Students experiences of theatre allocations.
Abstract: The aim of this literature review was to explore Irish student nurses' experiences of theatre allocations as limited research has been conducted in this area.

KEYWORDS Student nurse / Experience / Perioperative placement
Article Type: Report
Subject: Nursing students (Training)
Nursing students (Vocational guidance)
Nursing students (Research)
Surgical nursing (Practice)
Surgical nursing (Research)
Career choice (Research)
Experiential learning (Influence)
Experiential learning (Research)
Authors: Lydon, Christina
Burke, Eimear
Pub Date: 02/01/2012
Publication: Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2012 Association for Perioperative Practice ISSN: 1750-4589
Issue: Date: Feb, 2012 Source Volume: 22 Source Issue: 2
Topic: Event Code: 280 Personnel administration; 310 Science & research; 200 Management dynamics
Geographic: Geographic Scope: Ireland Geographic Code: 4EUIR Ireland
Accession Number: 283274418
Full Text: Hind and Wicker (2006) describe the role of the theatre nurse as purposeful, dynamic and rewarding. Theatre nurses require a multitude of skills including a broad knowledge base, adaptability and flexibility (Rothrock 2003). Woodhead and Wicker (2005) suggest that the theatre nurse provides a safe, efficient and caring environment for patients. However, Barker (1996) reported a threat to the existence of theatre nurses due to difficulties in recruitment and retention in this specialist area. Some authors suggest that these difficulties are due to an ageing nursing workforce (Holmes 2004) whereas others believe they stem from reduced student nurse placements in theatre departments (Ward & Saylor 2002, Hughes 2006). This is echoed by McCausland (2002) who maintains that lack of theatre experience for student nurses contributes to the recruitment and retention predicament.

In Ireland all undergraduate nursing students undertake a four year degree programme. Students are allocated and assessed by a preceptor in clinical practice. In addition, students have access to a clinical placement co-ordinator (CPC) who provides further support. The Irish Nursing Board (An Bord Altranais 2005) stipulates that all undergraduate student nurses should receive a minimum of two weeks clinical placement in theatre. In the UK however student nurses chose the specialist placements they wish to pursue during their training. On a national and international basis undergraduate nursing students receive varying placements in the operating theatre. It is important to review this and to explore if it impacts whether students selecting theatre as a suitable post when they qualify.

Theatre learning environment and future recruitment

Students worry about clinical placements due to feelings of inadequacy and fears of making mistakes (Pagana 1988). Clinical placements are stressful (Oermann 1998) but Landers (1996) reported that nursing students were particularly nervous and apprehensive about theatre placements. If students experience high levels of stress on clinical placement, this inhibits their learning (Oermann & Standfest 1997, Timmins & Kaliszer 2002). Levett-Jones and Lathlean (2007) reported lack of acceptance and limited integration into the clinical setting as sources of stress and anxiety for nursing students. It is obvious that stress is a factor that impedes learning and this must be considered for all students on theatre placements, due to the unfamiliar and demanding nature of the theatre setting.

A positive clinical environment facilitates learning (Hughes 2006). Bjork (1995) suggested that the theatre learning environment provided students with unique experiences and enabled them to develop nursing skills. Neascu (2006) recommended good communication skills and a welcoming atmosphere as essential elements of an effective theatre learning environment. Preceptors are important in creating supportive theatre learning environments (Burns & Paterson 2005, Warne et al 2010). Preceptors can create a sense of belongingness and motivate students to participate in theatre learning opportunities (Levett-Jones & Lathlean 2007). Neacsu (2006) highlighted the importance of preceptors to students in the perioperative setting, but also reported that theatre staff shortages negatively impacted on students' perioperative experiences. McCausland (2002) reported similar findings, as students reported that having a different preceptor every day impinged on their learning experience.

Hughes (2006) highlighted aspects of theatre placement that students enjoyed and disliked. Students enjoyed their theatre placement as it was interesting; staff were approachable and were willing to teach them. In particular, the students enjoyed the scrub role and the recovery areas of theatre. Some students reported some negative aspects regarding theatre placement including dissatisfaction with standing around for long periods; they disliked the lack of patient contact and found the day long. It must be acknowledged that the theatre environment may not be suitable for everyone (Hughes, 2006). Hughes (2006) and McCausland (2002) both found that overall students were positive about their theatre placements. They reported that the experience would enhance their practice in other nursing settings and that the majority of the students indicated that they would be interested in theatre nursing as a future career choice. In contrast, Walker (1999) reported that, although students were positive about their theatre placement, the majority were undecided if they would be interested in a career in theatre nursing.

Lack of recruitment and retention to the speciality of theatre nursing inhibits the existence of theatre nurses (Jarman 1989, Montgomery 1997). However, Marsland and Hickey (2003) highlighted that positive clinical experiences can enhance student nurses' learning and impact on their future career choices. Furthermore, Greggs-McQuilkin (2003) identified that clinical experiences influence the future career choice of student nurses. Therefore, the creation of positive experiences for student nurses in the perioperative environment could contribute to the future recruitment and retention of theatre nurses (McCausland 2002). Thus, it is important to explore undergraduate student nurses' experiences of theatre allocations and to plan for future retention of staff in this specialised area.

Method

The aim of this descriptive survey was to explore Irish undergraduate general student nurses' experience of theatre allocations.

Sample

In Ireland all undergraduate nursing students undertake a four year degree programme during which they complete a minimum two weeks of theatre placement. This study took place in Ireland in three different nursing schools, each attached to its own affiliated healthcare institution where the students go on clinical placement. A convenient target sample of 175 fourth year undergraduate general nursing students, from three teaching hospitals in Ireland were invited to participate in the study.

Data collection

Data were collected by administering a questionnaire. A similar study was undertaken by Hughes (2006) and permission was obtained to use the questionnaire in the current study. The original questionnaire contained 25 questions and a pilot study was conducted with ten students, following which the questionnaire was modified. In the current study the researchers refined the original questionnaire as the questions were open ended and qualitative in nature which would have made statistical analysis difficult. In order to capture the experiences of Irish student nurses the researchers amended the questionnaire by reviewing the literature and formulating the questionnaire in a more quantitative style. The redesigned questionnaire comprised 22 questions: seven likert scale questions, two closed questions and thirteen tick box questions. The questions consisted of knowledge, attitudes and opinion responses. In addition, the students were permitted to provide any additional information that they considered important and relevant to the study.

Content validity was established by requesting a panel of experts (lecturers, clinical placement co-ordinators and theatre managers) to review the questionnaire and determine if it measured the concept under investigation. In addition the questionnaire was piloted with 18 undergraduate nursing students who were not in the main study. Following the pilot study adjustments were made to the questionnaire.

Ethics

Ethical approval was sought and obtained from the local ethics committee. The researchers met the students at the end of class, informed them about the study and invited them to participate. A written participant information leaflet was provided for each student describing the study in detail. The students were invited to take a questionnaire if they wished to participate. Reminder emails were sent regarding the study. In an effort to protect anonymity and confidentiality no personal identifying details (like name of the participants) were requested and the completed questionnaires were returned anonymously to the researchers.

Results

This study was conducted in three sites in Ireland and achieved a 72% response rate. The students' theatre placements ranged from two to four weeks (Table 1).

Theatre experience

The students were mostly positive about their theatre placement: 63.7% (n=79) rated their theatre placement as very good or good, 25.8% (n=32) rated it as fair and 10.5% (n=13) rated it as poor or very poor. In particular, the students were very positive about the theatre staff: 63.5% (n=80) reported that staff were welcoming and approachable, 73% (n=92) reported that staff were eager to teach them and 42% (n=53) reported that staff were student oriented. In addition the students were positive as they gained an understanding of intra-operative care: they gained valuable experience, they enjoyed getting to scrub in and they identified theatre as an interesting placement. The results revealed that the areas of theatre that the students enjoyed the most included recovery, scrub role, anaesthetics and general theatre. The students cited a number of reasons why they enjoyed these areas of theatre including: they could see what was going on (70.6%), the theatre nurses taught them (66.7%), the surgeons taught them (63.5%), they were allowed participate (60.3%) and they felt involved (54.8%).

However, the students also identified some aspects of their theatre placement that they disliked including: reduced patient contact (56.3%), feeling in the way (43.7%), standing around for long periods (41.3%), being unable to participate (26.2%) and feeling bored (22.2%). In addition, a minority of students reported that some of the theatre staff were not suitable preceptors and were not interested in teaching students. Some of the students highlighted that they were only assigned to one theatre for the duration of their theatre placement and that this impacted on or limited their experience.

Theatre preparation

The students were asked how prepared they were for their theatre placement. Only 23.2% of the students felt very well or well prepared, 42.4% felt fairly prepared and 34.4% felt poorly or very poorly prepared for their theatre placement. The students felt that college staff could have prepared them better for their theatre placement by: familiarising them with the surgical instruments, providing information on the theatre nurse's role, practising the scrub technique and introducing them to theatre care plans and drugs.

Teaching sessions

Fifty two percent of the students received teaching sessions whilst on theatre placement. The students were taught about recovery care, the scrub role, airway management, care of the unconscious patient and anaesthetics. Overall the students were positive about the teaching sessions as the majority of the students (43.1%) reported that they were very good or good.

Staff support (preceptors/clinical placement co-ordinators)

The students placed value on the support they received from their preceptors whilst on theatre placement. The majority of the students (61%) reported that their preceptor was very supportive or supportive, 23.4% reported that their preceptor was somewhat supportive and 15.6% reported that their preceptor was unsupportive or very unsupportive. The preceptors were considered supportive by the students when they: orientated them to theatre, provided advice, assisted them in achieving skills and completing documentation, explained theatre instruments, and when they were approachable. The students felt unsupported when their preceptor was not familiar with their theatre clinical competency requirements and when they did not get the opportunity to work with their preceptor due to scheduling issues. It is concerning to note that 58.3% of the students in site B and 14.2% of the students in site C reported that they had no assigned preceptor whilst on theatre placement. However, the majority of the students (93.5%) had access to a clinical placement co-ordinator (CPC) whilst on theatre placement. Over 50% of the students indicated that their CPC was very supportive or supportive, 34% indicated their CPC was somewhat supportive, and 9% indicated their CPC was unsupportive or very unsupportive. The students valued being orientated to the theatre environment and the support provided by the CPCs. In addition, the students were appreciative when the CPCs called to see them and provided them with information pertaining to the theatre setting. However, some students felt that the CPCs could have provided them with additional advice (48%), supported their skills development further (19%) and provided further orientation to the theatre setting (27%).

Factors that facilitated/impeded learning

The students identified that supportive motivating staff, helpful preceptors and hands on experience were key factors that facilitated their learning during theatre placement. In addition, the students reported that teaching provided by members of the multidisciplinary team (75%) and exposure to an array of procedures and experiences (25%) also assisted their learning. The students also reported a number of issues which impeded their learning in the theatre setting. These included: fear of making a mistake (58%), limited patient care experiences (37%), and stress due to the unfamiliar nature of the theatre environment (33%). Furthermore, the students reported that unwelcoming staff (42%), not having a preceptor (29%) and the short duration of their theatre placement (29%) also impeded their learning.

Value of the theatre placement

The students were asked if they found their theatre placement a valuable experience. As can be seen in Figure 1 the majority of the students (69%) strongly agreed or agreed with this.

Despite valuing the theatre experience the majority of the students (56%) strongly disagreed, or disagreed that theatre would be a suitable first post upon qualifying. Further details are provided in Figure 2.

Discussion

In this study all the students were allocated a minimum of two weeks theatre placement. The majority of the students rated their theatre placement as either very good or good and the majority of students agreed that theatre was a valuable placement. These findings support those in the literature: Walker (1999) reported that students identified theatre was an important placement and Hughes (2006) discovered that students regarded theatre placement as a valuable experience. In addition, Sigsby (2003) and Neascu (2006) highlighted the benefits of a theatre placement as the skills and knowledge acquired could be used to enhance patient care in other clinical settings.

In particular, the students enjoyed anesthetics, the scrub role, and recovery aspects of theatre. Similarly Hughes (2006) found that students enjoyed the recovery role in theatre as they were able to participate and felt part of the team. However, an issue for the students in this study was the lack of patient contact. Interestingly some of the students highlighted their dislike of theatre reception which seems unusual considering there is good opportunity for patient contact in this area. Walker (1999) also identified that lack of patient contact was a negative aspect of theatre for students. Perhaps this is due to the uniqueness of the theatre environment in contrast to the general ward settings with which the students would be more familiar.

It is apparent from this study and from the literature (Neascu 2006, Hughes 2006) that helpful staff characteristics, such as willingness to teach students, being friendly and approachable, positively influenced students' theatre experiences. Henderson et al (2010) highlighted the importance of a positive relationship between the preceptor and student. In addition, Silen-Lipponen et al (2004) emphasised the importance of preceptors and their positive contributions to student learning experiences. In the current study the students placed value on the support they received from their preceptors whilst on theatre placement. The sense of belonging was clearly important to the students and greatly influenced their learning in the theatre environment. However, it was a concerning finding of this study that a large percentage of the students had no assigned preceptor. The students who had no preceptor missed valuable learning experiences and support in the theatre setting. Furthermore, the students highlighted that lack of continuity with an assigned preceptor negatively impacted on their learning experience.

On a more favourable note the majority of the students had access to a clinical placement coordinator who was seen as valuable theatre support mechanism. Lambert and Glacken (2004) and Lambert (2005) highlighted the significance of support structures in the clinical learning environment as well the importance role of the clinical placement coordinator. Furthermore, McNamara (2007) identified the clinical placement coordinator as an important support for student nurses in the clinical learning environment to facilitate learning.

Students were asked about factors that facilitated and impeded their learning during theatre placement. The results revealed that a supportive preceptor enhanced learning whereas an unsupportive preceptor impeded learning. Henderson et al (2010) highlighted the importance of the clinical environment for the development of knowledge and skills and identified that positive interactions with staff were imperative for learning and skill acquisition. In the current study, supportive theatre staff and hands on experience were highlighted by the students as factors which facilitated their learning. This supports Neascu (2006) who reported staff support as an important facilitator of learning. On the other hand fear of making a mistake and stress due to unfamiliarity of the theatre environment were identified as barriers to the students learning. It is widely recognised in the literature that increased levels of stress negatively impact on student learning (Timmins & Kaliszer 2002, Levett-Jones & Lathlean 2007). Interestingly the students also reported that the short duration of their theatre placement impeded their learning.

The achievement of a nursing degree provides the basis for specialisation in nursing (Rognstad et al 2004). There is agreement in the literature that positive clinical experiences influence the future career choice of student nurses (Greggs-McQuilkin 2003, Marsland & Hickey 2003, Fenush & Hupcey 2008). White (1999) identified that students had negative views of theatre nursing due to their limited experience in this area. Mathews (1995) highlighted that reduced patient contact and fragmented care dissuaded student nurses from pursuing theatre nursing post qualifying.

In this study, the majority of the students disagreed that theatre would be a suitable first post when they qualify. This is not surprising as the students were on a general programme and probably recognised the need to gain clinical experience prior to specialising. This is echoed by Palese et al (2007) who identified that putting theory into practice, developing professional skills and providing direct patient care were all factors that influenced newly qualified nurses' first career choice.

Limitations

A convenient target sample was chosen for the study which limits generalisation of the results. Data were collected using a questionnaire which permitted access to a large population. However there are also a number of issues with self report questionnaires including that participants do not have the opportunity to seek clarification and that participants may respond in a socially desirable manner. In addition the lack of reliability and validity testing of the data collection tool is a limitation of this study.

Conclusion

The purpose of this study was to explore fourth year undergraduate general student nurses' experience of theatre allocations. The majority of the students agreed that theatre was a valuable experience and they enjoyed the teaching sessions they received. The students highlighted the importance of clinical staff in welcoming and orientating them to the theatre environment. In particular, preceptors and CPCs were identified as important support structures. However at times the students reported that they were bored, they felt in the way and they missed patient contact. The students felt that they could have been better prepared by the college teaching staff for their theatre placement and the majority disagreed that theatre was a suitable post upon qualifying. Educationalists and clinical staff must work together to ensure that students are supported in all clinical areas, especially in challenging specialities like theatre. Improving students' theatre experience may attract them to specialise in this area in their future careers.

References

An Bord Altranais 2005 Requirements and standards for nurse registration education programmes (3rd ed) Dublin, An Bord Altranais

Barker M 1996 Should there be a nursing presence in the operating theatre? British Journal of Nursing 5 (18) 1134-7

Bjork TI 1995 Neglected conflicts in the discipline of nursing: perceptions of the importance and value of practical skills Journal of Advanced Nursing 22 (1) 6-12

Burns I, Paterson IM 2005 Clinical practice and placement support: Supporting learning in practice Nurse Education in Practice 5 (1) 3-9

Fenush JK, Hupcey JE 2008 An investigation of clinical unit choices by graduating Baccalaureate nursing students Journal of Professional Nursing 24 (2) 90-5

Greggs-McQuilkin D 2003 The speciality of medical-surgical nursing: the solid rock, not the stepping stone Medsurg Nursing 12 (1)101-5

Henderson A, Twentyman M, Eaton E et al 2010 Creating supportive clinical learning environments:an intervention study Journal of Clinical Nursing 19 (1-2) 177-82

Hind M, Wicker P 2006 Principles of perioperative practice London, Churchill Livingstone

Holmes SP 2004 Implementing a perioperative nursing elective in a Baccalaureate curriculum AORN Journal 80 (5) 902-10

Hughes S 2006 Evaluating operating theatre experience: Student nurses in South East Wales Journal of Perioperative Practice 16 (6) 290-8

Jarman B 1989 Theatre experience: a useful tool for recruitment? Nursing Standard 3 (40) 36-8

Lambert V, Glacken M 2004 Clinical suppot roles: a review of literature Nurse Education in Practice 4 (3) 177-83

Lambert V 2005 Clinical education facilitators: a literature review Journal of Clinical Nursing 14 (6) 664-73

Landers M 1996 Student nurses' appraisal of their theatre experience Nursing Review 14 (3&4) 13-5

Levett-Jones T, Lathlean J 2007 Belongingness: A prerequisite for nursing students' clinical learning Nurse Education in Practice 8 (2) 103-11

Mathews EA 1995 Where have all the student nurses gone? British Journal of Theatre Nursing 5 (9)18-21

Marsland L, Hickey G 2003 Planning a pathway in nursing: Do course experiences influence job plans? Nurse Education Today 23 (3) 226-35

McCausland LL 2002 A precepted perioperative elective for Baccalaureate nursing students AORN Journal 76 (6) 1032-9

McNamara S 2007 Illuminating the essential elements of the role of the clinical plaement co-ordinator: a phenomenlogical inquiry Journal of Clinical Nursing 16 (8) 1516-24

Montgomery A 1997 Recruiting: the ever-present problem British Journal of Theatre Nursing 7 (9) 14-8

Neacsu A 2006 Exploring student nurses' experiences of learning and skill acquisition in perioperative care Advanced Perioperative Care 2 (4) 167-75

Oermann MH 1998 Differences in clinical experiences of ADN and BSN students Journal of Nursing Education 37 (5) 197-201

Oermann MH, Standfest KM 1997 Differences in stress and challenge in clinical practice among ADN and BSN students in varying clinical courses Journal of Nursing Education 36 (5) 228-33

Pagana KD 1988 Stresses and threats reported by baccalaureate students in relation to an initial clinical experience Journal of Nursing Education 27 (9) 418-24

Palese A, Tosatto D, Borghi G, Mesaglio M 2007 Factors influencing the choice of the first ward: comparison between newly qualified nurses and managers Journal of Nursing Management 15 (1) 59-63

Rognstad MK, Aasland O, Granum V 2004 How do nursing students regard their future career? Career preferences in the post-modern society Nurse Education Today 24 (7) 493-500

Rothrock JC 2003 Alexander's care of the patient in surgery (12th ed) London, Mosby

Sigsby LM 2003 Avoiding problems when establishing a student learning experience in perioperative nursing Nurse Educator 28 (1) 1-2

Silen-Lipponen M, Tossavainen K, Turunen H, Smith A 2004 Learning about teamwork in operating room clinical placement British Journal of Nursing 13 (5) 224-54

Timmins F, Kaliszer M 2002 Aspects of nurse education programmes that frequently cause stress to nursing students - fact finding sample survey Nurse Education Today 22 (3) 203-11

Walker L 1999 'We want an allocation in theatre!' Diploma level nursing students have their say British Journal of Theatre Nursing 9 (1) 22-8

Ward RP, Saylor C 2002 Nursing school curricula and hospital based training programs AORN Journal 76 (6) 1022-31

Warne T, Johansson U, Papastavrou E et al 2010 An exploration of the clinical learning experience of nursing students in nine European countries Nurse Education Today 30 (8) 809-15

White J 1999 The impact of clinical experiences during preregistration diploma in nursing courses on initial career choice Journal of Nursing Management 7 (3) 157-65

Woodhead K, Wicker P 2005 A textbook of perioperative care, London, Churchill Livingstone

Members can search all issues of the BJPN/JPP published since 1998 and download articles free of charge at www.afpp.org.uk.

Access is also available to non-members who pay a small fee for each article download.

Provenance and Peer review: Commissioned; Peer reviewed; Accepted for publication October 2011.

About the authors

Christina Lydon

RGN, BSC (Hons), PGDip Perioperative Nursing, PGDip Public Management, MA Healthcare Management, MSc Nursing & Midwifery Education

Acting Theatre Clinical Nurse Manager, Theatre Department, Mayo General Hospital, Ireland

Eimear Burke

RGN, Dip General Nursing, Higher Dip Applied Science, BSc, MSc Nursing & Midwifery Education

University Teacher, School of Nursing and Midwifery, National University of Ireland, Galway, Ireland

No competing interests declared

Correspondence address: Eimear Burke, Aras Moyola, School of Nursing & Midwifery, National University of Ireland, Galway, Ireland. Email: e.burke@nuigalway.ie
Theatre placement duration in  Number of  % of students

weeks                           students        (n=124)

2                                     60          48.4%
3                                     57            46%
4                                      7           5.6%
Total                                124           100%

Table 1 Duration of theatre placement


Would you agree that your theatre placement was a  Percent
valuable experience

Strongly Agree                                          23
Agree                                                   46
Neither Agree Nor disagree                            19.8
Disagree                                               6.3
Strongly Disagree                                      4.8

Figure 1 Value of the theatre placement

Note: Table made from bar graph.


Theatre is a suitable first post when you qualify  percent

Strongly Agree                                         2.4
Agree                                                 17.5
Neither Agree nor Disagree                            23.8
Disagree                                              32.5
Strongly Disagree                                     23.8

Figure 2 Theatre is a suitable qualifying post

Note: Table made from bar graph.
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.