Educational interventions to improve electrocardiogram interpretation competence among nurses: A systematic review

To synthesise and critically appraise the evidence on educational interventions designed to improve electrocardiogram interpretation competence among registered nurses.

Electrocardiogram interpretation is a core clinical competence for nurses and is essential for recognising and managing cardiac abnormalities. Despite its importance, evidence consistently demonstrates suboptimal electrocardiogram interpretation competence among nurses, alongside variability in education and training provision.

Systematic review.

MEDLINE (Ovid), CINAHL, Embase and Scopus were searched from inception to 2 March 2025, with an updated search on 15 April 2026, supplemented by grey literature searching. Study selection, data extraction and quality appraisal using Joanna Briggs Institute critical appraisal tools were conducted independently by two reviewers. Due to heterogeneity in study design, interventions and outcome measures, a narrative synthesis was conducted.

Twenty-three studies met the inclusion criteria, including randomised controlled trials and pre-post quasi-experimental studies conducted across diverse clinical settings and countries. Educational interventions were associated with improvements in nurses' electrocardiogram competence. Interventions were synthesised into five themes: traditional and structured education; technology-enhanced learning; micro-learning approaches; blended and learner-centred models; and sustainability and reinforcement of learning over time. Interventions incorporating active learner engagement, structured practice and reinforcement appeared more likely to support meaningful learning gains. Evidence of learning attenuation over time was reported.

Educational interventions can improve electrocardiogram interpretation competence among nurses; however, electrocardiogram interpretation represents a complex clinical competency requiring ongoing development rather than one-off training. Spaced learning and reinforcement-based educational approaches may better support sustained competence.