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Effects of web-based electrocardiography simulation on strategies and learning styles

Efeitos da simulação etletrocardiográfica en ambiente web sobre as estratégias e estilos de aprendizagem

Efectos de la simulación electrocardiográfica en ambiente web acerca de las estrategias y estilos de aprendizaje

Abstracts

OBJECTIVE

To identify the association between the use of web simulation electrocardiography and the learning approaches, strategies and styles of nursing degree students.

METHOD

A descriptive and correlational design with a one-group pretest-posttest measurement was used. The study sample included 246 students in a Basic and Advanced Cardiac Life Support nursing class of nursing degree.

RESULTS

No significant differences between genders were found in any dimension of learning styles and approaches to learning. After the introduction of web simulation electrocardiography, significant differences were found in some item scores of learning styles: theorist (p < 0.040), pragmatic (p < 0.010) and approaches to learning.

CONCLUSION

The use of a web electrocardiogram (ECG) simulation is associated with the development of active and reflexive learning styles, improving motivation and a deep approach in nursing students.

Simulation; Electrocardiography; Internet; Computer-Assisted Instruction; Education, Nursing; Learning


OBJETIVO

Identificar associações entre o uso da simulação eletrocardiográfica na internet e os estilos e estratégias de aprendizagem dos estudantes de graduação em enfermagem.

MÉTODO

Desenho descritivo-correlacional com avaliação pré e pós-teste num único grupo. A amostra do estudo incluiu 246 estudantes que frequentavam a disciplina de Suporte Básico e Avançado de Vida.

RESULTADOS

Não foram encontradas diferenças significativas entre gêneros em qualquer das dimensões dos estilos e estratégias de aprendizagem. Após introdução da simulação eletrocardiográfica recorrendo à internet, encontraram-se diferenças estatisticamente significativas em algumas das pontuações dos itens dos estilos de aprendizagem teórico (p <0,040), pragmático (p <0,010) e das estratégias de aprendizagem.

CONCLUSÃO

O uso da simulação eletrocardiográfica em ambiente web está associado ao desenvolvimento de estilos de aprendizagem ativos e reflexivos, à melhoria da motivação e da abordagem profunda em estudantes de enfermagem.

Simulação; Eletrocardiografia; Internet; Instrução por Computador; Educação em Enfermagem; Aprendizagem


OBJETIVO

Identificar asociaciones entre el uso de la simulación electrocardiográfica en la internet y los estilos y estrategias de aprendizaje de los estudiantes de graduación en enfermería.

MÉTODO

Diseño descriptivo-correlacional con evaluación pré y post prueba en un solo grupo. La muestra del estudio incluyó a 246 estudiantes que acudían a la asignatura de Soporte Básico y Avanzado de Vida.

RESULTADOS

No fueron encontradas diferencias significativas entre géneros en cualquiera de las dimensiones de los estilos y estrategias de aprendizaje. Después de la introducción de la simulación electrocardiográfica recurriendo a la web, fueron encontradas diferencias estadísticamente significativas en algunas de las puntuaciones de los ítems de los estilos de aprendizaje teórico (p <0,040), pragmático (p <0,010) y las estrategias de aprendizaje.

CONCLUSIÓN

El uso de la simulación electrocardiográfica en ambiente web está asociado con el desarrollo de estilos de aprendizaje activos y reflexivos, la mejoría de la motivación y el abordaje profundo en estudiantes de enfermería.

Simulación; Electrocardiografía; Internet; Instrucción por Computador; Educación en Enfermería; Aprendizaje


Introduction

Traditionally, the electrocardiogram (ECG) has aided the diagnosis, treatment and monitoring of arrhythmias, coronary syndromes and cardiac revascularization(1Lessard Y, Sinteff JP, Siregar P, Julen N, Hannouche F, Rio S, et al. An ECG analysis interactive training system for understanding arrhythmias. Stud Health Technol Inform. 2009;150:931-5.). These pathologies, often found in pre-hospital, accident and emergency and critical care settings, pose a life-threatening risk that requires quick diagnosis and treatment. ECG monitoring and interpretation skills are gained in medical education and strengthened by experience. However, the need for immediate pattern recognition and subsequent procedures involves nurses in the processes of evaluation, registration, and initiation of reperfusion therapies as well as in the detection of complications and the request for assistance.

ECG interpretation requires high-order learning. Although the ECG has historically been taught in a traditional classroom, new methodologies have changed the teaching-learning process in response to the lack of time and resources. Health science educators should focus their teaching methods on the student, developing new learning processes and adapting their strategies to each context or discipline. In academic nursing education, this new status quo favors technology, motivation, active participation and simulation(2Bowden T, Rowlands A, Buckwell M, Abbott S. Web-based video and feedback in the teaching of cardiopulmonary resuscitation. Nurse Educ Today. 2012;32(4):443-7.). Multiple technologies have been applied to ECG teaching in medicine, nursing and pharmacy degrees for both undergraduates and postgraduates, including a multimedia CD-ROM, videograms, computer programs, computer-assisted tutorials, multimedia teaching and interdisciplinary approaches(1Lessard Y, Sinteff JP, Siregar P, Julen N, Hannouche F, Rio S, et al. An ECG analysis interactive training system for understanding arrhythmias. Stud Health Technol Inform. 2009;150:931-5.). Human simulation, web-based video and web simulation tools(5Güney E, Eksi Z, Çakiroglu M. WebECG: a novel ECG simulator base on MATLAB Web figure. Adv Eng Softw. 2012;54(1):167-74.) have been used to develop ECG diagnostic skills in advanced cardiac life support (ACLS).

The ECG diagnostic skills are not optimal, and training programs are not homogeneous in terms of time and methodologies. Students who received training in a lecture-workshop showed better results in ECG interpretation than those who followed self-directed learning(6Mahler SA, Wolcott CJ, Swoboda TK, Wang H, Arnold TC. Techniques for teaching electrocardiogram interpretation: self-directed learning is less effective than a workshop or lecture. Med Educ. 2011;45(4):347-53.); peer tutoring has proved to be more efficient than traditional classes. However, both the lack of conclusive results and the economic costs have led to the increase in the use of web simulation in the fields of medicine and nursing(7Akgun T, Karabay CY, Kcabay G, Kalayci A, Oduncu V, Gule A, et al. Learning electrocardiogram on YouTube: how useful is it? J Electrocardiol. 2014;47(1):113-7.).

Web-based learning promotes computer-mediated interaction and student-centered learning in most higher education institutions(9Lih J, Chan LCh. Learning strategies in web-supported collaborative project. Innov Educ Teach Intl. 2012; 49(3):319-31.). Some health science curricula include web simulation, which is widely accepted due to its easy, flexible and independent access, reinforcing individual self-study through training(1010 Nilsson M, Östergren J, Fors U, Rickenlund A, Jorfeldt L, Caidahl K, et al. Does individual learning styles influence the choice to use a web-based ECG learning programme in a blended learning setting? BMC Med Educ. 2012;12:5.). Students have acknowledged web ECG interpretation as a useful tool, with better immediacy, visualization and interaction than traditional teaching methods. Practical and professional training for nurses is based on acquiring skills, abilities and knowledge; various methodologies have been employed to teach ECG to nurses(1111 Spiva L, Johnson K, Robertson B, Barrett DT, Jarrell NM, Hunter D, et al. The effectiveness of nurses' ability to interpret basic electrocardiogram strips accurately using different learning modalities. J Contin Educ Nurs. 2012;43(2): 81-9.). Interactive web-based learning has been successful in critical care and cardiac monitoring units(1212 Schultz SJ. Evidence-based strategies for teaching dysrhythmia monitoring practices to staff nurses. J Contin Educ Nurs. 2011;42(7):308-19.), where in addition to preparing the skin or placing the electrodes correctly, potentially fatal arrhythmias must be identified.

The use of simulation in ECG courses has been shown to have advantages in the classroom, improving self-confidence and critical thinking. Web simulation and personalized training show good results in ACLS; their efficiency in arrhythmia interpretation should be extended to the entire ECG(1313 Varvaroussis DP, Kalafati M, Pliatsika P, Castren M, Lott C, Xanthos T. Comparison of two teaching methods for cardiac arrhythmia interpretation among nursing studies. Resuscitation. 2014;85(2):260-5.). However, these techniques may not suit all learners and are therefore critiqued based on the identified limitations(1414 Petti J. Interactive, technology-enhanced self-regulated learning tools in healthcare education: a literature review. Nurse Educ Today. 2013;33(1):53-9.). Furthermore, we need to discover their effects on nurses' knowledge, skills, satisfaction and learning styles(1515 Lahti M, Hätönen H, Välimäki M. Impact of e-learning on nurses´ and student nurses knowledge, skills, and satisfaction: a systematic review and meta-analysis. Int J Nurs Stud. 2014;51(1):136-49.). Strategies and learning styles are related to personal variables which explain ways of receiving, processing and retaining information; understanding these processes helps create an efficient learning atmosphere(1616 Kharb P, Samanta PP, Jindal M, Singh V. The learning styles and the preferred teaching-learning strategies of first year medical students. J Clin Diagn Res. 2013;7(6):1089-92.). Additionally, learning styles and strategies can be modified by the methodology used (for example, by using web simulation). Although the ECG simulator may be useful in gaining and maintaining basic ECG interpretation skills, empirical research is needed to analyze its association with learning approaches, strategies and styles of nursing degree students.

The six-second ECG (SS-ECG) is a free web simulator that generates and allows for the learning of twenty-seven common cardiac rhythms(1717 SkillSTAT Learning. SS-ECG (The six second ECG)(r) [Internet]. North Vancouver, Canada: British Columbia; 2015 [cited 2015 Feb 03]. Available from: http://www.skillstat.com/tools/ecg-simulator#/-play
http://www.skillstat.com/tools/ecg-simul...
). Using the "explore-review" function and clicking on any rhythm name, the software displays the rhythm and its description. Using the "explore-review-play" function allows for the diagnosis of the ECG after setting the game time period, dynamic or static rhythm display, sound volume and grid display.

The purpose of this descriptive and correlational study was to describe the relationship between the use of a web-simulator (SS-ECG) and the learning approaches, strategies and styles of nursing degree students.

Method

Design and Sample

A descriptive and correlational design, in conjunction with a one-group pretest-posttest method, comprised our research design. During 2012 and 2013, all the students who were matriculated in the ACLS course, which is part of the nursing degree curricula at the University of Almeria (Spain), were invited to participate in the study. Of the 258 students enrolled in the course, 246 students of both sexes participated in the study, 125 in 2012 and 121 in 2013.

Instruments

Two standardized tests were used, both of which had been empirically validated in the Spanish language. To assess learning styles, we used theCuestionario Honey-Alonso de Estilos de Aprendizaje (CHAEA) (Honey-Alonso Learning Styles Questionnaire)(1818 Alonso C, Gallego D, Honey P. The Honey-Alonso Learning Styles Questionnaire (CHAEA): interpretation, scales and implementation. Bilbao: Ediciones Mensajero; 1999.). The CHAEA consists of 80 items with a dichotomous reply, 20 items per style, which structures 4 learning styles according to individual preferences relating to accessing knowledge.Active style, based on direct experience, prevails in the inquisitive, resourceful and spontaneous student. Reflexive style, based on observation, is found in receptive, analytical and patient students. Theorist style, based on conceptualization, is strongest in methodical, objective and critically minded students. Pragmatic style, based on experience, is typical in practical, direct and realistic students.

To evaluate learning approaches, strategies and motivations adopted by students, the Cuestionario de Evaluación del Proceso de Enseñanza-Aprendizaje(CEPEA) (Evaluation of Learning and Study Processes Questionnaire)(1919 Barca A, Seijas S, Brenlla JC, Santamaría S. The CEPEA scale (Evaluation of Learning and Study Processes Questionnaire). An instrument to evaluate learning and study processes among the university population. Rev Gallego Port Psicol Educ. 2000;5:325-41.), a Spanish adaptation of the Biggs Study Process Questionnaire (SPQ), was used. The CEPEA consists of 42 items, 21 related to motivation and 21 related to strategies, using a Likert-style scale (1-5). At the first level, these categories provide the scores for 6 sub-scales, 3 for motivation and 3 for learning strategies: Surface Motivation (SM), Deep Motivation (DM), High Performance Motivation (HPM), Surface Strategy (SS), Deep Strategy (SD) and High Performance Strategy (HPS). At the second level, the scores for 3 learning approach scales, which integrate motivations and strategies, are obtained: Surface Approach (SS+SM), Deep Approach (DS+DM) and High Performance Approach (HPS+HPM).

Procedures

During the week prior to the intervention and after signing the informed consent form to participate in the study, the participants completed the CHAEA and CEPEA (pre-test) questionnaires. A 3-hour educational intervention using the SS-ECG simulator was conducted with groups of 15 students in two in-person stages. In the first stage (2-hour simulation exercise in a group using the SS-ECG simulator function 'PREPARED'), the teacher randomly projected one of the 27 rhythms to the entire class, concealing the diagnosis. Each student, who was randomly chosen, analyzed and diagnosed two ECG rhythms systematically, responding to the following questions: name of the rhythm; presence of atrial contraction (yes/no); sufficient ventricular filling time (yes/no); effect on cardiac oxygen supply/demand; cardiac output (sufficient/reduced) and gravity of rhythm. The rest of the students listened, although the teacher could ask them a question at any moment. The solution was then shown, the mistakes were analyzed and any questions were answered. In the second stage (1-hour individual-based simulation exercise using the SS-ECG function 'PLAY'), each student analyzed and diagnosed random ECG rhythms on their PC using the following pattern: 2 repetitions of 6 minutes, 4 repetitions of 4 minutes, 6 repetitions of 2 minutes, and 8 repetitions of 1 minute, resting for 3 minutes between each group of attempts. Post-intervention data were collected the following day, with each student completing the CHAEA and CEPEA questionnaires.

Ethical Considerations

The study was approved by the ethical and research committee of the Department of Nursing, Physiotherapy and Medicine at the University of Almeria (Protocol number: 6/2012). In accordance with the Helsinki Declaration, informed consent was obtained from the students.

Data Analysis

SPSS version 18.0 was used for the analyses. The reliability and validity of the model hypothesis were studied by analyzing the residual independence, normal distribution and homogeneity of variances. The Kolmogorov-Smirnoff test was used to analyze the normal distribution of variables. Descriptive statistics were obtained by measuring the central tendencies and rate of dispersion in the variables studied. An imputed score was calculated for standardized scales missing ≤ 10% of responses. Student's t-test was used to examine the differences between baseline and after intervention with simulation SS-ECG. We used Pearson´s correlation coefficient (r) with a 95% confidence interval for linear correlations between variables. A P-value < 0.05 was considered significant in all tests.

Results

The study sample included 246 students enrolled in an ACLS course as part of a nursing degree program during the academic years 2012/2013 and 2013/2014. The response rate was 95.34% (of the 12 students not included in the study, 5 declined to participate, and 7 only completed the pre-test). The distribution of the sample and descriptive statistics for each dimension in learning styles and approaches to learning are shown in Table 1.

Table 1
Descriptive characteristic of the sample (n = 246) - Almeria, Spain - 2014.

Mean differences were tested considering gender (t-test). No significant differences between genders were found in any dimension of learning styles and approaches to learning. After the introduction of SS-ECG simulation, significant differences were found in some item scores of learning styles: theorist (p < 0.040), and pragmatic (p < 0.010). Table 2 shows baseline, post-intervention, and within-group differences with associated 95% confidence intervals (CI) for learning styles dimensions.

Table 2
Baseline, post-intervention and change score for learning style dimensions - Almeria, Spain - 2014.

Additionally, there were significant differences in some items of approaches to learning: surface motivation (p < 0.001), deep strategy (p< 0.002), deep approach (p < 0.020), high performance strategy (p < 0.006), and high performance approach (p < 0.013). Table 3shows baseline, post-intervention, and within-group differences with associated 95% confidence intervals (CI) for approaches to learning dimensions.

Table 3
Baseline, post-intervention and change score for approaches to learning dimensions - Almeria, Spain - 2014.

At baseline, according to Pearson´s linear correlation analysis, there was no correlation between active learning styles and approaches to learning dimensions. However, significant inverse correlations (P < 0.05) were found between reflexive, theorist and pragmatic learning styles and all learning approach dimensions. After the intervention using the SS-ECG simulator, positive and inverse correlations were found between some dimensions of learning styles and approaches to learning. An inverse association was found between an active learning style and surface strategy (r > -0.137, p < 0.031) and surface approach (r > -0.131, p < 0.040). The reflexive learning style showed linear positive correlations with deep motivation (r > 0.223, p < 0.001), deep approach (r > 0.170, p < 0.008), high performance strategy (r > 0.164, p < 0.010), high performance motivation (r > 0.131, p < 0.040), and high performance approach (r > 0.193, p < 0.002). Theorist learning styles had linear inverse associations with deep strategy (r > -0.245, p < 0.001), deep motivation (r > -0.236, p < 0.001), deep approach (r > -0.256, p < 0.001), high performance strategy (r > -0.325, p < 0.001), high performance motivation (r > -0.266, p < 0.001), and high performance approach (r > -0.349, p < 0.001). Additionally, an inverse linear correlation was found between pragmatic learning styles and surface motivation (r > -0.166, p < 0.009), surface approach (r > -0.172, p < 0.007), high performance strategy (r > -0.130, p < 0.042), high performance motivation (r > -0204, p < 0.001), and high performance approach (r > -0.196, p < 0.002).

Discussion

It is important that educators understand their students' learning styles, and determining the mean values for the scores in each style helps to create an overall learning profile of the sample(1818 Alonso C, Gallego D, Honey P. The Honey-Alonso Learning Styles Questionnaire (CHAEA): interpretation, scales and implementation. Bilbao: Ediciones Mensajero; 1999.). The results show a variety of learning styles, in which the reflexive learning style dominates, followed by theorist, pragmatic and active styles. Our post-intervention results indicate a significant increase in theorist and pragmatic learning style scores, with no significant differences in gender and age.

The diverse nature of the students' preferences reinforces the need for various teaching strategies(2020 Cox L, Clutter J, Sergakis G, Harris L. Learning style of undergraduate allied health students: clinical versus classroom. J Allied Health. 2013;42(4):223-8.). Learning involves cognitive processes that include motivation, strategies, attitude, information processing, use of support/material and approaches to achieve goals(9Lih J, Chan LCh. Learning strategies in web-supported collaborative project. Innov Educ Teach Intl. 2012; 49(3):319-31.). Understanding their relationship with learning styles could help with methodological innovations(2121 Donche V, De Maeyer S, Coertjens L, Van Daal T, Van Petegem P. Differential use of learning strategies in first-year higher education: the impact of personality, academic motivation, and teaching strategies. Br J Educ Psychol. 2013;83(2):238-51.) and the creation of more efficient learning environments(2020 Cox L, Clutter J, Sergakis G, Harris L. Learning style of undergraduate allied health students: clinical versus classroom. J Allied Health. 2013;42(4):223-8.). Simulation increases nurses' understanding and skills, improving self-confidence in ACLS. According to several studies, these procedures in the short term could improve nursing students' ECG interpretation abilities, increasing the chances of a successful diagnosis and the retention of knowledge(1313 Varvaroussis DP, Kalafati M, Pliatsika P, Castren M, Lott C, Xanthos T. Comparison of two teaching methods for cardiac arrhythmia interpretation among nursing studies. Resuscitation. 2014;85(2):260-5.).

Following the use of the SS-ECG, increased scores were found in the theorist and pragmatic dimensions of learning styles. This strengthening of the logical, objective and methodical components of the learning process may signal an improvement in the students' perception of the theory-practice relationship. The significant differences in the deep approach and High Performance Approach scores could be due to the lack of improvements in relation to previous knowledge or the planning of activities focused on achievements. Consistent with the post-intervention results, we found a significant relationship between learning strategies and styles(2222 Vacas JC, Mérida R, Molina G, Mesa MP. Influence of learning styles of nursing students on teaching strategies choice. Rev Enferm. 2012;35(12):54-8,61-3.). The inverse association between active style and the development of surface strategies could indicate that spontaneous and resourceful students distance themselves from mechanical learning and repetitive information, and therefore, the interactivity with the simulators could prove to be useful and satisfying(1515 Lahti M, Hätönen H, Välimäki M. Impact of e-learning on nurses´ and student nurses knowledge, skills, and satisfaction: a systematic review and meta-analysis. Int J Nurs Stud. 2014;51(1):136-49.). Students who adopt a deep approach to learning, with brighter prospects of success, are considered to be ideal for active methodologies. Following the procedure, we found a positive correlation between motivation-deep approach and the reflexive learning style, typical of students who are interested in working autonomously to obtain maximum performance and results. This relationship is inverted in the theorist style, as we see that the attitudes towards Simulation-Based Learning are not uniform(2323 Yeun EJ, Bang HY, Ryoo EN, Ha EH. Attitudes toward simulation-based learning in nursing students: an application of Q methodology. Nurse Educ Today. 2014;34(7):1062-8.). Students with a pragmatic style who are interested in the application of content inversely correlate with those students who, using a motivation and surface strategy, aim to learn by memory.

The ECG facilitates nursing care in cases of acute coronary syndrome, with evidence showing the benefits of correct interpretation and monitoring of the ECG on the patient's safety. Cardiac patients believe that nurses need more solid ECG and arrhythmia training(2424 Albarran JW, Jones I, Lockyer L, Manns S, Cox H, Thompson DR. Patients´ perspectives on the educational preparation of cardiac nurses. Eur J Cardiovasc Nurs. 2013;13(5):451-8.), and the simulation could help undergraduate students acquire these skills. Some studies have found improvements in ECG knowledge after multimedia activities(2Bowden T, Rowlands A, Buckwell M, Abbott S. Web-based video and feedback in the teaching of cardiopulmonary resuscitation. Nurse Educ Today. 2012;32(4):443-7.), the use of Blackboard(c), WebCT(c) or Moodle(c)environments, or the incorporation of self-learning(2525 Zhang H,. Hsu LL The effectiveness of an education program on nurses´ knowledge of electrocardiogram interpretation. Int Emerg Nurs. 2013;21(4):247-61.). The clinical nurses' motivations toward Web-based learning were predicted by their self-efficacy in terms of the Internet, in which nurses with higher Internet self-efficacy tended to display higher motivations for Web-based continued learning(2626 Liang JCh, Wu SH. Nurses' motivations for Web-based learning and the role of Internet self-efficacy. Innov Educ Teach Int. 2010;47(1):25-37.). Instructional methods that actively engage learners improve learning outcomes; however, evidence regarding the use of web simulators as a learning methodology and its efficacy in practice is lacking(1212 Schultz SJ. Evidence-based strategies for teaching dysrhythmia monitoring practices to staff nurses. J Contin Educ Nurs. 2011;42(7):308-19.). Deciding to use web simulators is not related to learning styles but with the evaluation format used(1010 Nilsson M, Östergren J, Fors U, Rickenlund A, Jorfeldt L, Caidahl K, et al. Does individual learning styles influence the choice to use a web-based ECG learning programme in a blended learning setting? BMC Med Educ. 2012;12:5.).

Accommodating learning styles in a Web-based educational system benefits the learning process, and teaching students using Web-based resources can provide engaging and timely content(2727 Popescu E. Adaptation provisioning with respect to learning styles in a Web-based educational system: an experimental study. J Comput Assist Lear. 2010;26(4):243-57.-2828 Wink DM, Smith-Stoner M. Teaching with technology: free Web recourses for teaching and learning. Nurse Educ. 2011;36(4):137-9.). Using the SS-ECG simulator is a successful example of the melding of technology and education to enhance clinical learning using learner-centered activities. Whereas some studies indicate the use of traditional methods to improve satisfaction or to retain knowledge and skills(2Bowden T, Rowlands A, Buckwell M, Abbott S. Web-based video and feedback in the teaching of cardiopulmonary resuscitation. Nurse Educ Today. 2012;32(4):443-7.), the web simulation has been shown to be useful for teachers and students(2929 Hickey KT, Johnson MP, Biviano A, Aboelela S, Thomas T, Bakken S, et al. Cardiac e-learning: Development of a web-based implantable cardioverter defibrillator educational system. Telemed J E Health. 2011;17(3):196-200.). Teachers would have to consider learning approaches, styles, and strategies; therefore, it may be advisable to develop students' learning processes in the face-to-face context without technology before engaging them in technology-supported learning(3030 Lee K, Tsai PS, Chai CS, Koh JH. Students' perceptions of self-directed learning and collaborative learning with and without technology. J Comput Assist Lear. 2014;30(5): 425-37.).

Limitations

Based on the cross-sectional design, the results of the intervention may be different in the same students in previous courses or in similar interventions.

Conclusion

The study results showed a variety of nursing students' learning approaches, strategies and styles. The use of the SS-ECG web simulator inversely correlates with the development of active and reflexive learning styles and surface motivation. Conversely, a positive correlation between the use of the SS-ECG web simulator and the development of a deep strategy, deep approach, high performance strategy and high performance approach was found. This knowledge is useful in adapting teaching strategies to the students' learning style in nursing curricula as a means of improving the education quality. Prior to the inclusion of new web simulation methodologies in the classroom, it may be important to respond to these considerations to benefit the teaching-learning process among nursing students.

Acknowledgements

The authors wish to thank the subjects who participated in the study and SkillStat Learning Inc. for their permission to use the web version of the Six Second ECG.

  • 1
    Lessard Y, Sinteff JP, Siregar P, Julen N, Hannouche F, Rio S, et al. An ECG analysis interactive training system for understanding arrhythmias. Stud Health Technol Inform. 2009;150:931-5.
  • 2
    Bowden T, Rowlands A, Buckwell M, Abbott S. Web-based video and feedback in the teaching of cardiopulmonary resuscitation. Nurse Educ Today. 2012;32(4):443-7.
  • 3
    Alavarce DC, Pierin AM. Development of educational hypermedia to teach an arterial blood pressure measurement procedure. Rev Esc Enferm USP. 2011;45(4):939-44.
  • 4
    Chang MH, Hsu LL. Multimedia instruction: its efficacy in nurse electrocardiography learning. Hu Li Za Zhi. 2010;57(4):50-8.
  • 5
    Güney E, Eksi Z, Çakiroglu M. WebECG: a novel ECG simulator base on MATLAB Web figure. Adv Eng Softw. 2012;54(1):167-74.
  • 6
    Mahler SA, Wolcott CJ, Swoboda TK, Wang H, Arnold TC. Techniques for teaching electrocardiogram interpretation: self-directed learning is less effective than a workshop or lecture. Med Educ. 2011;45(4):347-53.
  • 7
    Akgun T, Karabay CY, Kcabay G, Kalayci A, Oduncu V, Gule A, et al. Learning electrocardiogram on YouTube: how useful is it? J Electrocardiol. 2014;47(1):113-7.
  • 8
    Cook NF, McAloon T, O'Neill P, Beggs R. Impact of a web based interactive simulation game (PULSE) on nursing students' experience and performance in life support training-a pilot study. Nurse Educ Today. 2012;32(6):714-20.
  • 9
    Lih J, Chan LCh. Learning strategies in web-supported collaborative project. Innov Educ Teach Intl. 2012; 49(3):319-31.
  • 10
    Nilsson M, Östergren J, Fors U, Rickenlund A, Jorfeldt L, Caidahl K, et al. Does individual learning styles influence the choice to use a web-based ECG learning programme in a blended learning setting? BMC Med Educ. 2012;12:5.
  • 11
    Spiva L, Johnson K, Robertson B, Barrett DT, Jarrell NM, Hunter D, et al. The effectiveness of nurses' ability to interpret basic electrocardiogram strips accurately using different learning modalities. J Contin Educ Nurs. 2012;43(2): 81-9.
  • 12
    Schultz SJ. Evidence-based strategies for teaching dysrhythmia monitoring practices to staff nurses. J Contin Educ Nurs. 2011;42(7):308-19.
  • 13
    Varvaroussis DP, Kalafati M, Pliatsika P, Castren M, Lott C, Xanthos T. Comparison of two teaching methods for cardiac arrhythmia interpretation among nursing studies. Resuscitation. 2014;85(2):260-5.
  • 14
    Petti J. Interactive, technology-enhanced self-regulated learning tools in healthcare education: a literature review. Nurse Educ Today. 2013;33(1):53-9.
  • 15
    Lahti M, Hätönen H, Välimäki M. Impact of e-learning on nurses´ and student nurses knowledge, skills, and satisfaction: a systematic review and meta-analysis. Int J Nurs Stud. 2014;51(1):136-49.
  • 16
    Kharb P, Samanta PP, Jindal M, Singh V. The learning styles and the preferred teaching-learning strategies of first year medical students. J Clin Diagn Res. 2013;7(6):1089-92.
  • 17
    SkillSTAT Learning. SS-ECG (The six second ECG)(r) [Internet]. North Vancouver, Canada: British Columbia; 2015 [cited 2015 Feb 03]. Available from: http://www.skillstat.com/tools/ecg-simulator#/-play
    » http://www.skillstat.com/tools/ecg-simulator#/-play
  • 18
    Alonso C, Gallego D, Honey P. The Honey-Alonso Learning Styles Questionnaire (CHAEA): interpretation, scales and implementation. Bilbao: Ediciones Mensajero; 1999.
  • 19
    Barca A, Seijas S, Brenlla JC, Santamaría S. The CEPEA scale (Evaluation of Learning and Study Processes Questionnaire). An instrument to evaluate learning and study processes among the university population. Rev Gallego Port Psicol Educ. 2000;5:325-41.
  • 20
    Cox L, Clutter J, Sergakis G, Harris L. Learning style of undergraduate allied health students: clinical versus classroom. J Allied Health. 2013;42(4):223-8.
  • 21
    Donche V, De Maeyer S, Coertjens L, Van Daal T, Van Petegem P. Differential use of learning strategies in first-year higher education: the impact of personality, academic motivation, and teaching strategies. Br J Educ Psychol. 2013;83(2):238-51.
  • 22
    Vacas JC, Mérida R, Molina G, Mesa MP. Influence of learning styles of nursing students on teaching strategies choice. Rev Enferm. 2012;35(12):54-8,61-3.
  • 23
    Yeun EJ, Bang HY, Ryoo EN, Ha EH. Attitudes toward simulation-based learning in nursing students: an application of Q methodology. Nurse Educ Today. 2014;34(7):1062-8.
  • 24
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Publication Dates

  • Publication in this collection
    Jul-Aug 2015

History

  • Received
    28 Feb 2014
  • Accepted
    28 Apr 2015
Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br