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

August 24, 2026 updated by: Naile ALANKAYA

Effect of Case-Based Collaborative Learning on Arrhythmia Recognition and Patient Safety Attitudes Among Novice Intensive Care Nurses: A Randomized Controlled Trial

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.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

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.

Study Type

Interventional

Enrollment (Estimated)

72

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Turkey (Türkiye)
    • Kartal
      • Istanbul, Kartal, Turkey (Türkiye), 17100
        • Recruiting
        • Koşuyolu High Specialization Training and Research Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Newly graduated nurses with less than one year of professional nursing experience
  • Currently working in the coronary intensive care unit or cardiovascular surgery intensive care unit
  • Voluntary participation in the study
  • Provision of written informed consent

Exclusion Criteria:

  • Previous participation in a structured arrhythmia or ECG training program

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Case-Based Collaborative Learning Group
Participants receive the institution's routine orientation for newly employed intensive care nurses in addition to a structured case-based collaborative learning (CBCL) program focused on arrhythmia recognition, ECG interpretation, clinical decision-making, and patient safety. The CBCL program consists of two 120-minute sessions delivered over two consecutive weeks. Each session incorporates clinical case scenarios, ECG tracings, individual assessment, small-group collaborative discussion, shared clinical decision-making, facilitator-guided analysis, and structured feedback.
Behavioral: Case-Based Collaborative Learning-Based Arrhythmia Education
The intervention consists of two 120-minute educational sessions delivered once weekly over two consecutive weeks by a researcher with formal ECG training and certification in ECG interpretation. Each session uses clinically oriented arrhythmia cases accompanied by ECG tracings. Participants first assess the case individually and then work in small groups of 5-6 nurses to discuss their interpretations and reach a shared clinical decision. Groups present their conclusions, followed by facilitator-guided whole-group analysis, clarification of misconceptions, and structured feedback. The program addresses ECG interpretation, life-threatening rhythms, bradyarrhythmias, atrioventricular blocks, atrial tachyarrhythmias, medication- and electrolyte-related ECG changes, QT prolongation, and monitoring problems. Patient-safety principles and appropriate nursing responses and escalation of care are integrated throughout the cases.
Other Names:
  • CBCL-Based Arrhythmia Education
No Intervention: Control Group
Participants undergo the institution's routine orientation process for newly employed intensive care nurses and continue their usual clinical practice. They receive no study-specific CBCL intervention or additional arrhythmia-focused education from the research team during the study period. After completion of the three-month follow-up and final data collection, participants in the control group are offered the same arrhythmia education program.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Arrhythmia Recognition and Awareness Test (ARAT)
Time Frame: Baseline and 3 months after randomization
The Arrhythmia Recognition and Awareness Test (ARAT) consists of 27 items assessing arrhythmia recognition and awareness. Each correct response is scored as 1 and each incorrect response as 0, yielding a total score ranging from 0 to 27. Higher scores indicate better arrhythmia recognition and awareness.
Baseline and 3 months after randomization

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Safety Attitudes Questionnaire (SAQ)
Time Frame: Baseline and 3 months after randomization
The Safety Attitudes Questionnaire (SAQ) is used to assess participants' attitudes toward patient safety. The questionnaire includes 46 items rated on a 5-point Likert scale and comprises six dimensions: teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working conditions. Higher scores indicate more positive attitudes toward patient safety.
Baseline and 3 months after randomization

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Naile ALANKAYA

Investigators

  • Principal Investigator: Naile Alankaya, Associate Prof. PhD, Çanakkale Onsekiz Mart University, Faculty of Health Sciences

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

August 1, 2026

Primary Completion (Estimated)

December 1, 2026

Study Completion (Estimated)

December 1, 2026

Study Registration Dates

First Submitted

August 19, 2026

First Submitted That Met QC Criteria

August 19, 2026

First Posted (Actual)

August 21, 2026

Study Record Updates

Last Update Posted (Actual)

August 26, 2026

Last Update Submitted That Met QC Criteria

August 24, 2026

Last Verified

August 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • COMU-SBF-NA-04

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data will not be made publicly available because the informed consent obtained from participants did not specifically include provisions for public sharing of individual-level data. Aggregated study findings will be reported in scientific publications.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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