During an outreach day in the A&E department, while also on call for any acute stroke cases, I was tasked with performing an electrocardiogram (ECG) on a 67-year-old male patient to assess the hearts electrical activity, and I saw this as an opportunity to teach and supervise a new healthcare assistant (HCA) with no prior experience in ECGs. My goal was to enhance the HCA’s understanding of ECG placement and interpretation while emphasising person-centred care.

I began by demonstrating the ECG procedure by showing her where to locate intercostal spaces for the chest leads and limb leads. To aid us I used a printed chest diagram. I explained what different ECG readings might indicate, such as a normal sinus rhythm and atrial. I demonstrated how to position the patient semi-recumbently for an accurate reading, while also highlighting the importance of consent and clear communication.

I shared a helpful mnemonic for the limb lead colours: “Ride your green bike,” where “ride” signifies the red lead for the right arm, “your” is the yellow lead for the left arm, “green” means the green lead for the left leg, and “bike” represents black lead for the right leg. I encouraged the HCA to take the lead role while I observed. By taking the initiative to prepare the HCA and delegating her responsibilities, I contributed to the effective coordination of the patient’s care. I stepped back to observe my colleague as she performed the ECG on the patient.

Before starting, we introduced ourselves to the patient. The HCA ensured the patient felt comfortable, explained the ECG in simple terms and gained the patients consent. The patient expressed his anxiety about being in the emergency department, so she prioritised his concerns. This thoughtful, holistic approach was creditable and I praised her afterwards, as it was vital for improving the patient’s overall care experience. She utilised calming communication techniques and maintained eye contact throughout.

During the ECG procedure we noticed that shaving was not needed. Although shaving can be necessary for better electrode contact, it was unnecessary in this case. The HCA prepared the ECG machine, ensuring all leads were functional. I noticed how she prioritised the patient’s comfort and her emphasis of staying still to prevent misreading’s which I complimented after the procedure was completed.

Next, she placed the six chest leads: V1 in the 4th intercostal space to the right of the sternum, V2 to the left of the sternum, V3 midway between V2 and V4, V4 in the 5th intercostal space along the midclavicular line, V5 at the same level in the left anterior axillary line, and V6 aligned with V5 in the left midaxillary line. Although she faced some challenges with lead placements, I gave her reassurance and encouraged her to use the diagram as a reference. Subsequently, I observed that she placed the leads accurately.

She ensured the leads for the ECG machine were properly connected before recording the ECG. We reviewed the results together and she noted that the ECG showed a normal sinus rhythm for this patient. The HCA removed the electrodes from the patient, made him comfortable, thanked him for his cooperation and documented the patient’s details on the ECG graph. We handed the reading to my nurse supervisor for further verification, where she confirmed it to be accurate. I was very impressed by the HCAs quickness and eagerness to learn a difficult procedure and how well she executed it.

In my feedback, I encouraged the HCA to ask reflective and open-ended questions to the patient such as “How are you feeling?”. I also suggested that she could strengthen and consolidate her understanding of chest lead placement and how each lead contributes to the ECG reading. I tried my best to maintain a supportive learning environment throughout the teaching session and supervision. The HCA expressed that the mnemonic I shared and the chest diagram for teaching the correct lead placements was particularly helpful. This session was valuable as it highlighted the importance of helping to teach junior colleagues essential clinical skills such as ECG. It has also taught me that granting autonomy to junior colleagues helps to foster their confidence in performing these procedures.