Study: Surgical preference cards reduce anxiety, boost competence in nursing students

Editor's Note

Training with surgical preference cards significantly lowers anxiety and strengthens clinical competence among OR nursing students, according to a randomized controlled trial published in BMC Medical Education on October 2.

The study enrolled 60 OR nursing students in Iran between 2023 and 2024. Students were randomly assigned to either an intervention group that trained with surgical preference cards or a control group that received traditional lecture-based instruction. The cards outlined surgeon-specific preferences for supplies, instruments, patient positioning, and procedural steps across common general surgical procedures. Training spanned two 1-hour sessions and addressed preoperative, intraoperative, and postoperative care.

As detailed in the article, baseline measures of anxiety and competence showed no difference between groups. Two weeks after the intervention, however, students who trained with preference cards reported markedly lower levels of both state and trait anxiety compared with controls. Regression analysis confirmed after adjusting for pre-intervention scores, state anxiety was significantly reduced (p=0.019) and trait anxiety was also significantly lower (p=0.005) in the intervention group. The researchers noted the structured, predictable nature of the cards likely decreased uncertainty, bolstered preparedness, and improved students’ sense of control in a high-stakes environment.

Clinical competence also improved. Students trained with preference cards scored an average of 12.83 points higher on the Perceived Perioperative Clinical Competence Scale compared to controls after the intervention (p<0.001). While between-group differences narrowly missed statistical significance in some analyses, within-group comparisons showed a clear and significant increase in competence for the intervention cohort. The authors caution the limited sample size and brief intervention period may have tempered the statistical power to detect stronger effects.

The article reports that despite their benefits, preference cards are often underused, inconsistently updated, or hindered by lack of surgeon engagement. The authors recommended educational and clinical leaders integrate preference cards into training and daily practice, maintain surgeon-specific libraries, and ensure regular updates to maximize their educational and clinical value.