This study aimed to assess nurses' performance in caring for patients with cardiac arrhythmias in Egypt. The researchers surveyed 67 nurses working in cardiac care units using a questionnaire to evaluate their knowledge, a skills assessment to evaluate their practice in identifying different arrhythmias, and a scale to assess their attitudes. The results found that 62.7% of nurses had an unsatisfactory level of knowledge, while 64.2% and 77.6% had adequate practice levels and positive attitudes, respectively. A statistically significant correlation was found between nurses' knowledge and practice, practice and attitude, and knowledge and attitude. The researchers recommend providing nurses with periodic training programs to improve patient care for those with cardiac arrhythmias.

1. 1
Nurses' Performance regarding Patients with
Cardiac Arrhythmias
Prof. Dr. Manal Houssien Naser, Dr. Samar Faltas Marzouk
Medical Surgical Nursing, Faculty of Nursing, Ain-Shams University
Mohammed A El Saied Mohammed,
Critical Care Nursing, Faculty of Nursing, Ain-Shams University.
Abstract
Background: cardiac arrhythmias are the abnormalities or perturbations in
the normal activation or beating of heart myocardium which could be either
too slow or too fast and can happen at any age. Aim of this study was to
assess the nurses' performance (knowledge, practice & attitude) regarding
patients with cardiac arrhythmias. Design: A descriptive exploratory study
design was utilized in this study. Subjects: Convenince study subjects of all
available nurses caring for patients with cardiac arrhythmias were included in
this study. Data Collecting Tools: a) self-administered questionnaire sheet to
assess demographic data & nurses' knowledge b) Arrhythmias' tool to assess
nurses' practice c) Nurses' verbated attitude Likert scale to assess nurses'
attitude . Results: Regarding demographic data; the mean age of nurses
under study was (31.57±4.59). It was revealed that, (62.7%, 64.2% and
77.6%) of the studied nurses had unsatisfactory level of knowledge, adequate
level of practice and positive attitude towards caring of patients with cardiac
arrhythmias respectively. Conclusion: there was highly statistically
significant correlation between practice and knowledge. As well there was
highly statistically significant correlation between practice and attitude while,
there was statistically significant correlation between knowledge and attitude.
Recommendations: Conducting periodic in-service training advanced care
program for nurses caring for patients with cardiac arrhythmias for
improving their performance and patient quality of care is essential.
Replication of the study on large sample and different hospitals setting in
order to generalize the results.
Keywords: Cardiac arrhythmias, Knowledge, Practice,attitude.
Introduction:
Cardiac arrhythmia is a kind of
disorder which shows abnormal
beats and such abnormal
heartbeats may cause increase or
decrease in blood pressure which
can be dangerous as it may lead to
paralysis or stroke or even sudden
death. Cardiac arrhythmias are
abnormality or disturbances in the
behavior of the heart’s electrical
activities. These disturbances
leads to abnormality in rate and
rhythm hence referred as
arrhythmic. The analysis of the

2. 2
electrocardiogram (ECG) signal is
the method available for
diagnosing cardiacarrhythmias. In
electrocardiograms, such
arrhythmias manifest themselves
as deformations or irregularities in
the observed waveform (Patel,
Gakare and Cheeran, 2012).
Cardiac arrhythmias are cardiac
rhythm disorders that comprise an
important epidemiological and
public health problem. Cardiac
arrhythmias are significantly
associated with increased risks of
cardiovascular complications and
sudden death, consequently
leading to decreased quality of
life, disability, high mortality, and
healthcare expense. Atrial
fibrillation (AF) is the most
common sustained arrhythmia,
and has beejn further increasing
with the aging of society. Most
cases are caused by myocardial
infarction and ventricular
fibrillation in out-of-hospital
cardiac arrest cases and
catecholaminergic polymorphic
ventricular tachycardia, are
estimated to be responsible for
10% of SCDs (Murakoshi and
Aonuma, 2013).
Sudden death is one of the most
important health problems in
western countries. It affects
approximately 1/1000
inhabitants/year. The principal
cause of sudden death is the
occurrence of malignant cardiac
arrhythmias, which result in the
loss of contraction of the heart
with subsequent lack of blood
supply to vital organs like the
brain. The immediate consequence
is loss of conscience, and if the
arrhythmia persists for more than
5 minutes, the patient dies
(Brugada, 2018).
Nurses needed to identify and
respond to cardiac arrest to detect
life-threatening arrhythmias and
decrease mortality in patients who
had an acute MI. Education of
staff involved in arrhythmia
detection of emergent arrhythmias
such as a systole and ventricular
tachycardia include bradycardias,
heart blocks, and both wide and
narrow complex tachycardias.
Beyond early recognition and
response to cardiac arrest, nurses
are now charged with post-
cardiopulmonary resuscitation
support, which requires
continuous assessment of
physiological parameters through
hemodynamic monitoring,
recognition of typical
complications (MI, adult
respiratory distress syndrome,
deep vein thrombosis, pulmonary
emboli), (Booker,2015).
Significance of the Study:
Total 52 million deaths, 15.3
millions were due to circulatory
diseases, most death from
circulatory disease where due to
coronary heart diseases(7.2
millions). About 330 to 350 global
deaths per year are due to the
cardiac arrhythmias with the
weighted average of 3158.1 death.
Prevalence of arrhythmias is
53/1000 (Rajput, 2016).

3. 3
In Egypt, Approximately 4
million people have
arrhythmias(Statistics by country
for arrhythmias, 2011).
According to medical records of
Intensive care unit in EL-
Demerdash Hospital affiliated to
Ain Shams University the total
number of patients admitted to the
department was (640)and the
number of patient who having
arrhythmias were (290) which
representing(45%)of the total
number of patients during the year
2015.
Aim of the study:
This study aimed to assess nurses'
performance caring for patient
with cardiac arrhythmia through
the following:
• Assessing nurses' knowledge
regarding patient with cardiac
arrhythmias
• Assessing nurses' practice
regarding patient with
cardiac arrhythmia
• Assessing nurses' attitude
regarding patient with
cardiac arrhythmia
Research questions
What are the nurses’ performance
regarding patients with cardiac
arrhythmias?
Subjects and Methods:
Study design:
An exploratory descriptive design
was utilized in this study.
Setting:
The study was conducted in
Cardiac care unit andpost open
heart Unit at Ain Shams
University Hospital.
Subjects:
A Convenient study subject of
all available nurses caring for
patients with cardiac arrhythmias
in the previously mentioned units
and agreed to participate in the
study were recruited in this study.
Tools of data collection:
Three tools were used in the
current study as the following:
ToolI: Nurses' self-administered
questionnaire (Appendix I) used to
assess nurses' knowledge
regarding caring for patients with
arrhythmias. It was adapted from
(Terry & Weaver, 2011) &
(Ambrose & Bradley, 2014) and
modified by the researcher. It was
written in Arabic language and
consists of two parts:
1-First Part: concerned with
demographic data. It was
consisted of 5 closed ended
questions such as (age,
gender, qualifications …
etc.).
2-Second Part: concerned with
nurses’ knowledge regarding
caring for patients with
arrhythmias that included ECG
(13questions), cardiac
arrhythmias and (16 questions)
and care provided for patients
with arrhythmias (13
questions).
Scoring System of nurses'
knowledge:
This part consists of 42
statements, which were grouped to

4. 4
3 subgroups i.e. (ECG, arrhythmias
and care provided to patients with
arrhythmias). The response was on
scale range from zero (Incorrect
answer) to 1 grade (correct
answer). A total score for nurses'
knowledge was categorized in to
unsatisfactory or satisfactory, the
total score was 42 and divided in to
two categories as follows:
 <85% (< 36) was considered
unsatisfactory
 ≥85% (≥ 36) was considered
satisfactory.
 Tool II : Nurses self-administered
arrhythmias’ tool; used to assess
nurses' practice regarding
differentiation between different
types of arrhythmias for patients
with arrhythmias ; this part adapted
from (Rosendorff, 2013 ) &
(Davies, 2014) and (Clutter,
2015) and developed by the
researcher to suite the aim of the
study and written in Arabic
language and includes(12 image)
of arrhythmias.
Scoring System:
This tool consists of 12 items.
The response was on scale ranged
from Zero (In correct) to one
(Correct). A total score for nurses'
practice was categorized in to
unsatisfactory or satisfactory, the
total score was12 and divided in to
two categories as follows:
 < 85 % (<10) was considered
unsatisfactory.
 ≥ 85 % (≥10) was considered
satisfactory.
 Tool III: Nurses' verbated
attitude likert scale (Appendix
III)
It used to assess nurses'
attitude toward caring of patients
with arrhythmias (14 items). This
tool was translated into Arabic
language and retranslated based on
review of literature, adapted from
(Wiley, 2016).
Scoring System:
This part consisted of 14
items. The response was on 5
points likert scale ranged from zero
(strongly disagree), 1 (disagree), 2
(some how), 3 (agree) & 4
(strongly agree). The total score 56
and divided into two categories as
follow:
 ≥ 85 % (≥ 48) considered
positive attitude.
 ≤ 85 % (≤ 48) considered
negative attitude.
II. Operational Design:
The operational design includes
preparatory phase, validity and
reliability, pilot study, and field
work.
1) Preparatory phase:
It includes reviewing of the
current and more recent national
and international literature reviews
concerning caring for patients
with cardiac arrhythmias of
various aspects of this issue in
order to develop the data
collection tools.
2) Testing validity & reliability:
Testing validity of the
proposed tools by using face&

5. 5
content validity. Face validity
aimed at inspecting the items to
determine whether the tools
measure what supposed to
measure, content validity was
conducted to determine whether
the tools cover the aim. Validity
was tested through a jury of 9
experts from Medical
SurgicalNursing Department, Ain
–Shams University (professors
3&assistant professor 4&lecture
2).The experts reviewed the tools
for relevancy, comprehensiveness,
simplicity and applicability, minor
modifications was done.
Testing reliability of the proposed
tools was done by chronbach
Alpha Test (P value <0.001).
Ethical consideration:
The ethical research
considerations in the study
include the following:
 Approval of the study protocol
was obtained from the ethical
committee in the Faculty of
Nursing at Ain Shams
University before starting the
study.
 The researcher clarified the
objective and aim of the study
to nurses, included in the study.
 The researcher assured
maintaining anonymity and
confidentiality of subjects' data.
 Nurses were informed that they
are allowed choosing to
participate or withdraw from the
study at any time.
3) Pilot study:
A pilot study was conducted
on 10% of the study subject in
order to tent the applicability of
the study tools, clarity of the
included questions as well as
estimation of the average time
needed to complete all questions.
Results obtained were studied and
analyzed.
Accordingly modifications
were made for the final
development of the study tool.
Then the six nurses selected for
the pilot study were excluded from
the study subjects and replaced by
another six nurses.
4) Field work:
1. Field work included
interviewing with all available
nurses caring for patients with
cardiac arrhythmias in the
previously mentioned clinical
settings to explain aim of the
study and effect of the study on
their performance as well as
patients quality of care and take
their approval to participate in
the study prior to any data
collection orally.
2. Assessing nurses' knowledge
practice and attitude regarding
caring of patients with cardiac
arrhythmias by using self-
administered questionnaire
tool, arrhythmia's tool and
likert scale as following:
 The self- administered
questionnaire tool was filled by
the nurses. It takes about 20-25
minutes for every nurse to be
fulfilled.

6. 6
 Arhythmias' tool was filled by
the nurse to assess their skills.
It takes about 20 minutes for
every nurse to fulfill at
morning and afternoon shift.
 Nurses' verbated attitude likert
scale was filled by the nurse. It
takes about 10- 15 minutes for
every nurse to be fulfilled..
3. Data collection took about 5
months started from April2017
till August 2017, the data were
collected by the researcher
through3days /week (Saturday,
Monday and Tuesday) during
the morning and afternoon
shifts, each nurse were
interviewed individually by the
researcher for about 60-85
minutes.
III. Administrative Design:
To carry out this study, the
necessary approval was obtained
from the hospital' director. A letter
was issued to them from the
Faculty of Nursing, Ain Shams
University explaining the purpose
of the study to obtain the
permission for conducting this
study.
Results:
Table (1): Frequency and percentage distribution of demographic
characteristics of studied nurses (n=67).
Items N %
Age(years)
<20 5 7.5
20-40 54 80.6
>40 8 11.9
Mean±SD 31.57±4.59
Gender
Male 24 35.8
Female 43 64.2
Level ofEducation
High school of nursing 19 28.4
Technical institute of nursing 26 38.8
Bachelor of nursing (BSC) 20 29.9
Other(Master or Diploma) 2 3.0
Table (1): shows the demographic characteristics of staff nurses.
Data in this table revealed that, the mean age of nurses under study was
31.57±4.59, 64.2% of them were females. Regarding level of education, it
was found that 38.8% of them were graduated from technical institute of
nursing while, the high school of nursing, Bachelor of nursing were (28.4%
and 29.9% respectively).

7. 7
Figure (1): Percentage distribution about years of experience in CCU.
Figure(1): illustrated that, 44.8% of the studied nurses have
experience<5 years and 32.8% have experience ≥ 10, while 22.4% of them
have experience ranged from 5-< 10years.
Figure (2): Percentage distribution of Training courses of ECG and
arrhythmias.
Figure (2):It illustrated that, 70.1% of the studied nurses have a training
coursesof ECG and arrhythmias while 29.9% of them have not any training
courses of ECG and arrhythmias.
Years of experience in CCU
32.8%
44.8%
22.4%
<5 5-<10 ≥10
Training courses in ECG and arrhythmias
70.1%
29.9%
Yes No

8. 8
Table (2): Frequency &percentage distribution of nurses' level of
knowledge about ECG (n = 67)
Items
Satisfactory Unsatisfactory
N % N %
-Definitionof Electrocardiogram 11 16.4 56 83.6
-Origin of heart beats 47 70.1 20 29.9
-Characteristics of normal heart rate 31 46.3 36 53.7
-Methods used to calculate heart rate 32 47.8 35 52.2
Components of ECG:-
A- Representation of P-wave
B-Representation ofP-R interval
C-Representation of QRS complex.
D-Representation of T-wave
E-The normal distance for QRS complex
F-Measurement of P-R interval
G-The number of small squares for P-R interval
34 50.7 33 49.3
30 44.8 37 55.2
26 38.8 41 61.2
20 29.9 47 70.1
40 59.7 27 40.3
28 41.8 39 58.2
38 56.7 29 43.3
-Meaning oflarge square equal 0.2 second 28 41.8 39 58.2
-Five small boxes on the EKG paper are equal to 20 29.9 47 70.1
Table (2):showed that, nurses had unsatisfactory knowledge about
definition of ECG, representation of QRS complex, representation of T-
wave, measurement of P-R interval, meaning oflarge square equal 0.2
second and five small boxes on the EKG paper are equal to (83.6%,61.2%,
70.1%, 58.2%, 58.2%, 70.1% respectively). While nurses had satisfactory
knowledge about origin of heart beats, the normal distance for QRS
complex and the number of small squares for P-R interval (70.1, 59.7% and
56.7% respectively).
Table(3):Frequency& Percentage distribution of nurses Knowledge about
arrhythmias(n=67).
Items
Satisfactory Unsatisfactory
N % N %
-Overview of arrhythmias:
A-Definition of arrhythmias
B-Characteristics of arrhythmias
C-Causes of arrhythmias
D-Risk factors of arrhythmias
E-Detection of arrhythmias from ECG rhythmstrip
F-Diagnosis of arrhythmias
G-Criteria used to exclude abnormal ECG
6 9.0 61 91.0
44 65.7 23 34.3
12 17.9 55 82.1
1 1.5 66 98.5
37 55.2 30 44.8
13 19.4 54 80.6
19 28.4 48 71.6
Characteristics of different types of arrhythmias
A-Characters of first degree heart block
B-Characters of ventricular tachycardia
C-Characters of atrial fibrillation
D-Characters of ventricular fibrillation
31 46.3 36 53.7
15 22.4 52 77.6
37 55.2 30 44.8
25 37.3 42 62.7

9. 9
E-Characters of P-pulmonale and p- mitral
F-Characters of ischemic heart on ECG rhythm strip
16 23.8 51 76.1
17 25.4 50 74.6
-Characteristics of ECG of patient with pacemaker 13 19.4 54 80.6
-Uses of ( cardioversion&defibrillator) 36 53.7 31 46.3
Table(3):it revealed that, nurses under study had unsatisfactory
knowledge about definition of arrhythmias causes of arrhythmias, risk
factors of arrhythmias, diagnosis of arrhythmias, characteristics of
ventricular tachycardia, characters of P-pulmonale and p- mitral and
characteristics of ECG of patient with pacemaker(91.0%,82.1%, 98.5%,
80.6%, 76.1%, 74.6%, 80.6%, 77.6%,76.1% and 80.6%respectively) .While
more than half of them had satisfactory knowledge about characteristics of
arrhythmias, detection of arrhythmias from ECG rhythm strip, characters of
atrial fibrillationand uses of cardioversion and defibrillator
(65.7%,55.2%,55.2%, 53.7% respectively).
Table (4):Frequency & Percentage distribution of nurses Knowledge about
nursing care provided to patients with cardiac arrhythmias (n=67).
Items
Satisfactory Unsatisfactory
N % N %
Checking the electrodes placement. 32 47.8 35 52.2
Nerve stimulated by applying carotid sinus
massage.
13 19.4 54 80.6
Nursing management for patient with tachycardia. 30 44.8 37 55.2
Nursing management for patient with bradycardia. 22 32.8 45 67.1
Nursing managementfor patient with atrial
fibrillation.
23 34.3 44 65.7
Nursing management for patient with
supraventricular tachycardia.
21 31.3 46 68.7
Nursing management for patient with heart block. 25 37.3 42 62.7
Nursing management for patient with PVCs. 22 32.8 45 67.1
Nursing management for patient with ventricular
tachycardia.
30 44.8 37 55.2
Nursing management for patient with ventricular
fibrillation.
31 46.3 36 53.7
Nursing management for patient with asystole. 30 44.8 37 55.2
Table (4): It revealed that, more than half of nurses under study had
unsatisfactory knowledge about Nursing management for patient with
bradycardia, Nursing managementfor patient with atrial fibrillation, Nursing
management for patient with supraventricular tachycardia, Nursing
management for patient with heart block, Nursing management for patient
with PVCs (67.1%,65.7%, 68.7%, 62.7% 67.1% respectively). And 80.6%
of them don't know the nerve stimulated by applying carotid sinus massage.

10. 10
Table (5):Frequency & Percentage distribution of nurses' total level of
practice regarding arrhythmias identificationfor patient with cardiac
arrhythmias (n=67).
Items of Practice
Satisfactory Un satisfactory
N % N %
Normal Sinus rhythm 46 68.7 21 31.3
Sinus bradycardia 42 62.7 25 37.3
Atrial flutter 38 56.7 29 43.3
Atrial fibrillation 37 55.2 30 44.8
Supraventricular tachycardia 35 52.2 32 47.8
Premature ventricular contraction 46 68.7 21 31.3
1st degree heart block 45 67.2 22 32.8
2nd degree heart block 45 67.2 22 32.8
3rd degree heart block 33 49.3 34 50.7
Ventricular tachycardia 39 58.2 28 41.8
Ventricular fibrillation 50 74.6 17 25.4
Asystole 65 97.0 2 3.0
Table (5): It revealed that, nurses under study had satisfactory level of
practice about identifying normal sinus rhythm, sinus bradycardia,
premature ventricular contractions, 1st degree heart block, 2nd degree heart
block, ventricular tachycardia and ventricular fibrillation, a systole(68.7%,
62.7% , 68.7 % , 67.2% , 67.2% , 58.2, 74.6% , 97.0% respectively).

11. 11
Table (6): Frequency& Percentage distribution of nurses' attitude regarding patient with cardiac arrhythmias (n=67).
Items
Strongly
agree
Agree
To
someextent
Disagree
Strongly
disagree
N % N % N % N % N %
1-I think that thegood treatment of nursing towards thepatient is
important.
61 91.0 1 1.5 5 7.5 0 0.0 0 0.0
2- I believe that providing a calm and comfortable atmosphere of the
disease has an effective role in advancing the patient's condition.
50 74.6 16 23.9 1 1.5 0 0.0 0 0.0
3-I think that not necessary to disturb the patient during sleep either day
or night when nursing care is provided to him.
39 58.2 18 26.9 9 13.4 1 1.5 0 0.0
4- I think it is necessary not to leave the patient alone in thetime of pain
and to take actions that reduce it.
49 73.1 14 20.9 2 3.0 2 3.0 0 0.0
5-I see that the explanation and awareness of thepatient environment
surrounding the hospitaland tools and order and routine reduces concern.
46 68.7 17 25.4 4 6.0 0 0.0 0 0.0
6-I think it is necessary to encourage thepatient to take out theinside of
the concern and provide nutrition for him.
43 64.2 19 28.4 3 4.5 0 0.0 2 3.0
7-I feel the importance of helping thepatient to cope with the disease. 45 67.2 19 28.4 3 4.5 0 0.0 0 0.0
8- I feel the need to do some of the procedures that help the patient in the
reassurance and confidence in the nurse. 48 71.6 15 22.4 1 1.5 1 1.5 2 3.0
9-I believe that thesocial and economic situation of thepatient affects
the relationship between the nurse and the patient and the nursing care
provided.
15 22.4 12 17.9 8 11.9 4 6.0 28 41.8
10-. I think dealing with a heart patient is very easy. 20 29.9 9 13.4 7 10.4 12 17.9 19 28.4
11- I see the need for a team spirit among nurses to ensure efficient
nursing care provided.
39 58.2 19 28.4 3 4.5 1 1.5 5 7.5
12-feeling bored when repeating the same patient to complain and
questions.
12 17.9 12 17.9 20 29.9 10 14.9 13 19.4
13-I think it is necessary to guide the patient to thecenters for follow-up. 29 43.3 35 52.2 3 4.5 0 0.0 0 0.0
14-I think that thenurse of the center of the heart must be qualified
scientifically and practically.
50 74.6 14 20.9 0 0.0 1 1.5 2 3.0

12. 12
Table (6): Described nurses' attitude regarding patient with cardiac
arrhythmias. It revealed that, the studied nurses were strongly agreed on
good relation between nurse and patient, calm hospital environment, not to
leave the patient alone, help the patient to be safe and nurse should be
qualified scientifically and practically (91.0%,74.6%,73.1%, 71.6% &
74.6% respectively).While, 41.8% of them were strongly disagreed on effect
of the patient social and economic status on his condition.
Table (7): correlation between knowledge, practice and attitude
Items knowledge Practice Test
Practice
0.834 r
<0.001** P-value
Attitude
0.277 0.207 r
0.023* <0.001** P-value
Significant level: Non Significant >0.05 Significant<0.05* High Significant <0.001**
Table (7): illustrated that there was highly statistically significant
correlation between practice and knowledge at r = 0.834 at P < 0.001. As
well there was highly statistically significant correlation between practice
and attitude at r = 0.207 at P < 0.001 while, there was statistically significant
correlation between knowledge and attitude at r = 0.277 at r = 0.023.
Discussion:
Concerning the demographic
characteristics of the study sample;
the results revealed that more than
three quarters of nurses' age were
between (20-40) years old and the
mean age of the studied nurses was
(31.57±4.59). This may be due to
the most of those nurses were
newly graduated, young and
tolerate the nature of the work in
the critical care unit. This finding
was in agreement with a study
done by Mohan, (2010) about
"assessment of knowledge
regarding interpretation of life
threatening arrhythmias and its
emergency management among
cardiac nurses in sctimst and found
that, about two third of the studied
sample were aged between (25-35)
years. On the other hand, this
finding was incongruent with a
study done by Pearson, (2013)
about "an algorithm to assist
critical care registered nurses to
correctlyidentify electrocardiogram
rhythm strip in southwestern
Mississippi " and found that, the
mean age of the study sample were
48.7 years old. As regards to
gender; the study results revealed
that, more than two thirds of the
studied nurses were females. On
the other hand, this finding was
incongruent with a study done by
Qadir and younis, (2014) about "
Quality of nursing care for patients
with acute myocardial infarction at
coronary units of Erbil city
hospitals " and found that, more
than two third of the studied nurses
were male.

13. 13
Concerning to nurses' knowledge
about ECG, the present study results
indicated that, more than half of
nurses under study had unsatisfactory
level of knowledge.This finding was
incongruent with the study done by
AL-Husaunawy, (2015) who found
that about three third of nurses gave
the correct answer regarding
knowledge about electrocardiogram.
Concerning to nurses'
knowledge about cardiac
arrhythmias .The study revealed
that, more than two third of the
studied nurses had unsatisfactory
level of knowledge about cardiac
arrhythmias. This finding was in
agreement with Rajput, (2016)
who found that, one third of staff
nurses were have good level of
knowledge regarding identification
of cardiac arrhythmias. On the
other hand this finding was
incongruent with Mohan, (2010)
found that, more than two third of
them had satisfactory level of
knowledge.
Regarding nursing care
provided to patients with cardiac
arrhythmias. The study results
revealed that, about two thirds of
the studied nurses had
unsatisfactory level of knowledge
about nursing care provided to
patients with cardiac arrhythmias.
This results was supported by
Owaid, Ahmed, Zedaan and
Shalal, (2016) who found that,
about two third of the studied
nurses had low level knowledge
related to early intervention of
ventricular tachycardia. This
finding was supported by Qadir
and Younis, (2014) who found
that, Levels of quality of nursing
care in coronary care unit was fair
(75%).
Regarding to nurses' practice,
the study revealed that, more than
two third of the studied nurses had
satisfactory level of 1st degree and
2nd degree heart block. This
finding was supported by Santos,
Sallia and Lucena, (2017) who
found that, more than two third of
the study sample had satisfactory
level regarding patients with 1st
and 2nd degree heart block.
As regards to nurses' practice,
the study revealed that, more than
two third of the studied nurses had
satisfactory level of nursing
practice regarding caring of
patients with Premature
ventricular contraction. This
finding was incongruent with
Kerbage, (2016) who found that,
two third of the study sample had
unsatisfactory level regarding
interpretation of premature
ventricular arrhythmias.
Regarding to nurses'
practice, the study revealed that,
more than half of the studied
nurses had satisfactory level of
practice regarding identifying
ventricular tachycardia. This
finding was in agreement with
Santos, Sallia and Lucena, (2017)
who found that, majority of the
study sample had satisfactory level
of practice regarding patients with
ventricular arrhythmias. This
finding was supported by Owaid,
et al, (2016) who found that, two

14. 14
third of the studied nurses had
satisfactory level of practice
regarding patients with ventricular
arrhythmias.
Concerning nurses' practice of
patients with ventricular
fibrillation, the study results
revealed that, about three quarters
of the studied nurses had
satisfactory level of practice
regarding patients with ventricular
fibrillation. This finding is in
agreement with Mohan, (2010)
who found that, more than two
third of the study sample had
satisfactory level of nurses'
practice regarding patients with
ventricular fibrillation. On the
other hand this finding was
incongruent with Owaid, et al,
(2016) who found that,about two
third of the study sample had un
satisfactory level of nurses'
practiceregarding patients with
ventricular fibrillation.
Concerning nurses' practice
about identifying patients with a
systole, the study results revealed
that, almost all of the studied
nurses had satisfactory level of
practice regarding patients with a
systole. This finding was in
agreement with Werner, Kander,
Axelsson, (2016) who found that,
the total study sample had
satisfactory level of practice
regarding identifying patients with
a systole.
Also, in the same line,
Ibrahim, (2016) found in a study
about "Effect of nursing care
standard on nurses performance
regarding caring for patients with
cardiac arrhythmias" that, about
two third of the studied nurses had
satisfactory level of practice
patients with a systole.
Regarding to the total nurses'
attitude, the results of the study
revealed that more than three
quarters of the studied nurses had
positive attitude regarding caring
of patient with cardiac
arrhythmias. This finding is in
agreement with El Sayed, (2017)
who found that, about two third of
the studied nurses had positive
attitude regarding management of
acute myocardial infarction within
golden hours.
Conclusion:-
More than half of nurses had
unsatisfactory knowledge about
ECG and more than two third of
them had unsatisfactory
knowledge about arrhythmias.
Moreover, about two thirds of
them had unsatisfactory level of
knowledge about nursing care
provided to patient with cardiac
arrhythmias. More than two thirds
of nurses had satisfactory level of
nursing practice regarding caring
of patients with cardiac
arrhythmias. More than three
quarters of nurses had positive
attitude regarding caring of
patients with cardiac arrhythmias.
Recommendations:
The results of this study projected
the following recommendations:-

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1- Conducting periodic in-service
training advanced care program
for nurses caring for patients
with cardiac arrhythmias for
improving their performance
and patient quality of care is
essential.
2- Devoloping a simplified and
comprehensive booklet
including basic information
about cardiac arrhythmias,
components of ECG, methods
to interprete ECG and nursing
role towards cardiac
arrhythmias.
3- Clinical instructors should be
available in critical care units
to provide staff nurses about
continuous education regarding
different types of cardiac
arrhythmias and its specific
nursing practice and
management.
5- The study should be replicated
on large sample and different
hospitals setting in order to
generalize the results.
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