Obtaining Patient Information and Anxiety in Novice Nursing Students During the First Clinical Rotation

Summary: BSN students’ anxiety levels during the first clinical rotation and the students’ ability to obtain previous shift’s patients’ data were investigated and the resources of the patients’ data students used were studied in order to better assist students to provide safe and appropriate care for patients during the first rotation. Content Outline: 1. Purposes of the study a. To identify the anxiety levels of novice nursing students (NSs) during their first clinical rotation. b. To gain the knowledge on the types of patient’s information and from what resources NSs obtained it during their first clinical rotation, as pertinent patient information guides NSs to assess and plan the care of the assigned patients. 2. Materials and Methods a. Subjects: Forty novice NSs in BSN program in their first clinical rotation. b. Anxiety assessment: NSs took the short form State Trait Anxiety Inventory (STAI) at the beginning of the clinical day. c. Patient information assessment: At the end of the clinical day, NSs were asked to indicate the types of patient information obtained within the first 2 hours of clinical and the resources of information. d. Frequency of assessments: the first clinical day, the fifth clinical day (midpoint) and the tenth clinical day (the last day) of the first rotation. e. Methods of analyses: Paired T test for comparisons of the mean STAI scores between the first day and the fifth day and between the fifth day and the tenth day. Descriptive statistics for the types and the resources of patient information (percentage of NSs who obtained each type of information).

between the fifth and the tenth day).The most prevalent resource for obtaining patient information used by novice NSs was the facility's computer system throughout the rotation.In addition, there is a slight, progressive increase in the number of NSs who obtained patient information from the previous shift RNs (18% of the students on the first day, 18% at midpoint, 22% on the last day).As the anxiety levels decreased and NSs had more clinical experiences, more patient information was obtained as expected.By the tenth clinical day, more than 90% of NSs obtained demographic information such as diagnoses, isolation status and allergies by 9am but less NSs obtained night-shift vital signs (80% of the students), oxygen saturation (70%) and the pain levels (38%).By the tenth clinical day, the early morning laboratory data of their patients were collected by 90% of NSs by 9am.The previous night's sleep status and intake and output were not consistently obtained by novice NSs.

Conclusions:
The study was conducted to identify the types of patient's information and the sources of information during the first clinical rotation when the anxiety levels were high.Novice NSs' anxiety levels decreased over time as they had more clinical experiences.Continuous reduction in anxiety levels may indicate that students were gaining more confidence, becoming familiar with the clinical environments and becoming more comfortable providing patient care as the semester progressed.Regarding resources for obtaining patient information, computer use was consistently the most popular source for all types of patient information throughout the rotation and this indicates the importance of orienting NSs to the facility's computer system at the very beginning of the clinical rotation.Not as many novice NSs as hypothesized obtained patient information from the previous shift RNs even by the end of the first clinical rotation, though there was a slight trend that more NSs obtained information from the previous shift RNs overtime.It is important to gradually encourage novice NSs, as their anxiety levels decrease, to obtain patient information from the shift report, especially information such as pertinent events that occurred during the previous shift.There were additional important findings from the results of this study.The fact that the majority of novice NSs obtained laboratory data by the tenth clinical day indicated that they were quickly learning to use critical thinking to understand their patients' conditions.On the other hand, it is eye opening to discover that more than a half of novice NSs failed to obtain the previous shift's pain levels of their patients.This suggests the importance of instructing NSs that obtaining pain levels as well as other vital signs of their patients is essential as they assess the patients and plan to provide the care for the patients.These findings will assist clinical instructors in guiding novice NSs to obtain essential information on the assigned patients at the beginning of the clinical day.This will enable NSs to develop systematic plans to provide safe and appropriate care for their patients.This may also help reduce novice NSs' anxiety levels leading to positive clinical experiences with greater learning outcome.

Title:
Obtaining Patient Information and Anxiety in Novice Nursing Students During the First Clinical Rotation

Keywords:
Anxiety, Novice students and Obtaining patient's information a.The anxiety levels of novice NSs dropped significantly and consistently throughout the clinical rotation (P<0.0001 for the differences in mean STAI scores both between the first and fifth clinical day and between the fifth and the tenth clinical day) b.The most popular resource: the facility's computer system throughout the rotation c.A slight, progressive increase in NSs who obtained the patient information from the previous shift RNs during the first rotation (18% of the students on the first day, 18% at midpoint, 22% on the last day).
d. Types of patient information obtained: i. Demographic information (by 90% of NSs by the end of rotation) ii.Early AM laboratory data (by 90% of NSs by the end of rotation) iii.Previous shift's vital signs (80% of the students), oxygen saturation (70%), pain levels (38%).iv.The previous night's sleep status and intake and output were not consistently obtained by NSs.

Discussions
a. Novice NSs' anxiety level decreased over time as they had more clinical experiences.b.The computer was consistently the most popular source for all types of patient information and this indicates the importance of orienting NSs to the facility's computer system at the very beginning of the clinical rotation.c.Not many novice NSs obtained patient information from the previous shift RNs even by the end of the first clinical rotation when the anxiety levels were the lowest.d.It is important to gradually encourage novice NSs, as their anxiety levels reduce, to obtain patient information from the shift report, especially information such as pertinent events that occurred during the previous shift.e.It is eye opening to discover that more than a half of the novice NSs failed to obtain the previous shift's pain levels of their patients even at the end of their first rotation.This suggests the importance of instructing NSs that obtaining the previous pain levels as well as other vital signs of their patients is essential as they assess and plan the care for the patients.
f.These findings will assist clinical instructors in guiding novice NSs to obtain essential information of the assigned patients at the beginning of the clinical day, and this will enable NSs to develop systematic plans to provide safe and appropriate care for their patients.

Primary Presenting Author
(Faculty) September 2009-Present.Associate Professor, Department of Nursing, Biola University.Teaching areas: 1.Theory teaching: Adult medical/surgical nursing, focusing on immunology-related diseases and oncology care.Pharmacology theory on oncology, infection, inflammation and women's health.Introduction to Nursing Research and Applied Research.Introduction to immunology as a guest lecturer for Dept. of Biology.2.Clinical teaching: For students in first and second clinical rotations for adult medical surgical and oncology nursing.(Research in mucosal immunology) September 2001-July 2008.Post-doctoral research fellow, Smith-McCune Laboratory, UCSF Cancer Research Institute.Research area: Mucosal immunity in cervical dysplasia and cancer: To characterize local mucosal immune response to HPV in high-grade cervical dysplasia and cervical squamous carcinoma.Author Summary: She received her Ph.D. in nursing from University of California, San Francisco in 2001 and has been teaching both theory and clinical nursing for novice students, as well as nursing research to senior students in BSN program since 2009.Recently she has been studying on various aspects of clinical education for novice nursing students for their better clinical learning outcomes.