Master degree nursing

Although the number of surgical procedures being performed has increased dramatically during the past 20 years,' nursing students today have fewer opportunities to care for surgical patients. Many surgical interventions take place in ambulatory care centers, and acute patients scheduled for coronary artery bypass surgery or transplantation often enter and leave the hospital through intensive care areas. Students observe in these clinical areas, but their practice in critical care settings is extremely limited. Students' exposure to patients scheduled for other surgical interventions also is limited because these patients undergo preoperative testing as outpatients and arrive at the facility only a few hours before the scheduled surgery. As a result, faculty members assigned to clinical teaching are becoming more creative in their use and development of clinical sites to educate students and prepare them for realistic roles in health care.

A study was conducted to evaluate the effects of using a perioperative clinical learning setting for a medical-surgical nursing course in a baccalaureate nursing program. The study compared knowledge among nursing students who experienced a five-week or eight-week perioperative clinical rotation with knowledge among students who experienced a five-week or eight-week rotation in orthopedic, oncology, transplantation, cardiovascular, or neurological units. Two hypotheses were posed.

* Students who experience a five- or eight-week perioperative clinical rotation will demonstrate greater knowledge of surgical patient care than students in other clinical rotations.

* Students who experience a five- or eight-week perioperative clinical rotation will seek perioperative employment more frequently than those who have not worked in these settings.

LITERATURE REVIEW

Development of educational courses for perioperative nursing is not new and has been well documented in a variety of journals during the past three decades. Much perioperative course development and implementation occurred in the 1980s as a result of Project Alpha, which was designed by AORN's National Committee on Education to encourage coordinated efforts in perioperative nursing education between AORN chapters and local schools of nursing. (2-6) A recent literature review revealed that a variety of perioperative courses, including undergraduate practicum experiences and domestic and international elective courses, have been developed.(7-11) Other courses focus on graduate or advanced education.(12) Although no articles discuss courses in associate degree programs, one article details a perioperative orientation program. (13)

No sources were found that discuss integrating perioperative clinical experiences for undergraduate students in every medical-surgical course in a nursing college curriculum, and no sources establish the equivalence of perioperative clinical learning experiences with other medical-surgical clinical learning experiences in a baccalaureate curriculum. In addition, many published articles describe the development of courses but omit a research base and evaluation of the courses' effectiveness.

METHOD

A repeated measure, experimental design that was reviewed and approved by the University of Florida Health Science Center Institutional Review Committee for the Protection of Human Subjects was used in this intervention study. Two cohorts of students who entered the nursing program in academic years 1998 and 1999 each were measured twice--at the end of their junior year and again at the end of their senior year. The independent variable was the clinical learning setting for a medical-surgical nursing course--either a perioperative or another medical-surgical setting. Dependent variables included knowledge of surgical patient care and employment in perioperative units after graduation.

SETTING. With more than 46,000 students, the University of Florida is the seventh largest university in the United States and the oldest, largest, and most comprehensive university in Florida. (14) It is among the nation's most academically diverse public universities (14) and includes a broad arts and sciences campus, an institute of agricultural sciences, and an academic health science center.

The College of Nursing, one of six professional colleges in the health science center, offers bachelor of science, master of science, and doctoral degrees in nursing. The undergraduate enrollment currently totals 670 students. Students in their freshman and sophomore years primarily take liberal arts and sciences classes and begin taking nursing courses in their junior year. Admission is very competitive. The university catalog states the middle 50% of admitted freshmen score 1190 to 1360 on the Scholastic Aptitude Test (SAT). The admitting high school grade point average (GPA) is 3.6 on a four-point scale.

For every space that was filled in the college of nursing in 1998 and 1999, five qualified students were rejected. After their first two years of university study, the overall GPAs were 3.42 for study participants entering the nursing program in the fall of 1998 and 3.48 for study participants entering the nursing program in 1999. Some preprofessional courses, including statistics, anatomy and physiology, chemistry, nutrition, sociology, growth and development, and psychology, have proven to predict success in the nursing program. Grade point averages in selected preprofessional courses were 3.48 for the students entering the nursing program in the fall of 1998 and 3.5 for students entering in 1999. Of students entering the nursing program, 103 of 138 in 1998 and 118 of 142 in 1999 attended the university all four years; others transferred to the university from community colleges.

The setting for the perioperative experience was a 367-bed community hospital where 1,945 surgical procedures took place during the three years of the study in the hours that baccalaureate students were in the perioperative setting. Surgeries performed during that time included coronary artery bypass grafts, aortic valve replacements, laparoscopic cholecystectomy, total joint replacements of the knee and hip, arthroscopy of the shoulder and knee, breast biopsy and mastectomy, lumbar and cervical laminectomy, cystoscopy, and other general surgeries. The patients were primarily adults.

Some nonperioperative clinical experiences took place in the same hospital. Others took place in a 576-bed academic health science center hospital a for-profit 275-bed community hospital, or a 217-bed Department of Veterans Affairs hospital, all of which are located within a five-mile radius of the city where the university is located.

SAMPLE. From a population of junior baccalaureate students entering nursing courses in fall 1998 (ie, cohort one, n = 138), 46 (33%) were randomly assigned to a clinical experience at the perioperafive site. Among junior baccalaureate nursing students entering in fall 1999 (ie, cohort two, n = 142), 51 (36%) were randomly assigned to the perioperative site. The two groups of students at the perioperative site were the experimental groups, and the remaining students in each class formed the control groups. In the experimental groups, 10 students (9.7%) were male, and the remaining students were female, reflecting the total class gender composition. All students were assigned the same textbooks, and students in each year were taught didactic content in large classes as a single unit by the same faculty members.

INTERVENTION. The perioperative student clinical experiences and other student medical-surgical clinical experiences were organized and conducted in the same way. Ten students and one faculty member were assigned to each clinical unit for a five- or eight-week rotation. Students in the first medical-surgical course (ie, in the fall semester) had eight-week rotations, and students in the second course (ie, in the spring semester) all had five-week rotations. The faculty member teaching the perioperative rotation was a master's degree-prepared, former perioperative nurse with perioperative experiences in a small, rural hospital in the southwestern United States and in a large metropolitan hospital in suburban Chicago. Instructors for the other clinical rotations all were members of the adult health nursing faculty.