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cardiac auscultation, cognitive load, nurse practitioners, nursing education, psychoacoustics



  1. Cyphers, Natalie A. PhD, RN
  2. Mest, Carol G. PhD, RN, ANP-BC
  3. Doyle-Tadduni, Mary Elizabeth PhD, MBA, RN


Background: Assessment is a vital role of all nurses, yet cardiac murmur identification remains difficult for students. Cardiac auscultation is a technical, not intellectual, skill, and a psychoacoustic approach to learning is recommended. A psychoacoustic approach involves repetition of cardiac sounds to facilitate auditory perceptual learning.


Purpose: The purpose of this study was to determine the effectiveness of a psychoacoustic learning modality for identification of cardiac murmurs by nurse practitioner (NP) students.


Methods: A repeated-measures design was used. Following a pretest, NP students listened to repetitions of heart sounds, then took a posttest. Students were instructed to listen to the heart sounds weekly, then given posttests at 1 and 3 months.


Results: All posttest scores were higher than pretest scores; no significant difference in scores was noted between posttests.


Conclusions: Psychoacoustic learning may improve cardiac assessment. Further research is recommended with prelicensure nursing and NP students.