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Please cite this article as: Zarei M.R, Bagheri S, Sedigh A, Ghasembandi M. The Effect of surgical preference card on the clinical self-efficacy
of operating room students. Nursing Practice Today. 2020; 7(3):183-189
Nursing Practice Today
Original Article
The effect of surgical preference card on the clinical self-efficacy of operating room
students
Mohammad Reza Zarei1, Sara Bagheri2, Amin Sedigh3, Mohammad Ghasembandi4*
1 Department of Operating Room, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Operating Room, Faculty of Paramedicine, Estahban University of Medical Sciences, Shiraz, Iran
3 Department of Operating Room, Faculty of Nursing and Midwifery, Khomein University of Medical Sciences, Khomein, Arak, Iran
4 Department of Operating Room, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Isfahan, Iran
ARTICLE INFO
ABSTRACT
Received 22 December 2019
Accepted 05 February 2020
Published 01 July 2020
Available online at:
http://npt.tums.ac.ir
Background & Aim: A wide range of clinical education of operating room students is done in
the operating room. One of the problems in students' clinical education is the lack of appropriate
learning tools in the operating room. The use of educational tools that improve students'
performance affects students' self-efficacy in the operating room. So, the purpose of this study
was to investigate the influence of the surgical preference card as an educational aid tool on the
self-efficacy of the operating room students.
Methods & Materials: This quasi-experimental study was carried out on 64 operating room
students of Isfahan University of Medical Sciences at AL-Zahra Hospital in the year 2018.
Participates were selected through convenience sampling and were divided into experimental
(n=32) and control (n=32) groups. The students in the intervention group performed surgical care
with using the surgical preference card. The data collection tool was a clinical self-efficacy
questionnaire. Data were analyzed with SPSS-21 software using the independent-t, paired t-test,
and chi-square test.
Results: The findings of this study showed that there was no significant difference between the
average self-efficacy score of the control group before and after the intervention (p>0.05). while
the average self-efficacy score of the experimental group increased significantly after the
intervention as compared with before the intervention (p <0.001).
Conclusion: The surgical preference card as an educational aid tool improved the students' self-
efficacy. Therefore, it is recommended to use this tool for the clinical education of other operating
room students.
Key words:
surgical preference card;
self-efficacy;
operating room;
students
Introduction
1
The operating room is a dynamic, high-
risk setting requiring effective teamwork to
provide optimal care for patients (1). The
teaching and learning process in the operating
room environment, then other clinical
environments because of variations in
surgical procedures and unpredictability of
surgeries is difficult (2). So, students should
coordinate their learning with their activities
in different clinical situations (3).
Clinical education is an essential part of
the operating room students' curriculum in
which students integrate knowledge, skills,
*Corresponding Author: Mohammad Ghasembandi, Postal Address:
Department of Operating Room, Faculty of Nursing and
Midwifery, Kashan University of Medical Sciences, Kashan,
attitudes, and philosophies of the profession
(2). Unfortunately, existing clinical education
does not equip the operating room students
with the required ability to acquire clinical
skills. Some reasons for this inadequacy are
the lack of coordination between the
theoretical and techniques contents, the lack
of cooperation surgeons and operating room
staff with students, and the lack of use of
educational aid tools in the operating room
(4).
Clinical self-efficacy is an important part
of clinical education and influences the
ability of students to take proper care of
patients (5). According to Bandura’s self-
efficacy theory, self-efficacy is defined as
believing in one’s own ability to do things
effectively in different situations (6).
Effective clinical training brings a sense of
self-efficacy and self-esteem in students.
Tehran University of Medical Sciences
Volume 7, No 3, July 2020, pp. 183-189
Isfahan, Iran. E-mail: m.ghasembandi@yahoo.com
DOI: https://doi.org/10.18502/npt.v7i3.3346
Surgical preference card-based education
184 Nursing Practice Today. 2020;7(3):183-189
Therefore, Students with high self-
efficacy can have a better performance in
difficult conditions (7). Studies show that the
self-efficacy of operating room students is at
a moderate level (8, 9). The use of learning
strategies and tools that students take part
actively in the learning process will increase
the students' self-efficacy (10).
Surgical Preference Card (SPC) is
considered an educational tool in the
operating room; Operating room nurses
know the technical requirements of surgical
procedures, and these nursing and surgical
routines are recorded as the Surgical
Preference Card (11). These cards contain
information, such as surgical position,
medications, and solutions needed for a
surgical field, equipment, supplies,
instrumentation, suture, type of surgical
dressing, and other instructions (figure1)
(12). With access to these cards, staff and
students can prepare the operating room and
predict surgical needs as a result; it improves
the operating room efficiency (13-14).
Although positive results have been
reported regarding the use of SPC in the
operating room environment, its impact on
has not been investigated. Therefore,
considering the importance of the training of
operating room students in clinical practice
and the need to pay more attention to their
clinical education, On the other hand, lack of
studies on the effect of clinical teaching
methods on self-efficacy of operating room
students, the present study was conducted to
investigate the effect of the SPC on the self-
efficacy of operating room students at Al-
Zahra Hospital in Isfahan.
clinical education on student self-efficacy
Figure 1. Simple of surgical preference card
M.R Zarei et al.
Methods
This quasi-experimental study was
carried out between two groups with a
pretest-posttest design at Al-Zahra Hospital,
in the year 2018. The study population in
this research included 83 operating room
students in total. Considering 95%
confidence coefficient, 80% Statistical
power, the minimum sample size was
selected 64 individuals (32 in each group).
Students were selected through convenience
sampling and divided into experimental
(n=32) and control (n=32) groups. Students
in both groups were matched based on the
academic year, grade point average, and
gender.
The Inclusion criteria included, samples
were selected from the second, third, and
fourth-year operating room students, the
student has passed internship theory courses
and participants should be selected from
undergraduate operating theatre students.
To measure the self-efficacy of students,
a questionnaire was used that was developed
by Sedigh et al., (2017) as a self-report
instrument (15). This tool consists of two
parts, the first section included demographic
characteristics (age, gender, Grade Point
Average, and academic year, Marital status,
habitat); and the second section contained 17
items with a 5-point Likert scale (1=strongly
disagree, to 5=strongly agree) to assess
clinical self-efficacy of students. The score
for the entire questionnaire ranged from 17
to 85, which to a better ranking, it turned
into percent. Therefore, Low self-efficacy
score from 0 to 33 percent, 34 to 67 percent
of mediocre self-efficacy, and high self-
efficacy was 68 to 100 percent.
Phrases in the questionnaire were about
perioperative care, preparing surgical
requisites (surgical set, equipment,
instrumentation, sutures, surgical dressing,
and other instructions) and the self-
confidence and independence of students in
the operating room. Based on the Sedigh et
al report, the reliability of the instrument
was calculated using the Cronbach alpha
coefficient, which was equal to 0.84 (15).
After a brief change in the questionnaire, its
validity and reliability were re-evaluated in
our study. Therefore, the validity of the
questionnaire was confirmed by 10 faculty
members of School of Nursing and
Midwifery of Isfahan, Iran and to confirm
the reliability of the questionnaire, 10
operating room students completed the
questionnaire before the intervention, and its
reliability was calculated using the Cronbach
alpha coefficient, which was equal to 0.81.
The intervention was conducted in two
stages. Students of the control group
attended apprenticeship in March 2018 and
students of the experimental group attended
apprenticeship in April 2018. The course of
apprenticeship lasted 5 days (Diagram1):
First stage: At this stage, the students of
the experimental and control groups without
any intervention and based on their
experiences of surgical procedure performed
surgical care. Post-surgical, self-efficacy
questionnaire was completed by the students
(pre-test).
Second stage: At this stage, the students
of the control group, as in the first stage, the
surgical care without using SPC and based
on their experiences performed. The
students of the experimental group in this
stage were familiarized with SPC. Then,
students with access to these cards
performed surgical care. Post-surgical, self-
efficacy questionnaire was completed by
students of the experimental and control
groups (post-test).
Data were analyzed using IBM SPSS
ver. 21.0 (IBM Corp., Armonk, NY, USA)
software. The normality of data was tested
using the Kolmogorov–Smirnov test. The
independent t-test was used to determine the
difference in the mean score of age, Grade
Point Average (GPA), and self-efficacy of
students in two groups. The chi-square test
was used to determine the difference in the
frequency distribution of gender, marital
status, and academic year between the two
groups. A paired t-test was used to
determine the difference in the mean scores
of self-efficacy in two groups before and
Nursing Practice Today. 2020;7(3):183-189 185
Surgical preference card-based education
186 Nursing Practice Today. 2020;7(3):183-189
after the intervention. The level of
significance was set at <0.05.
This study was approved by the Ethics
Committee of Isfahan University of Medical
Sciences, Iran (with the code of
IR.MUI.REC.1396.3.842). We explained the
objectives to the participants and received
their written consent for participation in the
study. The participants were further assured
confidential.
Results
The demographic characteristics of the
64 study participants are presented in Table
1. Based on the results of the independent t-
test, the chi-square test the 2 groups were
non-significantly different in terms of Age
(P=0.46, t=0.74), GPA (P=0.94, t=0.07);
gender (P= 0.52, X2=0.41), Marital status
(P=0.40, X2=0.72), residence (P=0.40,
X2=0.72) and academic year (P=0.08,
X2=0.96) (Table 1).
Based on paired t-test, between the
average self-efficacy scores of the control
group before and after the intervention, there
was no significant difference (p>0.05), while
the average self-efficacy scores of the
experimental group were significantly
higher after the intervention as compared to
before the intervention (p<0.001) (Table 2).
Based on independent t-test, the average
self-efficacy scores of the control and
experimental groups equaled 68.19 and
68.53 (out of 100), which before the
intervention indicating that statistically there
was no significant difference between the
mean scores of the two groups (P=0.90),
while after the intervention the average self-
efficacy scores of the control and
experimental groups recorded to be 67.93
and 77.33 respectively, which was
statistically significant (P<0.001). Based on
the independent t-test, the mean of changes
in self-efficacy scores in the experimental
group increased compared to the control
group, which was statistically significant
(p<0.001). (Table 3).
that their information would be kept
M.R Zarei et al.
Nursing Practice Today. 2020;7(3):183-189 187
Table 1. Demographic and qualitative characteristics of students in two groups
P-value
Groups
Outcomes
Control
n(%)/mean±SD
Experimental
n(%)/mean±SD
Gender
X2=0.41, P= 0.52
27 (84.4)
25 (78.1)
Female
5 (15.6)
7 (21.9)
Male
Marital status
X2=0.72, P= 0.40
22 (68/8)
25 (78/1)
Single
10 (31/2)
7 (21/9)
Married
residence
X2=0.72, P= 0.40
7 (21/9)
10 (31/2)
Dorm
25 (78/1)
22 (68/8)
Non-dorm
Academic year
X2=0.96, P=0 .08
14 (43/8)
13 (40/6)
First
7 (21/9)
7 (21/9)
Second
11 (34/3)
12 (37/5)
Third
t=0.07, P=0.94
17.09 ±1.08
17.07±1.40
Grade point average
t=0.74, P= 0.46
21.41±1.39
21.81±2.76
Age
Table 2. Comparison of the average self-efficacy scores of students (out of 100) between before and after intervention in each
group
Table 3. Comparison of average self-efficacy scores (out of 100) and difference scores before and after between the two groups
before and after the intervention
Independent t-tests
Intervention group
mean±SD
Control group
mean±SD
Self-Efficacy
p
t
P= 0.90
t= 0.13
68.53±11.11
68.19 ±10.71
Before
P<0.001
t= 3.70
77.33±10.75
67.93±9.55
After
P<0.001
t=5.47
8.80±1.2
-0.26±1.03
Before-After Difference
Discussion
The findings of this study indicated that
the use of SPC improved student self-
efficacy; that way the mean self-efficacy
score in the experimental group significantly
increased after the use of cards compared to
the control group.
A review of the literature, no studies
were found on the impact of the SPC on
students' self-efficacy, but educational
methods similar to SPC have been studied
on students' self-efficacy.
In a similar study performed by
Habibzadeh et al, to examine the effect of
evidence-based education on the self-
efficacy of nursing students, the mean score
of students' self-efficacy in the experimental
group increased compared to the control
group (16). In another study by Abdal et al,
to examine the Clinical self-efficacy in
senior nursing students, the use of logbooks
in clinical settings was introduced as a tool
for improving the self-efficacy of students
(7). The findings of Habibzadeh and Abdel's
studies were in line with our results and
indicated the use of educational guides in
clinical settings can improve students' self-
efficacy. Nowadays, due to the abundant
emphasis on resource management, cost
control, the effectiveness of patient care,
quality improvement, and responsibility, the
use of Strategies that can improve patient
care seems to be essential. These
frameworks and Strategies can be
formulated as educational guidelines (16).
The studies that contradict the results
with our results are the study of Tuttle and
cox. In a study by Tuttle et al., to investigate
the impact of simulated training programs
on clinical self-efficacy of nursing students,
the results showed that using simulated
Paired t-test
After
mean±SD
Before
mean±SD
Characteristics
p
t
P= 0.80
t= 0.25
67.93±9.55
68.19 ±10.71
Control
Self-Efficacy
P<0.001
t= 6.80
77.33±10.75
68.53±11.11
Intervention
Surgical preference card-based education
188 Nursing Practice Today. 2020;7(3):183-189
training programs increased the students'
self-efficacy in the experimental group
compared to the control group but this
increase was not statistically significant (10).
In another study by cox, et al; which
aims was to compare three training methods
(established curriculum (readings only),
Faculty-led curriculum, and Web-based
curriculum) on self-efficacy of medical
students. The results of this study showed
that using a web-based curriculum and
Faculty-led curriculum compared to the
established curriculum (readings only)
significantly increased students' self-efficacy
inpatient care (17). The results of this study
were in contrast to the results of our study.
The reason for this discrepancy may be due
to differences in the samples studied or the
use of training programs with an appropriate
approach to clinical guidelines. Overall,
clinical instructors by designing the surgical
preference card can provide an opportunity
for improving students' self-efficacy.
Students with access to specific Card to each
surgery learn the essentials of that surgery
and directly carry out surgical cares, As a
result, improve their self-efficacy.
Limitations of the study
The main limitation of this study was the
non-random allocation of samples in two
experimental and control groups. Due to the
problems that exist in the educational
planning of college, it was impossible to
actually allocate samples randomly. In
response to this limitation, the samples were
matched in both groups in the academic
year, gender and type of surgical procedure.
Conclusion
The use of the surgical preference card
for the training of operating room students
improves their self-efficacy. The findings of
this study showed that there wasn't a
significant difference between the average
student self-efficacy scores of the two
groups before using the SPC while the
average student self-efficacy scores in the
experimental group significantly increased
after using the SPC as compared with the
control group. Therefore, it is recommended
that operating room students use SPC as an
educational aid tool in preparing the
perioperative requirements and cares.
Acknowledgments
This article extracted from a master’s
thesis completed in the School of nursing
and midwifery, Isfahan University of
medical sciences, Isfahan, Iran. We would
like to thank the staff of the operating room
of Al-Zahra Hospital, Isfahan, Iran, and all
students who participated in this study.
Conflicts of interest
There are no conflicts of interest.
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