Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Master of Science in Nursing (MSN)


Yale University School of Nursing

First Advisor

Marjorie Funk


This thesis is a sub-study of the large study PULSE Trial. Nurses need to have sufficient knowledge to carry out high quality patient care and to produce good patient outcome. Preliminary study of the PULSE Trial has shown that nurses' ECG monitoring knowledge can improve after taking the online ECG course. This study aims to determine the retention of knowledge 1-2 years after the course and to identify factors associated with better knowledge retention. The sample of the study consists of the nurses who participated in all the three phases of the PULSE Trial. This includes 504 individual nurses, with average age of 38.5 (SD10.7); 90.3% of them are female; 72.0% are white, and 76.8% have bachelor's degree or higher. Retention of knowledge is measured by the change of score from post-test to follow-up test. The mean of the change is 8.6 (SD15.5) points, ranging from -39 to 63. There is significant knowledge decay (p<0.0001), but knowledge at follow-up test is still significantly (p<0.0001) higher than pre-test knowledge. Independent T test and one way ANOVA reveals that the contributing factors to better ECG monitoring knowledge retention include: having received in-service 12-lead ECG education, being familiar with the Practice Standards for ECG Monitoring in Hospital Settings, having reviewed the on-line modules before taking follow-up test, being in units with protocols for ECG monitoring. To prevent knowledge decay, individuals are encouraged to review the course. Units and hospitals are suggested to implement practice protocols coherent to standards, and to provide refresher courses. Future study will look into influence from unit culture and individual learning patterns.


This is an Open Access Thesis.