diseases, delivered through self-instructional online learning and classified as short non-degree courses. Among evaluated studies, improvements were predominantly observed in knowledge-based outcomes. Assessment approaches varied widely, with limited use of validated instruments and minimal direct evaluation of clinical performance. Several studies relied on practice-based proxy indicators or patient-level outcomes as indirect measures of competence. Primary healthcare is a strategic setting for implementing educational interventions to strengthen clinical competence across diverse health conditions. Although most evaluated studies report improvements in knowledge, evidence regarding their impact on multidimensional clinical competence remains limited. Future research should prioritize validated assessment instruments and practice-based evaluation approaches to better capture changes in clinical performance.

Near-peer teaching and electronic learning (e-learning) are two effective modern teaching styles. Near-peer sessions provide a supportive learning environment that benefits both the students and the tutor. E-learning resources are flexible and easily distributed. Careful construction and regular editing can ensure that students receive all of the essential material. Theaim of this study is to compare the efficacy of e-learning and near-peer teaching during the pre-clinical medical curriculum. Thirty-nine second-year medical students were consented and randomised into two groups. Each group received teaching on electrocardiogram (ECG) interpretation from a predefined syllabus. Eighteen students completed an e-learning module and 21 students attended a near-peer tutorial. Students were asked to complete a multiple-choice exam, scored out of 50. Each student rated their confidence in ECG interpretation before and after their allocated teaching session. The near-peer group (84%) demonstrated a significantly higher performance than the e-learning group (74.5%) on the final assessment (p=0.002). Prior to the teaching, the students' mean confidence scores were 3/10 in both the near-peer and e-learning groups (0, poor; 10, excellent). These increased to 6/10 in both cases following the teaching session. Both teaching styles were well received by students and improved their confidence in ECG interpretation. Near-peer teaching led to superior scores in our final assessment. Given the congested nature of the modern medical curriculum, direct comparison of the efficacy of these methods may aid course design. The aim of this study is to compare the efficacy of e-learning and near-peer teaching.