Mrs Dima Nasrawi

Background
Cardiovascular disease is the leading cause of death worldwide. Cardiac surgery is the main treatment followed by inpatient cardiac rehabilitation (ICR) to prepare patients for recovery.

Aim
The aim of this study was to describe the delivery, barriers, and enablers to patient participation in ICR programs after cardiac surgery.

Methods
This integrative review was guided by Whittemore and Knafl's methodology. This process included database searches, data evaluation, data integration, and presentation of results. Searched databases included Medline, CINAHL Complete, PsycINFO, Cochrane Library, and Web of Science. Publications dates included 2000 to 2021. Studies included Phase 1/inpatient phase cardiac rehabilitation following cardiac surgery. The Mixed Method Appraisal Tool (2018) was used to assess the quality of the included studies. Inductive content analysis was used to analyse the textual data.

Results
Using the inclusion and the exclusion criteria, 607 articles were screened. Five articles were included in this review, and they were appraised. Categories comprised of the following: i) ICR programs using a multidisciplinary approach beginning in the early postoperative stage; ii) ICR programs including multicomponents that were delivered through an individualised approach; and iii) enablers and barriers to patient participation to ICR. The enablers included religious faith and family support, whereas inconsistent pathways of cardiac rehabilitation referrals and detachment from patients' experiences and needs were barriers to participation in ICR.

Conclusions
In some instances, ICR programs were delivered using individualised approaches, but this is an area that needs improvement. A multidisciplinary team including nurses should be involved in the ICR phase after cardiac surgery to provide holistic care and enhance patients’ preparedness to participate in subsequent phases of rehabilitation. Only five relevant articles addressing the delivery of inpatient cardiac rehabilitation were identified in this specific topic area.

Australia’s higher education workforce has literally been decimated during the COVID-19 pandemic. Mass forced redundancies and non-renewal of casual contracts were highly stressful. And now some disciplines and academics who committed their lives to teaching feel publicly invalidated as unnecessary in the reconstruction of the sector to produce what the government deems to be “job-ready graduates”.

Graduating nurses should possess knowledge and understanding of cardiac arrhythmia interpretation, so they can assess abnormal and life-threatening arrhythmias. However, literature around nursing students' foundational knowledge in cardiac arrhythmia interpretation remains scarce.
To examine final-year nursing students' foundational knowledge and self-assessed confidence in interpreting cardiac arrhythmias.
Cross-sectional study design.
Two Australian universities (one regional and the other large metropolitan).
Nursing students in the final year of a program of study leading to initial registration as a registered nurse.
An online survey was adopted to examine final-year nursing students' foundational knowledge and their self-assessed confidence when interpreting cardiac rhythms.
A total of 114 participants completed surveys, representing a response rate of 22%. More than 70% of the participants were able to interpret asystole, sinus rhythm, and sinus bradycardia. Over 50% correctly identified ventricular tachycardia, atrial flutter, sinus tachycardia, atrial fibrillation, and ventricular fibrillation. Under 15% of the participants were able to interpret junctional rhythm, paced rhythm, and unifocal/multifocal premature ventricular contractions. Self-assessed confidence levels were generally lower than the accuracy rates of arrhythmia interpretation. Although many participants acknowledged that learning arrhythmia interpretation was difficult and challenging, most of them had positive perceptions and wanted to learn more.
Nursing curricula need to be supported and strategies need to be implemented to standardise educational electrocardiogram interpretation programs, which are critical to improving final-year nursing students' foundational knowledge and confidence in interpreting cardiac arrhythmias and enhancing patient safety.

Graduating nurses should possess knowledge and understanding of cardiac arrhythmias interpretation so they can assess abnormal and life-threatening arrhythmias (Australian Nursing & Midwifery Accreditation Council, 2019). However, literature remains scarce around nursing students’ foundational knowledge in cardiac arrhythmia interpretation (Habibzadeh et al., 2019), who are in their final year of study leading to initial registration as registered nurses. This presentation will showcase the teaching strategies that have been changed as the result of COVID-19, and will ascertain the students’ understanding of their foundational knowledge and their self-assessed confidence when interpreting cardiac arrhythmias with the use of an online survey. Online self-directed learning methods were used, often referred to as a ‘flipped classroom’ approach (Lo & Hew, 2017), in which online modules were completed in the students’ own time and then later reinforced through clinical application in online tutorials. It explores the challenges and opportunities in developing high-level educational cardiac arrhythmia interpretation.

Australian Nursing & Midwifery Accreditation Council. (2019). Registered nurse accreditation standards 2019. https://www.anmac.org.au/standards-and-review/registered-nurse

Habibzadeh, H., Rahmani, A., Rahimi, B., Rezai, S. A., Aghakhani, N., & Hosseinzadegan, F. (2019). Comparative study of virtual and traditional teaching methods on the interpretation of cardiac dysrhythmia in nursing students. Journal of Education and Health Promotion, 8(1). https://pubmed.ncbi.nlm.nih.gov/31807592/

Lo, C. K., & Hew, K. F. (2017). A critical review of flipped classroom challenges in K-12 education: possible solutions and recommendations for future research. Research and practice in technology enhanced learning, 12(1), 4. https://doi.org/10.1186/s41039-016-0044-2