Knowledge and Attitudes Towards ECG Interpretation Among Intensive Care Nurses: A Greek Cross-Sectional Study

Timely recognition of cardiac arrhythmias is essential in Intensive Care Units (ICUs). Electrocardiogram (ECG) interpretation is a core component of nursing practice, yet international studies show persistent gaps. In Greece, limited evidence exists regarding ICU nurses' interpretation, educational preparedness and role perception in ECG interpretation.

The aim of this study was to evaluate ICU nurses' knowledge, attitudes and self-perceived preparedness regarding ECG interpretation and to investigate whether these outcomes were associated with demographic and professional characteristics.

A descriptive, cross-sectional web-based survey was conducted among ICU nurses in Greece between October 2024 and February 2025. The instrument included demographic variables, 10 true/false knowledge items and 10 Likert-scale attitude items. Internal consistency was acceptable (α = 0.81-0.87). Data analysis included descriptive statistics, chi-squared tests and multivariable logistic regression (p < 0.05).

A total of 100 ICU nurses participated in the study. The mean knowledge score was 6.1 ± 1.8/10, with high accuracy on basic items (88%) but low performance on complex patterns (24%). Prior ECG training was the only independent predictor of adequate knowledge (OR = 2.85, 95% CI: 1.12-7.26, p = 0.028). The mean attitude score was 38.4 ± 6.2/50; although 96% recognised ECG interpretation as essential, 49% reported limited knowledge. Positive attitudes were linked to prior training, ICU experience and frequency of ECG evaluation, whereas 25% expressed ambiguity about whether ECG interpretation falls within nursing responsibilities.

ICU nurses demonstrated moderate theoretical ECG knowledge but variable preparedness and role clarity. Prior training, ICU type and clinical experience were key determinants. Standardised, simulation-based training and clearer responsibility delineation could strengthen cardiac monitoring safety.

Targeted ECG education and explicit clarification of nurses' responsibilities in cardiac monitoring are essential to strengthen arrhythmia recognition and timely intervention in ICUs. Implementing structured training pathways and ongoing assessment of ECG interpretation skills may support safer cardiac monitoring practices and more autonomous, confident intensive care nursing.