The study aimed to assess the level of knowledge of nursing students regarding preoperative nursing care and determine the most influencing demographic variables.
Nursing students must acquire the necessary competence during their nursing education to perform safely their tasks (16). In the present study, nursing students have adequate knowledge regarding preoperative nursing care. Nursing students are educated on preoperative nursing care in their courses of Fundamentals of Nursing and Medical Surgical Nursing. Moreover, the clinical practice of students in surgical units could increase their level of knowledge. Durmaz Edeer et al.(3) reported that clinical practice can improve learning abilities. However, comparing the preoperative care competence of nursing students is difficult because of relatively limited studies in this area. Research in the literature examined different samples of nurses and different topics as preoperative patient education. In this regard, future research in this area is important.
Since the International Council of Nurses was established in 1899, ethical issues have traditionally gained focus in the nursing profession (17). The nursing profession’s code of ethics enables nurses to offer ethical, competent and safe care (18). The American Nurses Association encourages ethical commitment in all interactions, even among nursing students (19). As soon as a student enters a university or a place of employment, the process of learning professional values begins (20). In the current study, the highest mean score was recorded for ability to fulfil legal responsibilities and adherence to ethical principles. The highest mean score in the scale items ensured that the confidentiality and security of written, verbal and electronic patient information are in line with ethical principles. This result could be related to academic instructions given to the students at the university and to the importance of code of ethics in hospitals. In Jordan, the code of ethics was published in 2013 not for heath sector alone but for all public sectors. Rahmani et al. (21) reported good moral awareness among nursing students. Khamis Mohamed et al. (22) found that a professional ethics dimension had the highest mean score rated by nursing students. Bijani et al. (23) found that the adherence to ethical codes was higher among nursing students than among practicing nurses. Other researchers found that students had a moderate level of ethical awareness (24, 25).
The results on the confidentiality and security of patient information are similar to the reports of Alnajjar and Abou Hashish (24), who found that nursing students understood that violating patients’ privacy or confidentiality is unethical. Another work conducted by Poorchangizi et al. (20) stated that the caring category, which included ‘protecting the confidentiality of the patient’ and ‘protecting the patient's right to privacy’, received the highest mean scores for professional values. Bijani et al. (23) found that the ethical rule that deals with ‘respecting the client/patients' privacy when performing nursing interventions’ received the highest average score from nursing students and practicing nurses. By contrast, Sinclair et al. (26) found that the patient's right to confidentiality, privacy, dignity or respect was violated by more than two thirds of respondents.
Research is a scientific process that collects and examines data to improve our comprehension of a certain issue or topic (27). Nursing research aims to obtain information involving the creation and comprehension of a problem through observation or any other approach (28). Starting research during the academic year is recommended so nursing students should be knowledgeable about research and should adopt a more positive attitude toward it (29). The International Council of Nurses underlined the significance of incorporating research into nursing students’ education (30). In the present study, the lowest mean score was recorded for the research and professional development dimension. This could be related to lack of students’ participation in scientific research. Moreover, the majority of nursing students in this study were in the first and second year of studying, which means that they did not take the nursing research course. In addition, this result could be related to the lack of attendance for seminars, conferences and training courses in nursing research and the lack of research grants or funding in developing countries. A previous study reported that researchers in developing countries had low funding, high research costs and very low rate grants (31).
Hussain and Afzal(32) found that the overall knowledge about research among nursing students is low. By contrast, Bamila N et al. (29) found that more than half of nursing students had adequate level of knowledge in nursing research. Moreover, Grande et al.(33) found that most nursing students were aware with the nursing research. Hanibernia S(28) found that majority of nursing students had good knowledge in nursing research.
This preoperative assessment aims to identify patient factors that significantly increase the risk for perioperative problems (34). In the present study, based on the evaluation of the preoperative patient data, the lowest mean score was recorded for the determination of complications that may develop during the operation (perioperative process). Although the result is low, it could be considered satisfactory given that most of the participating students reported that they agree to determine the complications that may develop during the operation.
To our knowledge, this study is the first to assess the relative contribution of demographic characteristics to perceived preoperative competence. Based on multiple linear regression, the place of residency is the most significant predictor of the preoperative competence of nursing students. The difference in academic achievement between urban and rural students is a global issue (35), and could be related to the fact that most students lived in villages. In Jordan, more than 90% of individuals reside in urban areas (36). In addition, the discrepancy could be attributed to their different learning capabilities and cumulative average. A previous study reported the significant difference in academic achievement between first-and second-year students in rural and urban areas (37). Another research reported that the academic performance of rural students was significantly worse than that of urban students (38).
Nursing competency is related to level of experience (39). The present study did not find an association between students’ age and preoperative competency level. This finding could be explained by the inadequate experience of nursing students in clinical settings. Female students obtained higher scores in preoperative care competence, but this finding could be related to the fact that most of the study participants were females. In addition, a previous study reported that female students performed better academically than male students due to their greater effort and attendance in class (40). Furthermore, males were more addicted to social media, which negatively affected their academic performance (41). Cho and Kim (42) found that age and gender did not affect global health and cultural competencies. By contrast, a previous work by Madjid et al. (43) reported that females and students aged 23 years were predictors of clinical competencies.
This study found no association between the cumulative average and level of perceived preoperative nursing care. The cumulative average results are more frequently utilized to assess performance on written examinations or in theory sections but not for practical sessions (40). This socio-demographic characteristic is not examined in the literature.
In this work, students who lived alone and with other students had the lowest score in the preoperative knowledge. This finding could be related to the huge difference in samples among these categories. Moreover, moving away from home and starting an independent life might present difficulties, such as loneliness (44). DEMİR (45) found that second year nursing students who lived alone felt unsatisfied with their academic performance, utilized the Internet in the morning and had more afternoon sleepiness.
4.1 Implications and Recommendation
The findings may be helpful for nursing educators, nursing managers and decision-makers to develop effective methods for enhancing preoperative nursing care. This study suggests the integration of preoperative instruction through various academic levels, along with clinical training, in the undergraduate curriculum. Understanding the significance of preoperative nursing care requires the creative use of teaching and evaluation techniques. Preoperative nursing care should be improved using inspiring educational methods to increase the proficiency of nursing students in preoperative care. In addition, clinical settings are crucial to the process of learning; as such, communication and cooperation between universities and hospitals should be improved. Faculty members in universities and policymakers can use the study's findings to develop useful strategies, such as routine training, creating rules and ongoing in-service education.
Future research should validate the present results. Other factors that might affect preoperative competence should be investigated. Mixed-method and qualitative studies should also be conducted to provide in depth understanding of the perceived preoperative nursing care competence.
4.2 Strength and Limitation
This study is the first to assess the level and factors affecting the perceived preoperative nursing care of nursing students. The sample size and response rate in the study is sufficient. Nevertheless, the study has limitations that should be considered when interpreting the findings. Firstly, the cross-sectional quantitative design adopted may not be sufficient to identify all potential factors influencing the preoperative care competence of nursing students. Secondly, the use of online questionnaires could limit the generalizability of the results. Other activities that occurred concurrently with the survey’s completion could have affected the results. Consequently, ‘history’ might have influenced how students responded to the survey (46).
4.3 Conclusion
The knowledge of nursing students in preoperative care plays an important role in perioperative nursing care. The perceived level of preoperative nursing care among nursing students was found to be adequate. In addition, place of residence was associated with preoperative nursing care competence.