Effect of an interactive e-book on nursing students' electrocardiogram-related learning achievement: A quasi-experimental design

Early recognition of cardiac arrhythmia is crucial for identifying patients who have a high-risk of cardiac arrest (Deakin et al., 2010). The electrocardiogram (EKG) is the gold-standard test for diagnosing cardiac arrhythmia; however, many nurses have low knowledge and confidence regarding performing EKG interpretation (Nickasch et al., 2016). EKG judgment involves complicated concepts, and identifying means of clarifying such concepts, and of promoting motivation to learn, is challenging. In nursing school, there is limited time available for each topic, and incorporating technology could help enhance teaching and learning. Digital technology now allows for the integration of text, sound, images, animations, and hyperlinks (Ho, 2012). Students are no longer limited to reading text in traditional paper-based books; they can now read digitally, using smartphones, tablets, and computers (Hwang et al., 2018). Electronic books (e-books) have become common in language, math, science, and music (Baek and Monaghan, 2013), as they are convenient, provide useful information, and afford enjoyment (Lai and Ulhas, 2012). However, e-books can have varying effects on students' learning achievement. Simply including multimedia functions in e-books does not guarantee better learning; instead, instructional design based on an appropriate theory or model is needed (Morris and Lambe, 2017). Thus far, research regarding the effect of interactive e-books on nursing students' learning is scarce, and studies of the application of instructional design in interactive e-books are also lacking. Considering this, the present study aimed to design and develop an interactive EKG-focused e-book based on the ‘attention, relevance, confidence, and satisfaction’ (ARCS) motivational model (Keller, 1979, Keller, 1987), and to evaluate the effect of this interactive e-book on nursing students' EKG-related learning achievement when compared to traditional learning materials.