An electrocardiogram (ECG) is the most common and accurate diagnostic tool for cardiac arrhythmia (Chan et al., 2016, Kim et al., 2015). In Taiwan, 838 unexpected cardiac arrest events were reported in 2023, with a 59.8 % mortality rate and most occurred in general wards (Foundation Hospital Evaluation and Medical Quality Promotion Association, 2023). Nurses, as frontline healthcare providers, should be competent in ECG interpretation. However, some nurses perceive themselves as least competent in the interpretation and management of cardiac arrhythmia in CPR, with many making mistakes in ECG interpretation during fatal rhythms (Çıkrıkçı Isık et al., 2020). The misinterpretation of ECGs can lead to the incorrect selection of medications, thereby reducing patient survival (Shaik et al., 2023). Thus, enhancing nurses’ competence in ECG interpretation is essential.

Traditional face-to-face training is challenging for nurses due to their rotating schedules, the emergence of infectious diseases like COVID-19 (Hao et al., 2022; Lee et al., 2024) and the limited time available for comprehensive knowledge transfer (Chang et al., 2020). Digital learning provides an alternative teaching method that overcomes the limitations of time and space, allowing nurses to learn at their convenience (Halim et al., 2021).

Digital learning is as effective as traditional teaching methods (Brusamento et al., 2019, Hao et al., 2022). Indeed, interactive eBooks with multimedia and interactive functions can motivate self-learning and learning efficiency (Yu et al., 2024). Although an interactive eBook can significantly improve the level of knowledge among nurses, the final score often falls short of mastery, currently ranging between 55.38 % and 73.48 % (Chen et al., 2025, Chuang et al., 2022, Hsieh et al., 2022). It has been suggested that additional feedback mechanisms should be implemented with the eBook to achieve greater learning outcomes (Hsieh et al., 2022).

Feedback strategies include verbal, written, audio, or video-based feedback (Natesan et al., 2023). Compared with other feedback strategies, video feedback is the preferred choice for learners (Bahula and Kay, 2021). It provides more detailed and clear elaboration, reduces misunderstandings and enhances reflection and higher-order thinking (Bahula and Kay, 2021; Mahoney et al., 2019), making it more suitable for learning complicated concepts, such as ECG interpretation. Hence, this study introduced a novel dual-component framework that integrates an interactive ECG eBook for self-paced knowledge acquisition with a structured video-based feedback loop. This design serves as a dynamic scaffolding mechanism, transforming the learner from a passive recipient of information into an active participant in a clinical feedback cycle.

The purpose of this study was to investigate the learning effects of combining an interactive eBook with video feedback on nurses’ ECG competence, confidence and satisfaction.