Case-Based Collaborative Learning for Arrhythmia Recognition in Novice Intensive Care Nurses

Overview

This randomized controlled trial evaluates the effectiveness of case-based collaborative learning (CBCL) in improving arrhythmia recognition and patient safety attitudes among novice intensive care nurses. Newly graduated nurses with less than one year of professional nursing experience working in coronary or cardiovascular surgery intensive care units are randomly assigned to an intervention or control group. Both groups participate in the institution's routine orientation process for newly employed intensive care nurses. In addition, the intervention group receives a structured CBCL-based arrhythmia education program delivered in two 120-minute sessions over two consecutive weeks. The program uses clinical case scenarios, ECG tracings, individual assessment, small-group collaborative discussion, shared clinical decision-making, and structured feedback. The control group receives no additional study-specific arrhythmia education during the study period. The primary outcome is arrhythmia recognition and awareness, and the secondary outcome is patient safety attitudes. Outcomes are assessed at baseline and at the three-month follow-up in both groups. An additional immediate post-intervention assessment is conducted in the intervention group to examine short-term changes following the educational program.

Early recognition and appropriate interpretation of cardiac arrhythmias are important competencies for nurses working in intensive care settings, where changes in cardiac rhythm may require rapid clinical assessment and timely escalation of care. Novice nurses may have limited opportunities to develop these competencies through clinical experience alone. This study therefore evaluates a case-based collaborative learning (CBCL) approach designed to integrate arrhythmia recognition with clinical reasoning, nursing decision-making, and patient-safety principles. The CBCL intervention uses clinically oriented arrhythmia scenarios accompanied by ECG tracings. Participants first assess each case individually and then work in small groups to discuss their interpretations and reach a shared clinical decision. Group conclusions are subsequently discussed with the educator, who facilitates analysis of the case, clarification of misconceptions, and structured feedback. Patient-safety principles, including recognition of hemodynamic instability, timely escalation of care, differentiation of true arrhythmias from monitoring artefacts, and assessment of the patient's clinical condition, are integrated throughout the educational activities. The main effectiveness evaluation compares the intervention and control groups at the three-month follow-up while accounting for baseline outcome levels. An additional assessment immediately after completion of the educational program is conducted only in the intervention group to explore the immediate educational response and whether the observed improvement is maintained at three months.