Development of an instrument to assess critical care nurses' arrhythmia knowledge

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)



First Committee Member

Nancy S. Hogan, Committee Chair


This study identified and described critical care nurse's arrhythmia knowledge and developed an instrument to assess that knowledge. The Keller Assessment Rating Tool (KART) was developed by the triangulation of qualitative and quantitative research methods. Critical care nurses were interviewed during five separate focus groups (N = 25). These focus group interviews provided opinions and beliefs of arrhythmia knowledge by discussion and rating of electrocardiographic (ECG) rhythm strips. This qualitative process was the initial technique for instrument development and provided content and face validity for the KART. The KART was then administered to 73 critical care nurses. Correlations and ANOVAs between specific demographic variables of the participants and their KART responses further supported construct and content validity and established reliability of the instrument. The finalized KART consisted of 29 items divided into basic, intermediate and advanced subscales. This study primarily describes the development of these subscales and how the original qualitative ordering of items changed when merged with the quantitative findings. The Chronbach coefficient alpha for the advanced subscales was.80. The Chronbach alpha for the entire KART was.82. These preliminary findings show that the KART discriminates varying levels of arrhythmia expertise. However, further refinement of the basic and intermediate subscales is necessary. Additional qualitative findings identified the informal use of unit based arrhythmia nurse experts that assist nurses who perform at the basic to intermediate level. This study also demonstrated a severe deficit in ECG interpretation of advanced arrhythmias, lead monitoring practices, and the need for established arrhythmia competencies. The KART and development of advanced practice expectations will identify nursing knowledge deficits and enhance achievement of arrhythmia competency in clinical practice.


Health Sciences, Nursing

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